The Challenge of Moving Into to Aged Care - Navigating Aged Care Podcast Ep.2
Posted 31s May 2024
Written by Jesse Gramenz 
Facility Manager Mark Aros (left) and Clinical Psychologist Zoe Falster (right) on the Navigating Aged Care Podcast set
In this episode of St. Vincent's Care's Navigating Aged Care series, the hosts discuss the emotional challenges of transitioning a loved one into aged care.
They are joined by residents and their families, as well as aged care staff, a geriatrician, and a psychologist.
"It often can't be done with a single interaction. Sometimes as you said before, we're working through this professionally. We've got a certain outcome in mind, but we need to be prepared to give families and my patients people time to work through these really complex decisions."
Dr. Richard on families processing a potential move to aged care
The guests share their personal experiences and offer advice on coping with the emotional journey of moving a loved one into aged care. They discuss the importance of support networks, therapy, and maintaining healthy relationships during the transition. The experts also provide tips on navigating family dynamics, maintaining boundaries, and creating a comfortable and personalized environment in the aged care facility. Overall, the episode emphasizes the need for empathy, understanding, and self-care during this challenging time.
Hosted by: Nicole Lessio
Produced by: MSQUARE Productions
Episode 2 Transcript
Nicole:
Welcome to episode two of St. Vincent's Care's Navigating Aged Care series. I'm your host, Nicole sio, and in this episode we'll be hearing from our experts about the emotional challenges of transitioning a loved one into aged care. That transition is something that affects not just the person entering aged care, but their loved ones too. So balancing our personal emotions with their needs is crucial. We'll be joined by the true experts in the field, the residents and their families, as well as aged care staff, a geriatrician and a psychologist. We are happy to welcome Grace and Sheridan again for this discussion. Thanks for joining me, grace and Sheridan. Thank you for
Sheridan:
Having us. Yeah, thank you.
Nicole:
I know that Sheridan moving your mom into age care happened just after your dad passed away. No one trains you for that. No one trains you for navigating grief and navigating change and all the financial decisions that you have to make. How did you cope with that whole emotional journey?
Sheridan:
Am I allowed to say alcohol?
Nicole:
Absolutely.
Sheridan:
It was really difficult. It was, and I had love to be able to say, oh, it was easy, and I just make out. I'm some sort of superwoman, but the reality of it was it was difficult. I couldn't have done it without support. I have just the most amazing friends and I just don't even know what I would do without them. They were incredible through all of it. If it was just to listen or to help or do whatever I needed, they were great. Also, my children who to be fair aren't really little children, they were also just incredibly supportive and patient and all that sort of stuff. And I think without a support network of people, it would've been, I think, probably insurmountable in some respects. But we touched on, I also think, and I'm saying this because again, it's an advocacy thing and thinking it's so important.
I think without therapy, my therapist was instrumental in a lot of it because again, you've got now someone who's completely unbiased, impartial, and I'm paying him to just listen to me whinge for a solid hour, poor guy. But yeah, it was very, very difficult. And how I coped was you just have to, and you have to remind yourself that it's temporary, that if you keep plotting away through it, it will have a point in time where this will end. And if you can keep focused on that, this isn't forever. And that actually helped. Well, for me it did anyway. It was really, really helpful to know that this is a challenge right now, but it will end. And I knew that I was going to learn a lot from it and grow from it. So I knew there was a silver lining in there somewhere. Yeah,
Nicole:
Doesn't make it any less difficult.
Sheridan:
No, no, it does not. No, it was very, very difficult. And it's
Nicole:
Really important to acknowledge that, isn't it Grace? Obviously it's a huge change for you as well, but it's a huge change for your daughter who you still a good daughter. Exactly. Yeah. How did you navigate that whole process? It was a massive change for you.
Grace:
What happened to me, I disassociated myself from the whole thing and I just was on autopilot, so I just kept doing what you have to do. And then I think a couple of weeks in I really broke down. It had really hit home, and I think that was That's true. Pretty true, isn't it?
Nicole:
Yeah.
Grace:
So everybody handles grief in a different way, and that's just what happened to me.
Nicole:
And that whole emotional transition of the move compounded by the grief, it's a lot to cope with, isn't it?
Grace:
Yeah. I don't think I would've come out as good if I didn't have Sheridan and my whole family with me.
Nicole:
That support network is vital,
Grace:
Isn't it? My son had come over from Adelaide, he was there too, and to have just the kids around me, I couldn't have done it without them.
Nicole:
How did you maintain a healthy relationship between the two of you? Because you are grieving a husband, you are grieving a dad, you are moving into a new place. How did you maintain that relationship between the two of you? Grace,
Grace:
We just through honesty, this is how I feel and this is what it is, and yeah, just talking about it. Yeah,
Sheridan:
I think it was really good too that we established pretty decent boundaries too early on while mom was living with me, I explained to mom that it's not personal, but I still had my son who's 12 at the time, he was still at home, and it's still really important that I consider his needs and his feelings. It's also a huge change for him too. Suddenly nannies living in our house, Poppy's died. It was a lot for a kid too, and so mum was really respectful of our space. So often at night, we'd come home, we'd all have dinner together or whatever, but then him and I would go into my room and the door would be closed and we'd either do whatever he wanted, maybe just watch TV together, or we'd sit there and we'd talk and mum respected that. That was our time because it was really important for him to have just me or to himself. He didn't have to share me with Nanny or anyone else, and it gave him an outlet as well. And I think that was one of the boundaries that we established early on in the piece,
Grace:
And it worked
Nicole:
Clearly, which is great. The challenge of transition is that it is either feeling like it's going to be a loss of something or the potential of a gain. How do you see it as the gain that it has clearly become for you? Grace,
Grace:
I never envisaged. I'd be doing what I'm doing, and I suppose that's the biggest gain out of all of it. Not to be stuck in a room just reading, watching television. I've been very blessed to have found another section to my life. Yeah,
Nicole:
Yeah. It's a whole new
Grace:
Thing, doing something I absolutely love doing.
