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Carol Bradley Bursack, Published August 24 2008

Sweet-talking nurse’s aides should not sugar-coat

Dear Carol: My dad had a severe stroke and is in a very good nursing home. He was a military man and always rather rigid. I cringe when aides in the home use terms of endearment like “Hon.” While there may be people who respond to that kind of talk, I think it makes my dad harder to handle. Am I imagining this? Should I talk to the staff or is this me? – Sandy

Dear Sandy: No, Sandy, it’s not you. While it’s often natural to refer to someone who is ill in a tender manner, sometimes the language that goes with this treatment can seem demeaning to the receiver.

We’re entering a new era in elder care, led by the Pioneer Network and others who emphasize resident-centered care. These progressive thinkers want homes where elders often live, including assisted living centers and nursing homes, to recognize the rights of seniors to make as many decisions as they are cognitively able, and to treat them with the dignity they deserve.

Kristine Williams, an associate professor at the University of Kansas School of Nursing, calls what you describe “elderspeak.” She also has been quoted as saying that it is not very far from babytalk. She has done studies that show more aggression in elders with Alzheimer’s when they are addressed in ways that are not comfortable for them. That includes “talking down” to them, which can include endearing terms such as “Hon,” speaking in an overly-caring manner (which is most likely taken as condescension) and continually correcting them.

There are, of course, people who enjoy a nickname. And there are times when a very ill, fragile person brings out the “mother” in any caregiver and calling this person “Hon,” as gentle hands turn them in bed, is loving and could be comforting to many. Much depends on the connections between the people involved.

That said, it’s best, at least until a staff member knows the resident well, to use a more formal greeting.

My military uncle would not have taken well to a soft, endearing “Hon” any more than your dad does. He liked “Colonel” just fine. He was, at the nursing home, called “Colonel” throughout his years there, even on his deathbed (except for the resident who purposely called him “Corporal,” which is another story), and he was fine with that. Yet my mother, at a frail 85 pounds, responded well to her caregivers, who had known her for years, when they sometimes substituted “Ruthie” for Ruth. These people were, by then, family. I know she felt loved. But that was after years of friendship and care.

It’s generally best for care center staff to error on the formal side until they know the person well. And, yes, you can certainly speak to the staff. Let them know, in a friendly way, that you can tell by your dad’s actions that he doesn’t like these terms. Ask them to call him whatever you feel he would like. See if it improves his behavior. Certainly elders have the right to be addressed in a manner they consider respectful, even if no disrespect was intended by the speaker. You are being your dad’s advocate when you clear the air on this issue.

Bursack is the author of a support book on family elder care. To submit questions to “Minding Our Elders” and view past columns, go to www.inforum.com and click on columnists. Readers can reach Bursack

at cbursack@forumcomm.com or write her at The Forum, Box 2020, Fargo, ND 58107.