How to Turn “No” to “Yes”

In my early days of caregiving, Mom’s “No!” was one of my greatest fears.  I felt powerless against it. It meant a fight. And I could not fight my mother. Sometimes, of course, what Mom was refusing to do was a task that could be put off until another day: letting me trim her nails, for example. If that was the case, I didn’t push very hard. But often, even though the task was a simple daily chore, it was important, for health or hygiene’s sake. So I had to learn to fight.

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Three ways to turn “no” into “yes”:

• Add a distraction or two.
• Don’t ask. Just do it.
• Wait and try again later, as if it’s the first time.

 

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Some days Mom could turn Alzheimer’s into a two-letter word: NO. Regardless of the issue or question at hand, her response to it was “No.” She could say it in a variety of ways:

• Sometimes she ignored me. Mom became an expert at avoiding eye-contact, simulating deafness, or speaking over me to any other face in the room—like my father’s, or Charley the poodle’s, or the weatherman’s on TV.
• Sometimes she used body-language. If I asked about putting on her shoes, for example, she’d wedge her bare feet tightly under her chair. Or if I wanted her to take her medications, she slapped her hands over her mouth.
• And sometimes she simply spoke up with a sturdy “No,” again and again if necessary, louder each time.

What to do?

• Add a distraction or two.

Distractions, of course, will vary from person to person, because each of us has different likes and dislikes. Extreme likes and dislikes make the best distractions. With Mom, I used a favorite food; or a sudden search for what-looked-like-a-flea in Charley-dog’s fur; or a new face on the evening news team. Once I discovered the value of distractions, I began to collect them in my mind like precious gems.

Example: Mom developed a dislike for taking her medications. Though they were clearly a necessity each day, I discovered the less emphasis I put on her taking them, the better. If she said no when I offered them to her, I’d wait a while, then introduce a distraction. Maybe…potato chips! A small handful of potato chips on a napkin were well-nigh irresistible, both for Mom and for Charley. As Mom munched and shared, munched and shared, I’d casually put her medications into her empty hand. As if by reflex she put them in her mouth, drank a sip of the water I offered, and went back to munching and sharing. Distractions could keep Mom from asking quite so many questions in a row. Distractions let me brush her hair. They were a God-send.

• Don’t ask; just do it.

If you know what the answer will be, why ask the question? Especially if you need a
“yes” but are certain to get a “no”?  So don’t ask. Just do it.

Example: I stopped asking Mom if she wanted to wash her hands before a meal. Though I knew washing was a necessity, especially with baths so few and far between, I knew she was sure to say no to it. So instead of trying to get her up and to the sink, I engaged in a stealth operation. Without a word about what we were about to do, I’d wet a washcloth with warm water, wring it out to semi-wet, and put soap on it. Then I’d wet a second cloth, wring it out so it wasn’t dripping, and carry both to where Mom was sitting at the table. Meanwhile I’d talk about whatever was on TV or who we might visit this weekend or where I used to buy my vacuum cleaner bags and oh my goodness why are there so many kinds they make it so confusing…. Talking nonstop, I’d rub the soapy cloth over her hands and then go over them with the damp one. Her hands were reasonably clean before she could even react. If she did get around to fussing at me, it would usually be with a demand to get that mess (i.e., the soap) off her fingers and get them dry!  I could comply with that order quickly and cheerfully.

• Wait and try again later, as if it’s the first time.

Some tasks absolutely required cooperation from Mom. Getting into a bathtub or shower, walking outside to get into a car, even putting on fresh clothes—these are things which I couldn’t do for her if she decided to put up physical resistance. So in these cases, I had to be prepared to take no for an answer. And I learned quickly that arguing made the situation worse: Alzheimer’s will not allow its victims to reason their way down from emotional crises. So I learned to try once, maybe twice, then leave the matter alone and try again later, as if it were the first time.

