Thursday, September 09, 2010

Posts Tagged ‘communication problems with aging parents’

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

No Money: No Comment

I was recently asked what to do about aging parents who had little or no savings but refused to discuss any aspect of their “money issue.” It reminded me that our role as adult children is not necessarily about problem solving; it is about compassionate containment. So many of the issues we feel compelled to “fix” have no clear answers. The best we can do is sort out what to accept from what we can actually change. Here was the advice I offered:

The issue of money, like so many other issues in the last phase of life, is about control. The best way to approach it is to reframe money as means of maintaining control. Lack of money takes away control. This link http://www.dsolie.com/articles/reframing.html will take you to an article I authored on “communicating touch choices” that offers a practical strategy for how to do this.

You may also want to consider three strategies that will help you “hedge” your parent’s financial risk:

1. Buy a long term care policy with a two years home care/two years nursing home benefit. This assumes they will cooperative with the process (i.e. signing the applications and answering questions).

2. Start funding a dedicated “side fund” for expenses that a long term care policy will not cover.

3. If you parents own their home, become familiar with how “reverse mortgages work and when they make sense.

Lastly, you need to began discussions with local area agencies on aging to determine what, if any, community resources can assist your parents if they run out of money.

This is a tough end-game, especially if you parents don’t want to talk about. The article will help you frame your conversations. Be patient but persistent in your discussions about control and your desire to help them maintain it.