Read an Excerpt
Elder Care Made Easier
Doctor Marion's 10 Steps to Help You Care for an Aging Loved One
By Marion Somers
Addicus Books, Inc.Copyright © 2006 Marion Somers
All rights reserved.
Improving communication in our family reduced my mother's fears and enabled us to open up for the first time in years. As soon as the in-fighting stopped, my family was able to make better decisions for my mother's future.
— A. C. in California
The single most difficult challenge you face as a caregiver could be managing communication — with the person you're caring for, your extended family, other professionals involved in your elder's situation, and, surprisingly, even yourself. Honest, open, crystal clear communication should be your goal. Why? Every time the lines of communication are unclear or broken off, your ability to make smart decisions is hampered. You could have arguments with loved ones, or expect the impossible from doctors, or cause your elder to become irritated by a situation you thought you had under control. Have the strength to implement a communication strategy that gets to the truth of your elder's situation.
Results of a recent study show that only 7 percent of all spoken words are listened to. Thirty-eight percent of verbal communication is understood by volume, pitch, and rhythm. The remaining 55 percent is determined by body language and facial expressions. Be aware of your tone, volume, delivery, and body language when communicating with others.
The simplest part of communication, as well as the hardest part, is listening. Early in my career I learned this lesson from one of my most vocal clients, who also happened to be an excellent listener. She had the ability to listen with her heart and soul to what was said. She would say that she also listened to what someone's body told her. When I asked her how she had become so skilled, she said, "We were given two eyes, two ears, and one mouth. If I listen and observe twice as much as I talk, I'll be able to understand not just what people are saying but also what they truly mean." I always try to listen twice as often as I speak.
Communicate with Your Elder
Your communication efforts should begin with a one-on-one discussion with your elder in order to figure out what issues need to be addressed. Start by building trust. Your elder has to know that you understand his/her values, struggles, and identity. When that happens, barriers disappear.
My clients often ask me, "Why is my mother so nice to you? She hasn't been that nice to us in years." I think it's because I don't judge my clients. I don't arrive with baggage from the past or preconceived notions of who my client is. I know this is difficult to do, but you should try, both for your sake and your elder's. Also, try to find the humor in any situation. Believe me, your elder is full of humor and wisdom. You don't have your needs met for decades without learning how to laugh and how to get what you want. Caregiving is a chance to embrace your elder emotionally and to work together to find answers and harmony.
As you listen and observe, focus on the activities of daily living, or ADLs. These are the activities of daily living that a senior encounters. Your elder will require assistance with some ADLs, whereas other ADLs might still be easily managed. The sum of your elder's ability to manage ADLs will give you a clear picture of his/her real condition. Also, look closely for signs that your elder exhibits while mentally retrieving information. Each person has a unique way of retrieving details, and usually his/her eyes will seek out the same-spot while doing it. But if people lie or are not fully functional on a mental level, they often look elsewhere to retrieve the answer. Also, their cheeks flush, and their palms get sweaty. Be aware of these visual signals so that you can pick up on your elder's mental ability.
To determine your elder's personal attentiveness, basic wellness, thought patterns, and speaking skills, get answers to the following 39 questions (there may be others). Answers to these questions will give you a baseline from which you can plan to meet your caregiving challenges. It might seem surprising, but some people start the caregiving process without asking their elder even one question.
