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Calming the storms

Martha, my mother-in-law who has Alzheimer’s disease, is now requiring more personal care every day.  It has been a long winter for her; she has been in the hospital several times with urinary tract infections, pneumonia, dehydration and this last admission was because she became weak, unconscious and fell.  With the resulting gash on her head, multiple bruises and right arm in a sling, she looks like she just lost a fight.  All of this kept her recovering between the hospital, rehabilitation unit and our homes.
Her memory is lessening; her paranoia is worse.  She asked her daughter, Carol, if today was the day we were going to kill her.  This breaks my heart, aggravates Carol and upsets her son and my husband Harry.   As you might remember, on most days at home, Harry and her son-in-law Kermit (yes, that is his real name) take care of Martha.  The problem is now she does not clean herself well after using the bathroom, hence the urinary tract infections, she cannot take a shower alone and has become more difficult in general.  This is where the family quagmire begins.
Martha has six children; five boys and a girl; so we know who is in charge, right?  Three of them live out of state; two are disabled veterans so the caregiving falls to the two children who live close where there is someone home full time.  Unfortunately, family members disagree and not just in this family.  Several believe Martha would be better taken care of in a nursing home with a specialized unit for dementia.  Another set believes she is not in that bad of shape and we should be able to take care of her ourselves.  Now, admittedly the common concern over money plays into these opinions.  Martha inherited some money from two of her sisters that did not have any children several years ago.  At the time she was not showing any signs of Alzheimer’s disease and went so far as to purchase her first home at the age of 80.
So we now find ourselves in more of a conflict resolution and basic mediation mode.  As the medical professional in the family I personally am working to improve my communication skills to be a more effective mediator.  Part of this involves learning re-framing, laundering, I-statements, paraphrasing, purpose-stating, preference-stating, agreement stating, matching, summarizing, validation and any other techniques I can find to reduce the family chaos.  Conflict comes in many forms so I am learning to analyze the situation and then work to deal with the different personalities in order to find a common ground.  One key is to understand a variation of the Golden Rule which is respecting one another as you would have them respect you.  Calming the storms so people can communicate more effectively has been a challenge and I have had to repeatedly use paraphrasing to insure the person’s point of view is accurately represented.  One example is where my brother-in-law wants to repeatedly tell his mother, Martha, that she has Alzheimer’s and expects her to “snap out of it” to make a decision on her own.  While that would be nice, it is not possible and by asking him how he sees her doing that since she is unable to decide something as simple as what to eat.
Our family is working to shift the stress into a realistic plan taking into consideration Martha’s needs, desires and financial situation.  Not the easiest challenge to overcome; however, if you find yourself in a situation which involves unpleasant family disagreements it may be a good idea to find a trained mediator.  Many times certified dementia practitioners, geriatric care managers, registered nurses and social workers have been educated to fulfill this role.  As always, let me know if I can help!

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