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.

A Good Life, a Good Obituary

A Good Life, a Good Obituary

I like to read obituaries, in death, as in life, I find it interesting to learn about people. And so, while returning to New Rochelle from Upstate New York, I read the obituary for Donald Lincoln (his middle named bestowed upon him by his paternal grandfather in honor of our 16th President) Burgess. He died on August 25, 2021, at age 102 years in Pittsfield, Massachusetts.

His family referred to him as “a scholar, musician, World War II veteran, business executive, gardener, friend and lover of the sea.” This care manager believes this description comes with certain characteristics which make for a good life. Among them, being a good person, courageous when the occasion calls, kind, helpful, loyal, trustworthy, selfless, generous and purposeful.

For Mr. Burgess courage and loyalty characterized his devotion to country. During World War II, on the U.S.S. Brough he made twenty-six North Atlantic Ocean crossings protecting convoys of troops and supplies. He continued another 18 years in the naval reserve, to his resignation at rank commander.

After forty-three years in the printing business where he worked his way up from office manager to president of Sutin-Burgess Printing Associates he retired. A life of purpose became most apparent. During this time and thru retirement, he was a gardener, taking pride in a backyard full of plantings he nurtured for many years. His generosity to community was highlighted by his love of music and using his piano skills to serve as the organist for his church. Perhaps most significantly he was the care-giver for Kathryn, his wife of sixty-four years. While I am not a fan of “single-handed” caregiving, the term used in the obituary, I can imagine his devotion to his wife, trumped all offers made to help him. He “surrendered his role to professional care-givers only as a last resort.”

And then came one of the hardest tasks older adults face, “letting go,” as his obituary read, of his home of over a half century. He entered Payn House in Chatham, New York. Its website describes it as “a sensible, affordable option for the independent retired person.” Here, Mr. Burgess drew on his strengths from times past. While adjusting to a new home and befriending residents, “he maintained ties with far-flung family” and dwindling friends. “Doug, found among new friends and activities respite from loss, and opportunities to give of his time and abilities.”

Besides his children, Mr. Burgess left behind ten grandchildren and nine great-grandchildren. Judging from his well written obituary, I think his family recognized all the pieces that made for a life well lived. Quoting the author, futurist and pastor Erwin McManus, “a life well lived is the most exquisite work of art.” Douglas Lincoln Burgess, you were a masterpiece.

Resistance and Seniors: A Care Manager’s Tale

Resistance and Seniors: A Care Manager’s Tale

Like in the childhood game, “telephone,” the first call came from the neighbor across the street, who called the son in Texas who, in turn, called his sister in New Mexico, who, in turn, called me, the eldercare consultant in New Rochelle.

It seems the neighbor across the street observed their eighty-two-year-old mother taking her garbage to the curb. How, she inquired of the son, could he and his sister be so neglectful, not her words exactly, it was more the tone of her voice. I imagine, the neighbor was trying to be helpful. Given the adult children’s geographic distance, perhaps she thought they were not aware of what was taking place during these thrice weekly jaunts to the curb. The truth be known, the son and daughter had been trying, unsuccessfully, for over a year to persuade their mother to just give a companion a try. Just a try.

Despite hints of early dementia, the mother was readily able to reiterate to her children all the reasons for not wanting anyone coming to her house. To start, she was not having difficulty managing on her own. Regarding her shopping needs, what she was not able to pick up in the supermarket, there was a COVID volunteer from her local church she could count on. A companion would interfere with her privacy. Hinging on that, she had her sentimental belongings throughout the house, and she was certain they would disappear within a week of the companion’s arrival. And so, it was with this background that a daughter, undaunted by her mother’s past refusals, called this eldercare consultant, confident that what she and her brother were unable to do, I could accomplish.

With the weight of the adult children and the neighbor accompanying me to her house, I met with the mother. She was welcoming and showed me around her home. I was slightly suspicious. Tours usually come after a client gets to know me. Perhaps the unsolicited tour was to make a point about her capabilities or maybe she was just being hospitable. With the sightseeing out of the way, we got down to the reason for my visit. Mom was well rehearsed. She conveyed to me all the same reasons she had shared with her children.

This type of resistance is not unusual, as an eldercare consultant I have come across it repeatedly. The mother recognized that accepting help brings with it relinquishing privacy and adjusting to a new routine. She saw it as a sign of weakness to acquiesce. What she was indifferent to, was a little bit of help could go a long way to ensuring her continued safety and longevity in her home.

