Any advice on communication strategies?
I have one relative who is hard of hearing and may or may not choose to wear his hearing aids, so I shout.
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I have one who has increasing dementia and who forgets or mangles 50% of what we say to her, so we speak slowly and repeat ourselves.
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I have one who is just out of hospital who is confused much of the time, but may or may not have actual cognitive impairment. Hard to tell.
Out of four elders I care for. The 4th one can hear just fine, but filters everything through his extreme religious/political filters so he garbles even the most secular messages and somehow manages to insert his faith into them. It's really hard to follow when it's about things like the dinner he may have just eaten, his pain levels, or his most recent lab test.
I find myself either shouting or baby talking or explaining over and over to each of them, almost every day. When the "maybe cognitively impaired" one got released from the hospital Thursday, they gave her a simple Velcro back brace and a set of simple printed instructions. But the number of calls I've gotten, the number of hassles it's caused them, the complaints! The stress of wrapping it around her waist, omg! You'd think it was self-neuro-surgery. I've tried to show her twice, several nurses tried, the physical therapist tried, her husband/my dad tries. She just called me AGAIN, probably for the 10th time in 3 days, to tell me how "terribly confusing these darn braces are." I spoke to her in baby voice, even though she may be fine mentally, super slowly, using tiny, simple words. She got offended! Now I'm in hot water for leaving her all on her own to figure out how to use it, but there really is NOTHING anyone can do to help her put it on/take it off/understand it.
I'm open to ANY suggestions about how to communicate with old people. I also spent 10 minutes explaining the process of choosing between Extra Strength Tylenol ("when you're in pain") or the narcotic to bust in half ("if you're in extreme pain"). So I said, "Are you in any pain?" She said, "No, of course not! I took the pill." I said, "Which pill?" Turns out, the narcotic. So I said, "Did you remember to cut it in half?" and she said, "Which one should I cut in half?" *me banging my head against the wall*
Now what? I guess I should break the remaining 3 in half when I'm there tomorrow, but seriously? But she cannot determine what +4 hours is, and she can't determine her own level of pain? She's the mentally sound one, or so I thought. Now I'm confused!
The hospital urged us to put her into a nursing home post-op, but she refused vehemently. We also didn't want her to be in quarantine for 2 weeks while they restrict all visitors...because she won't get the shot since she insists that the government is lying and they really are injecting the virus into people to GIVE them Covid to "thin the herd"?!?!?!
I'm trying to be patient, loving and clear in my communication. Nothing is getting through - not signs on her wall, not the doctor's orders written and highlighted on her nightstand, not repeated verbal admonitions...
The one with narcotics sounds a little scary. Can someone be hired to set up her meds (making sure all the pills are cut in half so the correct pills get divided?) Mom had a weekly pill box with 4 spaces for each day to keep track of her pills and times to take.
Hearing - I know how that is dad was horrible with his hearing aids. Had some success when I got him VA benefits and got hearing aids through them. He wore those the best until he got to SNF. But even those were problematic because he was profoundly deaf and had been without hearing aids for so long some of the connections between brain and ears were permanently broken and his common response was often "what?" Also tone and not necessarily volume is the key. Unfortunately I've never had a "soft, ladylike voice." I'm naturally loud, my father hear me sometimes but heard my husband's register easier. Though now my husband is deaf and its starting all over again.
The dementia one - may never understand - or understand at the time but forget later. My MIL used to call all 3 of her sons 10 - 15 times per day each with the same stinkin question. She'd write the question down on several pieces of paper and distribute them throughout the house as she did the dates from the newspaper. So whenever someone was at the house, that person was to pick up the written questions and destroy them. That worked for a short time. MIL then hid one under the tablecloth - you just have to love it.
I'm sorry I have no real advise - even though they act like perpetual 2 year olds you can't talk to them as two year olds, its just going to upset them and they'll feel insulted. Talk slower. Try shorter sentences. Try and break instructions to just a few steps. Hopefully the back brace person will get the hang of it sooner than later.
Good luck.
What about postcards? Sent from whatever beach/mountain/lake shack you just ran away to? Or just talk to the wall instead, like Shirley Valentine did in the film.
Seriously, you are doing an amazing job.
I don't think it's a sheer matter of hearing problems you're facing, but of comprehension problems. They may hear what you say, just not process the words properly.
What you're running into with not getting thru with signs on the wall, the doctors orders written and highlighted on the nightstand and repeated verbal admonitions is typical with dementia. They're incapable of reading signs or written instructions, or comprehending verbal admonitions. It's in one ear and out the other. My mother has fallen off of her bed at least 10x the past month alone because she can't remember being told not to lean over the edge of it. Even if your elders don't have a "formal diagnosis " of dementia, if it quacks like a duck and waddles like a duck, chances are good it's a duck!
Wishing you the best of luck realizing you can't be all things to all people, and hiring some extra help for your loved ones who need it.
Do you really need to follow anything he is saying? Does it require input from you? If no to both, then just let him ramble on. Perhaps have some ear plugs for yourself, to help tune it out. A few well times Um-hmmms might give him the idea you are listening, even though you aren't. It doesn't sound like any of his ramblings are all that important.
If he has chronic pain, then a dispenser like described for the other might help. If someone isn't consistent about taking pain meds, pain levels can creep up when a dose is late. By getting it on regular intervals, it would help keep it under control better.
Slow, keep it simple and repeat when necessary. If it isn't something important, don't bother repeating. You can often feel like you're talking to yourself, and for the most part you are! YB always went on and on with mom. After the first few words, between hearing loss and dementia he might as well be talking into the void!
