Memory Care with Teresa Youngstrom
Dementia Support for Caregivers
[music] Take care partners. So glad you're here, Teresa Youngstrom, with a better approach to memory care. You know, how's your day going? This caregiving thing is so hard, and just want to take a minute and check in with you. I've always been a caregiver because I've been a nurse for a very long time, almost 40 years, and that part seems to come pretty easy for me, but caring for a family member, you know what? It's a whole 'nother level. So I just want to reach out to those of you that are doing that for a loved one that's a family member, especially if you live with that family member, wow. You know what? I just want to remind you that you've got to take care of you, got to get some help. You either have to bring help in or, you know, your loved one may have to go somewhere, and you care for them at a different capacity, but I just want to remind you that it is hard, and I feel for you, one of the hardest things I ever did in my life, okay? And so what you're feeling is normal, but you have to take care of you. You've got to get help, maybe the support group, maybe it's listening to my podcast, but either way, you just need to be around some people who care, bring in help, recruit some people to help you, okay, because that's a tough job. Today, I want to talk to you about just some great tips on caring for someone, things that I've learned over the years, and it's advice that I give out on a regular basis. So if we were to sit down around the kitchen table, these are some of the things you're going to hear from me, and if you've listened to any of my material, some of these things you've heard before, but maybe you really don't understand what I was talking about. So we're going to go over some things today, some tips and some things to help you care for that person who has brain failure. And you know, folks say, "Well, what if it's this diagnosis or that or this?" And I said, "Well, what it all comes down to, guys?" Yes, there are a chazillion diagnosis, and it seems like there's now an alteration of that type of diagnosis, good, but what it all comes down to is providing comfort measures, you know, symptom management and comfort care. That's what we do, and we join them on their journey. Don't think you can correct them and have them straighten up and walk the straight line in your world, because it just doesn't work like that. Remember it's brain failure? Did I say remember? I'm always telling you not to say that. But it's brain failure, it's unpredictable, it'll change. As soon as we think we've got them figured out it changes, right, because maybe today they're uncomfortable with something, maybe they ate too much at the holiday, all right. So here's the first tip for today, and you've heard this before, if you've heard me talk before. You got this, ready? Ready, ready, ready? Here it comes. Whoa! We're supposed to approach from the front, not the back, not the side. Why? Why do we approach from the front? Keep in mind that people that have brain failure typically lose peripheral vision, peripheral vision, my ability to see out here, that way you use when you're changing lanes in your car, peripheral vision, out here. Even with normal aging, we lose some peripheral vision, but guess what? When we get brain failure, it comes in almost a scuba mask. So you startle them by coming in from the side or from behind and throwing your arms around them, you get the dukes up, "Boy, you just messed up. I hate to tell you." And if you didn't know better, well, now you do, and we'll do it better next time. And just know that we're always learning new things, but we got to approach from the front. We don't touch somebody until they give us permission to. What's that? Yeah, we got to make sure that they're tracking with us. Oh, hey, Teresa, the nurse, it's so great to see you. So not only do we approach from the front, but we greet them from the front. Keep in mind, Mayo Clinic says your tone and your body language is even more important than the words that you use. Tone and body language. So check yourself at the door before you come in to see them and make sure you've got those particular things in check so that you can position yourself to win when it comes to an interaction with that loved one. It's about the relationship, and we want to keep the relationship great. You're startling them, catching them off guard, surprising, getting the dukes up. Listen, these folks, I don't know how, but they remember how we make them feel. They may not remember the words we use, "Oh, well." But they remember how we make them feel, and are you making them feel safe? Are you making them feel secure, happy, important, and like they have purpose? Those are great things. Let's remember to, say it one more time, approach from the front. All right. Next thing on my list. Here we go. Are you ready? All about you need to accept and agree. Accept and agree with who? Accept and agree with your person you're caring for, that loved one, whether it's someone where you work, maybe you're a caregiver at a retirement community, behavior unit. Maybe this is at your home, maybe you're coming in to visit mom, and maybe she's not making sense today, but you can accept and agree. You can just say, "Wow, I had no idea. I'm so glad you told me that." Did it hurt anything? I think the challenge comes, and