Nicole:
Yeah, because you're not just a resident, you're also a volunteer at St. Vincent's Care, but that gives you a really amazing insight into it's fabulous transitions that other people are making. What are some of the things that you are seeing new residents going through when they're first coming through the doors?
Grace:
I see them going through fear, going into the unknown, and I just feel like I want to step them through it step by step and contribute. That way. Maybe we can do more to help them by people like myself that have come into aged care and can talk to them. Yeah, maybe more can be done that way.
Nicole:
The wise guide?
Grace:
Yeah. Oh, well, not just me, other people that have gone through it,
Nicole:
Of course,
Grace:
Just to ease them into this situation that there is another life out there. This is not somewhere where you come and this is the end. This is a new beginning.
Nicole:
That idea of you being a butterfly, you've been in your coco and you get to come out is a fantastic one, but doesn't come easy,
Grace:
Does it? Doesn't come easy.
Nicole:
No. So at the times when you were feeling like it wasn't going to come, how did that feel for you? Grace? Terrible. Yeah.
Grace:
Dreadful.
Nicole:
Yeah.
Grace:
You feel lost, you feel? Yeah. It's a horrible feeling, but I think you either come out of it, you either give yourself a good shake and say, get on with it, or you give into it just depends on maybe the support you've got around me. And I was blessed. I had her right by my side through the whole thing.
Nicole:
That's a pretty intense situation to walk through though. Yeah. Isn't it Sheridan?
Sheridan:
Yeah, it is. And it is really hard to see the light at the end of the tunnel when you're stuck in the middle. And I'm sure I wasn't always the nicest person to be around just Was she grace
Grace:
Mom? No, she had to be. Well, that's who she was at the time, and I had to respect that because I wasn't much better. We were both, it was into the unknown and what do we both do? No one prepares you for it. No. Who prepares you for your loved one dying? Who prepares you for anything? So you do the best you can with what you've got,
Nicole:
And we should be prepared because we know it's inevitable.
Grace:
Inevitable, but we are not,
Nicole:
But we're not. So those emotions are always on the surface, aren't they? With us, and I think
Sheridan:
Because we'd never been through it before, you didn't go through it with really with your parents? No, and I'd never obviously gone through it, and I'd never seen you go through it with your parents, so there was no previous knowledge to even draw off. And even me talking to some of my friends, they've never been through it either, so they're like,
Nicole:
We're no help to you.
Sheridan:
But all they could do was the one thing you really did need was you needed someone to listen and to be heard. And I was fortunate that I did have that. So even when I wasn't being the nicest person, my best friend, she took me away for a weekend and I'm sure I was a punished that whole weekend, but God love her. She knew that I was in that head space and that level of patience and that is amazing and will always be greatly appreciated. And that's it. You just need to be patient with yourself and patient with people around you.
Nicole:
Is that the best advice you think Grace is?
Grace:
I think so. Again, I think it depends on if somebody's been ill for a long time, you can prepare yourself that little bit more with me and Sheridan. It was sudden it wasn't sort of something that you expect, but yeah, no, you can't prepare anybody, but you can be there for them, but you can't tell them I know how you feel, because no one knows how you feel. It's such a
Nicole:
Terrible platitude, isn't it?
Grace:
And so you can't even walk someone through it, but all you can do is say, I'm there. Yeah.
Nicole:
I think that is a brilliant piece of advice because you can't be in someone else's shoes. You don't know what they're going through, but you can be there for them. I think the gaining of wisdom and knowledge about the processes as well is really useful to be able to just give a little tip here and there if they need it. Do you think so Sharon?
Sheridan:
Definitely.
Nicole:
I really appreciate having this chat with you guys. I know it's an emotional time when you put someone, I'm using the language actually. That idea of putting someone in an care facility, does that weigh on your mind?
Sheridan:
Yeah, massively. Yeah, of course it does, because your wording was perfect actually. Literally how you think about it, you're like, pud, it's like dropping your dog off at a kennel almost. That's how it feels. You just feel like a jerk, but it shouldn't, but
Grace:
You don't, and that's why it should be given a nicer name. Maybe
Sheridan:
It just needs to be normalized. It needs to be normalized as a part of the human experience.
Nicole:
Yeah. You're moving in.
Grace:
I'm moving into a new residence and this is the name of it, something under those circumstances, not nursing home. No. As soon as you mentioned that people just are petrified
Nicole:
And we don't want to feel that terror, do we? No. I've loved getting to know both of you and finding out how you've navigated this entire time and the relationship that you have. I want to thank you so much. Thank you for joining me today, Sheridan. Thank you, grace. Pleasure. We've got our experts coming up to talk about emotional transitions in just a moment. Welcome back to our experts, mark and Zoe and Richard, thank you so much for joining us. It's a pleasure. We're talking about emotional transitions today, Richard. We rightly focus on the person who is moving into aged care and that is an emotional transition for them, but it's an emotional transition for the family members as well, isn't it?
Richard:
Yeah, look, it can be a really emotional one, particularly I think where someone has lived with another person and that person is now moving into residential care. It can represent a really significant change and sometimes it can feel like a loss I think when that person isn't living with you anymore. So it can be a really vulnerable time as I think we've heard in other episodes. There's lots of positive things about it as well, but you do have to be on the lookout for some of those more negative emotions at the same time.
Nicole:
Zoe, I'm going to get right into it. The guilt, that emotional transition for the people who are putting their loved one into aged care, there's a huge amount of guilt that's associated with that. How on earth do we navigate it?
Zoe:
Yeah, the guilt can be enormous and for some others this is not. So we think it's the first thing to recognize is it's highly variable and highly individualized to the relationship that you have. We often talk about two things in psychology. One of them is justified guilt and unjustified guilt, and it can be helpful to differentiate between the two things. Justified guilt is where there is something that we are responsible for that we have to do something to fix. And then the other one is I guess the guilt that we carry when we can see that someone is going through a really tricky tough time that we're not actually responsible for ourselves. So it can be helpful just differentiate between those two things. I think the other thing to think about when we think about any kind of negative emotion is why are we having it and what does it mean that we're having it?
