Module 5 : Communication and Relationships

Jeanie Crane, author of Let`s Visit, is a Fort Worth, Texas advocate and community volunteer. Drawing on her experiences as a family caregiver and a volunteer she offers some insights into how to interact with older adults.

• Knowing grandparents seems to be a key in relating well to older adults. People who were around grandparents seem to be more comfortable and communicate more easily with older people.
• Older adults do not consider themselves older; they see themselves without age. Although their appearance may be that of someone who is older on the inside they feel the way that they have felt throughout their lives.
• Older adults may experience `time stress.` The world is moving too fast for them. Although many people experience this time stress it can be challenging for older adults as they have to make constant adjustments to changes not only in the outside world but in their own health and lives.
• Everyone needs to be needed and to “live the best quality of life whatever the circumstances.”
  Everyone needs to feel as independent as possible and have choices and control.

Sometimes we have to go back to the basics of communication and be reminded of ways to relate the most effectively to each other.

Looking at someone and making eye contact (if they are comfortable with it) is important in making that human connection and communicating respect. Do you think that many older adults with chronic illness may want to say “put down your paperwork, clipboard, stop doing that and look at me” ?

“There is a reason that we have one mouth and two ears”

Have you been guilty of any of these actions?

• Talking “at” older adults and  not talking “with” them.
• `Multi-tasking` or doing something else (portioning out medications, changing linen, writing checks, and other activities that are part of your caregiving role while your family member is trying to talk to you?
• Not looking your family member in the eye, not sitting down at his/her  level, or talking to them face to face when you are with them?
• Interrupting him/her  because you have a solution that you want to use to solve what you see as a problem?
• Interrupt him/her because you have heard the same thing many times?

Listen to the language and terminology that the older person uses. Follow his/her lead and use language and words that he or she uses. Do not expect someone to change language to accommodate yours.

Addressing someone. Ask someone how he/she would like to be addressed. Does he want to be called by a title and last name or by first name. Do not assume. When in doubt use a more formal Mr. Jones or Mrs. Smith. Differences in generations. Words used by different generations may have completely different meanings. Here are some examples:

• Cool now means `good` but the definition that an older person might refer to temperature.
• Bad is known among younger people as meaning something good or exceptional whereas someone from an older generation may view this word as referring to something `not good` or `risky.`
• Stereotyping and labeling has occurred in all generations and in all cultures throughout history. Stereotyping is the tendency to describe everyone in a group as having the same characteristics. This always leads to the use of labels. This is especially true in words used to describe older people.

Be cautious about the language you use. The use of language depends on the setting and the individual. Some terms could be offensive to some people. Everyone does not use words the way that you do. Use “people first” language so that you refer to the person first, and not to any disabilities he/she may have.”A person with arthritis” is a more respectful phrase than “an arthritic.”

Which of the terms from the list below would you use when talking with, talking about or writing about older people? How would you feel if you were labeled with any of these words?

Terminology with Older Adults (PDF), adapted and updated from information used by the School of Nursing, Texas Christian University, As People Grow Older by Jane Oderberg and Sue Smith, 1995. Note: You must have the Free Adobe Acrobat Reader to view or print the PDF version. Click here to download it. [the above links open in a new window]

1. Seniors; older adult; elderly; older people
2. Low income; disadvantaged; poor
3. Incapacitated; incompetent;

The caregiver or listener can use reminiscence to build a better relationship and build a bridge between the past and the present. In addition, reminiscence can help the person be listener to:

• Gain a clearer understanding of the person`s values, needs, and emotional and psychological resources.
• Build a better relationship with someone from a different generation.
• Find common life experiences and feelings.
• Gain knowledge and understanding of the period in which the person lived.
• Gain insight about the person`s behavior now and in the past.

If someone begins to be upset or angry, redirect the conversation into another area.  Perhaps find a key word or experience in the story that is a more current experience for either of you.  Steer the conversation in a different direction while not ignoring that he/she may be upset.  Listen, reassure and be supportive.

