What Nurse Ingrid Tells Her New CNAs: Basic Lessons Regarding Our Seniors

From my perch at the homecare agency

From early on at the homecare agency I started back in the nineties, I cherished the enthusiasm that my younger nursing assistant recruits brought along upon entering the elder care field. To some degree, I reckoned that made up for some of their ill-conceived notions about our seniors.

As my agency grew, I realized that of our care recipients who were relatively young, say in their mid to late seventies, only a few were cognitively impaired. The problem was that all of them were on occasion treated with condescending attitudes. I would pull at my hair when I witnessed an elderly person being typecast as a daft and with nothing left to say that would be of interest to anyone.

“I would pull at my hair when I witnessed an elderly person being typecast as a daft and with nothing left to say that would be of interest to anyone.”

Because they had slowed down, people confused the natural aging process with cognitive impairment, which was an abomination. People would thus not give them the patience to express themselves fully, cutting them off in mid-stride, or displaying intolerant mannerisms and body language.

The Nature of Social Isolation

The result often was that perfectly intelligent individuals who were simply getting on in age clammed up, losing the necessary confidence to speak out, except perhaps when they were in the company of people who were of their own age group. Even their children who, by the way, were just as disposed to intolerance, frequently exhibited exasperated mindsets towards their elders.

By contrast, I was continually astounded at the number of seniors who, once shown some listening calm and patience, would regain their confidence and show zestfulness again.

And worse off were care recipients with short term or normal age-related memory loss. Unless a CNA was particularly savvy or trained for the task, caregivers commonly saw no difference between Alzheimer’s and normal age-related memory loss, with the result that the person with short term or normal age-related memory loss would not get a fair shake. What they got instead was a decline in their quality of life.

All humans require social interaction. Research shows that when elderly people experience social isolation, they are at risk for developing memory and cognitive problems, depression, and physical issues such as heart disease.

How Stigmatizing Stereotyping Can Be

My main concern, then and thereafter, has always been to pass on my learning to my caregivers. I remember saying to them repeatedly across time that people perform differently at older age, which is why it is important not to generalize.

I would give them examples of how stereotyping our seniors could cause them to carry a stigma akin to a heavy weight on their shoulders.

“We need never assume that because a person is advanced in age,” I heard myself saying only too frequently, “they must have illnesses or disabilities; we must instead learn to deal with each person on their own merit.”

I talked about how an older person who can socialize with ease, laugh out loud and get animated in pleasant company will thrive better than someone who is living in a shell, hardly ever daring to show excitement over anything. Remember this I would tell whoever was listening: “Laughter is the ultimate antidote to depression; encourage it whenever you can.”

Giving back the Gift of Self-confidence

I also observed how there would often be someone in the care recipient’s family who monopolized the conversation, whatever the topic. In some such situations, the older parent may end up feeling they don’t have a say on any matter, and they may –once again- clam up into a silent world. My CNAs would thus find themselves in the unhappy role of mediators.

I thus heard myself saying to my caregivers, perhaps hundreds of times, things like: “All it takes most of the time is to listen and give our elderly client time to fully express themselves.” Or, conversely, “slow down, then encourage them to speak to you at length. If they’re withdrawn, you can draw them back out. You can give them back the beautiful gift of self-confidence.”

“The person you are talking to,” I would highlight, “has a lifetime of experience and knowhow in areas that would dazzle you.”

Patients with Dementia

In addition, I was always anxious to teach some basics about patients with dementia. At first, I heard myself saying such rudimentary things as: “Patients with dementia should never be treated as children, nor thought of as imbeciles. When you start realizing that our seniors have personalities, feelings, and sensitivities, you will by nature become more compassionate; on the other hand, if you think of them as children, you will start looking down on them with hopelessness and disdain.”

In time those thoughts became more sophisticated, teaching specifically how to engage people with dementia. I resurrected a host of activities that they could conduct with their patients, emphasizing the importance of keeping the patient active, enjoying certain activities, and mentally and physically stimulated. “Try to get them to laugh out loud,” I would say, again and again.

Non-verbal and Body Language

Also, I explained that “speak” doesn’t mean verbally only. We speak with words, gestures, body language, and tone of voice. Even our eyes speak. We can be having a talk with an elderly client while maintaining respectful eye contact, or they can be talking to us while we remain watching TV.

Non-verbal language can be more important than verbal, or spoken, language. Although experts vary in the percentages or ratios of how much of our communication is verbal, most agree that over 50 percent is done by body language: facial expressions, gestures, eye contact, and touch. Even our tone of voice and how far we space ourselves from others can be significant.

We must always calibrate our “speaking” to pass gentle and caring messages to the ones we look after: sit up, lean forward, look them in the eye, show a friendly face and let them finish their thoughts, however long it takes.

People in the early stages of memory loss are hard enough on themselves without us piling on. Sometimes a simple word gets stuck somewhere in their minds, driving them nuts attempting to recall it. And when they fail, they clam up again –and they withdraw. Nothing is more frustrating to a perfectly healthy older person than not to be able to remember the name of their favorite news anchor, someone they watch every day.

Sometimes the recollection comes to them in seconds, other times not at all, and on those occasions, they torment themselves and incur yet more loss of self-confidence. When they can’t recall some item they ought to easily remember, it evokes in them a foreboding sense of mortality.

Dear Caregivers!

We see you at a client’s home, as you keep Mom fresh and well nourished, her nails manicured, her hair brushed, her demeanor calm and contented.

We see dozens of you in the living facilities, going from one hall to the other, from one room to the next, trying to dispense comfort here and there, trying to make life for others a little less painful, a little more dignified.

We know you well, and We see you everywhere. You keep humanity going. What would we do without you? What, without your passion and sacrifice, would become of those millions of us as, year after year, we age and become dependent?

There is a whole galaxy of things I want to say to you. I can try to condense them all with a little “thank you”, despite the fact that, in the face of your daily grind, that will sound jarred and empty. Still, we tip our hats off and pay tribute to you, our treasured and indispensable caregivers.

Yours,
Nurse Ingrid.