1. Is he/she getting any exercise?
2. Is he/she getting enough fresh air?
3. Did he/she stop going to the barber shop (beauty parlor)?
4. Does he/she have foul body odor?
5. Is he/she wearing torn clothing?
6. What is his/her sleep pattern?
7. Can he/she drive without incident?
8. Is his/her general hygiene suffering?
9. Is his/her mail opened?
10. Are his/her bills overdue?
11. Is his/her checking account overdrawn?
12. Has he/she lost all interest in money?
13. Have his/her drug prescriptions not been filled or are they out of date?
14. Does he/she avoid answering the phone or calling people back?
15. Are plants in the house and in the garden dying?
16. Is the lawn overgrown with weeds?
17. Is his/her home a mess or in disrepair?
18. Is trash everywhere?
19. Is laundry everywhere?
20. Does he/she have any unusual bruises or scratches?
21. Is his/her eyesight diminished?
22. Does he/she have a hearing loss?
23. Has he/she been falling down or losing balance frequently?
24. Is he/she wetting the bed or battling incontinence?
25. Is he/she shunning friends and/or family?
26. Has he/she lost interest in former passions or hobbies?
27. Has he/she undergone a medical crisis or the loss of a loved one?
28. Does he/she cry often or is he/she prone to fits of anger?
29. Can he/she remember what he/she had for breakfast?
30. Has he/she been experiencing short-term memory loss?
31. Does he/she become easily confused, irrational, or upset?
32. Does he/she wander away from the home or get lost?
33. Does he/she frequently stammer and search for the correct word in conversation?
34. Does he/she repeat conversation?
35. Does he/she wear the same clothes?
36. Is his/her personality inconsistent?
37. Does he/she forget family members' names?
38. Does he/she have a diminished sense of day, month, or year?
39. Has he/she lost the sense of taste?
Once you've gathered the answers, you'll be able to clearly understand problematic areas that require attention and care. The good news is that you should also be comforted by the ADLs your elder can still perform. Focus on them, since positive reinforcement and taking advantage of what still "works" can go a long way toward keeping your elder a vital part of the family and community.
Make Special Considerations
Sit where your elder would like you to. Don't violate personal space; ask, "Where would you like me to sit?" Include your elder in the decision-making process whenever possible. This is empowering. Sit in a well-lit room where there is good light on your face. Your elder might even be lip-reading and not be aware of it. Clean his/her eyeglasses if necessary. Bring food with you so that there's a tasty treat every now and then, but be sure it meets all dietary requirements. Try not to be interrupted by phone calls, the computer, TV, radio, and visitors. Take care of the simple creature comforts. Have your elder sit in a favorite chair. If you don't make the simple effort, your elder's focus will be on personal needs that aren't being met, instead of on conversation.
Start with Chitchat
Start all conversations with chitchat about your elder and the day. Tell your elder why you're there; don't ask if he/she knows why you're there. Always make your elder the center of attention. Be light, gentle, and general, and talk about the big events of the day. Don't focus on problems or specifics until you have to. Discuss familiar topics, not the latest top-selling rap album. Ask questions like "Tell me about your childhood, your children, your husband, or your wife." Keep your sentences short and concise. Ask questions and wait for the answers before rushing to the next subject. Give your elder time to process and formulate answers. Limit your vocabulary, stay on one subject, and say one sentence at a time. Be careful not to send mixed messages, and don't use slang that may not be understood. Ensure that what you're saying is accurate. If it's not true, don't say it. Do not exaggerate.
Tips for Holding Attention
Consider wearing bright clothing (red works best) and shiny jewelry to keep his/her attention on you. Make direct eye contact and let him/her get used to your scent; hold his/her hands and do anything you can think of to make a direct human connection. Don't begin every conversation by talking about his/her ailments. Instead, talk about positive memories and important people from his/her life. This talk can be triggered by an item found in the house such as an old photo, a piece of furniture, or a travel memento. If he/she is bedridden or in a wheelchair, make sure you communicate at eye level when possible. Being at a level higher than him/her is an unintentional power play that affects communication.
Paraphrasing what your elder says lets him/her know that he/she has been heard and lets you know that you've been heard; it also allows you to provide clarifications. If conflicts arise, face them directly. This usually dissipates the problem. Get feedback from your elder, too. Ask things like "Can you be more specific about that?" Use positive reinforcement. This is all about making your elder feel good and establishing a rapport, which is especially challenging if you haven't had a good relationship in the past. Find something positive to relate that will increase your bond. Even if the only fond memory you have is of mom's chocolate chip cookies, let her know how much you loved them. Honor who she is and who she was.
Announce Your Visit
Let your elder know when you will be coming. Call ahead of time. Ring the door bell or knock on the door before entering if your elder is in a nursing facility or hospital. You wouldn't like it if people barged into your home unannounced, even if they were taking care of you. Let him/her know why you're there — to cook a meal, to drive to the doctor, or to let the plumber in. Be polite and considerate. Respect space and never take it for granted.
Keep Seniors Involved
Aging can be a cruel process, and being removed from your family's communication loop can be most cruel of all. Your job as a caregiver is to limit his/her feelings of isolation and frustration. Show you care by visiting in person or over the phone. Send an email message, a greeting card, or a handwritten note. A simple gesture can make someone feel wonderful.
Many of your elder's choices are disappearing, so it's important that you involve him/her in every decision when possible. Does she want to wear the blue dress or the green dress? Does he/she want to drink apple juice or orange juice? Ask him/her what color bed linens or comforter cover he/she would like. Consider using flannel sheets in the winter since they're especially soft and warm.
Also, brighten your elder's day. It's important to have living things around. Bring colorful fresh flowers that smell good. Awaken the olfactory senses. Baby powder is a favorite, as are the aromas of ground coffee beans, orange peels, watermelons, and vials of lavender. Smells can trigger good memories that lead to hours of positive stories and feelings.