Example: On a day when we had a doctor’s appointment, if Mom refused to go outside to the car, I let the matter go. I let time pass and let Mom forget, if she  would, that we had ever talked about it. After an hour or so, I’d mention it again, as if it were the first time: “Let’s go see Dr. Smith, Mom, and then we’ll go out to lunch!” If I thought it would help on that particular day, I’d tell Mom we were going to lunch without mentioning we’d stop at the doctor’s office first. If she said no again, I’d wait longer. Yes, sometimes it took hours to get her to cooperate, so I learned to make appointments later in the afternoon. And if Mom agreed to leave at 11:30 am for a 2:30 pm appointment, we left then. Better to be early than not get there at all. But sometimes we didn’t get there at all. I had no option: I’d simply have to call the doctor to say Mom wouldn’t come. But I found that giving Mom time to relax and forget her earlier refusal usually worked. We didn’t miss many appointments.

A key part of this strategy is making each attempt sound like it’s the first time you’ve talked about it, because for the one you’re caring for, it may seem as if that’s exactly the case. There’s no value in saying, “Mom, I know you don’t want to do this today, but we have to go to the doctor.” Instead, I could downplay the doctor and emphasize some new distraction. Or I could simply take her arm and lead her to the car with no explanation at all.

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I had to keep Mom safe. I hoped to keep her comfortable. I wanted to make her happy. But her “no” stopped me. Using the three strategies above, I found I could help Mom cooperate on the difficult days. Using them, I wasn’t fighting my mother; I was fighting Alzheimer’s. I didn’t raise my voice; that made things worse. I didn’t get physical—unless she was putting herself in danger. I just found some good ways to get done what had to be done.

Before we close, here’s an important note.

If your loved one is causing harm to herself or someone else, you can’t depend on distraction, surprise, or delay. You MUST be prepared to intervene. Consider now whether you’re able to handle such a situation yourself. If not, be prepared to summon help: get a commitment in advance from a neighbor, relative, or friend or call 911.

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Father, You are the source of all wisdom, strength, patience, and love. We trust You to light our way as we care for our loved ones. Please answer when we call for help and remind us we are never alone.

“Are not two sparrows sold for a copper coin? And not one of them falls to the ground apart from your Father’s will. But the very hairs of your head are all numbered. Do not fear therefore; you are of more value than many sparrows.”      (Matthew 10:29-31  NKJV)

 

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What If…?

The what-if’s of caring for a loved one with Alzheimer’s can defeat us before we even start to fight. They can be overcome—knowing the truth of that statement is the first step to victory—but defeating them requires action.

We’re all familiar with what-if’s. They pop up all the time, it seems. What if I get lost? What if I have a flat tire? What if I oversleep? What if…? What if…? What if…?

What if something bad happens?

Caring for a loved one with Alzheimer’s is difficult enough without entertaining the what-if’s. If you allow the Alzheimer’s what-if’s to get a foot in the door, they’ll suck all the air out of the room. Your caregiving creativity will faint from lack of oxygen and the confidence and determination that get you through your day will melt and run down your back like sweat.

Yes, it’s hard to escape fear. The extreme unpredictability that goes along with Alzheimer’s produces thoughts that can range from “What if Mom won’t get in the car to go to the doctor today?” to “What if I get sick? Really sick? Who’ll take care of Mom then?”

How do we turn those thoughts off? Well, we can’t just push them out of our heads. What we must do is replace them with other thoughts. In this case, we replace the negatives with positives, the doubts with certainties, the fears with strategies for action.

In short, we plan.

Plan. I know from experience that’s easy to say and hard to do. Deciding in advance what you’ll do in a particular situation is especially challenging when you’re dealing with a disease like Alzheimer’s. Symptoms vary widely. There’s no dependable time-line for progression of the disease. And each person experiences Alzheimer’s in an absolutely unique way. So where can a caregiver even begin to plan?

Actually, the starting point is simple to determine:

You start with what is. Right here, right now. Keeping your mind occupied with solving the challenges of the present can turn fearful thoughts into a feeling of accomplishment.

And don’t forget to watch for opportunities to laugh. Mom trying to chew with her dentures in upside down began as a mysterious problem and ended with laughter and a potato chip snack. Thinking and talking about good memories, short or long term memories, is better than imagining disasters.

For the larger questions and situations we anticipate will come up in the future, we engage in more formal planning. First determine the issues that must be planned for. Then study the information you find on the topic, talk to people who have knowledge and experience in each area, and come up with a list of options. Alzheimer’s caregiver support groups are an excellent source of information. You’ll meet people there who are facing or have already faced the situations you’re planning for. You’ll find candid discussions, information based on personal experience, practical advice and suggestions. In addition, there will be a trained group leader who can direct you to even more helpful resources.

