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Breaking Through the Barriers By Joyce Brimhall, GeroTrends Consulting Margaret, an experienced caregiver in assisted living for more than four years, was walking down the corridor after a care-plan meeting wondering what had gone wrong. "I was positive that I knew just what I was going to say about Fred, but somehow I just couldn't get my point across," she said to herself. "It seems as though every time I started talking about Fred, Susan interrupted me and said, 'Oh, Fred's just getting old!' Insensitive remarks really upset me and I lose my train of thought. I really need to talk to Susan to see if we can resolve this so that I can feel I'm contributing to Fred's caregiving and being a productive part of the team." The issue that Margaret was trying to address was her concern about Fred's ability to respond. Margaret has always regarded Fred with respect and never had any difficulty communicating with him. Fred has been a resident in assisted living for two years now. He was 81 years old with a chronic heart condition when he moved in after losing his wife of 58 years. Fred has always been pleasant but sad. He attends special events but sits alone. He listens with interest when others talk, but has little to say in response. Although, as Margaret recalls, whenever he does respond, he has always been very appropriate and clear about what he was expressing. Last week, as Margaret knocked on Fred's door, she noticed that Fred took longer than usual to answer. At the time, she didn't think anything of it, but wondered if he was all right. Once he opened the door and she saw that he looked his usual neat-and-tidy self, she didn't give the delay a second thought. Later in the week, on two separate occasions, the same thing happened. Margaret finally confronted Fred. Margaret sat down with Fred, positioned herself so that she had good eye contact with him and said, "Fred, it seems to be taking you longer than usual to get to the door. Is this just my imagination, or are you having problems hearing when I knock?" "Oh no," Fred replies, "I hear you just fine. I guess I'm just not as spry as I used to be." Even though Fred denies it, it is possible that he is experiencing a gradual loss of hearing related to aging called presbycusis. Since Fred is not as communicative as other residents, it's important not to make a quick evaluation. Pointing out to Fred that Margaret thinks he's losing his hearing and should have it checked would have been premature. Not only would she be risking alienating Fred, but she would also be making an assumption that requires more assessment, since Fred might become defensive. At the next care-plan meeting, Margaret was determined to express her concerns. She needed and wanted feedback from other caregivers. If others were noticing Fred's slow response or if he was asking people to repeat things, Fred needed to be referred to his physician. Margaret is convinced that something can be done to enhance the quality of his life. After all, that's what caregivers do--see that every possible avenue of improvement is explored. Let's take a look at how Margaret has handled this situation so far. She deserves to be commended for her communication skills with Fred. First, Margaret did not jump to the conclusion that Fred must be hard of hearing because he didn't get to the door right away. There could have been other reasons for his delays. Secondly, when it happened the second and third time, Margaret decided to say something to Fred, but not the minute he opened the door. Instead, she sat down with him so they could make good eye contact. Margaret spoke clearly, lowered her tone of voice and began talking. Rather than make a statement about Fred's possible hearing loss, she took responsibility and stated her observations about the change in Fred's behavior in a non-threatening way. Margaret was smart not to press the issue without finding out if anyone else had noticed that Fred could be having hearing problems. Because of Fred's heart condition, he could be having trouble moving as fast as he used to, or if Fred is feeling depressed, he may be reluctant to answer the door at all. Changes in cognitive function could also be a factor. The importance of reporting observations without interpretation cannot be stressed enough, since there could be any number of reasons for Fred not coming to the door as rapidly as he once did. What is important is how Margaret communicates to Fred and others about her observations. Here are some of the techniques found to be effective when communicating with older adults:
Before the next care-plan meeting, Margaret talked to Susan about being interrupted and asked directly if she had done something to offend Susan. If so, she wanted to know so that whatever was happening between them would not interfere with the next meeting. Susan apologized and stated that she had been up most of the night with a sick child and was feeling "a little cranky" due to lack of sleep. Because Margaret asserted herself, she could clear the air and not embarrass herself or Susan by assuming Susan was not regarding the importance of what Margaret had to say during the meeting. By addressing the issue up front, Margaret was able to clarify the issue with Susan, express her concern about Fred without feeling intimidated, get the feedback she needed from her team and demonstrate good team-building skills. Since others admitted to observing possible hearing problems, the team agreed that referring Fred to his physician to be evaluated would be a positive course of action. When Margaret visited Fred and presented this solution to him using her best communication skills, Fred agreed to the suggestion. Because Margaret's approach was open, sincere, positive and nonjudgmental, and because she used empathy and demonstrated respect for Fred's situation, she received the results she wanted. And, Margaret never had to compromise herself. Being honest and open promotes a strong sense of personal integrity and dignity. Joyce Brimhall is a gerontologist and the owner of GeroTrends Consulting in Scottsdale, Ariz. Ms. Brimhall currently serves as a consultant in the senior-housing industry. She is a member of the adjunct staff of the gerontology program at Arizona State University where she teaches courses on age-related issues. Ms. Brimhall serves on the advisory committee for the gerontology program and is a member of the board of directors for the Greater Phoenix Chapter of the Alzheimer's Association. She is available to conduct training sessions on developing front-line, staff-education programs, providing dementia care, and recognizing and meeting mental-health needs of older adults. Ms. Brimhall can be reached at (602) 946-3650; e-mail: joycebrimhall@juno.com.
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