Who shall separate us from the love of Christ? shall tribulation, or distress, or persecution, or famine, or nakedness, or peril, or sword? As it is written, For thy sake we are killed all the day long; we are accounted as sheep for the slaughter. Nay, in all these things we are more than conquerors
​through him that loved us. Romans 8:35-37

CAN ANYTHING separate me from the love of Christ? was the only question that St. Paul felt worth consideration. In this paragraph he takes the extreme conditions of being, and carefully investigates them, knowing that they include all between. First, he interrogates Existence—"death and life"; next, created Intelligences—"Angels, principalities, and powers"; next, the extremes of Time—"things present, things to come"; next, of Space—"height and depth"; lastly, the created Universe—"any other creature." Each of these extremes is passed in review. He is like a man proving every link of the chain in which he is going to swing out over the abyss. Carefully and fervently he has tested all, and is satisfied that none of them can cut him off from the love of God.
​
We strangely misjudge and mistrust the Love of God our Father, and think that our distresses and sufferings, our sins and failures, may make Him love us less. But in the home, it is not the troop of sturdy children that engross the mother's care so much as the puny feeble life, that lies in the cot, unable to help itself and reciprocate her love. And in the world, death and pain, disease and sorrow, sin and failure, so far from separating us from God's love, bind us closer.

Oh blessed Love! that comes down to us from the heart of Jesus, the essence of the eternal love of God—nothing can ever staunch, exhaust, intercept it. It is not our love to Him, but His to us, and since nothing can separate us from the love of God, He will go on loving us for ever, and pouring into us the entire fullness of His life and glory. Whatever our difficulties, whatever our weakness and infirmity, we shall be kept steadfast, unmovable, always abounding in the work of the Lord; gaining by our losses, succeeding by our failures, triumphing in our defeats, and ever more than conquerors through Him that loved us. Source: Our Daily Bread

This is the close of the Apostle’s argument. He has shown that believers are dear to God because they are in Christ; that their every need has been anticipated and provided for; that their guilt has been canceled and provision made for their holy and victorious character; that the Holy Spirit is in them and with them forever; that sin is under their feet and heaven over their heads-what, then, have they to fear?
​
Paul then goes on to show that the love of God is unaffected by even the most extreme changes of our condition-neither death, nor life, Rom_8:38. That it is undiverted from us by any other order of beings, whether angels, principalities, or powers. That it is universally present throughout creation. And finally, that this love is in Christ Jesus our Lord. But in order to know and experience this love, we must be united to the Lord Jesus by a living faith. Then we shall be more than conquerors, that is, we shall not only be victorious, but shall get spoil out of the very things that have hurt us.
(F.B. Meyer)

​The Gain of the Christian Conquerors

I. Its nature. "We are more than conquerors." As I have said, the phrase implies that in the conquest itself is something greater than mere conquest—it is its own reward. To overcome temptation is better than to have had no temptation to grapple with, for the conquest, however hardly won, leaves the soul greater, stronger, and more blessed.
(1) Every conquered temptation deepens our love to Christ, and thus we are more than conquerors. We come here on the track of that great law of the human soul, of the action of which all life is full—the law that the trial of principle is its true strengthening. Passion catches fire by antagonism, difficulties waken it into stormy majesty, and it makes them its servants. Men speak of the power of circumstances to hinder a Christian life; of course they have a power, but it is none the less true that a strong love makes the most adverse circumstances the grandest aid to its own progress.
​(2) The love of Christ to us is a pledge that our conquests will become our gains. The living Christ is watching the temptation, and He will take care that its issue is a greater glory than that which could have come from a life of perpetual repose. God will open hereafter the marvelous book of the human soul, and show how each struggle left its eternal inscription of glory there.
II. Its attainment. How shall we know that we are becoming more than conquerors? When the love of Christ is the strongest power in life and a progressive power.  (E. L. Hull)

Every miracle of Christ was done overflowingly. The lame men not only walked, but leapt. The wine which Jesus made for the wedding feast was more than almost any company could have consumed. The very fragments of His feeding are twelve basketsful. He supplies all wants, and then He is at all costs besides—"Whatsoever thou spendest more." Now, apply this to our Easter theme. Christ has placed our life far above the level of the life we had lost. We lost a garden, we have gained a heaven. "More than conquerors." Then, too, His seeming absence is only a more ubiquitous presence. He is richer, and none are poorer; He is exalted, and none are orphaned. The problem is solved—how there can be distance without separation—how the communion can be invisible and yet be more real than when eye meets eye and hand clasps hand, for He is more than conqueror.

The very same principle which is thus embodied in the death and sufferings of Christ operates in the experience of every believer. Every man who is in earnest about his salvation has found, and the more earnest he is the more he has found it, that he is placed to contend not only with flesh and blood, but also with Satan. In this great contest, what is God’s undertaking for His people? That they shall overcome? More than that. The power of Christ that is in you shall do what the presence of Christ always did when He walked the earth. Whenever walking this earth, an evil spirit met Christ, the evil spirit was afraid. And they shall be afraid of you. "More than conquerors."
​(J. Vaughan)

This section of blogs will be on the subject of seniors, elder care, elder abuse, victims of trauma, and legal issues concerning assisted suicide and euthanasia. If you are a caregiver, or a senior with issues that your dealing with, and finding it difficult to get any help, or guidance, there may be something here to help you. Material will be added as I come across more on these topics. Please go to the resource page of this site also-there is a great deal of information, videos, and content on that page that you may find help. Some of the blogs below are from previous years, I've brought them back to the front of the site, because the information is relevant, and useful for today. I'll add, there's a great deal of information that's buried in the archives that is very helpful for a caregiver taking care of a senior-I'll keep bringing them to the front, so they don't stay buried.
The problems the elderly and caregivers are dealing with are many, and any real help for them, is getting harder to find. That's what this site was meant for originally, and it will be brought back to the forefront for those who are dealing with these issues, either for themselves, or their family members. Keep returning, as new information will keep being posted.

Inspiration Ministries- Ministry for the Disabled-Opening the World for people with disabilities
https://www.inspirationministries.org/

​Alexander Graham Bell Association for the Deaf - Service Agency 
http://www.agbell.org/

Deaf Connect 
http://www.deafconnect.com/
The World Deaf Directory which has over 7,000 Deaf e-mail addresses listed.

American Council of the Blind 
http://www.acb.org
Welcome to the web site for the American Council of the Blind. This service provides general information about the Council, including recent issues of our monthly publication, The Braille Forum.

American Burn Association 
http://www.ameriburn.org/
The American Burn Association Website links to information and interactive communication on burn care and related research, teaching, rehabilitation, and prevention issues. This site also provides a private discussion group for ABA members devoted to the exchange of ideas, problems, and issues related to the National Burn Registry.

Burn Institute 
http://www.burninstitute.org/
The Burn Institute is instrumental in organizing programs such as Burn Survivor Support, Burn Research & Treatment, Burn Education, Juvenile Firesetter and Community Service. Through the Burn Institute's grants, funding is provided for research projects designed to improve or develop new methods of burn treatment. Their website is dedicated to keeping those interested up to date on their current initiates and programs; they also provide resources and support for burn victims.

