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Elder Independence: Establishing Common Ground

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Following a stroke, 80-year-old Mr. Stuart had trouble balancing, was weak on his right side and could not move around safely inside his home. But when physical therapist Jonathan Weiss arrived for a session, Mr. Stuart adamantly refused. He was fine, he insisted. He needed no help.

Jonathan, who works for the Visiting Nurse Service of New York, could clearly see otherwise, so he did what he often does in such situations: He looked around the home. When his eye landed on Mr. Stuart's military awards decorating the apartment, Jonathan had just the opening he needed. He plays in a rock band that performs for Israeli soldiers, through an organization called the Israel Service Organization (ISO), similar to America's well-known USO. "I told him about the concerts we put on for soldiers in Israel, and he told me about how much he appreciated the USO when he was in the service, how much it meant to the troops and boosted morale," says Jonathan.

While he was sharing his memories of military service, Mr. Stuart was gamely shifting his weight from sitting to standing, then walking throughout his apartment on even and uneven services -- in other words, doing physical therapy. "Our conversation allowed him to put aside his barriers," notes Jonathan.

Across the country, the over-65 population continues to grow, and seniors with chronic debilitating conditions are increasingly opting to age in place. For them to remain independent and safe in their own homes, they must be active participants in their care. (I recently explored the emerging caregiving modality, health coaching, which uses a partnership-approach to keep patients healthier and out of the hospital.)

For physical and occupational therapists, visiting nurses, home health aides and other professional caregivers, establishing common ground is a valued tool of the trade to help build trust and forge the partnership needed for effective care. "Usually there's the common ground that the patient needs physical therapy and you're a physical therapist," says Jonathan. "But there are times, especially if the patient is uncooperative, you have to find something more than that."

Whether you're caring for an aging parent or a neighbor in your apartment building, or helping a home health aide connect with your ill spouse, look to establish common ground -- or, in the case of family caregivers, to build on long-established common ground -- to drive forward a successful caregiving relationship.

Start With Daily Life

To find common ground, you may have to look no further than the television set.

Brian Finnerty, who is also a physical therapist, knew he'd have his work cut out for him when he came to help Mrs. Finch, in her 80s, build up her strength and balance. She had been off her feet for a while, as visiting nurses helped her with wound care, and was in no mood to be cooperative.

He started where he often does with patients. "How was your weekend?" he asked. "What did you do?"

This tack, at first, seemed unpromising. "Nothing," she answered. "Just watched television."

"What did you watch?" he asked.

The patient did not answer, but the home health aide volunteered, The Big Bang Theory, CBS's hit sitcom.

Brian -- himself a fan of the show -- had found his common ground. "We talked about different episodes, our favorite characters, that there's a Big Bang Theory marathon coming up," he recounts. "She was laughing, the aide was laughing, I was laughing. We really established a nice rapport, and that made the session go easier."

Without another complaint, Mrs. Finch was standing, walking, transferring her weight -- whatever the physical therapist asked her to do. "I always look for that common ground, because it helps establish a genuine connection," says Brian. "If someone says, 'I didn't do anything over the weekend,' I keep going. What did you watch on TV? What did you do for work? Do you like the Mets or the Yankees?"

Music offers another fruitful connection. Jonathan noticed Paul Simon's Rhythm of the Saints in the CD player of a recalcitrant patient who suffered from early-stage Parkinson's disease "and wanted me out of the house." Himself a musician inspired by Paul Simon, Jonathan got his patient talking about the CD, the singer and the Simon concerts he'd attended. "We started to connect on that common ground," Jonathan recalls, "and he started to participate in the exercises."

They turned on the CD, which provided additional benefit to the therapy. "For patients with Parkinson's, music can really help them rhythmically attach to the movements they need to do. It aids them in initiating movement, which can be difficult otherwise." (Watch this video for much more on music's remarkable ability to establish connection, even with the most distant patient.)

How to Establish Common Ground

For most family caregivers, common ground has long been established with the loved one you're caring for. Still, the following tips can help start conversations, provide guidance to those caring more distant family members or friends, or help professional caregivers establish a productive connection with your loved one.

  1. Begin with a keen observation of the living environment. Photographs are a great icebreaker and source of common ground, as are sports memorabilia, books, music collections, evidence of travel, and artwork, especially if it has a story behind it. I've spoken with caregivers who have bonded over an expertise in martial arts, a lifelong knitting hobby and even a common interest in collecting figurines.
  2. When caring for an older person, keep in mind that they've lived a good long time. Through conversation or evidence in the home, explore their background, careers they may have retired from, hobbies they may have had when they were younger. Notes Jonathan, "They've worked hard all their lives, and now they want to fall back on things they loved. How can you bring that back to them?"
  3. Get the patient, or loved one, talking during the care. You may learn something you didn't know, discover surprising common ground, and, at the very least, pass the time more pleasantly during certain caregiving tasks.

Says Brian, "I find that when I establish common ground and good rapport, my patients will go that extra mile for me, do all the exercises I ask them to do."

Share your experience seeking or finding common ground in a caregiving situation.

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