Edie was not a happy person when I entered her home for the first time; she felt “everyone was making way too much fuss over a little thing.” Her physician had ordered home care nurses to visit her after her hospital stay because she had episodes of dizziness and falling. Edie had been recently diagnosed with an irregular heart beat and required new medications. Recently, the grandson who lived with her had married and moved out of state, so she was alone in a big, empty house. Her son, Bob, lived in a neighboring community and visited her daily before and after work. He wanted his 90-year-old mother to move in with his wife and him, or at least to move into a nearby assisted living facility. Edie would have no part of this: she wanted to remain in her own home and she didn’t want to interfere with his lifestyle.
Yet as each day progressed, Edie’s preferences were becoming less and less achievable, and the stress was taking a toll.
In just a few visits with her, I could tell by listening to her conversation that she was scared to be alone but unwilling to give up control. She could no longer manage the stairs to her bedroom at night so she slept on the recliner. She was having difficulty reading her medication bottles so she rewrote the names and times she should take them in large, black marker over the label, but this was a challenge for her to maintain. She was skipping her mid-day breathing treatments because she could not manage all the steps needed to set up her equipment – yet she was telling her son she had done them. She called the police several times a week after dark because she was sure someone was trying to break into her home.
Bob was doing the best he could: juggling a full-time job, his own home and family, and the new responsibility of daily visits to his mother. Some days he didn’t know where to turn, what short-cuts he could take, and how long this balancing act could continue. He was stopping in at Edie’s at 4:00 a.m. on his way to work, only to find Edie asleep on the recliner. He would quietly set up her breathing treatment and leave. Edie would call him several hours later to see when he was coming, having no awareness of his pre-dawn visit. Bob would stop on his way home in the late afternoon to check on her, and set up the evening treatment. His time with his mother was always hurried, little conversation between them occurred, and neither he nor Edie felt these were good visits.
By listening to both Edie and Bob describe their daily routines and stressors, I was able to develop several simple solutions that would make life easier for everyone. First, we got a pill box to organize her meds; Bob would have to refill it weekly, but this would greatly reduce the chances of missed or wrong doses. Second, we set up an area life-alert system so that she had easy access to emergency services. And third, by listening to Edie’s description of her neighborhood, we discovered a tremendous resource in close proximity: her neighbor, Sam. Sam had spent the last few years caring for his own mother. After his mother’s death, Sam found himself at loose ends. A brief conversation between Edie and Sam led to Sam deciding he would like to check on Edie daily. Every day around noon, Sam stopped over and had a cup of coffee with Edie. They would chat, and he could then he would check her blood pressure and set up her mid-day breathing treatment. Often, he would shop for her if he was heading to the grocery store himself. The change in Edie’s comfort level was amazing: she began to enjoy being “single” again, laughing and telling stories about her life. Her sense of loneliness and fearfulness greatly diminished. And Sam blossomed again in his caregiver role.
These simple adjustments answered the prayers of everyone involved. Edie maintained independence, giving her son a bit of relief and more time to look into long-term solutions that would better meet all their needs. And Sam felt needed again.
When we listen deeply to the individuals involved in a caregiving relationship, we can more fully assess the specific dynamics of their situation and more readily identify effective solutions. By listening with the intent to care, we gain a diversity of viewpoints that improve overall patient care.
Caregiving is never easy, it is never perfect, it is always a juggling act. But when individuals feel that their views are heard and respected, it can renew their sense of independence and self-control.
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