Widows Christian Place-If you have become a widow/widower, you may find some help here.
http://www.widowschristianplace.com/

​I’ve watched some Christian TV shows recently that went into the subject of the dying process, and grief. They were well done, good content, nice tidy formats with inspiring and uplifting endings that gave you “warm fuzzies”. There are many books out on this subject that also fit into this category.

That’s just the problem. society and Christian TV has learned how to use every aspect of life, and turn it into a money-making opportunity.

The story-line, and the content is very carefully worded, air-brushed, sterilized and choreographed to get the most out of the broadcast. Author’s use this “cut and paste” method to make their books appealing, with the emphasis on an upbeat ending. They want you to purchase their next book.

The intentions for these programs and books are good, but as one who worked in health care for over 30 years, they lack authenticity. Much is omitted to make the subject matter “palatable” to the public, and send a heart-warming message that “God loves you”, and “everything will work out”.

The reality for many in nursing home care facilities:

Many elderly live in isolation, some who have long ago been abandoned by family members, or do not have any family; and live out their lives never seeing a visitor. I’m saying this from first hand experience.

Some live in abusive environments, and suffer from the affects of the abuses; broken limbs, black eyes, over-medicated, and more. I could share things that break my heart, but will not. Neglect, abuse, and brutality is an every day occurrence for some of the most vulnerable; young and old alike, behind closed doors. Sometimes we see the end result of these abusive situations on the news, after the abused is dead.

Many very good caregivers never tell the full scope of their exhaustion, stress, and what they endure daily. If they did, they know many would not believe it; or care.

If a visit to some of the nursing home facilities was made unannounced, especially on a weekend, it would be an eye opening experience. Just walk the corridors, look into the rooms, and pay attention. Watch the employees, and listen to them.

People learn to wear masks, and put up a good front. But if you are discerning, you can see through the smoke-screen and see the reality of a situation.

There are wonderful health-care facilities, and good loving home care environments. But, the reality is that there are also some that aren’t.

Many times during the 3 years my mother was in nursing home care, I or my brother would walk into her room in a late afternoon on a weekend, and find her bed still un-made, and she would be slumped over in her chair still in the rumpled slit-up-the back nursing gown that she had slept in the night before, and her hair uncombed. I would go through the process of bathing her, cleaning and making her bed, visiting with her, combing her hair, taking care of her hygiene.

When I was doing this, sometimes an aide would come in and pretend to be very surprised and say “Oh, I was just on my way in here to take care of your Mom, you didn’t have to do this.” I would do the best I could to keep my composure. I knew very well what the staff had spent their day doing; goofing off, and gossiping the day away.

There were many times I’d drive home with gut-wrenching guilt, because I could not take care of her myself at home anymore, because her diabetes had become too serious, and her feet needed doctor’s care every day. For many years I had taken care of other people’s mother’s right up to their deaths, but now I was helpless to do the same for my own. I was in free-fall myself. I had lost my husband to heart disease, sold our home, his business, and mine; and didn’t know when I was going to hit bottom.

But, God did give me the privilege of being there on my mother’s last two days on this earth. I walked into her room late afternoon the day after Easter in 2008. My brother was with her, he told me she was very bad, I already could see she was. As he left to go home, we looked at each other and I said; “I won’t be home tonight, I will stay with her from now on.” For the last two days I closed her door, and took care of her; only the nurses came in to give needed medications, and check her vitals. I would not allow people to look into her room, or anyone to make any remarks of disrespect. I took care of her personal needs to the end; including making sure her body was bathed after God took her.

He answered my prayer that I would be with her, and she would die with dignity.

Many caregivers can identify with these kinds of situations.

Yes, God does care, He is with us in the worst of these situations; but at the time, it can seem He is out of reach, unconcerned with our plight, and silent. In these times; it is all one can do sometimes to keep putting one foot in front of the other, and keep going. During these times, I clung to Him; also in silence.

I’ve heard scathing criticism from well known preachers and teachers who say this should not be the plight of any Christian walking rightly with God, there must be something wrong with your faith. I will only say this; read the book of Job, (especially the accounts of his three miserable comforters), and read the accounts of Paul’s sufferings, and what he tells us about it. Then go on your merry way. At least muster up enough compassion to leave those in these situations in silence without heaping further suffering on them.
Lorna Couillard

The problem of elder abuse is a growing one, and often isn't seen, because many of the elderly remain silent, out of numerous fears.

They are targets for scammers, drug addicts who break into their homes, and rob them of their medications, their money, at times attack them physically, leaving them brutally harmed or even killed. 

Sometimes they are also exploited and abused sexually. This is the most deplorable, and despicable act anyone could imagine.

Most nursing homes and senior centers are excellent in their care, and support their seniors very well. But, the problem of neglect and abuse does exist in some. An attentive eye can see those who are victims of abuse. The problem of elder abuse also comes from family members, friends, and people who have come into their lives, and have learned how to bully them, and mistreat them.

SOME SIGNS TO LOOK FOR:
1. Bruises on the face and body-black eyes, black and blue on the arms especially. Frequent bruises on the same person. Broken bones.
2. A senior who seems asleep a lot, slumped in a wheelchair for long periods of time.
3. Long periods of silence; unresponsive; if this is someone who has usually been active and vocal, who becomes despondent.
4. Expressions of fear-of being spoken to, or touched. Flinching when spoken to, or approached.
5. Malnutrition, being noticeably underweight. 

If you serve as a pastor or teacher in an adult class, and have elders in your church, or have a nursing home ministry; it would be a good idea to take notice of them, and watch for signs of abuse.

Below is a helpful link to a site for help, and a video that will help identify the signs and resources to help in this area.
www.nij.gov/topics/crime/elder-abuse

This post on the subject of trauma, and it's aftermath. 

When Jesus began his ministry. He stood up in the temple and spoke this proclamation:
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Luk 4:18  The Spirit of the Lord is upon me, because he hath anointed me to preach the gospel to the poor; he hath sent me to heal the brokenhearted, to preach deliverance to the captives, and recovering of sight to the blind, to set at liberty them that are bruised, 
Luk 4:19  To preach the acceptable year of the Lord. 

In these verses, he proclaimed his mission to the world, that He has come to be the healer of every pain, illness, sorrow and those who are broken in mind, body, and spirit. But, in order to do this, he has commissioned us, his disciples as well in this mission. 

When the subject of abuse and trauma are brought out, it is many times carefully covered up, staged; and air brushed. Victims of trauma learn to keep silent, they quickly learn people are uncomfortable with uncensored reality. They quickly come to realize the cold, indifferent attitude of a world consumed with it's own desires for pleasures.

Jesus came to set the captives free. Each encounter he had with those who cried out to him for healing came as they were, there was no time for pretense, careful staging, or worrying about what people thought. We see him making mud and rubbing in a man's eyes as he healed him of blindness, standing and asking how long a child had been as he was from the distraught father, before he delivered him from demonic bondage, commanding demons tormenting the wild man from Gadarene, and not worrying that it may not sit well with the towns folk. He asked questions, he entered into their suffering, He moved with compassion. 
​
There are those who have experienced trauma, perhaps multiple times; who are expected to "get over it", within a period of time set by the onlookers. If you don't seem to improve within the timeframe set for you by other's, avoidance and labeling comes next. The video below is excellent on this subject. This woman has many very important points that bring light on how to minister to the trauma victim. She also makes some very good comments on what trauma victims experience from family, community, and the world in general. Her observations are very discerning. She discusses sexual abuse, but also many other forms of abuse, and those experiencing great losses. It's a valuable video to watch, and gain some understanding of those who have suffered greatly, and what we can do, to be the hands and heart of Jesus, to help restore, and heal those who are broken physically, in soul, and spirit.

