Caregiver Time – The Power of Our Time

ONE NINE: CAREGIVER TIME – THE POWER OF TIME

Mary Gilliam, MBA, LNHA, Certified Dementia Practitioner

 

The dawn of a new year is a good time for us to reflect on something extremely important.  Time – or in our case caregiver time.  This upcoming year has the same maximum amount of time for each one of us.  The same 24 hours in each   day.  The same 7 days each week.  The same 12 months in the year.  We each get to decide how we will use our time and when the day is over, the time we had is forever gone. The decisions on how we prioritize this time determine many things such as how we will perform at work and how our personal relationship will develop.  Time is the most valuable resource we have.

It seems like many people live life with the attitude that the busier one’s schedule is, the more significant their life. The ability to multi-task has become glorified to the point that focusing on one task at a time can be misinterpreted as laziness or unproductive.  As a culture, caregiving is a great opportunity to reconsider the way we place value on what we spend our time doing, in making choices and setting our priorities.

Cheryl Beaver, Director of Community Relations at Monarch Senior Solutions, recently spoke on the power of time.  She highlighted a plaque she had given her daughter hanging prominently in her room stating; “do something that fuels your soul.”

For millions of Americans, caregiving is what fuels a passion of purpose, empathy and love.  These moments of joy can come in the simplest of caregiving tasks.  Cheryl told a story of a recent client she had gone to visit late morning during her off time.  Upon entering the room, Cheryl noticed the client was still in bed, wet and weak.  She immediately helped her to a sitting position, gave her a bear hug to help stand her up when all the sudden the client started passing a large amount of gas.

“Did you hear that?” said the client and she was cradled between the arms of Cheryl.

“No, no, didn’t hear a thing,” responded Cheryl allowing her to maintain her dignity during this transfer.  A moment passed as they slowly transferred to the wheelchair.

Her client looked up, caught Cheryl’s eye and said, “Well, I hope your sense of smell is as bad as your hearing.”

The two of them burst out in a belly laugh and a normal caregiving moment was instantly turned into a lifelong memory.

Time well spent and inspiration looks different to different people.   For Cheryl, that moment where she allowed herself to slow down and make the client in front of her the most important person in the world.  Cheryl said that “E-Mails, phone calls, meetings, life stops in that moment for a short period of time to serve the person in front of me.”  That is the time that it well spent.  It is not scrolling through FaceBook, rather it is laughing with the person in front of you.  It is these moments, transferring a sweet, wet, thankful client to a chair and laughing until your stomach hurts over flatulence, these are the moments that matter.  These are the moments that allow us to create hope, be a blessing, be an inspiration and share our love wherever we go.

 

Mary Gilliam’s passion for serving seniors has become a lifelong mission.  She is the founder of Monarch Senior Solutions and responsible for leading the in-home care partners and senior advisors.

Mary holds a Master’s Degree of Business Administration with an emphasis on Health Care Administration and is a multi-state Licensed Nursing Home Administrator.  She has been in long term care operations since 2002 serving those in assisted living, memory care and skilled nursing. 

Improvisation Techniques to help Dementia Care Communication

Loved One Suffering From Alzheimer’s? 

7 Ways Improvisation Techniques Can Help With Communication

Mary Gilliam, MBA, LNHA, Certified Dementia Practitioner

 

Communicating with someone with Dementia can be challenging.  Such as any skill mastery, it can take time and practice to learn the nuances of keeping a conversation engaging.  While improving communication skills might not make being a caregiver less stressful, it can make the moments you have more meaningful.  Oddly enough, the principles of improvisation can be implemented to help create a positive dialog for you and your loved one.

  1. “Yes, And”

In improvisation, “Yes, And” is one of the most important rules.  This is the rule of agreement, where under no circumstance should you discredit your partner.  No’s stop the flow of conversation.  Someone suffering from Alzheimer’s receives a lot of “no’s” throughout any given day. “You can’t go outside.”  “You can’t get up and walk.”  “Your room isn’t that way.”  “No.  No.  No.”  By agreeing using “yes, and” you can give validation.  You can continue conversation in a positive way.  “Yes, we are going to go home right after we eat.”  “Yes, your Mom is on her way here.” “Yes.  Yes.  Yes.”

  1. Listen & Respond

During conversation, it is important to actively listen to your partner and respond appropriately.  Sometimes with Alzheimer’s or other forms of dementia, we have to read between the lines in our listening.  For example, if someone is looking down at their bare feet saying, “I’ve lost my monkey’s.”  They might mean, “I need to find my shoes.”  We as caregivers, must listen and respond to what is said but also to what is meant.

