What are The Basics? They are the starting points, from the signs indicating that a senior requires additional care, to the areas of a senior’s life that may be most affected and that family caregivers will want to make a priority. They are the topics for early and ongoing consideration and attention: recognizing the signs, health, home safety, role reversal, communication, stress and compassionate caregiving.
Recognizing the Signs
Most of us notice that something is amiss with an elderly loved one long before we do anything about it. But the time to pay attention and do something is when you first suspect that something is wrong. By being attentive and taking early and immediate action, you will get ahead of the game and have more time to take the necessary actions before a crisis occurs. Early action ensures that life during the care-giving period will be better for you and your elder loved one.
The need for care comes with signs, and chances are good that those signs, even if subtle, will be everywhere. The house may be dirtier or more cluttered, clothes may not get laundered or cleaned regularly, bills may not be paid. Watch for unfilled prescriptions for medications, multiple messages on the answering machine, broken or dilapidated appliances, rotten food – or no food – in the refrigerator, a lack of attention to personal hygiene, or a general unkemptness that seems to affect all areas of life. If the elder has a pet, it may hot have been attended to for a while, and if the elder is still driving, there might be dents or scrapes on the car. (See “Taking Away the Keys” for more on this subject.)
There may be other signs not listed here. The point is: be attentive for anything that seems different from the norm, out of place or a bit chaotic. Physical challenges, memory lapses, cognitive impairment and loss of vision are some reasons that seniors struggle to perform the routine activities of daily life. And most seniors will not ask for help.
Changes of this kind may be alarming for you, but try to see them as symptoms signaling that change is occurring. The changes can be quite subtle and may seem so minor as to be easily ignored. Others will occur incrementally, so you may not notice. Things may seem normal, but if your intuition tells you something is amiss, pay attention; that inner voice may have something valuable to say. Watch for patterns of change and remember that mental deterioration (dementia) is not a normal part of aging. Many of us believe that it is, but it’s not. Pay attention to the signs, and when you notice them, take action.
Health Issues
Health issues are another real concern. Watch for weight loss or eight gain, changes in appetite, difficulty swallowing, daytime sleepiness, bruises, (a possible sign of falling), spilling and dropping things, muscle weakness, dehydration (a common problem for seniors), physical weakness and insomnia. Pay attention to cognitive functions. Is your loved one frequently forgetting things, getting lost while driving, losing reasoning skills, becoming short-tempered or easily frustrated, repeating stories, failing to finish sentences, wandering off in conversation, becoming unable to focus, forgetting to turn off appliances – all the while making excuses for these cognitive deficits? If any of this rings true for you, you need to see a doctor and have your loved one evaluated. Begin with the primary care physician. If a referral is necessary, the doctor will determine whom you need to see next.
Home Safety
This is also the time to take a walk through your loved one’s house, checking carefully and making notes about anything that seems to be out of place, missing or just not right. As you proceed and discover, avoid getting frustrated, and don’t point out to your loved one the things you have observed. Stay positive and understand that these changes are never intentional and are beyond the elderly person’s control. Pointing them out will only increase everyone’s stress while causing frustration, shame, defensiveness and sadness for your loved one. The reality is that most people don’t want to live this way, but they don’t know how to improve the situation. As you become a caregiver, this becomes your charge. These things have happened, so move forward without blame, shame or guilt, and take the necessary steps to begin rectifying the situation.
If you pay attention to the signs, you face the truth head on, and you follow the procedures given on The Care Company website, you will be better prepared when something more serious occurs. The signs of aging are your wake-up call to step in and take action.
If you have done your due diligence, then you have already made the house safe for your loved one. If not, please refer to the free “Elder-proof Your Home Scavenger Hunt” for the best ways to make the house less hazardous for your elder. A safe house is a place where the chance of falls and other accidents is minimized, which means less time in the hospital, where many seniors begin an irreversible decline. According to the statistics, one in every three seniors over the age of 65 will fall. Elder-proofing the house will give your senior a much better chance of remaining part of the two in three who don’t.
If you haven’t already discussed safety with your loved one, then you need to explain that you want to help avoid any future problems and that more than anything, you want your loved one to live independently. Remember, stay positive and take your time. Let your loved one know that you want her to be safe. Explain the reasons why you are concerned about safety. Be clear about the issue of falling, and know that falling is one of the biggest fears that the elderly worry about secretly. “What happens if…?” is often the question that is there but not spoken. Just because it hasn’t been brought up doesn’t mean it’s not a real concern.
Note: Making the house safe does not guarantee that a fall will not occur. Lack of balance is a serious physical issue for many seniors.
Role Reversal
For many caregivers and their loved ones, role reversal is one of the most difficult challenges. It’s hard to think of being – and then to actually be – the go-to person for a parent or loved one. We naturally think of our parents as the ones who are supposed to care for us, so we are never really prepared for this transformational time in our lives, and there is no way to plan for the feelings that naturally occur.
Your relationship with your loved one is evolving. You are becoming the voice of authority. You are becoming the trusted advocate. You are becoming the one person who will filter all information for the senior. It’s a big responsibility, and you need to move slowly through the process. Give your loved one and yourself time to get accustomed to this new reversal of roles.
