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"Come on Dad, put your shoes on, we're going to be late!" The busy business
woman/daughter/caregiver exhorted her father as I eavesdropped from a distance.
The father glanced at her slyly from the corner of his eye as he continued to
fumble with his shoe. Exasperated, she bent down and swiftly tied the shoe. "OK,
Dad, pick your feet up, let's go!" Dad kept his feet firmly planted on the floor
in front of his wheelchair.
Noticing that I was watching, the daughter looked at me and stated
emphatically, "It's a control issue."
"Yup," I thought. "It's a control issue, all right. But who's controlling
who?"
Independence and Control in Caregiving
As caregivers, we often get caught up in what we think are the urgent needs
of the moment, and we lose sight of the fact that there are two people dancing
this caregiving waltz. One may be more "able" than the other, but both have the
very basic need to stay in control and independent. Where problems arise is when
my need to be in control as a caregiver gets in the way of my care recipient's
need to keep whatever control he or she might have left.
As humans, we are hard-wired to seek independence...or "autonomy," as the
psychologists like to call it. The toddler resists being put down for a nap. The
six-year-old shouts, "You're not the boss of me!!!" The adolescent counts the
days to "freedom." Each important independence milestone is hard-won.
Small wonder, then, that the octogenarian is not likely to relish losing a
lifetime of independence. Couple that need for independence with the obvious
fact that our care recipients are not completely independent any more, and you
have a recipe for resistance.
Now throw in the fact that we caregivers are often overwhelmed and strapped
for time. We're sometimes an impatient lot. The recipe for resistance just
doubled.
As caregivers, the most important thing for us to understand in this dance is
we're the ones who are going to have to make adjustments. And the biggest and
most difficult adjustment we're going to have to make is to SLOW DOWN. We'll get
there faster if we do.
Our older loved ones simply cannot move as quickly as we do. They may need a
few minutes to digest what we're asking them to do. If they have physical
issues, they then have to muster the energy to move. It may take a few minutes
to locate the sweater, or comb the hair. If the issue is dementia, it may be
difficult for our loved one to remember what we just asked them to do. Whatever
the reason, it takes longer to get things done when you're elderly and not in
the best of health.
Think about your own reaction when someone tries to rush you. Assuming the
house isn't on fire, I know that my immediate reaction will be to get irritated
and drag my feet. I don't like being "bossed around," and the old three-year-old
in me resurfaces. I'll skip the tantrum (most times), but I'll try to take back
control by going into slow motion. Usually I can recognize what I'm doing and
make a conscious decision whether I want to give in, or whether I want to push
back. Sometimes it just "happens," and that's when things can escalate.
Our care recipients often lack insight. They will react to the tension in our
voices, and the attitude of our bodies, even when they don't grasp why they are
reacting. It's our job as caregivers to learn what the triggers are for
resistance and to plan accordingly.
Expect that everything you do with your older loved one will take longer than
it "should." If it should take five minutes to get ready and out the door, plan
on a minimum of 20 minutes. If there isn't enough time for a slow march up to,
into, and back out of the shower, then skip the shower and use no-rinse body
wipes instead.
Try dancing a slow waltz instead of a jitterbug for a few weeks and see if
your elder doesn't seem to be less agitated and contrary. The Horse Whisperer
always made faster headway with the rebellious horse than the cowboy who tried
to break the horse into submission.
...Not that your elder is a horse, but you get my drift.