Family Caregiver Support

“Lie to my mom?”

Mom taught you to always tell the truth. But in the context of caring for someone with memory loss (dementia), honesty may not always be the best policy. There may be times when the kindest strategy—the one that reduces your loved one’s anxiety or fear—is to omit the truth or bend it a little. This is called “therapeutic fibbing.”

When your loved one is distressed

  • Try distraction first. Put your relative’s forgetfulness to work for you by focusing his or her attention on something else. For instance, if your dad is persistently asking to see his mother, don’t bother explaining that she died decades ago. Instead, validate his emotions and meet him in his memories. “You want to see your mother. Tell me about your mother.” Shortly, change the subject, even move to a different room. Then lead his attention to a favorite activity.
  • Bend the truth. If distraction doesn’t engage his attention, you might say, “Your mother is visiting her sister and will come see you tomorrow.” Or, if he wants to drive to the store, rather than reminding him that he can’t drive and the car was sold, say, “The car is in the shop, Dad. It should be back tomorrow.”
  • Omit the truth. If mom gets fretful about going to the doctor, consider: Does she need to know that that’s where she’s going? Perhaps instead, go to lunch and then “happen” to stop by the doctor’s on the way back. Was anything—other than her anxiety—lost in her not knowing ahead of time?

Therapeutic fibbing may not immediately appeal to you. Simply know it is a proven technique for relieving distress and bringing a confused loved one back to a state of tranquility. The underlying principle is that your relative benefits more from feeling safe and calm than from knowing “the truth.”

Not sure about therapeutic fibbing?
We at Iowa City Hospice understand. As the Iowa City, Muscatine and Cedar Rapids experts in family caregiving, we know that therapeutic fibbing is often difficult for family members. Give us a call at 1-800-897-3052, toll-free. There are many ways to ease distress in a person with dementia. We can help.

What to do with their stuff?

Perhaps your loved one is downsizing. Or maybe planning a move to assisted living or a nursing home. He or she may even have passed away… If you find yourself needing to pack up a relative’s belongings, start by sorting them into five categories:

  • items to keep
  • items to sell
  • items to donate to charity
  • items to shred
  • items to throw away/recycle

Items to keep and to throw away/recycle have obvious action steps. If you have a lot to dispose of, ask the local waste hauler to drop a debris box at the curb.

Items to sell. There are a variety of options for professional help with reselling.

  • Estate liquidators do on-site sales. They review, organize, and price the goods and host a sale in the home. They typically take a percentage fee on what they sell, plus hourly charges. You can find a local referral through the American Society of Estate Liquidators.
  • Auctioneers take a fee for selling items off site.
  • Consignment shops offer items for a set period of time, such as 30 days. They take a commission on sales. Find out what happens if your items don’t sell.
  • Consider selling them on eBay or to an eBay reseller.

Items to donate. You can claim a tax deduction for the fair-market value of items in good condition. Get a dated, itemized receipt from the charity.

Items to shred. If you are going through old bank statements, tax records, or any documents with important financial information—social security numbers, bank account numbers—you will want to shred them to prevent identity theft. Certainly you can shred them at home, but this is time consuming. There are companies that can deliver a container they will pick up later and shred the contents. You may also find a local merchant, such as a photocopy store, that has a shredding container you can put your documents in for a per-pound fee.

Want help with all of it?

  • A senior move manager. They charge an hourly fee and will do everything from packing to coordinating with resellers to taking leftovers to charity. Check with the National Association of Senior Move Managers.
  • A junk removal service. These companies can remove everything. Get a cost estimate first (ask if there’s a fee for the estimate). They resell items, recycle them, or dispose of them at the local landfill. A nice plus: they finish with a thorough cleanup!

Daunted by the prospect?
Moving or distributing a loved one’s belongings has an emotional component in addition to practical realities. We understand. As the Iowa City, Muscatine and Cedar Rapids experts in family caregiving, we at Iowa City Hospice have helped many families through this process. Give us a call at 1-800-897-3052, toll-free.

Communicating with aphasia

If your loved one suddenly developed difficulty with speaking, he or she probably has aphasia, typically from a stroke or traumatic brain injury. Slow or garbled speech can be frustrating for everyone. Recovery is enhanced by following the advice of speech and occupational therapists. Your support is invaluable in terms of bolstering self-worth and confidence.