While empathizing with each of the mother’s reasons for refusing help, I used one of my tried-and-true strategies. “Give it a try, just for a few weeks,” Not a budge. “How about if you think about it?” I asked. Affirmative. And with that I said I would give her a call in a few weeks.

“I’m happy you didn’t forget about me,” she said two weeks later. In the same breath, she said she would be in touch with me when the time was right. Will the time ever be right I thought to myself? Or will the next call be from the daughter, all her mother’s excuses banished, replaced with an urgent request for help.

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.

New Help in Choosing a Nursing Home

New Help in Choosing a Nursing Home

Selecting a nursing home here in Westchester County, or beyond, is filled with a myriad of emotions. Sometimes the decision is made easier by the fact that the complexity of care needed can only be met in a nursing home. Other times, it is the exhaustion experienced by the caregiver that necessitates entering a nursing home. And still, other times it is for rehabilitation and the stay is short term.

Regardless of the scenario, the process of selecting a nursing home can be daunting. Many times, the person is in the hospital and the discharge planner will hand a family member a list of nursing homes and ask them to select three. You may well know three great Italian restaurants in the area, but nursing homes are a different story. Over the years, as an elder care consultant, I have learned the good, bad and ugly about the residences in Westchester County and have guided families accordingly.

In conjunction with my assistance, the Center for Medicare and Medicaid Services (CMS) provides a helpful guide in the form of Nursing Home Compare. This five-star quality-based system, not unlike how hotels are rated, allows a person to compare various factors that, in their totality, lead to a better level of care and consequently a higher star rating.

Enhancing the need for consumers to learn as much as they can before selecting a nursing home, in October of 2019, CMS announced that it would add a new icon which is a red circle with a white stop hand in the center. This icon, seen below, alerts the researcher that the nursing home has been cited for abuse which has caused resident harm within the past year. Their star rating will be capped at two stars and only if the facility goes without an abuse citation for one year will the icon be removed.

While the abuse icon is another step to motivate nursing homes to look at the quality of care they are providing, experience has taught me that the absence of an abuse icon does not necessarily mean the absence of abuse. Visit at off-hours, smell, observe and talk to staff and residents. A difficult decision can be made a little easier.

Nursing Home Abuse Icon

 

ADL’s and IADL’s: The Alphabet of Assessing an Adult Senior

ADL’s and IADL’s: The Alphabet of Assessing an Adult Senior

Where does this geriatric care manager start when a family is eager to help an aging parent?  The answer is an assessment. It is a bevy of questions that are asked to determine how best to approach the issues at hand. Some of the questions I ask are unique to the situation, but others are basic: Activities of Daily Living aka ADL’s and Instrumental Activities of Daily Living aka IADL.

Activities of Daily Living tell about an adult senior’s ability for self-care. Is a parent able to feed herself? This does not include preparing a meal or even chewing or swallowing the food, it is bringing food to one’s mouth. Dress and undressing without assistance, from underwear to shirt and tie.  Toileting: is the older adult able to ambulate independently or with a walker or wheelchair to the toilet?  Transferring:  can the person independently move from one place to another, from a bed to a chair?  Personal hygiene: can an older person bathe themselves, brush their hair, their teeth?

While the Activities of daily living provide a gauge as to whether an adult can live safely on their own, the Instrumental Activities of Daily Living, are also of important consideration. IADL’s include the ability to manage money this would include paying bills in a timely manner. The ability to go grocery shopping or to use a food delivery service. Getting to and from doctors’ appointments.  Household chores including doing laundry, hand washed or otherwise, and selective house cleaning.

Beyond these two significant areas, an assessment will look at the finances of the older adult to determine if there can be alternate living arrangements or home care paid for privately or thru an entitlement program. Knowing about family support within the geographic area in which the older adult resides is important. The role that can be played by adult children living at a distance. The physical, emotional and cognitive conditions the senior may be confronting, and the ability to take the corresponding medications responsibly. The “story” of the senior’s life. Personality traits, occupation, significant events that may influence how best to approach a parent. Who might it be in the family or beyond the family that may have the greatest chance of influencing the senior?

By combining responses to ADL’s, IADL’s, and the topics discussed above, this geriatric care manager can help families take the first step to bringing a parent to a healthier and safer way of living.  To this end, health care directives and a power of attorney should be in place to ensure that next steps can be taken without complications.