Calming the Tides

Tonight, I had a phone call from a woman who was trying everything in her power not to yell at her mother with Alzheimer's Disease. It was 1:00 am in the morning, and her mother was up in the front room of their apartment screaming that she wanted to go "home". Unfortaunately, her home had been deemed unfit to live in, because it had been neglected for so long and had pet excrament and urine all over the house. Her mother had been given Seroquel by the doctors, but nothing was soothing her mother's agitation tonight.

Calmly, the caller ask what she could do. The front and back door to the apartment were locked and she wasn't worried about her mother leaving the house so much as she was possibly going to make a lot of noise or start breaking things.

We went through different re-direction techniques, like giving the mother a cup of tea and a cookie, or telling her that the family would "go home" tomorrow as a little white lie. These methods seemed to sooth the mother for mere moments though, but her mind was still racing and she was talking non-stop about different things. I asked the caller to reminisce with her mother about an old memory or story she likes to repeat to others. But this wasn't working either, so finally, I asked the caller to say good night to her mother and walk into another room. I was hoping that this would switch her mother's train of thought to self-sooth.

However, we had no such luck. The caller thanked me and said that she would probably have to sleep in her mother's room tonight to get her to sleep. I fely bad that I couldn't do more.

Is Dementia Subjective?

As you may have read in earlier blogs, I work at the Alzheimer's Association National Helpline. The title of this blog is laden with a caller's anxiety and feelings of resentment that this terrible thing has happened to their loved one and their family. Instead of quoting a bunch of stuff straight from the http://www.alz.org/ website about what is Dementia versus Alzheimer's Disease, or what are the signs, in this blog I will attempt to speak of the a caller's reactions my words as a counselor when we discuss this issue.

I always ask why the person thinks their loved one has Alzheimer's Disease, so I can see where they are in the process of understanding the concept, and then I ask what they think may have caused the symptoms that they are observing to show up now. Sometimes, I hear a simple, "my mother hasn't been able to take care of herself since the surgery", or "well, her father had it at this age and we just had an argument", or "I was just reading about Alzheimer's on your website and it sounds a lot like me, and I take a lot of medications for my other illnesses".

Everyone has a different picture of what Alzheimer's Disease looks like in their head, most of the time it is of someone who is 80 years-old and so obviously demented that they need to be in the care of a nursing home. But what about the loved ones we know who are losing the ability to care for themselves at age 40 or 60? What then? Can we blame physical/mental decline on a biological change in the brain 100% of the time? 

I usually ask the person to think about all the different things that may be contributing to the emergence of the Alzheimer's Disease other than age or genetics. To think about any major stressors that have impacted their lives recently, or any anniversaries of depressing events of years past. I'm not trying to dismiss the possibility of Alzheimer's Disease, but show the caller that there are many complex elements of a person's life that can be factors in causing someone to act Demented.  I suggest writing down their newly refined thoeries and speaking with their loved one's doctor for further discussion of their symptoms.

However, even doctors have their own theories of what Alzheimer's Disease is. I've heard some doctors saying the most outrageous things, like Alzheimer's doesn't really exist or that there are no treatments for Alzheimer's symptoms so why diagnose it. I tell the caller that if they get these reactions from a health care professional to start looking for a second opinion. Go to a neurologist, or a geriontologist, or even a psychiatrist. I believe that if the family or the individual feels that there is something wrong, then there usually is, be it physical or mental. 

The other important fact that I highlight to callers is that their loved one is at an un-determinded stage of  Alzheimer's until they are thoroughly diagnosed. This means that your mother or father, sister or brother, friend or lover are still capable individuals until a doctor/court says otherwise, so let them know your concerns and encourage their participation in asking the doctor questions about the disease and the diagnosis process. 

At the conclusion of the call, there is usually a sigh of relief that there is nothing set in stone yet about their loved one and that there are still things to be done, an action plan to talk to the doctor has been created.

Hmm... this could be an example of good ole social work empowerment?! 

A Story of Grief

I've been thinking about the various callers to the Alzheimer's Association helpline and how some people reflect on short snap-shots of time while others are stuck in a grief process; whether or not their loved one has actually passed away or has irreversibly changed in their personality. It is a re-occurring theme both on the helpline and in my own life, so I'm sure that that is why I am sensitive to this issue.

I believe that "death and dying" topics are most difficult to hear and navigate our callers through because we get stuck in their sorrow, pushed away by their anger, or distracted by their memories of joy. Raw emotion is hard to contend with by using mere words, but those are the tool of the counselor.

