Building a healthy relationship with your aging loved one.
Life Story Part 2: "Knowing who I am means a lot to me"
Last month we spoke about the significance of capturing a loved one’s Life Story. It was mentioned that the key details from the story can be very powerful in building relationships and providing comfort in new surroundings, after a move.
The Life Story can also be beneficial in another way. Key details reveal qualities about the individual’s personality and preferences. How he expresses himself [“Call me Bill.” VS “You can call me Mr. Johnson”], how he sees and responds to circumstances [he was an accountant who prided himself on performance excellence VS he is a fine artist who focused on metal sculpture]. Insights to his preferences [“I would like a snack –something crunchy will do.” VS “It is time for my 2pm Earl Grey and biscuit."]. Access to one’s Life Story can provide great insight which is needed for positive and meaningful interactions-- increasing the quality of time spent together.
For the gentleman who prefers to be addressed by his surname, who values details and precision and who keeps to a defined daily regime-- he will have a different experience in his day, have different expectations from others and require a different approach than the laid back, artistic fellow who enjoys variety and the spirit of the unknown. For anyone wanting to be a part of someone's life, each person needs to be honored as they are.
Building a healthy relationship with your aging loved one.
Life Story Part 1: "Meet me where I am"
What sums up a life? What makes it into your Life Story? You’ve had so many experiences in life- some you would label good and others bad. Everything else is a measurement in-between. If you were to create your Life Story, what would make the cut? What moments have you forgotten? What lessons are so close to you that you can’t even “see” them anymore because they are so much a part of you now? And hey, what about the fact that you are still living? Essentially still writing your story! Who is to say that your biggest life lessons aren’t still to come? Who is to say that the biggest breakthroughs and “Ah-ha” moments aren’t ready to reveal themselves in the next few years, days or even hours.
One thing you know is so far, your life (or rather your experiences in life), have shaped you into the You that you are today. You are still being shaped regardless of your age. A person’s needs can change throughout their life. We wrote about Needs last month. Consider the experience of an individual of a certain age, who is moving out of his longtime family home to somewhere with more support for his current needs. The move is an adjustment to routine, with new faces, new food, new address and phone number- new everything! Change isn’t necessarily bad, but it is different, and it takes time to establish his bearings. It takes time to become comfortable while settling into the new space. Consider that this individual has some memory impairment. Building those new bearings and comfort can be more challenging.
Enter in the power of the Life Story. Imagine how would the staff at the care facility relate to this gentleman better when they knew key details that define (in his eyes) who he is in his life. Imagine the depth of relationship he would have with a supportive companion who knew that he prided himself as a community involved man in his younger years of retirement. Imagine the quality of their time together when it is evolved around more meaningful activities and conversations that encompasses and celebrates those key details from his Life Story. It sets up the opportunity to create the space for new experiences, learnings and exploration together even at this time of his life. Giving him the opportunity to continue adding more chapters to his Life Story.
We all have needs. They may change at different times of our life given circumstances, but there always seems to be a few core ones that never go away or lessen in our lifetime. If we pay attention to them and speak up and they are met (either by others or ourselves), then we tend to feel good, safe, secure or content. If our needs are not met, if we aren’t aware it is a need, if we are too shy to speak up- then we don’t feel good. We may look outward and blame, get angry or sad. We may look inward and think we are not worthy. When needs are not met, I am sure you would agree- that we feel bad.
What if you could no longer effectively communicate what your needs are? If you spoke and others who could help you, didn’t understand and so they didn’t/ couldn’t help? What if they did understand but didn’t know how to meet what you were needing? It would be like asking someone to scratch an itch on your back and they don’t get that spot even with your directions. It would be frustrating and most likely would cause upset. IE: Out of frustration you might think: Why can’t you understand? Are you stupid? Or outbursts IE: slapping a person’s hand away, leaving upset, yelling or sour looks. It would be agonizing and exhausting for both the person with the unmet need and the person trying to help.
