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Old 04-18-2012, 08:03 PM   #1
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The residents

We encountered some strange thing in the NH Tuesday. My FIL has some friends in his wing and they eat together at the table for meal at times. I didn't realize they actually were looking out for one another and one guy is particularly nice to his mates. He is nice to my FIL too. He was nice to me too until this year. Maybe it is his disease, the guy got meaner this year and misunderstood lots of things in the cafeteria. Well, sometimes we took over some seats to eat with my FIL. Not very often since we don't stay to eat every time. Probably the caregiver didn't realize it and set us up at my FIL's table but "got rid of" the other 2 residents. (One didn't come to eat anyway and etc.) Well we sat with another resident who does not talk either.
I will skip the details, but basically this guy started yelling about we should not be there - he eats at the next table. He probably thought we should not have been there. He yelled and shook his head. He talked to everyone around us. He showed the other caregiver how good she is.... I am the bad guy because he misunderstood me some time earlier thinking I took the dessert like stealing it back in Jan. (I only took the extra dessert on the cafe counter for my FIL. I don't like desserts myself.) He does not remember that long. But I must have triggered him. He told my husband in front of my FIL that he is not the son and I am not the family. He ran up and down to complain about this. He told his tablemate that we should not be here because we didn't do anything and he said we are not family and blah blah blah.
All through lunch hour, I sat there and tried to hear what he had to say. He just thought we are the bad guys and so on.
Well, the resident is bothering the other resident's family in this case.
The caregivers and directors know about it. Next time we can only choose to get a table away from this guy so we can eat in peace. I just don't like the fact that he disturbed us and also my FIL as well. He made sure my FIL was OK by asking him is he OK. He told us off in front of my FIL. Well, my FIL was sleeping and he needed to be fed by us. So we were there to help my FIL, not to do nothing!!
This guy is a war vet so maybe he gets too suspicious about us. Whatever the reason is, this is disturbing the family. It should not have happened. The caregivers/director apologized to us.

I know they cannot control their residents but when it comes to disturbing other residents, it is really something the NH should pay attention to. I know some med may not help and his family may not like to give him more med as sedative.

We can only run away from this guy at meal time - go to the back of the room like before. Should we have left? No, everyone knew he was crazy.

I now wonder how the NH should make sure the residents don't bother one another and the families.

Nina

Last edited by ninamarc; 04-18-2012 at 08:21 PM.

 
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Old 04-18-2012, 10:49 PM   #2
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Re: The residents

Nina, what you described is not unusual. When you go into their world you have to expect demented behavior. The resident is not crazy... he has dementia and exhibiting demented behavior in an effort to express himself. They thrive on routine routine routine. You disturbed his routine and it can cause upset. It is what it is. Interference by the staff could have made it worse. By telling him he is wrong when he thinks he is right... it only makes it worse. If you do not want to be disturbed, ask if there is a private dining area or go to an area where other residents can not see you.

I am at Mom's facility during meal time frequently. There is one lady in a wheel chair that will point me out, explain that she has seen my police record, and assures everybody that I am a criminal. This happens about every other time I am there. The other times she is very nice to me. There is another resident that occasionally tells me that I don't belong there but the next time he will sit beside me and be very pleasant.

Yep it is their world and that is the way they are. You also don't know what has happened in the rest of his day. He may be having a bad day and had been acting out all morning. He might have been set off by something as simple as you sitting with his friend... your FIL. You might have had a dress color on he didn't like. You never know because there is no way to think like they do. Remember they do not have the ability to express their emotions like we do.

Disturbances do happen. It is how some residents express themselves. If he is causing no harm, I am sure that is why the staff let him be. I don't expect the staff to maintain a situation that appeases me, but one that is the best for the residents. Medication may or may not be an option.. but I am sure they are treating him to the best of their ability. You can't treat medically for unusual situations when their routines are disturbed. That is unfair to them. Disturbances are routine in a care facility with dementia patients. The staff will not even try to eliminate all disturbances. I am sure they would have stepped in if there was any physical altercations. I am sure they were watching... and they know this man better than you do.

