Thursday, May 31, 2018

Eldercare Q-A: Dad needs care; Mom won't budge. What do I do?

A client asked me this question a week ago.  More specifically, she said,

"My dad has dementia, and my mom is trying to care for him.  It's not working.  She asks him to take a bath, and he doesn't.  Same with brushing his teeth.  He's not defiant; he just forgets.  Almost immediately. Mom refuses to hire outside caregivers; the only outside caregiver she will accept is me. I work two jobs and can't help any more than I do now.

"They have money.  It's not the issue.  But pride is.  I'm almost wrung out from the stress.  Yes, I love both of them deeply. What can I do?"

My answer to her and to others in the same, or similar boats:  I'm so sorry you are in this difficult situation!   You seem understandably torn, wanting to help your parents while maintaining a sense of sanity. Since your mother is competent, though stubborn, it's impossible to force her to accept help for her husband, either in the home or elsewhere.,

There are some things you can do, though, to make the situation bearable until something changes.

1.  Increase your personal support.  Support groups allow you to vent your feelings, and to hear from others, so you don't feel so alone.  There are Alzheimers Support Groups throughout the country.  They encourage caregivers, both spouses and adult children.  And they offer information and resources.

2.  Visit assisted living communities which have memory care areas, so you can get an idea of what your parent or parents might need when the time comes.  Start with research online to get the basics, and later do on-site visits.

3.  Consider hiring a geriatric care manager.  A geriatric care manager understands the needs of the elderly and of those with dementia specifically.  He or she can ask a lot of questions about your parent's situation and come up with a plan of action that will benefit the entire family.

4.  See if your parents will agree to care on a trial run of home care, or a temporary "respite" stay in an adult family home or heavy care assisted living community.

Monday, April 30, 2018

Decision Fatigue: Do you suffer from it?

I first heard the term "Decision Fatigue," in church last Sunday.  The more I thought about it, the more I realized that pretty much all of us who work with seniors, or are seniors, have it to some extent.

We tire when we make too many decisions.  On average, we make 35,000 decisions a day.  Big ones, little ones,  What to wear?  What to eat?  What to buy?  And the list goes on. 

No wonder at the end of the day, we're fatigued.  When we make too many decisions over a day's time, we are more apt to go for a candy bar, or make a bigger decision that's not in our best interest or in the interests of others.

So what's the cure?

In general:  Stop being the decider of everything.When you can, delegate tasks or stop doing them. according to "The Cure for Decision Fatigue , from Jim Sollice in The Wall Street Journal.  The Internet can be a real energy drainer.  When you click on the Internet during work time, you're allowing fatigue to set in.

For adult children:  Use mornings to schedule a talk with the administrator about your parent's care.  Certainly don't opt for the end of the day when you are both tired. Late morning is often the best time to discuss important topics with your aging parent.  You haven't made too many decisions; you are relatively fresh and can give the conversation your best.

Saturday, April 21, 2018

Everyone Needs More than One Mother--Why and How?

"Everyone needs more than one mother.  I borrowed that phrase years ago, and it's proven true.  

Many of us lose our mothers well before they die if  mental illness, dementia or other diseases take away much of who they are. 

"She's just not the same," many adult children say about the "new mother" who often seems like a different person from her former self.  Her new behaviors--saying things that don't make sense, forgetting, fibbing, being overly defiant or overly needy--seem confusing.  Once in awhile, the mother her children remember from before her illness shows up and children may be pleasantly surprised.  I've heard: "She recognized me.  We had a short conversation and she actually made sense!"

Confusing?  You bet.  My mother was chronically mentally ill and passed in 2004.  Toward the end of her life dementia also set in.  When I grappled with her behavior and with my response, professionals would say things like,  "Embrace the person your mother is now.  And embrace the other mother, the one you remember."

