We often experience a wide range of emotions when a family member moves into a nursing home. This week on the podcast, we welcome Carmen Bowman to discuss those feelings, how to confront them, and act in the best interest in the family.
Schenk: Hey out there. Welcome back to the program. This week we are going to be talking about the emotions that come along when our loved one, our family member moved into a nursing home, whether it be guilt, anger, sadness, grief. We are going to be talking about those and ways that we can address those.
And we are not doing that alone. We are actually going to have Carmen Bowman on the program today. Carmen Bowman is a consultant, trainer, author and owner of Edu-catering, catering education for compliance and culture change, turning her former role of regulator into educator. Carmen was a Colorado state surveyor or inspector and a policy analyst for the federal government division of nursing homes of CMS, where she taught the national basic surveyor course. She has been a part of many national cultural change projects with CMS, the Pioneer Network National Culture Change Organization. She has a master’s degree in healthcare systems, a bachelor’s degree in social work and German – sprechen Sie Deutsch? She cofounded the Colorado Culture Change Coalition and has authored eight culture change workbooks, plus hosts a monthly web culture change talk show, “Conversations with Carmen.” And we are again so happy to have her back on the program after a little bit. Carmen, welcome to the show.
Bowman: Thank you. Hi, Rob. Thanks for having me.
Schenk: Well for you and I, I don’t want to dissolve any of the Hollywood magic, but for you and I, it hasn’t been that long since you and I last spoke. However, in terms of the listener out there, it’s been quite a while. But we had Carmen on the show back in Episode 167 talking about culture change in nursing homes. I think that’s a really important episode for everyone to go out and listen to right now. So we talked about the importance of language, the importance of approaching nursing home life from a perspective of just life. We don’t want to use the wrong words like “facility” because what does “facility” say versus this is somebody’s “neighborhood” – things like that, cultural change. And I encourage you go to the show notes, read more about Carmen because this is kind of her deal, as I mentioned at the top of the show.
So we want to have her back on because talked for a few minutes about – at least off air – about how we have never had on this podcast an episode dedicated to addressing the emotions, addressing the reality of having a loved one in a nursing home and the feelings that come with that. Now I know that my clients come in and they have a whole range of emotion where it’s usually guilt is the main one, but I want to have Carmen on to talk about that.
So Carmen, can you just, however you want to do it, my question is just open – the floor’s open to you. Can you address the feelings that a typical family member goes through when they are first having to realize that a loved one is going to go into a nursing home and that happening?
Bowman: Okay, well I have two first words we can look at since that interests you and I, Rob. One time a leader in our culture change movement said something I never heard anyone say, and she said, “Why do we call them a loved one?” And you and I know why we call them a loved one, but what if they’re not as loved as that implies? And I don’t know, I’m just intrigued by language, everybody, and so I’m not saying that’s right or wrong. I love it when people raise those issues, and so just off the bat, sometimes, maybe that’s the right word and sometimes not. Sometimes I tend to say like, if we know, “Your mom, your dad, your friend, your relative,” and don’t please mishear me, anyone, not correcting, it’s just that language is interesting and it’s really good to find the right word.
And then another word that has come up is this – sometimes we say that we have to “place Mom” or we have to “put Mom” in a nursing home.
Schenk: I did that one on purpose, so I want to see if you would get me on that.
Bowman: Nice work. So everyone, what I’ve realized is you put things on a shelf. You place things in a pantry. And really they’re not probably the right words when you’re dealing with people. And look at how it just adds to the problem. Those are institutional words. They are non-person words. And so I just want to encourage everyone to like sort of have permission – you don’t have to use those words even though you’ve heard them. So “we helped Mom move to a nursing home.” “Mom moved into a nursing home and it’s killing us.”
So to your question now, Rob, we have to speak in generalities, everyone, so this may not be everyone’s experience, but I do believe a majority of people really struggle with guilt, and that too makes sense, right? Probably in our heart of hearts, we feel like we should take care of someone in our homes. We know other cultures do that. I think we for the most part admire that. There’s something to be said about all these generations living under one roof and learning from each other and living life together. If you can do that, do it. And then we know that that doesn’t work for a lot of people as well and it’s more of our culture in America that we even have nursing homes.
