The Ten Commandments: Strategies for Communication

The Ten Commandments: Strategies for Communication

Before you turn away from this blog given its title, let me assure you I am not offering religious guidance. Instead, I want to offer ten communication tips if you are caring for someone with dementia, Alzheimer’s Disease or otherwise. I take no credit for these suggestions, but because I feel each is so relevant, I want to share them with you. They were written in 1996 by Jo Huey, of the Alzheimer’s Caregiver Institute. These approaches were based on her thirty-five years as a caregiver.

  1. Never Argue- instead, agree: What a person with dementia is saying is what they think to be true.
  2. Never Reason- instead divert: Reasoning is a futile effort, because the part of the person’s brain that controls logical thinking has been hindered.
  3. Never Shame- instead, distract: Change the subject as quickly as possible, the person with dementia may not realize what they are saying or doing could be viewed as inappropriate.
  4. Never Lecture- instead reassure: Imagine how much better it would feel if you just smiled and reassured someone with dementia: “I did the same thing yesterday.”
  5. Never say “Remember-” instead, reminisce: A person with Alzheimer’s Disease, cannot remember. So, if you were looking thru a photo album, say “this looks like Phil and Sue when they went camping at Lake George.” The person may use this cue to connect, otherwise, treat the album as just that, photos of people enjoying themselves.
  6. Never say “I told you”-instead, repeat/regroup: As the caregiver, you are the priority. Take a step back, start the conversation the next day. The person with dementia will pick up on your stress, causing the conversation to be frustrating at both ends.
  7. Never say, “You can’t,” instead do what they can: Such an approach is another reminder to a loved one that they are losing their independence. As the caregiver, you are tasked with the responsibility to search for the things that a person with Alzheimer’s can do successfully. This is what we call a “strength based approach.”
  8. Never command/demand, instead ask/model: The adage that actions speak louder than words, is equally relevant to a person with Alzheimer’s Disease. Because your loved one may not pick up on your verbal sense of urgency, it is better to model behavior. For example, if it is meal time sit across from the person and take a few bites of food. They are more likely to mimic your actions than heed your words.
  9. Never Condescend, Instead Encourage/Include: When caring for someone with dementia we may tend to exclude them from conversations regarding their health and overall wellbeing as if they’re not there. Not only can this hurt your loved one’s feelings, but it can result in aggression toward the provider of care. Rather, stand or sit next to them and allow them to be a clear part of the conversation.
  10. Never force, instead reinforce: No one likes to be told they’re doing something wrong. A better approach is to start by telling them what they’re doing well. Then, gently approach what they could be doing better.

In 1996, the same year that Jo Huey compiled these strategies, Motorola came out with their Startac phone. It was the first flip phone. It offered a vibrate alert as an alternative to a ringtone. The phone was so popular that Motorola sold 60 million of these phones at $1,000 a clip. How cell phones have evolved over 26 years. But the advice offered by Jo Huey is as relevant today as it was 26 years ago. I hope her suggestions can offer guidance as you face the challenges that can accompany a dementia diagnosis.

An Aging Life Care Specialist Goes Underground

An Aging Life Care Specialist Goes Underground

We Aging Life Care specialists ask a lot of questions. Most pertain to the medical, social, emotional and the home environment. Now we are going even deeper in the home and descending to the basement.

Why the basement you ask? Because in some homes, across all fifty states, evil may be leaking from the ground. It’s colorless, odorless, invisible and can only be detected by testing. This mysterious element is called radon. It is a radioactive gas that comes from the decay of uranium found in the soil one’s house is built on. It typically moves up through the foundation to the air and enters one’s home through cracks, walls, construction joints or gaps in the foundation around pipes. A home traps radon inside, where it can build up. The ventilation and the air flow patterns in a house will affect how much radon will be pulled into different areas of the house. The age of the home, does not make a difference. According to the United States Environmental Protection Agency radon is the leading cause of lung cancer in non-smokers in the United States. The higher the radon level in a house, and the longer the exposure period, the greater the risk to the occupants.

