When Communicating is Difficult

02/09/2010

For a number of you reading this article who deal on a daily basis with caring for someone with dementia or on the autistic spectrum, it is preaching to the converted to say that communicating with the person that you care for can be difficult when the goalposts are constantly changing. For instance, when the here and now in the conversation alters from 1953 to 1976 in the blink of an eye, or when any form of communication at all can only take place when the other participant in the conversation needs to have their back to you and be involved in a complex and repetitive movement ritual before they can answer "yes" or "no" to a simple question, such as "Would you like something to eat?"

Carers working within a non-domestic environment have told us here at the Dignity in Care Team, on a number of occasions, that dealing with the comfort and wellbeing of service users with communication difficulties, whether through dementia or other conditions, can take some organisation. Dignity champions caring for a family member in a home environment have commented on the same thing - and added that in spite of what they had always been led to believe that there are days when familiar surroundings seem to be of no help at all. It stands to reason that if you are I can have days when we get out of the wrong side of bed feeling that we want to bite someone, that a service user or family member is not going to feel the need to hold back if they wake up feeling similarly inclined.

We all know that it is important to remember that a person with a medical condition which affects their perception of the here and now is still a unique and valuable individual in spite of their medical condition, and we have been told by our dignity champions that if you can make the effort to understand what the person is going through, it might be easier for you to realise why they behave in certain ways. This can, of course, take a while to work through and is something that can be challenging to keep on top of when you have a number of service users all seeking your attention at the same time. Even one person with challenging behaviour or perceptions can seem, at times, to be one person too many In a care home or daycentre setting, the good management of people and resources can solve many problems, whereas as a family carer in domestic surroundings, event with extra support, you are often on your own.

Good communication can be key. One team carer of an older lady with dementia tells the story of a difficult situation arising out of an apparent treat - the older lady had asked about having afternoon tea in the garden, and the carer had organised this for one Sunday afternoon when most of the other residents were relaxing or taking a nap, feeling that this would be a good time for her to be able to connect with the service user. Mayhem! Screaming, crying, overturned table , broken crockery, all of the other residents woken up and upset - this took days to put right. It turned out that the older lady, who most of the time exists mentally very comfortably in the early 1950s, was expecting the proper afternoon tea of the time with china tea service and cake stands, hats and gloves to be worn and her best dress put out for the occasion. To be led outside in her gardening clothes and cardigan and presented with tea in a beaker and a wilting sandwich on a paper serviette was, to put it bluntly, a nasty shock to the system. A bad result that was nobody's fault, just a situation that could have done with some thinking around.

The main problem can be that however well we know the people that we care for, just like everyone else a bad day can make a small problem into a larger one and in many cases for the people that we care for communicating any problems is not always easy on a good day. Dignity champions have discussed solutions to this problems that have worked for them - simple sign language, distraction, writing things down or sharing new aspects of a service users ritualised behaviour with the rest of a care team once these have been witnessed, but the general consensus of opinion appears to be that everyone that we care for is an individual with their own foibles and peculiarities, and sometimes when all other avenues of communication have been found to be ineffective the only solution is to continue to be sympathetic and wait it out until the person you care for is feeling more amenable.

And the tea party that never was? The carers and management of the residential home put their heads together, talked the problem out and went shopping at the local car boot sale. A china service with cake stands, tablecloth, flowered hats and white gloves were found for just a few pounds. The garden tea parties are now a regular occurrence in the garden in sunny weather or the conservatory when it is colder, with the older service user acting hostess when she is able, and quite a few of the staff and residents join in and dress up in their best clothes. Now that's what I call an effective solution arising from good communication.