Responses These techniques may not necessarily come one right after another. You may have to return to some of them more than once as you respond to the behavior. Your goal is to help the person meet a need that does not harmful supports independence.

• Set healthy boundaries that help you help your family member within your physical and emotional limits. Respond to the behavior while keeping the care receiver safe and meeting his/her needs.
• Allow the person physical and emotional space while maintaining a safe environment.
• Encourage him/her to sit down if standing.
• Redirect a person who is becoming more agitated by encouraging him/her to talk to you or giving him or her something else to do . This may help calm the person so you can deal with the problem more objectively.
• Eliminate distractions , if possible. Sometimes a person may be distracted or agitated by too much noise or activity.
• Really listen to find out what is causing the behavior.
• Use active listening by paraphrasing what you hear to identify what is causing the problem.
• Allow the person to talk out feelings and listen for clues about what is causing the problem.
• Listen for clues about what the person needs that he or she is not getting.
• If it is possible to meet the need, help the person to explore options to get the need met. Offer options if he/she cannot see any.
• Ask the person the consequences of what will happen if they do not change the difficult behavior. For example, ask “What happened the last time that you stopped taking that medication?” Remind the person about what may happen if they will not or cannot respond.
• Confirm any plan that comes out of the discussion to resolve the problem.

Repeat back to confirm any action or behavior that is going to take place to resolve the difficulty. Ask the person to put the action in his or her own words. When dementia or mental illness is present

If the behavior is caused by dementia or mental illness, do not confront. Acknowledge the feeling if not the content. You do not have to agree with the person but accept that the person feels that way. Remember that it is difficult behavior – not difficult people.

• Explain what is happening to the care receiver (medical condition, medications, mobility, and other needs)
• Ask for help from family members with activities around the house, emotional support and help with the care receiver.
• Negotiate or suggest how responsibilities can be shared to help the caregiver help the care receiver.  Discuss the `best fit` for the abilities or interests of family members.
• Acknowledge the emotional support and shared household responsibilities.
• Periodically revisit how well the shared roles are working and adjust them.

Relationship with the care receiver Although a controversial concept, some people believe that a common experience is a `role reversal` whereby the caregiver experiences a feeling that the roles and relationships of a lifetime are reversed. Adult children may feel that they not only take over the role of caregiver but also becomes the primary or sole decision maker.  This change in responsibilities creates a completely new relationship.

Reminder:  The parent will always be the parent and the child will always be the child. Examples of Possible Role Reversal of the Spouse #1.  The husband, who always managed the family finances, is now unable to balance the checkbooks, pay bills, who has a full-time job, make investments due to Alzheimer`s disease.  The  wife assumes management of finances in addition to other household responsibilities.
#2.  The wife becomes ill and can no longer manage household responsibilities such as cooking and cleaning.  The husband must learn how to do laundry, shop and prepare meals.

Why are sibling relationships important? Because all the siblings are the children of the care receiver. Your relationship with one another will affect the care that the parent will receive.

If the siblings are relating well and have built a partnership to share responsibilities the parent will benefit. If the siblings are in conflict over responsibilities or finances the parent`s care may be directly affected and he/she may feel the stress of the conflict. This stress makes it more difficult to have manage an illness and maintain confidence in his/her ability to remain independent. Recognizing feelings and understanding how relationships with siblings developed over time can help siblings to negotiate their roles and responsibility with aging parents. Go to Sibling Assessment to get a clearer understanding of your relationship with your sibling(s) so you can identify how you can get their help in sharing caregiver responsibilities.

Note: You must have the Free Adobe Acrobat Reader software installed on your computer in order to view or print the PDF version. Click here to download it.
You cannot change the values or behavior of a sibling but you can change how you relate to a sibling

The question for the caregiver is:
What can I do to improve the relationship with my (brother, sister, stepbrother, stepsister)?