Although you may have never discussed these touchy subjects before, it's time to shed light on your elder's finances and legal situation. It might be difficult to discuss topics that have previously been off-limits, but it's crucial that you have this information. Imagine yourself in your elder's shoes. Consider the mental and physical situation, and then try to think of what you would like done and said for you, as well as what you'd like to remain private. See Step 5: Manage Financial Issues, and Step 6: Take Care of Legal Matters for more details regarding how to handle these extremely private topics.
Don't Focus on Past Conflicts
Be extra sensitive about how you bring up unresolved history. Bringing up such subjects can cause your elder to tune you out or become upset. What happened in the past happened then, and people have their own perspective of what occurred. Your elder can become entrenched, and that's no position to be in now. If something must be done about the past, encourage your elder to let go, but don't ever put him/her in a defensive position.
If your elder would like to face tough issues from the past with people who've passed on, suggest he/she close his/her eyes and then talk about it. This exercise can really help someone express repressed feelings. Your elder can reach a sense of finality this way, too. It's vital that your elder get rid of any accumulated baggage and unburden him/herself of old grudges, hurts, and heavy loads that could make it more painful to pass on from this earthly experience. By encouraging open communication, you can lead your elder down a path of positive reflection that wipes the slate clean before the end of the human journey.
I once had a client who was being taken care of by her three adult daughters. Each one of them individually told me how the mother had favored another sister, and each time it was a different sister. There was so much conflict that I told them to drop the nonsense from that moment forward. They did, and the final six months of their mother's life included many of her happiest days.
Allow your elder's feelings to surface. Facilitate open, honest dialogue. Never try to suppress things he/she wants to discuss. This time is usually filled with reflection and new understanding, and your elder will probably want to talk to someone about it. That someone can be you. Validate emotions. Your elder might say, "I'm afraid of going to the hospital." Acknowledge the comment and agree that you understand how that could be disquieting. You might not ameliorate any fears, but at least your elder won't be alone with them any longer.
As many elderly come to the end of life, even those who say they don't believe in a higher power question what they've done with their lives. Believers and nonbelievers alike become more appreciative of the sunset, the stars, and a newborn baby. Allowing your elder to discuss his/her deepest thoughts is a vital part of caregiving. Your elder needs someone to talk to about the time on earth. It's often to address unresolved pain or anger that has been carried around, sometimes for decades. Doing so frees your elder to face the next journey, wherever that may be. Facilitating this conversation is important. Help your elder appreciate the small things in life and work through painful issues with you, another family member, or a therapist.
Your elder might strike out at you verbally, but you have to stay positive. I once had a frail and usually quiet woman erupt suddenly. She said, "You're one nosy bitch!" I replied matter-of -factly, "Yes, I like to know a lot of things. I know a lot of things about you." From then on, she was much more communicative with me. Your elder wants to be heard. Pay respect and treat your elder as a vital member of the family. He/she is not a burden. Insist on adult-to-adult communication. Never talk down to your elder or treat him/her like a child. That only adds to the resentment and the feeling that others have taken over his/her life. Don't discuss your elder's ailments with others as if he/she isn't present. This also takes away your loved one's personal power.
During your elder's lifetime, the way we communicate has changed at warp speed. Your elder may not be comfortable with recent technological advances, and it's your task to teach him/her. I highly recommend you make sure he/she is comfortable using a computer. Show how to log on and log off, and how to access the Internet and email. Write it out step by step and go over the instructions in person. Turn any fear of the computer into an opportunity to bond. Using email can change your elder's life because staying in touch with younger relatives (especially grandchildren and great-grandchildren) and friends becomes infinitely easier via the Internet.
Bring all other electronic lines of communication up to speed. Buy a home phone with large numbers and increased volume, and place it in the room that your elder occupies most frequently, preferably in the bedroom. Make sure there's a list of emergency phone contacts near each phone and posted on the refrigerator. Buy your elder a cell phone if necessary, if you want to have the ability to locate him/her immediately. Consider installing surveillance ware if your elder is usually alone or if you want to maximize your safety awareness. It has to be installed with your elder's consent. Other elder-friendly electronic enhancements include phones with increased volume and ring tones for the hearing impaired, as well as camera phones that allow you to see each other while speaking on the phone. These products break down communication barriers and make it easier for your elder to avoid emotional and physical isolation.
Excerpted from Elder Care Made Easier by Marion Somers. Copyright © 2006 Marion Somers. Excerpted by permission of Addicus Books, Inc..
All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
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