Where Mom Lives – How Can I Make Her?

Recently, I was in my car listening to a local radio call-in show with an attorney as the guest expert.  He is a general practice attorney – meaning he has no specific specialty and most certainly, he was not one who specializes in elder issues.

The caller’s question was as follows:  “My mother is 86 and can no longer take care of herself.  She has been living with me, but that is becoming hard for me. My sister and I would like to have her move in to an assisted living but Mother says she won’t go.  How can we make her?”

The attorney immediately began to explain the complicated process of seeking guardianship for her mother. Rightfully, he explained how time consuming this could be, that she and her sister would need an attorney and that the court will appoint an attorney for her mother as well.   Of course, he suggested the woman call his office later that day.

I found myself shrieking at the radio!  There are so many other options before suggesting this route – which is the most complicated and often emotionally painful.   I knew it would not do any good to call in myself, I am certain the attorney pays a fee to have that half hour all to himself.  I doubted they would allow me to add to his answer. I also didn’t have time to pull over, to make the call safely.   Therefore, I decided to write this post!  The caller may never see it but some of you may find it helpful and share with others.

While the attorney is correct that seeking guardianship could be a way to take control of her mother’s living situation, this should be the very last resort as it can be expensive and unpleasant.  Let’s take a look at this scenario and talk about all the options and strategies.

First, the attorney should have asked several questions before he moved directly to the guardianship plan.  The caller did not explain what she meant by saying that her mother could no longer care for herself.  What kind of care needs does she have? Does the mother need assistance dressing herself, toileting, assistance getting in to and out of the bathtub?  Is there a walk in shower in the daughter’s home?  Are there grab bars?  What kinds of medications does her mother need?  Does she has memory loss and if so, how extensive?  Does she forget details of conversations or names or does she forget where the bathroom is located and who her daughter is?   Does she use a walker or wheelchair?  Does she use any portable medical equipment such as oxygen?

The next question I would ask would be about the daughter’s statement that caring for her mother is becoming hard for her.  Why is it becoming a problem? What does this mean?  Is her mother too heavy for her to lift in to the bath and back out?  Does the home have too many stairs? Or is the daughter simply missing her independence and flexibility having to stay at home with her mother?

These are all pertinent questions. If the problem is the lifting or the lack of flexibility has the daughter considered hiring an in home care worker.   If the family can afford the cost of assisted living, they should also be able to hire an in-home worker to help with the bathing tasks or staying with the mother while the daughter goes out.  When families complain that their loved one doesn’t sleep at night and keeps them from sleeping as well, they often seem surprised when I suggest hiring an in home caregiver to be up and awake with their loved on at night. This way the family caregiver can get a good night’s sleep. Yes, it means you will have someone else coming in to your household, but it can also make the family caregiving burden a bit lighter.

Is the situation more complicated?  We don’t know if the daughter is married. Perhaps her husband is no longer accepting of having the mother stay with them.  Of course, if part of the problem is the actual design of the home itself – too many stairs, no walk in shower, certainly the solution won’t be a quick fix.

A very important question concerns powers of attorney.  Has the mother designated a power of attorney?  Is someone both the power of attorney for healthcare as well as financial decisions?  I recommend everyone have a designated power of attorney, as well as a living will in the event you should become incapacitated and cannot make your own decisions.  Remember, powers of attorney do not go in to affect until you are deemed incapacitated by a medical professional.  Thus, in this particular case, if a physician deems that the mother is not capable of making responsible decisions, the physician would then sign a capacity statement that states such. Only then would the power of attorney be activated.  Most physicians take this very seriously and give such a decision great consideration.  With my own mother, her physician met with her several times and spent quite a bit of time talking with her and questioning her before he decided that she truly did not have the capacity to understand and make important decisions.

Now let’s call out the elephant in the room. Please bear with me as me as we talk this through.  The caller said the mother is 86 and can no longer care for herself.  Yet the mother “won’t go” to the assisted living.  I don’t like the daughter’s phrase “How can I make her?”  Few of us like to force or be forced.   However, let’s give the daughter the benefit of the doubt for a moment.  If the mother cannot care for herself and there are legitimate reasons why the daughters cannot care for her in their homes, what is her choice?   Caregiving takes a toll.  Not only is it physically exhausting, it can be emotionally exhausting as well.  Numerous studies show statistics that indicate as much.  In a study done in partnership with AARP and the National Alliance for Caregiving, 11% of family caregivers indicate caregiving has caused their own health to deteriorate.  A National Family Caregiving Alliance report published in 2012 states that anywhere from 40 to 70% of family caregivers are clinically depressed.  I can go and on.  My point here is we tend to focus on the person needing care rather than on the caregiver.  The health and well-being of the caregiver is often overlooked.    As with any relationship, and in any disagreement, both parties should be considered.

I do not mean to sound cruel, but sometimes there are no perfect answers.  If the daughter can no longer keep mother in her home, this may be the next best choice.  No, Mother may not want to go.  Often families simply stop here.  Maybe a more forceful conversation or action should occur.  Many older adults become very resistant to change.  The thoughts of any kind of change in routine or living arrangements can be difficult for them to accept.  This is particularly challenging if the person has a dementia.  However, sometimes it is simply unavoidable.    What if the daughters had a very frank discussion with their mother, and urged her to simply visit or do a short-term stay at an assisted living?   Maybe Mom is not aware of the toll her care is taking on her daughter.

