With Empathy and Dignity
by Caren Redlich
The fifth commandment states that we are obligated to honour our parents. This statement indicates a requirement for respect. Does it also include kindness, empathy and dignity? Absolutely. Even more. The term ‘honour’ refers to deeds that raise the status of parents or provide them with comfort, such as giving them food and drink, dressing them and escorting them (Rashi). We must acknowledge who our parents are, not do anything that might cause them to be disgraced or degraded, and serve them unselfishly, not for the sake of an inheritance or other ulterior motive. Anything else that brings them honour is required by this commandment (Ramban). This is the ideal. However, it’s not so simple for some adult children harbouring resentment towards their parents because of abuse and/or neglect. For them it’s a struggle to even speak to their parents, and sometimes they choose not to. No judgement is necessary because people are doing the best they can. However, if you grew up in a loving home and you know you were given everything you needed to be happy, then your desire to help will be there.
As parents age and become seniors, they may need help with various things. Housing changes, medical help, financial assistance and home health aide services are commonly needed by seniors. Nothing is simple as parents age and possibly develop health conditions or illnesses. One of the most complicated and stressful dilemmas is if one or both parents develop dementia. With this illness comes memory loss, agitation, frustration, anxiety and depression. It’s heartbreaking to watch this happen to a client, a friend or other non-family members, but when it’s your parent, and if they are in an advanced stage, you mourn. Not initially, because the beginning stages are mild. When it moves into the moderate-to-severe stages it’s very difficult to manage. The sooner dementia is diagnosed and treated, the better off the patient is. Medications, diet, exercise, support groups and socialisation make a big difference in cognition improvement. It’s important for the patient to be evaluated by a neurologist for a differential diagnosis. Is it Alzheimer’s disease or frontotemporal dementia? Vascular or Lewey Body dementia? A neurologist specialising in dementia can order the PET scan to evaluate so they get the correct diagnosis and treatment.
The Mayo Clinic recently published a magazine called Understanding Alzheimer’s. One of the articles in this publication reports about the Dementia Action Alliance, which is a non-profit national organisation of people living with dementia, family caregivers and friends. The goal of this organisation is to educate, advocate and, therefore, reduce the stigma associated with this illness. How can we preserve the dignity and well-being for a parent or grandparent with dementia? Here is the guidance quoted straight from the people who are part of this alliance:
1) I am a person. Know me and relate to me as a person with a unique background, life history, interests and capabilities. When you call me ‘patient’, ‘victim’, or ‘sufferer’, I feel minimised.
2) Understand that my autonomy, choices, dignity, reciprocal relationships, privacy and self-determination are fundamental to my well-being.
3) Support my holistic emotional, social, physical and spiritual dimensions.
4) Promote ways I can continue to experience personal growth and development through purpose, meaning, relationships and enjoyment in my daily life.
5) Recognise that my personal goals, measures of success and interests may change over time and may not be the same as yours.
6) Recognise that choices may have risks—a normal part of everyone’s life.
7) Partner with me, utilise my strengths and provide the right amount of support and opportunities I need to achieve my goals.
8) I am trying to communicate the best I can. Understand that my verbal and physical expressions are my way of communicating. I may say or do something I regret.
9) Understand that my personhood may be hidden but it is not lost.
10) Place my needs before tasks and understand that we need to work together at my pace.
11) Help me stay connected to what is important to me.
The Mayo Clinic emphasizes that ‘people with dementia can continue to live meaningful active lives and they shouldn’t stop doing what they enjoy. It’s important to continue usual activities, recognising that some adaptations may be needed. Many people in the earlier stages of dementia and even into the middle stages can learn new skills, routines and habits. There are treatments available that can help slow or manage symptoms. Some people living with dementia respond by seeking out new hobbies and interests while at the same time learning how to simplify.’
One of my long-term clients is a lovely woman who is over 90 years old and is suffering from Alzheimer’s disease. She has a loving family who are very supportive and who have allowed her to live with them for many years, even prior to her illness. Over time, it became apparent that she had developed dementia. They did everything they could to have her properly medically evaluated and treated. Her doctor prescribed the appropriate medications to help slow down the progression of the disease.
This amazing client of mine has been living with this illness for many years and has been in the end stage of it for quite a while now. With her, I observed a very slow process. She is a Holocaust survivor, and even though she was not able to have a higher education, she had a lot of cognitive reserves that kept her sharp and as on the ball as possible. During the later stages of her illness, she became aphasic, losing her ability to speak. Her family hired a speech therapist to work with her until she was able to speak very well again!
Dignified as she always was, her family certainly did everything they could to preserve her dignity and her life. They arranged for all the health services she had come to require and gave her all the love and attention she needed to have got to this point. They will keep giving her nachas till 120!
Caren is a Licensed Clinical Social Worker located in Rockland County, New York. In 1991 Caren graduated from Columbia University Graduate School and worked for various corporations, organisations, some of the NYC mayor’s offices, assisted-living facilities and an adult daycare. Caren has many years of experience providing individual and group therapy for women aged 18 to 90 years old. Some of the issues addressed are depression, anxiety, trauma, grief and loss, coping skills, elder care, chronic illness and stress management.
Currently, Caren is in private practice and has also developed a senior care business called Senior Direct LLC. In addition to psychotherapy, services offered to seniors and their adult children include home care aide referrals (placement and maintenance) and Alzheimer’s care consultations and recommendations for improving quality of life. Caren also teaches classes on fall prevention, avoiding depression and preventing cognitive decline. The classes are taught at assisted-living facilities, senior clubhouses and other senior residences.