Perhaps you’ll be able to rank the options in order of your preference, perhaps even determine exactly what you think is best to do. But at the very least, when the issue comes up and it’s time to take action, you’ll have a list of options.

Information is the best defense against the what-if’s. In the weeks ahead, I’ll be writing about some of the issues I faced as my mom’s disease progressed, things like the extra complications Alzheimer’s adds to other illnesses, legal documents you may need, the decision on if and when it’s time to consider admitting your loved one to a professional care facility, hospice considerations.  Listing those subjects here makes them seem cold and clinical and clear-cut. They are none of those things—instead, they’re intimate and emotional and confusing. But as you think about them, and as you read and hear how others in your position have dealt with them, you’ll find yourself putting your own head and heart into your own personal caregiving journey. The panicky “What-if’s” will give way to deliberate consideration of wise options for the one you love and care for.    

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How long must I wrestle with my thoughts and day after day have sorrow in my heart? But I trust in your unfailing love; my heart rejoices in your salvation.  I will sing the Lord’s praise, for he has been good to me.  (Ps. 13:2,5-6 NKJV)

Dear God, time is your creation. Protect us as we travel through it, holding tight to the hands and hearts of those we care for. Protect us from fear and doubt and panic.  Remind us of your unfailing love–help us revisit the many, many times you have held us up and helped us move forward. Give us Your wisdom to see what matters, deal with what is, and plan for what will be. In Jesus’ sweet name we pray. Amen.

 

 

 

 

 

 

Tissues in Your Pocket

Most Alzheimer’s caregivers realize early on that we have little control over what any day will bring. Planning each day in advance may give us a sense of control, but so much of Alzheimer’s is unpredictable. Based on my experience, caregivers spend at least as much time reacting as acting.

One of my mom’s major goals in life was to be prepared for anything that might happen to her or her family. I remember her purse was both tool box and first aid kit, containing a screwdriver, bandages, string, scissors, various nuts and bolts she had found on streets and sidewalks—once I even saw a fish stringer in there. But the things we used most often were the tissues she always carried. She stuffed her already bulging purse with them and stashed them in every pocket on any piece of clothing she wore, “just in case.”

“Just in case.” That phrase covers a lot of territory for caregivers. We can’t predict what might happen in the next few minutes, much less the next few hours. But…unpredictable doesn’t have to mean unprepared.

For caregivers, being prepared is a state of mind.

I wish I had seen that truth earlier. Instead, of all the emotions that rolled over me during my first weeks of caring for Mom, fear was predominant.

Fear hung around long after shock left. I spent only a couple of weeks being surprised at things like Mom putting Dad’s shoes in the trash, or telling me how lovely the artificial flowers smelled at the grocery store, or accusing the neighbors of peeking into the windows. I soon learned such things were simply to be expected.

Anger lasted longer. I was angry at the disease, at my father for hiding it for so long, at myself for missing the signs, and, yes, sometimes at my mother who often seemed to enjoy the chaos she created. But after a while, anger became a motivator. My frustrations prodded me to look harder for cause and effect relationships I could use to smooth the rough road we traveled each day.

For example: I learned I didn’t always have to explain to Mom what I was going to do. Announcing I was about to brush her hair or help with her shoes often resulted in a barrage of “No’s,” maybe because she felt I was telling her what to do. So I began to say less and simply do what had to be done. When my actions were a surprise to Mom, it took a minute or two for her to puzzle them out. By that time the job was usually finished. Using the disease against itself lessened my anger and fueled my confidence.

Still, fear of catastrophe stuck around for a long time. I was afraid the time would come when I couldn’t control Mom’s anger and she or someone else would get hurt. Would I be able to get her to take her medications every day? What if I couldn’t make her get into the car? Or out of it?

Adding to the pressure of my fear was the feeling I absolutely had to make things work. I had stepped into caregiving of my own accord. No one asked me to. Dad couldn’t do it alone, and he refused to allow a nurse or professional into their home. So, ignorant of what I would be facing, I just jumped in. But after only a few weeks, I began to question whether I could manage Alzheimer’s alone. I started each day with dread, praying for help, praying for a miracle.