 

Understand that I am not comparing an 86 year old to a toddler, (Although frankly, sometimes the behavior is similar!), but often children do not want to go to school or to the church nursery in the beginning. They may cry and put up a fuss the first few times.  My own three-year-old granddaughter says she loves preschool.   Upon pick up she always says that she enjoyed it. Yet, she was crying almost every time her mother dropped her off.  Not only did the teachers assure my daughter that the child stopped  crying shortly after arriving, but she goes on to have a good experience. In addition, my daughter watches through a one-way window to the classroom and can see that she does stop crying quickly and joins the children in activities.  Lately she is crying less and less often.  It is a great relief to all of us.  Often, in the beginning the older adult complains and is unhappy in a new living situation. But after a time, the person becomes more settled.

This is another area where the physician may be helpful.  My mother’s doctor stated it quite clearly after her second broken hip.   “Ruth, you cannot go back home to live. Your condition will not allow it. You can no longer do stairs so I don’t think you can go to your daughter’s either. I suggest you try assisted living. “

There are some caveats to the short-term stay, but often, if the stay is strategically planned, the individual adapts. Many of today’s assisted living communities are quite lovely and offer wonderful amenities. Many allow pets.  Mother may have a preconceived notion of what an assisted living may be like and this could change upon visiting.  Many of them also provide the opportunity for a short-term stay, often called a “respite stay”.  This refers to allowing the caregiver to have a time of respite from caregiving duties.    This may even be a potential solution for this daughter.  Maybe she really just needs a break.

If a short term stay to determine if your loved one can adapt is used, careful planning is necessary.  I have seen families plop Mom or Dad down for a short-term stay at an assisted living “just to see if it works” without taking any of the individual’s personal effects. The thinking is “why bother if it doesn’t work out?” Well, you should “bother” to help ensure it does work out!  I am not suggesting you initially bring all of the person’s possessions but some familiar items are crucial to a successful stay. If possible, choose a time when some particular activity will occur that your loved one may enjoy such as a concert or outing.

One situation of which I was aware involved the son taking his mom to a local assisted living for a short stay just to see if it might work.  Her room was basic, with no artwork on the walls, unfamiliar furniture and bedding.  The son brought only some clothing. There was no familiar blanket or bedspread, nor any familiar family photos.   While this woman was used to calling her friends and children daily, there was no phone in her room.  The family felt it was not worth the trouble in case it didn’t work out.   She had a cat at home that she dearly loved. Of course, the cat (assisted living rules would have allowed her to bring her cat) did not come with her.   I was not surprised that after one week, the poor woman was miserable, uncooperative and the son said, “This just isn’t going to work”.

The challenges of caring for aging loved ones are many.  There are situations where seeking legal guardianship is necessary, but even legal experts say it can be time consuming and costly. It can be humiliating for the older adult who may be somewhat capable. In addition, it can cause irreparable emotional damage to a family.  I believe all other avenues should be pursued first.

Do You Hear What I Hear?

I am having a lovely holiday season thus far.  The first one that I am truly savoring in a long time.  But I am writing today about some  who are not singing such a happy tune.

At this time of year, it seems the whole world is merry and bright.  Or at least that is what we often assume.  One particular television channel has continuous holiday programming this time of year.  We can count on the fact  that while there may be some sadness or tears within the movie, the ending is always  a happy one.  The themes revolve around finding the Christmas joy, gathering with family, and celebrating the season.  And did you notice there is nearly always continuous snow, but everyone still gets out and about?  They seem to have blue skies and sunshine along with all the snow. Few become snowed in and the power rarely goes out. And if it does, there are always plenty of candles and blankets at hand.  If someone gets stranded, it’s in a lovely small town, with a beautiful inn that just happens to have  vacancies with a warm and loving innkeeper that makes them feel right at home!

However, I recall those not too distant years when I was not really feeling the holiday spirit.   Many caregivers simply view this time as one full of more “shoulds” to add to their already heavy list of tasks.  With their overloaded schedule, added expectations of decorating, gift buying, baking and finding joy are almost too much to bear.   The  holiday chaos  that energizes some, comes close to pushing others over the edge.  In addition, some caregivers have  recently lost their loved ones, and this time of year is a reminder of that empty chair, the lost voice, the warm hugs that are no longer there.

Caregivers, I understand.  You are not alone.  There are thousands out there who feel just as lost and tired as you.  I have been there.  I experienced  many  holidays feeling overwhelmed  with all the usual holiday tasks, plus  trying to do my best at the office, be a good wife and mom, as well as working hard to create some holiday spirit and joy for my mother for  whom I cared.  As I look back, those holidays are a bit of a blur.  So,   I give you permission to skip the decorations, forget the tree, and heck, it’s OK with me if you need to say “Bah Humbug” this year. Don’t go shopping, or bake cookies, just try to find time for a nap.

Last year, I spent the holidays struggling to find my way in the new world of NOT being an active caregiver, while grieving the recent loss of my mother.  I felt a sense of relief that my burden was lessened and I had more time to carry out my holiday tasks, but I also felt guilty about that.    In some ways, I was relieved.  I was relieved that her suffering was over. I was relieved to no longer watch her slow decline and her frustration with such.  I was relieved to be able to travel to be with my grandchildren without worrying about her care – who was with her? Were they following my instructions?  Would she fall while I was away?  My worrying had been on overload for many years and it was quite strange to experience this new normal.  But I also missed her as we carried out family holiday traditions of which she had been such an integral part.   Not only did I still feel the numbness that comes after losing a loved one, my heart was very sad that she was not with us.  It has taken a while for me to clear my head.  It has been nearly a year since I last wrote a blog post. I just couldn’t do it.   I needed time to heal and to find my bearings.