What you can do to engage your sibling(s)

• Complete the Sibling Assessment.
• Plan ahead and make a list to identify what help that you need in caring for the family member.
• Take the initiative to communicate with the sister or brother.
• Establish some boundaries about what your abilities and resources are and be prepared to talk to your sibling about them.
• Set up a family conference in a neutral place such as a restaurant or library.
• Identify the needs of your parent as you see them and ask your brother or sister to do the same.
• Explain or update the sibling on the parent`s current health status.
• Clearly identify some of the tasks including health care transportation, appointments; things around the house that need attention, financial issues, and everything that needs to be done.
• Tell your brother or sister which of the tasks that you prefer to do yourself.
• Ask your sibling(s) which ones he/she (they) can do based on their abilities. Think about the skills and interests of each sibling and determine the `best fit.`
• Communicate directly
• Use “I” messages avoiding phrases like `you should` `you don`t`. Instead say things like “When you don`t come to visit or call and offer to help me with Mom, I feel overwhelmed by the responsibility.”
• Deal with history of working with the parent and resolve any conflicts.
• Clearly identify who is going to do what.
• Develop a communication schedule
• How often?
• By what means? Phone, email?
• How often will you meet and where?
• If possible, both siblings can talk to the parent about how you would like to share responsibilities
• Make sure that the care receiver is comfortable with your plan.
• Be flexible and willing to adjust the plan based on the caregiver`s response.
• Keep conflicts between siblings out of the discussion with the parent.
• Follow through.The best plans fail because they are too complicated, the parties to not really agree, or , or the receiver does not consent.
• Change the plan if it does not work or needs adjustments.
• Avoid getting in the mindset that includes `he should,` `why can`t she?` What will this accomplish for you?
• Communicate, communicate, communicate.

If you are the primary caregiver

• Take the initiative.
• Maintain communication with your brothers and sisters about what is happening with their parent. This communication should increase if the parent`s health changes.
• Make periodic phone calls and ask siblings about a schedule of regular contact. For example, suggest that you call them (decide how often) and they call you the next time.
• If you use a computer, use email to give periodic updates and ask for assistance. Create a `group address` on email to send the same message to all siblings.
• Follow-up and set the example of communicating. Ask for their involvement. This will become a new habit over time.
• Use the guidelines for a family conference in the section above.
• Use the telephone if a person to person conference is not possible at the time. Ask for a conference call with several siblings.
• Involve all siblings regardless of their ability or willingness to assume caregiving responsibilities.
• Use caution in making use of the time during visits at home for holidays. It is especially important at this time to talk in a neutral location and not mix celebration with the business of talking about caregiving.
• Respect the fact that your sibling/s have other responsibilities including jobs and family. Put yourself in the other person`s position.
• Ask for help.
• Be persistent yet respectful. What will happen if you continue to assume the primary role? Will resentment build? How will this affect the relationship with your parent?

If you are living a distance from your parent

• Take the initiative.
• Maintain communication.
• Ask how you can help. What activities can you do from a distance?
• Offer to help with research about health issues or resources.
• If you use a computer, offer to find links to information about health issues or benefits.
• Make phone calls and gather information that you share with the primary caregiver.
• Recognize the demands of the sibling in the primary caregiver role and the stress that it may cause.
• Offer to be a partner in problem solving.
• Listen if the caregiver just needs to talk.
• Don`t tell the caregiver what he or she should do. Offer suggestions.
• Tell your sibling how much you appreciate what he/she does.
• Send a thank you note, gift certificate, or some other token of appreciation to the primary caregiver.
• Ask for help from other siblings and family members.
• Plan a visit as often as you can.
• Ifyou are not the primary caregiverask that personwhat helphe/she needs.
• Share your observations about your parent`s health and situation with your sibling.Your fresh perspective may be welcome but avoid sounding judgmental. The sibling may take your comments personallyif you do not believe thathe/she are doing the job right.
• Ask how you can make the situation better instead of telling the primary caregiver what he/she should do.
• Communicate, communicate, communicate.

Keep asking the question:What can I do to improve the relationship?