So it’s normal to feel guilt. That’s what I want to tell everyone. Realize it’s normal. Think about how we all know that we tend to not deal with grief like we should. Flipping over to someone passing away, guess what? Life goes on. Tomorrow comes. You’ve got to make dinner. You’ve got to go to work. And we tend to not deal with those feelings. And would you agree, Rob, from what you’ve seen, probably guilt lands in that same arena that people are dealing with a lot of guilt.
Schenk: For years. For years and years, absolutely.
Bowman: Yeah. So number one, please be honest with yourself and recognize it, okay? And then it’s also normal and then probably grief is your next step, everybody. And I’m speaking to myself too. We’ve all experienced things that aren’t great, that aren’t good, that’s not what we hoped for. And therein lies the opportunity to grieve, and I too have realized if you don’t grieve, you don’t deal with it and it’s going to bubble up at some point. So it’s healthier to deal with it. So grief about the situation with Mom, Dad, relative moving into a nursing home is real, and you deserve to let yourself cry and talk and deal with both grief and the guilt that go hand in hand.
Now here’s the next thing we see happen with the guilt. Now you, anyone dealing with this and generalities again, you might tend to now react out of your guilt. So here’s an example. It’s a very true example and listen to the daughter – the daughter only means well. Ready? She says, “Take my mom to every activity whether she wants to go or not.” And do you hear it’s really guilt speaking? “I feel guilty for” – see, look at the words – “for putting my mom” – see how it adds to the problem? – “into a nursing home and I couldn’t take care of her myself and I should have. A good daughter would do that. And so really my guilt, if you help her have something to do all day long, then I feel less guilty, right?”
And it’s okay, everybody, because here’s the truth. Here’s what you need to also hear – the truth of the day for let’s say your mom in the nursing home, for many people, it can be a good day. Thank God we have people having good experiences in nursing homes, right? And let’s just say Mom likes to stay in her room, loves her shows, and let’s say people get to know her around those shows. My own grandma had her shows and now you kind of enter in, “Hey, what happened with so-and-so today?” and you have fun with it and it’s part of their life and it’s okay. And so then what I encourage professionals to say to the family member dealing with the guilt is this – I imagine putting my arm around the person saying, “Hey Daughter, your mom is doing fine. She stays in her room. She’s happy. She watches her show. We have fun talking about what goes on in the shows, and you know, we can never make her go to those activities anyways. You know that, right?”
And then you would say, “But your mom seems to be doing okay, but really how are you doing?” You see how it switches in a loving way? Part of our privilege is to care for families too, and families, I know you’re listening, it’s okay to ask for help. It’s okay to say, “I’m struggling here.” It’s okay to say, “Is there another family I can maybe talk to?” I’ve come to believe we maybe need more support groups, that kind of a title. “Can you give me some support for what I’m going through in looking at my mom or whoever now living in this nursing home?”
Schenk: That’s a really interesting perspective and thought, Carmen. I appreciate that. I wanted to touch on something that you just mentioned. It almost seems like, and we kind of talked about this in the culture change episode, but one of the ways I hear you saying to deal with this is to understand or attempt to understand it from the perspective of the family member that is in the nursing home. That might not be a good day to you as a 50-year-old or a 45-year-old or a 30-year-old because you’re going to go to the bar, you’re going to go to your kid’s event or something like that, but that could have been an awesome day for your mom to see, I don’t know, “Guiding Light” or whatever, “Family Improvement,” whatever the show is. That could have been awesome. And so understanding that in terms of just that’s going to lead to better outcomes for your mom, but also that could help you check your emotions. That could make you feel better.
And the other thing that I wanted to ask you, in your experience, in your educating nursing homes and their employees, do you typically think that it’s okay for individuals to go through that with as a family, as sometimes it’s better as a family for them to not get together to talk about those emotions? I don’t know. Do you have a thought on that? You might say like, “Go get help,” or “Go talk.” Do you find that help typically comes from other family members?
