Eldercare Conversation With A Resistant Senior by Anita Kamiel, R.N., M.P.S.

couple having serious talking in home interior

We talk a lot about how important it is to have those serious end-of-life discussions with your elderly loved ones as they enter their golden years. It’s so important to hash out their preferences for care while they are still fully cognizant, before any decline in mental capacity. We also know that under the best of circumstances this can be awkward and, when emotions kick in, even painful to the family to face these issues head-on.

All this can feel downright impossible if the senior is not cooperative. This intractability can be the result of their age accompanied by lessened patience, a personality shift due to an underlying disease condition, or it may just be an extension of a lifelong contrariness.

While we usually dismiss their resistance as “a phase,” we must understand that the elderly have much to lose. Their diminished physical capacity leaves them vulnerable to many losses, especially the loss of their independence as the captains of their fate. They fear these conversations may mean yielding their housing, financial, and day-to-day decisions to third parties they don’t necessarily fully trust or respect. Understandably, they don’t want to deal with that. This is only exacerbated when relationships with potential caregivers have been rocky in the past.

So, how do we get the critical conversation going? How do we get recalcitrant seniors to engage? Each case is unique. I don’t pretend that my suggestions will work in every case. These are just pointers I have picked up from years of studying and dealing with the elderly.

First and foremost, I always find it best to approach the elderly with the respect they deserve. They need to know their opinions matter the most here. You must make it perfectly clear that they have a voice and your desire is to comply with their wishes. I cannot stress how crucial real and deep listening is in this situation.

Threats and scare tactics are unduly harsh and totally counterproductive. See your role as one of facilitator with agenda questions. You should be hearing their voice much more than your own.

Ask how they would like you to handle any hospital stay and follow-up care. What kind of insurance do they have in place to cover all this? The David York Agency website has an excellent checklist on our resources page that can be used as a guide for end-of-life planning.

Gently broach the subject of what they would like you to do if they are suddenly ill. I would back away immediately if there is any resistance. It may take a few tries to get through this conversation, but that is OK. These get them to start thinking. The failed attempts are warmups to the successful one.

In certain cases, you might want or need a family meeting with the senior included. On the other hand, you may not want to make a “federal case” out of the whole thing by calling a potentially intimidating meeting. If you call a meeting, make sure not to muddy the process by holding it during a holiday. Holiday time doesn’t lend itself to the focus required to get this task done and may just end up ruining everyone’s celebration.

In some instances, a third-party facilitator such as a geriatric care manager or another geriatric professional might be quite useful. This is true whether you have solid family relationships or not. These neutral advisers help to keep fears and emotions in check, everyone on track, and the atmosphere non-threatening.

These conversations must be predicated on trust and there is no place for any ill will. Be fair and evenhanded. You will gain a lot more trust if you are honest about the pros and cons of every type of available care and residence option. People are much less likely to get defensive if they feel you are not trying to manipulate them.

It may take some time to build that trust—even months—which is why planning is so important here. However, I realize that in many situations time is of the essence, so if you missed out on this lead time, you can still make it up in the end game.

Emotional stroking can help a resistant senior be coaxed into engaging. Remind them how much you love them. Tell them how caring for them would be your pleasure as compensation for all they have done for you all these years.

You need to be patient. The world they mastered as they grew from scared child to adult can seem like a scary place again. Emphasize how you are not going to abandon them and will be there for them always.

Again—really listen! Repeat their wishes aloud for clarity and so they can confirm what you said. It will calm seniors to know you understand them. Also, it will build the bridge to ease subsequent conversations that may be necessary.

I suggest ending with a big group hug. It wipes away any mistakes made during the discussion—and even in years past. Let me know if I can help!

Anita Kamiel, RN, MPS, is the founder and owner of David York Home Healthcare Agency, licensed by the State of New York. She holds a master’s degree in gerontological administration and is fully acquainted with all factors related to eldercare services and the latest guidelines for seniors. Thirty years ago, she realized the need for affordable, quality home health aide services provided and supervised by caring individuals. You can contact her at 718-376-7755 or at www.davidyorkagency.com. David York Agency is also on Facebook, Twitter, Google+, and LinkedIn.

4 Ways to Cope with Caregiver Stress

caregiver-stress

Even if you only provide care for a loved one on a part-time basis, you know that the undertaking can be stressful. Strategies for coping with caregiver stress early on are essential. You need to find time to rest and nurture yourself or you may find yourself facing both emotional and physical side effects of long-term stress. Not only are you facing the stress of providing physical care, but you are also dealing with a type of loss of the loved one you knew in the past who has now become dependent.

