Episode 10 Companion Care

The Transcript

Dale Johnson: There’s a lot of noise out there, a lot of noise in our world. We calm things down every Saturday morning at this time. We give your ears a break, a conversation that starts here with Dr. Sandra Miller from Complete Hearing in Lincoln. Dr. Miller. Thank you.

Dr. Miller: Good morning. Nice to be back.

Dale Johnson: Another Saturday morning. We are going to answer a question right away that hasn’t even been asked but it would if we carried on any further and that is the link between helping a patient hear better and Companion Care. The care that’s provided to people in later years or people who need someone to look after them if they come back from the hospital, if they start to develop issues and we have a guest in the studio thanks to you and we will answer that question about what the link is between hearing and Companion Care.

Dr. Miller: Right. We’re really grateful just in terms of we see patients in different levels of their journey in terms of hearing and that just means we may see them at their very young age and then we may see them in a transition. Where they’ve had something happen where they’re coming in to have their hearing tested. I think this really links to Companion Care because when we have patients come in and we may find they need some help from us so we end up fitting them with some devices.

Dr. Miller: What happens when they go home is always our concern, so we’re always encouraging our patients to make sure you bring someone with you, whether that’s a spouse, son, daughter, significant other or a Companion Care person. And that just means we cover so much information that we want to make sure when that patient gets home they are successful and we’ve always talked about the whole concept of we treat you as an entire person.

Dr. Miller: My patient is just not coming in, putting hearing aides on and we’re sending you home. That’s why we do a very thorough intake form and included in the intake form is always going to be what is your dexterity like? What is your living situation like? Who is at home to help you? If the patient has difficulty with those things, we want to make sure they have the support at home that they need and we’re going to cover those things with that patient. And sometimes they may say to us, “Well, Dr. Miller, I live at home alone.” “No, I don’t have any family here.”

Dr. Miller: And so if they have some concerns in terms of what we have concerns that how is this going to go at home every day? I’ve taught you a hundred things about this new product and how you’re going to manage that when you get home. We try to make it as simple as possible, but there’s some things you’re still going to need to know and to have somebody there to be an encourager, have them checking up on things is such a relief to us and having that support side. So in taking care of we treat you but we treat your family as well. Meaning we want to do it a full compass that we take care of them top to bottom and we’re making sure you’re supported not just in our office but when you get home that you have the support that you need.

Dale Johnson: So we have Karla Frese from Home Care Partners of Nebraska. Karla, thank you very much for coming in. Talk about the Companion Care link between what you do for patients and when Dr. Miller does for patients.

Karla Frese: Part of our goal is quality of life and that is building a care team and that team can include professionals like Dr. Miller and then as she mentioned, it also includes the home. So, that term it takes a village, it really does. So you know we think about holistic care, so it’s not just about one task, it’s about what does that quality of life look like and how can we be a part of that, especially when somebody is aging in place.

Karla Frese: So when we think about day-to-day activities and how important hearing is, whether it’s communication, whether we are going on an appointment, where important information is going to be said or maybe it’s maintaining something like the device, the batteries, the follow-up appointments, things like that. Putting them in, taking them out, putting them in the right place at night so they’re charged, things like that, that the caregivers get to know your routine and we put it into the care plan to make sure that you have this great device to help you with quality of life. Are you using it and are you using it correctly?

Dr. Miller: I think that’s such a great point because a lot of times we will get to a point where we try to go into facilities here around Lincoln and just say, “We’d love to just train your staff.” Because ultimately, especially when we talk about patients who have significant amount of hearing loss, number one, maybe dealing with memory loss and dementia, how important the sense of hearing is to keep you connected. And so I love what you said to me the other day. We were talking about when a caregiver comes in, does that caregiver know even how to interact with that patient?

Dr. Miller: Whether it’s a visual problem, whether it’s a hearing problem, it’s a dexterity problem, whatever that might be. That you … I was just so taken back by the training you take your staff through in terms of, especially when it comes to each part of that. So maybe touch a little bit on that because I was so impressed with that.

Karla Frese: Sure. One of the trainings that we did for our care partners was a virtual dementia simulation. And what that looks like is you put somebody in an environment where you impair the senses so you may be impair the vision, you impair your hearing by putting headphones on with a lot of background noise. We impair our hands and kind of think about what if I had dexterity issues. And so maybe you have gloves that only have three or four fingers. You impair something in your soles to signify pain or discomfort.

Karla Frese: And then you ask somebody to do some tasks and it’s a stressful environment and things are over-exaggerated for a reason. And when we leave that a simulation, then we talk about, what was that like when you couldn’t hear? What was that like when you couldn’t see what you needed to see and how did that affect the task you are willing to do and then relate that into being better caregivers.

