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Sunday, September 19, 2010

Challenging Behaviors, Chapter 2 - Understanding the Resistance

For resistant elderly, the more subtle or indirect the assistance is, the more likely you will have success. Please understand that these elderly are, at their core, terrified. They often have always been fiercely independent and prided themselves as not needing anyone. In reality, we are all interdependent but don't try to reason with someone who has lost the ability to reason. You will lose every time. Elderly folk remember nursing homes and other assisted living facilities [even though the concept of assisted living hadn't been thought of yet] as terrible warehouses of miserable humans who are not cared for properly. While nursing homes and other similar facilities still have their problems, they are nothing like they were in the 50's.

Almost every new client I get insists on staying home and I have to accept this and try to make this happen for them while trying to gently educate them by taking them for "tours" and not putting a lot of pressure on them. Also, natural consequences can be a great motivator.

Many times, family and others trying to help a resistant person help too much. Just how much help is too much help? Well, that differs from person-to-person, which makes it difficult to have a one-size-fits-all answer. If the "helpers" quit helping in certain areas and suggesting an alternate, the resistant person will initially try very hard to coerce, guilt trip or whatever has worked in the past to get the "helper" to continue helping. Once the resistant person realizes that the "helper" will no longer step in, he/she will either a) agree to the alternate solution or b) find another "soft-touch" somewhere to help out. There is nothing you can do if the resistant person chooses "b." Again, you just have to sit back until "b" either shows it works out or the "soft-touch" gets tired and beats a hasty retreat. Playing a rendition of "Good Cop/Bad Cop" can sometimes be helpful. If you can have others [Adult Protective Services, the doctor, etc.] be the "Bad Cop" and set yourself up as the "Good Cop" all the better.

Does it look hopeless? It isn't necessarily hopeless but you have to make a plan and be patient. Talk with Adult Protective Services, especially if the resistant person is being financially exploited or abused. Have a consultation with a Geriatric Care Manager with behavioral experience, who can help you make a plan and give some creative suggestions on how to handle the issue. Contact your local Area Agency on Aging for local resources. The key is to pick your battles and get everyone involved with the resistant person to agree to the plan. One weak link will make positive change almost impossible.

Sunday, September 5, 2010

5 Wishes Advance Directive

I received the following email from Paul Malley, President of Aging with Dignity [not associated with this blog] reminding me about the 5 Wishes:

"We came across your "Aging with Dignity" blog and thought the information contained in it was great. We note in particular you 7/10/10 post on advance directives. I'm not familiar with the laws of Washington, but some states don't automatically recognize the durable power of attorney as the durable power of attorney for health care. Some even require they no be the same person if that person is a beneficiary of the estate or would have some other conflict of interest.

"Moreover, it is not necessary to retain an attorney to complete a durable power of attorney for health care. There are many forms available for that purpose, many of which are provided by the states free. Our own Five Wishes advance directive/durable power of attorney for health care form is easy to understand and use and requires no attorney. It meets the legal requirements of 42 states, including Washington. It also makes provision for empowering the health care agent to apply for Medicaid amount the other powers to be designated. It also satisfies HIPAA requirements.

"I hope you take a moment to familiarize yourself with Five Wishes and what makes it unique among all other advance directives/living wills. A good place to start would be at our website, We have many care manager/consultants like you who are among the 23,0000 Five Wishes partner organizations nationwide."

My organization often deals with legally touchy situations requiring the use of an attorney for estate planning/advance directives but in the past I have used the 5 Wishes form to help me get a clearer understand of the kind of treatment a new client would like in the event that client could not tell me. I highly recommend it. Thank you for the reminder Mr. Malley!