Your Eldercare Compass
Helpful tips for family caregivers

Dementia and communication: Listening

People with Alzheimer’s or other memory loss conditions often have trouble expressing themselves, sometimes right from the start of the disease. This can easily lead to confusion and frustration for both of you. Your willingness to exercise patience is key to successful communication: Patience and calm, over and over and over again. This is hard! AND it’s essential to keeping a positive relationship.

There are some practical tips, too. Even in the early stages, word finding can be difficult, so they may describe an object rather than name it. They may forget what they just said and say it again. They are easily distracted. You can help by using the following strategies:

• Avoid groups. One-on-one conversations work best.
• Limit distractions. Turn off the TV or radio. Do one thing at a time; for example, converse OR put on shoes.
• Allow time. Rushing creates stress, which makes it harder—for us all!—to find the right words or keep thoughts organized.
• Offer encouragement. Don’t interrupt or try to finish their sentences. Smile and make eye contact. Project the reassurance that they can take all the time they need to say what they want to say.

As dementia progresses, you may need to redefine what a conversation is with your loved one. It may be less of an exchange of ideas and more an opportunity for your relative to engage with you. Your focus is on making the exchange a pleasant one.

• Avoid correcting them. It’s okay if the details aren’t right or their logic is “off.” When inaccuracies are pointed out, they may misinterpret your corrections as dislike or disrespect.
• Learn to read their tone and body language. Search for the emotion or meaning behind their words. For example, repeated questions often indicate anxiety. A sudden demand to leave a gathering can be a sign of confusion or overwhelm.

Video chatting for the "tech challenged"

Many older adults are embracing technology to stay connected with family and friends during the pandemic. Although some popular technologies—Zoom, FaceTime, and Skype—are relatively simple, they still require a computer, tablet, or smartphone. Plus some tech savvy.

Your loved one may be challenged to learn new skills because of memory issues. Or perhaps arthritis or vision or hearing problems.

Weigh the tech options for your family member against these criteria:

• Very simple interface. Every feature adds complexity. Best is a large screen, large buttons, volume control, and limited choices. Look for a “senior tablet” or “senior smartphone.” Or consider a voice-activated device with a screen, such as Amazon Echo Show. “Alexa, call Sally” is pretty simple. Some people may still need a helper, though.
• No setup required by the older adult. Ideally, you can send or bring the device preconfigured. Look for services that will set up a new device—including with contact lists for phone calls—and then send it to your loved one’s home essentially ready to plug and play.
• Tech support available. There will be problems! Ideally, the device needs to be fixable remotely (by you or a technician not at the house).
• Wi-Fi handled. Someone needs to get the device hooked up to Wi-Fi. Or, the device should come with its own built-in cellular connection.

Devices that respond to voice commands are understandably attractive. But consider privacy issues. Is the artificial intelligence assistant always listening? Where and how are the audio requests stored? Are your loved one’s data being sold to third parties? Are there protections against hackers?

Another option is using the phone plus a digital photo frame that you update remotely. It’s not nearly the same as video chatting, but your loved one can still keep abreast of growing grandchildren and family activities.

"Should we bring Dad home?"

In the context of COVID, many families are wondering if an older relative would be better off moving out of their assisted living, memory care, or skilled nursing facility. It’s not an easy question to answer.

The advantages of facility living. Facilities have staff on site 24/7 to assist with residents’ needs. They can provide meals and a comforting routine. Staff coordinate readily with medical personnel. Support can be ramped up as needed. With COVID protocols in place, there are usually limited opportunities for residents to engage with people they know.

Issues to consider about relocation.

• Exposure to COVID. If members of your household are going to work or school, will your loved one truly have less exposure than in a facility?
• Caregiving support. If your relative moves in with you, what level of support can you realistically offer? If into an apartment, do you have a home care agency lined up to help? Can they provide 24/7 care (the safest)? What are the agency’s COVID protocols? You don’t want caregivers bringing the virus into the home.
• Cost. What is the expense relative to the cost of facility living? Is this sustainable?
• Social isolation. Loneliness, boredom, and depression are devastating. Persons with dementia are declining rapidly under isolation, and deaths are increasing. (Weight loss, falls, and sudden frailty are signs of a big problem.) Assess your relative’s ability to connect with others in the facility as compared to the proposed new situation. Which is better?
• What if your loved one gets sick? How will you care for them? What if you get sick?

This is a difficult decision. You need to reflect upon the pros and cons with a realistic accounting of resources and capabilities. And consider implications for the future—when your relative’s needs may increase and/or the threats of COVID decrease.