  1. Commit 100% to the Moment

In both improvisation and dementia, things can get weird fast.  It’s important to fully commit to the conversation in whatever direction it may go.  If your loved one lives in an assisted living but they are talking about how fun the cruise activities are – re-focus to the moment, you are on a cruise.  Each moment is a little different and it’s important to commit to whatever moment your loved one is experiencing.

  1. Go with the Flow

During improvisation, you can’t always control the direction of the scene.  Similarly, we can’t control dementia.  Sometimes, a caregiver might approach a loved one and start being yelled at.  The next visit could be mean an embrace.  It is vitally important to go with the flow with your loved one and where they are at in the moment.  If the visit is going in the wrong direction, make it short and try again at a later time.  If the visit is positive and productive – stay longer and take advantage of making a moment.

5.  Accept offers and gifts

During acting scenes, imaginary items add a new dimension to the scene.  Someone can pretend to be shooting a basketball through a hoop and our minds help us imagine what they are doing.    If someone suffers from hallucinations commonly associated with Parkinson’s or Lewy Body Dementia, a third party might witness a similar scene of a person handing an invisible item to someone else or perhaps picking up something from the floor.  Just as you would be participating in a scene – take the invisible item from them and go with it.  It’s not real to you, but it is very real to the person you are connecting with.

  1. Silence can be powerful

                Both on stage and during conversation, silence can be powerful.  There is nothing wrong with taking your time to answer a question to direct conversation.  Don’t be afraid to take several moments of silence to figure out where the conversation is going and the best strategy to keep it going in a positive direction.  Moreover, remember that it is not always necessary to fill the air with words, sometimes a gesture such as holding hands is the most powerful thing we can do with a loved one.

  1. Accept the reality given to you

When communicating with someone who has dementia it’s so easy to say, “no Mom, we aren’t at home” or “No Dad, your wallet wasn’t stolen.”  It’s easy to want to draw someone back into your world instead of attempting to jump in theirs.  With improvisation acting, the whole goal is to understand the story your partner is laying out and to jump in that reality and roll with it.

Both with improvisation and with communicating with someone with dementia, there are no rules and you can’t rehearse set scenes.  It is a learning process to grow and develop techniques of productive communication.  The guidelines established in improvisation acting transcend the stage and can be highly effective in guided communication with someone suffering from dementia.    Next time you are communicating with someone with Alzheimer’s or other form of dementia keep these principles in mind and see how it can help make more moments into memories.

Mary Gilliam presents Improv Principles to North Texas Area Gerontological Society, McKinney, Texas

Mary Gilliam’s passion for serving seniors has become a lifelong mission.  She is the founder of Monarch Senior Solutions and responsible for leading the in-home care partners and senior advisors.

Mary holds a Master’s Degree of Business Administration with an emphasis on Health Care Administration and is a multi-state Licensed Nursing Home Administrator.  She has been in long term care operations since 2002 serving those in assisted living, memory care and skilled nursing. 

Life After Diagnosis | The New Normal

Life After Diagnosis | The New Normal

Mary Gilliam, MBA, LNHA

The New Normal

Receiving the diagnosis of a degenerative disease for yourself or a loved one instantly changes everything.  In the moment, fear and thoughts of what the future holds are consuming.  Denial.  Anger.  Guilt.   Hope?

Slowly over time, the normalcy of life without diagnosis transitions to a “new normal.”  Perhaps for someone with Alzheimer’s, that means repeating forty-three times in a ten-minute period that a loved one is at work.  Or, for someone that was diagnosed with ALS, transitioning from walking to a motorized wheelchair.  Maybe it is removing imaginary snakes from the ground because a loved one suffering from Lewy Body Dementia has the disturbing hallucinations each night.

After diagnosis, there are many changes that happen over time and respective idiosyncrasies, but it is still a life to be had.  It’s what I call the new normal.

The new normal changes throughout the disease process.  At first, the new normal is static; perhaps a reflection of the past with apprehension of the future.  Then the disease can turn from subtle to drastic, creating new norms for everyone in the path.

This new normal should be one that is embraced and cherished.  Each day is a blessing and although someone might excessively repeat something because they forget, it doesn’t mean they have forgotten love.  Just because someone with ALS is losing muscle mass and to transition to a wheelchair, doesn’t mean they can’t embrace a moment.  And just because someone with Lewy Body Dementia has disturbing hallucinations doesn’t mean they can’t have moments of a beautiful reality.