Working with families and individuals over the years, we have probably seen most of the different reactions people may have to this. Anger may arise from the new inconvenience and be coupled with anger left over from unresolved emotional issues. Family members may become frustrated by the new challenges they face. Sadness (particularly for women, and especially if they are presumed to be the obvious caregiver) may result from the loss of a parent’s ability to connect.
Few people are able to deal with such change in an objective, non-emotional way. But try, because the more you succeed, the better off you and your loved one will be. Give yourself a break. This is a journey; trust that you will find your way. (If you are struggling with this, you might consider an individual coaching session with Cindy or Kelly to help you break through your fear. So often, a phone call with someone who is there just for you can make all the difference in your ability to deal with this new role.)
Avoiding Frustration
Don’t be upset if, after recognizing and communicating with your loved one that he needs assistance, your good intentions are met with resistance. Typically, older people do not like change and don’t want to be reminded that they need help. As we say in any process we share with you at The Care Company, approach change gently. When you find yourself in this situation, you may experience a strong urge to “fix it” and fix it now! But you can’t rush in and change everything all at once. Yes, you need to move purposefully, but you also need to have a plan to ensure that you are effective and efficient and not solving one problem only to create others.
Here’s a trick that might help you get through some of the daily emotional challenges and communication issues that will arise from time to time. If you find yourself frustrated and about to lose your temper (remember: yelling at your elderly loved one is not a good option because it increases stress, diminishes trust and solves nothing), try going to a place where you can become what we call a Distant Observer.
Put yourself in your loved one’s place and imagine how you would feel. Imagine the loss of independence. Imagine the experience of facing tremendous physical and mental challenges that increase every day. Imagine being unable to remember, or having to go to doctors constantly. Imagine that the things you take for granted – fixing a meal, walking to the car, doing the laundry, taking a shower – suddenly become enormous challenges. Now, looking at if from this perspective, do you understand why the elderly are often so crabby?
Here’s what to do when your loved one gets a little testy. Take yourself out of the fray. Consciously think about rising above the situation and looking down on it objectively. You’re there and so is your loved one, but you’re not engaged in the emotions. Suspend judgment. (Don’t skip this step. Living in judgment will bring the discussion to a halt.) Take a breath, and let your intelligence take over. Remove the emotion. Stay calm and take one issue at a time. You will not cover all the subjects you want to, so be clear about one or two things you want to check off the list. Doing this simple exercise will remove you from the conflict; you’ll able to act compassionately, and you won’t take personally anything that might be said in frustration. If your good intentions are welcomed, consider yourself lucky.
Smooth the Way to Avoid Unnecessary Stress
Families often have internal conflict. Siblings may rally and provide great support, or they may resist your efforts. Not everyone will necessarily agree that your elderly parent or relative needs care. They may even see the need but be unwilling to spend the extra money or take the time required to care for an aging parent. If that’s the way it is, chances are that no amount of cajoling, pleading, or guilt-tripping will make a difference.
Whatever the differences are, do not argue about them in front of the elder. An elderly person who thinks that she is responsible for family fighting will experience stress and, possibly, depression, sadness and even illness.
The aging process is neither kind nor easy. Once you realize that your loved one needs support, avoid making too many changes too quickly. If he lives at home, respect that things have been done a certain way – his way – “forever.” For the sake of his comfort level, make any necessary changes incrementally. Don’t walk in and completely rearrange his home one day just because you think it would be easier for him. Explain what you want to do for him, and then explain it again as you are doing it.
Have compassion. If you are becoming short on patience during an interaction, leave the room, take a breath and come back. You don’t want your good intentions to be misinterpreted or swept away by an angry outburst that may lead your loved one to perceive you as a threat.
Remember, any change feels threatening, especially to the elderly. Try to remember that change is hard, even when it is meant to help. Ease into the process. Take your time to set the stage for how your move forward.
Empowered Caregiving
Empowered Caregiving relies on your ability to maneuver through the roadblocks gently and without frustration. It depends your being clear about your goals. It may take a few attempts to succeed, but once you have begun the process and established trust with the elder, things will get easier. In the beginning, you will probably encounter resistance. Know this going in, and adjust your expectations accordingly.
We reiterate that just because you think you are doing the right thing does not give you the right to ignore a senior’s pride. That pride is extremely important, and you need always to be aware of it, respect it and nurture it. Be cautiously persistent, and eventually you won’t be seen as a threat, but as a welcome participant in your loved one’s well-being.
Let’s re-cap the steps you are going to take:
- Fine-tune your observation skills.
- Watch for the signs (listed above).
- Watch closely for cognitive decline.
- Contact and schedule an appointment withhthe PCP if you notice a decline.
- Check the house to see what/if anything is out of order.
- Do not discuss your observances with your loved one. No point. Nothing accomplished. Stay positive.
- Make changes slowly, and explain every one of them.
- Be patient and calm, and whatever you do, don’t yell at your loved one about this situation.
- Become a Distant Observer
- Become an Empowered Caregiver who knows how to maneuver gently through the landscape.