I can think of a few people who are locked into the moment of their loved one's passing. Watching the death bed scene replay in their minds with mixed emotions of closure and sadness. It seems that our minds drive us to process or digest the relationships we had with our loved ones, by constantly flashing reminders at us. For example, I have heard callers identify a mystical connection to a song that played on the radio or a bird that flew overhead and they believe with all their heart that this is a signal from their departed loved one. I hate to disillusion such beautiful rationalizations, and when I am counseling I never confront these beliefs, but do these thoughts prolong the grief process?

One misnomer that I would like to dispell for any new grief counselors out there is the idea that "grief gets easier with time". In my experience as a counselor and as a person who carries grief, I think that the only thing that changes with time is the attention/support that a grieveing person is offered by friends, family, or one's religion. As if the fact that others stop acknowledging the loss, then it shouldn't be so pressing on out minds. Grief is certainly an uncomfortable topic to discuss and perhaps that is why everyone is in a hurry to dismiss it or make people "feel better". I would rather learn how to cope with my grief and live with it, since it is part of me. I wonder if that is a good perspective to have as a counselor?

Online Humanity

As more technology invades our daily life are we aware, or do we even care, that we are giving up our identities? And I'm not talking about identity theft, but I'm talking about the human element of meeting someone face to face. Technology, like the Internet, enhances our communication with others, allows us to learn about distant cultures, and entertains us. Sounds pretty good to me. But if the medical or social work profession starts to main-stream services to clients online, what are the implications?

I have to say that a great deal of my time at work is spent online, looking up information for people calling the Helpline and showing them where they can go online for further social/medical connections, and then I plug their information into a database to relay to others the next steps that are to be taken with a client. Every care note is electronic, there is even a way to speak to a helpline specialist purely by e-mail! No personal connection required! Aren't we losing something here? At least the security of being in the presence of another human being conveys comfort. But there are so many callers, and people sending e-mail, so it must be helpful, right?

But here are the positives of being dependent on the use of your voice only: 1) You focus on purely what is being said, and can not look at a person through tinted glasses - less discrimination?; 2) Unlimited information is at my disposal via the internet, and a quick way of sending information to others; 3) Immediate gratification, for better or for worse, a caller can pick up the phone or start typing and tell others exactly how they feel!

This is a big topic and I am only skimming the surface. What do you think?

Please scan these interesting articles:
"Protect your Online Privacy: Start Blogging"
"What if your car cared about your health"
"UPMC center showcases ‘virtualization’ of healthcare"

Trending Elder Care

Today, I'm going to link you to an issue that I am passionate about, the future of elder care. I had heard about this interview at www.LinkedIn.com as part of the American Society on Aging group. I have also had many questions on the helpline asking for information about, for lack of a better term, "group homes" for seniors. I proudly introduce you to "The Green House Project"!

http://www.blogtalkradio.com/ecarediary/2012/02/07/the-green-house-project-creating-viable-long-term-care-home

"eCareDiary's Director of Events, Polly Whitehorn will speak to Susan Frazier, COO of the Robert Wood Johnson Foundation-funded Green House Replication Initiative at NCB Capital Impact that creates small homes that offer intentional communities and high levels of care."

How Do You Teach Social Work?

This question was asked of me today, and I thought... "hmmm... I should know the answer to this because I have been in the field for over a decade". The lady on the phone called the Alzheimer's Association because she couldn't sleep, and was worrying about an up-coming class she was going to be teaching to fledgling social work interns. She explained that she had to utilize eight different vignettes over the term of an eight-week course to highlight social worker responsibilities. "This sounded like a fun class", I thought, "very open-ended to different ethical debates". I actually suggested that she utilize the NASW Code of Ethics when dissecting each vignette. Did I ever tell you that I almost minored in Philosophy?

I think that learning Social Work has to be experience-based.... for sure. I have had so many volunteerships and internships it's scary, but totally worth it. Social Work seems to be a job you grow into over time in my opinion, and as the subtitle of this blog states, I am always learning from clients and other social workers!

I wonder how others feel about teaching Social Work? Or Learning it!

As the Faces and Guns Pass Me By

This might seem like a strange blog entry title, but it was what actually happened to me today. I met well over 200 people in a matter of four hours. This occurs once a month at a local Sportsman Show where my husband and I sit at a booth and sell self-defense keychains. Yes, I married a wonderful husband with a great interest in self-defense tools.... And yes, this is a part on my life that I never saw coming.... a social worker selling self-defense keychains at a gun-show. But the interactions with strangers is of great interest to me. Mostly, I think what really attracts me are the seniors who are there and our keychains bring back memories of their youth when they were in military service. I love those stories!

Another fun element of the day is that mostly everyone dresses the part at a sportsman/gunshow. The seniors will wear their old military hats and the young men with their sons/daughters are in hunting clothes. I feel like I am in another world there. It's certainly a culture in and of itself to be pro-gun in the United States. Are there political issues on people's sleeves, yes sir! During an election year there are politicians advertising their views there... of course the are of the Conservative persuation. But one year there was a gentleman who was alowing people to take a test and it gaged where they were on the political landscape, I was judged as a Moderate. Needless to say I think that the atmosphere got me into a "groupthink" mindset. 

