JOAN’S BLOG – MON/TUE, FEBRUARY 8/9, 2010 – COMMUNICATION WORKSHOP – HELPING HEALTH CARE WORKERS UNDERSTAND OUR NEEDS

The issue of misunderstanding between caregivers, home health agencies and health aides involved in our spouses’ care has come up under a variety of different discussions on the message boards lately. I thought this was a good opportunity to present an on-line workshop (sorry, no video) on some of the causes and solutions to communication problems. This blog is a shortened version of one of the interactive workshops that I present at conferences and meetings. Today’s workshop deals only with in-home care. Out of home care is a different situation and separate discussion.

Communication is a tricky business. What we hear, process, and understand is often based upon our familial, educational, and philosophical history. If 100 people are in a room listening to the same speech by a politician, educator, health professional, or John Doe, a discussion after the speech by any number of those in the audience will yield exactly that many different interpretations.

This example is not meant to be political – you know I do not get into political discussions on this website, but I am using it because it is such a perfect example of communication based upon one’s history:

Mr. Any President since Harry Truman makes one simple, short statement: I want to reform Health Care. He says absolutely nothing else. Just that one statement. Based upon your political, family, job, medical, and personal experiences, you INTERPRET that statement to mean:

• I am Big Brother Government. I am going to make your health care decisions. I am going to decide whether you live or die. I am going to make you see the doctor I want you to see when I want you to see them. OR 

• Oh, how wonderful. The government is finally going to do something about the Insurance Industry. OR

• This is great. I love the idea of eliminating all insurance companies and letting the government run the show. OR 

• I will need to hear more information before I have any opinion. OR an unlimited list of other interpretations.

It is one statement. Everyone heard the same statement. Everyone interpreted it differently based upon their own personal history and philosophy.

This interpreting of information differently goes on every day in every industry as well as mundane common conversations among friends and colleagues.

Another important fact to remember about communication is that many people are not good listeners. Not only do they have their own agenda and ideas, but they may be distracted by problems and issues that have nothing to do with you. They may listen with “half an ear”, taking in only parts of what you are trying to convey.

That brings us to the conversations we have with health professionals with whom we are entrusting the care of our precious spouses, who cannot speak for themselves. When you are dealing with a Home Health Agency and the aide sent to your home, clear interpretation on both sides is absolutely necessary. This requires a bit of gumption on your part. I used to be meek, but circumstances have forced me to stand up for what my husband needs, and I am not shy about it.

Now the question becomes - how to practice your newfound bravery without appearing antagonistic, angry, or pushy. Having spent my entire adult life in one area or another of Communication Education has taught me a variety of methods of presenting unpleasant information in the best possible light. It has also taught me alternate sweet methods of implying – Do what I want or &%^*#@. Not that we would ever say that to someone with whom we are doing business, but…………….we may have wanted to. Here are some basic communication rules for dealing with the Case Manager in charge:

• Be friendly, honest, and indicate that YOU are the one who needs the assurance and help -“I am so worried about my husband/wife. I have been his/her only caregiver, and I need to make sure that the transition to someone new goes smoothly. We all need to be on the same page to ease my mind.” This should put the person with whom you are doing business in a “helpful”, rather than “defensive” mood, which would occur if you approached them in a more demanding manner. 

• Write down a Care Plan by making your own list of what you want done. Be firm, but make it seem as if YOU are the one who needs the Care Plan in order to keep things straight.

• Make it simple in list form. When it comes to communication, simple and short is best. 

• Go over it individually, face to face, point by point.

• Ask for the person to repeat it. Indicate that this is for YOUR benefit, so the person will not feel that you are being condescending. 

• Ask if they have any questions over what is expected, and alter the list together if necessary.

• Both of you sign it. 

When the home health aide assigned to your spouse comes to the house, have the Care Plan in hand, and go over it with them point by point, using the same pleasant communication strategies outlined above. Explain that you know that BOTH OF YOU are only concerned about the welfare of your spouse, and you want to make sure that YOU have it clear in your mind what is going to be done for him/her. Again, this takes away the person’s defensiveness, and puts them at ease. It does not appear that you are either antagonistic or clueless.

Since it is home health care, you have the option of staying home the first few times to make sure your spouse is being cared for properly. When you return, it should obvious by the demeanor and condition of your spouse if instructions have been followed properly.

If you notice any problems, talk to the aide first, and go over what you feel has not been done to your satisfaction. Follow the calm, polite rule. This will generally eliminate any angry antagonism on their part. Even if they do answer angrily, I have always found that returning angry with calm, polite, sweetness, takes the wind out of the angry sails. They can’t argue with someone who will not argue back. (Also works well with spouses who are arguing irrationally)

If the situation does not improve, call the case manager, and explain calmly which specific instructions are not being followed, and that your only desire is to resolve the situation.. Polite, polite, polite. The time worn adage – “You catch more flies with honey” is absolutely true in communication.

If the case manager does not resolve the situation, even termination can be achieved without rancor. Simply point out (politely and calmly – the two major communication buzz words) that since the plan is not being followed properly, you will have to cancel their services. Thank her/him for their time and service. Why bother being calm and polite when firing an agency? It will keep YOUR stress level down.

As I said in the beginning, this was a shortened, simple version of a longer, interactive workshop. It is, as always, personal advice based upon my professional experience. As is this website’s policy, it is not professional guidance or counsel.

In any case, I hope it has been helpful to you.

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