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Posted: September 01, 2004

Professional Caregiving

Helping Families Make Good Decisions Starts With Our Own Understanding of Change

Helping families make good care decisions for their loved ones is not as simple as recommending resources, suggesting options, and ?Voila!? -- the best decision is made. Nope, doesn?t work that way.

Too often, we professionals give out resources and forget to help the client examine where exactly in the change process they are, since the steps for each stage are quite different and may spell the difference between success and failure.

We need to think about and master change in our own lives in order to effectively help the family caregivers and their elderly.

Mastering change in our lives is about mastering the mind gremlins, or ?self-limiting talk.? We so often have the best intentions to make positive changes in our lives and then disappoint ourselves with an inability to focus on the goal, make strides as we had planned, reach for that final stretch or maintain what has recently been accomplished.

Making change is not simple. Remembering that clients often jump into action before the groundwork has been properly prepared may cause them to fail in the initial attempt and then get frustrated and their gremlins begin to pop up. ?This is harder than I thought . . . I can?t do it? or ?She?ll never let me forget this, and I am not willing to risk our relationship.? This so-called self-talk defeats us and promotes a sense of incompetence.

Dr. James Prochaska, director of the Cancer Prevention Center at the University of Rhode Island, developed a helpful tool for working with cancer patients in disease prevention, health improvement and maintenance. It?s a tool that is easily applied to any change process. The stages of change can be applied to all scenarios in which modified actions are needed because they help us identify where our family caregivers are in the process of change. Prochaska?s six stages of change, and what to do in each, are summarized here:

Stage One: Pre-contemplation. This is when the need for change has been brought to our attention, not from within, but from external forces. The boss, the doctor, your spouse telling you that you must do X for Y. Lose weight for your health, organize your office before you get your raise, recommend a geriatric assessment for a parent, etc. Here, the task is to be curious about the need for this change which has not yet been considered. Why is it being recommended?

Stage Two: Contemplation. This occurs when one acknowledges that change is needed, but weighing the plusses and minuses of the change being considered is keeping us up all hours of the night. Here the task is to weigh the pros and cons of making the change, and determine whether the pros outweigh the cons so we can commit to the next steps. The Pros/Cons list, or cost/benefit analysis, is a necessary exercise that helps us process and visually weigh the options swirling in our heads.

Stage Three: Preparation. In this stage we are planning to take action in the near future, or we may have already instituted some small behavioral changes, but we still need to be convinced that taking action is best. In this stage we want to get ourselves ready for the steps we will actually take and be attuned to any behavior (or gremlins) that can derail our efforts. Going public with our commitment helps us focus and identify roadblocks that keep us from being successful and figuring out how to go around these barriers.

Stage Four: Action. Here we actually are making the change. This stage requires the greatest commitment of time and energy, but unless there is strong preparation, it is likely to fail. We develop a game plan broken into achievable, measurable steps and implement them. Some find making the list of steps, putting them in a calendar, checking them off when completed, using a coach (friend or professional) to keep us on track, and help us get back on track if we have moved away from task.

Stage Five: Maintenance. Change never ends at the action stage, although we often think it does. Turning new behaviors into habits takes time, and unless the new behaviors are sustained, the temptation to return to earlier behaviors must be fought ongoingly. Here we focus on working to prevent relapse, celebrating wins with others, and enjoying the successes achieved thus far.

Stage Six: Termination. Here, we cross the finish line, having identified the problem, an action plan, behaviors to embed and those to replace, and we have avoided beyond any temptation to return to old behaviors. Some changes, like addictions, never really can be terminated, as they require a life-long commitment to sustain.

Because each stage has its own set of action steps that help cement the integration of learning for the next stage of change, we are hardened against the saboteur, the negative voice within. Despite that gremlin telling our clients why they won?t succeed, we are better armed to assist them with specific actions to take at each step along their journey.


Sylvia Nissenboim is a licensed clinical social worker and who has been working in the field of adult day services in the St. Louis area. She is the director of four adult care and enrichment centers for the American Red Cross and also operates a personal and professional coaching firm, LifeWork Transitions, specializing in caregiving concerns, adult day care management and other aging services, such as virtual coaching and family care giving support groups. She co-authored The Positive Interactions Program, is a national speaker, and has served as president of the Missouri Adult Day Care Association and as a member of the Missouri Governor's Advisory Council on Aging..

© 2004 Pederson Publishing, Inc. All Rights Reserved.
Commercial use, redistribution or other forms of reuse of this information is strictly prohibited without the prior written permission of Pederson Publishing.

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