This year, while I miss her, I find that I am savoring the holiday tasks.  For the first time since I left my job in order to devote more time to caregiving, I have the time to simply savor the season.   I’m not as rushed, nor as weary.    But I am still sensitive to the  challenges caregivers face.  As I listened to the sermon in church on Sunday, I immediately related the topic to caregiving.  While I would hope that everyone can experience  a joy this time of year, that is deeper and more meaningful than a brightly decorated tree or   stockings hung on a mantle, for some that deep, sacred joy may be overshadowed by tasks and exhaustion.   (Yes, I believe in that church stuff.  If you don’t, stick with me anyway,  as there is still a valid point to be made.)

The sermon was about Mary.  Mary was going through a challenging time. She had been broad sided with some shocking news that would change her life in unfathomable ways.  And let’s remember she was just a young girl.  Not only did she have to process this new situation, she was going to have to explain it to her parents and to her fiance.  Would they believe her?  Would her fiance, Joseph, leave her?  What about the community – would she be shunned, ostracized, or worse? Imagine the gossip!  But apparently her family listened to her,  Joseph listened to her, ( yes, with a little insight from an Angel) and so did her cousin Elizabeth. They listened to her story, they accepted what she had to tell them and they didn’t simply assume she had done something wrong.  Well, maybe they did for a minute… but after listening, they began to understand.

This is a gift  we could offer an exhausted, joyless caregiver – the gift of listening, and not assuming.   In many years of working with caregivers one of the things I learned is that sometimes all a caregiver really needs is to be able to talk about the situation. Caregivers spend a lot of time worrying about the emotions of the person for whom they are caring but  often keep their own emotions locked inside.   They are dealing with an exhausting task and we know that sometimes even those we love immensely can get on our very last nerve!   Offer a caregiver the gift of allowing them to vent!

I urge you to do what is called ” active listening”.  This means you not only hear the words they say, but you seek to understand the meaning behind the words. And you make sure you understand before you offer advice.  Maybe you do have some helpful advice to give, but first allow the person time to express their feelings, worries  and their frustrations.   Take time to try to understand their perspective and give them the gift of a time of “release” of  those emotions and frustrations.

For those who are grieving or who have recently transitioned to no longer being a caregiver, some will take longer than others to transition from being an on duty, always-on-high-alert caregiver, to their new normal.  We should not assume they are over it and ready to enjoy their new-found freedom.  For a while, it may be challenging  to find a new purpose.   Some may be struggling with guilt for feeling relieved, as I did, or feeling  they did not do enough, or that they should have done something differently.

I recently had a new thought on guilt.  I think that in some ways guilt is an “active” emotion.  We can actively explore what we might have done wrong, what we could have or should have done differently.  It gives us something to “do” with our minds.  When the reality may be that we simply did our best and now all we have is sadness.  Many of us don’t like to feel or sit with “sad” so guilt moves in to fill the void.  Maybe we can hear beneath those feelings of guilt, recognize their sadness and let them know that sad is ok.  By feeling  or acknoledging their sad,  they can more readily move on from that sadness.  I like to say you need to sit with it for a while.  Running from it, trying to mask it, may delay the healing process. But as you listen, refrain from offering advice immediately.  Let them take the lead in asking for advice. As they feel heard and understood and become comfortable with feeling the sadness, they may take the initiative to then ask you for advice.

For some, revisiting memories or thinking of that missing person during holiday festivities is too much to bear.  I know of someone who is experiencing that this holiday season.  It is hard for me to understand because I personally love revisiting memories, it is comforting for me.  But for him, this first holiday season after his loss, it is too soon and too painful.  But I can  listen to his silence and be with him in that silence – letting him know that I hear him and he is not alone.

There are other gifts we can give.  Make a meal and drop it by.  You might offer to run an errand or to stay with the person for whom they are caring for a bit so they can run errands.  But a listening ear is unique and much-needed.  I believe this gift will be welcomed with a grateful heart.

It would be my personal hope that all frazzled caregivers would experience the deep joy this season represents – the joy of unsurpassed love, forgiveness and promise from our Father in Heaven.  Some may have known that joy, but it is buried beneath their current sorrow.  Some may choose to never pursue that source of joy.  But whether or not that is the case, this holiday season, I just want you to know, I hear you.

 

 

 

 

Memories…and Grief

In her book Blue Nights, author Joan Didion says that memories are not comforting. She expresses her resentment concerning comments from well-meaning friends who say they hope her memories bring her comfort.  She says no – they do not. They simply remind her of what she no longer has.    Of course, she is writing this as she grieves her daughter’s death.  And in that context, she is correct.,

I, too, am grieving. So, I recently read Didion’s book The Year of Magical Thinking, written about the year after her husband’s sudden death. Then I dove in to Blue Nights.  Next, I will most likely revisit C. S. Lewis’s, A Grief Observed. That’s one of the things one does when grieving – you read about grieving. And those things written about grieving are often written by those who are grieving.

Back to the subject of memories.  Memories are important to me.  I was the recipient of many family heirlooms over the years which hold special memories for me.  I feel blessed to have had a large family including wonderful grandparents and many aunts and uncles with whom I was close.   My special possessions include:  Aunt Maxine’s uncomfortable arm chair; Granny Thomas’s sofa which I have had recovered three times (and the last time it had to practically be rebuilt – but I spent the money to rebuild it because it was so sentimental to me); Uncle Carl and Aunt Dorothy’s photo albums and WWII memorabilia (they had no children.);a quilt from my Aunt Bea; the dresser that was my father’s when he was young man; and my sweatshirt  and hat from Girl’s State my junior year in high school.   And, of course, I have boxes of my children’s photos under the guest room bed; their preschool drawings carefully folded in a large manila envelope; baby clothes wrapped in tissue paper and stored in a trunk – you get my point.  In addition, for more than a decade, I worked for the Alzheimer’s Association and my work revolved around the premise that memories are precious and the loss of memories a tragedy.

