An excellent article on ambiguous loss suffered by those who have a loved one with Alzheimer’s or other dementia. This is a loss that occurs in many stages and is no less traumatic than what one experiences with an unexpected, unanticipated loss. Perhaps such a loss is even more devastating.
What are your thoughts on this matter?
One of the most frequent stresses I hear from those caring for a loved one with Alzheimer’s or other dementia is having to REPEATEDLY answer questions for which an answer has been given – numerous times. This article provides some tips on communicating with someone who is literally not on the same wavelength as you.
Think of a moving/relocating experience you’ve had with all of its inherent tasks of purging of items, packing what remains, and leaving all that is familiar as you move into uncharted territory. In your new neighborhood you’re starting all over again to find: new friends; a new supermarket with the best deals; perhaps the best school(s) for your children; a new church; and new ties to the community. Not exactly an enjoyable experience. It took you some time to adjust to your new community and feel that you fit in, didn’t it?
Now imagine doing the same thing as someone who is at least 70 years old with failing health, no family nearby, and perhaps with a compromised cognition level. Vulnerable adults move into a long-term care (LTC) housing environment because of a condition, or combination of conditions, that make living independently no longer an option. Because of this disruptive move, another disorder – adjustment disorder – makes their move a perilous one.
A loss of context in a new environment. In my work as an advocate for vulnerable adults, I had the privilege of hearing a wonderful speaker, George Dicks. At the time, Mr. Dicks supervised the Geriatric Psychiatry Service clinic at Harborview Medical Center in Seattle, WA. He was also a contracted instructor for the University of Washington, teaching courses on Gerontology, Psychiatric Consultation, and Mental Health. He emphasized that residents living in nursing homes and assisted living facilities struggle to look for context within their new environment. For example, context is hard to come by when your daily bath occurs at 2:00 in the afternoon instead of in the morning or evening as was the case prior to the move. And forget about finding comfort in routine because the demands on LTC staff are such that caring for numerous residents on their shift can’t possibly assure a routine on which the residents can rely.
Just providing care doesn’t mean that a staff person is caring. Everyone who moves into a long-term care facility will have difficulties, but those who are cognitively impaired face an especially arduous adjustment. As I previously mentioned, staff are hard pressed to provide individual care to their residents, and oftentimes are poorly prepared to handle the disorders that walk through the door. Just getting through their daily shift is troublesome so trying to learn the habits and routines that are so vital for quality of life of the resident with dementia is a very time-consuming task.
Quite frequently, the only contact a staff person has with a resident is when they are making demands of that resident: “time to take your medicines Mrs. Jones;” “let’s get that soiled clothing changed Mr. Smith;” “open your mouth Mrs. Clark so I can feed you.” Providing for basic needs is not providing care. Why? Because the staff are requiring something of the resident. There is no connection. When a staff person interacts with a resident, absent a provision of care, that’s a better definition of care.
How to lessen the effects of adjustment disorder. Those living in a long-term care housing situation oftentimes feel as though they left all their power, and all of their basic human rights, at the door. They are constantly surrounded with reminders of their condition – all those other residents who look as lost and helpless as they do – and it seems that the only time anyone pays attention to them is when someone is demanding something of them in the form of providing some sort of assistance with their care needs. If every staff person spent just five minutes of non-task-oriented time with each resident during their shift, those residents just might start feeling better about themselves.
- Walk with a resident for a few minutes by simply accompanying them in the hallway and reassuring them along the way.
- Play music the residents like in the common areas and in their rooms – and don’t assume that you know what they like to hear. Take the time to find out what gets their feet tapping.
- When you walk past a resident, greet them, smile at them, just as you would if you were in a social environment instead of a clinical environment. Again, do so even when you’re not providing a care service. Your friendly, heart-felt greeting may just make their day.
- Start a dialogue with residents that allows them to open up to you about who they are; what their lives were like prior to arriving at the facility. If you need to jot down some of their stories so you’ll remember them later, do so and continue the dialogue the next time you see them. Wouldn’t it be a pleasant surprise to a resident when you asked them, “Tell me more about your grandson Charlie. He seems like a real character!” Wow – you were actually listening, and it shows. Now you’re connecting with the resident.
If you are a staff person in a long-term care facility, can you put your grandma or grandpa’s face on your patients/residents faces thereby having a greater incentive to connect with those receiving your care? Or if that doesn’t work for you, do what you must in order to add an element of care to those you serve. Just because you’re helping the resident perform a task, doesn’t mean that you’re providing the care that they really need.
