The Elephant in The Room: Addressing Safety Even If You’re Not Ready to Discuss the Rest

By Tiffany Cloud-Mann, M.Ed.

As some go home for the holidays, they may be presented with changes in a loved one’s cognition. Seeing a loved one cognitively change from the person you know to someone you don’t recognize is extremely tough.  I recognize that it’s much easier for me to tell you, as a professional, what action items should be taking place regarding your loved one’s care or what difficult conversation should be happening tomorrow, but I know it’s not as easy as I may think. Knowing something is drastically changing, but it hasn’t been discussed yet can feel like an elephant in the room. Why is it hard to discuss a topic like dementia and Alzheimer’s? It could be the person hasn’t gotten an official diagnosis (even though you are noticing changes) or maybe the family doesn’t understand the diagnosis, or they don’t know what they don’t know, or maybe there is just denial on all ends. Dementia affects who we are and who we have been, and it’s devastating. With families come dynamics that play into to all of this. I see these conversations unfold uniquely or not at all because we each play a role in our family unit, we have experiences that have happened over the years that tell us how we interact and it’s because we love each other and don’t want to disrespect or hurt the person that is affected or the caregiver caring for them that we find it hard to navigate these waters. It’s hard. I get it. I have been touched in my own network, by seeing changes in someone and wondering why no one is talking about it. I sometimes even come off as bossy or direct to these personal connections, hoping that conversations will happen, wanting the best for them and being reminded by my own work in the field that these discussions are so tough.  

In my schooling to learn how to become a counselor, I was taught that my clients know themselves best and what’s best for them. Although I may not agree with their choices, they may not be ready for mine. I must think that also applies to those in a caregiver role. I may feel you need to take some steps towards an action item, but what if you know what’s best? You know yourself and your loved and what they need at any given time to deal with what’s happening around them. I don’t. I do although feel like there are things, no matter the situation or possible diagnosis, or whether we are talking about it, that we can address or attempt to.

Question Time

Safety in all areas is something we can think about and attempt to put guards in place around. What am I talking about? When I think about safety and keeping a person with cognitive changes safe, I think about the safety of their person and the safety of their finances. I don’t fear much, but I do fear and well, it saddens me to think of someone losing all their financial resources because their judgement and reasoning is off. It also worries me to think of someone harming themselves or another person in some way because they’re having trouble with daily living tasks, they have never had trouble with before. Safety must be evaluated in terms of safety in the home, out of the home and regarding finances.

Is the person leaving the stove on after cooking, putting items in the microwave that don’t belong there or attempting to use machinery or other tools incorrectly? Have you noticed them falling in the home around stairs, changes in elevation or throw rugs? Do you know that they still understand what to do if they fall or if there is an emergency and they need to call for help? Can they still take their medications correctly? Have you noticed them getting lost walking in the neighborhood? Are they getting lost in familiar places while driving or forgetting the rules of the road? Have your road with them lately or inspected the car for dings? Regarding their bank account and assets, are they giving away items or spending money on things they normally wouldn’t purchase? Are they bouncing checks regularly (and it’s out of character) and having a hard time budgeting or keeping their checkbook balanced?

Yes, and Now What?

So, what if you answered Yes to all my questions, but you don’t know what’s officially going on with your loved one, you don’t want to believe this is happening or you aren’t ready to have this talk with your family? You can still address safety. It may take some creativeness or “therapeutic fibbing”, yes white lies, but with all good intensions of keeping your loved one safe. For example, maybe you suggest to your parent who is having trouble with managing their finances, that you are putting a power of attorney in place for your own financial matters and it would make you feel good if they did the same. Maybe you know changes are present in their cognition and you are concerned they are still driving, so you tell them there is a driving evaluation center at the local university and they may be able to get a discount on their insurance if they get evaluated. Many times, the success of difficult conversations hinges on how we “frame” them. It’s sometimes easy not to talk about the elephant in the room, but harder on ourselves to ignore all that comes with it.

Us Care Managers at LifeLinks have years of experience evaluating safety and having difficult conversations. We are also experts at framing scary situations, in a way that provides acceptance and peace. I find it an honor to walk with families along their journey and it reminds me daily that although communication is key, we each speak a unique language within our own families that is navigated best by those in it. Put safety first and the discussion second, it’s okay.

And for a tidbit about elephants, did you know elephants are known for forming deep family bonds? Your herd doesn’t have to only include family, it can be friends and care managers like us!

#caremanager, #caregivers, #safetyinthehome, #difficultconversations

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