The Son Who Answers Every Question
Mrs. Kaur, 79, is in rehabilitation after a hip fracture. She has moderate hearing loss in both ears and wears a hearing aid in her right ear, which is often switched off in the morning. Her son arrives during your 9 a.m. shower shift and tells you, “She wants her shower at night. She hates mornings. And she doesn't want that aide.” Mrs. Kaur watches the two of you and smiles and nods. When you ask her directly, she says, “Yes, yes,” without looking at your face. She has capacity and makes her own decisions.
1. Describe how you would actually communicate with Mrs. Kaur to find out what she wants.
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Set up the conversation before you ask anything:
- Get her attention first; never speak from the doorway or from behind her.
- Face her, at eye level, with light on your face, and turn off the TV or radio.
- Check the hearing aid: is it on, is the battery working, is it in the right ear? If it is off, turning it on may change the whole conversation.
- Speak clearly at a slightly lower pitch - not louder. Shouting distorts sound. One idea per sentence, then pause.
- Use gestures, written words, or a picture if she is not getting it.
Verify understanding. A nod and a “yes, yes” while she is watching your face and not the question is not consent; nodding can be a social reflex. Ask a question she must answer differently to show she understood, for example, “Morning shower or evening shower - which one?”
Document what she chose, and how you confirmed it.
2. The son is doing the talking. How do you handle him without damaging the relationship?
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Acknowledge him first. He is trying to help and probably interprets for her at home. “It's good that you look out for her - I want to get this right.”
Then redirect the decision to her. Thank him, and explain plainly that you need to hear it from her because it is her care and her choice. Ask him to step out for a moment, or ask her when he is in the hallway - she may defer to him only because he is answering first and faster than she can process the question.
If her answer contradicts his, follow her choice, say so neutrally to him, and tell the nurse that a family conflict exists. Do not get pulled into an argument in the hallway.
Confidentiality: do not discuss her care or schedule with him unless she has agreed to it or he is on the authorized release. Being her son does not by itself give him that access.
3. She confirms she does want the evening shower. What do you do with the 9 a.m. slot, and what if she had refused altogether?
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Honor her stated choice. Move her to the evening slot, or offer a partial wash now and the shower tonight. Tell the charge nurse so the shower list is corrected rather than leaving a gap.
If she had refused the shower entirely: that is also her right. Do not let the son overrule her, do not try to talk her out of it with the shower already running, and do not proceed because the schedule says so. Offer alternatives, re-offer later, and document the refusal and what was offered.
Either way, tell the nurse that the son is speaking for her and that her hearing aid is frequently off in the morning. That second detail is a care issue, not just a family issue - a resident who cannot hear the aide cannot consent, refuse, or participate in her own care.