Karla Frese: So we need to be more patient, we need to make sure if there is a device to help with this, that we’re using it. We need to maybe have more visual cues and more guidance to somebody. And so we kind of learn that to how are we caring for somebody and really customizing the care to make sure that we’re doing things very situational and person- centered care. So really getting to know somebody, getting to know, I know what you’re not capable of, so I’m going to focus on what you are capable of. What are you able to do?

Karla Frese: So you may be able to do 80% and I’m just helping with that 20% but it is so important for me to empower you not to do the task 100% for you. Even though I could do it faster, to be able to have the patience to say, “Dr. Miller, here is the hearing aid, here is the battery, here’s how it goes in.” Maybe I show you once and then you do it. So I’m modeling something but then allowing you to do the activity for yourself.

Karla Frese: But going through that training and just really having somebody walk in the shoes of somebody with a sensory impairment and understanding why it’s so important for us to change the way we care for somebody, especially if there’s a cognitive impairment involved, it really takes additional training to understand and put yourself in those shoes. Not only at home but also when we’re going out. So when you think about going on an outing and you’ve got maybe brand new hearing aides and you’re not quite adjusted, you’re not used to them, it might be really important that we choose an outing that’s maybe more quiet. And there’s not so much sensory overload or we do something and it’s a shorter period of time and then we do an activity that is more relaxed or quiet, that sort of thing.

Karla Frese: So it’s important not only in the home, but also when we think about going out. Because our goal is to bring sunshine to someone’s day. We want to get out, we want to engage, we want to interact. Isolation and being alone is something that happens a lot with seniors, especially if somebody has passed and they’re a widow or a widower. And so when we’re there, whether it’s grocery shopping or where we’re getting out to a museum, whatever it is, depending on the day and the weather, it’s really important to think of the overall health of somebody when we’re planning those activities.

Dr. Miller: Yeah, exactly. I think so much about when we talk about so much in our clinic, we talk about this connection point that has to happen and you connect with people and your environment through hearing. That’s how you interact and engage. And so when people can’t hear, that’s just a detriment to them essentially just for the fact that I can’t communicate while I’m at the doctor. When I wanting to go enjoy something on an outing, I’m not able to engage.

Dr. Miller: And then when we get them engaged, are we doing it at the right rate, exposing them to the right things at the right pace, and especially taking the consideration. So as an audiologist, I think that I’ve become so used to my patterns because I know when I’m with my patient that I have to slow down. I have to look at them in the face. I have to make sure that I’m using words that they understand and know how to rephrase things when they don’t get it the first time. And that has become so innate to me.

Dr. Miller: So when we try to teach this to the significant other, we have to write down a list. And then sometimes it’s even practicing. “Hey, remember when she’s in the kitchen and you’re watching television and you’re trying to talk to each other, that’s not going to work.” And so to teach them those skills, but also have a caregiver who understands that. That you can’t just walk up from behind the person and start talking and even have them know that they’re there.

Dr. Miller: And so it can be a startle effect, which we talked about the other day. Your cortisol goes through the roof and now there’s anxiousness and fear and whatever that might be. To have the understanding of truly how to care for that patient at home. And like you said, when we’re out and about as well.

Karla Frese: It really does. You’re right. And that approach is so important and when we think about even mental health, so when you’re not hearing 100%, you may have misperception of is so-and-so talking about me, or so-and-so is laughing, but you couldn’t hear what they said. And so it’s so important not only to communicate what we want and the task we’re trying to accomplish, to be face-to-face, eye level, making direct contact right in front of somebody so that they understand us, but also so that something’s not misunderstood. And then the mental health is affected. Or somebody like you said, becomes more isolated or withdraws because they feel like they can’t interact, they can’t understand. And so therefore they can’t add to the conversation.

Karla Frese: So we want to make sure that we’re always keeping that in mind and being very intentional. And when we do that, it makes things easier for the caregiver because they’re able to get things accomplished in a more pleasant way. And it might be just like you said, rephrasing. So sometimes it’s not a hearing issue, it’s a comprehension issue. And so for the caregiver to know the difference, so I don’t just repeat the same thing that I said, but I reword it in a way that’s little bit different and maybe I add a gesture as well.

Dr. Miller: Yeah, exactly.

Dale Johnson: If you’d like to hear this conversation again, best place to go is complete-hearing.com, the podcast there at Complete Hearing in Lincoln. Karla, thank you very much. How can someone reach out to Home Care Partners of Nebraska?

Karla Frese: Call us today. Home Care Partners of Nebraska, (402) 780-1211.

Dale Johnson: Thank you, Dr. Miller.

Dr. Miller: Thank you.