​Note: This is a repost from 2019-very relevant for today.

Definition of Terminal:
Terminal condition means an incurable and irreversible condition, for the end stage of which there is no known treatment which will alter its course to death, and in the opinion of the attending physician in that disease category, will result in premature death.
​
Terminality is defined as having a condition that is irreversible and will result in premature death, someone like Joni Eareckson Tada would fit that description, as well as thousands of other’s with disabilities, in wheelchairs, and chronic diseases, such as those on kidney dialysis. None of them are dying, but are living in a terminal state.

Health Insurance is a very big issue-a big area of misuse and abuse-especially with family members involved. For example:

                         Loopholes for Health Insurance Plans

In Oregon, people labeled as “terminal”, can be denied coverage for treatment, but have been offered coverage for suicide instead. For instance, the case of Barbara Wagner, who had lung cancer. The Oregon Health Plan refused to pay for a drug that would possibly prolong her life, but offered to pay for her suicide instead.

Elder abuse is often difficult to detect. This is largely due to the unwillingness of victims to report. "Shame, dependence on the abuser, fear of retribution, and isolation from the community are significant obstacles that discourage elders from reporting … "

     What Is My Stand on Physician Assisted Suicide and Euthanasia

Euthanasia involves the intentional killing of a patient by the direct intervention of a physician or another party, ostensibly for the good of the patient or others. The most common form of euthanasia is lethal injection. Euthanasia can be voluntary (at the patient's request), non-voluntary (without the knowledge or consent of the patient) or involuntary (against his or her wishes).

The bottom line of this is, it is killing-going totally against the sixth commandment in the bible- Thou shall not kill. Ex 20:13

Legalization of assisted suicide is a recipe for elder abuse. It devalues people with disabilities. Its promise of individual choice is an illusion. 

Policy debates around this question generally fall into two categories: physician-assisted suicide and euthanasia. These terms are often used interchangeably; however, the distinctions are significant. The act of physician-assisted suicide involves a medical doctor who provides a patient the means to kill him or herself, usually by an overdose of prescription medication.

Physician-assisted suicide and euthanasia violate the sanctity of human life.

People living with terminal illness deserve more than the offer of a physician to facilitate their death. They merit true compassion. Accessing expert palliative (hospice) care and comfort care — treating the symptoms and making the patient as comfortable as possible during the natural dying process. Palliative (hospice) care differs from acute care in that it becomes appropriate when aggressive therapies are no longer beneficial to the patient and there is no longer an attempt to cure the disease.

Barriers need to be removed that prevent patients from receiving available treatments for pain and other symptoms — not alleviate the safeguards that protect patients from psychological or financial coercion to choose an untimely death. The goal should not be to legalize physician-assisted suicide but rather to adequately provide available means of care so that patients and their families do not feel the need to consider an early death.

              What Results in the Legalization of Assisted Suicide
​

• Social acceptance of physician-assisted suicide sends the message that some lives, especially those of elderly, disabled and dependent citizens, have less value, and are not worth living. 

 

• Better medical alternatives exist to physician-assisted suicide.  However, they are not brought to the light as much as they should, family members need to be more engaged, and aggressive in becoming informed to the resources available. Today's pain management techniques can provide relief for up to 95 percent of patients, thus offering true death with dignity. 

 

• Physician-assisted suicide often ignores anxiety, depression, and family problems, which is a legitimate cry for help. 

 

• Physician-assisted suicide gives too much power to doctors, threatening patient autonomy by allowing physicians to decide whether a patient lives or dies. This is occurring now in  the Netherlands, Europe.

 

• The practice of physician-assisted suicide threatens to destroy the delicate trust relationship between doctor and patient – a relationship based on the patient's belief that his or her physician will pursue the goal of protecting life. 

 

• Physician-assisted suicide opens the door to euthanasia. Then, when this boundary is overstepped, where is this going to lead? Where will this mindset go next? Who else will be termed “better off dead?”

Assisted suicide is a half-way house, a stop on the way to other forms of direct euthanasia, for example, for incompetent patients by advance directive or suicide in the elderly. So, too, is voluntary euthanasia a half-way house to involuntary and non-voluntary euthanasia. If terminating life is a benefit, the reasoning goes, why should euthanasia be limited only to those who can give consent? Why need we ask for consent?" 

It must be recognized that assisted suicide and euthanasia will be practiced through the prism of social inequality and prejudice that characterizes the delivery of services in all segments of society, including health care. Those who will be most vulnerable to abuse, error, or indifference are the poor, minorities, and those who are least educated and least empowered. This risk does not reflect a judgment that physicians are more prejudiced or influenced by race and class than the rest of society - only that they are not exempt from the prejudices manifest in other areas of our collective life. 

While our society aspires to eradicate discrimination and the most punishing effects of poverty in employment practices, housing, education, and law enforcement, we consistently fall short of our goals. The costs of this failure with assisted suicide and euthanasia would be extreme. Nor is there any reason to believe that the practices, whatever safeguards are erected, will be unaffected by the broader social and medical context in which they will be operating. This assumption is naive and unsupportable."

Above and beyond all of this; the question is, what does God think of this?

To the unbeliever, once you die that's it, no memory of this life, and you simply cease to exist. The truth is, we exist forever, either in heaven with God, or hell. The choices we make in this life, and what we do with Jesus Christ will determine where we will spend eternity. Scriptures teaches:

Heb 9:27  And as it is appointed unto men once to die, but after this the judgment: 

When we stand before God, we will give an account for every decision we've made-whether it be good or evil. God's commands regarding life are clear:

Exo 20:13  Thou shalt not kill. 
Deu 5:17  Thou shalt not kill. 

​In the years I took care of elders, many of them went through the valley of suffering, losing strength and their health, and faced death. But there were medications, procedures, and treatments available that allowed them to go through their end days to a great degree without pain. I took care of many in this situation, and my mother until her death, and many years with my husband as he dealt with heart disease, til his death. No one enjoys the pain and suffering involved in these realities. But, the value of human life must be taken into account. 

When you know God has created each individual, and the value he puts on every person, and know that the commandment to no kill is still His word to us today-it brings a perspective to the extent we are expected to go to give that person as much care and dignity possible. 

The Hippocratic Oath needs to be reinstated in the medical profession, and not altered to allow this evil practice.

My concern is also for the doctor's and nurses who give in to this practice of legalized murder, and play God every time they end a life by injecting the poison to kill. Over time, if they ever had a soul with a conscience, they must come to the place of having trouble living with what they do-as the numbers of people they kill adds up. If it doesn't, it can be compared to the Nazi ovens, and concentration camps, and the murder and carnage that took place there at that time. I see no difference really-and foresee us coming to that time of barbarism again with these laws being put into place, not just here but around the world. Think about it.
Lorna Couillard

Helpful Tips For Decreased Appetite 

Making sure a senior or someone gravely ill gets the needed nutrients each day can be a great challenge. With age comes decreased appetite, depression, stress, anxieties of daily living; and  it all plays a roll in causing your loved one to avoid eating. For those who face terminal illness, all the more reason they have to avoid eating altogether. 

