A Guide for Families

Family Questions: The First Thirty Days: Helping Your Loved Ones Adjust

Making Your Visits Count, And Visiting By Mail

Dad and I never did talk much, and now conversations are even harder. What can I talk about that won't make us both uncomfortable?

Often relatives and friends find it painfully difficult to visit a family member during the early days of his residency. They may feel it their “duty” to keep the conversation light and to avoid any discussion topics that might make everyone uncomfortable.

But talking about the “uncomfortable” things can be therapeutic for nursing facility residents - and for their family members. And if he can't talk frankly with you, his family member, who will he be able to “talk it out” with?

Knowing that you won't flinch from difficult issues might help your dad grapple with them all the sooner. You can help make your conversations more productive in other ways as well:

• Often conversations in the early days of residency revolve around the decision to admit the family member to the home. When discussing it, avoid loaded terms like “helpless” and “incompetent” terms that strike at the heart of your family member's self-concept. Instead, stress the more objective side of your case: “Your condition requires that you have 24-hour nursing care.”

• Use your conversation to lovingly motivate your family member. Saying, “You can't even get out of your wheelchair by yourself” is in essence saying he might as well give up. But if you know he can do better and you say, “After you can transfer from your wheelchair to a chair maybe we can plan an outing in the car,” you're inspiring him to achieve.

• Finally, remember that the most important part of any conversation is the time you spend listening. A relative who says, “I want to go home,” wants to feel that you care. Turning away from his honest expression of emotion because it makes you feel uncomfortable will only make further communication more difficult.

Instead, encourage him to talk about home and the things he misses. Then listen! Listen as you would to your boss or your spouse —carefully and patiently. Accept the fact that at first a lot of his conversation will cover the same ground over and over, but don't feel as though the conversation is pointless.

Realize, instead, that your family member is “working through” a major life change in the best way available to him, and he needs your help.

How can visits seem like they used to be at her home?

Geriatric care providers recognize that sometimes the best therapy in the world is a visit from a loved one. Unfortunately, visits can sometimes be an emotional challenge for family members - and instead of tackling the challenge, too often they give up altogether.

Successful visiting is like any other social skill - it can be improved upon with a little bit of work and some practice. The payoff will be more enjoyable visits for both you and your resident. Consider these tips for better visiting:

• Plan ahead. You can help avoid the “duty” visit by remembering why you used to visit your relative before she became a resident. Then fill the visit with similar activities. If you shared a passion for jigsaw puzzles, bring one along and help her get it started. If you're both big readers, start a book aloud that you can read a chapter out of each time you visit.

  Write letters for her, take her out to lunch, meet her new friends, or brag about the kids - with grade cards, photographs, school projects, and even videotapes to back you up! The possibilities are endless, but the point is to think ahead.

• Remember this is a visit to your family member's new home, not a hospital room. Fill the visit with things you felt comfortable doing before she entered the home. Touch, if it feels natural to do so, and talk as you used to. Take her for lunch and to the mall, or out to get her hair done. Ask your family member for a tour of the home. Don't feel pressured to entertain; instead, if she's able, let her be hostess to you.

• Don't fear reminiscing. Gerontologists are showing that such “life review” is an important adjustment mechanism that helps elderly people put their situation into perspective and deal with lingering conflicts.

• Remember you're an important link to the outside world. If she wants to gossip, then gossip. Keep her involved in the family, the community, and the church. Don't be afraid to seek the same amount of advice and comfort from her as you did before she moved into the home.

  Sometimes you'll have to let her vent her anger and frustration at the situation, and at her new limitations. But remember, you don't have to remedy the problem in order to be of some help, you just have to listen.

• Get to know the staff. These care providers are part of the extended family that constantly works to improve the overall quality of life for your loved one. Fill them in on your family's favorite stories about your resident, and about her personal idiosyncrasies, to help them understand her individual needs. Volunteer to help in the facility's group activities to get better acquainted.

My kids can sometimes be a handful. Should I bring them on visits or will they just wear Dad out?

