Tool to discuss reality of care needs in case it's useful?

I don’t know if this will be of use to anyone else who is struggling to find a way forward with increasing care demands, but I thought I’d share it in case it is.

I’d originally posted the personal context but I realise that probably isn’t necessary.

I had some training a few months ago on managing difficult conversations, which boils down to:
Choose time carefully and plan what you are going to say
Open the conversation by stating the problem and the effect it is having.
Support with evidence
Listen and acknowledge
Discuss what needs to happen
I prepared a list of:
everything I am doing at the moment
everything his carers are doing at the moment
what he is able to do for himself
what I will be able to carry on doing
what he will need carers to do for him
with a blank column for what he wants to be able to do for himself in future
I then printed off the list, took it round with me and did the conversation. Every time we went back to the ‘I’ll cope’ line we went back to the list and looked at it again. I left the list with him to look at and then came back to it again. It was a bit traumatic but in the end he agreed he needs four care visits a day at times which mean I won’t be involved with the daily care needs. We’re going to have to come back to the list again, as we’ve not managed to answer all the questions yet. And of course this is just an emotional tool rather than a practical one, but it’s helped me deal with that side of things.

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Thank you so much for sharing this CarsonGrey_2006, difficult conversations are always really challenging and this is such a thought out way to approach it. I am sure will be so useful with other carers.

Best wishes


It’s a great list.
When I was supporting mum, she developed sepsis and lost the ability to walk. She really wanted to go back to her home where she lived alone, her home for 50 years. But unable to get out of bed to get to the tiled meant she would have to wear incontinence pads for her unpredictable bowels. This was, for her, the deciding factor when choosing a nursing home instead.
It’s easy to find little things in favour or against something, but ultimately there is a very short list of “must have” things. What might seem doable in summer is not so doable in a long cold dark winter night!

This will only work if the person you’re discussing something with is of sound mind and has a working memory.

I’ve found it impossible in the last few months to have a sensible conversation with my wife.

She misremembers things (even the beginning of a conversation two minutes back) and then begins to confabulate and construct answers based on a false premise.

It all goes downhill very quickly.

Ayjay, that is a really good point, but terribly sad too.
Trying to reason with someone with dementia is a waste of time, very upsetting for the carer if they don’t realise the person concerned has lost the ability to reason.


Thank you

This is only a option however if the person in question is of sound mind and can communicate and work independently. Most people with disabilities are not of sound mind however. But you also need to take the personality of the carer into account too. Some frankly are unfit.

My parents had disabilities. My dad had calipers and dreadful rheumatoid arthritis. Mother had other issues. From when my sister’s and myself were children. They had sound minds to their deaths.
If you mean people with learning disabilities, many many have sound minds. Am I misunderstanding the posts?
My lovely husband, wasn’t of sound mind, due to vascular dementia, very sadly he pre dementia he always had a thirst to learn.