Nevertheless, I understand Joan’s point. You see in these weeks after my mother’s death I find myself waking at 3:00 a.m. thinking of that last week of her life. I go over every detail of the week and the days just after.  I recall the phone call informing me of the incident that began the final trajectory of her life.  I remember the recognition in her eyes when I told her she was very ill and we were not going to be able to make her better.  I go over the last few days when she did not awaken and we sat by her side listening to her breathing and wondering when she would breathe her last. And I recall the service: who attended; who did not; the flowers; leaving her for the last time.  And part of me wants to NOT recall those details – at least not every single morning at 3:00 a.m.

I find myself recalling a particular Christmas sometime in the late 80’s and a quick conversation with my mother.  I remember it was just past noon and I was playing with our recent purchase, a video camera.  I was filming the beautifully set holiday dining table and the kids playing with their new toys. My mother was in my kitchen assisting with preparations for Christmas dinner. She reminded me it was about time to mash the potatoes and I tersely commented that the potatoes could wait!  And I feel sad and ashamed that I answered my mother in such a hateful manner.  I haven’t reviewed the video- I didn’t dig it out of the box it is stored in and play it again.  The memory simply popped in to my head the other day  – a video in my mind – along with my profound regret at having spoken to her in such a way, over a simple comment about mashing potatoes.

After I go over the last days of her life at 3:00 a.m., I move on to the last few years.  I recall moving Mother from her home to assisted living.  I recall my agony even though my siblings and I discussed the options at great length and realized it was the correct decision. I also recall how much my mother missed that home and her church and her neighbors.  I recall every illness, every fall, each trip to the E.R., and every hospital stay.  I recall every milestone that marked her increasing frailty.

I have to dig deep and really force myself to recall the good times. Memories like Mother’s first trip to New York City with my sister and me.  I recall her delight in buying a hot dog on the street, her excitement when she purchased a Christmas sweater at Saks Fifth Avenue, the expression on her face as she watched a Broadway musical.   I remember her joy at having special alone time with her grandchildren when she kept them while we were out of town. She loved telling of their exploits while Grandma was in charge.

The mind is a strange and wondrous thing – but it is a muddled mess when one is grieving.  Didion says when a parent dies something deep inside us is dislodged. She also says it is normal to feel raw, fragile and unstable.

In these weeks since my mother’s death, so many things are difficult. I have a hard time in social situations – I have to force cheerfulness and conversation.   Sleep is difficult – I wake frequently and have strange dreams.   Chores are looming and I can’t seem to summon the energy to get them done.  Thus, it seems logical that it would also be difficult to recall the good times, and to focus on the happy memories, during this raw, fragile and slightly unstable time.  I so hope Joan found comfort in her memories as time passed.  I, for one, am glad I have them, like a gift, waiting to open them when the time is right, when my emotions are not so tender, when my heart is not so sore.

 

I Wondered

I wondered what it would be like.  Would I be enormously relieved?  Would I be sad? Would I cry? Would I feel guilty, worry that I hadn’t done enough or could have done better?  Would I wonder what I was supposed to do next after so many years of focusing on her well-being? Would I continue to automatically turn my car toward her nursing home?  Would I, without thinking, look for her favorite but hard to find cookies in the grocery aisle? Would I still wake up at 3:00 a.m. to worry about her or her latest illness, or challenge? Would I feel grief?

The answer is yes – to all the above.

I have written about grief before.  My brother passed away suddenly and way too soon.  Grief can hit you like a hurricane.  Or it may grab you by the ankles at unexpected times and in subtle ways.  My brother’s death set me reeling and I am still not quite on steady ground with his leaving.  But many times as I watched my mother endure her slow decline, I wondered if it was time.  I wondered how much longer I would have to watch, to worry, to be so incredibly tired.   I was on an emotional see-saw wanting her suffering to be over while wanting to help her still find joy and experience some sense of purpose.  I felt tremendous guilt at having some of those thoughts and feelings.

Those of us who are caregivers have been grieving for a long while.  We have been grieving all along the journey. And we worry – that we are not doing enough or doing it good enough. Sometimes we are sick and tired of caregiving.  So, I suppose it is normal to wonder if we will also grieve when that journey is over.

I felt grief when I had to take over her checkbook.  The woman who had been a whiz at bookkeeping, balanced her checkbook to the last penny, and shamed me for not doing so, now put the stamps on after I wrote the checks for her bills.

I felt grief when the woman who was known for her fashion sense put on earrings that didn’t match her outfit.

I felt grief when she longed for her house and asked me to take her back there.

I felt grief when the tall woman with the rim rod straight posture became stooped and twisted.

I felt grief that last Sunday when I looked in to her clear blue eyes and said, “Mama, you are pretty sick and we are not going to be able to make you better.”

Sometimes we were Frick and Frack, sometimes yin and yang, Lucy and Ethel, and sometimes we were oil and water.  She could drive me up the wall.  I often did not meet her expectations.  Sometimes she was my pal.  Sometimes she was my sounding board, my benefactor, my counselor and advisor, my shopping companion and recipe sharer.  Sometimes she took care of me.