Try these aphasia communication tips:

  • Remove distractions. Turn off the TV or radio. Move to a room that is quiet.
  • Allow time. It takes more effort to organize thoughts and form words.
  • Let them find the right words. Filling in and guessing what is meant may seem helpful. It actually undermines self-esteem.
  • Listen patiently. Communication is more than an exchange of facts. It’s a way to express personality and competence. As a listener, relate as if you have all the time in the world.
  • Confirm your understanding. Repeat back what you think was said.
  • Keep it simple. Speak in short sentences. Avoid a long string of ideas or requests.
  • Consider apps. There are many mobile- and tablet-based apps for aphasia. Some provide assistance with speech exercises. Others offer symbols your relative can point to instead of speaking. Some even help your loved one stay engaged with others by sending emails and texts based on the symbols!

Create a Communication Card
To help your relative stay engaged and be independent, create a “business card” he or she can pass to waiters, receptionists, merchants, or service providers. Personalize it appropriately:

  • I have aphasia: I have trouble speaking.
  • No need to shout: I am not deaf.
  • I do not have dementia: I think very clearly.
  • Please be patient: Give me time to find my words.

Is communication difficult?
You are not alone in feeling frustrated. As the Iowa City, Muscatine and Cedar Rapids experts in family caregiving, we at Iowa City Hospice can help you and your loved one find easier ways to continue relating even in the face of aphasia. Give us a call at 1-800-897-3052, toll-free.

Getting out of the mental spin cycle

Do you find yourself in a repetitive cycle of reliving an exchange over and over? Reflecting on experiences gone badly is one way we learn. We think about what happened and look for insights that might promote a positive outcome in a similar situation next time.

But sometimes reflection can be unhealthy. If you find yourself in a memory loop continuously going over a negative experience, it may be more rumination than reflection. Instead of finding a way toward closure, it can be more like picking an emotional scab and not letting the wound heal.

Research suggests that a process of self-distancing can help us gather useful insights without getting stuck in a quagmire of replays. Try this:

  • Describe the event in the third person. Imagine you are an observer of the situation. If you were someone watching the dynamic, what events occurred? Write the “story” from this perspective.
  • Avoid the words “I” and “you.” Instead, use the names of the individuals involved. “Sarah told Bob she thought their dad was not taking all his medicines. Bob, who orders their father’s medicines through the pharmacy, got angry about her comments.”
  • Answer the question “Why?” and list many possible answers. In your description, address why the people did what they did. Then ask yourself, “Do I know for sure that’s the reason?” Think of several alternate explanations. For instance, Bob might find himself exploring whether Sarah brought up the issue because she thinks he’s incompetent, or because she’s noticing something different about their dad’s memory.
  • Describe the event from the future. Project yourself a week or a month down the road. Maybe a year down the road. How are you likely to tell the story? This perspective can reduce the emotional punch of the event and help you distill it down to its salient features.

Caught in a loop?
Especially with family members, it’s easy to get stuck in old patterns as events trigger well-worn dynamics. At Iowa City Hospice we understand how hard it is to get unhooked. As the Iowa City, Muscatine and Cedar Rapids experts in family caregiving, we can help you gain a fresh perspective. Give us a call at 1-800-897-3052, toll-free.

Common elder scams

Financial abuse of the elderly is thriving. Advise your loved ones to be on the alert for these common scams:

Government impostors
Individuals call saying they represent Social Security, Medicare, the VA, or the IRS. They describe a problem with an account. Or taxes owed. Then they ask for name, date of birth, and Social Security number for “verification.” They may claim that arrest is pending and money is required. Another variation requests bank account information to “direct deposit an increase in monthly payments.”

Grandparent scam
Someone claiming to be a grandchild calls. They are distressed and say they are in trouble and need a money transfer. Then a “policeman” or “doctor” gets on the phone. They may add credibility by mentioning details gleaned from the true grandchild’s Facebook page. Another tip-off? The “grandchild” will likely say, “Don’t tell Mom or Dad!” (Thieves thrive on secrecy.) Average scam: $2000!

Loans taken out
Scammers can use personal information to secure a loan at any bank. It could be months before your relative finds out a car loan, mortgage or line of credit has been taken out under his or her name. Your loved one could be liable.

Tips for your relative:

  • Never give out sensitive information unless you initiated the contact. Official organizations do not initiate calls. Even an official-looking email with a link to an official-looking website can be a scam. Most legitimate communication comes by regular mail.
  • Hang up immediately if they talk about jail or cutting off payments. Threats like these are bogus. Social Security, Medicare, and the VA do not suspend accounts or stop payments.
  • Put a freeze on all credit reports. New loans or accounts cannot be opened without personal authorization.
  • Sign up with AARP Watchdog Alerts. Go to aarp.org/money/scams-fraud/ to learn about current scams. Or call 877-908-3360.

Concerned about financial abuse?
As the Iowa City, Muscatine and Cedar Rapids experts in family caregiving, we at Iowa City Hospice know how scary it can be to realize a loved one has been scammed. Give us a call at 1-800-897-3052, toll-free. We can talk about ways to protect your relative from financial abuse.