Speaking up is only one part of the story when communicating needs. A person with dementia may not be able to communicate their needs verbally and so we need to look at the larger picture. Put your detective hat on and investigate the clues. In addition to what the person is saying, what is this person feeling? How is this person behaving? What do I know about this person’s life story? Consider too what was going on just prior to the upset. Perhaps there are additional clues and insights there.
Visiting another lady in a care facility, I was wheeling her through the empty dining room- we were just touring around to see what we could find. She started to become agitated and said “I can’t do it! I can’t do it!” She was really stressed. When we passed through to a quiet area, I turned to face her. I knelt down and took her hands in mine looked her in the eye and with a smile said “There is nothing to do. We got it all done and thank you so much for your help!” I didn’t know for sure what caused her upset, but I had a hunch. Going through the dining room with all the tables nicely set with tablecloths, place settings and such may have triggered a memory or past feeling of preparing for a social gathering- I knew that was a big part of her life. Feeling like it was too overwhelming a task to do now, she expressed anxiety and upset. She needed reassurance, that all was taken care of and even acknowledgement of her contribution for a job well done. Her smile and softened shoulders confirmed my hunch was right and we both carried on.
Empowering Another Without Interfering
I recall visiting a lady living in a care facility years ago. I met her in the hall and we sat to look outside at the spring flowers coming up. A series of small strokes in the past had resulted in her limited speech. She could answer yes/no and occasionally a short, clearly spoken phrase. I had been visiting her twice a week regularly for about 8 months or so and we had gotten to know each other quite well.
On this day, she grimaced, and her hand went low on her stomach. “Are you in pain?” –Yes. “Is it an ache or like someone stabbing you?” Nothing. “Is it an ache?” –No. “A stabbing?” –Yes. “Well that doesn’t sound good. Why don’t we go to the nurse’s station and see what she has to say?” –Yes. I wheeled her there and called the nurse’s attention. She came over and ask us “What is wrong?” I crouched down next to my lady and looked at her. I provided the context of what had just happened and my lady’s decision to come to the nurse’s station. I gave them the space to communicate from there. As needed, I filled in more specifics as to what I saw and what I understood from my lady being careful to not diagnose or step in where it was not my role.
Those clues helped the nurse ask more specific questions which my lady was better able to answer. The three of us contributed to effective communication. The nurse could make a plan to help her now as well as a plan to monitor her later. A couple of days later, I learned from my lady’s family that she had a Urinary Tract Infection (UTI) and was being treated. Good to catch that early. I was glad to be able to help my lady access the assistance she needed.
When our loved one is in pain, we want to do everything we can to help her. Sometimes the most efficient and effective thing we can do is to listen, to acknowledge what she is saying and observe what is going on. By doing so, we empower our loved one as well as those around them, allowing for better understanding and assistance.
I titled this article after that song by The Beatles. It is an uplifting tune and injects hope through the lyrics to the listener. That is what I wish for you if you find yourself feeling a little down at the moment. If you are feeling a little tired. If you are feeling a little disappointed by something that is not as it should be.
You are a Caregiver. You bounce, you bend, you flex and you adjust to all that comes your way. It can be exhausting and being exhausted isn’t conducive to problem solving, making you less able to respond the way you want to. But feeling it can be a helpful indicator- a reminder that something needs to change. Either permanently or for a temporary basis. Something needs to shift when you catch yourself exhausted.
Take inventory. Step back from the routine knee-jerk reactions and responses to what the moment is throwing you. Take a breath or two. Yes, it is so easy to just do it yourself (because you are experienced and know better and…), ask yourself “is this the best use of my energy?” Don’t get me wrong, if in that moment you are faced with something that would jeopardize the safety or well-being of your loved one, of course step in and do what you need to do. What I am encouraging you to consider- and act on- is to expand your Circle of Support so it is not just on YOU.
What is a Circle of Support? These are the people, systems and services that work with you in your Caregiving role. They benefit you and your loved one. They can be family members, friends, services in the community, systems created by others who are in your shoes. Not just anyone will do though. You have certain criteria that they need to meet. Approach your family members and friends and inquire about their availability- the time (days/ time of day) that you can count on them to do what you need them to do. Having that preset schedule in place allows you that respite time to truly unwind or to know that what you need is going to get done without reminders or micro-management from you. Be clear on what you need and how they can best help you and what that means. If family or friends can provide only casual assistance and not the firm commitment mentioned, then consider checking out a few local services in your area. Learn about them- how they operate, who would be coming, and that they are clear about what it is they will be doing. That understanding will really and truly be helpful to you and to your loved one.
