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The best way to help older people is to stop ‘telling’ and ‘fixing’

The way we communicate with seniors living in residential aged care or at home can either build or inhibit their capability, writes Lindsay Tighe.

The key to enabling aged care consumers to have more choice and control over their lives is to change the way we communicate with them.

Traditionally, aged care has been delivered in a “provider knows best” approach, but since the reforms began in the sector this has now shifted to a “consumer knows best” philosophy.

Lindsay Tighe

Lindsay Tighe

This shift demands that we change the way we practice.

The premise of my work is to acknowledge that everyone is far more capable than they realise and the way we communicate with each other can build or inhibit people’s capability.

Communication generally is done too much from the ‘telling’ space and it’s apparent that this approach, whilst done under the guise of being helpful, is one of the biggest inhibitors of enabling and building capability.

Sadly, this telling is often done unconsciously and habitually, probably because this style of communication has been role modelled in our lives, with no awareness of the adverse consequences.

When looking at any change in behaviour, the starting point has to be our mindset and the assumptions that sit behind it.

What assumptions are we making about our roles as aged care professionals? And what assumptions are we making about the older people we’re interacting with?

This kind of reflection can be enlightening. Invariably we find the roles we have created, and the assumptions we’ve made about what seniors want from us, leads directly to us being “fixers, advisers and tellers.”

And that’s despite what we know about consumer directed care, and the wellness and reablement approaches.

Consider how detrimental the telling approach can be and, in particular, how for the person being told it can create:

  • dependence on the teller or fixer
  • less creativity and responsibility
  • passivity or rebellion, or a bit of both
  • a loss of confidence and capability
  • feelings of being disrespected, not understood, frustration or anger
  • a lack of engagement or motivation

Traditionally in aged care we have created care recipients who grow accustomed to being told what to do. Their passivity then creates in aged care professionals a belief that older people need to be told what to do – and so the vicious, unconscious cycle continues.

If aged care staff can redefine their roles to become enablers, by seeking out capability, then they can help to break the cycle and enable consumers to have the control.

One of my favourite quotes is from Plato, who said:

“We all have innate wisdom; we just need to be asked the right question.”

This quote reminds us that if we have a certain mindset when we interact with people, we enable them to become whatever we are holding to be true.

In other words, if you treat a person like they are incapable, they will become incapable. If you treat them like they are capable and wise, they will be more capable and wise.

As a society we have a long way to go in becoming more conscious of our communication and recognising the detrimental impact that most of us have when we unconsciously fix, tell or advise.

I am excited about the possibility for aged care if we all learn the skills to be a better questioner and start to release the capability that resides in everyone.

Lindsay Tighe is the founder of Better Questions and an executive coach, speaker, trainer and author.

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6 Responses to The best way to help older people is to stop ‘telling’ and ‘fixing’

  1. daniella August 19, 2016 at 11:44 am #

    Fantastic article Lindsay, thank you for writing it. I think the key is to encourage everyone involved to think about how they think about older people…how we think about older people colours the tone of voice we use, the words we choose, the preferences and choices we honour and respect…our limited expectations of others become a self-fulfilling prophecy.
    Thanks again for the terrific article.

  2. Marcia Wood August 19, 2016 at 12:50 pm #

    Thanks for this lovely article Lindsay. I wonder when the RACFs are gonna start using this approach though. If you’re gonna apply this theory you’d pretty much have to ask what time the resident would like to get up and have a shower/wash in the morning right? Lots of facilities wake them poor things from 7 and wack them in the showers though.
    Also, I’d love to know how you’d use this approach with an advanced stage of dementia where there’s not much verbal communication.
    Thanks a lot.

  3. Drew Dwyer August 20, 2016 at 2:11 pm #

    Great read, thanks! I do see this change in mindset and culture beginning out there, some residential homes and providers are changing their models in meaningful ways.

    This should be encouraged and valued as good emotional intelligence and mastering the skills to enable their client. Clients are also learning to take control, but they need more education also. In the end their are also many clients in care that are quite forthwith when giving direction. Trust is an important thing too.

    Balance in building a therapeutic relationship and supporting the trust factor also needs temporal considerations. Changing the ACFI would shift mindset and give value to what time it takes to support people to achieve as much wellness as possible. Care is still the function and focus for the role The skills in restorative, reablement and social communications are great parts of the carers tool box.

  4. Maggie August 21, 2016 at 11:44 am #

    At long last. Thank you. We work with our elders who have much more experience about life than we have. Listening is the most important thing we can do. I encourage anyone working in care to really get to know the people you work for/with. Even if there isn’t much verbal communication look into a persons eyes, feel what they are telling you. Go to dementia or montessori training and you might just get how a person with dementia feels. A huge change in the age care sector must take place. Its should never be all about the ADLs and this where the conflict of time management and the must does seem to take precedent. Time to get to know our elders, listen to their stories, their backgrounds. Example – A person that is said to have “behaviours” might just be a person that has been very busy taking care a family, volunteering, working on the big projects for Australia. Thanks again.

  5. Lisa August 21, 2016 at 12:36 pm #

    I have attended one of Lindsay’s ‘Better Questions’ workshops and can thoroughly recommend it, Lindsay has a tremendous passion for what she does, she inspired, motivated and gave practical examples of how to apply her techniques. As a nurse in RAC, I find I can apply the strategies I learnt in many scenarios – including when assisting a profoundly dependent person with end-stage dementia. Agreed, however, that some of us are ahead of the curve regarding outdated care regimes – but the tide is turning and our aged citizens are beginning to find their collective voice – I personally prefer to be on the front of the wave despite its difficulties, rather than be swept away by the tsunami of change that is coming!

  6. Christine Mifsud August 22, 2016 at 9:50 am #

    Hi Lindsay, I did your Asking Better Questions training last year so know where you are coming from. While I agree 100%, I think it is going to take a generation to embed this change of attitude towards older people in residential settings. I have had to place both parents in an ACF and recently assisted a client with the transition. I find the loss of independence heartbreaking to see. This is no reflection on the quality of care provided, but ACFs, perhaps for good reason, seem to be very unprepared to let residents take some risks and residents’ own knowledge about what they can and can’t do is not given much credence. I even wonder if this is truly possible in a congregate setting?

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