I tried.  I didn't totally succeed, but I gave it my best shot.  And I also grieved the mother I'd lost years before.  Now that I'm working with adult children who are making important, difficult decisions for their aging parent,  I'm convinced that the grieving and acceptance go hand in hand.,

But my premise:  "Everyone needs more than one mother," still seems true.  Many of us don't have the "model mother" even in childhood.  I know my children didn't. But God often puts others into our lives who can make up the difference in filling that maternal role.  In my case I had substitute mothers throughout my life including my youth group leader who taught me how to back pack, an elderly, wise woman who cheered me on as I began to write professionally, and a good friend who kept me afloat during my kids' teenage years

Like many of you, I've ended up in the mothering role as well.  These days I fill those shoes as I help adult children find placement for their aging parents.  It's a difficult role, and it's my pleasure to help. A long time ago, in college sociology class, our working group named leaders.  My classmates named me the emotional leader.  Kind of like a mom.

Happy Mothering!

Friday, March 30, 2018

Adult family homes, assisted living: good but not like heaven

"This side of heaven, you won't find a perfect home."

Some 20 years ago I heard that statement.  And it certainly rings true, today.  At Silver Age Housing & Care Referrals, where I work helping families find quality housing and care, chiefly assisted living and adult family homes, we do our level best to rise to the standard of the heavenlies.  But the truth is:  no one can find the perfect home.

That doesn't keep us from trying.  We take our "matchmaker" job seriously, to find homes that will be good fits.  Together with the family, we search for a home that will make their loved one feel comfortable and cared for.

The search isn't always easy.  Take Rick and his family.  At 63, he was one of our youngest clients.  He had suffered Traumatic Brain Injury as a result of a motorcycle accident at age 22.  For the next 41 years, he lived with his parents, until their physician told them, "No more."  The stress was building; they needed a break from caregiving. 

What does Traumatic Brain Injury look like?  That depends on what part of the brain is injured.  Some people have seizures.  For others, behavior and personality are affected.  Anger erupts for seemingly no reason.  And nearly all TBI patients have short-term memory loss.

That was Rick's issue.   He remembers his high school days in detail, and events up to the time of the motorcycle accident.  Today he is pleasant and polite, but won't remember any conversation 15 minutes later.

He and his parents talked about his needs for a new home in what we describe as an intake.  It's a key part of our process, because we can't find the best home for anyone unless we discover not only their diagnoses and medications, but what makes them tick.

So we drew up a list of must-haves:  1.  The chosen home had to fit the family's budget.  2.  It had to be within 15 minutes  from the family home.  3.  It needed caregivers who were highly experienced and who could learn more about Traumatic Brain Injury and how it compares with dementia.  4. Preferably there would be one or two younger residents and at least one male caregiver. 5.  It must allow smoking outside.

 I looked for these qualities in the homes I researched and visited. The top three homes were the ones we toured together.  Rick and his family liked one home especially, and two weeks later, he moved in.

Today I visited.  Rick seemed happy.  He didn't remember seeing me before, but that's part of the condition.  He walks outside from time to time, something he had always enjoyed.  He likes the food.  And he has bonded with the male caregiver.

Is this adult family home heaven?  Of course not. He has only been there two weeks.  Give him two more weeks, and he will feel more and more at home.  In the meantime, the caregivers are enjoying him.  He helps with the laundry, folds and puts away his clean clothes, and looks for other things to.  "I like to help," he says.

Monday, March 26, 2018

Why Loneliness Kills Seniors--and Some Ways to Combat It

What is the greatest health threat in the aging population?
  • Smoking?  No, but don't start the habit now.
  • Obesity?  Bad, but it doesn't rise to the top.
  • Cancer?  Very dangerous, but something else has it beat.
The answer:  Loneliness. 


Bruce Frankel isn't.  He explored the topic last December in a presentation "The Loneliness Epidemic" for a national group called The Society of Certified Senior Advisors.  If you work with seniors, have an older parent or relative or you are a senior yourself, this information could help change a life.

"Isolation and loneliness constitute the greatest public health hazard for the aging," said Frankel, quoting John Cacioppo, who headed the University of Chicago's Center for Cognition and Social Neuroscience until his death earlier this year.

Some 42.6 million seniors suffer from chronic loneliness, caused by factors including a loss of social confidence, and a loss of friends and social contacts as their world shrinks, Frankel says.

Here are frightening results of loneliness:

1.  Lonely people have a 50% greater risk of early death compared to those who have social connection.

2.  Loneliness increases the risk of stroke by 32%, dementia by 64.9%.

3.  Loneliness affects the body's physiology:  it increases cortisol, damages white blood cells, impairs the immune system and increases inflammation.

