You Can’t Do That!
You can’t go outside without a coat, its 20 degrees out. Sit back down, you can’t walk with a broken hip. You can’t have a knife they are sharp you might cut yourself. You can’t walk by yourself, you might fall. You can’t get up yet it’s only 3:30 in the morning. You can’t wear these shoes, they aren’t safe. You can’t eat yet, its not time for lunch. You can’t go outside unless you have someone with you. You can’t take your clothes off, we are in the hallway. You can’t go in there, that’s not your room. You can’t, You Can’t, You CAN’T, YOU CAN’T . . . . . . . .
When I was a kid, I HATED being told “you can’t”. As a matter of fact, when I heard that it just made me want to do whatever it was I was told not to do even more. Just think if a kid, who hasn’t had the taste of freedom yet, doesn’t want to listen to the “you can’t”, imagine how an adult who has had years of freedom in decision-making doesn’t listen to the “you can’t”.
One facility I worked in had a gentleman admitted to our rehab unit. He had had a stroke. His speech was slurred and he had limited movement on his right side. He refused to work with therapy. He wouldn’t even let them eval him. I don’t like to go down and meet our new Residents until I’ve had the opportunity to look over their History and Physical. Therapy knew he was military and they knew I was military so they came and got me and told me I needed to get him to cooperate with therapy. He had admitted over the weekend and this was Monday. This was in the day and age of hard copy charts and I hadn’t been able to get a hold of his chart.
I went down to meet him. When I walked into his room, the tatoos on his right hand fingers immediately caught my attention. Then I noticed the tatoo on his right forarm. I immediately realized I was talking with a retired Marine. I introduced myself with my name and that I was a Navy vet. The Navy and Marines love to give each other a hard time. He turned his gaze my way, his eyes lit up and his stuck his left hand out to try and shake mine. I said you are a Marine aren’t you! A smile went across his face and he mumbled the words yes. The tatoos on his hands were those of a vietnam vet. We sat and talked and he was able to tell me he retired at 30 years. Then came the bombshell I was looking for. He spent 20 years as a drill sargent. That is as hard core as you can get. A 30 year retired Marine Corps Drill Sargent. This man was used to giving orders and people obeying immediately. He wasn’t going to be taking any orders, especially from some punt therapist.
After spending time with my brother-in-arms, I went back down to therapy. I explained to them that if you want him to work with you, then you are going to have to do things his way. You ask him to show you what he can do and then ask him how you can help him get moving again. The gentleman in charge of his case, promptly informed me that that’s not how it works. Therapy tells him what to do and he needs to do it. Because of course therapy knows best. This Marine was in our facility less than a week when family moved him to another facility that would work with him.
No one likes to be told what to do. Yes I understand that we need to make sure they are safe, but does it have to be so negative? I don’t think so. Let’s go back and review the “You can’t” statements. “You can’t go outside its too cold” Instead could we say “Before we go outside can we put on a coat first?” “You can’t have a knife” I understand knives are sharp, however our residents have probably been using a knife longer than most of us have been alive. My Mother-in-law had Alzheimer’s. She used to host all the holiday meals in her home. She would make enough food to feed the entire neighborhood for a week. I know because we ended up taking most of it home with us afterwards. When she got to the point she could no longer make the meals, we started hosting them in our home. We would pick her up and have her come over and help get everything prepared and cooked. One year at Christmas she asked if I had an elecric knife. I replied “Yes I do.” She asked if she could use it. She was going to cut up the ham. Without hesitation, I opened my cabinet and pulled out the electric knife and put the blades in and handed it to her. My husband nearly had a heart attack. He said “She can’t use that, She’ll cut herself.” Before he could even finish the statement, I gave him a look and then plugged the knife in. Guess what? Mom sliced that ham perfectly and there was no fingers lost or blood shed.