If you feel the need to say unimportant things while there, just to break the silence, keep it to simple words and simple concepts, like Nice day today! Are you hungry (thirsty)? Coffee or Tea? Water or juice? The Boogie Board I suggested for the relative with the hearing issue might be helpful for her as well. You could write down simple (as few words as possible) instructions, questions or statements. A small white board could be used as well - with the distancing we had to keep at MC, the LCD wouldn't help, so I picked up one that was small enough to handle but big enough to see at 6'.
I know mom used to hang onto notes the staff gave her and would cycle through them, even though they were old. Maybe a small notebook, or something to keep notes in that she can look at?
It might be best to get a timed/locked dispenser, at least for the narcotic. She may not need pain meds every 4 hours, but you could set it for that anyway. Better that she get them this way than taking a whole pill who knows how often.
It's hard to know when to set it for the Tylenol. Maybe stagger them and see how it goes? For instance make both every 8 hours, but set up so she gets one at 4 hours and the other 4 hours later?
8am Narcotic
12 noon Tylenol
4pm Narcotic
8pm Tylenol
etc.
Adjust as needed.
They have audible and visual alarms. Since she's not the one with the hearing issues, that could work. Then you can have better control over her taking the medication.
"She's the mentally sound one, or so I thought. Now I'm confused!"
If she had surgery/anesthesia, there could be residual dementia-like issues. Check for UTI? Monitor the issues. If it gets worse, get her evaluated for dementia.
For the brace, can dad just put it on for her, rather than just trying to show her or explain?
She absolutely denies doing this, but my dad is likely to be the one telling the truth.
Ugh!
My mother wore one hearing aid. As her dementia progressed, she'd misplace it, forget it, not change the battery, say she didn't wear one (funny, when I found it and brought it to her after that last statement, she asked where I found it, forgetting she said she doesn't wear one!)
What I did was get a Boogie Board LCD "tablet." You can write on it and erase it. If it wasn't something simple that I could pantomime, like a drink or something to eat, I'd write it on the screen and she could then read it. It worked well, the staff loved it AND the dental hygienist bought some for the office!
It was easier than trying to find paper to write on and less wasteful.
I can empathize with your frustration. I can barely cope with one person, and bless you, you are doing 4 times the work. Big hugs to you.
Your ability to communicate well with people with hearing problems and /or dementia is VERY difficult. You can really only do so much and it sounds like you are doing quite a bit in this department. While is may not feel like it is "working", no matter how hard YOU try, it may only working marginally well, through no fault of your own.
Most people do not want to go into a nursing home. Very understandable. But, when they are therefore going to be demanding and requiring too much more help from others, it's really not their choice anymore. I made my mom go to rehab after operations, one in actual rehab, one in a local nursing home. It was VERY helpful for ME. She didn't love it but it really was necessary. The stress of bringing her back home when she couldn't do simple things for herself was just not an option for me.
The person that couldn't understand tylenol vs narcotics - are they living alone? Sound like a convo I've had with my mom but she lives with me and I can monitor it enough to keep a good handle on it. But if this person is alone and in charge of their meds, that sounds a bit scary. Obviously they don't really seem to have the capacity to figure these things out for themself and could be making many errors. Sometimes outside help is needed.
Good luck.
As far as the one with the severe hearing loss, my brother shouted at our mother, and finally just stopped talking to her, which was extremely cruel in my opinion. It turned out that volume is not so much the issues as tone, plus a properly adjusted hearing aid. Take your relative to a hearing aid specialist and make sure his aids are adjusted correctly, and if he refuses to wear them, change the tone of your voice somewhat. My mother simply can't hear low-registers, so now when my brother talks to her, he speaks in a slightly higher register and she hears him pretty well. She's never had a problem hearing me.
I think you're going into far too much detail regarding the pills, too. That applies to the one with dementia, too. (I think the one with the pills and the brace has a touch of it as well.) Honestly, just like with a child, repeating something simply multiple times will work better than going into more detail or trying to hard to explain more than is necessary.
I don't know why you'd turn down going to a nursing home because of a two-week quarantine. That's the norm nowadays, plus if she was in the hospital you wouldn't be allowed to visit either. They aren't quarantined as in left alone on their own for two weeks -- there are caregivers who are specifically assigned to her only, so nothing she might have is carried back and forth to other residents, that's all. My mother was quarantined for two weeks after getting out of the hospital, then for another three when she tested positive on her last day, and she had five-star service because she had her own personal caregiver 24/7.
I say do the nursing home and don't sweat the quarantine period, but certainly ask the staff there first how they handle unvaccinated residents (and she won't be the only one, too, BTW). I'll wager she'll be in there with everyone else after her quarantine, because they'll be pretty strict about visitors being vaccinated and she'll benefit from the herd immunity.
There's just always going to be a segment that won't get the vaccine. My mother-in-law is one, and her reasoning is that "I don't catch viruses." Oh, OK. She said she never get the flu, so she won't catch this either. She's only considering the vaccine because she heard she might not be allowed to fly unless she's been vaccinated. Mind you, she hasn't flown anywhere in three years, and at 85 I don't expect her to, but that seems to be the one thing that'll get her to change her mind. If it works, so be it.
With the one who filters everything through religion, just stick to the topic and don't allow yourself to be drawn in to his particular angle of approaching things. Selective deafness on your part would be the best way to go here, I believe.
Pretty scary to inter them in one of those places after that, but even more scary that her anger, confusion and rage at the situation might cause her to break something else soon. Next time, nursing home. I'm done with this drama.