By Steven Mattingly
One of the most difficult tasks you face as an Executive
Director of an Assisted Living Community is talking with family members about
changes you and your staff see in their loved ones. It’s never easy for family members to see
the changes or as is more often the case, to process how the changes are
affecting their loved ones daily life.
I’ll give you an example from personal experience. All other members of my family are located
near our ancestral home in Kentucky. I
moved to California more than 15 years ago and as a result I didn’t see my
mother regularly the last 12 years she was alive. Unlike my siblings I didn’t get to enjoy her Sunday
fried chicken, watch her consistently lose at cards, or for the umpteenth time
ask “which hand are we on” in Shanghai (a rummy type card game). The image I instead saw during my semi-annual
visits was how much my mother was changing as she aged. When I tried to talk to my siblings about the
things that I saw they were always either surprised or defensive. I was the person who informed my younger
sister that our 80 year old mother could no longer safely provide free
childcare for her two children after school.
You can imagine how well that was received. I added a different and at times not welcomed
perspective to the family dynamics, not unlike what I often do with family
members of residents of our community.
Perhaps the most important role of an Executive Director and
his/her team is to be the objective viewpoint in the family dynamics that
envelope every single resident in a community.
I often tell family members that we are the people who now live with
their loved one 24/7/365. We are better
suited to know a resident needs because we see and experience the difficulties
their loved one encounters each day. Family
members sometimes tell me that their loved one saves all their complaints and
sad stories to share when they visit; I think that is not the case in most
instances. What our team most often
observes is the “gearing up” for the visit phenomenon. Residents, even those with advanced dementia,
go into a different functionality when loved ones visit. They are more engaged, more alert,
participate in the conversation more, and exhibit their “best” behavior when
families visit. What happens when the visit is over I describe
as the “crash”. Even residents
who normally have great coping skills when dealing with their daily challenges
experience, albeit small in some instances, some diminishing of their coping
skills. That’s when my staff sometimes
tells me “I wish their son/daughter/friend could be here now”. The implication is the family needs to see
and hear what they are experiencing after a visit.
A few years ago I worked with a family who adamantly
maintained that their mother was not incontinent and how could we charge them
for that level of care and the accompanying undergarments. After many rounds of discussion I finally in
a moment of great exasperation told the family fine, take Mother to live with
you for a week and if you don’t come back with an understanding that she is
incontinent, I’ll not charge you rent for a month. It took less than 24 hours and mother was
back in the community. As much as I
wanted to feel a sense of triumph I couldn’t.
What I had done was remove one more element of the dignity that Mother
had in the eyes of her children. It was
needed to make sure their mother got the care she needed and we were correctly
paid for providing that care, but it was hardly something that I saw as a victory
in any sense.
Many of you by now have realized that I often use my own
family to illustrate situations or problems.
I find it is often easier to talk with a family about a problem or
concern if you use a third party to illustrate the point. But I also think I use my own family stories
so that our resident’s families can know my empathy is real. I too have had to face a world with aging
parents.
Contributing author Steven Mattingly is the Executive Director of Pacifica Senior Living Assisted Living in San Leandro, CA.
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