The world wants me back. Meetings occur, events happen. I see folks out and about who say, “Hey, how are you?” and they expect the standard “I’m fine.” answer. I am not accusing or blaming – it’s just the way it is.  It’s been a month.  The night after my mother died there was a lovely harvest moon. As my sister and I gazed up at it that night, I commented that Mom was in Heaven, shining down on us.  This weekend was the next full moon.  As I gazed at it alone, I sent her a little wave and a wink.

I miss my mother.

This day

My heart is heavy.  I am unspeakably sad.

There has been no “event” that touched me directly.  There have been storms and rain, and floods.  Some have lost so much, but I have not.  Yet, I am sad – for them.

The world is a place of hate and turmoil now. Senseless killings, by evil people – some not so evil but simply ignorant – but killings, nonetheless. And I am sad.

There is little decorum now.  Mores, rules, traditions seem to be lost.  Casual and careless, are the norm.  Children are disrespectful, demanding, preoccupied with devices, not busy with imagination.  Innocence and purity are rare. We know too much, yet we know so little.  Private matters are not private.  It makes me sad.

Leaders do not lead.  So many do not stand for what is noble or  honorable – so many are crude, blustering, bullying, dishonest, and hateful- equally on one side or the other.  It makes me sad.

I watch as women I love slowly, slowly fade. I see friendships separated by miles and infirmity.  So many are ravaged by age and a disease that robs them of memories – of themselves.   I watch as millions of dollars are flashed at one who can throw a ball.  Yet this disease could be cured wtih more funding.  I watch as someone who was once strong and alive, struggles to be herself, but the body and mind become stiff and twisted and blurry – so that who she really is, or was, seems so often to be out of reach.   It makes me sad.

I struggle with the loss of strong, loving, people who gave my life color and history and a sense of being part of something solid and good.  I struggle with missing someone who left me quickly.  I wrestle with guilt at thinking there would be more time so I lost precious time and sharing.   I fight the guilt that I should reach out to others who loved him but I lose that fight. I cannot face them yet. I have no comfort to give them right now.   It makes me sad.

I am blessed.  I still have others to love and who love me.  I have young lives and warm wiggly bodies to hug, to watch in their childish glees as they experience the joy of ponies and dump trucks and ice cream.  I should look forward with light, not wallow in dark.

And I will try.  I will pray.  I will push on.  But, this day, I am unspeakably sad.

Compassion, Control, Autonomy, Respect

The question before us was “Are we caring with compassion or control?”   I was sitting in a session at a recent geriatric conference in the north east.  The speaker threw out this question…and I must admit, in all my years of being involved with, concerned about and responsible for providing care to someone “chronologically superior” (Yep, another new term since “old, aging, senior, and elderly” are the latest terms to become politically incorrect.)  I had never thought of it in quite that way.

At times, I have been involved in the process of establishing or changing state regulations concerning long term care, particularly those with a dementia.  I have participated in, created, and presented training for both family caregivers and those who work in long term care. Always, I have espoused the “person centered philosophy”.  I have advocated for seeing beyond the disease or the infirmity to see the true person before us, needing our care.  But this is a new wrinkle – a slightly nuanced way of looking at how we provide care.

Imagine the gentleman who has eaten a “sunny side up” egg each morning of his 82 years. He now finds himself residing in a long term care facility.  And suddenly he can no longer have his eggs prepared as he prefers.  It has something to do with health regulations about contracting food borne illness, and I get that – but still – imagine his chagrin that first morning in his new “home”.  Or the lady who has had a “toddy” each evening before dinner since she was old enough to imbibe.  But in her new home, that is not allowed.   She can have iced tea, coffee, fruit juice, but no “toddy”.

The speaker pointed out we usually lead with safety. But must we?  Or more importantly, should we? And then what about autonomy?  Can we have both?  Now most seniors (forgive me, but it’s shorter than the phrase “chronologically superior” and I am a lazy writer so I will use “senior”  from here on out, but with the utmost respect.) will tell you adamantly, they do NOT want to give up their independence.  But is that really what they mean?  You see none of us are truly independent. We don’t cut our own lumber and then nail our house together. We don’t build our own car, nor drill for the oil we have someone else put in it for us. We don’t grow all our own food, we don’t weave the cloth and make our own clothes.  What we have and what seniors want is really autonomy.

Autonomy is defined as the quality of being self -governing or self-directing.  And that inherently means we have the right to make some bad decisions – stupid decisions- decisions that result is some sort of harm to ourselves.  If we decide to eat nothing but donuts and cookies, we will end up with some results that may not be “good” for us.  When my college-aged daughter chose NOT to put oil in her car, she soon experienced the ramifications of that choice – a dead car!  But most of the time, we do make fairly considered decisions as we “self-direct”.  They have ramifications but not so serious or final.  I prefer bright colors, not beige and earth tones. I love my bright wall paper and colorful décor.  I did my research and chose my quartz kitchen counter tops, over the ever popular granite.  But when I put my house up for sale, this could impact how soon it will sell or regrettably, the price I receive.  But right now it makes me happy!

As we age, unfortunately, there are some things that may impact or threaten our autonomy.  It takes us longer to recover from illness or injury.  We may experience some slowing down of our physical abilities – we may lose a bit of balance, or our joints creak and take longer to loosen up in the morning. And yes, sometimes it takes our brain – our internal computer- longer to boot up!  And depending on our general health and our genetics, some of us may experience more illness or physical challenges than others.  Some find themselves facing serious acute or chronic illness or conditions – such as arthritis,  Parkinson’s disease, cancer or Alzheimer’s or a related dementia.