what I saw in my family is that there were certain individuals, my dad in particular, who thought if he would accept and agree when she was saying things that were wrong and off the wall, that it was allowing her to be in a place where she wasn't making good, where she was wrong. He didn't want her to have this disease anyway, and so he frequently wanted to do a lot of explaining. What's that? I know we do too much explaining. Let's not do that. Let's just accept and agree and move on. If all you can say is, "Wow, I had no idea. I'm glad you told me." You know what? So great. You can say, "Oh, oh, oh, I meant to tell you, I've got new bird feed and your bird feeder. Let's go check this out or I've got new whatever to go outside and check something out." Did you see the new flowers coming up? We got to go check this out, and we redirect them back to something that brings them joy. Okay? We're not asking them to give us a dissertation. We're not asking them to write a paper on what the latest and greatest news is. You know, I hope you're not even sharing the news with them. There's nothing great in the news lately, and so they don't need to hear about that or see that. I've told you before that they are sort of like an easy target when we come in to unload our problems and challenges on because they're there. And for us to say, "Oh my gosh, this happened, that happened, then the other," and I've made those mistakes. Trust me, you are just learning from my mistakes. I've made those mistakes, and then later in conversation, heard someone telling me about all the problems in the world, and they were all related to what I had said to her when I got there. What a big, huge mistake. So I learned, and I didn't do that again, came in with giving them a moment of joy, okay? Reminding them how great it was to be there, and wow, those glasses look so great on you. I love when you wear those, and how can you give them a compliment, make them smile, maybe bring them a little bouquet of flowers, whatever it is, everyone's different. But you know how to bring them a moment of joy. And if they are forgetful, you can do that same moment of joy over and over. It's not rocket science, guys, it's not that hard. All right, so we're going to accept and agree, and we're going to approach from the front. All right, let's see what else I got up my sleeve today. What I brought for you, oh, we did that one, got to toss that one next. Oh, yeah, stop correcting. I know this can be hard, and you will catch yourself for a long time. But stop correcting, they can be wrong. It's okay. It's okay if they don't know who did what, or they're blaming you for something. Oh, I'm really sorry. Mama shouldn't have done that. So glad you let me know. Move on. It's not a big deal, but stop correcting. Maybe they are reaching for the wrong food off of someone else's plate, something like that. You know, sometimes we need to really look at their field of view. Think of them with their scuba mask on. What can they really see? And are they seeing you bring in their meal? Are you starting out here and bringing it down and setting it down so they can see where it is? You know, do you have everything on the same colored everything? You've learned so much about better dining habits for people that have visual challenges, physical challenges and memory type challenges, you know, to help them discern what's really on their plate, how to make food look enjoyable if they're on the puree diet. There's so many great things going on out there. So check it out. Check it out and see what else you can come up with. But I just hope that you will think about this one. And stop correcting them because in the long run, I mean, 98% of the time, it just doesn't matter. And we can let that go. All right. Let's see what's next brought with me what's that avoid yes, no questions. Wait a minute. Let me read that again. Avoid the yes, no questions. So important guys, because guess what? If I ask you, are you going to get out of bed today? No. Oh, well, it's hard for me to go on to the next part, isn't it? Because you've already told me and sounds like case closed. But if I come in and ask if you need 10 more, you know, would you like to get up now or in 10 more minutes and I give you that either or, or if I say, Hey, did you want the cereal for breakfast or can I make you some bacon and eggs? And how about we switch to the either or? And avoid those yes, no questions. This is a really, really, really important technique because you'll find yourself fighting with someone who's saying no, but you're asking the yes, no question. And I, I've just watched this in action. And what it appeared to be so many times for me is that that person, they seem to not really understand what I was asking, but they had learned that yes means you do stuff to me and no means you might leave me the heck alone. And they go for no, it's easy. No, no, no, no. Do you want an ice cream sunday? No, no. But if I come in with the ice cream sunday and I say, cherry, no cherry, cherry, no cherry, trust me, they're going to have a decision and they're going to probably want that. So how can we use either or, and again, something else that will take practice? It took me practice and you're going to catch yourself messing up on that one. It's okay. You know what? I'm ready to forgive you, takes practice, took practice for me, this