Bowman: I think aren’t we all learning about trauma – I don’t know if you would know this, Rob, in the new regulations, nursing homes are now required to provide trauma-informed care, and so as a society, we’re learning more about how to help people with trauma and I think it tells you that the support can come from different places. There are people going through the same thing as you, so wouldn’t that be your family members? Potentially. Like firefighters talking to fellow firefighters, right? But then also could you also get help from people who don’t work in the same setting or aren’t facing the same dilemma with Mom, right? So I believe there’s help to be had.
Schenk: Anywhere you can get it, I guess. It’s almost like I would draw the analogy of the Anonymous organizations like Narcotics Anonymous or Alcoholics Anonymous, but there’s also the organizations that are dedicated to the family members of those in those groups. So those groups, by way of example, will meet and they’ll talk about their relationships with the alcoholic or the addict and receive comfort from others going through that same experience. So if I understand you correctly, if you’re having a hard time out there because of the situation, then you might seek solace from someone that’s going through the same situation or not.
Bowman: Right. And I would say, Rob, unfortunately I don’t think all these support groups necessarily exist and I’m actually encouraging, again, professionals to offer them, but you, people, all of us, we have got to go get what you need. So be, what’s the word – take the initiative. Tell the social worker, “I need to talk to another family that’s had their mom here longer than me.” Go get your own support. Make it happen. Say, “Why isn’t there a support group?” Come on, everybody. Let’s make things happen that would help.
Schenk: That’s exactly right. And I would say, so if you are listening and you are interested in that, go to that nursing home. You can talk to the administrator, the social services director. You can talk to – every nursing home under regulation, definitely under federal but depending on what state you’re in, has to have resident council meetings. This is where the residents get together and typically it’s for the purposes of grievances but get to know people there. Maybe you know who your mom’s roommate is – does your mom’s roommate have a daughter that you can talk to or whatever?
Bowman: Yes.
Schenk: So that’s something you can definitely take the initiative and go if you need the help.
Bowman: Yes.
Schenk: But I hear you because I mean I was raised like you’ve got to swallow your emotions and just keep on rocking and rolling, so it’s important to get help if you need it.
Bowman: Yeah.
Schenk: What are some other issues that you’ve seen with regard to emotions and dealing with the situation?
Bowman: Well, you know I guess I would…
Schenk: I think you mentioned anger and kind of rage and you take that out on the staff itself?
Bowman: Yeah. It’s a truth, everyone, that staff can become scapegoats for this anger that’s inside you. Try not to let that happen. It’s not fair to them. It’s not going to help you, you know? And I would add the word “partnership.” Some in our culture change movement, we have realized we should look at family members as a partner. We actually call them family care partners. And whether nursing homes offer you that to you or not, you can talk the language. “Hey, can we be partners rather than enemies?” And here we have a lawyers’ podcast, so you’ve seen the enemies stuff probably plenty – all the more reason, everyone, to all of us approach it as a partnership. I’m not a family member here to judge you or get you in trouble and, guess what? I have a daughter in high school and for the first time, I’ve now encountered my daughter says, “Mom, do not intervene with my teacher because I don’t want there to be any reprisal,” and this is how families sometimes make people who live in nursing homes feel, and we’ve heard them say it. And I don’t like it, but she’s the one walking into that school every day, not me. So it’s a tricky line, and if we approach it as partners, we’re going to win much more in the end.
Schenk: That’s right. Well Carmen, I think that we – I feel like we’re just crashing the surface but I think this was good, actionable content for listeners out there that are going through that grief, going through that guilt, going through that anger of when their loved one – there I go again – when their family member moves into a nursing home. So we really appreciate that. For the audience out there, again, Carmen’s information will be in the show notes, so I really encourage you to go check that out. And again, check out the previous episode about culture change – a lot of good information about language and how to approach nursing home care from the perspective of the people that are living there. So anyways, Carmen, thank you so much.
Bowman: Thank you, it was great. Appreciate it.
Schenk: Well always interesting talking about language. That’s one of my favorite things about how language develops, how it changes, how it has the power to uplift or demean. So I am always grateful to really be able to take a moment to reflect on the language that I use and how it might be affecting the people around me. So my hat’s off to Carmen. Thank you so much for showing that to me.
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