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Observations and commentary on aging, caregiving, and the complex journey through the second half of life.

Hospital Quicksand: Words Are Not Enough

I was asked for suggestions on how to help seniors preserve control in a hospital setting where all control quickly vanishes. Interesting question I thought. What would make things better? And then I remembered David.

David is a friend of mine who suddenly fell into frightening rabbit’s hole when he was being worked up for cancer. What was supposed to be a routine out patient biopsy triggered a medical crisis that sent him directly to intensive care. Thankfully he clawed his way back out of this nightmare after weeks of doom, gloom, and what seemed like endless setbacks. But he said something to me during one of my visits that gave me a jolt of fear and insight. “I losing track of what is happening,” he said in a medicated monotone. “I am losing my ability to figure things out.”

This disorientation happened to a middle-aged, educated, no-nonsense adult. What happens if you wind up in the hospital at advanced age, wrestling chronic illness, and overwhelmed by the healthcare system? Now what?

It turns out, words are not enough. With so much information coming at hospitalized seniors from all sides and wrapped in medical jargon, seniors quickly get overwhelmed. They need a better way to manage information. Enter the lowly dry erase lapboard. This simple yet elegant white 9”X12” melamine hardboard turns out to be an ideal control preservation tool. Here’s how.

Ellen’s mother was admitted to the hospital for suspected congestive heart failure. Her mother was anxious and having a hard time understanding all the things that needed to get done for the medical work up. Sitting on the edge of her mother’s bed, Ellen used a dry erase lapboard to outline out what was going to happen and why. It looked liked this:

1. CXR > Lungs > Any Fluid?

2. Echo > Heart > How Strong?

3. Test > Blood > Any Problems?

As she outlined one item at a time, Ellen’s mother had questions. “Let’s find out,” Ellen told her. Knowing what is going to be done and in what order is the first step in regaining control. The dry erase lapboard provided a visual aid to decode the process and resulted in a fundamental shift in the balance of power for Ellen’s mother. The same approach was used throughout her hospital stay and at discharge.

Here is what the dry erase lapboard outline looked like on the day Ellen’s mother was discharged:

1. New Medication > Reduces Fluid Build Up >Take One Every Day

2. Walking > Strengthens Heart > 15 Min, Twice A Day

3. Follow Up > Family Doctor > Two Weeks

The board costs four dollars. The marker two dollars. The ability to understand and preserve control: priceless.

Here is a good place to get the boards: http://www.dryerase.com/blank.htm

10 Comments

  1. I am very excited that David is coming to the February conference of the National Association of Senior Move Managers (NASMM). Having read his “SayIt” book years ago, and having it be required reading for my team members, I delight that others in NASMM will be introduced to this insight and his important tips for communication. I’ve often told people this book should be required reading for everyone on the planet. —So, has the book been translated to other languages yet?!

    Travel safely next month.

  2. Love this idea. Questions: Does the board remain in the room perched up against a wall? Do you update the board while speaking with medical staff?

  3. David,

    One of my Denver friends, Stephanie West Allen, commented on your blog on her blog Idealawg this morning.

    I love your suggestion and see immediate application to this outside of the hospital room as well for the financial planners and estate planners I’m trying to positively influence.

    I’d love to have your permission to post this in my blog, Seedlings, and expose your blog and thinking to those who are following my musings on generativity, legacies, purposeful trusts and gifts, purposeful philanthropy and teams of affinity.

    I’ve just launched a “community” called the Purposeful Planning Collaboration. We will have a quarterly call which I’ve entitled the Industry Innovators and Thought Leaders Series. I’d love to ask if you would be willing to participate as one of our Industry Innovators and Thought Leaders. We could discuss a topic of your choosing that would be of interest to this diverse community of financial planners, estate planning attorneys, wealth psychologists, beneficiary coaches, trustees. The normal format is that you pick the topic, I get my advisory board to approve it, and then you give me a series of questions to ask…that would allow you to conversationally get your key points across…we do that for 30-40 minutes…and then we allow 15-20 minutes for the Collaborators to ask you questions and/or share their experiences that confirm the wisdom you have just shared with them. I usually make a point at the beginning and at the end of the call to plug your book or books. So you don’t have to do the self-promotion thing…I will do it for you.

    So I hope you will consider this invitation and would be honored to have you as a guest. Jay Hughes is going to be the first Thought Leader and I’d love to have you follow shortly thereafter.

    My very best and heartfelt thanks for a wonderful piece. I’m subscribing to your web site and will look forward to following your postings.

    John A

  4. John,

    I would be honored to participate in one of your Purposeful Planning Collaboration quarterly calls. Is there any chance I could listen in on Jay’s call?

    You certainly have my permission to post this blog on Seedlings.

    Best regards,

    David Solie

  5. You raise a good point about where the boards stays. I would say yes, keep the board in plain sight and cross out items as the are done (as opposed to erasing them). We all like to know when we are making progress necessary tasks. Update the board when it makes sense. But remember, keep it distilled and don’t pile a lot of medical jargon. It is not a medical status board. It is a “next steps” board.

  6. I am hoping for a Spanish translation in 2010.

  7. Great idea – I plan to pass it on to my blog readers, too. Just last week we visited my husband’s senior cousin, who had on her hospital room wall a white board where the doctor had drawn her leg bone and the location of all the breaks her auto accident caused. I’m sure she shared it with everyone who visited – probably up until her discharge. It gave her, and us, a way to visualize her injuries. Now, if he had also put her treatment plan there, we could have visualized that, too, and how we could help. Great blog – thanks!

    Sharon

  8. Great article… My background is as a gero-psychologist and I do a lot of evaluations of people’s cognitive ability in order to help with diagnosis and to personalize treatment and care.

    I have often seen people who have language deficits (from strokes, head trauma or other things) identified by staff as having full blown dementia – and therefore as not able to express opinions/understand their options. The white board is also a great tool for these people. For those with more significant aphasia/language comprehension problems communicating though the board but offering three choices that you then point to allows them to express an opinion. So, for example, write a question – “How bad is your pain?” Give three choices “Bad”, “medium”, “OK” and point to each asking the person to nod or otherwise indicate their response. With this sort of tool – you can move to other conversations and significantly decrease the sense of frustration for people who have difficulty communicating.

    As you point out, it’s not just the frail elderly who are affected by confusion. Hospitals – in and of themselves – are confusing and the effects of surgery on our thinking are much more significant than most physicians acknowledge. While most people recover and get back to their normal level of cognition, studies are clear that people’s IQ drops about 10 points for up to three weeks after a significant surgery. So, they get back to normal after the hospitalization and after they are being given instructions on their post hospital care.

    I would also love to post this article on our blog. Living Well – Assisted Living at Home is a California-based company that focuses on providing elders with a real alternative to moving into a facility – regardless of frailty – by providing a complete suite of services from health care, to home modifications, to social activities

  9. Please feel free to post the article on your blog, Living Well. I think your suggestions for expanding use of the board are excellent.

  10. Wow, what an excellent idea for avoiding confusion when working with the elderly. I wish more hospitals and senior care homes used this system.