Here are some ways to cope with the changes caregiving may throw at you.

  1. Take Time for Yourself First.

When you are on an airplane, the flight attendant will tell you to put on your own oxygen mask in case of an emergency, before you assist anybody else. This is because you cannot help others unless you have helped yourself first. Eat healthy meals, get enough sleep, and treat yourself to a fun evening every once in awhile.

  1. Communicate While Building a Support System.

Never be ashamed to ask for help. If brothers, sisters, parents, and other loved ones do not know that you need help, they cannot offer it. You may just need to vent to somebody who cares, or perhaps it would help you to have somebody come over and cook dinner once or twice a week. Let people know what you need.

  1. Seek Mental Health Care for Yourself.

The power of weekly or bi-weekly therapy becomes quickly apparent when you begin regular sessions. Therapists and psychiatrists are often well-versed in stress management techniques, especially if you find a professional who specializes in this area. If you yourself are an elderly caregiver, make sure to find an appropriate therapist that is fully acquainted with that situation and that you can relate to.

  1. Hire a Home Health Aide.

In her book, To Survive Caregiving: A Daughter’s Experience, A Doctor’s Advice, Dr. Cheryl Woodson describes her own experiences with caregiver stress. One of her biggest pieces of advice is not to forget that you have needs. You cannot be Superman and do it all, and there is no shame in hiring help when you need it. Professional home health aides can provide excellent, compassionate care for your loved ones.

Caregiving can be burdensome when you are stressed out and struggling to balance that role with your life, but when you are refreshed and taking care of yourself, it can be a wonderful way to bond with your loved one. For more ideas on how to care for yourself or your caregiving friend, contact us.

At the David York Agency, we are dedicated to providing the resources, advice, and high-quality home healthcare services that can make caregiving more manageable. For more information on David York Agency’s qualified, compassionate caregivers, contact us at 718.376.7755. A free phone consultation can help you decide what services might be best to provide you and your loved one and the support you need to manage.

If you’d like to hear more from us, please like us on Facebook or follow us on Twitter, Google+ or LinkedIn.

Quickest Way to the Heart Is Through the…Nose?

aromas and the brain

The scent of chimney smoke on an autumn night, a pot roast on the stove, Sunday gravy, fresh-mown grass, baking bread. By reading these words and recalling these smells, we experience the powerful connection between aromas and the brain. Chances are the mere act of reading about these familiar smells evoked memories and emotions.

This isn’t poetry, it’s biology. Our sense of smell is connected to the limbic system, the oldest part of our brain. Eons ago, our sense of smell was key for knowing when it was time to eat, to sleep, to run, to fight, and even to reproduce. Over time, the human brain has become more sophisticated, adding complex reasoning and language abilities. Nevertheless, our sense of smell can still bypass this more modern brain and evoke a physical response, long before we have “thought” our way there.

The power of smell can be very valuable in caregiving situations. Often, when working with individuals who are anxious, have cognitive challenges, or are struggling with disorientation, the strategic use of smell can trigger memories of safety and comfort.

The web site Senior Care Corner encourages caregivers to experiment with scent when working with clients:

”Aromas, familiar scents and the smell of familiar food cooking can bring back memories; both good and bad, for our senior loved ones. Being able to capitalize on these familiar aromas may be able to help family caregivers keep the mood upbeat and the day calm.”

Aroma is a powerful tool for evoking feelings of calm, comfort and ease. The beauty of this approach is that it engages the individuals in our care in a personal and meaningful way. You can begin by asking a few simple questions like, “Where did you grow up?” or “What was the favorite thing you ate as a child?” or “What did you love cooking for your family?” Your sleuthing will provide clues about the kinds of smells that will be calming and comforting.

And, scent does not always have to come from food. Caregivers can experiment in many different ways. Open the windows on a spring day, bring in a handful of pine needles in winter, or experiment with aromatherapy oils like lavender or citrus.

At David York Agency, we are always on the lookout and dedicated to understanding and implementing the best and most effective techniques in home healthcare. If you are in need of full or part-time in-home care services, we can help.

For more information about David York Agency’s qualified, compassionate home caregivers, contact us at 718.376.7755. A free phone consultation can help you decide what services might be best to provide you with the assistance your loved one needs as he or she ages. If you’d like to hear more from us, please like us on Facebook or follow us on Twitter, Google+ or LinkedIn.