1. Opening Doors to Effective Caregiver and Family Relationships Diane M. Wood, MA, Cert. Geriatrics/Gerontology Dir. Of Community Relations OK DHS – Aging Services

2. Or is it………………………

3. Objectives  Now, Then and tomorrow  Think about the iceberg  Quality Improvement = Quality of Life  What does Cultural Competence have to do with it?  OMG THIS Family!!  How it can work, with realistic expectations.

4. Then, Now and Tomorrow

5. Rank from the most important to you to the least important:  Right to complain  Choice  Respect  To be fully informed  Privacy  Right to participate  Right to be notified  Right to receive or refuse visits  Freedom from restraints  Security  Manage financial affairs  Not required to work or perform services,

6. Think about an Iceberg – on 10% is seen

7. Weaver. Gary R.(1986). Understanding and coping with cross-cultural adjustment Stress. In R.M. Paige (Ed). Cross- cultural orientation. New conceptualizations and applications. Lanham MD: University Press of America.

10. What does Cultural Competence Have to Do with it?

11. WHO DO YOU SEE? HOW DO I SEE MYSELF? WHO DOES MY FAMILY SEE?

12. British cartoonist William Ely Hill (1887–1962) published "My Wife and My Mother-in-Law" in Puck, an American humour magazine, on 6 November 1915, with the caption "They are both in this picture — Find themPuck

16. You have got to figure me out! Put the pieces of the puzzle together Relationships take time and are a journey…

17. Medical Background: Languages spoken, educational background, childhood years, military history Social/Cultural Information: Ethnicity; leader of a cultural organization, community Roles: leader in the community, organizer, helper Usual level of social involvement Occupational Background: Work history Membership in professional organizations Professional awards, merits, achievements Interest/Abilities: Personal care activities Mealtime activities Task / Chores Physical abilities Social activities Intellectual activities Spiritual Creative Spontaneous Current Abilities: Cognitive Long-Term Perception Attention Language Praxic abilities (ability to perform purposive movements; use of objects Judgement Motor Status: (how well does a person move through space) Eye/hand coordination; fine motor skills; ambulatory; assist needed for transfers. Sensory Status: Visual impairment; wears glasses; hearing loss – hearing aid Social Abilities: Current participation in social clubs, activities, sorority; fraternity, What are the current social roles Current level of involvement Spiritual Needs Strengths Special Considerations/Other: Contents of a thorough Activity Assessment

19. Quality Improvement (QI) = Quality of Life Quality improvement is more than preventing falls, preventing pressure sores, increasing staff to resident ratio. As care communities become more person-centered, Quality of Life becomes a QI measure. If making a change on behalf of a resident to improve Quality of Life, just as with the QI process, everyone involved in care must be included in the cycle of communication. Getting Better All the Time – Working together for continuous quality improvement; www.isabella.org/Isabella/News/Article.aspx?id=cff0ab07-d3b1-4645-a81f-953b1d80337f# www.isabella.org/Isabella/News/Article.aspx?id=cff0ab07-d3b1-4645-a81f-953b1d80337f#

20. Quality Improvement (QI) = Quality of Life We each define Quality of Life differently! How do you define it?

21. OH MY GOODNESS!!!! THIS Family!!!!

24. Even “Healthy” Families Experience Unhealthy Emotions as it relates to caregiving and long-term care placement..  Denial  Anger  Despair  Blame  Avoidance  Guilt Gray-Davidson, Frena (1999) 3 rd Ed. Alzheimer’s Sourcebook for Caregivers

25. Hard decisions in Hard Times for Families  Families are exhausted  Families have preconceived notions about ltc  Families are facing huge responsibilities  Families need adequate information  Families are facing making legal decisions; honoring wishes  Families are facing making life- sustaining or non-treatment decisions.  Families need to identify alternatives Davidson, Joyce D.; Doka, Kenneth J., (2001) Caregiving and Loss

26. How it can work – realistic expectations………….. Caregivers need tolerance as affirmative respect Caregivers need information and education not a dream experience

27. Education about disease process – staff and family Staff needs to understand, “It’s not personal – these are the families feelings.” (in most cases) Facilitating a discussion among family Asking “What is your hope and what is your personal need?” Clarifying what the family wants - Do not attack Do not bring up the past Do not speculate about each other’s future behavior Respect each other’s differences Agree to abide by planning decisions Understand in most cases, families are doing the best they can. Repeat

28. Ask “What is your hope and what is your personal need?”

30. Do not bring up the past

31. Do not speculate about each other’s future behavior

32. Respect each other’s differences

34. Questions/Discussion?