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Last Modified 07/22/04

CARE Connection - September 2009

New CARE Training quickly approaching

The Fall 2009 CARE New Assessor Training will be held Wednesday, September 16 at Goodland Regional Medical Center, 220 W 2nd Street from 8:30 am - 4:30 pm Mountain Time (9:30 am - 5:30 pm Central Time). 

This will be the final CARE training for 2009 in Northwest Kansas.

To reserve your space, please call Tammy G at 1-800-432-7422 or (785) 625-2037.

Have you tried the CARE blog?

The NWKAAA CARE blog can be found at http://nwkaaacare.blogspot.com/   At this location you can alert other assessors about presentations of interest, discuss general CARE questions, or share pertinent information.  This is not a secure location so we cannot discuss individual client information, but we can discuss the "big picture" to help each other learn from our more challenging situations.

It seems to be letting everyone view / post now; if not, please let me know!

As an added security feature, all postings have to be "approved" by us before they will show up on the blog.

Check back periodically for useful information and discussions!

Please remember to fax your completed CARE assessments in a timely manner!!  Feel free to call and make sure we received it so you don't have to track it down later!

New "Explore Your Options" Coming Soon

The new edition of the Explore Your Options will be in 2 separate books.  One book includes the "county information" currently in the back of the book and the other is the general information currently in the front of the book.

It is also available online at http://www.agingkansas.org/Publications/eyo/eyo_index.htm 

More from "How to Win Friends and Influence People"

Cooperative clients help produce more accurate, helpful CARE assessments.  Many of the remaining principles in Dale Carnegie's book explain how to achieve this ultimate goal.

The only way to get the best of an argument is to avoid it.

Combative clients will only defend and embrace their position, regardless of the "logic" you present, resulting in resentment and lost pride.  It's helpful to "welcome" the disagreement while staying calm and listening to the client.  Focus on areas of agreement ("Your daughter is worried about you.").  Acknowledge errors if one has been made or agree to explore the opposing opinion after the interview.

Show respect for the other person's opinions.  Never say, "You're wrong."

It's human nature to dislike admitting fault.  It's hard to avoid taking innocent comments personally once you feel like you're always "wrong."  Our clients may truly feel they are able to draw a clock, even though we've never actually seen one that resembles their artwork.  There are a lot of questions after the clock, so dealing with a client who thinks you're upset with them because they didn't do a good job will be really difficult and will probably produce inaccurate information.

If you are wrong, admit it quickly and emphatically.

Admitting errors clears guilt and allows everyone to move forward quickly.  Even if the error is not your fault (client misunderstood) acknowledging the error will help them save face and continue to cooperate.

Begin in a friendly way.

Discussion is more likely to occur if the client feels at ease with their assessor.

Get the other person saying "yes, yes" immediately.

Emphasize areas all parties already agree on so you build momentum toward acceptance.  If it is logical for the client to rehabilitate and return home, as desired, remind them that if they work hard with the therapists they might be able to go home when they are through with therapy.  In these situations it may be helpful to emphasize that clients go in and out of nursing facilities all the time.

Let the other person do a great deal of the talking.

Listen to the client's story, concerns and achievements to diffuse tension, build relationships and make more appropriate referrals.  Most people need to share what's on their mind before they can openly listen to your ideas.

Let the person feel that the idea is his or hers.

People are more motivated to achieve their own goals than those set for them.  By making suggestions, you can help the client determine the best course of action for their situation.  The client will come to the conclusion you desire with your guidance and believe that they thought it was the best all along.

Try honestly to see things from the other person's point of view.

Understanding our clients decisions, agenda and personality is directly related to their perspective of the situation and motivation.  We were able to explore this idea briefly during the elder sensitivity portion of the update training as it relates to physical disabilities.  We have to individually learn to emotionally understand our client's perspectives.

Be sympathetic with the other person's ideas and desires.

Most people hunger for sympathy.  "I'd feel the same way under those circumstances" is a rapport building comment that makes the person feel "normal" and like you really are trying to help them.

Appeal to the nobler motives.

People usually have two reasons for doing something:  the real reason and one that sounds good.  Most of us strive to show others the reason that sounds the best, so by helping the client show off a great plan, we will gain their cooperation.  An example Carnegie used was that a gentleman did not like a photograph that was taken of himself, so instead of complaining "Don't publish it, I don't like this picture" the man explained "Please don't publish this picture; my mother doesn't like this picture."  It is important to remember not to try to be manipulative when appealing to noble motives.

Dramatize your ideas.

Dramatization assists clients with vision / hearing deficits and improves accurate communication.

Throw down a challenge.

We can help challenge someone's capabilities or self-perceptions, especially in the instances of rehabilitation stays.  We might be the extra "push" the client needs to want to get better.

Begin with praise and honest appreciation.

Some of our clients will find the comments section of the CARE assessment to simply be a list of their shortcomings.  We should look for things they have done well in addition to their challenges.  We may simply need to say "You have come a long way since your stroke!" to give them the praise they deserve.

Call attention to people's mistakes indirectly.

Remember to emphasize that the person isn't flawed, it's the environment or situation.  Many of the person's shortcomings may be improved with assistive technology or home modifications.  We do not need to emphasize to the person what they can't do; we must emphasize what they can do!

Talk about your own mistakes before criticizing the other person.

It's motivating when another has overcome the same challenges.  This may be a good time to mention a community support group for people going through similar situations.  Discussing personal experiences builds rapport.

Ask questions instead of giving direct orders.

Asking "how" when discussing ADLs and IADLs will help you gain useful insight when coding these activities.  Hearing the process may help you determine whether a client should be coded as a 2 or a 3 on a certain activity much easier!

Let the other person save face.

This is especially pertinent to the clock draw.  Try not to allow others to "make fun" of the client's clock.  This seems like it should be one of the easiest parts of the CARE assessment; however many times it is one of the most difficult and frustrating things we can make the client do.

Praise the slightest improvement and praise every improvement.  Be "hearty in your approbation and lavish in your praise."

Specific compliments emphasize a client's progress.  It may be as simple as "You walked all the way down the hall today!" instead of "You only walked down the hall today."  Phrasing can make all the difference!

Give the other person a fine reputation to live up to.

Respecting others' capabilities will empower them to succeed.  For example, stating "You're quite capable, and you could go home after your physical therapy is through" will encourage a client to work their hardest in order to achieve the ultimate goal of returning to the community.  A less upbeat message may cause a client to believe that physical therapy will not help enough and they are destined to live their remaining years in the nursing facility, when in actuality all they needed was a little "push" to work hard with their therapist.

Use encouragement.  Make the fault seem easy to correct.

This principle will be helpful when a client is discouraged that they "can't do what they used to" when discussing ADLs and IADLs.  Some assistive equipment may help them regain the independence they desire.

Make the other person happy about doing the thing you suggest.

Frame requests in terms of what others find motivating.  "Why would the client want to do what I'm asking?"  For some it may be to qualify for Medicaid to pay for their nursing facility stay.  For others it may be satisfying others' requests (son, daughter, spouse, doctor) to enter the nursing facility.  Still others may be using the nursing facility as a temporary stay and will return home as soon as they are through with rehab.