Expanding your Circle of Support will be as uplifting as that tune. It will inject hope and create a feeling of balance back into your life.
Please click the link below and take a moment to watch and really listen to these wise words. Enjoy!
Caring for your Parents AND your Children
You wake up to another day much like the one before, thinking about your career or business and what is going on in your children’s schedule that week. Today is different though. You received a call from your dad and you learned that your mom had a stroke and is now needing some additional support.
Not only is this scary for you, after all it is hard to face your own parents’ mortality, but how will this all come together in an already busy life? Deep breathe, and take the next step.
Learn as much as you can about the situation at hand. What is needed and why. Just gather the details that are available at this time. Have a conversation with your siblings if you have them. Give everyone an opportunity to talk and be heard. You may find that one person is having a harder time with the news than another. That is ok and gives you better insight to their contribution and/ or how they may deal with future information. Allow some space for that to sink in and for ideas and suggestions to come forward, being sure to include the obvious choice which is to let your parents share what they have decided for themselves.
Share the details with your own family, making sure they are able to understand what is going on. Let them know that their grandparents will be needing some extra time and care from the family. Allow some space for that to sink in and for ideas and suggestions to come forward.
Everyone’s role and responsibilities will shift and change to help one another out. At times it will be unclear as to what is needed or the share of the work is not balanced or you will be just too tired. It is helpful to be quick to express your appreciation and offer words of kindness while you are working things out. Kids can learn and develop new skills that help the whole household, parents can learn to trust a little more in their kids’ abilities and everyone can learn to rely a little more on each other. Deep breathe and take the next step together.
I participated in a workshop held by Bethany Care in Calgary a few years ago. They discussed their philosophy of care which is called Supportive Pathways. The instructor spoke of how to look to one's own personal beliefs and how they relate to care for an individual with dementia. She emphasized the importance of providing meaningful activities for the individual, even if that individual wouldn't remember the activity later. She challenged a common question that I have heard several times in conversations with family and individuals while in this business, that question is "why go to the trouble of ______ (ie: getting him/ her dressed for the weather, going out, bringing him/her to the coffee shop/ice cream parlor/wherever, only to have him/her not remember the outing?" The instructor clearly stated in response to the question "Life is more than memories." It may be true that the senior might not remember getting the specialty coffee/ ice cream or whatever it was, but you can be most certain that in the present moment- they really, REALLY enjoyed it! Isn't that what life is really, really about?
For more information about Supportive Pathways, please click this link.
As a family member who is now becoming a Caregiver, you have a lifetime of family history and dynamics with your loved one and you may wonder, how it will all work?
Your loved one may have been a difficult individual who has had the same behaviours, attitudes and outlook their whole life. They might not even realize or not want to acknowledge any past consequences from their behaviour or actions. Also, if there is cognitive impairment or delirium present, then that adds to the complexity of the situation. You may have feelings that had not been worked through and feel incomplete with them.
Recognize your loved one must initiate their own healing process, if they are able or desire to. They cannot be “fixed”. With some preparation, you can put together a plan that will give you better insight into the approach you will take to be a Family Caregiver and it may prevent or at least smooth the tougher times a little better.
Start off with spending some quiet time with yourself and check in for guidance. Use a notebook and write out the topics and incidents that set you off and caused you to react. Identify your hot buttons or triggers that caused you grief, anxiety or stress. These can include certain subjects, names, words or phrases and even non-verbal triggers such as attitudes, looks, moods and other specific behaviors. What you are doing is bringing to light the triggers so you can reduce your reactivity to them. If your trigger is hit, you will instantly recognize it as a trigger and be better able to follow through on your predetermined action rather than be swept away with your reactions.