Often strong emotions indicate strong relationships and strong feelings that we have for other people. So if we're feeling an enormous amount of guilt, it's a good indication that there's an enormous amount of care there as well. And it's not to say that if there's not an enormous amount of guilt, there's not care, but usually you wouldn't have the enormous feeling if there wasn't. Yeah, so just to take stock, I guess that feeling this is meaning something. It means that I do actually care about this. It does actually matter. And then I guess the question is, okay, well what do I do about it? What do I do with this big, enormous, uncomfortable feeling? I kind of talked a little bit in another episode about I guess the different reactions that we can have to guilt. Sometimes we run away from it, sometimes we overcompensate for it and everything in between. I think the really important thing is that this into aged care, it's really about the person going into aged care make it about them. So what does that person need? What can you do with your feelings to help them support them? And then where can you go to get support with your own feelings as well? So you may need to talk to some friends, some colleagues maybe even go get some therapy or counseling as well.
Nicole:
Yeah, it's an important thing to remember that while it is the person, that family support system is also going through a whole process of their own, so we are all in it together, I think is important to remember. Mark, for you, this is your, well for all three of you, this is your every day, this is your work. Every day you see people navigating these transitions. You see the emotions on everyone's faces, you see the relationships in front of you. It's not the same for all of us who are doing it once. Perhaps what makes for a really good transition then that you've seen?
Mark:
Firstly, I'd like to say Richard, and I think Zoe absolutely hit the nail on the head. The guilt is very real and it is because people genuinely care. But I think part of it is to succeed. I think you really need to allow the person to focus on why they're doing it in the first instance, why they're looking into residential care. And once you put a perspective on that, I think it's easy to navigate everything around and have plan your actions to get to the end goal and support the person coming in because they feel they will. Sometimes I got to tell you, sometimes a person coming into aged care will help the guilt along because they don't want to come into aged care. So I think you have to be objective about why you're doing this, and it is typically because you want the best outcome for the person. You couldn't provide their care at home, you couldn't support them, and you know that when they're coming to residential care, they'll be getting the assistance and the care and the environment to support the person to live a great life. Optimum life
Nicole:
Optimum. Absolutely. Richard, you would have some patients who come in with their family members and they would have quite emotional reactions to the advice perhaps that you might be giving them. How do you navigate that with that family dynamic?
Richard:
Yeah, look, it's often takes time. It often can't be done with a single interaction. Sometimes as you said before, we're working through this professionally. We've got a certain outcome in mind, but we need to be prepared to give families and my patients people time to work through these really complex decisions. Sometimes it's really helpful. I've seen for me as a doctor to take a level of responsibility for a decision might be in the person's best interests from a health perspective where families are feeling particularly burdened that they may be influencing the decision themselves. So I can say, for example, you've been having so many falls and there's no one around to be able to pick you up, and I can see your family are really worried about that and you are too. So because of your falls, not because of any failure on your part or anything else, it sounds like it makes sense for you to make this transition. So attributing it to a physical or a health course can sometimes be more palatable for people than something that is somehow outside of their control or in some ways their fault. So sometimes I'll adopt that approach. Other families will really want to have a much more collaborative approach and so that everyone's very much participating and not wanting to follow our medical or clinical lead when it comes to the decision. So for me, it's often about reading the play and picking the approach, picking the strategy in different situations.
Nicole:
That's a key point you make, Richard, that everyone is an individual. Isn't that right, mark?
Mark:
Absolutely. And can I just add to that and just being aware as a clinician or as a home manager, that these decisions are being made and there are really stressful times of people's lives, so sometimes you can think I'm communicating wonderfully, but it's not necessarily what the person's taken in, so you really need to check in and get them sometimes to repeat what you're saying just to ensure that what you're saying is getting across. Because I think there's a lot that's missed when you're under stress.
Nicole:
That's true, isn't it, Zoe?
Zoe:
Absolutely. I'm so glad you brought that up. Yeah, absolutely. And people will take from conversations what they want to take from conversations sometimes as wellsly. Absolutely. Right. And that can be for the person, it can be for their family, it can be for the clinicians as well. You're right. I think some of the things that really stand out for me in these conversations are the importance of empathy and validation. So really just giving everyone in the room the chance to reflect and recognize what's going on for them and just letting them know that that makes sense.
Nicole:
Yep. Because we often think we're the only people who have ever gone through anything, so it's important to understand that it's a fairly natural reaction to the things that are going on, isn't it? Yes.
Mark:
Yeah, and that's a true story though, isn't it? I'm the only mark that's going through this at the moment. Yeah, so I'm the only person, but it's important. Other people have gone through and have guided the process for others, and it's important for them to share that, but for that person, it's absolutely the first time and yeah, it's all new
Nicole:
And that's something that you have to be cognizant of, I imagine, mark, because you would use acronyms and you would use all sorts of offhand, sort of really shorthand for what you do and that person's going, I've never heard this before.
Mark:
I think health professionals are terribly guilty of that using, it's not intentional, it's just come so easy with any profession, but you're absolutely, absolutely right that we just have to be mindful to use language that sort of connects with a person and they understand. So we have to modify our messages sometime.
Nicole:
Yeah. Richard, do you find that in your practice that that kind of modification has to happen consistently?
Richard:
Yeah, I do. I mean it depends. So some people who have been around healthcare or perhaps even worked in health or aged care will have a really high degree of literacy around lots of these things and will feel patronized if you simplify things down too much. But others, it's a much more foreign area that they haven't worked in before. Just like if I'm talking to a friend of mine about his financial career, I'm going to need him to simplify things down. It's exactly the same in reverse, so I would be clear and use language and try not to use acronyms as much as you possibly can in that situation so that the message is more clearly conveyed. Because as you said, it's often an emotional time. There's often ill health and lots of family dynamics that can come into play with all these things, so keeping things really clear and an empathic, as Zoe describes is so important.
Nicole:
I really want to touch on that family dynamics aspect because often there is one person in the family that is in charge of making all the decisions and then everyone has to come along. Or if there's a great collaborative effort, then that's wonderful, but often it is that one person. How do you maintain the boundaries with the family as you're navigating this whole process? Zoe?