However, there are things that can be done to help, and give encouragement to them so they can enjoy the mealtime, and promote a desire to eat.

Offer high caloric drink foods such as ice cream, milk shakes, or eggnog. Offer familiar foods. Favorite foods can stimulate the appetite. Try making the main meal of the day at lunch when the appetite is larger. If the person needs assistance in eating, sit directly in front of them and show each spoonful to help them orient.

I found when I was caring for my mother as she grew weaker, and lost her appetite that there were certain things that I could do to help her maintain a sense of identity, and control over her decisions; which is very important to their well-being. At mealtime I’d place the best and sweetest red seedless grapes I could find on her plate, and allow her to pick one up herself with her fingers and nibble at them even while she ate her main courses; most of the time she would end up finishing her entire meal, chatting with me about daily stuff, and picking up one of the grapes and helping herself. She also liked banana, pear, and peaches when they were sweet; so I’d make sure there was a small amount of one of these on her plate at each meal. It helped a great deal in getting her to eat, and it was good for her in many ways.

The atmosphere in the home or their residence is very important, but often overlooked. If they enjoy a certain type of music, play some of their favorites during mealtime; encourage them by asking them if they remember when they first heard the song, and what they think of it, or what memories it brings to them. If they like a certain TV show, see if it helps to have it on while your helping them eat; it may be helpful to bring their spirits up, and promote their appetite. If there is a lot of tension, or stress in the environment they are living in; this will play a great role in their outlook, and their well-being. 

Swallowing Problems 

Allow time between bites and check mouth periodically for food in the cheek. You may need to remind the person to swallow. Gently stroking the throat will help to stimulate swallowing. Observe what food textures cause the most difficulty. Liquids can be thickened with gelatin or applesauce. Solids can be moistened or pureed for easier swallowing. In some cases, using a straw may be the best approach. If they are very weak, and have trouble sitting up on their own. If they give signs of resistance; let them have a few minutes, and try again. Please use love, and patience. If they continue to resist; do not continue to force them to the point of causing them to become angry, or resentful. You will only have a more difficult situation next time. Treat them with the same dignity you would want to be treated with.

Digestive Upset

Keep a food diary to enhance nutrition dialogue with the person’s doctor. Include what foods they have problems or complications digesting and record their daily food menus. Review it with their doctor or dietician for feedback. They may be experiencing digestive problems or irritable bowl syndrome due to their menu. If they are not having regular bowel movements, this is an indication that there is indeed digestive problems. Try to encourage more liquids, sips of juices thru a straw through out the day may help promote more regular bowel movements.

Motivational Problems 

Presentation is key so serve appetizing looking meals by accenting plates with a garnish (i.e. strawberry, coconut flakes or melon). Talking about the day’s events while they are eating can help take their minds off not feeling well. Don’t be concerned if they reach with their hands to the “goodies” first, let them pick what they want, and continue to feed them the veggies and main part of the meal along with what they are helping themselves to; it doesn’t hurt anything, and you will be surprised that they very well may end up eating their entire meal, by just being willing to let them make these small expressions of independence. It’s much more important to them than we realize.
Lorna Couillard

I worked the night shift to the morning hours all the 30+ yrs of my work, and many of the elders were notorious for being up and more active during the night than the day. Some of them developed the habit because of anxieties, pain that kept them awake, or were just naturally inclined to be up at night.  I would be frustrated with this trend; but finally learned to except this and "go with the flow". I also learned to see the humor and uniqueness of these folks, and respect their approach to dealing with insomnia. I'd often find them doing all kinds of activities in the middle of the night, from small repairs to something in their room, to watching a movie, or some craft project they enjoyed doing. Now, I am one of them.

During the wee hours it would be typical to find them raiding the refrigerator, fixing themselves a cup of tea and a snack, working on a book, studying, listening to radio talk shows or music, or wanting me to sit and talk with them. At times I'd find several of them together having a group discussion, either in one of their rooms, or even right in the middle of the hall. Many times I sat at 2:00 or 3:00 in the morning hearing a story of various family problems, an elderly lady dealing with missing her late husband, a loss of a home, or sit next to the bed of one in chronic pain, and hoping the meds that were given would start to relieve the suffering; prayer was always in the prescription also.
​
If you are caring for a loved one who has developed problems sleeping at night, it is not uncommon. You may be able to find ways to help them get a  full nights rest bey offering a sleeping aid prescribed by their doctor, a hot cup of tea and a snack before they retire, a radio playing by their bedside, or something to read that interests them. But, if they continue with the trend of sleeplessness, you may have to accept it, and do the best you can. I took care of my mother for over 10 years and she also tended to be awake many nights. If I was home on my nights off, and heard her up and rustling about in her room, sometimes I'd get up too, and we'd talk for a while. After a short time, it sometimes worked to help her get back to bed. If not, I just learned that her knowing I was there, and cared for her brought a lot of peace to her. That's what good care giving is all about.
Lorna Couillard

Exactly because most people tend to avoid the sick and dying, ministry to these persons is a defining task of Christian discipleship. As Followers of Christ, we are called to remember those whom the world forgets and avoids.

Pastoral Presence - A Ministry of Care and Hope

Christian ministry to the sick or dying creates and environment from which a patient may draw physical, emotional, and spiritual sustenance. This environment of caring is created by the Holy Spirit and mediated by pastoral presence.

We must first remember that our visit is an offer of presence. The patient may or may not accept this offer. Many variables having nothing to do with our merit as visitors can lead the seriously ill patient to withdraw from our presence. Love compels us to accept both the decision to welcome and the decision to withdraw.

Pastoral presence can be shared with the sick or dying person through prayer, scripture, touch, empathy, and listening.

Prayer

Prayer at the bedside can be meaningful or mechanical. The difference is determined by the sense of participation experienced by the patient and the visitor. In the case of an unconscious or confused patient, the family members in attendance may become primary participants.

Each patient has a different devotional makeup. Patients with deep spiritual maturity will experience prayer differently from patients who view prayer as a kind of theological magic.

Guidelines for Prayer 

Prayer with purpose. Be specific about your petitions for the patient based on what the patient has shared during the visit. Relevance and specificity communicate sincere interest in the patient.

Put the patient in control. When the conditions of the visit create some doubt about the propriety offering prayer, say to the visitor, “I will be praying for you during your illness.” If the patient responds positively, ask the question, “Would you like for me to join you in prayer now?” While most patients respond positively, asking the question allows the patient to control the depth of spiritual sharing and set the stage for building trust.

 Avoid preaching to the patient with your eyes shut. Do not use prayer to teach, correct, persuade, or challenge.

Avoid praying at such a rapid pace that the patient might infer insincerity. Pausing for a few seconds before beginning the prayer can help to calm and assure.