old nurse to learn. I needed to learn so many things, but this is the next thing I want you to try and remember. Avoid the yes, no questions. All right, you can do it. Let's see. Here's a big one. Here we go. Here we go. Here we go. Questions, can we learn, can we learn to tell stories? What's that? Well, can we learn to tell stories? Because what I observed and caring for people over so many years is that when I'm telling a story or singing a song, especially if it's about the grandkids, if I know she loves dogs and cats, I'm telling them about a puppy or a cat and it's a happy story, not a sad story, always. It goes over so well than if I'm drilling you with questions. I sometimes get family members who talk to their loved one on the phone and the ones out of town, they don't see it up close like you do. You're caring for this person every day and so it's frustrating, isn't it? Because in their mind, mom's pretty good. I don't know what you're seeing. I had that in my life, but I do know, too, that the right side of our brain has an idle chitchat. So on the phone, they can be like, yeah, fine, fine, good, yeah, fine, you too, yep, take care and they have some idle chitchat in there and they can almost hit replay and it's that same type of thing. You start drilling with a lot of questions and they just might be ready to hang up the phone. They might just put the phone down. My gosh, I've seen that too. They're tired of you. You start asking too many questions, too many questions challenges me and I'll push back and it might make me angry, it might make me fearful, it might make me cry. I don't know, but we're probably not going to get along as well as if you told me a story about something that is so engaging. I love to tell my mom's stories about her raising me and things that she did. You've heard me tell you about how much I love when she braided my hair and that would make her smile. Did she remember it? Probably not, but it made her smile, but I wasn't asking her questions. I wasn't saying, do you remember, do you remember that time was probably 1970? Okay. No, no, no, no, no, no, no. Oh, mama, one of my favorite things that we did together growing up was when you would braid my hair. I loved that. I thought I was so special going to school with my hair braided because my mom could braid hair. Something fun like that. It would make her smile and honestly, she had trouble with short term, short term memory and so I could use that story again and again. She also loved for me to tell stories about puppies and kittens. My mom ran the Humane Society in my time when I was a kid in my childhood, loved puppies and kittens and would save so many animals. It was her mission and so you could tell stories about puppies and kittens and that would bring her joy to or show her pictures. I have to tell you guys, it got to the point where my mom had declined to the point where she was in the hospital bed. We needed a hoier lift to get her out of bed to put her in her wheelchair and we're talking bed baths and changing diapers. Okay. I know a lot of you aren't there, but that's where we got to that stage because it's always changing and you know, it's a chronic debilitating disease and the brain may stop working sooner but then eventually physical things we start noticing, don't we? And she didn't walk anymore, she couldn't bear weight after a while and we progressed to the point where being in the hoier, using the hoier. But changing the diaper with her, I'm telling you, if I would engage her in a story about the grandchildren, about my dog, oh my goodness, she was just on, she was locked on or sing a song with her. My mom never did sing in front of me, but I got to tell you, that hoier lift for some of you who don't know what that is, it's kind of like they come in different shapes and sizes. This one was a full length because she was a no, she couldn't bear weight at all. And so it was a canvas that was the length of like from her shoulders to her knees. And it had loops on each on the four corners like what would be by her shoulders and probably by her knees. And you would roll her over on her side, you would stretch that out under her, roll her back. And then the piece of equipment came over sorta like this big microphone piece of metal here. And it would extend over the bed, you would hook it to it and then pump it up and you would use it to then sit her in the wheelchair or into her chair. But I got to tell you, it frightened her immensely and she could get so furious. And then she's going to be furious for a while because, you know, you're inclined to just do it faster and press on and move her and get her over there and she's screaming. Now maybe she's cussing and things get a little out of hand, she could be swinging, okay? Because their brain understands fight, fight, flight, right and they're going to start swinging if they have to. This limbic system in their brain tells them to defend themselves and they will. And so what we learned is that if we sang to her during the Hoyer lift, she would lock on and be listening and I'm telling you what, next thing you know, she's easing down into her chair and she she didn't have a cow about it. She didn't get frightened because I was singing to her the whole time up, up and away in my beautiful, my beautiful bow. And she would say, "Lud," it was so great, she didn't sing, but she did. She