Elder Care: Communication variations

Each time I talk to my aged mother on the phone, I find myself pondering the puzzle of communicating with an elderly dementia sufferer. It's not that my mother doesn't understand what I'm saying. She understands me quite well and can respond appropriately, too. But, because of her short-term memory deficit, which is severe, this can only take us so far. For example, she'll ask me how the weather is where I live. I'll tell her and ask her how the weather is where she lives. We'll go back and forth a few times with pertinent comments on the weather. And then she'll ask me again how the weather is at my place. The same thing happens with any other line of conversation I may start. We can get two or three exchanges in and then she's already forgotten where we started. Thinking she's uncovered a new subject to talk to me about she'll revert to the original question again. And so it goes.

There's nothing wrong with these short, superficial conversations. Before dementia set in, I would talk with my mother once a week or so, and that level of contact and communication was sufficient. At that stage in her life, my mother still had outside contacts, friends and activities which provided stimulation for her. Now that dementia has shrunk her world to a very small space, I find myself struggling to determine for myself what communication means at this stage of my mother's life.

I realized recently that communication per se serves various needs. Obviously, a phone call facilitates the simple transmission of information. But there's more to it than that. There's also the strengthening of the thread that binds us across a long distance. There's the easing of loneliness during a long, quiet day. There's the proof that connections still exist. There's the stimulation to her brain that comes from the need to marshall thoughts and express ideas. And more. Looking at each of these elements independently, I've come up with a few ways to satisfy her needs, beyond the phone call.

1. Hearing a beloved human voice: I confess I don't always have something special to say to my elderly mother. And she's not always able to carry on much of a conversation. Yet I know it's meaningful for her to hear my voice. In between calls, I'll leave messages for her on her answering machine. That way she knows I'm thinking of her, even though we're not engaging in a phone chat.

2. Pet therapy: A brain with dementia is especially in need of stimulus. As I see my mother withdrawing from social activities because she can't follow what's going on, it becomes harder to find ways to engage her. Enter animals. Animals are the gentlest of stimulators. Their presence is non-threatening and non-demanding. They're simply there, willing to be touched, cuddled, played with, watched. A tremendous amount of good comes from this. It's novel, it's fun and funny, it's different each time the animal comes, it provides variety, it stimulates memories. I could go on and on. Many assisted living facilities schedule weekly visits from animal shelters, who bring an engaging assortment of critters for the residents to play with. Perhaps your own caregivers or care manager has a pet they'd be willing to bring along to your parent's house from time to time. How about visits to the zoo?

3. Communication can be more frequent if there's a written option. Take a look at my post about the Presto email printing service. Using this machine and service can broaden an isolated older parent's world immensely. While this system doesn't allow immediate two-way contact, it can provide a platform from which you can dive into more topics of conversation. Use the photograph, or the message you emailed your parent to spark new avenues of communication.

4. Reminiscence is a strong pull among the elderly. But it's not possible to always lead your parent down memory lane in every phone call. How about setting up a long-term memory project, which you can revisit with them from time to time? If your parent is able to follow through on tasks independently, I encourage you to give them a micro-cassette recorder with a bunch of blank tapes, on which to record the tales of their youth, your younger years, whatever appeals to them from their memory vault. It may feel awkward to them to speak into the recorder at first, so you can help them get started by selecting the topic you want them to reminisce about and giving them a list of questions. Or, you can do this in person with them the first time or two, till they get the hang of it. You'll need your own microcassette recorder on which to play their tapes to transcribe them. You could also have a copying service copy the recordings onto CDs for you and your family. This sort of project can span many months and include looking through photographs, getting supplemental information from your relatives...a whole host of opportunities limited only by your own creativity.

Well, these are just a few of the ways in which I've broadened my definition of communication in an attempt to offer and receive more from my contact with my mother. Do you have other ways of creative communication with the elderly parent you are caregiver for, that you can share?

Elder Care: Powerful Tools for Caregivers

I've taken the title for this post from the 6-week course given by Legacy Caregiver Services. I already mentioned Legacy in my previous post. I have had the opportunity now to read The Caregiver Helpbook which they offer to class participants.

The class and the book are all about helping caregivers for elderly parents or relatives (or spouses) develop self-care tools to reduce personal stress, communicate their needs to family and health care providers, deal more effectively with challenging situations, and more. The book is full of practical information offered in a straightforward manner. It doesn't talk down and it's not full of psycho-speak. I found every page had something of value to offer me, whether it was something I hadn't thought of or a simple validation that, yes, I was doing the right thing.

If I'm rhapsodizing a bit too much here, it's only because I haven't ever found an offering that is as substantive and validating as what Legacy provides (and, no, I'm not on their payroll!!). I feel quite heartened that a book and a class like those offered by Legacy exist. It's good to have a resource that not only recognizes the subjective nature of what we, as caregivers for elderly relatives, each experience, but offers thoughtful and provocative ideas to help intelligent people help themselves. And lots of resources with addresses and phone numbers, too.