Avoid trivializing prayer by competing with noisy distractions like a loud television, boisterous visitors of the patient in the next bed, or clanging equipment operated by the medical staff. Allow these tasks and distractions to exit before beginning prayer. The dignity with which we treat the act of prayer sets the tone for the patient’s participation.

Avoid using prayer as means to shorten or conclude the visit. Prayer should happen in natural progression and not as a way to cope with anxiety over the patient’s distress or to control the length of the visit. Patients can sense this impropriety and consequently feel disregarded and manipulated.
Use the patient’s name in prayer. Praying for “this, our brother” or “this, our sister” in the petition will be rightly received as impersonal. When visiting someone unfamiliar, clarify the name and proper pronunciation at the beginning of the visit.

Scripture

God’s presence is revealed in and mediated through Scripture. Because the Bible speaks directly or indirectly to every need and because patients embody a multitude of needs, it is important to share scripture skillfully and carefully:

Be brief. Seriously ill patients do not have the stamina or power of concentration for a Bible study or lengthy reading.

Commit helpful passages to memory for use in prayer. Some appropriate selections are Isaiah 41:10; Psalm 146:5; John 14:18; Romans 5:3-4; and Revelations 21:4. 

Be sensitive to the moment. Some visits will not lead to the readings of scripture or its use in prayer. 

Notice the patient’s spiritual or devotional literature as you enter the room. The presence and identity of this material may provide clues concerning the patient’s receptivity.

Read passages of scripture that have been meaningful to the patient in the past. Once the invitation to read scripture has developed during the visit, the visitor may ask the patient for favorite or best-loved passages. Be careful during serious illness not to require more energy and reflection than the patient can generate.

Touch

Touching is a powerful nonverbal communication. Because they are sometimes lonely and isolated by their illness, patients need touch to sense genuine concern. A caring, tender touch such as holding a patient’s hand during prayer communicates blessing. Propriety dictates how to touch the patient. Touching the hand or the forearm is appropriate for patients of the opposite gender. Gently touching the patient’s shoulder is an alternative for persons of the same gender.

Empathy

Mediating Christ’s love entails developing sensitivity to the patient’s experience. While diseases can be diagnosed and verified with ever-increasing precision, the individual patient will have a “private interpretation” of being ill. The attitude, which enables the visitor to grasp these unique interpretations and experiences, is called empathy. Empathy means freeing us to see, understand, and experience life through another’s being.

Listening

Listening is the heartbeat of pastoral visitation and the radar that guides us into the empathic understanding of the patient’s experiences. Intuition alone cannot substitute for listening. Disciplined effort is required to share the meaning of other’s experience. Before visiting the patient, pray for the strength to listen in order that the grace and love of God may be manifest in conversation. 

Listening Basics 

God listens to all of us. We should listen to each other. 

Most people believe they listen better than they actually do.

Each patient is unique. Do not assume to know the patient’s values, needs, concerns, and attitudes without careful listening.

Listening involves the whole body. Behaviors that can help patients know our interest in their feelings are called attending behaviors.
They include
(1) taking a comfortable position that allows us to make easy eye contact; (2) maintaining an alert posture such as leaning slightly forward;
(3) maintaining a relaxed demeanor. Avoid standing with arms folded (nonverbal statement suggesting a barrier).

Listening involves all the senses. Observe the patient’s nonverbal clues. Are the patient’s physical behaviors (facial expressions, fidgeting with his hands) congruent with verbal messages? Nonverbal clues are indicative of the patient’s feeling and thinking. 

Listening for the tone of voice as well as the content of the patient’s statement. 

Resonate with the patient’s communication. Do not be thinking of the next response to the patient while he or she is talking.

Listening is interactive. Communication is completed, and the patient is affirmed when we verbally follow up the patient’s conversation. Respond with restatement of the patient’s statement that seems parallel in meaning.
Example:
Patient: “God must be mad at me. I’ve had so many problems with my health, just when I was planning to retire.”

Visitor: “After experiencing so much hardship, you’re wondering if God is being fair.” 

Be alert to the meaning of the patient’s disclosures, rather than the facts. As a rule, do not probe for facts. Allow the patient to reveal what is important by responding to his or her feelings.

Responses the visitor might employ combine a feeling word gleaned from the patient’s message with the context of the feeling. Examples: 
“So, you feel frustrated because of this confinement.”
“I’m sensing how frustrating this illness has become.”

Listening may require more than one visit. Our willingness to listen non-judgmentally over time can free the patient to risk genuine feeling without fear of ridicule or rejection.

Even though we are ever journeying toward death, the prospect of death becomes a crisis when the patient experiences a terminal diagnosis. Ministry to the dying is the ministry of companionship. The visitor listens empathetically during multiple visits as the patient explores what has and does mean the most to him or her. The visitor attempts to be open to the patient’s intense feeling. The visitor tries to support the patient’s family members by allowing them to share honestly what they are feeling.

Death generally occurs a little at a time. Some patients integrate death into their lives over time while others fiercely deny death. Eventually denial will yield to other powerful feelings. This progression is normal. Allowing and receiving the full expression of feelings is a vital part of ministry to the dying. 
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 Feelings spotlight an inner struggle against emerging losses connected to the following needs: control, personal identity, relationships, and sense of completeness. Don’t give false reassurances or minimize problems. The patient will perceive that he or she cannot be honest about troubling concerns. 

Be alert to what is known as “unfinished business.” Are there persons to whom the patient wants to be reconciled? 

Allow the dying patient as much control as possible. Honor as many choices as possible relating to a wide array of concerns: food, visitors, and spiritual resources. Do not impose opinions when the patient is so vulnerable.

If chosen to listen, allow the patient to “tell his or her story.” This is a time of exploring the chapters of the patient’s life and a process that helps the patient accept life for what it has been and what it will be. 

There will be times when the visitor will be helpless to comfort the patient and will have to wait with the patient for the promise of Christ: “I will not leave you orphaned; I am coming to you”(John 14:18). Our primary task is being present.
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Sharing ourselves with the sick and dying is sharing Christ. Through presence, prayer, scripture, empathy, and listening, we share Christian hope. People who are sick and dying need hope as much as they need medical care. Our presence with them as a servant of Christ and members of his Body brings the gift of hope.
Lorna Couillard

There is truth in the statement, “You can never satisfy some people.” If the person you can’t seem to satisfy is the older adult you care about or sibling caregivers, remember that your priority is to satisfy yourself first.

This may sound selfish. However, unless you make efforts to continue your own life in a positive manner, you won’t satisfy anyone – including your older adult.

Good communication is key to both family caregiver and older adult feeling good about a caregiving situation. Also, both need to be open to asking for and getting help. Help may come from family members, friends, health care providers, care services, community resources and in support groups. 

The following are some tips for improving communication and handling conflict:

Step back from the situation.

By taking a step back from your family caregiving situation, you can better review reasons why things are happening and alternatives for dealing with problems. This can only be done by taking a break from caregiving duties. With a better understanding for your situation and feeling that there are options for help, your may feel relieved and better equipped to deal with your situation. You will be more open to positive discussion with your older adult. 

If an older adult is constantly complaining or criticizing, a temporary break may help you understand why this is happening. You may realize that the complaining and criticizing may have nothing to do with you. The older adult may be unhappy about needing help, feels sick or uncomfortable much of the time, suffering from clinical depression or dementia, has lost contact with his or her friends or is just angry about life. 