Plan ahead when downsizing

Moving into a smaller living situation is a big decision. More emotionally challenging, however, are the many little decisions your loved one must make about what to keep and what to let go.

  • Possessions, from knickknacks to garden tools, hold many dear memories. Letting go of them is like discarding the people or events they are associated with.
  • Downsizing can feel like a little death, at the least the death of their younger self. When boxing up the possessions of decades, it’s not a big jump to realize that one day—after dying—these possessions will be boxed up and permanently disbursed.

Allow plenty of time
Senior move experts recommend a minimum of three months’ lead time. A less hurried approach will allow your loved one to ease into the project and savor memories before saying goodbye. Consider these steps:

  • Talk with your family member. Approach the topic carefully: “While we have the luxury of time, Mom, let’s begin to plan how things will fit in your new space. Only you know what’s most important to have with you.”
  • Know what space is available. Obtain measurements or, better yet, visit the new residence and measure the floor space (and the closet space!). Create a layout drawn to scale to help your relative visualize what furniture will fit. Likewise, plot space for books, clothing, hobby materials, and other personal items.
  • Be sensitive. That set of books may never have captured your interest, but they may hold beloved memories for Dad. This is your opportunity to learn the history of treasured possessions. Such sharing helps your loved one say goodbye, and it provides a way to “pay last respects” to parts of his or her past. What you hear may also change your mind about what to keep!
  • Take time. Go at your parent’s pace, even if it seems tortoise-slow to you. If you rush, you’re likely to run into resistance or exhaustion.

Is downsizing on your radar?
We at Iowa City Hospice have helped many families go through the process of moving to a smaller household. Give us a call at 1-800-897-3052, toll-free. As the Iowa City, Muscatine and Cedar Rapids experts in family caregiving, we can help you support your loved one in making this transition as smoothly and sensitively as possible.

Distraction techniques

If the person you care for has a problem with memory loss (dementia), you may find that he or she gets agitated about things that don’t make sense. Your long-retired dad, for instance, may wake up in the mornings and insist, “I have to go to work!” It can be confusing for you. And frustrating!

Disregarding these comments will only make your relative more determined. And it’s pointless to try to reason. The disease has robbed that ability. Instead, spend some time connecting with your loved one in “their reality,” and then distract them.

Compose yourself. Your body language, face, and tone of voice speak volumes. People with dementia still perceive respect versus dismissal. If you need time to calm yourself, make an excuse to get something from the car or to go to the bathroom, so you can return refreshed.

Validate their concern. “Gosh, Dad, I see you are ready to go. I wish I had your enthusiasm about work! Is there something special at work today?” By joining in their emotional reality, you are not telling them they are wrong. They feel reassured you understand.

Distract. Engage them in a fond memory of something related. “Remember your first client back when the business was new? What was it they had you do?” As you reminisce, consider walking together into another room to shift their attention. Once in the other room, draw on their forgetfulness and eventually offer an alternative activity: “I’m hungry. Let’s have breakfast” or “Oh look at that messy walkway! Would you sweep it? That would really help.”

Reflect. If your relative obsesses on things that don’t make sense, look for triggers or the underlying meaning. If Dad associates morning with time to go to work, have a task for him to do that addresses that need—in this case, to feel productive.

Does your loved one get agitated often?
It can be very wearing when a relative gets stuck, especially about things that aren’t real to us. We at Iowa City Hospice have a lot of experience with dementia. As the Iowa City, Muscatine and Cedar Rapids experts in family caregiving, we can help you learn validation and distraction techniques. Give us a call at 1-800-897-3052, toll-free.

The value of nostalgia

Nostalgia has historically gotten a bad rap, viewed as a precursor to feelings of sadness and longing. Emotional downers.

Today we know that’s a faulty assumption. Research shows that nostalgia typically brightens mood. This is because nostalgia helps us in many ways:

  • Focus on the positive in our past. People, events, places. We remember good times with maybe a laugh or a chuckle.
  • Gain a fuller perspective on the meaning of our life. Recalling past activities and roles increases our life satisfaction and boosts self-esteem.
  • Remember ourselves in connection with others. Even if we’re alone at the moment, we affirm our close ties with others.
  • See ourselves as beloved and belonging. Remembering our importance to others can help ease anxieties about life and end-of-life.

The consequence of nostalgia is more positive thinking. Even when memories are tinged with bittersweet, research shows that nostalgia has a “redemptive” value. When we’re recalling an event that has some sad or disappointing aspects, we end up focusing on the positive. It’s a natural process of sifting through life stories and saving the good stuff.