And you know what? Miracles came. Not the sudden cure I hoped for, but miracles nonetheless. Little ones I almost didn’t notice at first, like a close-in parking space when we were running late to an appointment. There were big ones, too, huge ones like the doctor who finally found that Alzheimer’s wasn’t the only danger Mom faced: He diagnosed her severe depression and prescribed the medication that gave her, for a while, more good days than bad.

In fact, so many miracles came my way, I began to expect them. On some otherwise-impossible days, Mom would at least agree to take her meds. When we were out of the house, I realized people seemed to sense her instability. I learned how to steer her away from situations that, I knew from experience, might provoke her anger. If she refused to get in the car, I postponed the errands and rescheduled the doctor’s appointments. If she refused to get out, I sat with her until she got tired of saying no.

Although some of the solutions worked pretty reliably over time, I knew no amount of advance planning could ever address the daily challenges of Alzheimer’s. But I was freed from paralyzing fear because I began to expect an answer in difficult situations. And because my trust was based, not on my power, but on the power and faithfulness of God, I stopped imagining disaster. Because I believed  the Giver of all good gifts, the Maker of all miracles,was on my side, I could think more quickly and clearly, come up with a way, find one more miracle.

As the Alzheimer’s progressed, Mom continued to pick up her tissues and put them in the pockets of the old green cardigan she wore every day. I took a few out every now and then, secretly of course, so she’d have room to add more. The day came, though, when it no longer occurred to her to pick them up. So Dad and I did it for her. Putting a fresh tissue, carefully folded, into her sweater pocket made us feel a bit more powerful in the face of Alzheimer’s. “Now, Mama,” I’d say. “Now we’re ready for anything.”

For me, the miracles that carried us down the rocky roads of Alzheimer’s are like tissues I saved in the pocket of my spirit. There were so many problems, but so many more miracles. And each problem solved was a promise of more solutions to come.

I pray you fill your own pockets with confidence. Begin to expect miracles. Watch for them. And in the hardest times, remember the ones God has already sent. Each one carries His assurance: He is with you, to help you. He will never leave you alone.

With a pocket full of faith, we’re ready for anything.

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You will not need to fight in this battle. Position yourselves, stand still and see the salvation of the Lord, who is with you….Do not fear or be dismayed… for the Lord is with you.     (2 Chronicles 20:17   NKJV)

Loving Father, we know You are on our side. We know You can do all things. We know You want us to come to You with our fears and our needs. Thank You for fighting on our behalf. Even in the face of Alzheimer’s, Your constant love casts out our fear.

 

Parenting Our Parents

An incident I witnessed on a vacation many years ago continues to shine a light on one of the hardest tasks of caregiving.

During our hike through a national park, our family stopped in a picnic area to have lunch. As I made sandwiches for my three young sons, I could hear wails from the picnic table next to ours.

“But Mom, it’s my money.” The little boy’s face was red; his eyes were swollen.

An older girl and another boy, siblings, I’m sure, looked almost as sad. They watched the mom as she said, “John, I know you worked hard for this money. But you aren’t taking good enough care of it. If I hadn’t seen it and picked it up, your allowance would still be back there on the counter in the gift shop. You can spend it, but I’ll carry it with me.”

I tried not to stare, but I couldn’t escape hearing John’s next plea: “But Mom! I’m old enough! I’ll do better. Please?”

“Johnny,” his mom answered, and I’m pretty sure I heard tears in her voice, too, “I don’t want you to lose everything you worked for. If you lose it, all of us will be unhappy. I’ll take care of it for you.”

I remember how sorry I felt for Johnny. But I hurt for his mom as well. We want so much to make our children happy, but there are times when we just can’t. Sometimes we have to say no.

Since my children are grown now and have children of their own, I thought I was free from having to make those hard choices. I was mistaken. Like many caregivers, I had to step back into the parenting role again.

Parenting my parents.

Mom was in her sixties when Dad realized she could no longer balance the checkbook. Mom had always paid the bills; Dad took over that job, too. As pots and pans were scorched on the stove because Mom forgot about them, Dad became the cook. When he ran out of clean clothes, he started doing laundry. They went to the grocery store together; Dad did the shopping while Mom wandered up and down the aisles, stopping to look at greeting cards or artificial flowers or bars of soap.

