Jun 8, 2010

Fighting for Control

By Viki Kind

One of the reasons that our loved ones argue with us is that people want to keep some control over their lives, especially when they feel as though they are out of control. We all want to have a voice. As people begin to lose their mental and/or physical abilities, they want to hold on tight to as much of their decision making power as possible.

When you say to your loved one, You should do what the doctor told you to do,? you sound as if you are trying to be the boss of this person. Yes, you are there to advocate, respect and protect your loved one, but that doesn?t mean you have to control everything. If this is a person who still has some voice in his or her life, you will want to use the Shared Decision Making Model.

The Shared Decision Making Model tool is used to determine how much your loved one should participate and how big of a voice he or she should have in important life and health decisions. With this tool, you can adjust this process to fit your loved one?s mental abilities as they change over time. If your loved one has fluctuating capacity, you will need to adjust the age range as your loved one?s condition changes each day.

The Shared Decision Making Model states that we should include people in the decision-making process based on their mental age. Whether you estimate your loved one's mental age or the doctor has given you an approximate age, your answer will fit into one of the following categories. These age ranges will help guide you as you begin to use the Shared Decision Making Model.
  • Zero to six years old
  • Seven to thirteen years old
  • Fourteen to seventeen years old

Here are the basic guidelines of the Shared Decision Making Model. If the person in your care is in the zero-to-six-year-old age range, you will need to make the decisions for him or her because it wouldn't be safe for the individual to participate in important decisions.

If the person is in the seven-to-thirteen-year-old age range, he or she will be able to have a voice in most decisions but will not make the final decision.

If the person is in the fourteen-to-seventeen-year-old age range, the individual may have enough capacity to make his or her own decisions. If not, you will want to use the seven-to-thirteen-year-old guidelines.

The ages on the chart are a guideline, not a rule. You can adjust the ages up or down a little bit, but be careful about moving the developmental age too far out of the decision making guidelines that are shown here: You might end up using the tool in the wrong way.

When communicating, one way to help the person share in the decision making process and keep some control is to try asking instead of telling:
  • What do you think about these options?
  • What do you think would be the right thing to do?
  • What would you suggest?
  • Would you like some more time to think about this?
Then give the person the time and space to think about it.

If you find yourself in a conflict with your loved one, the first question to ask yourself is Do I want my loved one to agree with me because this is the right thing to do or is it because I want things done my way?

I understand that this may be difficult to admit to yourself. We all have strong opinions about how things should be done, and we often think we know best. But be careful that you are not putting your opinions in front of the previously stated values of your loved one.

Remember that, if possible, we are to respect and honor what the person would say he or she would want. If the person never liked to do something in the past, why would he or she want to do it now? Or if you find yourself pushing for something, even when the person has said no, ask yourself, Am I respecting this person and his or her values? Why am I pushing so hard to get my way?

You might also want to check in with the decision making process and ask, Am I using the right level of shared decision making with this person? Even though it might seem easier to just take over the person's life, it is not a respectful or loving thing to do. If the roles were reversed, I don't think you would want someone to do that to you. Each day, we have to remember to balance respecting the person with protecting the person. This isn't easy to do, but I know you can because you are an Everyday Hero.

Viki Kind MA, is the author of The Caregiver's Path to Compassionate Decision Making - Making Choices for Those Who Can't. You can learn more about Viki at TheCaregiversPath.com

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Original content Viki Kind, the Alzheimer's Reading Room