Zoe:
To be honest, I look to the person and what their preferences are. If they've indicated, well, first of all, if they've got capacity and they can make the decision in an informed way, they make the decision and we inform whoever they want us to inform. If there are issues of capacity, we do need to look for next of kin or an enduring guardian to help us make decisions. Again, it's what they've set up. So they may have chosen one person to act in that capacity, or they may have, they may have chosen a few people to act in serial, and it's just a matter of knowing what their preferences are, communicating appropriately and making sure everyone's on the same page.
Nicole:
What if they're not Zoe?
Zoe:
That happens quite a bit.
Nicole:
Yes. What happens then, mark? How does that manifest in the aged care facility?
Mark:
We have to have frank conversations that it's really when there are Australian family dynamics that really we need to put the person, we need to put the resident first and foremost. So any dynamics has to play out cooperation. We just have situations. Many are situations where we communicate with a family member and then they won't tell anyone else, and then we get conflicts and no one's informing me, and you go, but we've done that. So really we have to have frank conversations about what our expectations are as well, and the reasons are that it's for the benefit of the resident coming in,
Zoe:
And then when there is a lot of discord, it's often really helpful to go back to the core of why people care so much. And often when you've got, let's say, potentially siblings who have different perspectives on what's good for mom, if you talk to those people separately and understand at the core of what they want to do, they want what's best for mom, and then they can relate on that level and then hopefully reach a bit more of a compromised decision.
Nicole:
It's a hard one to navigate though, isn't it? Yeah. The transition into aged care is a really challenging one for everyone involved. Richard, what would you say are some of the best tips that you can give us that will help us navigate that with our parents?
Richard:
Look, I think some of the planning, if you can, in terms of the decision and taking some time over it and putting things in place so it doesn't have to happen in a hurried way is often a really good thing. And we talked about some of that in a previous episode. When someone's been unwell physically or mentally in the lead up to the moving into residential care, it's important to make sure that there's going to be some handover or continuity if you can, from the person in terms of the medical and nursing care that they're receiving as they're making that move. And then there's a whole range of different things that others will be able to talk to even more fluently than I, around creating an environment, bringing those things with the person that make them feel comfortable, being clear around what their preferences are with things like food and the environment and things that they do to occupy their time, activities, et cetera. And then maintaining that visiting so that the person isn't feeling like they're moving and that their world is completely turned upside down. So really maintaining that contact in the early stages and beyond of the transition into the residential aged care facility,
Nicole:
The bringing things with us. Mark, how important is that for that transition? How does that, I guess, cushion those emotions?
Mark:
I think it's incredibly important to bring items that familiarize you with the environment and give you a home-like environment, something you're familiar with and tie you back to what's important to you. So I think it's critical.
Nicole:
Makes sense. Zoe, from a psychological perspective, how does that help in that transition? It
Zoe:
Helps in a number of ways. So as you say, it's a way of bringing part of your history and your identity into the accommodation with you, which can be really nice. Just reminder for the person to reminisce on. It's a really great trigger for staff as well. When they walk into the room and they see a photo or they see a poster, they can then ask questions about that and they can start to connect with a person, which is really valuable. It can serve as a memory aid, it can serve as a way to help a person keep recognizing different people in the family a number of different ways.
Mark:
I think you're spot on, sort of gives you the backstory and sort of humanizes you and makes you a real person. A whole person tells you a story that you have grandchildren that you've worked, and I think it's a terrific idea to be able to do that.
Nicole:
That's really important, isn't it, Richard? To acknowledge that that person is a person with an entire backstory that you can acknowledge that in their care.
Richard:
Yeah, and it's interesting. The longer I work in this part of medicine, the more interested I am in the backstories of people alongside, of course the medical detail, but it's that person. It's what makes them the person inside the patient. I often say that makes them stick with you and really makes you really drawn to them and remembering that those details. The other thing I think is that whenever anyone moves into an environment where other people are like a hospital or a hotel or residential aged care facility, there's a fear that you are just another resident. You're just another client. And so if you can bring these items with you that express your identity and allow people to understand that and see you, I think it makes you feel like an individual still. As Mark described, I think it's critical.
Nicole:
Yeah, Zoe, that is a fear though, isn't it? That we're just going to be another number.
Zoe:
Yeah, it can be.
Nicole:
How do we mitigate that?
Zoe:
Well, I think it's about bringing your genuine self with you and being willing, I guess, to share that with the people around you as much as possible. Not being the lady in room nine 17, but actually having a personality, having an identity, putting that forward.
Nicole:
Can families help in that as well when you're transitioning in?
Zoe:
Yeah, I think families can go a long way in just reassuring a person that they can do that. In encouraging them and maybe making some overtures themselves to connect with some of the other residents or staff and talk about their parent with them. Start to talk about some of the things they did early in their life. I tend to find a lot of people of a certain generation don't like talking about themselves, don't like boasting or big noting themselves. Sometimes that's family's job. We can boast about
Nicole:
Them. It's always helpful to pump up someone's tires in front of others. That's right. Make sure they know how important they are to us. That emotional part I think is what a lot of people are absolutely terrified of, mark, that they're losing so much from moving from one place to another. What would you say to them to help ease their minds?
Mark:
I think it's recognizing that it's just a new chapter and we have to acknowledge that it is a huge transition when you look at someone moving from a four bedroom house, three bedroom house that they've spent the last 40, 50 years in. So we do have to acknowledge a sense of loss and a significant radical change. But as we've said, bringing the things that are important and being generous of self and sharing something about yourself with others, I think it just makes the whole process that much easier.
Nicole:
Zoe, we need to be gentle and kind with ourselves too, don't we?
Zoe:
Yeah. I think as carers and family members, absolutely, it's going to be stressful. There are going to be sleepless nights or nights where we dwell on things a little bit that's really natural and normal, and I think as much as possible, it's really good to share that, not hold that too much inside ourselves, but let those close other people around us know that it's something we're struggling with and seek that reassurance and support from our supports as well.