Dad kept these changes to himself for as long as he could, but eventually Mom’s behavior became so bizarre it could no longer be hidden.

“Why didn’t you tell me, Dad?” I asked after one of Mom’s harder days.

“Now Katrinka, I wasn’t hiding anything. I figured your mama just wasn’t interested in her old routines anymore.”

Balderdash. You don’t raise your children or your parents without coming to know them inside and out. And I know that, inside, Dad was 1) afraid of the possibility Mom was ill, and 2) determined that if she was ill, he would keep their home running just as it always had. “Normal.” That’s what he wanted. The two of them living in the pink brick house, taking care of each other, as they had ever since they were married.

While they did stay in their home, “normal” became me spending my days with them in the pink brick house. At first I helped Dad take care of Mom. Later on, when macular degeneration rendered Dad almost blind, I found myself more often in the role of parent, mainly to Mom, but sometimes to both of them.

Remember when you put things like scissors and knives and matches away, out of sight and out of reach of your children? That’s one of the first things I did when I discovered Mom had Alzheimer’s. I hid anything I could imagine might cause her harm if she used it incorrectly.

And that was just the beginning.

Dad and I had to watch closely to make sure Mom didn’t turn on the range or other appliances. Once I found her using one of Dad’s screwdrivers to open a package of paper table napkins, so the tools were moved to a safer place. We no longer left Mom at home alone, even when she insisted she’d “be fine.” She would sit right where she was, she said, while I drove Dad to the bank or the post office. But I had to say no; Mom had to come with us. She didn’t cry like little John did. She became angry, shouting and waving her arms. We’d wait, ask her later if she’d like to go for a ride, and sometimes she said yes. When she said no, Dad and I postponed our errand.

Out of desperation, sometimes I treated Mom as I had treated my sons when they were children. I often bribed her with ice cream or lunch at her favorite café if she’d go to the doctor with us first. Sometimes I made up stories about the magical powers she would gain by taking the medications she didn’t want to take.

Like Johnny’s mother, I knew I had to take charge. Certainly Mom, and often Dad, too, simply weren’t capable of using good judgment when making choices and decisions. Mom, of course, was impaired by Alzheimer’s.

Dad’s judgment was impaired by his love for Mom.

The no’s to Dad were always hardest. No, it wasn’t a good idea to plan a big party at a restaurant for Mom’s birthday. No, taking Mom camping “one last time” in their bright yellow tent might be fun for him, but not for her. No, I didn’t think it was wise to take a long trip in their travel trailer. No. No. No.

Like Johnny, Dad made promises. He promised to ask people to be quiet at the party. He would gladly pat Mom’s back ‘til she fell asleep in the tent. He was sure she’d love a trip in the trailer, but if she asked to come home, he’d bring her home, right away. He promised to tell me when he couldn’t see well enough to drive.

From Dad’s perspective, I’m sure it didn’t seem too much to ask for simple, normal life. How I wanted to give him just that! And I tried. But from my perspective, it was a struggle to maintain whatever modicum of normal we could hold on to.

Of course, Alzheimer’s was the problem. Both Dad and I tried to say no to Alzheimer’s. Neither of us was successful…except in one regard: somehow we managed to say no to the disease stealing all our joy. Specifically, I kept my eyes and ears and heart alert for the occasions when life felt like old times. I made sure Dad noticed on mornings when the three of us sat at breakfast with toast and tea. I rejoiced openly when we arrived home from the store and Dad and I put away groceries with Mom telling us what to put where. I prayed with gratitude as my husband and I watched Gunsmoke with my parents: Mom asking the name of each character, Dad answering her and then offering everyone something to drink.

Normal.

As I held on to as many of the routines as I could, I also held on to my temper. Usually I was able to resist the frustrated tone that tried to creep into my voice; instead, I held on to the respectful attitude I had learned from my parents. There was no question in my mind that each of them deserved my respect as much at this time of their lives as they ever had.

Easy? No. Whoever said, “The hardest thing about everyday life is that it’s every day” spoke truly. And most caregivers recognize the words as an extreme understatement.

But let’s also be sure to recognize the bigger truth of caregiving:
As we work to preserve what we can of the “normal” life of the past, we’re also safeguarding—in the present—something even more precious: our loved ones’ dignity.

