When My Job Becomes About Families as Well as Residents

I've talked for awhile about a resident I've had for several years whose dementia has now progressed to where she needs to move to the next level of care.  The family has been fabulous to work with the entire time she has lived with us and even as we plan for the next stage of her care.  I have had families who, for whatever reason, absolutely fight my assessment of the need for a different level of care.  Pretty much the entire time this resident has lived with us, her illness has had the slow, almost imperceptible decline.  So this week when there was an abrupt change, it took everyone by surprise.  Everyone had planned on an orderly, planned in advance transition.  And now we were looking at a much quicker move to the appropriate level of services.  As I was talking with the family about the new move date, I could hear, even over the phone, the sense of loss in the daughter in law's voice.  In my focus to be sure the resident's needs were met, I had for the moment, forgotten about the needs of the family.   I was reminded of another resident's daughter at this same juncture where she said to me, "This is no longer my mother.  This is a woman whose needs I am making sure are met, but it isn't my mother."  I was quickly reminded of the multitude of losses faced by families.  One of the losses is the extended family that our small, 16 bed assisted living has become.  The move itself signals many losses of the resident and of the person that she had been.  Although her body is still pretty healthy, the core of what makes each of us who we really are is gone from this resident.  In fact some of the symptoms as the disease progresses, paranoia, eating better with finger foods, the tearfulness are probably the exact opposite of who she was before the illness.

I see that on a very limited scale already with my mother.  The change in personality is much less now that she is taking the Aricept than it had been prior to starting the medication.  Yet I can see small changes that she is no longer who she once was.  As I mentioned before, the witty, highly intelligent, able to debate any topic characteristics are no longer there.  They have been replaced by obsession with the cats.  I'm always amazed at how intricately my past experiences have prepared me for where I am now.  That there can be any other explanation for this but a loving God who has a plan for my life is inconceivable.  And I'm reminded now of the many public speaking engagements I made while I worked for the mental health center.  One of the most requested topics is dealing with stress.  And one of the basic causes for depression is on-going stress over a prolonged period of time.  Exactly the situation so many families and caregivers face.

I am thankful for the wake up call on the phone the other day to remind me I am where I am not just to care for residents, but just as much for their families and loved ones.  I hope I can take my own advice as I begin the journey myself.  I hope my family will "hear" me as a professional with expertise to share and not as the child so that I can help my family as well as the families of my residents.