Understanding that complaints and criticism aren’t because of you can help soften their effects.

If criticism aimed at you was part of your former family situation, it is unrealistic to expect that this will change. If this is the case, it is especially important to seek outside help for family caregiving needs. Outside help may include turning to family members or friends, hiring care services or utilizing free community services. 

A family caregiver support group is also a good alternative. A group can help you feel less alone in dealing with issues. Also, other caregivers offer great tips in support groups on how they’ve dealt with similar situations. Support groups for people with specific illnesses are also available and may be a good place for your older adult to vent feelings.

Listen.

Everybody thinks they listen. But especially in close relationships – spousal, parent-child or close friend – people begin to complete each other’s comments or fail to hear other’s thoughts because there is an assumption of knowing what will be said. Or, in the case of an older adult constantly complaining, a caregiver is likely to tune out repeated complaints. It is human nature.

To really listen, make an effort to focus on what is being said and speak only after your older adult has finished talking. You will likely be surprised at what you hear. Think about the comments and then try to envision yourself as saying those words and why you would say them. In other words, spend time in your older adult’s shoes.

In situations where closeness has caused you to take your older adult for granted, these conscious listening periods can re-ignite feelings of empathy that may make communicating easier. Also, your increased responsiveness may be noticed by your older adult who may then be willing to try the “listening game.” 

Say “I” instead of “You” statements.

It is important as a family caregiver to be assertive but not aggressive. Assertiveness helps you maintain your personal boundaries and what you are willing to accept and do as a family caregiver. 

To assert how you feel and not be accusatory, it is better to use “I” statements, such as “I feel …,” “I need…,” “I will …” and “I expect …” “I” statements allow you to express your feelings and are less likely to make others feel defensive. For example, say “I feel bad about what happened,” rather than “You made me feel bad about what happened.” The other person is more likely to be open to positive discussion about what happened than be defensive about causing hurt, and will likely volunteer an apology. Also, you may find out that hurting you was unintentional.

When using “I” statements, be specific about consequences. Rather than saying “You need to pick up Mom on time or else there could be problems.” Try saying, “I can take Mom to the store, if you can pick her up at 3 p.m. If she isn’t picked up on time, Mom may wander … or … Mom will not have a place to sit and wait at the store … or Mom buys frozen foods and they could melt.” Don’t assume another person understands your reasoning for requests. Instead, they may infer that you think they are unreliable. 

Find a good time for conversation.

If you know your older adult or others doing family caregiving don’t like to talk in the morning, during the evening news or in the car, plan to discuss concerns at another time. Everyone has better and worse times for talking and listening. Sometimes simply asking, “Is this a good time to talk about something that I’m concerned about?” indicates your respect for the person’s time. If the person suggests another time, defer to his or her personal judgment. However, don’t allow someone to continue to put you off. Your feelings are important.

Step Away From Emotions.

Sometimes the best way to deal with conflict is to step away it. By simply saying, “I’m sorry, I can’t discuss this anymore. Maybe we can talk later,” and step away, you are acknowledging that the discussion is important to the other person while respecting your own limitations for handling the situation. After time away from the person or issue being discussed, what was so important to stand up for in the conflict may seem of little consequence later. If after stepping away and you feel the topic is still important, the matter can be brought up at a less emotionally charged time.

Become a duck.

Envision issues causing conflict as water and you as a duck. Other than making you smile, it sends an image to your brain that issues don’t have to be important – they can be like water and roll off your back. You can decide to make issues important or unimportant. For some family caregivers, this means recognizing that personal or relationship harmony is more important than winning any argument or ever being right. For others, realizing that people rarely make other people change, works for them. Find a perspective that works for you. Repeat it mentally and even verbally to yourself as needed. This perspective can make the difference as to whether family caregiving is a stressful, worrisome experience filled with conflict or generally a good experience that you choose to have.

Tips For Being A Health Care Advocate

A family caregiver is often put in the position of providing guidance and advocating for the medical care of an older adult. Communicating with a doctor who treats the older adult can be sometimes awkward.

As a family caregiver, you want to respect the wishes and dignity of the older adult you care about. However, sometimes older adults may not ask questions or be self-advocates with medical providers.

If you go to doctor’s visits with your older adult, physicians tend to be willing to speak with you about your older adult’s care. However, it is advisable and many physicians require that a Power of Attorney For Health Care or authorization form be completed, giving you that power. It can be placed in your older adult’s medical file so there is no question that the physician may speak with you about your older adult’s health concerns and treatment without violating any confidentiality rules.

The following are some things to keep in mind and tips for better communicating with your older adult’s medical providers:

Have medical information handy. Always have a current list of your older adult’s prescribed medications, over-the-counter drugs and vitamin supplements being taken when seeing the doctor. Also, when your older adult has blood work or other medical tests done, make sure the doctor gives a copy of each report to you or your older adult. Keep the reports in order by date in a large envelope. Take the reports to doctor appointments, especially when seeing a medical specialist who may not have all records.

Write down concerns and questions. Prior to visiting the doctor, it is best to write down any concerns and questions. Include personal issues with, for example, swallowing tablets or a schedule that may interfere with taking medications. The visit with the doctor is usually short and it is easy to forget everything you want addressed.

Speak up. Make sure you make your key concerns known at the onset of the visit to help prevent the doctor from jumping to conclusions about treatments or dismissing issues you believe are important. Some physicians are less aggressive in treating an older adults for various reasons, including using “age” as a blanket answer for older adult medical problems.

Age, medical cost or personal discomfort of the older adult may be reasons a physician may not prescribe tests or medicines. A good question to ask is: “What treatment, tests or next step would you recommend if he/she was age 40 and had these symptoms?” You and your older adult should be offered the full range of tests and treatments, allowing you and your older adult to decide what may be too uncomfortable or expensive. Ask for referrals to medical specialists or get a second opinion, if that seems like the next logical step.

Ask questions. Don’t hesitate to ask when words the doctor is using are unfamiliar or his instructions are unclear.

Be informed. Learn about your older adult’s illness. Ask the doctor for literature about an illness or have him write down both the medical term and general term for an illness. There is lots of information in libraries, on the Internet and from health groups about health problems. Pharmacists are also great sources for information about medications. Make sure what the doctor and pharmacist say about a medication is not in conflict; if it is in conflict ask them to speak directly to each other.

Keep contact information. You and your older adult should have a current list of the names, addresses, and the office phone and fax numbers of all physicians your older adult is seeing and has seen. Blood work and other tests often should be sent to both a primary doctor and specialist, and you will be asked for address information. Also, if a doctor’s office is unresponsive to your telephone call or you are a long-distance caregiver, faxing your questions in writing to a doctor can sometimes prompt a response.

Important To Deal With Depression

Depression is one of the most common mental problems affecting older adults. It is also one of the most treatable. Family caregivers often are uncertain about whether they should suggest that their older adults seek professional help. However, in many cases, older adults themselves are aware that they are unhappy but feel uncomfortable about reaching out for help.

The best way to approach your older adult is to express it as concern for his or her health. If anger is part of the older adult’s depression, do not bring up the topic during an angry moment but instead later when emotions are calm.