I would have been pleasant to the man, told him I was sorry for any misunderstanding, and assure him that I would do better in the future. His delusions are real to him and if you validate them and give him hope in the future he might calm down. But my best guess is that you were sitting with his buddy You had displaced him and he was not sure what to do except express his concern. If possible I would have invited him to sit with you, even beside his buddy. Many times that can solve the problem. Or you can just deal with it and chalk it up to a noisy afternoon in dementia land!

On my last visit with Mom there was one crying because somebody woke her up, one was yelling at another resident who had touched her, yet another was insisting it was meal time and demanding food, while one was singing opera! B wanted to show me her legs (for the 100th times). Sweet Ms. K was sitting across the room smiling at me as she waited for me to come say hello. It is what it is and I just try to help calm the ones I can!

Love, deb

 
Old 04-19-2012, 07:48 AM   #3
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Re: The residents

I have noticed at my aunt's facility the residents attachment to their routines such as who sits where and who eats where, are very very strong. Any little thing that changes the routine easily upsets her or one of the other residents and then there is hell to pay of the type you describe.

Our facility has a little room with a dining table and chairs which they call The Social Room.

If someone wants to visit a patient at mealtime, they can reserve this room and eat together there so that we don't disturb the routine of the others. However, my aunt does not like to always go there because it disturbs her routine :-)

Maybe your NH has a similar room where you could meet separately.

Because my aunt is so entrenched in her routine, as a result we are getting away from visiting around mealtimes because it just causes too much trouble for everyone involved.

Quote:
Originally Posted by ninamarc View Post
We encountered some strange thing in the NH Tuesday. My FIL has some friends in his wing and they eat together at the table for meal at times. I didn't realize they actually were looking out for one another and one guy is particularly nice to his mates. He is nice to my FIL too. He was nice to me too until this year. Maybe it is his disease, the guy got meaner this year and misunderstood lots of things in the cafeteria. Well, sometimes we took over some seats to eat with my FIL. Not very often since we don't stay to eat every time. Probably the caregiver didn't realize it and set us up at my FIL's table but "got rid of" the other 2 residents. (One didn't come to eat anyway and etc.) Well we sat with another resident who does not talk either.
I will skip the details, but basically this guy started yelling about we should not be there - he eats at the next table. He probably thought we should not have been there. He yelled and shook his head. He talked to everyone around us. He showed the other caregiver how good she is.... I am the bad guy because he misunderstood me some time earlier thinking I took the dessert like stealing it back in Jan. (I only took the extra dessert on the cafe counter for my FIL. I don't like desserts myself.) He does not remember that long. But I must have triggered him. He told my husband in front of my FIL that he is not the son and I am not the family. He ran up and down to complain about this. He told his tablemate that we should not be here because we didn't do anything and he said we are not family and blah blah blah.
All through lunch hour, I sat there and tried to hear what he had to say. He just thought we are the bad guys and so on.
Well, the resident is bothering the other resident's family in this case.
The caregivers and directors know about it. Next time we can only choose to get a table away from this guy so we can eat in peace. I just don't like the fact that he disturbed us and also my FIL as well. He made sure my FIL was OK by asking him is he OK. He told us off in front of my FIL. Well, my FIL was sleeping and he needed to be fed by us. So we were there to help my FIL, not to do nothing!!
This guy is a war vet so maybe he gets too suspicious about us. Whatever the reason is, this is disturbing the family. It should not have happened. The caregivers/director apologized to us.

I know they cannot control their residents but when it comes to disturbing other residents, it is really something the NH should pay attention to. I know some med may not help and his family may not like to give him more med as sedative.

We can only run away from this guy at meal time - go to the back of the room like before. Should we have left? No, everyone knew he was crazy.

I now wonder how the NH should make sure the residents don't bother one another and the families.

Nina

 
Old 04-19-2012, 10:34 AM   #4
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Re: The residents

Deb, I understand that. I just don't like emotional abuse. For a while, I won't go see my FIL anymore. Why am I taking all the abuses for my FIL - the neighbors, the house deal, the NH, the caregivers, and etc. Why am I doing this? He is not my Dad. I need to see my parents too. I have had enough. So I will cool down for a while and won't see my FIL for a while. My husband can go see him.
The guy discriminated against me greatly. You see, I am not white so it is like public insult to a colored person. Anyway, I understand that they cannot help it.

I just need a break for my own mental health.