Apologies for the scare, but the good news is that radon levels can be measured and if remediation is necessary, there are solutions. The place to start is with A Citizen’s Guide to Radon, published by the EPA. In a nutshell, the average radon concentration for homes in the United States is 1.3. It is when the radon levels, goes beyond 2 picoCuries per liter (the EPA will explain the jargon) that thought should be given to resolving the potential problem. While you can hire a professional tester to determine the radon level, you can easily start with buying a do it yourself test kit available in hardware stores or online. You can also call: 1-800-SOS-RADON (part of the EPA). This testing method consists of a small charcoal canister. The radon in the air is absorbed on the charcoal and the decay products can then be measured by a laboratory. The laboratory cost is usually incorporated in the cost of the canister. It is suggested by the New York State Department of Health, that two separate charcoal canister measurements be used before deciding to correct the situation. If mitigation is necessary the most common method is to have a vent pipe system and fan installed, which pulls radon from beneath the house and vents it to the outside. More information is available from the EPA at 1-800-55RADON.

So, why this article on radon? This past January was officially declared Radon Awareness month. But beyond this, often, as Aging Life Care specialists, we turn to our personal experiences when they can enhance the lives of those we help. Some years ago, with great excitement we closed on our dream weekend home in the woods. Surrounded by nature, deer leaping thru the woods beyond, a welcoming lake for rowing and swimming, what could be better? The answer would have been a tent for camping had we not taken care of the high radon level that was noted in the inspection report. As Aging Life Care specialists, it is our goal to keep our clients safe at home. Checking for radon is another step to ensure their safety.

Nurturing the Nurturer: The Use of Doll Therapy for Older Adults

Nurturing the Nurturer: The Use of Doll Therapy for Older Adults

As Aging Life Care Professionals®, when we are asked to assist with securing placement in a nursing home, there are many questions we ask beyond the physical and cognitive conditions that are prompting the move. Primary among those questions is: what was mom or dad’s occupation? Those families who have parents in their mid-eighties and beyond often reply by giving dad’s occupation and the fact that mom was a homemaker.

Remembrances of lifelong professions can be retained long after actual employment or the responsibilities of raising a family have ceased.  Take Gene, a retired fireman who had been diagnosed with dementia.  On the day he arrived at the nursing home, being the conscientious firefighter he once was, he spotted a fire extinguisher and was headed straight to his job. Fortunately, his daughter positioned herself to block his access.

For mothers and wives of this era, the role of family nurturer is often rooted in the person. This is not to say that fathers have not played prominent roles, but for mothers or other women that have been employed in caregiving roles, it is not a job that finished at five. In later years, should there be cognitive loss accompanied by agitation we, as Aging Life Care Professionals, look to guide the family in ways to lessen the anxiety their loved one may be experiencing. Nonpharmacological approaches are preferable. One such method is doll therapy.

Doll therapy is just what it says. It is providing a person with a doll, that she/he can hold, cuddle, talk to, even dress and undress.  The latter helping with finger dexterity and hand-eye coordination. The doll can give a person a sense of comfort and purpose with the goal being redirecting the anxiety and bringing a parent to a sense of calm and contentment. Beyond this, a doll can be a starting point for reminiscence, asking a parent to recall their days as a new parent, bearing in mind that it is the long-term memory that is most vivid.

Research studies have shown both increased happiness and increased social interaction using doll therapy. But doll therapy is not without controversy. Some feel the dignity of a parent is compromised using a doll.  Other concerns are that dolls are demeaning and infantilize older adults. A passerby may look at a person with a doll and remark that the senior looks “cute” holding a doll. Not the way a relative wants their spouse or parent to be perceived.

As Aging Life Care Professionals, our approach is a person-centered one. To each client, we bring a toolbox of suggestions, techniques and resources. While the use of doll therapy is one such example, we customize the guidance, recognizing the unique needs of each client while working together with families to ensure practical and realistic outcomes.

Can an Adult Senior Remain at Home? …That is the Question

Can an Adult Senior Remain at Home? …That is the Question

As an eldercare consultant, I am familiar with the statistic that close to 90% of adult seniors, have expressed a desire to remain in their homes for as long as possible. The terminology in the world of eldercare is “aging in place.”

My lack of surprise about aging at home, while corroborated by AARP, has its source in the adult children who visit my office frustrated that their parents feel there is no compelling reason for them to move out of their house. A typical scenario as described by a son or daughter: no bathroom or only a half bathroom on the main floor, stairs that must be ascended or descended to get to the kitchen, no direct access to the outside without holding on to a hand rail that is unstable accompanied by a walkway that is crumbling, nonstop repairs both large and small.

Sitting across from these adult children, I understand their unease. They are often wakeful at night, distracted at work, consumed with the responsibilities of calling the plumber, roofer or making sure a path has been shoveled after a snowstorm.  I also know from talking with adult seniors the comfort that comes with continuing to reside in a lifelong home. Change is never easy or welcomed.  So, what’s an eldercare consultant to do?