Generally, there are two types of depression – incidental and clinical. The incidental type of depression is normal, periodic and is in reaction to a life occurrence. Clinical depression is an imbalance in a person’s physiology, often referred to as a “chemical imbalance.” 

Both types of depression can be treated. Sometimes for incidental depression, increased social contact and attentiveness by friends and relatives is all that is needed to get someone out of depression. Physical activity can also reduce feelings of depression. However, if incidental depression lingers over an extended period of time, the personal lifestyle of isolation from others and a negative outlook on life that develops from depression can become a way of life and only medication can help. 

It can be difficult to tell in older adults if depression is incidental or clinical. Older adults, simply because of age deal with issues that may cause depression, such as frequent death of people close to them, physical limitations due to pain and chronic illnesses, and mobility and vision problems that may restrict them from hobbies and social activities. 

Getting a professional opinion, ideally from a geriatric psychiatrist, is the best way to determine if your older adult has a problem with depression. Because older adults react differently to medications due to having slower metabolisms and special sensitivities, a psychiatrist with training in geriatric care is best. However, if a geriatric specialist isn’t available, at least turn to a psychologist or psychiatrist – not a general physician – for mental health treatment. 

With proper medical treatment for depression, an older adult will likely become more socially and physically active. Often medical treatment for depression can result in unexpected improvements in addition to reducing depression, such as increased mental clarity and memory, less pain, less gastronomic and headache problems, and positive changes in other physical disorders. 

Interrupted sleep is common among adults age 70 and over. Treatment for depression can also improve sleep and result in greater personal energy for an older adult.

How do you know when an older adult’s depression is a normal part of life or in need of medical attention? Lack of doing normal activities and isolation from social contact are good indicators that there is a problem. Also, often there are specific emotional, cognitive, physical and behavioral symptoms.

The following are symptoms in each category:

Emotional: crying, apathy, lack of feeling or interest, and overall dissatisfaction with life. 

Cognitive: memory problems, disorientation, decreased attention span, feeling pessimistic, low self-esteem, hopelessness, difficulty concentrating, suicidal thoughts and dwelling on past failures. 

Physical: headaches, weight loss or gain, stomach distress, sleep disturbances, pain and fatigue. 

Behavioral: reduced activity, obsessive worrying, hostile, agitation, irritable and restlessness. 

In addition to being concerned about your older adult and possible depression, make sure to note if you are having symptoms of depression and get medical attention, if necessary. Also, consider taking a break from caregiving, if it is causing you stress. It may be all you need to regain a positive perspective on life.

Personal Care Is Important 

Proper daily hygiene and dental care, adequate intake of water and other personal care concerns are important for family caregivers to take note of with their older adults. Long-term lack of personal care can lead to serious health problems. 

Poor personal cleanliness can be a symptom of low self-esteem due to depression or other mental health problem, mobility limitations or lack of energy from interrupted sleep or a physiological problem such as a thyroid imbalance. 

Poor dental care can also be a symptom of low self-esteem due to depression or other mental health problem. Or, an older adult may not be able to afford dental care, have transportation to get to dental appointments or could have problems gripping a toothbrush due to pain from arthritis or other ailment. 

Dehydration is prevalent among older adults. The normal physiological triggers that prompt thirst lessen with age. Dehydration can lead to symptoms of dizziness and weakness, and may cause heart and other serious health problems if not addressed. 

Poor personal hygiene can lead to skin and hair problems. Lack of dental care may result in an older adult not eating properly because of pain with chewing or lack of teeth to chew. A serious lack hygiene and/or dental care can lead to skin and gum sores, infections and chronic diseases that can develop from sores. 

If an older adult is not keeping up with personal care, make a list of your concerns and address them with your older adult. Approach the issues as health concerns without being critical of your older adult. If this doesn’t help, make an appointment with a primary or geriatric physician and address the concerns with the doctor with your older adult present. A complete mental and physical health evaluation should be done. A doctor’s perspective may help your older adult realize the importance of these issues as they relate to health. 

Older adults need to have a daily routine of personal hygiene and dental care, dress in clean, day clothes (not stay in bed clothes) and maintain a schedule of activities. Regular dental care check-ups should be scheduled and, at a minimum, older adults should have annual check-ups by a physician for preventive health care. 

Many Considerations For Housing & Care

If mental and/or physical frailties become a concern for older adults and their family caregivers, there are now many living options to choose from. The first priority in considering any housing change for an older adult is personal safety. If a living situation is now making the person unsafe, a change needs to be considered. “Unsafe” can be the actual living circumstance (i.e. too many steps to climb) or the person isn’t doing self-care (i.e. eating or hygiene.) 

Changing an older adult’s living situation doesn’t have to mean moving out of the existing home (if the housing situation is safe.) There are now many homemaking, meal delivery and personal care services that will come to an older adult’s home. 

Also, if one person living in the home is able but the other person needs help, having the frail older adult go to an adult day center for one or more days per week may be a good option. Personal care such as bathing can be taken care of at the center. Also, going to the center can provide the frail older adult with socialization and the caregiver with a break from caregiving duties. 

For older adults who want to consider moving from home, there are many options – from senior apartments, some with federal subsidy and others without, to retirement communities that offer unassisted to assisted living situations. 

Moving to housing with a minimum age requirement (usually age 50), can be a positive move. Being with other seniors, there may be more socialization opportunities. Also, if care services are needed, they may be readily accessible 24 hours per day. 

Whether it is an in-home service or special housing, the older adult’s preference must be a priority. Family caregivers can assist with the decision, but an older adult’s wishes need to be respected. Also, it is best to check with several options, interview people, ask detailed questions using check lists and tour housing and facilities. Check any contracts carefully. Housing and services for older adults has become very complex. 

A skilled nursing care facility is required only when specified by a physician. In the case of terminal illnesses determined by a physician, in-home or facility hospice care are options. 

Ask Questions, Consider Options For Home Care

There are several options when trying to find in-home help to care for your older adult. The key is to find reliable help that you and your older adult comfortable with and meets the specific care needs.

Home care is defined by the type of care needed – homemaking, hands-on personal care (i.e. bathing, toileting), and supportive medical care. 

Or, you may hire a care worker independently or through a home health agency. 

When considering a home health agency for a care worker, there are some questions to ask in advance that can assist you getting help which is best suited for your older adult. Before hiring an agency, ask:

Is the agency certified for participation in Medicare and Medicaid programs or private insurance? 

Does the agency accept payment from Long-term Care policies, Family Care or the Community Options Program? 

How long has the agency been serving the community? 

Is the agency accredited by the Joint Commission On Accreditation of Healthcare Organizations (JCAHO), or the Community Health Accreditation Program (CHAP), or other recognized accrediting body? Does it state this in its agency literature and contracts? 

Does the agency provide an initial assessment to determine if the patient would be appropriate for home care and what those services might be? 
Is there a fee for an initial assessment? 

Does the agency provide all services needed? Can it provide flexibility to meet the patient’s changing health care needs? 

How does the agency choose and train its employees? Are criminal background checks made? Are employees given drug screens? Does it protect its employees with written personnel policies, benefits packages and malpractice insurance? Are the employees boned and insured? 