Nina

 
Old 04-19-2012, 01:40 PM   #5
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Re: The residents

As long as he is cared for then you should definitely meet our own needs too.

I know it is hard to not take it emotionally/personally just because their illness affects their behavior.

When you're getting frazzled or burned out then definitely it is, in my opinion, better to take a break.

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Originally Posted by ninamarc View Post
Deb, I understand that. I just don't like emotional abuse. For a while, I won't go see my FIL anymore. Why am I taking all the abuses for my FIL - the neighbors, the house deal, the NH, the caregivers, and etc. Why am I doing this? He is not my Dad. I need to see my parents too. I have had enough. So I will cool down for a while and won't see my FIL for a while. My husband can go see him.
The guy discriminated against me greatly. You see, I am not white so it is like public insult to a colored person. Anyway, I understand that they cannot help it.

I just need a break for my own mental health.

Nina

 
Old 04-19-2012, 08:22 PM   #6
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Re: The residents

You have to understand that this resident has dementia. He is not a rational thinking adult with the cognitive ability to think as you and I. He is not intentionally subjecting you to emotional abuse. He is incapable of doing that. He is only responding to some emotional upset that he feels. Remember that dementia patients are single focused on themselves. No, he can not help it. So please do not take it personally. He doesn't care who you are, all he knows is that somebody upset his routine and he is responding the only way he knows how.

It sounds like you are burned out. Perhaps you do need to go see your parents and take a break from the FIL for a while. Let your hubby go visit and you go see your family

Love, deb

 
Old 04-20-2012, 06:49 AM   #7
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Re: The residents

Thanks, Suzy and Deb for your reply.
I think it is hard though, not to take it personally. For example, my FIL's caregiver back in 2007-2010 is a black lady. My FIL in his good times liked to call the maid Monkey if he didn't like the bother (his late wife hired the maid.) He hated fat people so he called fat people elephant. He is not exactly non-discriminating. He is political and people think he is a nice gentleman. Well, he is very single-minded and selfish and he does discriminate against people with color or weight. He is 91 so it is the older generation as well. But the caregiver was a little upset and she didn't like to be called animal. He called me monkey once in 2009 too. Yes you are right he is sick. But it is his value system.
Nothing we can do with the sick persons and we should not take it personally. But this does not mean the person was not discriminating and etc. It is their misinterpretation but it is from the value system. No one should take the discrimination either.
If someone is discriminating and calling names in the public, the person is said to be wrong. But it is OK for a demented person to do that...
It is a mutual respect issue. I know the patient cannot help it. But it is hard not to take it personally.

Nina

Last edited by ninamarc; 04-20-2012 at 07:14 AM.

 
Old 04-20-2012, 07:45 AM   #8
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Re: The residents

Nina, we all have likes and dislikes. Some of them do related to ideas that could be considered discriminatory. It is our social filters that allow us to be that nice person and not blurt out every like and dislike we perceive. in the demented they lose those social filters. They lose the ability to empathize. They lose the ability to understand how their comments affect others. They are self centered and totally focused on their own situation in the moment. Your FIL had likes and dislikes as you have mentioned. Yet he was a "nice guy" until the dementia. He knew it was unfair and unkind to express the fact that he didn't like fat and project his ideas on others. That was his social filter at work.

No, they can not change who they are or the impulsive actions they take now in the moment. Sometimes it is not a perfect combination but you can't change who they are or how they act. My mother loves my daughter. We all know this. She has always accepted everything about my daughter. Yet, before she lost the ability to communicate she told my daughter she was "Too Fat to love!" I stopped short and looked at my daughter.... who burst out laughing! I just shook my head and laughed with them because Mom was laughing at this point. Mom had NO idea that what she had said could be taken as hurtful. My daughter never thought twice about it because she knows her grandmother loves her no matter what. My daughter went right back the next time to hear her grandmother tell her how much she loved her. That is the nature of dementia. You have to understand the inabilities and leave that happened in the past.. in the past.

I am not saying it is ok for somebody to say hurtful things about another person. What I am saying is that there is nothing you can do to change the demented behavior so why get upset and beat your head against a wall for something that can not be changed. Hurt feelings are a result of your expectations and thought process more than what is said. It is your internalizing what is said. In this situation we are the only one that can change in order to prevent or eliminate the negative feelings. We are the rational thinking cognitively aware adults in the situation. As I have said many times, it is how we perceive and what we do about it that counts more than what happened.

