Social work group facilitation for Alzheimer's disease caregivers

¶ … Group Process and Skill Selection

Recent developments at the medical industry increase the life expectancy. Census reported that 36.3 million Americans were 65 and over in 2004 and 71.5 million Americans will be 65 and over in 2030 (see, census.org). Therefore, the age related diseases and related industry (i.e. eldercare) have been taking an important part of the American society. Taking care of a person with memory loss, dementia and Alzheimer's disease is a demanding task as it requires mental and physical strength. Social supports groups are very helpful to deal with mental and physical distress for Alzheimer's patients' caregivers. In this brief document, a social group session is discussed.

ANALYZING GROUP PROCESS AND SKILL SELECTION

Introduction

Garvin, Gutierrez, and Galinsky (2004) describe the social work groups in which the social workers participate as part of their professional activities either as participants or facilitators. The interaction between social workers and group incorporates groups that individuals exchange their issues, improve their life, enhance their functionality, refine their methods to deal with challenges and evaluate the social justice. In the same book, Garvin et al. (2004) point out two important factors -the personal boundaries and mutual respect- that form the quality of mutual interaction between group members. In this aspect, the social worker, as a facilitator, should facilitate the value of each individual and emphasize on interactive help between group members. The latter would help individuals to understand the importance of interdependence. This interdependent relationship between the group members would provide the positive and the negative aspects of their experiences. However, there might be a disadvantage that some group members would not like to work together as they would feel a competition or vulnerability. Although there is not a common way to degrade the group member's hesitations to interact, the more suitable model for a particular group would improve the outcomes of the social work. The well-known models are mutual aid and cognitive-behavioral models. The motivation of mutual aid model is the processes that occur among the group members whereas the cognitive-behavioral model focuses on the behaviors and thoughts that differ within the group members. Northen and Kurland (2001) took these two models as a whole and let the group define their model. The example their used was an environmental group highlighting the importance of mutual respect.

Why is the Alzheimer work group? How do group members sit around the table?

Recent developments at the medical industry increase the life expectancy. Census reported that 36.3 million Americans were 65 and over in 2004 and 71.5 million Americans will be 65 and over in 2030 (see, census.org). Therefore, the age related diseases and related industry (i.e. eldercare) have been taking an important part of the American society. Taking care of a person with memory loss, dementia and Alzheimer's disease is a demanding task as it requires mental and physical strength. The physical work caregivers undertake is very hard including bathing loved ones, feeding them, running errands and trying to understand what the loved ones really need. The results of this long-term care are exhaustion, anxiety and depression (Molsa, Marttila, Rinne, 1995). These effects would be traumatic and would last long time after stopping to take care of the person (either patient's death or sending the patient to a nursing home). Moreover, at some cases it could cause neglect and elderly abuse (see, http://www.nia.nih.gov/Alzheimers/Publications/caregiverguide.htm).

Taken all together, this paper aims to focus on Alzheimer's disease caregivers in Miami, Florida. Maintaining social contacts and peer support are an important safeguard for caregivers' wellness and happiness. This work group aim to develop a mutual support system sharing the positive and negative aspects of being Alzheimer's caregiver.

The supportive and accepting atmosphere reduces the stress and facilitates self-expression and willingness to share ideas and behavior. In this context, the facilitator tried to create such an atmosphere that everybody is included in the group and respected in the aspects of their individual faith and belief and personality. The eye contacts and facial expressions are given privileges. Therefore, the skilled facilitator took a chair to e able to observe each member's face expressions and body signs (Figure-1). In this particular group, the caregivers C. And D. are the first individuals entered in the room together. They, both, went to the same college to study nursing and working for the same company as the caregivers. They were talkative and making jokes when other caregivers entered to the room. Caregivers A and B. also knew each other from their caregiving career in Century Senior Community. They were both K-12 graduated and Caregiver B. started her career after taking care of her mother who suffered from Alzheimer's for a long time and passed away almost 7 years ago. The last three people sitting on the right side of the table are the relatives who take care of their significant ones. E mentioned that she is part time caregiver for her mother suffering from Alzheimer's disease whereas F. And G. are full time caregiving their husband and father, respectively.

Figure 1. The seating diagram.

