Any advice on communication strategies?

I don't have all the answers you're looking for, but I would say, just try treating them and talking to them as you would want someone to treat and talk to you, if you were in their shoes. Sometimes just putting ourselves in someone else's shoes, can totally change our perspective on things. Wishing you the best.

I don't think you can get thru to any of them especially where drugs are concerned, expecting them to dose the tablets properly and take them on time is too much. Cognitive impairment IS present when simple instructions cannot be followed. They need paid caregivers coming into each home to help with meds, braces and all the rest. Thinking you alone are able to provide adequate care to SO many elders is unrealistic. Some things WILL fall thru the cracks because it's just too much for one person to handle. Rehab SNFs are always the best option, in my experience, and none of the elders "want" to go, which is to be expected. What awaits them at home WITHOUT rehab, however, is normally a whole lot worse than what they were in for IN rehab, especially without full time carers present.

I don't think it's a sheer matter of hearing problems you're facing, but of comprehension problems. They may hear what you say, just not process the words properly.

What you're running into with not getting thru with signs on the wall, the doctors orders written and highlighted on the nightstand and repeated verbal admonitions is typical with dementia. They're incapable of reading signs or written instructions, or comprehending verbal admonitions. It's in one ear and out the other. My mother has fallen off of her bed at least 10x the past month alone because she can't remember being told not to lean over the edge of it. Even if your elders don't have a "formal diagnosis " of dementia, if it quacks like a duck and waddles like a duck, chances are good it's a duck!

Wishing you the best of luck realizing you can't be all things to all people, and hiring some extra help for your loved ones who need it.

While they are clearly not toddlers, as people age much of their behavior is similar to toddlers. You still want to speak to them like adults, but just remember that following multiple steps becomes difficult, vision is not what you think it is, and of course, hearing is also not what you'd expect. It all just takes a great deal of patience as well as figuring out better ways to plan things.

As far as the one with the severe hearing loss, my brother shouted at our mother, and finally just stopped talking to her, which was extremely cruel in my opinion. It turned out that volume is not so much the issues as tone, plus a properly adjusted hearing aid. Take your relative to a hearing aid specialist and make sure his aids are adjusted correctly, and if he refuses to wear them, change the tone of your voice somewhat. My mother simply can't hear low-registers, so now when my brother talks to her, he speaks in a slightly higher register and she hears him pretty well. She's never had a problem hearing me.

I think you're going into far too much detail regarding the pills, too. That applies to the one with dementia, too. (I think the one with the pills and the brace has a touch of it as well.) Honestly, just like with a child, repeating something simply multiple times will work better than going into more detail or trying to hard to explain more than is necessary.

I don't know why you'd turn down going to a nursing home because of a two-week quarantine. That's the norm nowadays, plus if she was in the hospital you wouldn't be allowed to visit either. They aren't quarantined as in left alone on their own for two weeks -- there are caregivers who are specifically assigned to her only, so nothing she might have is carried back and forth to other residents, that's all. My mother was quarantined for two weeks after getting out of the hospital, then for another three when she tested positive on her last day, and she had five-star service because she had her own personal caregiver 24/7.

I say do the nursing home and don't sweat the quarantine period, but certainly ask the staff there first how they handle unvaccinated residents (and she won't be the only one, too, BTW). I'll wager she'll be in there with everyone else after her quarantine, because they'll be pretty strict about visitors being vaccinated and she'll benefit from the herd immunity.

There's just always going to be a segment that won't get the vaccine. My mother-in-law is one, and her reasoning is that "I don't catch viruses." Oh, OK. She said she never get the flu, so she won't catch this either. She's only considering the vaccine because she heard she might not be allowed to fly unless she's been vaccinated. Mind you, she hasn't flown anywhere in three years, and at 85 I don't expect her to, but that seems to be the one thing that'll get her to change her mind. If it works, so be it.

With the one who filters everything through religion, just stick to the topic and don't allow yourself to be drawn in to his particular angle of approaching things. Selective deafness on your part would be the best way to go here, I believe.

It is really hard to communicate with people with hearing problems. They often don't think they have a problem. My mom says "well, you're speaking so softly". Umm, no, I'm not. Speaking normally and you can't hear! But will she even try to do something about it? Nope. I guess she thinks that I should be the one to do something about it. That annoys the crap out of me. Because it is similar on a number of issues and levels, not just about hearing. But in all cases, I think the person with the issues should be trying to fix them instead of expecting the rest of the world adapt to their deficits. OK, sorry, done ranting.

Your ability to communicate well with people with hearing problems and /or dementia is VERY difficult. You can really only do so much and it sounds like you are doing quite a bit in this department. While is may not feel like it is "working", no matter how hard YOU try, it may only working marginally well, through no fault of your own.

