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By Sara Abramov, B.S.W., Care Manager for Family Care

Some of the most important components of working with older adults or any vulnerable populations are the ability to read warning signs as well as the ability to observe the environment for things that are not being said to us. Warning signs and subtle observations can clue us into problems that our clients are experiencing, but for whatever reason, choose not to share with us. Problems can range from not enough food in the house or a serious decline in a health condition to abuse and/or neglect.

For the purpose of this article, I will use the word “us” to refer to people who work directly with older adults (staff and volunteers) and the word “clients” to refer to older adults.

Many of you might ask, “Why can’t we just ask our clients point blank about abuse, neglect, poverty or their health, instead of sitting there and looking for clues?” And the answer is simple: older adults have many fears as well as trust issues that stop them from opening up to anyone. Often times, they can go to great lengths trying to hide facts simply because they are afraid of change…the “unknown” which might result from our intervention. Other times they are embarrassed about their situation and prefer to suffer than to admit that there is a problem. Therefore, being able to observe things that are not being said to us is very crucial. Now that we know the importance of reading the warning signs and/or the subtle observations, I would like to share a technique that I have used over the years and have found very helpful.

For example, when I notice any significant weight loss, I know this can indicate anything from a medical condition to not enough money to buy food. In situations like this, I would subtly (as part of conversation) ask the client how they feel today, or when was the last time she/he had seen his/her primary care physician (Note, it’s important to ask questions subtly, without alarming the client, as often times when they get alarmed, they are not so open to providing accurate information).

If, on the other hand, I sense somehow that the weight loss is more about the client not having an adequate food supply in the house, I have found it helpful to start a general conversation about my and/or the client’s favorite food, about how much I enjoy cooking or even about cooking shows. Once the conversation is flowing and the client is sharing recipes, it’s easy to ask the client to show you one of the ingredients since “you have never heard of this ingredient.” Thus, you get the client to open the cupboard or better yet, the refrigerator, and you can take a peek. I have used this approach more than once and it works every time.

The above example is just one of many ways I address a concern regarding a client. It is not intended to solve every issue we face with clients; instead it can serve as a guide towards reading a situation with clients who don’t open up easily for various reasons.

As volunteers, noticing changes, warning signs or environmental cues can be an important piece of the ongoing overall coordination of services for JFS clients. The techniques described above can be helpful for reporting suspicions or concerns you may have with a client(s). If you do have suspicions or concerns from any of the signs you have noticed, it is always important to follow up with your client’s care or program manager, so they can address the situation you have noticed.

Finally, I would also like to stress the importance of building a trusting relationship with our clients from the very start. On initial meetings, I find that most of the older adults are reserved, distanced and are not too eager to share their stories with us. Therefore, I always begin by telling them a bit about myself, such as where I am from, how long I have been with JFS, what I like about my job, why I chose this line of work and so on, not saying anything too personal at that time. I find that clients feel more at ease once they know a bit about us. Then, to further develop a trusting, caring relationship, you can follow up on items they now share with you as the relationship grows, such as calling them on their birthday, inquiring about their sick friend or asking about their newly born grandchild. The trust that builds can open so many doors and help everyone do their best jobs. Thanks for noticing!