Nicole:
Yeah, I think that's a really important tip that we are not alone. We can actually share and find that community of people who can help us navigate as much as we can, help our parent navigate those transitions. So thank you to Grace Sheridan, Dr. Richard, mark, and Zoe for joining us. We've heard about navigating emotional transitions as we support our loved ones in aged care. Thank you for tuning in. If you enjoyed today's episode, be sure to hit the follow button, share it with your family and friends. Don't forget to visit our website, www.sbcs.org au to watch the videos from our latest campaign, which inspired this podcast. You can also stay connected with us on Facebook, Instagram, or LinkedIn by searching St. Vincent's Care. And if you've enjoyed this podcast, leaving a rating or review would mean the world to us. It really helps other people find this content. Next time we're going to be chatting about how our loved ones can successfully integrate into their new aged care community and make it a home for them. We look forward to talking to you then. Bye for now.
Welcome to episode two of St. Vincent's Care's Navigating Aged Care series. I'm your host, Nicole sio, and in this episode we'll be hearing from our experts about the emotional challenges of transitioning a loved one into aged care. That transition is something that affects not just the person entering aged care, but their loved ones too. So balancing our personal emotions with their needs is crucial. We'll be joined by the true experts in the field, the residents and their families, as well as aged care staff, a geriatrician and a psychologist. We are happy to welcome Grace and Sheridan again for this discussion. Thanks for joining me, grace and Sheridan. Thank you for
Sheridan:
Having us. Yeah, thank you.
Nicole:
I know that Sheridan moving your mom into age care happened just after your dad passed away. No one trains you for that. No one trains you for navigating grief and navigating change and all the financial decisions that you have to make. How did you cope with that whole emotional journey?
Sheridan:
Am I allowed to say alcohol?
Nicole:
Absolutely.
Sheridan:
It was really difficult. It was, and I had love to be able to say, oh, it was easy, and I just make out. I'm some sort of superwoman, but the reality of it was it was difficult. I couldn't have done it without support. I have just the most amazing friends and I just don't even know what I would do without them. They were incredible through all of it. If it was just to listen or to help or do whatever I needed, they were great. Also, my children who to be fair aren't really little children, they were also just incredibly supportive and patient and all that sort of stuff. And I think without a support network of people, it would've been, I think, probably insurmountable in some respects. But we touched on, I also think, and I'm saying this because again, it's an advocacy thing and thinking it's so important.
I think without therapy, my therapist was instrumental in a lot of it because again, you've got now someone who's completely unbiased, impartial, and I'm paying him to just listen to me whinge for a solid hour, poor guy. But yeah, it was very, very difficult. And how I coped was you just have to, and you have to remind yourself that it's temporary, that if you keep plotting away through it, it will have a point in time where this will end. And if you can keep focused on that, this isn't forever. And that actually helped. Well, for me it did anyway. It was really, really helpful to know that this is a challenge right now, but it will end. And I knew that I was going to learn a lot from it and grow from it. So I knew there was a silver lining in there somewhere. Yeah,
Nicole:
Doesn't make it any less difficult.
Sheridan:
No, no, it does not. No, it was very, very difficult. And it's
Nicole:
Really important to acknowledge that, isn't it Grace? Obviously it's a huge change for you as well, but it's a huge change for your daughter who you still a good daughter. Exactly. Yeah. How did you navigate that whole process? It was a massive change for you.
Grace:
What happened to me, I disassociated myself from the whole thing and I just was on autopilot, so I just kept doing what you have to do. And then I think a couple of weeks in I really broke down. It had really hit home, and I think that was That's true. Pretty true, isn't it?
Nicole:
Yeah.
Grace:
So everybody handles grief in a different way, and that's just what happened to me.
Nicole:
And that whole emotional transition of the move compounded by the grief, it's a lot to cope with, isn't it?
Grace:
Yeah. I don't think I would've come out as good if I didn't have Sheridan and my whole family with me.
Nicole:
That support network is vital,
Grace:
Isn't it? My son had come over from Adelaide, he was there too, and to have just the kids around me, I couldn't have done it without them.
Nicole:
How did you maintain a healthy relationship between the two of you? Because you are grieving a husband, you are grieving a dad, you are moving into a new place. How did you maintain that relationship between the two of you? Grace,
Grace:
We just through honesty, this is how I feel and this is what it is, and yeah, just talking about it. Yeah,
Sheridan:
I think it was really good too that we established pretty decent boundaries too early on while mom was living with me, I explained to mom that it's not personal, but I still had my son who's 12 at the time, he was still at home, and it's still really important that I consider his needs and his feelings. It's also a huge change for him too. Suddenly nannies living in our house, Poppy's died. It was a lot for a kid too, and so mum was really respectful of our space. So often at night, we'd come home, we'd all have dinner together or whatever, but then him and I would go into my room and the door would be closed and we'd either do whatever he wanted, maybe just watch TV together, or we'd sit there and we'd talk and mum respected that. That was our time because it was really important for him to have just me or to himself. He didn't have to share me with Nanny or anyone else, and it gave him an outlet as well. And I think that was one of the boundaries that we established early on in the piece,
Grace:
And it worked
Nicole:
Clearly, which is great. The challenge of transition is that it is either feeling like it's going to be a loss of something or the potential of a gain. How do you see it as the gain that it has clearly become for you? Grace,
Grace:
I never envisaged. I'd be doing what I'm doing, and I suppose that's the biggest gain out of all of it. Not to be stuck in a room just reading, watching television. I've been very blessed to have found another section to my life. Yeah,
Nicole:
Yeah. It's a whole new
Grace:
Thing, doing something I absolutely love doing.
Nicole:
Yeah, because you're not just a resident, you're also a volunteer at St. Vincent's Care, but that gives you a really amazing insight into it's fabulous transitions that other people are making. What are some of the things that you are seeing new residents going through when they're first coming through the doors?
Grace:
I see them going through fear, going into the unknown, and I just feel like I want to step them through it step by step and contribute. That way. Maybe we can do more to help them by people like myself that have come into aged care and can talk to them. Yeah, maybe more can be done that way.
Nicole:
The wise guide?
Grace:
Yeah. Oh, well, not just me, other people that have gone through it,
Nicole:
Of course,
Grace:
Just to ease them into this situation that there is another life out there. This is not somewhere where you come and this is the end. This is a new beginning.