Most people do not want to go into a nursing home. Very understandable. But, when they are therefore going to be demanding and requiring too much more help from others, it's really not their choice anymore. I made my mom go to rehab after operations, one in actual rehab, one in a local nursing home. It was VERY helpful for ME. She didn't love it but it really was necessary. The stress of bringing her back home when she couldn't do simple things for herself was just not an option for me.

The person that couldn't understand tylenol vs narcotics - are they living alone? Sound like a convo I've had with my mom but she lives with me and I can monitor it enough to keep a good handle on it. But if this person is alone and in charge of their meds, that sounds a bit scary. Obviously they don't really seem to have the capacity to figure these things out for themself and could be making many errors. Sometimes outside help is needed.

Good luck.

"I guess I should break the remaining 3 in half when I'm there tomorrow, but seriously? But she cannot determine what +4 hours is, and she can't determine her own level of pain?"

It might be best to get a timed/locked dispenser, at least for the narcotic. She may not need pain meds every 4 hours, but you could set it for that anyway. Better that she get them this way than taking a whole pill who knows how often.

It's hard to know when to set it for the Tylenol. Maybe stagger them and see how it goes? For instance make both every 8 hours, but set up so she gets one at 4 hours and the other 4 hours later?

8am Narcotic
12 noon Tylenol
4pm Narcotic
8pm Tylenol
etc.

Adjust as needed.

They have audible and visual alarms. Since she's not the one with the hearing issues, that could work. Then you can have better control over her taking the medication.

"She's the mentally sound one, or so I thought. Now I'm confused!"

If she had surgery/anesthesia, there could be residual dementia-like issues. Check for UTI? Monitor the issues. If it gets worse, get her evaluated for dementia.

For the brace, can dad just put it on for her, rather than just trying to show her or explain?

My husband's hearing is practically non existent. Too many years of target shooting and using power tools, plus 14 days of IV gentamycin effectively wiped it out. That plus dementia makes conversation hard.. He can not hear the higher ranges so when I talk to him. I have to stand close to him, tap his arm and have him look at me then tell him slowly. One concept at a time. I can't say get your shoes and jacket on because we are going to the store. I have to say,put your shoes on. Get your jacket. Let's go to the store.
I can empathize with your frustration. I can barely cope with one person, and bless you, you are doing 4 times the work. Big hugs to you.

"I have one relative who is hard of hearing and may or may not choose to wear his hearing aids, so I shout."

My mother wore one hearing aid. As her dementia progressed, she'd misplace it, forget it, not change the battery, say she didn't wear one (funny, when I found it and brought it to her after that last statement, she asked where I found it, forgetting she said she doesn't wear one!)

What I did was get a Boogie Board LCD "tablet." You can write on it and erase it. If it wasn't something simple that I could pantomime, like a drink or something to eat, I'd write it on the screen and she could then read it. It worked well, the staff loved it AND the dental hygienist bought some for the office!

It was easier than trying to find paper to write on and less wasteful.

"I have one who has increasing dementia and who forgets or mangles 50% of what we say to her, so we speak slowly and repeat ourselves."

Slow, keep it simple and repeat when necessary. If it isn't something important, don't bother repeating. You can often feel like you're talking to yourself, and for the most part you are! YB always went on and on with mom. After the first few words, between hearing loss and dementia he might as well be talking into the void!

If you feel the need to say unimportant things while there, just to break the silence, keep it to simple words and simple concepts, like Nice day today! Are you hungry (thirsty)? Coffee or Tea? Water or juice? The Boogie Board I suggested for the relative with the hearing issue might be helpful for her as well. You could write down simple (as few words as possible) instructions, questions or statements. A small white board could be used as well - with the distancing we had to keep at MC, the LCD wouldn't help, so I picked up one that was small enough to handle but big enough to see at 6'.

I know mom used to hang onto notes the staff gave her and would cycle through them, even though they were old. Maybe a small notebook, or something to keep notes in that she can look at?

"The 4th one can hear just fine, but filters everything through his extreme religious/political filters so he garbles even the most secular messages and somehow manages to insert his faith into them. It's really hard to follow when it's about things like the dinner he may have just eaten, his pain levels, or his most recent lab test."

Do you really need to follow anything he is saying? Does it require input from you? If no to both, then just let him ramble on. Perhaps have some ear plugs for yourself, to help tune it out. A few well times Um-hmmms might give him the idea you are listening, even though you aren't. It doesn't sound like any of his ramblings are all that important.

If he has chronic pain, then a dispenser like described for the other might help. If someone isn't consistent about taking pain meds, pain levels can creep up when a dose is late. By getting it on regular intervals, it would help keep it under control better.

I think you have the patience of a collection of Saints! (What would that be called.. 🤔 a communion of saints?)

What about postcards? Sent from whatever beach/mountain/lake shack you just ran away to? Or just talk to the wall instead, like Shirley Valentine did in the film.

Seriously, you are doing an amazing job.