Next, write out your boundaries. In a healthy relationship, boundaries outline how the relationship will work –what is acceptable and what is not. Factor in what you know about how your loved one expresses their self, consider the general mood they carry and the language they use. For example, a father who has always been demanding and loud may make his requests sound more like commands. The son may accept this of his dad but not accept swearing and verbal abuse. Creating boundaries ahead of time keeps you from reacting in the moment.
Don’t over complicate this process of creating boundaries, it will feel natural to you as you will be honoring yourself and your well-being. Your boundaries will be a measurement tool to help you determine if your role as a Family Caregiver will be a fit or not. If your boundaries are constantly being crossed, you will know that to continue will not be in the best interest of your health and well-being. You will be empowered to seek out other options. You can still be part of your loved one’s care but in the capacity that is sustainable and healthy for you.
What activities are beneficial? It seems like my loved one is losing her zest for life.
What a big question that is! Have you pondered it before? Perhaps at various stages in your life. Maybe you have reached an answer and maybe it still eludes you. If it has, I encourage you to keep searching for an answer that feels right for you.
The answer that feels right for me is Meaningful Work. I believe that all humans have a deep desire for Meaningful Work. It can take many forms. It can be your career, your family duties, whatever and however you express who you are. There is a positive outcome because of your Meaningful Work and it usually involves or impacts another person in some way. It feels good to do something that another person will find enjoyment in or benefit from.
I don’t believe we ever finish our Meaningful Work. We don’t retire from it- it just changes form. Our desire for it never leaves but it can get stifled. Our expectations, our health, the people we keep around us, the environment we live in may impact our desire to do Meaningful Work. Sometimes we can change those elements that stifle it so the desire can be expressed. We can also modify our Meaningful Work to accommodate obstacles that cannot be changed.
Seniors are no different. Their obstacles can include not only health issues, transportation, encouragement from others to go for it, but also having access to the opportunity to do Meaningful Work. Seniors living in many care facilities and retirement residences have many of the household tasks done for them. While the benefits of having housekeeping and cooks is obvious, the seniors have to ensure their Meaningful Work is expressed in other ways. This takes some creativity and perhaps encouragement from others. It is too easy to “not bother” and have their world get a little smaller and their desire stifled.
Activities are needed to engage the mind, extend their abilities and keep them moving. Use your loved one’s life story to figure out what activities and topics of interest would be great to bring back into their life- even if they need to be modified a bit to accommodate their current circumstance.
Explore and play. Ensure that your loved ones have access to express themselves through Meaningful Work. Watch them shine!
How do I know what Senior Supports my mom needs and what kind of supports are out there?
Isn’t it interesting how you go about your day to day business and until you are placed into the role of family Caregiver for your aging parents/loved one, you don’t realize that there is a whole world of information and resources available to tap into. It wasn’t in your radar before and now it is.
First of all, how do you know what supports you need now and what can come later? Sometimes it will be obvious. You may get specific requests from your loved one. You may just observe the challenges your parent is facing. It will be pretty straightforward- most of the time.
Sometimes you need to dig a little deeper on your own to uncover any issues. Start off with giving your loved one a hug! During the hug, gauge her level of strength- is it strong or weaker than expected? Has she lost weight? Is she eating enough and are they healthy choices? Use your nose- is personal hygiene compromised? Have a look in the fridge. Is there a variety of food that is still in good condition? Is the mail piling up? Start by opening a casual conversation and check in with your loved one and see what she says. These are a few simple checks you can do without feeling like you are imposing.
When you (and your loved one) recognize the need for some additional support, you can choose to make an appointment with her family doctor. You can discuss the concerns and receive guidance as to the next steps. Depending on the concerns, the doctor may have additional questions or request a test or two, just to rule out other reasons that might be capable of causing the concern. It is good to rule that out so you can focus the right kind of support.
You can also choose to contact Home Care to request an assessment. An appointment will be arranged by the Home Care Nurse who will come out to talk with you and your loved one. You will have the opportunity to share your concerns even if you aren’t sure yet what the solutions are. She will give you a list of local resources that you can tap into. She will be a great resource for both of you going forward.
These are a few starting points to tap into when you find yourself wondering “what do I do next?”