So how do we find the balance as we provide care for those who are experiencing challenges that impact where and how they continue to live?   And if we must err on the side of safety,  shouldn’t it be equally important  to show them respect and maintain their dignity?

One of the things I have observed over the years is that those aging individuals -no matter their physical or even cognitive challenges -who have a reason to be , who continue to have a purpose, seem to do better, live longer, manage the challenges facing them a bit better.   Researchers in happiness have discovered this as well. In the book, “100 Secrets to Happy Life” by author David Niven, he states that numerous scientific surveys indicated the number one factor in determining happiness was that a person’s life had purpose and meaning.

Yet, what meaning can we help our “seniors” find – particularly those who reside in long term care, when they are often relegated to simply sitting in a wheelchair being treated like children? How do we provide autonomy, purpose, meaning and dignity to those who are losing ability?

I have announced to my children that when I can no longer “wipe myself” when I go to the bathroom, that is when I want to be “taken out.”  I say it with a wry sense of humor – but frankly, I mean it.   I have watched my mother endure strangers doing such intimate care for her, and I have had to become used to doing such care for her over the past few years.  In the beginning, it was embarrassing for both of us.  Once, I even had to give her an enema, as the assisted living staff “didn’t do that”. But her doctor said she needed it, (Just so you know, they don’t do that in the ER either. We went there when my mother complained of severe abdominal pain. The ER physician literally said “She’s full of poop and needs an enema.  But we don’t do that in the ER.”)  So, what choice did I have? So, I did it. I gagged, but I did it. And now, stuff like that is no big deal.  But occasionally when I am providing intimate “bathroom care” for my mother, she will say with exasperation “For heaven’s sake, I can’t believe this.” And I know she is disturbed that it has come to this.  So, I always tell her I am sorry if this care is embarrassing for her. But that it’s ok. I love her and she needs my help so not to worry.  I figure, if nothing else, an apology might make her feel better.

A few weeks ago, there was a disagreement with one of the nurses at the nursing home where my mother resides and one of the Certified Nursing Assistants.  The C.N.A. had actually read the note I had placed on my mother’s wall. My mom isn’t at her best early in the morning.  Her meds usually don’t kick in for a couple of hours after that 6:30 a.m. dose.  She is often stiff, confused and obstinate at that time.  It seems that most often, she does much better at 8:30 when her meds have taken effect and her private caregivers, who she knows and trusts, come  to get her day started. This is written on a note on her wall. I have several notes on her wall. I learned early on that no one reads “the chart” carefully and with many staff changes, this was a way to relay information about my mother’s care and preferences.   This particular nurse,  who clearly had not read the note on the wall, was upset that the C.N.A, based on Mother’s reaction and resistance that morning, decided  to let her sleep a bit longer.  When I arrived later in the morning the nurse told me of the incident and said “I told him that she has Altheimer’s and she can’t decide when she gets up”.

I was able, with great restraint to keep from saying all that I really wanted to say. But my blood pressure surely was off the charts after hearing that stupid statement. Yes, I said stupid.  Because it was stupid, and disrespectful and not at ALL part of the person centered care philosophy that has been allegedly taught to long term care staff for years.  I wanted to say, “First of all, you are a medical professional. You have presumably had considerable education and training, thus you should KNOW HOW TO PRONOUNCE THE WORD!  THERE IS NO “T” in Alzheimer’s.”   But no, I didn’t say that.  I also did NOT point out that even a person with Alzheimer’s can and should be allowed to make some decisions about their life and care!  But I did point out the note on the wall (that had been there a good six months. Obviously,  she pays attention to detail) and I did  explain that my mother’s cognitive condition was still fairly good, even with her diagnosis and that yes, she most certainly could wait until her private caregivers arrive to get up and dressed.   But once again, that issue of autonomy, dignity and choice was before me.

I certainly don’t have all the answers.  It is not a simple issue.  How far do we take this? Do we allow the individual who falls frequently, to simply get up at will and risk the consequences of bumps, bruises and broken bones?  Our family has struggled with this as Mother has terrible balance caused by her Parkinson’s and has had several falls and broken bones.   I was chastised by someone who works in food service about the “sunny side up” egg controversy.  She assured me I would NOT want food borne illness to run rampant through the long term care facility.  I know a nursing home administrator who has arranged a “physician’s order” for a cocktail for some of his residents.    Not all, but for those for whom it would do no harm.  And, of course,  we can’t let the individual who can no longer safely drive, continue to get behind the wheel.   I have seen families wait way too long to deal with this challenge – sometimes with tragic consequences.  But is there a way we can have the conversation sooner rather than later and offer some alternatives that still allow some autonomy?

It’s certainly a vast and complicated question. I do not claim to have all the answers. It does pose a dilemma.  If nothing else, I suppose. just bringing it up, may stir some conversation that could make a difference.  I realize that some decisions about care, safety and control are easier than others.  One expert I listened to recently, suggested that we ALL make a “when I can no longer drive” plan, just like we make any other retirement plans.  That way, we have a say in the matter. And it helps our children or loved ones with viable options when that time may come.  I also know that dementia, the losing of cognitive ability, complicates the issue greatly.  But does common sense have something to offer? Can we, if nothing else, NOT paint everyone and every situation with a wide swath of “disability and indignity”?