Children, obey your parents in the Lord, for this is right.  “Honor your father and mother,” which is the first commandment with promise: “that it may be well with you and you may live long on the earth.”   (Eph. 6:1-3 NKJV)

Father, help us to be patient with those we care for as You, Father, are patient with us.

Time — You Have to Take It!

If you’re an Alzheimer’s caregiver, you know that even well-established routines eventually go by the wayside. And we have to let them go. Fighting to make our loved ones comply with a schedule they no longer remember or understand is upsetting to everyone involved, and usually futile.

So how do we help those we care for meet the necessities of life? We develop a different mindset: a watch-for-the-opportunity mindset and a seize-the-opportunity approach to caregiving. Eating, drinking, bathing, dressing, even visits to the bathroom—we‘ll find we have a sort of radar that tells us, “Now’s the time. Go for it!”

I like schedules. I get that from my mother. In our house, there was a set time to go to bed and a time to wake up. A time to get dressed and a time to leave for school. A time to come home and a time to do homework. A time to eat and a time to refrain from eating. There was no time for snacking, sleeping late on weekends, watching “silly” shows on television, or talking on the phone. On Wednesdays, you changed the sheets on your bed. Groceries were purchased on Fridays. Though you took a bath every day, or rather, every night, just before you brushed your teeth and went to bed, you washed your hair only once a week, on Saturday afternoons.

No wonder I like routines. My time was meted out to me so carefully, without a schedule I wouldn’t have known how to spend it.

But caregiving changed my perception of time.

While those in the early stages of Alzheimer’s often respond well to a predictable schedule, Mom didn’t. The disease quickly erased all her lists and plans. It took away her expectations and left her with confusion about what was going on and fear of what might happen next.

I could have insisted we adhere to our agenda and occasionally she might cooperate. But, for example, if she refused to eat at breakfast time, should I deny her food until lunch? That might have satisfied my desire for order and routine, but it would not have met her needs. So I stopped insisting and improvised instead. Dad and I ate in front of Mom in hopes it would make her hungry. I offered—and by offered I mean prepared and placed in front of her—non-traditional breakfast items, like a meatloaf sandwich or mashed potatoes and gravy. If she still refused to eat, I put the food away and waited for the next promising opportunity.

That’s the key: be ready for the next opportunity. When it comes, don’t demand. Offer.

Experience taught me there would be another chance to get Mom to cooperate. Most days, her moods were as changeable as Texas weather: it might be cold and dreary in the morning, warm and sunny a couple of hours into the day, and cloudy and cool at bedtime. So I waited for a change of mood. How did I know, for example, she might consent to eat? I watched for her to be restless. When she began looking around as though searching for something, I offered food. Maybe she’d eat “breakfast” just before noon, and “lunch” just after. But all that mattered is that she ate and felt well. It made no serious difference whether she took a bath twice a month or once in two months; as long as she was clean enough to be healthy and comfortable, we were fine.

In general, the time to wake up was when Mom woke. The time to dress was when she would allow herself to be dressed. The time to eat was when she was hungry, or when she saw some delectable dish—potato chips or ice cream or tomatoes—she wanted.

I recommend that, when watching the clock doesn’t work, watch the cues you receive from your loved one instead. You may find you have to make your offers many times, but eventually you—and your loved one—will succeed.

One more point, as important as any in this blog: be sure to take your time. When you have a break in caregiving, don’t spend the free time cleaning or catching up on work. Instead, do something you enjoy—read or listen to music or talk on the phone with a friend. Even better, have a friend or volunteer come spend a morning or afternoon with your loved one so you’re completely free to follow your own pursuits. Even a break of an hour or so will allow you to get outside, take a walk, breathe more freely.  Scheduled or unscheduled, free time is tonic for caregivers. Claim as much of it as you can.

Let the notion of time change as it must. If you work with it, not against it, you will free yourself and the one you care for from its demands and, instead, indulge its possibilities.

What time I am afraid, I will trust in thee.  In God I will praise his word, in God I have put my trust….  (Ps. 56:3  KJV).

Father, we know that all time is in Your hands. Guide us to use it for the well-being of our loved ones and to Your glory. We trust You, all the time.