“Sit down” – Instead could we say – “Do you need help with something?” “Can I help you reach something?” So many times when someone is standing up their bottom hurts or they are just plain tired of sitting or they may even need to go to the bathroom. The older I get the less I like to sit for long periods of time. 30 minutes is about all I can handle before I start getting restless. I can always tell if Pastor has gone over the 30 minute limit. I start skirmming in my seat and I’m even taking notes on the sermon and can’t concentrate on what is being said. One gentleman we had in our facility hated being still. He had been active his whole life and never had time to sit down. Everyone kept telling him to sit back down. Finally staff came and got me. Activities can take care of him. I was working on my documentation. Since it was all paper and not digital I just took it with me and went and sat in the lobby with him. When he would get up, I would put my paperwork down and we would walk up and down the hallways. We repeated this about every 15 minutes for the next hour. I finally said I have to go get ready for an activity and help get others down to the activity room. He asked if he could help. I said sure and we walked up and down the halls inviting others to the activity and he even helped me push wheelchairs down the hall to the activity. He actually stayed for the entire activity for the first time. After the activity was over he helped get everyone back to their rooms. I thanked him for his help and for staying for the activity. He thanked me for allowing him to feel useful. The sad part is, he had been in our facility for 6 months and I was just now figuring this out. His behaviors were because we kept telling him to sit down instead of looking for something for him to do that gave him purpose in his life.
“You can’t get up, it’s only 3:30am” – We have people in our facility that have worked night shift their entire career. We are not going to change them. Why can’t they be up at 3:30am? And why can’t they get something to eat in the middle of the night. This is why we do an assessment. Our assessment should tell us their likes, dislikes and routines. We are supposed to be person centered care. I’ve gotten up in the middle of the night before because I couldn’t sleep or because I woke up hungry and went out to get something to eat. I’ve cleaned house in the middle of the night, read a book or even turned on the TV. Instead of saying go back to sleep or do you need a sleeping pill, we could say: are you hungry, do you have to go to the bathroom or would you like to come sit with me while I do some paperwork. One facility I worked in had some staffing challenges on third shift. Since I was a nurses aide and a department head, I was asked if I would be willing to help out. Since I wasn’t familiar with the routine of nights they gave me the “easy” job! I got to wash all the wheel-chairs. One of our night owl Residents were up wondering the halls. She asked if she could help me. (I did NOT need help). I said, “Sure, I never turn down help.” She helped by drying the chairs off after I had scrubbed them. She had worked night shift in a factory and just couldn’t seem to change her sleeping pattern. After that night, staff started having her do little things around the facility at night to give her purpose. This decreased her behaviors emencly.
“You can’t go in there” – Instead could we say “Can I help you look for something?, Are you looking for your room, it is over here.” Then help redirect them to another room. We had residents that would wonder in and out of others rooms. They loved to shop and they were shopping. Sometimes we had to let them take things and then return them after they sat them down or after they went to bed. Setting up a place, if possible, for your Residents to go shopping helps to decrease this behaviour. I have a friend that LOVES thrift stores. She has to stop at one every time she is out with friends. She even went out to eat and to the thrift store for her birthday. She will be that one resident going in and out of everyones room.
If you have worn heels your entire career, walking in flat shoes may just be a fall risk. One admission was a very well put together woman. She had been a business woman her entire career and didn’t even own flat shoes. When she moved in, her family was instructed to purchase more appropriate shoes. Now mind you, her heels were not the heels you are thinking. They had a thick base to them and not the pencil thin heel. She was not falling at home, as a matter of fact she got around great. The reason for her admission was Dementia, she was no long safe to be at home alone. Her clothes matched her shoes and her shoes matched her purse. The family brought in flat shoes and guess what? Yep, that’s right, she started having falls. She was falling over backwards. A therapy consult showed that the muscles in the back of her legs had shortened due to many years of wearing high heals. So for her to wear flats was a fall risk. Therapy suggested she keep wearing her high heals which in her case was much safter than flat shoes.
No one likes to be told “You Can’t Do THAT”. Changing how we respond to someone can change how they respond back. The next time you have a resident doing something you don’t want them to do, try changing your approach and what you say. After all this is their home and we are just visitors. Our responses, whether positive or negative, will determine how they respond back to us. Lets strive to respond positively in every situation we find ourselves in.
Tammy Point NAAP Leadership Team