Nicole:
That idea of you being a butterfly, you've been in your coco and you get to come out is a fantastic one, but doesn't come easy,
Grace:
Does it? Doesn't come easy.
Nicole:
No. So at the times when you were feeling like it wasn't going to come, how did that feel for you? Grace? Terrible. Yeah.
Grace:
Dreadful.
Nicole:
Yeah.
Grace:
You feel lost, you feel? Yeah. It's a horrible feeling, but I think you either come out of it, you either give yourself a good shake and say, get on with it, or you give into it just depends on maybe the support you've got around me. And I was blessed. I had her right by my side through the whole thing.
Nicole:
That's a pretty intense situation to walk through though. Yeah. Isn't it Sheridan?
Sheridan:
Yeah, it is. And it is really hard to see the light at the end of the tunnel when you're stuck in the middle. And I'm sure I wasn't always the nicest person to be around just Was she grace
Grace:
Mom? No, she had to be. Well, that's who she was at the time, and I had to respect that because I wasn't much better. We were both, it was into the unknown and what do we both do? No one prepares you for it. No. Who prepares you for your loved one dying? Who prepares you for anything? So you do the best you can with what you've got,
Nicole:
And we should be prepared because we know it's inevitable.
Grace:
Inevitable, but we are not,
Nicole:
But we're not. So those emotions are always on the surface, aren't they? With us, and I think
Sheridan:
Because we'd never been through it before, you didn't go through it with really with your parents? No, and I'd never obviously gone through it, and I'd never seen you go through it with your parents, so there was no previous knowledge to even draw off. And even me talking to some of my friends, they've never been through it either, so they're like,
Nicole:
We're no help to you.
Sheridan:
But all they could do was the one thing you really did need was you needed someone to listen and to be heard. And I was fortunate that I did have that. So even when I wasn't being the nicest person, my best friend, she took me away for a weekend and I'm sure I was a punished that whole weekend, but God love her. She knew that I was in that head space and that level of patience and that is amazing and will always be greatly appreciated. And that's it. You just need to be patient with yourself and patient with people around you.
Nicole:
Is that the best advice you think Grace is?
Grace:
I think so. Again, I think it depends on if somebody's been ill for a long time, you can prepare yourself that little bit more with me and Sheridan. It was sudden it wasn't sort of something that you expect, but yeah, no, you can't prepare anybody, but you can be there for them, but you can't tell them I know how you feel, because no one knows how you feel. It's such a
Nicole:
Terrible platitude, isn't it?
Grace:
And so you can't even walk someone through it, but all you can do is say, I'm there. Yeah.
Nicole:
I think that is a brilliant piece of advice because you can't be in someone else's shoes. You don't know what they're going through, but you can be there for them. I think the gaining of wisdom and knowledge about the processes as well is really useful to be able to just give a little tip here and there if they need it. Do you think so Sharon?
Sheridan:
Definitely.
Nicole:
I really appreciate having this chat with you guys. I know it's an emotional time when you put someone, I'm using the language actually. That idea of putting someone in an care facility, does that weigh on your mind?
Sheridan:
Yeah, massively. Yeah, of course it does, because your wording was perfect actually. Literally how you think about it, you're like, pud, it's like dropping your dog off at a kennel almost. That's how it feels. You just feel like a jerk, but it shouldn't, but
Grace:
You don't, and that's why it should be given a nicer name. Maybe
Sheridan:
It just needs to be normalized. It needs to be normalized as a part of the human experience.
Nicole:
Yeah. You're moving in.
Grace:
I'm moving into a new residence and this is the name of it, something under those circumstances, not nursing home. No. As soon as you mentioned that people just are petrified
Nicole:
And we don't want to feel that terror, do we? No. I've loved getting to know both of you and finding out how you've navigated this entire time and the relationship that you have. I want to thank you so much. Thank you for joining me today, Sheridan. Thank you, grace. Pleasure. We've got our experts coming up to talk about emotional transitions in just a moment. Welcome back to our experts, mark and Zoe and Richard, thank you so much for joining us. It's a pleasure. We're talking about emotional transitions today, Richard. We rightly focus on the person who is moving into aged care and that is an emotional transition for them, but it's an emotional transition for the family members as well, isn't it?
Richard:
Yeah, look, it can be a really emotional one, particularly I think where someone has lived with another person and that person is now moving into residential care. It can represent a really significant change and sometimes it can feel like a loss I think when that person isn't living with you anymore. So it can be a really vulnerable time as I think we've heard in other episodes. There's lots of positive things about it as well, but you do have to be on the lookout for some of those more negative emotions at the same time.
Nicole:
Zoe, I'm going to get right into it. The guilt, that emotional transition for the people who are putting their loved one into aged care, there's a huge amount of guilt that's associated with that. How on earth do we navigate it?
Zoe:
Yeah, the guilt can be enormous and for some others this is not. So we think it's the first thing to recognize is it's highly variable and highly individualized to the relationship that you have. We often talk about two things in psychology. One of them is justified guilt and unjustified guilt, and it can be helpful to differentiate between the two things. Justified guilt is where there is something that we are responsible for that we have to do something to fix. And then the other one is I guess the guilt that we carry when we can see that someone is going through a really tricky tough time that we're not actually responsible for ourselves. So it can be helpful just differentiate between those two things. I think the other thing to think about when we think about any kind of negative emotion is why are we having it and what does it mean that we're having it?
Often strong emotions indicate strong relationships and strong feelings that we have for other people. So if we're feeling an enormous amount of guilt, it's a good indication that there's an enormous amount of care there as well. And it's not to say that if there's not an enormous amount of guilt, there's not care, but usually you wouldn't have the enormous feeling if there wasn't. Yeah, so just to take stock, I guess that feeling this is meaning something. It means that I do actually care about this. It does actually matter. And then I guess the question is, okay, well what do I do about it? What do I do with this big, enormous, uncomfortable feeling? I kind of talked a little bit in another episode about I guess the different reactions that we can have to guilt. Sometimes we run away from it, sometimes we overcompensate for it and everything in between. I think the really important thing is that this into aged care, it's really about the person going into aged care make it about them. So what does that person need? What can you do with your feelings to help them support them? And then where can you go to get support with your own feelings as well? So you may need to talk to some friends, some colleagues maybe even go get some therapy or counseling as well.