Yesterday, someone from the activities department at the nursing home brought my mother a baby doll.  She had heard Mother had Alzheimer’s and that Mother loved looking at the numerous photos placed around her room of her every young great-grandchildren.  I know there are many women with Alzheimer’s who are comforted by having a baby doll.  They have moved back in time, in their minds, to when they had been mothers (Ah, there is that purpose and meaning thing again), so they do find comfort in holding or tending to a baby doll. I have seen it be quite effective.   But shouldn’t one do a bit of research? Maybe have a conversation with the person or observe her behavior before making such a gesture? Common sense tells me yes. That would be the respectful thing to do.

Apparently even my mother thinks so. She loves seeing those photos of her babies. And she loves holding them and interacting with them when they visit her.  When presented with the baby doll yesterday. however, she articulately said “Get that thing out of here.” So there.

 

Sacrifice

This week I read an article a friend of mine shared on Facebook.  It had to do with families who have special needs children.  I agreed with most of the premise in the article. However, the author stated that nursing homes would be empty if only family members were willing to sacrifice.  That – I certainly don’t agree with.

No, I don’t have a special needs child.  I do have a cousin with two special needs children, and my husband had a sister who was developmentally challenged.   I have watched both families struggle to make sure all were well cared for.    For 15 years I have worked with families facing tough situations and challenges as they struggled to provide care for a loved one with Alzheimer’s.  And I have a mother who is in failing health with two progressive, degenerative diseases.

I actually did the brave but probably stupid move of commenting on the article.  My comment was simply that “families struggle mightily with tough decisions and sometimes there are extenuating circumstances and situations where the right decision just might be a nursing facility.  I don’t think we should ever “judge” what we view as someone else’s sacrifice”.  And lo and behold the author of the article responded very angrily.  She informed me that it was “trendy” to tell others not to judge and that there was absolutely no reason why someone, no matter the condition/illness/etc. couldn’t be cared for at home.

Clearly, for both that author and me, if we put it out there, we must expect that someone might just disagree with us. That is a risk I take every time I post a blog – or post anything on social media.  So, first, she needs to toughen up!

But secondly, seriously, now dare we, any of us, sit back and judge or even challenge, from afar what constitutes “sacrifice” for someone else?

I learned from years of facilitating support groups, that one person cannot and should not judge another person’s pain.   Sure, you have the fakers out there, who try to exaggerate their hurt or pain for whatever warped psychological reason.   But in general, your pain is your pain.  We should never try to gauge if your pain hurts more than my pain.  There is no way to measure or prove whose pain is more intense or “worse” so don’t even try.   The same goes for sacrifice.

Each family situation is different when it comes to caring for a loved one with a serious health or developmental challenge.  And each family may come up with a different solution.  I caution families to “never say never” – never make specific promises or rash declarations about what you will or will not do, because you simply don’t know what the future may hold and what sounded like a great solution now, may not work a year down the road.  Finances, other family issues and challenges, what other resources and assistance are available, your own health challenges, might all be a factor in decisions about care.

I do know one thing for sure. (to  paraphrase Oprah) Actually I know several things for sure about caregiving and one of them is, it will be harder than you think.  No matter how determined you are, or how organized, or how many resources you have, it WILL be more difficult that you thought it would be.

And the one difficulty that you simply cannot know or prepare for is the emotional challenge.  In fact, that may be the biggest sacrifice one makes as a caregiver.  You will sacrifice your emotions. You will begin a ride on a roller coaster of unfathomable twists and turns, highs and lows.  The guilt will hang over you like a huge dark cloud. You will second guess yourself at every turn.  You will research and consider and ask others, and read books and in your heart know that what you are doing is the best thing, but then guilt will creep in.  It will nag you and harangue you like no other emotion.

My family and I did all we could do to keep our mother in her home. Her illness and our circumstances, her doctor’s advice, and two consecutive broken hips finally made that impossible.   And frankly, it made sense.  Why should we spend mother’s resources on heating a huge house when she lived in two rooms? Why should we spend resources on extensive repairs when we may need that money to provide for her personal and medical needs for many years to come? Why should we keep her somewhere, where none of us live? Where we cannot be there at a moment’s notice to assist or be with her?

Assisted living met our needs for many years.  But even in assisted living, I was on call at all times.  My mom’s needs super cede my own.  I have cancelled trips, spent many sleepless nights – some just worrying but some in the recliner in her room at the assisted living- and even left my full time job in order to be available for whatever she needs, whenever she needs it. But advanced illness means she must how receive more intense care.  And a skilled nursing facility is where she can receive that care, 24 hours per day, 7 days per week. My own home is not designed to care for an ailing aged person properly.  I am not a nurse and there are simply things I cannot do for my mother.   24 hour nursing care in the home is cost prohibitive.  Yet someone else can write an article that says “nursing homes would be empty if families were willing to sacrifice” and the guilt returns as my anger rises.

Heck yes, there are some facilities where, as I often say “I wouldn’t put my dog there”.  But facilities are necessary – like it or not.  And we as a society should make sure those places are regulated and monitored properly.  They should be  expected to and held accountable for providing quality care – not just on  the logo on the side of their van- but in the actual day to day care for those who reside behind their walls.  But don’t tell me what I have sacrificed or not sacrificed.   Don’t tell me what I “should” do, when I have pondered, prayed, sought wise counsel and spent many hours seeing to my mother’s wellbeing.

This morning, my mother shed tears and said she wanted to go back to her home. But in this place, where she now resides, wounds have healed; medicines are given properly and in a timely manner; equipment she needs is ready at hand; and the extra human hands we need are nearby as well.  My heart broke once again, and I shed my own tears.  But I know this is the best place for her at this time.  Whether our sacrifice, both mine and my mother’s is greater or less than another’s is not the point.  That both of us are sacrificing much and that love is at the core of all most certainly is the point.