I wonder what would happen if I told people there that I am a social worker?

Shhhhhhhhhhh!

Today was a split shift for me, and perhaps that made me a bit rough around the edges. The last call of the evening, at 10:45 pm, was a lady who didn't understand why her mother didn't do everything in her power to prevent herself from "getting Dementia".

"Okay, I've heard this one before", I thought, "let the caller vent and settle down and then discuss with her the idea that her mother doesn't have the intention or where-with-all to want to have Dementia". And maybe something happened in the past where her mother was abusive to her, so she is thinking that Dementia is a payback of some sort. I thought I had it all covered...but... the caller kept yelling into the phone, not like on speaker phone where you are trying to do two things at once, but really yelling into the phone.

Going through my mind was, do I assess for suicidal ideation and/safety? Can this be her norm in communicating with others? Is this a personality disorder? What is going on, I thought? In some ways her thoughts were making sense, she was following some logic, albeit poor logic, but she wasn't out of control, she was just sustaining her energy to yell. Wow, I thought. What happened?

It turns out her mother gorged herself on food in the home today, and her mother was a diabetic, and money was a huge issue in the household so the caller was scared that she might have to go without food. Really I thought? Is that it? Mom was over-eating... I quickly turned down the volume so I could think while the caller continued. She said that when her mother overeats, she gets sick and can get explosive diarreah. "Okay" I thought, "That's no fun".  So was she scared of what tomorrow might bring? I started to try to normalize her experience, telling her that over-eating is exhibited in many Dementia patients and that backfired on me, because remember "mother allowed her Dementia to happen". Oh my! Terrible I thought, how do I sooth this caller, how? It is now 20 minutes into the call and she is still at a heightened level of anxiety.

Go back to the basics I thought.... well, no I didn't really think that.... it was more like what do I do when someone is mad... AGREE with them! But I can't agree with everything she is saying. So I started saying how mad that would make me if I found my kitchen ran-sacked....

She said, "so I'm not crazy?" I thought.... then said "no your burning out, you need a break... how are we going to do that for you?" Ahh... that was good, got her to stop for a second and feel heard. She said that she was going to go out tomorrow with her sister for a break, but before then she had to secure the cabinets in the kitchen and the refrigerator. She was going to use bike chains. Okay.... that's a soluntion, but so is increasing the mother's supervision I said. I told her that there were respite programs that she could take advantage of, or maybe adult day care. Again, money was an issue. I told her that it would be alright, that we were going to help her figure it out. Those were the magic words! I found them. We weren't going to let the caller be alone in her misery. That help her settle down. "Finally" I thought, she ... and I could have some peace. *sigh*

Slacking Off

Every once in a while I do something silly, like sleep in bed all day. I know, I know, it's me avoiding something. Today, I saw my 75 year old Aunt who had traveled from Ohio to Illinois in 6 hours yesterday, attended one funeral, and then traveled another 2-3 hours to visit a relative in a nursing home, and lastly came to a 3 hour dinner at my mother's house. Just the dinner wore me out! So what am I avoiding in life I wonder. I certainly should have more energy than my elder in this case.

Can social work be so tiring that on off days we collapse, mentally and physically? Of course, this doesn't always happen to me, but wow it really felt good to hide in a warm bed, playing with my pet cat, and hearing the silence of the morning turning into afternoon then early evening. I was in control of nothingness. It felt good to rebell! But now I have to get myself up and ready to counsel others, with a feeling of guilt that I can't waste a day like that again.

I kind of have to snap back into their reality of chaos and feeling overwhelmed by life and care-giving. My head is spinning, but after the first call of the night I'm back in the game! What a topsy-turvey few days it has been.

Stress Becomes Me

I have not yet figured out why I am so hung up on trying to create things, but today in particular this feeling of creation is stressing me out! I came home from the call center today at about 8:30am, and slept pretty soundly. But upon awakening I felt a wave of unsatisfaction... if that is possible. I think that on my days off, which are in the middle of everyone else's work week, I feel a little out of step. Creating something while off of work hours would make me feel useful. Purhaps that's why I started the Social Work Cafe, but there is only so much I can create there.

Exercise would probably be a great stress release, I should've gone for a walk today, but didn't think of it until now. LOL So much for my coping skills. Tomorrow, I have to clean and run around on errands, that should make me feel normal again. Perhaps i was just having a bad day. Anxiety tends to enter my world at times and I just get overwhelmed like everyone else. I have to remember to not be so hard on myself. There is time to "get ahead" or "figure it out"... this thing called life.