Nicole:
Yeah, it's an important thing to remember that while it is the person, that family support system is also going through a whole process of their own, so we are all in it together, I think is important to remember. Mark, for you, this is your, well for all three of you, this is your every day, this is your work. Every day you see people navigating these transitions. You see the emotions on everyone's faces, you see the relationships in front of you. It's not the same for all of us who are doing it once. Perhaps what makes for a really good transition then that you've seen?
Mark:
Firstly, I'd like to say Richard, and I think Zoe absolutely hit the nail on the head. The guilt is very real and it is because people genuinely care. But I think part of it is to succeed. I think you really need to allow the person to focus on why they're doing it in the first instance, why they're looking into residential care. And once you put a perspective on that, I think it's easy to navigate everything around and have plan your actions to get to the end goal and support the person coming in because they feel they will. Sometimes I got to tell you, sometimes a person coming into aged care will help the guilt along because they don't want to come into aged care. So I think you have to be objective about why you're doing this, and it is typically because you want the best outcome for the person. You couldn't provide their care at home, you couldn't support them, and you know that when they're coming to residential care, they'll be getting the assistance and the care and the environment to support the person to live a great life. Optimum life
Nicole:
Optimum. Absolutely. Richard, you would have some patients who come in with their family members and they would have quite emotional reactions to the advice perhaps that you might be giving them. How do you navigate that with that family dynamic?
Richard:
Yeah, look, it's often takes time. It often can't be done with a single interaction. Sometimes as you said before, we're working through this professionally. We've got a certain outcome in mind, but we need to be prepared to give families and my patients people time to work through these really complex decisions. Sometimes it's really helpful. I've seen for me as a doctor to take a level of responsibility for a decision might be in the person's best interests from a health perspective where families are feeling particularly burdened that they may be influencing the decision themselves. So I can say, for example, you've been having so many falls and there's no one around to be able to pick you up, and I can see your family are really worried about that and you are too. So because of your falls, not because of any failure on your part or anything else, it sounds like it makes sense for you to make this transition. So attributing it to a physical or a health course can sometimes be more palatable for people than something that is somehow outside of their control or in some ways their fault. So sometimes I'll adopt that approach. Other families will really want to have a much more collaborative approach and so that everyone's very much participating and not wanting to follow our medical or clinical lead when it comes to the decision. So for me, it's often about reading the play and picking the approach, picking the strategy in different situations.
Nicole:
That's a key point you make, Richard, that everyone is an individual. Isn't that right, mark?
Mark:
Absolutely. And can I just add to that and just being aware as a clinician or as a home manager, that these decisions are being made and there are really stressful times of people's lives, so sometimes you can think I'm communicating wonderfully, but it's not necessarily what the person's taken in, so you really need to check in and get them sometimes to repeat what you're saying just to ensure that what you're saying is getting across. Because I think there's a lot that's missed when you're under stress.
Nicole:
That's true, isn't it, Zoe?
Zoe:
Absolutely. I'm so glad you brought that up. Yeah, absolutely. And people will take from conversations what they want to take from conversations sometimes as wellsly. Absolutely. Right. And that can be for the person, it can be for their family, it can be for the clinicians as well. You're right. I think some of the things that really stand out for me in these conversations are the importance of empathy and validation. So really just giving everyone in the room the chance to reflect and recognize what's going on for them and just letting them know that that makes sense.
Nicole:
Yep. Because we often think we're the only people who have ever gone through anything, so it's important to understand that it's a fairly natural reaction to the things that are going on, isn't it? Yes.
Mark:
Yeah, and that's a true story though, isn't it? I'm the only mark that's going through this at the moment. Yeah, so I'm the only person, but it's important. Other people have gone through and have guided the process for others, and it's important for them to share that, but for that person, it's absolutely the first time and yeah, it's all new
Nicole:
And that's something that you have to be cognizant of, I imagine, mark, because you would use acronyms and you would use all sorts of offhand, sort of really shorthand for what you do and that person's going, I've never heard this before.
Mark:
I think health professionals are terribly guilty of that using, it's not intentional, it's just come so easy with any profession, but you're absolutely, absolutely right that we just have to be mindful to use language that sort of connects with a person and they understand. So we have to modify our messages sometime.
Nicole:
Yeah. Richard, do you find that in your practice that that kind of modification has to happen consistently?
Richard:
Yeah, I do. I mean it depends. So some people who have been around healthcare or perhaps even worked in health or aged care will have a really high degree of literacy around lots of these things and will feel patronized if you simplify things down too much. But others, it's a much more foreign area that they haven't worked in before. Just like if I'm talking to a friend of mine about his financial career, I'm going to need him to simplify things down. It's exactly the same in reverse, so I would be clear and use language and try not to use acronyms as much as you possibly can in that situation so that the message is more clearly conveyed. Because as you said, it's often an emotional time. There's often ill health and lots of family dynamics that can come into play with all these things, so keeping things really clear and an empathic, as Zoe describes is so important.
Nicole:
I really want to touch on that family dynamics aspect because often there is one person in the family that is in charge of making all the decisions and then everyone has to come along. Or if there's a great collaborative effort, then that's wonderful, but often it is that one person. How do you maintain the boundaries with the family as you're navigating this whole process? Zoe?
Zoe:
To be honest, I look to the person and what their preferences are. If they've indicated, well, first of all, if they've got capacity and they can make the decision in an informed way, they make the decision and we inform whoever they want us to inform. If there are issues of capacity, we do need to look for next of kin or an enduring guardian to help us make decisions. Again, it's what they've set up. So they may have chosen one person to act in that capacity, or they may have, they may have chosen a few people to act in serial, and it's just a matter of knowing what their preferences are, communicating appropriately and making sure everyone's on the same page.
Nicole:
What if they're not Zoe?
Zoe:
That happens quite a bit.
Nicole:
Yes. What happens then, mark? How does that manifest in the aged care facility?