Just yesterday a particular guy in Mom's unit walked around the corner, looked at me squarely, and said... "If you weren't such a lazy old witch I would have my lunch by now!". My response... "Good afternoon John".. with a smile. Then I ask if he would like some ice cream. He said sure but before I could get it fixed he hurled sever more insults in my direction. I just keep fixing his bowl of ice cream and added a piece of chocolate cake to it. When I handed it to him he said it looked good, thanked me, and walked off happily eating. I could have responded differently by getting upset but that would only spiral the situation downward. Instead, I figured out that he was hungry which was causing the disruptive behavior.

As an example of how our perception colors what is said and lead to our feelings.... You mentioned the name "Monkey". For you it was a hurtful comment. My daughter's nick name is Monkey and she LOVES it! What is said or done does not matter as much as how we perceive what is said or done. So it is your mindset that FIL has dementia and all the other residents around him have dementia... and that their comments and actions are demented behavior that is not relative to you at all. When that happens, their comments will not be internalized and create distress in your life. At this point you are the only one in distressed because your FIL and the other residents have left the incident in the past and don't even remember it

Love, deb

 
Old 04-20-2012, 08:37 AM   #9
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Re: The residents

Well the unfair thing is that people with Alzheimers and Dementia get a Free Pass.

Even if they may have been prejudiced bigots while they were well, or didn't get along with someone and were rotten to them, or were just a mean lousy SOB their whole life, once they have this type of disease, unfortunately, one cannot really "hold them responsible" for their words and actions anymore. It may be horrible things they say but they're off the hook for them.

I realize that must be very frustrating in certain cases.

But that is more a reaction from the past I think, then the present. Everyone a the NH knows that the demented are no longer held responsible for their words.

It must be frustrating that the person gets off the hook when maybe they were always that way.

But...

All one can do is put oneself in the situation and find a way to deal with it, or not put oneself in the situation.

There is nothing to force you to go to visit him, if you find it that hard to deal with. Just do not go.

Or, if you want to go to show you are making the effort or to accompany your husband, there is nothing to make you stay long. I know it is far away but that does not mean you have to stay long. Just go in with a treat or something, say Hello, I passed by to see you, and if the conversation turns, then say, I have to go now, bye. Then go down to the lobby and read a good book while the other person(s) stays with him.

--------------------
Quote:
Originally Posted by ninamarc View Post
Thanks, Suzy and Deb for your reply.
I think it is hard though, not to take it personally. For example, my FIL's caregiver back in 2007-2010 is a black lady. My FIL in his good times liked to call the maid Monkey if he didn't like the bother (his late wife hired the maid.) He hated fat people so he called fat people elephant. He is not exactly non-discriminating. He is political and people think he is a nice gentleman. Well, he is very single-minded and selfish and he does discriminate against people with color or weight. He is 91 so it is the older generation as well. But the caregiver was a little upset and she didn't like to be called animal. He called me monkey once in 2009 too. Yes you are right he is sick. But it is his value system.
Nothing we can do with the sick persons and we should not take it personally. But this does not mean the person was not discriminating and etc. It is their misinterpretation but it is from the value system. No one should take the discrimination either.
If someone is discriminating and calling names in the public, the person is said to be wrong. But it is OK for a demented person to do that...
It is a mutual respect issue. I know the patient cannot help it. But it is hard not to take it personally.

Nina

 
Old 04-20-2012, 08:56 AM   #10
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Re: The residents

Thanks Suzy and Deb! Suzy, you are right on - they are off the hook!!
Well, the caregivers would sometimes tell the person, oh please don't say that, it is not nice and etc. But I know the person does not get it. So it was just comfort talk to the person to smoothe things out.
Yes, my FIL's home care nurse didn't like the term elephant. She is not fat but her worker was. Once she tried to fix this fat caregiver for my FIL and she came along. My FIL said oh she walks like elephant! The home care nurse tried to tell him it is not nice to say that! But of course she knows she cannot convince him. It was just a nice talk while confirming that it is not a right thing to say for the rest of us.
I think the issue here is really that the people are worried that other "normal' people will believe that it is OK to say that kind of stuff. It is Not OK. Not that I or they take it personally, but there is a line that we need to know this is wrong. No, my FIL is "not" wrong, but we needed to know this name calling is wrong for the rest of us. I cannot call the black lady monkey or she would kill me!
Deb, well, Monkey may seem to be cute sometimes, but it is not the point.
For some people, it is the principle although they know the patient cannot help it.
What is wrong with saying it is wrong, but of course, the person is not wrong.

