Her mental arithmetic skills are fabulous

I am a self-employed domiciliary carer, and, in this job, I work morning hours.  My day begins with a journey to arrive at my place of work – wondering how my client will be today. Sometimes she is already beginning her breakfast preparations – the same thing each day. Sometimes, and more often lately, she is still upstairs. Today she is already in the kitchen and welcomes me with a smile.

Much of our conversation is a repetition of previous breakfast conversations: I’m often asked to join her and will have a cup of tea. It is increasingly obvious that the client is having memory problems and my goal in the mornings, when she is most able, is to converse in such a way as to promote trust and find out about family and friends, her personal history and events in her life to maintain her narrative when she is becoming lost and muddled. I exchange information and although it isn’t remembered it will be perceived as a normal conversation. In her 80’s The client has a lot of stories to tell and all of them are helpful for her care. 

One morning she became fixated with the kitchen floor: she was able to describe her kitchen floor in detail. It didn’t correspond to what she was currently seeing and this caused no end of upset -where was she?, why was she here?- that no amount of quiet reassurance did much to alleviate. 

On another day, during a chat, she remembered her grandma’s kitchen -particularly the tiled floor pattern – a-ha, bingo – this is where she was earlier. We talked about floors and then, in the future I can immediately return to the reminiscence of grandma and the pattern and colours, entering her world. In this way I validate her experience and can even give it context to the present. If none of that helps settle her then I can just say it must be in the other room and suggest that we look in later, the pattern interrupt enables me to change the subject.

She is a fashion-conscious lady with beautiful clothes, many of which are favourites Today whilst dressing there are several layered blouses, a matching skirt and cardigan plus her daily choice of jewels. It is better for her to keep her independence and confidence in her abilities to choose and dress than worry about the layers and only intervene if completely inappropriate for the weather. We invariably look at photos of her late husband and she talks to me about the funeral order of service showing me the choice of hymns and telling me who did the readings. I listen and make new comments again, always agreeing that grandchildren do a marvellous job of speaking on these occasions.

Downstairs we make a list for shopping and choose the comfortable brogues to walk about in. The client is becoming a little unsteady on her feet which may be due to failing eyesight (must get an optician’s appointment organised), sore feet or even mild dementia changes in the brain causing a misreading of the physical world around her. All the above are simply suppositions that are worth bearing in mind and reporting to the team of carers and family.

exchanging the information with others enables the client to maintain her confidence and us to foresee difficulties pre-empting them by simple means. The client locks up and we put the keys into the safe place in the car, where they are left. This has been agreed in the past and I make a joke of it so as not to imply that they will get lost/ she isn’t to be trusted with their keeping. It avoids consternation and worry on our return as to where they have got to – helping the smooth running of the client’s day.

She loves the drive through the country, and we point out changes to each other as we go. I try to keep off the subject of driving and cars as she is no longer safe at the wheel. This is a very sore point with her, and I sympathise and distract her, if ever it comes up, as she feels her autonomy eroding and it is upsetting.

Shopping is always interesting. I encourage her to push the trolley and choose the items off the list. The client loves to see people, especially mums with young babies or children and will stop to talk and pass comments on them and how lovely they are! Sometimes I need to prompt her to move around the shop. I never know if this is the client’s outgoing friendliness or the result of loneliness or, indeed, her dementia status but the client appears to get a lot of joy from these interactions.

We move on. The client is still just able to use cash and I leave her to do so. Many of the checkout people know her and show patient understanding. They offer help unobtrusively and it is only occasionally that I am needed. She maybe beginning to lose the ability to recognise money denominations and their value but her mental arithmetic skills are fabulous!

We arrive home and put the shopping away together although the client complains the cupboards are all wrongly filled -she still doesn’t recognise this as her home and will tell me at length about the old kitchen and its arrangement. These conversations will be helpful in my increasingly detailed picture of her previous life, and I shall be able to be with her there if she has slipped back through the time warp of dementia; nothing is wasted information and I try very hard to listen and not pepper her with questions. Questions often serve to muddle and long, convoluted sentences lose the client and make them uncomfortable. The client and I have simple exchanges, nonetheless suitable to us both.

Much of this morning has been fun and it has run smoothly. The client is helping by laying the table and I am making her choice of lunch as my colleague arrives for the afternoon shift. They will eat together. I give the client a quick hug and say see her another day, handing over relevant information to my successor and leave.

It never feels like work! 

One response to “Her mental arithmetic skills are fabulous”

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