would sing the end of that song with me. How cool was that? Music is an amazing tool, don't overlook that music, use it, it's got to be music they love. It's great if it's music from the past, we have a group from church we take out to different memory care and we sing, we're just called make a joyful noise. Anybody who wants to come can join us. And we go sing in memory care, but we only sing patriotic songs or holiday songs because they remember those. And it's amazing that they don't need the words to those songs, you know, they know the words to those songs, God bless America, you know, and sometimes you would have veterans who would stand up when we sang those patriotic songs, it was so amazing. And they would join us in those songs, it was good. So you song, definitely, if you need to, but tell stories, don't ask them questions. Mom, do you remember what day it is, Mom? What's your name? Mom, do you remember birthday? Mom, do you remember where this is? Do you know where this house is? Do you know who you're married to? Oh my God, you guys are missing it, missing it. You know what? Let the doctor ask the question. Our job is just to join them on their journey with this thing and love them along to the best of our ability and our ability to come alongside means wherever they are today. So if they're in a great place, you know, how cool is that? Introduce yourself, come on in and start working on that relationship. Pay them a compliment, okay? Sit down and visit for a while before you start all your tasks. That'd be a good thing. Maybe tell them a story as soon as you get there. Find the stories they love and use them again and again, not rocket science. I hope that that instruction is helpful to you. It was very helpful to me and singing with her during difficult things. You know what else is a difficult thing? I'm in toenails, yep. So as the nurse, I did do that. I trimmed her fingernails and toenails. And if I was singing to her during the toenails or telling a story, she would tolerate it so much better. But here's the thing, if they start to get uncomfortable or if they start to, you know, push back, pull away, things like that, well, then pause, pause and either get a better song or tell a better story. Go ahead and pause and then engage again and then say, oh, and then what happened, you know, this, that and the other, be animated, love them through that story and then see if you can go ahead and finish the job. But at any moment that they're not tolerating it, it's just like giving the back, there were some days that, you know, I did the face and hands, got the diaper changes, she was done with me. Well, okay, we're done. Guess what? It's personal care. It's one on one care. I can be done whenever. And we go on and get out to the breakfast table. You don't have to do the whole bath at one time if that person's not tolerating that. All right. So back to the board. It's about telling us stories, okay? Tell stories. Don't ask a ton of questions. Tell some stories. They will love you for it, okay? They will love you for it. All right, here we go. Next thing on my list, what's that? Say you're sorry. This one's vital. I'm gonna show you again. Say you're sorry. You know what guys, we can be, we can diffuse a lot of anger. If we would just humble ourselves and say, we're sorry, even when it's not your fault, I know it's probably not your fault. I was there, still there some days when I'm visiting individuals, all right? But if something I do upsets them, if I come in too fast, if I sit where I'm not supposed to, sometimes I'm just talking too fast. I like to talk and sometimes I'm talking too fast. I've told you before, we have to consider how many words they're using and then consider how many words we should use. So if they're only using three or four words to respond to you, pull it way back, pause more often, fewer words. Hi mom, good, not so good. I love you, okay? We can keep it simple. We don't have to give them an interrogation and we don't have to try and obtain all the information at one time. So we can hit pause, we can go slower, okay? We definitely should be saying we're sorry all the time, all the time. And I do know that sometimes you would come at me with, she would follow up my I'm sorry with and you should be sorry, that was pretty sorry what you did, okay? I really hadn't done anything, but if I had startled her or something, maybe I did deserve that. And I guess sometimes I sure did because sometimes I was impatient too, I'm human, you know, and trying to get on with her care. And but if I came in too fast, it, you're foiled, I mean, trust me, you are just making big mistakes and you're just going to make everything take longer. So hit the pause button, count to 10, give them a few minutes, maybe another compliment. It's got to be sincere though, what did I say, tone and body language? That's right. It's got to be sincere. If they see through you and you're just blow and smoke, trust me, you are not going to do well at this. And also guys, if you're not meant to be at that type of caregiver that gives physical care, that's okay. Did you hear me? I'll say it again. You want to be the physical caregiver, that's okay. That's when you're the manager, I guess, and you hire the people to give the care or you do all the research to find the better place to help take care of mom. And then you manage the care