Replacing “You” messages with “I” messages is an important way of expressing ourselves clearly and effectively.  “I” messages are the foundation of assertive communication while “You” messages are the foundation of aggressive communication.  Following are some key differences between assertive and aggressive people:

• Assertive people ask others for what they want or need; aggressive people demand what they want.
• Assertive people consider the needs of others; aggressive people are only concerned with having their own wants and needs met.
• Assertive people respect others’ rights; aggressive people do not.
• Assertive people are interested in building relationships; aggressive people often use methods that destroy relationships and alienate potential allies.

Assertive communication, or what is called the “DESC method,” has four basic steps:

              1.           Describe the observable behavior or problem

              2.           Express how you feel

              3.           Specify what needs to happen

              4.           Consequence: state the anticipated outcome

Following is a scenario that one could easily respond to using the DESC method: Your widowed mother has recently moved to an assisted living residence specializing in dementia care. One day, you come to visit and two nurse’s aides are laughing about an incident involving a male resident who urinated in the entryway’s potted palm. Several other residents are in earshot of the aides. Assume that you go ahead and visit with your mother, but when you are ready to leave, you are still bothered by the aides’ behavior and you seek them out in their lounge.

1. Describe: “When I came in today, I heard you laughing about the man who peed in the potted palm.”
2. Express: “I felt embarrassed for myself and for the other residents who were in hearing distance.  No one likes to be made fun of, especially about behavior due to dementia.”
3. Specify: “I understand that your job isn’t easy and that humor is a release. But in the future, when you laugh, please make sure that no one is present who could be hurt by your laughter.”
4. Consequence: “If I witness disrespect for residents and families again, I will feel it necessary to contact the administrator.”

The messages in this speech are certainly clear, but actually saying them word-for-word isn’t realistic; chances are, the nurse’s aides are going to interrupt you to defend themselves. Also, the “consequence” may sound threatening and aggressive, not assertive. The reality is that interruptions and defensiveness should be expected when DESC is used. Our role is to stay focused and to continue using “I” messages despite any “You” messages given in return.  If you communicate assertively while respecting the rights and needs of others, you may not need to get to the “consequence” step. For example, after the “specify” step, a question such as, “Do you agree?” may yield a favorable response.  Unfortunately, the word “consequence” has gotten a bad rap, as in the phrase, “suffer the consequences.” A better word might be “resolution.” By concentrating on a resolution, there is a greater desire to reach an acceptable solution for all parties involved. If we refrain from giving an ultimatum, which is aggressive communication, and instead suggest solutions that allow for others’ ideas, a compromise may be achieved. 

At its best, assertive communication gives us a chance to hear all sides of an issue and to learn from one another so that communication moves forward. Sometimes, however, saying nothing at all until one can say something truly constructive may be the best you can manage under duress. Lady Dorothy Nevill once said, “The real art of conversation is not only to say the right thing in the right place, but to leave unsaid the wrong thing at the tempting moment.”

Why Financial Planning is a Must

By Daniel Kuhn, MSW, Mather LifeWays Institute on Aging

In light of the fact that people can live with chronic medical conditions such as stroke, diabetes, and Alzheimer’s disease for many years, caregivers often face the harsh reality of paying for expensive home-based and residential care. Practical steps should be taken to minimize the financial impact of these and other long-term illnesses.

Most caregivers eventually recognize the need for some type of respite and rely on costly in-home services or adult day care. If care at home becomes too difficult, placement in a care facility, such as an assisted living facility or nursing home, is considered. This option is typically seen as a last resort for a variety of reasons, not the least of which is the great expense. A monthly nursing home bill of $4,000, for example, is common.

Most people pay for the bulk of care out of their own pockets. Medicare and private insurance generally do not cover the costs associated with the care for a person with a chronic illness. Moreover, few people have the means or the foresight to purchase expensive long-term care insurance. For those with low incomes and assets, there are often state and federal programs that subsidize home-based and residential care. Government agencies responsible for these programs, including local Area Agencies on Aging, the Department of Veterans Affairs, or the Department of Health and Human Services, can be contacted for information. Family service organizations also are excellent sources for information about eligibility requirements.

Middle-income Americans probably face the greatest financial challenges in coping with their costly, chronic illnesses. Their savings may dwindle to keep up with the increasing costs of care, and they may be forced to spend down their income and assets in order to qualify for government entitlement programs. Means to protect assets and income can be complex. It is advisable to consult an attorney who specializes in elder law.

For a married couple, the financial status of the disabled spouse and the well spouse are linked inextricably. The well spouse may or may not have the right to act alone with respect to finances, even with joint ownership. The provisions of every creditor, bank account, pension plan, IRA, and investment should be looked into. Most couples plan for retirement, but relatively few plan for chronic illness. They must reorganize their priorities, plan for expensive care, and ensure the financial security of the well spouse. Planning for the needs of both parties is essential and usually requires help from others. Trusted family members or friends should be asked to lend some assistance. At a minimum, these helpers can handle time-consuming “leg work,” such as clarifying who owns and owes what, exploring programs and services, investigating investment options, and seeking out qualified professionals.

Adult children are not legally responsible for expenses incurred by parents, but they may feel a moral obligation to assist in some way. Apart from doing important “leg work,” they can share in the actual care or offer to pay for needed services. Children should be prepared to take on responsibility for a disabled parent by being thoroughly informed about his or her financial status. Management of income and assets as well as living trusts, wills, and powers of attorney need to be explored.

Elder law attorneys or certified financial planners should be consulted for their expertise. These professionals can offer guidance on a variety of tools available for planning for the future. Two professional organizations that provide referrals to their members include the National Academy of Elder Law Attorneys ((520) 881-4005) and the Institute of Certified Financial Planners ((800) 282-7526). Free information on legal issues can also be obtained from the public interest law firm known as the National Senior Citizens Law Center ((202) 887-5280).

It is preferable for financial planning to be addressed early on in the course of chronic illness so that your loved one can participate in decision-making. Every effort must be made to protect income and assets, manage present needs, and plan for future care. If such preparations are not made ahead of time, it may be too late to afford the best possible plan of care in the future.

Daily Affirmations for Caregivers

By Bernie Siegel, M.D.

• I love myself.
• I respect my own needs.
• I am able to ask for what I need.
• I am open to receiving.
• I can ask for help and support.
• I am kind and gentle with myself.
• I deserve care.
• I know how to nurture myself.
• I replenish my energy by eating healthy foods.
• I take the time to exercise daily.
• I have all the energy I need.
• I am compassionate with myself and with others.
• I am able to feel and express all of my emotions.
• I forgive myself and others.
• I am able to renew and refresh myself.
• I take time for fun.
• I love and trust in the process of life.
• I am whole and alive.
• I am at peace with myself.
• I trust that I am doing the best that I can.
• I am enough.
• I am loved.

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