If a realtor's mantra is “location, location, location!”, then anyone caring for someone living with dementia should own the mantra “approach, approach, approach!”.
It is truly all in the delivery. You can choose to let the words just randomly fall out of your mouth and hope that the listener can read minds and secretly knows of all your good intentions. Or, you can be more thoughtful about WHAT you say and HOW you say it. It is all up to you, within your full control to either make it or break it, literally.
Let's take, for example, Martha. She is a 91-year-old woman who has sheltered in place with her caregiving daughter, Theresa, for the past 5 months. The only time she has spent outside of her home (because of COVID fears) was to visit her granddaughter's house. And that has only amounted to 5 separate occasions.
Now fast forward to our present-day when Martha needs to have her oxygen levels checked by her pulmonologist. The only way the insurance will continue to pay for her breathing treatments and 24 hour/ day oxygen is if she goes into the clinic for an “office visit”. But get this, Martha has severe dementia and is unaware of COVID. Her daughter has worked tirelessly not to escalate any of Martha’s already existing anxiety with more fear and panic over our current world pandemic. With that being said, she has not seen many folks wearing face masks.
Keenly aware of the impending potential for Martha to become panicked over the changes she will encounter at the doctor's office, Theresa called ahead to talk to the incoming nurse. “Mom does not know about COVID” she explained, “We need to make sure she is safe from other patients, but I can foresee it will be difficult to get mom to wear a mask herself. She just wouldn’t understand why and if I explain it to her, she may become very paranoid.”
Theresa pulls the car up to the front entrance of the clinic, leaving Martha in the passenger seat listening to the old cronies music on the radio. Theresa then goes into the clinic to let them know that Martha is here for her visit. “Does she have a mask?” the nurse asks. “No,” Theresa explains (again), “Mom won’t wear one. She has Alzheimer’s disease and doesn’t understand what is going on. I don’t want her anxiety to get worse, so we don’t even watch the news in front of her. Can you please just call us when the waiting room is empty and you have a room ready for us?”
Cautiously the nurse agrees and says that she will call when a room is open and the doctor is available. After a grueling 20 minute wait in the car, Theresa gets a call that a room is open for Martha. As the two of them walk through the double doors another, different, nurse approaches them, “She needs to wear a mask, you both need to wear masks”, she breathes heavily through her N95.
“I talked to the nurse just a little while ago,” Theresa indicates by nodding her head to the back office, then quietly turns to the new nurse and winks her eye as if to say, “Please do not make me say all of this in front of my mom, she is scared… I don’t want her to be more scared.”
The new nurse turns her gaze towards Martha, “Look, honey,” she begins, “We just can’t have you here spreading your germs everywhere. You could get everyone in here sick. We just can’t take that chance.”
At that moment Theresa turned on her heels in anger, “Where is the doctor?” she demanded in anger, “We had this all set up. Why would you say such things?”
Simultaneously Martha bursts into tears, crying and sobbing so hard no one can understand what she is saying. When she finally calms down, all she can repeat is “I’m going to get everyone sick. I have bad germs. I’m going to get everyone sick…”
After one of the most difficult doctor appointments that Theresa has even taken her mom to, she finds them both leaving exhausted, escalated, and frustrated. Theresa is seething with anger, wishing the staff would have tried a different approach, thinking about the words they said, how they said them and who they said them too… considering the consequences of the pending alternative.
Martha is spiraling. She has suffered from anxiety and paranoia for years, increasingly becoming more difficult to de-escalate as she journeys through with Alzheimer’s disease. Theresa is now charged with the ever more difficult task of providing care to Martha, who is now painfully afraid, paranoid of her own “germs” and teaming with anxiety over every person she sees wearing a face mask (even as they drive the familiar route home) that afternoon.
She had not noticed any changes on the ride in, things were glossed over to appear fairly normal (mostly due to the fact that Martha was not looking for any changes. She was in a good mood, happy to get out of the house, breathe some fresh air and listen to some tunes). It was her overturn mood, one created by a bad communication approach by a nurse, that heightened her awareness, causing her to be overburdened with enhanced anxiety, subsequently leaving Theresa with more work on her hands and both of them leaving an “essential” health care provider with much more than just the fear of COVID-19.
(all images courtesy of: Image by <a href="https://pixabay.com/users/geralt-9301/?utm_source=link-attribution&utm_medium=referral&utm_campaign=image&utm_content=441406">Gerd Altmann</a> from <a href="https://pixabay.com/?utm_source=link-attribution&utm_medium=referral&utm_campaign=image&utm_content=441406">Pixabay</a>