The structural factors impacting the group and members' dynamics

The most significant structural factor is the members' cultural background. They all have Hispanic background and are able to speak Spanish. One of the reasons is that 60% of population of Miami is Spanish Speaking with 52% Hispanic background (see, census.org, 2000). The group meets in a small room assigned for the meetings in a Church in Miami Dade County with moderate furniture. The group members heard about the group at their community and informed each other.

Definition of the group members

The younger college educated group is more open to talk about their experiences, emotional and physical issues whereas two older professional caregivers with certification are more silent and gave an impression that they feel jeopardized by the younger ones. At a certain moment, all the group members shared some important positive aspects of caregiving. They agreed that the meaning of life and purpose were changed such as their existing relationship with their family members got stronger while they started to build stronger ties with new people. The person G. was the wife of an Alzhemer's patient who has been taking care of his husband for three years. Her testimony was touchy for all group members. She feels that this is the meaning of lifelong commitment. The F. sitting on the other side of G. told that it is her duty to give back what she got from her family. Person E. noted that she tries to protect the balance between her private life and the loved one's needs. Although she visits her mother everyday she would not spend more than 3 hours per day with the mother.

Expression of feelings

In this group, the most emotional person was the wife; however, it could not be the accurate observation from the first session. She was trying to block the negative feelings of the daughter. The daughter mentioned that it has been six years that she has not been going out and dating with anybody since her divorce. The wife believed that the daughter should not be talking about these challenges in a group.

The elder caretakers usually agreed with each other whereas they exhibited persistence to young caretakers' solutions and experiences. The young caretakers believe that it would help to the caretaker and the patient to have some sort of breaks. These temporary breaks would give relief to caretakers and help them to balance their emotions and feelings. One of them told that she goes to movies when the loved one goes to sleep and regardless of the theme of the movie she would cry. She described her crying spells as a sort of anger that not being able to change the effects of Alzheimer's and watching the loved one's decline helplessly. At this very moment, the wife made nervous and fast face gesture.

Membership dynamics

It is obvious that younger people were sharing the positive and negative feelings whereas the other two ladies (the daughter and the wife) were actively disagreeing. Although the elder caretaker sitting on the left gave two of his experiences and showed dominance, he and caretaker sitting next to him were silent outsiders. They seemed like they were not ready to express themselves. The reasons could be that they felt inferior or embarrassed to express their anxiety, sympathy and long-term frustrations.

Participation and levels and styles of influence

The wife and the daughter were highly participating, mostly debating to each other. The facilitator was carefully pointing out the emotions and addressing the positive aspects of the caregiving when it came to the point of conflict. On the other hand, the facilitator let the group unite together. The elder male caregiver waited through the end to tell his experiences and how he attached to them. The elder female caregiver was very silent unless someone asked direct questions. None of the group members was ignored but the elder professional caregiver chose to be silent. The most dominant character was the wife while the young caregivers mostly talked about modern techniques and approaches to caregiving.

Conflict Management

Group members were pretty good at taking back step when the conflict occurred. Nevertheless, the facilitator was able to manage the conflicts between group members.

Member roles

The young members, C and D, were defining the problem intellectually with a dry wittiness whereas the old professionals were serious. The wife monopolized that her emotional issues are bigger than the others as she has a life commitment. The elder female caregiver was completely silent whereas the young group members were very talkative and open. Elder male caregiver was carefully listening to the others and agreeing or disagreeing by giving examples of his experiences with loved ones. Thus, he cares an internal leader role. However, the facilitator made sure that most caregivers -regardless of the relationships to the patients- have the similar issues and ties as it is expected from a skilled facilitator.

The scapegoat was two daughters, E and F. The reason for that F. expressed her feelings about the nursing home and her father's uncontrollable anger whereas E. is not spending enough time with the loved one.

Manly the facilitator was dictating the ideas when it came to the conflict with a touch of the humor. The facilitator did not let anyone or the subgroup to dominate over the others. The facilitator tried to give as equal as possible time to each member. Although the elder caretaker lady was not willing to talk about herself, the facilitator directed questions to her to open her up.

Future Work

The next session would be in an outdoor place where the group members show some affords, canoeing is a good example. One would try to put two people confronting with each other in the same canoe to increase the dynamics between them. After this short session one would try to expose their emotions and approaches. Why do they confront or agree? Why are they afraid or feeling in a competition?