It is the social values I am talking about, and I am not saying I want to hate this person or what. I know he is old and cannot help it anymore.
Off the hook? Maybe, but we have to make sure other normal people don't believe in it. I need to know other guests there don't take it for real. Of course, I cannot help if someone discriminates or has the wrong mindset or the dislikes, but I can stand to say the principle.
No I don't hate the guy and I can see the guy again but I just don't want this to happen again. So we will avoid the guy at meal time.

Hugs,
Nina

Last edited by ninamarc; 04-20-2012 at 09:01 AM.

 
Old 04-20-2012, 07:02 PM   #11
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Re: The residents

....."I think the issue here is really that the people are worried that other "normal' people will believe that it is OK to say that kind of stuff."....

Nina, rational thinking adults do not learn antisocial behavior from those with dementia. We understand the behavior exhibited by the other resident is inappropriate. Making an example out of this residents, escalating the situation, is not what is needed. It only annoys the resident further and brings more attention to what is being said. What the resident said is wrong, we know it is wrong, but he doesn't have the mental capacity to change, learn, or understand. You said the staff did express that what he said was inappropriate. They validated your social values as best they could. Why are you so angry about the situation? Perhaps it was what you perceived others were thinking? Did anybody else join in his rant? On the one hand you say you understand that he can't help it but on the other you want something to happen to change what is.

The fact that a word or words can be perceived in many different ways IS the point. You have your perceptions, I have mine, and the demented resident has his. Each of us has a perception of what is. We have an expectation that people will honor our perception. Yet there are situations when the person, as the resident at your FIL's facility, doesn't have the ability to live up to your expectations. Is it worth getting so upset about the fact that somebody is unable to control their emotional outburst in a way to meet your expectation of social values. You know what that resident did is wrong... and so does every other rational thinking adult in the room. How much intervention would have made it ok?... especially knowing you are not going to change the resident because he is demented! Beyond that other demented residents are not going to learn from that resident either. For them and the resident who was angry... it has all been forgotten in the fog of short term memory loss. In the demented resident's mind I am sure you were being inappropriate by sitting at his table with his buddy and disrupting his routine. He expressed his anger in the moment and you brought yours home with you

I am just trying to understand your anger at a demented resident.

Love, deb

 
Old 04-21-2012, 08:14 AM   #12
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Re: The residents

It is really personal. It is not about the demented person.
You are right, it is about my perception or my caregiver's perception (the one back home about being called animal.)
One thing we feel is that the demented person is still a person. Every person has his/her own value and etc. Although it was not "personal", the people who received that felt bad.
You understand? We have a right to express our emotions and hurts. We are not robots. You think about emotion as physical, I think about it due to my whole being and my limitation and disability. It is not the insecurity, but no one likes to be hurt or insulted even if it was not meant to be.
It was not our fault either because the caregiver should not have set up the table there as we asked if this is OK? But it WAS NOT OK. What can we do? I had to be calm so as not to upset my FIL. I sat through it and took it nicely.
Ok, nicely.

I am Ok now but people need some time to express the hurt even if it was not intented to be rational.

Nina

 
Old 04-21-2012, 08:58 AM   #13
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Re: The residents

Deb,
The other factor now I think of it: it is the frustration that my FIL or the patient will never understand that what happened was not real. I know there are many times when my FIL was talking in his own world and blamed us here and there. It is very frustrating that we had no way to make him understand that those things were not true. It is never possible to make him understand his son is not in the same field and cannot help him whatsoever (for at least 10 years or more! I didn't know this until much later.)