Positive Change?

In the past couple of weeks I had the opportunity to attend the first ever Healthy Aging Summit in Washington DC where I presented an academic poster and I was invited to be a presenter at the Florida Council on Aging’s Annual Conference on Aging.

Usually, I am busy blogging about dementia care of the lack there of or information that I hope will be helpful for caregivers.  While this post will certainly speak to those issues, I want to share some information that I have gathered from these two conferences and some random thoughts about some of what I heard and learned.

First, I have always thought that we brilliant baby boomers should be able to offer solutions to some of the “aging” challenges we bring as we age!  Turns out I was correct.

The opening keynote speaker at the Healthy Aging Summit was Colin Milner, the CEO of The International Council on Active Aging gave me a new term during his presentation – Longevity Revolution.  Not only is that a more positive description than the Silver Tsunami term or Elder Quake  that has become popular,  it spoke to his philosophy that we should begin to  look at aging in America as an opportunity rather than a challenge.   Milner challenged attendees to look at the possibilities of aging rather than the challenges.

I liked that term, “Longevity Revolution” now that we ARE living longer.  I also liked the comment by Moderator Dr. Don Wright, Deputy Assistant Secretary for Healthcare Quality within the Department of Health and Human Services, who said “We want people to die young as late in life as possible.”    That would certainly be my goal – and why I often say I want to be hit by a bus. No one wants to “live” in a state of decline, dysfunction and dependence.   We all want to go, after a great and active day, quietly in our sleep!

This conference was interesting as well, because I serve on the board of directors of an organization that hopes to foster opportunities for our citizens to live and age with dignity and purpose.  Within that organization we are facilitating a project   looking at how we could change/adapt/redeploy resources to meet the needs our aging population presents.  One of the ideas is that we might focus on the entrepreneurial opportunities this could provide.  

I am fortified and pleased that at the conference I am currently attending, it appears folks are tapping in to that entrepreneurial spirit. One company will deliver nutritious frozen meals to your home. These meals can be simply warmed up in the microwave.  Yes, there is a cost.  But many of us would pay for that service, to ensure that our parents or even for ourselves are receiving proper nutrition!  Or how about the company that is starting a “shared housing” business?  What if you had an extra room in your house that you were willing to rent at a very reasonable rate and you simply needed a drive to the grocery store and to your doctor appointments a couple of times per month? Or let’s say you are retired, live alone and you just need someone to mow your yard or shovel your snow?    This company will screen both you and your potential “tenants” for compatibility and of course, safety – they do criminal background checks – and then connects the two of you.   Sort of like those on-line dating sites, but no dating involved!  This would be perfect for college students who need an inexpensive place to live and could provide some simple assistance for those who can still remain in their own home with a little help.    Yes, it’s similar to the “golden girls” concept but intergenerational and would be helpful for those who may not have a group of friends with whom to reside.

The down side to some of this positive thinking is that, as we try to put a positive spin on aging, we must still accept the fact that we all DO age.  One presenter spoke the need for more personal responsibility, meaning that many of us KNOW what we should do to improve our health as we age, but we simply don’t do it.  (Put DOWN the donut and exercise, friends!!)  However, we must be careful with this theory. As one aging expert said “Something in our bodies will break as we age, through no fault of our own!”  We mustn’t make those who develop an illness or find their abilities diminishing as they age feel guilty, as though they have done something wrong.   Certainly, that would be the pendulum swinging too far in the other direction.

And as I listened to two Alzheimer’s researchers speak about healthy cognitive aging, I thought of all those brilliant and otherwise healthy individuals I have known who have had to face the challenge of Alzheimer’s disease.   It’s hard to put a positive spin on that.  I was a bit miffed and felt that maybe they were trying to be positive about a topic that has no positive aspect.  But then  I had this thought,  maybe as we begin to think more positively about our aging population, we will lose the stigma that Alzheimer’s and other dementias still carry.  Alzheimer’s has been easy to ignore.  It has been seen as an illness only afflicting the “old”.  Those with Alzheimer’s have not often remained in the public eye – thus easy to ignore.  But that is changing and it can’t happen too soon. With more individuals being diagnosed earlier in the course of the disease and those with Young Onset speaking out, we are now hearing their voices and seeing their faces.  Maybe this will motivate our elected officials to put their money and policies where their mouth is. Not one candidate says Alzheimer’s research is not important.  Maybe we can use our power and our voices to compel them to increase the funding to meet the need for more effective treatments and a cure.  No more lip service, let’s demand action.

The times are changing and it is important that those who work with the aging population be flexible as these times change. This week, I not only presented a workshop on “Sex in Long Term Care” at a large aging conference, I listed to another presenter discuss sex after age 60.  Some of you may not want to talk about sex, especially in the context of your parents or grandparents who live in long term care!  That’s why the subtitle of my presentation is “Eeeew or OK?”, because many do think of it is an “eeeew” topic!  However, as we baby boomers, who coined the phrase “make love, not war” move in to long term care it is an important topic for both those who reside in long term care and those who work in long term care.  In addition, whether you like it or not, believe it is “normal” or not, hate the topic or embrace the topic, the Caitlyn Jenners of the world are aging and may, at some point, reside in long term care. Are we ready for that?

So, today, I am intrigued at the possibilities.  Maybe, this “longevity revolution” can be an impetus for positive change, not just a tsunami or quake!  And just as the baby boomers influenced the work place, forced civil rights changes and lead the sexual revolution – we can be the motivators and even the innovators as we enter our final years.