Breaking the Stalemate
Persuading a loved one to do something they don’t want to do—go on a diet, exercise, or give up smoking or alcohol—is often challenging under normal circumstances. When the person is living with dementia and the issues in question relate to things which impact independence, quality of life or dignity, it can be even more challenging and emotionally trying.
Tough conversations can be made easier when involving a care professional—a third-party expert offering an objective, independent, evidence-based recommendation, rather than a loved one who may be perceived differently by the individual. Involving a care professional (i.e., physician, nurse, social worker, etc.) in the decision-making process can help “break the stalemate” and alleviate feelings of pressure and/or guilt the family member may be having about making these types of decisions.
Relinquishing driving privileges, for example, is often a difficult conversation to have with a loved one. Many are resistant or unwilling to give it up voluntarily. A situation such as this is a prime example of when asking a care professional to be part of the discussion can be helpful.
“When I worked as a geriatric nurse practitioner providing primary care in an internal medicine clinic, if a patient scored poorly in executive thinking, which determines their ability to make safe decisions, and short-term memory, I was required to recommend to the state motor vehicle department that they can no longer drive,” said Marge Dean, RN, CS-BC, GNP-BC, NP-C, MSN, FAANP, a member of AFA’s Medical, Scientific, and Memory Screening Advisory Board. “I let them know I would be making that recommendation, explain that the final determination would be made by the motor vehicle department, and tell them how they could request a hearing to state their case if they so choose.”
“I had one patient who owned a car lot, selling cars his whole adult life, present all types of reasons at each visit as to why he should be able to continue driving. For example, he promised to only take lightly trafficked back alleys,” Dean said. “We discussed the fact that if a child chased a ball into the alley, he could hurt that child, and that such a tragedy would always be with him. He finally understood and gave up the keys after that.”
Living arrangements can be another sensitive topic. Some loved ones may want to remain at home, on their own, without help—even after an incident where they got hurt and required a trip to the hospital. When something like this happens, a family member can ask the hospital social worker to conduct a risk assessment as part of the individual’s discharge planning—a process which determines what type of care someone will need after they leave the facility. Discharge plans are aimed at preventing readmissions and making a move from the hospital as safe as possible.
During this process, the social worker will evaluate the individual’s condition and living situation, looking at factors such as:
• Can this person safely live alone?
• Are they able to comply with their discharge instructions?
• Do they require in-home care, such as a home health aide?
• Do they need services, such as meal delivery?
• Are safety improvements needed in the home?
• Should the person return home or go to another care facility?
Both the individual and their family members will be part of the discussion. Then the social worker will work to create a discharge plan based on the findings of the assessment and afford everyone the opportunity to give feedback. Any concerns would be voiced at this time. The hospital will not discharge the individual until the plan has been finalized and is able to be implemented.
“Risk assessments are a great opportunity for families,” said Jennifer Reeder, LCSW, AFA’s Director of Educational and Social Services. “Not only will an expert review their loved one’s needs to maximize safety and quality of care; they will actually help the caregiver carry out whatever recommendations are made.”
“If the person needs in-home care, the social worker will provide a list of options,” Reeder continued. “When the person requires services, such as meal preparation or transportation, the social worker will connect the family with them. The social worker can also let you know how much will be covered by your insurance as well as Medicare and/or Medicaid.”
No one knows your loved one better than you. Sharing your concerns with a care professional and getting them involved to help “make the case” for choices that are in the best interest of their health, safety, and well-being is a tool that caregivers should keep at their disposal.