in a different way and you still can be the daughter or the son. That's okay. We are wired different. Thank God. We are wired different, okay? I have certain siblings who would manage the funds and finances, certain siblings who could order things, certain siblings who did this or that or the other managed the, cut the grass, got the firewood, did all those different things. Thank goodness. Thank goodness we're wired different. Pretty boring. We're all wired same. So that's okay. If you feel like Sundays, oh, I don't know how I can do this well. If it's time to, if it's time to look for, if you're considering whether it's time to move mom into a place, then chances are it's probably past time. Can I just tell you that? And I would start looking for someone to help you find the next best place. Someone who knows, there are companies that do that and they know where the best places are and why, right? So back to the board, but this is the next thing I want you to try and remember. Say, I'm sorry. I know, because here you are saying you're sorry for stuff you didn't do, didn't, you know, maybe, maybe you didn't do what she's accusing you of. And I'm asking you to say you're sorry. But guess what? Guys, best diffuser of their agitation is to go ahead, suck it up and say, I am so sorry that shouldn't have happened. What was I thinking? And just do it. All right. Just say, I am so sorry. That shouldn't have happened. And teach the people around you to say they're sorry. That bit of humility, I'm telling you, that's your secret weapon. When it comes to reconciling quickly with this person, remember it's about the relationship. And they remember how you make them feel. And so if for some reason you've upset them, whether it was something you did physically, maybe you stepped on the go, I am so sorry stuff happens, you guys, we're human. You know, maybe you came into a quick startle them, oh, man, dad, I am so sorry. What was I thinking? I didn't mean to upset you, you know? And I know what you're saying, well, what if they come back with, yes, you did. You do this all the time. You're so mean. Okay, suck it up again, probably, probably, I should have been talking about saying, I'm sorry a while ago, because they remember how you make them feel. It's about a relationship. And so if you've been finger wagging them and correcting and drilling them with questions and rah, rah, rah, okay, we've got to recreate this relationship, we're going to have to back up. We're going to have to apologize, we're going to have to say we're sorry. I am so sorry, okay, and see what we can do to reconcile that relationship. It'll be tough in the beginning if the relationship has been, you know, difficult, but I know you can do it. It's so important, so important, because it's the quickest thing to get them back on track and following with you. And you might even sit and visit for a while and start over, hey, it's so great to see you, you know, or there have been times when I have left and waited 15 minutes and come back and introduce myself all over again to visit and give them a compliment again and try again. And don't come in too fast, consider how many words you're using, use fewer words, maybe add some hand motions to this, you know, so then they're following along a little better. We never know when we come in, whether they're tracking with us or whether if they're in a different place and space and time, there have been times when I walked in and my mom is back in time and she's looking for her parents. Okay, so I'm not even on the record yet, and she's asking me questions about whether they're there or not. It's not time for me to drill her with questions. Somehow I have to join her on the journey and validate her position. Well, let me check the driveway. I'll see if they're here. That makes them feel so important that you are validating their concern. You're not correcting it. You're not belittling it. I've told you before, your parents have been gone along Ouch. Not only does that hurt, but you may have just sent them into a world of sadness because they don't remember hearing their parents are gone and, you know, the grief is overwhelming and they may blame you then, oh boy, so we're just headed down all the wrong path. So the best thing we can do when we come in, we assess what, you know, hey, mama, it's Teresa, the nurse, how are you? And sometimes she would know and sometimes she would just start drilling me with questions about her parents being there. And I would have to join her on the journey wherever it is, validate it, right, deescalate that, and then redirect her back to a happy place and start over there. This part, though, is your best friend. Say I'm sorry whenever they're just raised in an eyebrow at you. You know the look. You know the look we all know and you can't laugh like that. I was just that cracks me up to think sometimes the looks that I got when I was not on the right side of things or if I came in too fast or, you know, wanted to do something she wasn't loving. All right, so say you're sorry guys, you got this last time. Okay, last but not least, this is a really important one, but I don't talk about it enough, but I want to share it with you guys today. Here it is. I want you guys to be grace givers. What's that? What's a grace giver? Well, a grace giver is someone who's willing to let stuff go. Give them grace even