Joco Opinion

Caregiving 101 — In difficult caregiver role, use all kinds of communication

Updated: 2014-01-31T18:08:53Z

By JOY GIPPLE

Special to The Star

My father-in-law (FIL) was spittin’ mad.

He had recovered from pneumonia at our home, but was still very weak. My husband and I decided to use FIL’s insurance benefits, and we moved him into a rehab facility for therapy.

And FIL was livid.

“Come and get me! Therapy does not do any good! I want to go to my house! I do not want to die in some nursing home!”

Communication is critical in caregiver relationships. It. Is. Hard. Work.

My husband and his dad are best buddies, but they aren’t always the best communicators. That’s where I enter the picture.

Although I’ve been married to his son for 33 years, FIL still treats me differently — more polite, more kind — than his own children. So when there’s a tough issue to address, I get sent in — kind of like a hostage negotiator in the movies.

I’m not a good talker; I prefer writing. FIL is not a great listener; he likes to read and mull things over.

So for this negotiation, I chose my weapon — I mean communication style — carefully. I armed myself with a printed list. I headed it: Things to REMEMBER, Things that are the TRUTH. And, knowing FIL’s volatile nature, I enclosed the list in a plastic sleeve, in case he got the urge to tear it to pieces.

The list included things like: Your family loves you. You almost died of pneumonia. You are getting better. We cannot care for you until you are stronger. You can go home when you are strong and safe enough. This is not a nursing home — it is a rehab center. Therapy works. Look around — people are leaving as they get better.

I gave FIL the list and a hug, and left. Later that day, he consented to our therapy plan.

Don’t get me wrong. I’m not some magical communication fairy and it wasn’t happily-ever-after. As FIL’s mental and physical capacities fluctuated, there was a lot to communicate about, and it was rough.

We had to explain, discuss, clarify, repeat, provide written documentation and professional opinions … and listen. In FIL’s case, we also had to read.

FIL is a prodigious letter writer and list maker himself. So recently, when he seemed unable, or unwilling, to express his opinions verbally, I used the list system in reverse.

I gave FIL three sheets of paper, one for each of his three residence options: our home, his house and a veterans nursing home. I made three columns on each page: Pro, Con and What We Need to Do to Make This Happen. I filled in some of my ideas, then asked FIL to add his remarks.

We were surprised by several things FIL wrote that he’d never mentioned aloud, such as, “I didn’t live to be 97 to die in a basement!” What?! He was referring to a guest bedroom that we thought he enjoyed. It was an easy fix to tell FIL that he could have a bedroom upstairs instead.

Written, factual information works well for communicating with FIL. But for my grandmother with dementia and my dad with Alzheimer’s, a completely different approach was required.

Dementia patients are often living, or reliving, a different time or place, real or imagined. Insisting on the facts only brings frustration. We found it better to meet them in their memory or join them in their reality — whatever that was at the moment.

If Grandma refuses to go to the dining room for lunch because she wants to ride the streetcar to the movies with her friend and she’s waiting for her dad to give her a quarter, why argue? Why not give Grandma a quarter and offer to walk her to the streetcar? By the time you reach the dining room, Grandma has forgotten all about the movie anyway.

Because Dad loves music, we often sing, hum or whistle a familiar tune to distract, entertain or motivate him.

Communication among family members sharing caregiver decisions also can be challenging. We say too much. We don’t say enough. We make assumptions. We say the wrong thing. We say the right thing in the wrong way.

Note to self. For any caregiver-related communication:

1. Listen, and not only with your ears. Encourage others to speak or write and be aware of facial expressions and body language.

2. Apologize/forgive. Ever blurt out something you didn’t mean or use the wrong word in an email? Emotions cloud our judgment, and we all make mistakes.

3. Persevere. Talk, write, watch, listen, smile, touch, sing. Use every means of communication you can, and don’t stop trying.

Freelancer Joy Gipple of Shawnee writes Caregiving 101 every other week.

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