Tips to embrace The New Normal:

  • Be flexible to change

Use the principles Dr. Spencer Johnson illustrated in “Who Moved My Cheese” to help with family members.  Know that change is inevitable, anticipate it, monitor it and adapt to it.  Don’t be surprised if the mother you knew to hate fish wakes up loving it one day or a priest and family man start swearing like a sailor.  To accept the new normal, you have to be flexible to the changes that come with it.

  • Savor the good, get over the bad

There are good days and bad days when it comes to degenerative diseases.  When your loved one is having a good day, spend the extra time enjoying the moments.  If it is a bad day, cut the time short and re-approach.  Often, just an hour and a new approach can create a different response.

  • Stay educated and objective

Staying objective is harder said than done when it comes to the care of a loved one.  Heed the advice of professionals.  For example, if multiple professionals are telling you it is time to make some changes; listen.

  • Learn different realities

When a loved one has a diagnosis of dementia, it is especially important to live in their moment.  While it is very easy to correct and criticize, it is impossible to rationalize with an irrational disease process.  Learn the other person’s reality and get in it.

  • Take care of yourself

Finally, as a caregiver of someone with a degenerative disease, it is most important to take care of yourself.  Give yourself space and rest so that emotionally you can be present.  Take care of yourself physically so you have the strength and the stamina to pursue your labor of love.

 

 

 

“DNR” VS. “OOH-DNR” – What to know about Do Not Resuscitate

What to know about Texas Do Not Resuscitate Orders

Navigating Advanced Directives can be a confusing endeavor.  One of many advanced directives is commonly known as a Do Not Resuscitate or “DNR.”  A DNR is an election as well as a medical order that instructs health care professionals not to conduct cardiopulmonary resuscitation “CPR” should a person’s heart stop beating or breathing stops.

What most people do not know is that there are two kinds of DNR’s.  There is an in-hospital DNR and an out of hospital DNR.

When entering a hospital, if a patient is terminally ill, overall physical condition is severely or permanently compromised, they may elect and physician agreed to be a DNR.  This signed document will be maintained in the patient’s chart and would be respected by hospital personnel.

However, this form is only applicable inside the hospital.  If the patient or responsible party wants the DNR to continue, an out of hospital do not resuscitate “OOH-DNR” would need to be filled out and signed by a physician.

This document would stay with the person whether that is at home, in an assisted living or even taking a road trip.  In the event of an emergency, paramedics could review the form to help best assist someone to maintain their wishes.

OOH-DNR’s are state specific.  Therefore, if a client has an OOH-DNR from California and moves to Texas, a new OOH-DNR would have to be executed.  More information on OOH-DNR’s for Texas can be found at the Department of Texas Health and Human Services.

Call today for questions – 469-300-2288

Choice or Chance: Controlling End of Life Chaos

In a world of uncertainty, we often attempt to control everything we can within our lives; what food we eat, what clothes we wear, who we choose as our spouse, and so on.  We work hard to do the things we want, the way we want them.

If we feel like we are in control of our own destiny, than why do we, as a nation, leave the end of our legacy completely in chance’s hands?  Less than thirty percent of the population addresses advanced directives.  Even fewer seem to have the difficult conversation with a family member.

Specifically after the age of 65, we are playing a game of risk with what happens to us if we have a stroke, fall, or develop Alzheimer’s disease.   We are no longer in control of our fate which can place the burden on a spouse or a child.  Often, the family member designated to make decisions is too emotionally distressed to be offering guidance on another’s life saving measures or lack thereof.

Being proactive and taking control over end of life decisions can reduce stress in an already traumatic situation, reduce family member’s fear of making the “proper” decisions and ensure your final wishes are carried out.  Not sure where to start?  Here are a couple of helpful hints in dealing with advanced directives.

  • Start thinking about advance directives early and give yourself plenty of time to make decisions. Often, people change their mind of what they would want over a period of time so spend time to make a decision you are comfortable with.
  • Initiate the conversation with family. Although it might be a difficult to start, put it into perspective; it’s not more awkward than having the birds and bees conversation with your child.
  • Use a worksheet such as “Five Wishes” to help family members best understand what you would want during end of life care.
  • Fill out advance directives forms such as power of attorney and living will with details of how you would want your end of life care to proceed. Include directives such as if you would want a g-tube if you were aspirating, if you would want CPR, etc.

“I am the master of my fate; I am the captain of my soul.” – William Ernest Henley