Plus, those positive feelings generated by nostalgia help combat loneliness.
That makes nostalgia a good coping mechanism. By the elder years, many peers have moved or died. And age and disease put real limits on a person’s ability to meet new people and forge new friendships. By reminiscing when we’re feeling lonely, we change our perception of our self. We rekindle our sense of belonging and regain a sense of social support. And that’s enough to change our mood.

So next time mom launches into another story from her past, remind yourself that she’s using a valuable coping skill.

Worried about a loved one’s isolation?
As the Iowa City, Muscatine and Cedar Rapids experts in family caregiving, we at Iowa City Hospice notice that older adults often feel isolated and lonely. It’s amazing what a trip down memory lane can do to lift their mood. If you are concerned about someone you care for, give us a call at 1-800-897-3052, toll-free. We can help you with perspective and resources to improve the situation.

What is an occupational therapist?

Eating, dressing, getting in and out of a chair. In the course of daily life, we use many skills to accomplish even “simple” tasks. Walking or using a fork is surprisingly complex. Nerve signals and muscles have to coordinate in a very specific order. A healthy body is a marvel!

We take these skills for granted until something interrupts our abilities. Arthritis, for instance, can make it hard to grasp a fork. A stroke may require a right-handed person to learn to do things with the left hand. The tremor of Parkinson’s can make dressing a challenge.

Occupational therapy can be used to help your loved one

  • remain at home despite a chronic condition;
  • recover from a surgery or other health event;
  • improve the ability to accomplish specific tasks or activities.

Occupational therapists have special training to help people overcome new challenges with the daily tasks of living. A therapist might show your loved one some exercises for better coordination. They might recommend special equipment or supplies. Maybe all that’s needed is a rearrangement of furniture in the house. Or a slightly different approach to doing the same thing.

Occupational therapy can be provided at home or in an outpatient clinic. It usually starts with a home visit. The therapist will

  • watch your loved one perform various tasks;
  • evaluate the home for safety and convenience;
  • recommend exercises and/or home modifications;
  • consider best options for transportation;
  • develop goals based on your relative’s abilities, interest, and budget.

Participate in the visit if you can. That way you learn what might help your family member live to the fullest in spite of limitations.

Ask the doctor for a referral
If you think your loved one would benefit from knowledgeable guidance, ask the doctor for a referral. Occupational therapy is covered by Medicare. Also by Medicaid and most private insurances.

Does life seem harder than it was?
If you notice your loved one struggling to do things that used to be a simple part of daily life, he or she might benefit from the services of an occupational therapist. As the Iowa City, Muscatine and Cedar Rapids expert in family caregiving, we at Iowa City Hospice have seen firsthand how much a simple device or a change in approach can transform an elder’s self-sufficiency. If you are concerned about a loved one, give us a call at 1-800-897-3052, toll-free.

When language falls apart

One common outcome of a stroke or other brain injury is the sudden loss of ability to process language. This disability is called “aphasia” (ah-FAY-zya).

Depending on which part of the brain has been damaged, the affected person may have trouble speaking or trouble understanding. Or may have difficulty with reading or writing.

Needless to say, this is frustrating—for the injured person and family members too!

Aphasia does not change intelligence
People often assume that someone with aphasia can no longer think clearly. Or that hearing is affected. As a result, those with aphasia frequently have others yelling at them. Or acting as if they have dementia. Not true! Hearing remains the same. And unless the stroke or trauma affected the logical thinking portion of the brain, your loved one is just as “smart” as they ever were.

Aphasia does affect relationships and self-esteem
Talking is how we express our personality. It’s also how we interact with those we love. Without full language capabilities, your relative may feel “less than” and withdraw. This can lead to isolation and depression.

Work with the rehab team
It’s important to engage speech and occupational therapists soon after the stroke or trauma to better understand the full impact. They will identify strengths and weaknesses and develop exercises and strategies to help your relative live fully. Don’t get discouraged! Therapy takes practice and time, but it makes a big difference.

Stay engaged
When a loved one struggles with speaking, it’s tempting to want to “help” by doing things for him or her. Help your loved one stay involved with friends, hobbies, and activities, as well as with family discussions and decision making. You may need to get creative and be patient. But staying engaged will help the person you care for regain as much language ability as possible.

Does aphasia have you down?
We at Iowa City Hospice notice that aphasia is one of the more challenging outcomes of a stroke or brain injury. It affects family relationships and your loved one’s feelings of self-worth. As the Iowa City, Muscatine and Cedar Rapids experts in family caregiving, we can help you find optimal strategies. Give us a call at 1-800-897-3052, toll-free.