Mrs. G is a 66 year-old woman who had a stroke while attending a baseball game. She had 4 children (2 daughters living locally and very involved and two sons living out of the area). Mrs. G was in a skilled nursing facility, following, yet another hospitalization in the one year since having the stroke. Each daughter had their own vision of what was best for their mother. The particular dynamics of this family along with the stroke, and resulting brain damage in Mrs. G, made decision-making quite difficult. Most of the decision-making and financial management was turned over to the eldest daughter, who was recently out of work for several months on medical leave due to severe gastrointestinal problems.
The younger daughter initiated the phone call to our organization, based on a referral from a co-worker. After talking to Victor, the younger daughter, immediately understood the benefit of our services and arranged for an In-Home Consultation. Mrs. G bonded quickly with Victor and was eager to get started.
The eldest daughter, however, was a little hesitant to begin. Finally, after, several months, I think in a moment of desperation, she called and said, reluctantly, "Just go ahead and start." Plans were made to begin the following week.
That Friday evening, the eldest daughter called Victor in an emergency. She had received several disturbing phone calls from Mrs. G and the nursing facility that and did not know what to do. After a few phone calls to the facility and Mrs. G, Victor called the eldest daughter to give her an update. He had helped to initiate a plan to fix the most immediate issue. Relieved, the eldest daughter said, "If I had hired you last year, I probably would not have needed to go out on leave."
Mrs. C was a 75 year-old woman living at home, mostly independently, but struggling with day-to-day personal care and upkeep of her home. She had brought in the services of a home care agency to provide a caregiver a few days per week. This caregiver was helpful when she was there but had frequent personal issues that impacted the days and times she would come. Mrs. C was often rude and insulting to people around her and was described by her friends and family in this way for most of her life. Prior to the current caregiver, the home care agency had tried several others before her. None proved to be a good fit. Mrs. C would call the agency and complain about every caregiver. In addition, most of the caregivers would not return due to the way she treated them. The agency knew the client needed consistency of hours and personnel but felt helpless to make any sort of change for fear the client would be upset.
Victor was introduced to the client by the home care agency because the family stated they wanted someone to help find an assisted living facility. In assessing the situation, he discovered she really did need much more help than she was receiving. Victor was able to build trust with Mrs. C quickly and she allowed him to make changes that neither the family nor the home care agency was able to accomplish. Through a very careful screening process, he conducted phone interviews of caregivers before introducing them to Mrs. C. She then had the task of choosing between a much smaller pool of qualified people. This process allowed her to feel a part of the process as she had the final decision, without overwhelming her with the entire process of selecting the best fit. He was also there to support her through the transition process. She would call him when she would get upset that the caregiver was not doing things the way she expected. Victor would work with both her and the caregiver to make sure there was some compromise. These interventions allowed care to continue.
With our help, the client was able to continue living in her home safely. The key to this case was really listening to the client about what she wanted. Those around her had grown tired of the constant complaints, many of them seemingly unrealistic. As a result many had begun to minimize her comments. Our care manager was trained to hear the real discomfort beyond the actual complaint and respond to that concern. Over time, Mrs. C grew to trust the care manager and knew that he would respond to her pleas.
Mrs. A was a 91 year-old woman living with a full-time caregiver in her own home. She had been diagnosed with dementia likely caused by Alzheimer's Disease approximately 9 years ago. The caregiver was kind and trustworthy but had no training in dementia. Mrs. A had two sons and a daughter who were becoming increasingly frustrated by Mrs. A's behaviors and comments. They admired their mother and did everything they could for her. Now with advancing dementia, she seemed more difficult to please. The requests were often contradictory and seemingly unrealistic. A frequent theme was the desire to move back to her original hometown, which was out-of-state and no longer had any relatives or friends living there.
Victor was referred by a friend of the family to provide brief family education. The family had read all the information they could about Alzheimer's Disease but were still at a loss to understand how the disease was changing their mother. During the first visit, the eldest son commented on how Victor was able to connect with Mrs. A in a way that no one had been able to in years. She was laughing and appeared stress-free. Victor coached the family on a series of techniques, specific to Mrs. A, that they could use when interacting with her. They quickly learned how to incorporate the techniques in her day-to-day life and really came to understand how dementia was affecting her behavior. The change in her children's behavior allowed them to better cope with the situation. It also, in turn, improved her behavior and made her care much more manageable.