Bring them. It's easy to underestimate the importance of a connection between children and elder family members, but studies show that the relationship between grandparent and grandchild is second only to that of parent and child.

For the elder person, grandparenting is an opportunity to satisfy a natural wish to continue in a family role. It allows him to pass on feelings and attitudes to another generation - to share what is important in his life with someone whose life is important to him.

• If your family member can communicate, let the child and family member play games like Tic-tac-toe or Hangman, simple card games, checkers or dominoes. Share coloring books and drawings. Think of games from your own childhood or, better yet, help your family member think of games from his childhood to share.

• Don't be concerned about the commotion that always accompanies kids. It can be a welcome change to the usually sedate home environment, and studies show that even unrelated elderly people enjoy seeing children at open parties or public activities.

• Encourage physical intimacy between children and elderly family members, particularly if the resident can't speak. Kids can tend to be bashful in this kind of situation, but model eye contact, hand-holding, back-rubbing and hugging for them. Simply holding a baby is often therapeutic for residents who can't interact well.

• Occasionally bring, or send ahead of time, a small gift for the family member to give to the child.

• If you have problems managing the visit, take only one child at a time. But allow enough time for a fruitful visit.

• If the resident is not actually your children's grandparent, show your appreciation for his willingness to take on the grandparenting role. If he is, reserve to him as many of the traditional rights and privileges of a grandparent as possible. For example, make sure that except for the immediate family, he's the first to see grade cards, dance costumes, etc.

• Be sure to visit on days that are special for the children, such as Halloween (in costume), the first day of school (in uniform), etc. It helps keep your family member involved in the children's lives. Try to continue or build new family traditions: “It's what we always do when we visit Grandpa.”

• Encourage older kids to pursue their so-called “living history,” in which older family members bring history alive by telling children their unique role in the public events of their lifetime. Encourage the elderly family member to open up by providing the child with questions like: What was it like learning in a one-room schoolhouse? What was the Depression? How did people get along? What was life like during World War II? You lived on a farm? You milked cows? Give adolescents a small recorder and plenty of tapes and start an oral history of your family.

Mom's nursing facility is two towns over and I can't always visit. Should I send mail?

Few things can brighten a resident's day more than receiving mail. Whether you use it to stay in touch with a family member between visits or to remember a distant family member you can't visit as often as you'd like, don't ignore these therapeutic benefits of regular letters and notes to your family member:

• Start small. A bright and cheerful greeting card can be as welcome as a long letter - sometimes better. A simple, short note is better than nothing; the importance of mail is the connection, not necessarily the content.

• Take note of special occasions like St. Valentine's Day, Mother's and Father's Days, holidays, family birthdays and anniversaries. Relay children's news regarding school, vacation, Scouts, and Little League.

• Since mail can double as decoration for your family member's room, select bright, colorful note cards, scenic postcards or page-a-day calendar classics that she'll enjoy seeing on her walls.

• Send photos featuring the activities and accomplishments of you and your family: show her your garden, the kids after a day at the beach, a newly decorated room, a pet, or your new hairstyle.

• Invite the kids to contribute a finger painting or a handmade card. Mail appropriate wall decorations to commemorate holidays. Send an envelope of colorful leaves in autumn.

• If your family member has moved from your community, clip the local newspaper for class reunions, school activities, engagements and births, local elections or other items of interest to her. If she has trouble reading the small print of the paper, recopy the stories in large print, or enlarge them on a copy machine. Don't forget gift subscriptions to her favorite magazine. (Some even have large-print editions.)

• Remember that it will often be a staff member who receives and directs your letter, so address it fully - including the family member's full name - and add your return address. Date the letter. Identify all people in photographs you send. When you mention people by name, include a brief reminder of who the person is.

• If you know your family member will be reading the letter himself, make it easy on his eyes. Print in large letters with a dark ink on light paper. If your family member is capable of writing in return, make sure she has a supply of stationery, pre-addressed envelopes and postage stamps - and don't forget that even postage stamps come in a huge variety now.