when they're wrong. It's allowing people to be wrong and not holding a grudge, not getting a good mat over it. Letting it roll off your back. Things like that. Trust me, you'll be a happier person too if you're a grace giver. I work on that. I work on being a grace giver, work on not only being humble enough to say I'm sorry when it wasn't my fault and she may come at me with what it's all your fault. It's just you're just your fault and I might have to, you know, not just accept and agree. I'm sorry, mama. What was I thinking? You know, I'll just do better next time. You've taught me better than that. I'll do better next time and then make sure that the next time I come in, I don't have a chip on my shoulder for her coming at me when she was the one who was wrong anyway. Okay, because trust me, they can tell when you walk in the room if you've got a chip on your shoulder and here's something that's really important for caregivers, especially those of you who are out there doing a lot of care like you're the primary caregiver for this person because it's easy if they upset you and send you out of their room maybe with, you know, some with two cents, mama, mama, you know, hollering at you. That's all your fault. And then they're calling you, they hit the call light, whatever it is, if they're in a community and you're the caregiver and you come in, you know, sometimes we come in like this. Now what do you want? Okay, that's not being a grace giver. That's not letting it roll off your back. We really have to let things go, let it go, let it go. Don't worry about it anymore. I'm serious. You have to let it go and let it go far away. It'll eat you up otherwise. Okay. It's brain failure. Chances are they don't remember it and what are we doing, bringing it back up? Or this is another mistake that I can make like you had the whole house clean and everything. You just ran out for a short time and she's still able to be alone, but you come back and oh my goodness, she's been rooting around, rooting through things, throwing things around. Everything's a disaster. Like mom, what do you do? Gosh, you know what? If your interaction with her starts off like that or with him, you are in a world of problems because they're, all you're going to do is cause their fists to come up and they may send you away and oh my goodness, now you can't even give great care or clean up the mask or try and investigate what really happened. So when you walk in, like I said, stop outside the door and get yourself right. Race yourself. If you don't know what you're going to find in there, okay? But if you're coming into a lot of crisis like that, chances are they shouldn't be left alone, okay? Just a couple of two cents words of advice, but make sure that you notify your face. You're happy to be there, not in a dorky way. Make sure you're sincere and come in and then greet them no matter what it looks like, no matter what it smells like, no matter what. And so that they know first and foremost, you care, you love them, you care and pay them a compliment, even if things are kind of crazy, we can clean it up later. Their relationship is the most important things, guys, and so think about being a grace giver. I want you to work on that and about letting it go because you let this stuff build up on you, the stuff that they do, the mistakes that they make, it's going to be hard to go forward. It's going to be very hard because all you're going to see is their faults. How about you find their joy, how about sitting outside and enjoying the, maybe you have bird feeders around, maybe you have deer around, maybe you have, let's see, I don't know, maybe it's some picture book that they want to see, picture album or something, maybe you've got something on the computer that they can enjoy, pictures of something, an eagles nest, a hatching babies or whatever it is, music, maybe you put on their favorite songs and sing with them. We talked about that a little bit, music is an amazing tool, but make sure you're just not trying to give them tasks that are above their level of ability. I just don't want you to position them to fail, I want you to position them to win. Give them a task, they can simply do and feel like they have purpose, maybe they're helping you to make the biscuits and all they're doing is pouring the flour in, all right, but you just couldn't do it without them. I hope you're following my point there. So the last tip for today is to be a grace giver and let those problems go, let them go far from you, don't let them eat you up, don't let it eat them up, don't let them be any source of anger for them either. This caregiving thing is really hard guys and I know it's really hard and I hope that these words of advice today are helpful to you, hopefully you put them in practice and watch it a couple of times if you need to, be sure and like and subscribe and share it with someone. It's the only way we're going to get the word out there far and wide that there is help and there is hope with dementia care. It's not all Debbie Downer, it's not all, oh, they just get mean and you put them somewhere. That breaks my heart, it's not like that. There is a person in there if we can weed through what's going on with them and see the person that's inside there. Hopefully these tips today will help. I'm Teresa Youngstrom and just remember you got this. [Music] (upbeat music)