Mark:
We have to have frank conversations that it's really when there are Australian family dynamics that really we need to put the person, we need to put the resident first and foremost. So any dynamics has to play out cooperation. We just have situations. Many are situations where we communicate with a family member and then they won't tell anyone else, and then we get conflicts and no one's informing me, and you go, but we've done that. So really we have to have frank conversations about what our expectations are as well, and the reasons are that it's for the benefit of the resident coming in,
Zoe:
And then when there is a lot of discord, it's often really helpful to go back to the core of why people care so much. And often when you've got, let's say, potentially siblings who have different perspectives on what's good for mom, if you talk to those people separately and understand at the core of what they want to do, they want what's best for mom, and then they can relate on that level and then hopefully reach a bit more of a compromised decision.
Nicole:
It's a hard one to navigate though, isn't it? Yeah. The transition into aged care is a really challenging one for everyone involved. Richard, what would you say are some of the best tips that you can give us that will help us navigate that with our parents?
Richard:
Look, I think some of the planning, if you can, in terms of the decision and taking some time over it and putting things in place so it doesn't have to happen in a hurried way is often a really good thing. And we talked about some of that in a previous episode. When someone's been unwell physically or mentally in the lead up to the moving into residential care, it's important to make sure that there's going to be some handover or continuity if you can, from the person in terms of the medical and nursing care that they're receiving as they're making that move. And then there's a whole range of different things that others will be able to talk to even more fluently than I, around creating an environment, bringing those things with the person that make them feel comfortable, being clear around what their preferences are with things like food and the environment and things that they do to occupy their time, activities, et cetera. And then maintaining that visiting so that the person isn't feeling like they're moving and that their world is completely turned upside down. So really maintaining that contact in the early stages and beyond of the transition into the residential aged care facility,
Nicole:
The bringing things with us. Mark, how important is that for that transition? How does that, I guess, cushion those emotions?
Mark:
I think it's incredibly important to bring items that familiarize you with the environment and give you a home-like environment, something you're familiar with and tie you back to what's important to you. So I think it's critical.
Nicole:
Makes sense. Zoe, from a psychological perspective, how does that help in that transition? It
Zoe:
Helps in a number of ways. So as you say, it's a way of bringing part of your history and your identity into the accommodation with you, which can be really nice. Just reminder for the person to reminisce on. It's a really great trigger for staff as well. When they walk into the room and they see a photo or they see a poster, they can then ask questions about that and they can start to connect with a person, which is really valuable. It can serve as a memory aid, it can serve as a way to help a person keep recognizing different people in the family a number of different ways.
Mark:
I think you're spot on, sort of gives you the backstory and sort of humanizes you and makes you a real person. A whole person tells you a story that you have grandchildren that you've worked, and I think it's a terrific idea to be able to do that.
Nicole:
That's really important, isn't it, Richard? To acknowledge that that person is a person with an entire backstory that you can acknowledge that in their care.
Richard:
Yeah, and it's interesting. The longer I work in this part of medicine, the more interested I am in the backstories of people alongside, of course the medical detail, but it's that person. It's what makes them the person inside the patient. I often say that makes them stick with you and really makes you really drawn to them and remembering that those details. The other thing I think is that whenever anyone moves into an environment where other people are like a hospital or a hotel or residential aged care facility, there's a fear that you are just another resident. You're just another client. And so if you can bring these items with you that express your identity and allow people to understand that and see you, I think it makes you feel like an individual still. As Mark described, I think it's critical.
Nicole:
Yeah, Zoe, that is a fear though, isn't it? That we're just going to be another number.
Zoe:
Yeah, it can be.
Nicole:
How do we mitigate that?
Zoe:
Well, I think it's about bringing your genuine self with you and being willing, I guess, to share that with the people around you as much as possible. Not being the lady in room nine 17, but actually having a personality, having an identity, putting that forward.
Nicole:
Can families help in that as well when you're transitioning in?
Zoe:
Yeah, I think families can go a long way in just reassuring a person that they can do that. In encouraging them and maybe making some overtures themselves to connect with some of the other residents or staff and talk about their parent with them. Start to talk about some of the things they did early in their life. I tend to find a lot of people of a certain generation don't like talking about themselves, don't like boasting or big noting themselves. Sometimes that's family's job. We can boast about
Nicole:
Them. It's always helpful to pump up someone's tires in front of others. That's right. Make sure they know how important they are to us. That emotional part I think is what a lot of people are absolutely terrified of, mark, that they're losing so much from moving from one place to another. What would you say to them to help ease their minds?
Mark:
I think it's recognizing that it's just a new chapter and we have to acknowledge that it is a huge transition when you look at someone moving from a four bedroom house, three bedroom house that they've spent the last 40, 50 years in. So we do have to acknowledge a sense of loss and a significant radical change. But as we've said, bringing the things that are important and being generous of self and sharing something about yourself with others, I think it just makes the whole process that much easier.
Nicole:
Zoe, we need to be gentle and kind with ourselves too, don't we?
Zoe:
Yeah. I think as carers and family members, absolutely, it's going to be stressful. There are going to be sleepless nights or nights where we dwell on things a little bit that's really natural and normal, and I think as much as possible, it's really good to share that, not hold that too much inside ourselves, but let those close other people around us know that it's something we're struggling with and seek that reassurance and support from our supports as well.
Nicole:
Yeah, I think that's a really important tip that we are not alone. We can actually share and find that community of people who can help us navigate as much as we can, help our parent navigate those transitions. So thank you to Grace Sheridan, Dr. Richard, mark, and Zoe for joining us. We've heard about navigating emotional transitions as we support our loved ones in aged care. Thank you for tuning in. If you enjoyed today's episode, be sure to hit the follow button, share it with your family and friends. Don't forget to visit our website, www.sbcs.org au to watch the videos from our latest campaign, which inspired this podcast. You can also stay connected with us on Facebook, Instagram, or LinkedIn by searching St. Vincent's Care. And if you've enjoyed this podcast, leaving a rating or review would mean the world to us. It really helps other people find this content. Next time we're going to be chatting about how our loved ones can successfully integrate into their new aged care community and make it a home for them. We look forward to talking to you then. Bye for now.
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