Yes the person is not related to me but why am I so upset? Why was I so upset? It is about what he said - the racial blurring (go back to China and that kind of thing; she stole the food...) It is serious accusation although it was his imagination or anger that we sat in the wrong place. I get upset because I don't want to feel I am a bad guy and I am not. I know people around us understand this. For small things, I don't mind. Say, the resident can say something about small things that don't make me upset and I laughed about it. It depends on the issue.
Someone in the hallway called you lazy witch without any big fuzz. It was not advertized in public in the cafeteria and etc. So this would be nothing to me as well. Your Mom called your kid fat lovingly - it is different.

The guy was angry and I was afraid as well at that time. Hope he would not attack me. You need to know it is the context that was scary. It is not all about demented person. Right,I may not be able to be a caregiver for a demented person, but I am a person and I can feel that way. At the same time, I know we have to bear with him. That is it. Nothing is wrong and I did nothing special to hurt him and I am not making this a big deal. I got upset and I thought bad thoughts or negative thoughts. That is all.

Nina

 
Old 04-21-2012, 09:31 AM   #14
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Re: The residents

This is not about what your FIL understands because he is NOT going to understand. He does not understand the frustration of the other resident. He does not understand your frustration. Other than any immediate impact on him in the moment he doesn't understand or remember the incident. They have no way to understand what is real. They only have what they perceive in the moment and it is fleeting... gone with their short term memory as soon as it is perceived. So don't worry about the long term effects on the FIL. The person present that has retained the memory and internalized it is YOU!

When dealing with demented residents, they are likely to blurt out inappropriate statements. They may be minor or major. They may be small or huge. They have no way to weigh the effects on somebody else. There are no degrees of inappropriateness to them. Something comes in their mind and it comes out of their mouth... and there is no way for them or us to control what comes in their mind. Their social filter is broken and there is no way for us to teach them or correct them effectively. They also have no idea what audience they might have. They don't care. They are self absorbed in their own world and the rest of you people don't matter... unless you disrupt their routine. You are the one that was offended, held on to the memory, and let it fester. As soon as the resident's routine was restored he went on about like in his normal way.

Yes, a demented rant can be scary but there are ways to defuse the situation. No, you didn't do anything intentional to set him off but my guess, because of the things you said he included in his rant and his routine, you came between him and his buddy. He has no idea who you are. You are just an intruder in his world. He reacted to that intruder. He can pick up on non verbal cues... your fear and your anger. That typically will make his rants worse because he is getting the reaction he needs to make you move on They do revert back to a very primal way of reacting. That is why I said several post ago that inviting him to sit by his buddy would have been a good choice of reactions. It gives him what he wants and deescalates the situation. That is why calm smiles work so well.

You do have a right to feel whatever you feel but then you have to rationalize what the situation was. That is what we do that they can't do. Yes, it does take practice to accept these commonly unacceptable outburst. It is not the same as somebody who is cognitively aware doing this in a restaurant. It is up to us to understand the difference. He said something that struck a raw nerve in our reality and created emotions that are directly tied to you. If you give credibility and value to his rants then it continues to disturb you. If you understand that his rants are demented rants then you can get past them. That is why I say it is not what happened as much as how you internalized it that matter the most. I think no less of you because a demented man made a racial slur.... and I bet nobody else does either

Yep, you can feel however you feel... and I am not saying what happened was appropriate. What I am saying is that you are in control of how you let it affect you. With understanding of the situation you can let go of the anger which is beneficial to you

Love, deb

 
Old 04-21-2012, 01:45 PM   #15
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Re: The residents

Deb,
It is not his table. The guy always sat at the table next to my FIL's table.
He just wanted to mind the business to say we should not have taken 2 other spaces for other residents. But the caregiver said one lady was not there and etc.
The table has no more space for another person. Only 4 persons space and the other resident who does not talk was with us as well.

It should have been the NH's caregivers who knew how to do it. The girl should have known that it was too close to the residents but I guess she didn't realize it. The guy does not sit there and sometimes he may sit with my FIL but rarely. He just wanted to say we don't belong there.

No, it does not make me feel very bad and it is not bad for me. I just expressed what I felt. Sometimes people do have different views about certain issues. I think it is odd that someone hit on you and you feel nothing.... For kids, it is different because they are simpler and may not have such anger.

Nina

Last edited by ninamarc; 04-21-2012 at 01:47 PM.

 
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