For this consultant, the major consideration is safety. There is no compromise on this issue. To ensure this safety there are three necessary requirements. First, the willingness of a parent to agree to whatever modifications should be made to the house. First, the readiness of the parent to accept home care if necessary and first, the financial wherewithal and/or community support services to achieve these outcomes.  Yes, they are all number one priorities.

To this end, I frequently visit the parents in their home. Often, mom and dad need to be heard and understood, with a focus on empathy. Once they know I understand their situation, it is easier to start to effect change. The secret is small steps. With each step, it is validating their willingness to undertake necessary changes. That validation provides the incentive for the next step until a safe living environment is accomplished.

But please don’t think I come with a magic wand. Sometimes the ideal, or even close to it, becomes unachievable. It may be the staunch autonomy of a parent or it is the symbiotic relationship of husband and wife who create such a strong wall (yes, this one is achievable), that adult children, the family favorite, or even this eldercare consultant cannot convince them that they are putting their safety at risk. Then Father Time steps in and removes aging at home as a choice. A fall, noncompliance with medication, or one of those all too frequent storms we’ve been having here in Westchester County, may result in a whole new aging in place definition and destination.

A Flower and a Shower: Caring for Someone with Dementia

A Flower and a Shower: Caring for Someone with Dementia

Several years ago, I put a new bathroom in our new home. When it came time for the shower, I described to the salesman the type of showerhead I was looking for. “It’s called a sunflower,” he said and off we went to the display.

To this geriatric care manager, the notion of a sunflower showerhead, AKA a rainfall showerhead, suggests something very soothing. But enough about what I imagine. From a practical point of view, a shower for a person with Alzheimer’s Disease can sometimes take on an entirely different aura. Why can bathing be such a challenging task?

For some, it is the loss of independence. A caregiver or a family member is now either in the bathroom or outside the door. Privacy is trumped in the name of safety. Especially challenging when the aide is female and her client a male. Also, the person with dementia may not recognize that something is wrong, and becomes agitated, even belligerent. Why are all these people telling me what to do?  The senses may also contribute to this encounter. The water streaming out of the showerhead or the spigot, can be frightening to the person with dementia. Even the sound of the water can be unsettling. Stepping into a bathtub may bring a fear of falling.

The following strategies may help to reduce the stress of bathing:

  1. Choose the right time of day. If the person is experiencing sun downing, mornings may be the preferable time.
  2. Use a strength based approach. Have the person help in the bathing process as much as possible.
  3. If a person is resistant to a bath, try bringing in some favorite music or say something like: “a short bath and then a big scoop of strawberry ice-cream.” A reward system works well.
  4. Know thy self. If you have had a long day, put off the bath.
  5. If these strategies fail, try some non-rinse body soap and shampoo.

The explanations for why a person resists bathing is as varied as the person. By exploring various techniques combined with the acceptance that what is not achievable today may be resolved tomorrow or the next day, brings a degree of calm to an otherwise unsettling illness.

A Doctor’s Simple Request

A Doctor’s Simple Request

In the last weeks of Helene’s life, she entered Calvary, a hospital devoted to end of life care or as Calvary likes to say, “where life continues.”  A short distance from her home in Pelham, New York and my office in New Rochelle, as her geriatric care manager, I visited regularly.  While I could easily acknowledge that my visits were to support her caregiver who was there daily, I also knew my final good-bye was not far off.

But before my good-bye came, there were conversations with clergy, the social worker, nurses and the sharing of information with the family. The reputation of Calvary has always been stellar so I was not surprised by their responsiveness to Helene’s needs and my queries.  What I was not prepared for was the request of her palliative care doctor. It was not medical history or questions about next of kin, but a simple request to see a picture of Helene in the years prior to her decline.  I could not think of a doctor, in almost three decades of practice who ever made such a request.

As my relationship with Helene had extended over seven years, I was beyond eager to share pictures and tell stories. The doctor was an enthusiastic listener.  There was the photo of a just finished visit to the beauty parlor, another of Helene showing me the house in which she once lived and one of her oldest grandchild standing proudly by her side. Her life as a magazine illustrator was also shared minus pictures.

As geriatric care managers, we are usually called into service when there is a life changing event. While our attention is focused on a presenting issue, we are always mindful that a lifetime preceded the current situation. Illness alone does not define the person. The doctor in his thoughtful gesture understood this and let me tell Helene’s story one last time. Sometimes I think it was for my benefit more than his. Nevertheless, his patient became a person and my good-bye, when it came a week later, was softened by his simple request.