Alzheimer’s and other dementia don’t hold a candle to the positive effect music has on its victims. The attached video, a brief portion from the documentary, Alive Inside, is entitled: “Music and Memory, an old man’s reaction to hearing ‘his’ music.” It illustrates so beautifully how music can unlock the brain that is addled by memory loss resultant from injury or disease.
I hope Henry’s story, and his dramatic transformation, encourage you.
The article posted here is well worth the read. It is very comprehensive and reveals the nitty gritty of the decisions that are so important, and too often emergent, as we and/or our family members age.
When my husband and I set up our living wills/advance health care directives a few years ago, we did so as a living gift to each other. The attached article reflects that sentiment as well. With all of the details spelled out in advance, the surviving loved one is not thrust into an emergent decision that by its very nature holds one of the biggest responsibilities we can carry on our shoulders. To be sure, an advanced health care directive doesn’t take away all of the end-of-life challenges that occur but it does allow the surviving family members to feel at ease as they respect their loved one’s wishes that were expressly made known well in advance of the need for implementation.
Having these discussions with loved ones can be uncomfortable for some, but if framed in the guise of being a living gift to those left behind, the discussions take on a whole new meaning and can’t help but come out in a positive light.
Do you find peace within the circle of your family; or does meditation or prayer, an inspirational book, or music fill your soul? Wherever the source – how do you keep that peace from slipping away?
Certainly when we’re exposed to sorrowful or earth-shattering news, any semblance of peace and calm seem to disappear, such as: acts of terrorism – both domestic and abroad; heartless school shootings; bigotry and hatred; and even devastating illness. How many times has your armor been pierced by such circumstances?
Too many to count. So how do we find peace amongst the chaos?
We can find peace in many small ways – probably the easiest way to do so is to acknowledge the beauty that surrounds us. It doesn’t matter whether you’re a creationist or an evolutionist, the beauty you see is the same. It’s always refreshing when I walk through my local plant nursery, Molbaks, to see the intricacies of flowers and their natural, yet seemingly unrealistic, colors. How did that happen? How can so much detail just happen and we had nothing to do with it? I relish the peace I feel when roaming the rows and rows of flowers and I capture that moment and take it home with me.
And the colors of sunrises and sunsets – what a joy to behold! Even though my house is located in such a way as to not be able to directly see the sun’s rising and setting, I still have the privilege of seeing its aftereffects in the pink and ruby colors of the sky. My mother’s favorite color was pink, so when the sky is beautifully colored in that tint, I credit my mother for this natural artwork, somehow executed from her heavenly resting place.
Celebrating even the smallest of victories in one’s life. Time and again I remind myself to acknowledge the small goodnesses and victories in my life. I learned this practice shortly after having a fairly major orthopedic surgery several years ago. The recovery and rehabilitation were lengthy so I had to take comfort in even the smallest signs of improvement so that discouragement didn’t creep in to rob me of the positive steps I had made towards recovery.
So too is it important to pay attention to all the emotional windfalls that come our way. A huge lottery windfall – such as recently happened (December 2013) in California and Georgia – isn’t the type of emotional windfall I’m talking about. We can experience far more authentic emotions that are not tied to money or things. Someone greets me with a smile or has a word of encouragement that I absolutely needed at that moment? That feeds my soul. I greet someone else with a smile and a hug? Even better – now I’m paying it forward! It’s been said many times before that the richest and longest lasting gifts are those that don’t cost a cent. As trite as it may sound, it’s still absolutely true.
Where or how does one find peace when hit with a wall of hurt – whatever that hurt may look like? In my experience, I have to force myself to look away from the hurt/pain/stress/negativity in order to clearly see some peaceful element, regardless of how small, that will convince me that all is not lost, because I still have this, whatever “this” may be. When we consciously turn away from the wall of hurt, we then have the ability to find some element of peace, somewhere, in our purview. That doesn’t mean that we ignore what is required to resolve the hurt that came our way, but we make a conscious decision to redirect our focus elsewhere so that all the focus isn’t on the hurtful things that have come our way.
Dona Nobis Pacem. I really like this blog entry entitled, Dona Nobis Pacem, from a blog written by Kathy that focuses on her quest to find peace after the death of her mom to pancreatic cancer. To be sure – finding peace is a journey, it’s not just a decision one makes – and Kathy’s article addresses the work required to attain peace. But initially she had to make a decision to simply start on that peace-finding journey, and doing so, she’s nearing her quest. I hope you will visit Kathy’s site and take the time to also watch the video she attached that highlights the song Dona Nobis Pacem – Give Us Peace.