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My mother is 98 years old and in a nursing home. She has lost most of her hearing and stopped wearing her hearing aids several years ago. She has extensive cognitive impairment.
My brother visits her twice a week, and thankfully she still recognizes him. I live 300 miles away but, at age (75), health problems prevent my traveling anymore to visit her. I call her about every 4-5 days and am always relieved that she still recognizes my voice, but that's about the only good thing I can say about these phone calls. Because she can't hear very well, she doesn't understand what I'm saying, no matter how slowly I speak or how carefully I try to enunciate my words, and I do try to keep the sentences short and simple. I'll say something and she, in trying to understand what I just said, repeats it back but it's hopelessly garbled.
It seems safer to let her lead the conversation, but mostly what she says is confused, and many words aren't real words at all. I listen intently, trying to identify her mood, and then offer some reply ("Oh, yes, Mom, you're so right." or "Yeah, Mom, I know, you just can't get everything done in one day." And so on.)
This goes on for about 20-30 minutes. I feel her confusion and frustration when she doesn't understand what I've said, and I feel my own frustration when I can't figure out what she's trying to tell me (or how much of it is real). Sometimes I think I should call her a lot less often, to minimize her struggle with phone conversations, but then I fear she'll think I've forgotten her or, worse yet, she'll forget who I am and won't recognize me/my voice when I do call.
I'll add that I do send her a notecard every week, something I started doing a few years ago when my brother and SiL moved her into their house. Back then she looked forward to the cards and the short notes describing what my husband and I were doing, and asking her about her life, her bird feeder, etc. As the years passed she grew vaguer about them, not sure if she'd received one that week (my brother always assured me that she had), couldn't remember what it looked like, or what I'd written. Now, in the nursing home, she doesn't mention them at all. That makes me sad because I'd like to think that a pretty card every week would brighten her day, but they seem not to register with her at all anymore. My brother does think that just the act of an aide bringing her something for herself cheers her up, even if she promptly forgets what it is, and so I continue to send a card every Tuesday.
Does anyone have any advice on how I could better talk with my mother on the phone, or anything else I could do to maintain the waning connection between us?
Thanks for any advice or insights!

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Short of going to see your mother in person, there isn't really anything you can do to fix this situation. Your mother cannot interpret or hear what you're saying, so the whole phone 'conversation' is an exercise in futility. Expecting her to gain anything from a phone conversation is expecting too much; what you want is for your benefit, not hers at this point. With advanced dementia & hearing loss at play, nothing you say or do will fix this situation. I myself went through this very thing with my mother who was 95 and living in a Memory Care AL 4 miles away. The phone became impossible for her to use due to the advanced dementia and hearing loss combined, so my only option was to go see her in person. So I did. I'd take my husband along with me and go at least once a week, more often as she declined and got closer to death. Being able to hug her and give her a kiss was the only thing I could do to help her feel my love; other than that, communication was impossible.

Continue to send the cards to your mom. Perhaps the aides at the nursing home can facilitate a Zoom chat with your mom whereby she can see you for a little while, even if she can't hear you. The aide can hear you, and then speak loudly enough for mom to hear what she said. Whether or not your mom will be able to understand the words that the aide speaks to her is another story entirely, however. But at least she'll be able to SEE you and you'll have some screen time. During Covid when there were no visits allowed for over 12 months, I either had window visits or Zoom visits with mom every week.

Best of luck with a difficult situation.
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It’s going to be difficult and heading toward impossible. Sometimes we just have to accept that this is how they are now. There’s nothing you can do about the changes she is going through, and you’ve tried so hard. I suggest you minimize contact now because it can’t help her much, she’s barely understanding it, and it’s upsetting to you. Very sorry.
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You could send her a framed picture of you for her room. My friend has advanced dementia and lives in memory care. She talks to her parents’ photos every day. I have no idea if she knows who they are now but it seems to bring her comfort.
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Continue the cards & photos.
They make great conversation starters for carers & add happiness.

Have you tried video calls? Would need a staff member to set it up, leave for 20-30 mins & return. Most places are short staffed these days 😔 which makes that hard.

A tablet size is easier to see. Could enable Mom to lipread you better? However, might be too confusing & not improve your conversation much.

My LO sadly can not see the tablet screen well enough to lipread, so prefers to speak her news on a phone, despite not hearing any back. On occassion we do try the video & she seems happy to see people's faces & wave.
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Contact the local phone company. If she has a landline, they'll give her a special ADA phone that has volume and tone settings.

We got one of these phones for my mother, and it was a lifesaver because of the tone feature. She couldn't hear deep voices, so turning up the tone made it possible for her to hear men's voices better.

Her hearing issues weren't only related to volume, and your mom's likely aren't either. If she can understand your brother but not you, try lowering the tone of your voice when you speak to her.
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