If you want to find out if there's a course offered in your area, or find out more about the book, contact Leslie Congleton at 503/413-7032 or email Leslie via this link.

Elder Care: caregiver training and more

Thank you to Ryan Malone, who commented on my previous post Dementia and Montessori. I want to call your attention to Ryan's site: Inside Assisted Living. I urge you to peruse the information he has collected. It's full of good ideas, and also has links to three other blogs on elder care. I've looked at a number of sites and blogs that present such information and I find most of them are a bit weak. What Ryan's put together, and the blogs he links to, are topnotch. I'm not going to repeat the blog links here, because I hope you'll take some time to go to Ryan's site and get into them yourself.

Another exciting resource I've found is Legacy Caregiver Services, in Portland Oregon. They have developed a 6-week course for family members caring for loved ones, called Powerful Tools for Caregivers. To spread the word, they've trained leaders to present the course all over the country. Judging by the course outline on their website, they've really captured the essence of what people in our situation want and need to know about. I was glad to see there's a good overlap between the issues I'm getting into here on Mimi's Place, and what they discuss.

As part of the course, you receive a handbook, which Legacy has been gracious enough to send to me. Once I have a chance to read it I'll post information on it here. So check back..... And to learn about their class, go to their website Legacy Health Services. You'll need to email them to find out if there's a class being offered near you.

Do you know of any other really solid websites or other offerings, that actually get to the nitty-gritty of our situation? If so, please email me about them.

Elder Care: special attention for dementia

There was an interesting article in the New York Times Education section on Sunday Nov. 2. Titled Coming Full Circle, it describes the use of Maria Montessori's teaching techniques to create activities for elderly people with Alzheimer's and other memory deficiencies.

Some assisted living and dementia care facilities are now using the full-time program developed by Dr. Cameron Camp, an experimental psychologist. His program uses Montessori techniques to "build on existing skills and habits, with the goal of improving quality of life and independence by using cognitive strengths to neutralize weaknesses, making frequent use of repetition to create unconscious learning." More specifically, Dr. Camp says, "the key to working with someone (with memory deficiencies) is to build on the skills she has retained--writing, reading, playing the piano--rather than letting her deficits limit her life."

To quote further from the article,"A common misconception about people with dementia, Dr. Camp said, is that they no longer learn. But they do: residents learn to find their dining room table, for example, well after the onset of Alzheimer's disease. And because they no longer have the higher brain function they had as adults, he reasoned, they are well suited to Montessori."

A number of facilities around the country are now using the programs and materials developed by Dr. Camp through the Myers Research Institute in Beachwood, Ohio. Again, quoting Dr. Camp, "We start by saying that a person with dementia is a normal person with memory deficits. Then you can circumvent the deficits by using the strengths. That's how you create what Montessori called 'normalized environments,' meaning environments that challenge you but let you succeed."

I find this fascinating. What a wonderful approach to the dementia conundrum. Nobody per se is talking about restoring dignity or self-respect, but you can see from the description of these programs that that is the outcome.

My elderly mother who has dementia is in an assisted living facility that runs such a program, which they call Circle of Friends. My sister and I enrolled her in the program, but she had only negative things to say about it and refused to attend for more than a few minutes. In reading this article, I now think that perhaps she was still too disoriented by her recent move to assisted living and couldn't focus on the the activities. Her response was to say something insulting and leave in a huff. Now I'm hopeful that, as her memory loss progresses, she may actually be more acquiescent about staying in the program. I feel very lucky that she's in a facility that is forward-thinking enough to offer such a program.

If you are the caregiver of an elderly parent is in assisted living or Alzheimer's care, check if they have a program like this. And bring this program to their attention. The more places that offer this sort of program, the better! Here's the link to the article, which is worth reading in its entirety: www.nytimes.com/2008/11/02/education/edlife/montessori.html?_r=1&ref=edlife&oref=slogin. This should take you directly to the article. If for some reason this link doesn't work, just go to www.nytimes.com/edlife and search the issue from Nov. 2, 2008 for the article Coming Full Circle.

Great websites

I want to draw your attention to something I've just added to this blog site: a list of websites and blogs that I think offer the best of information and ideas for those caring for their elderly parents.

I'm not actively going out to find these sites. However, when an outstanding or especially useful one comes to my attention I'm going to share it with you here.


Look on the sidebar at right, under the heading Websites I Like, and take a little time to peruse what these sites offer:

Aging in Place: a round up of various cool technology that facilitates seniors staying at home. Also offers musings related to what seniors really need, all in a well-written and clear presentation by Lauri Orlov.

ShirleyBoard: offers some useful online tools to help organize the plethora of paperwork and info that caregivers have to manage. ShirleyBoard also links to:

SeniorCare Marketer: Although this site defines itself as geared to the business of aging, I found it contains excellent posts on issues related to the future of senior care, along with useful links. It's refreshing to read well-written, thoughtful pieces about the industry of aging. Personally I find such knowledge useful in evaluating the services and products I need, along with helping me make sure my expectations are valid.

I'm in the midst of evaluating a very unusual website that I think you'll love. Check back soon.