Does the agency provide literature explaining its services, eligibility requirements, fees and funding? 

Does the agency have arrangements in place for emergencies? Are the agency’s caregivers available 24 hours per day, seven days per week or on what limited time basis? How quickly can they start? 

Are references from former clients and doctors available? 

What types of programs does the company have in place for assure quality care is provided? 

Will the agency go to bat for you if your insurance company, Medicare or Medicaid fails to cover a claim you and the agency thought should be covered?

Hopefully these tips and information will help give assistance to anyone who has taken on the role of caregiver. It is by no means a complete guide, but it is information I've found helpful in through the years I worked in the healthcare field, and as a caregiver.

Communication with a physically impaired person can be a difficult and frustrating task, but good communication skills can prevent catastrophic reactions. In dealing with persons with limited physical or mental abilities, it is important to listen, speak clearly and slowly and use non-verbal communication (body language) to help convey your message.
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These are a few things I've learned while working with impaired persons in home health care, and residential care with seniors.

Communicating with the hearing impaired

If the person wears a hearing aid and still has difficulty hearing, check to see if the hearing aid is in the person’s ear. Also check to see that it is turned on, adjusted and has a working battery. If these things are fine and the person still has difficulty hearing, find out when he/she last had a hearing evaluation; 
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Wait until you are directly in front of the person, you have that individual’s attention and you are close enough to the person before you begin speaking; 

Be sure that the individual sees you approach, otherwise your presence may startle the person; 

Face the hard-of-hearing person directly and be on the same level with him/her whenever possible; 

If you are eating, chewing or smoking while talking, your speech will be more difficult to understand; 

Keep your hands away from your face while talking; 

Recognize that hard-of-hearing people hear and understand less well when they are tired or ill; 

Reduce or eliminate background noise as much as possible when carrying on conversations; 

Speak in a normal fashion without shouting. See that the light is not shining in the eyes of the hearing impaired person; 

If the person has difficulty understanding something, find a different way of saying the same thing, rather than repeating the original words over and over; 

Use simple, short sentences to make your conversation easier to understand; 

Write messages if necessary; 

Allow ample time to converse with a hearing impaired person. Being in a rush will compound everyone’s stress and create barriers to having a meaningful conversation. 

Communicating with the deaf
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Communicating with the deaf is similar to communicating with the hearing impaired; 
Write messages if the person can read; 

Use an ipad, ipod, laptop, or other device with illustrations to facilitate communication; 

Be concise with your statements and questions; 

Utilize as many other methods of communication as possible to convey your message (i.e. body language); 

Spend time with the person, so you are not rushed or under pressure.
 
Communicating with the visually impaired

If you are entering a room with someone who is visually impaired, describe the room layout, other people who are in the room, and what is happening;
 
Tell the person if you are leaving. Let him/her know if others will remain in the room or if he/she will be alone; 

Use whatever vision remains; 

Allow the person to take your arm for guidance; 

When you speak, let the person know whom you are addressing;
 
Ask how you may help: increasing the light, reading the menu, describing where things are, or in some other way; 

Call out the person’s name before touching. Touching lets a person know that you are listening; 

Allow the person to touch you; 

Treat him/her like a sighted person as much as possible; 

Use the words "see" and "look" normally; 

Legal blindness is not necessarily total blindness. Use large movement, wide gestures and contrasting colors; 

Explain what you are doing as you are doing it, for example, looking for something or putting the wheelchair away; 

Describe walks in routine places. Use sound and smell clues; 

Encourage familiarity and independence whenever possible; 

Leave things where they are unless the person asks you to move something. It can be upsetting for them if they cannot find something missing from a place they purposefully keep it.

A calm, kind voice is a key to good communication, and comfort.
Lorna Couillard

This post will answer any questions or accusations of my history, and whether I'm a phony, or not. The Statement of Faith page of this site will add more to what's below, but this will take care of any issues of those who would like to spread rumors and stories.
From the early 1979, to 2005 I worked numerous jobs in the area of senior care, and took care of my mother for many of those years, also at the same time. Along with this Lynn dealt with heart problems from 1982, till his death in 2004, there were many issues that came with helping him, and living with someone with serious heart problems-but God was there through it all, and I saw His hand in many of the things he went through. Much of my life has been involved with people with serious health problems, and the aged. It has molded me into what I am today-and how I look at life.
I see through eyes that have taken care of many in various conditions of health issues, and coping with it, and finding joy, and the strength to go on, and keep facing life, and doing it with a sense of responsibility. Lynn and I both took care of our parents till they died, and worked sometimes 2 jobs to maintain ourselves, and still run our home businesses; Lynn raised cattle, I raised Arabian horses, and showed them. We were never bored. During this period I was working caring for seniors nights and weekends, and a full time day job at a publishing company, until 1994, when the company moved out of state. 
During the years of taking care for mother, diabetes took a toll on her, and in 1997, cervical cancer and surgery. At this time, I had taken a test and passed it, to enter nursing school, I planned to start that fall. The very next day, after receiving the letter of the schedule to start, my brother called and told me of mother having cancer, and they needed me to come to New York, and be with her-I was the only one who knew what to do for her. I had to make a decision to either go to my mother, or enter nursing school. I prayed about it, and knew I had to go to be with my mother. I closed the door to becoming a nurse, and surrendered to what I believed God wanted. Shortly after this, Lynn had another minor heart attack, and had to retire permanently from his job. Life at this point, was a roller coaster. I was still working caring for seniors in home health care.
In 1999, she had to have part of her foot amputated. Then, another blow- a fall in 2004 that broke her left hip. Lynn had died the same year, in July 11, 2004-another heart attack at home, in my arms. At this time, life was undefinable, I functioned on auto-pilot, and numb.
From then on, she was wheelchair bound, and I could no longer care for her at home, because the infection in her feet needed daily care I could not give. I brought her to the house several times a week, and had her spend the day with me, until her death. The last picture below shows her with my brother, coming for the day with us.
I've had it said to me that I don't smile enough. There's reasons for that, that I won't go into. Most do not care to hear what the reasons are. I get up and keep going with the strength God gives, and am thankful to be able to continue to maintain my own life. God has been very good to me, better than I deserve. But, a smile on my face, is the least of my concerns. I've come to accept that I do not fit in with most social activities or events, and don't attempt to fit in. I haven't lived a life, that many would want to know of or understand. Most of the things I see people doing, and spending their time and money on, is senseless to me.
Lorna Couillard

The Ministry Charter was an addition to the ordination I was given into ministry in 2012. Years before, I worked many years in private homes, caring for seniors in the area I lived, as well as nursing homes. Below is a very damaged, water stained photo of a couple in their 90's in their back yard-their two sons had given them a small celebration for their 70th wedding anniversary. Lester was 95, Susan was 93, and we made a small luncheon and gathering on their back lawn. Guests from the area came to congratulate them, and some to share memories of their lives together over the years. This was in the mid-80's, and I was in my 30's. Below this, one reference from my last employment, by the Director of Nursing at that time.

Click the link to read the miraculous answer to prayer of Lester's salvation, at 95 yrs. old- Born Again-Just In Time
https://www.thenightwatchman.org/devotions/born-again-just-in-time