More affects of loneliness, according to Frankel:  "When we're lonely, we become hypervigilant.  We perceive more danger than we otherwise do.  We become hypervigilant to signs of rejection and judge our relationships weaker than they are.  We are more defensive, more aloof."

Steps Away From Loneliness:

1.  Don't deny it.

2.  Understand what it does to the body and especially the brain, and how it interferes with interactions with others.

3.  Respond.  Find at least one person to trust.  As you move forward, seek out like-minded people to connect with. Consider volunteering.

4.  Expect the best. 

Do you have personal experience with loneliness?  How do you and/or others combat it?

Wednesday, February 28, 2018

This eldercare blog celebrates 250-plus posts!

In 2010 I hatched a dream.  Incubating in my mind for months, the dream came to fruition in this blog.  For years I'd worked with adult children as they grappled with issues relating to their aging parents.  I'd had my own struggles with my parents who had died several years earlier.

I reasoned, "Why not use what I have learned and would continue to learn to help others?" Specifically I wanted to educate, encourage and applaud Baby Boomers as they sloughed through a real-life course they'd never studied in school.  After all, who takes a class on "Everything you ought to know about understanding your aging parent?"  I was a writer, so the written word was my medium, and this blog, Boomers Guide to Eldercare, launched in 2010.

Time flies.  I realized a few weeks ago that I'd published the 250th post.  So I celebrate this milestone a bit late, which is my style.  This post is number 252.

Publishing a blog is an educating process.  Over the years, I interviewed and took courses from doctors, nurses, social workers and more.  I learned the most from my clients who often took heroic measures to advocate for their aging parents. The original blog labels, "Know Yourself," "Know Your Parent," "Communicate With Your Parent," and "Advocate for Your Parent" expanded tremendously to include posts on faith, caregiver helps, end of life and hospice.

Readers today have shifted a bit from the early days of this blog. Besides adult children, there are Boomers who are looking ahead at health care options for themselves, and lastly, senior care professionals such as marketing directors, social workers and administrators.

A few of my favorite posts?  "One Woman's View:  Mom's Mental Illness is so, so sad," "Faith and Dementia:  One Man's Story," and "On Giving Up Worrying (About My Aging Parent) for Lent."

If you've read this blog before, what do think of it?  Do you have any topics related to eldercare you would like to read about?

Sunday, January 28, 2018

Note to Adult Children, Senior Care Pros: Mind Your P's &Q's

Mind your P's and Q's. 

If you're a Millennial, you might say, "What?"  But if you're a Boomer, chances are you heard this phrase growing up.  Many times.

Translated, Mind your P's and Q's is "Mind your manners," "Mind your language."  "Be on your best behavior."

If you work with seniors or if you have an elder in your life, I'd like to suggest another meaning for the P's:  three words that are important, for one reason or another.

PATIENCE--We know that seniors walk more slowly, so we change our pace to meet theirs.  Other parts of their bodies also require us to adjust.  We speak distinctly and sit face to face when we know they're experiencing hearing loss.   But what about decision making?  For many independent seniors, a decision like giving up driving or moving to a retirement community is huge, requiring months and even years to process.  As  professionals, or as adult children, it's frustrating to hear for the seemingly millionth time,  "We're just not ready yet."  So what do we do? Probably the biggest gift we can give seniors in the throes of decision is emotional space.  We also can acknowledge the difficulty they're facing, saying things like  "I can tell this is hard for you.  I want you to know I'm here to help.  Another tact is to extend invitations to explore options but with no  strings attached. 

PERSISTENCE--This may seem to contradict the patience idea.  This is the Yin and the other the Yang.  As senior professionals, if we are so patient that we wait a long time before contacting a senior prospect after the initial visit, he or she may go elsewhere.   As adult children, if we don't bring up the issue at all, our children may jump to an erroneous conclusion that we don't care. My advice is to keep talking, but at a slower pace than you might prefer.

PUSHY--Don't do it!  Seniors hate even the slightest hint of pushiness.  Their idea of pushiness is likely different than yours!  You can tell when they're viewing you as pushy if they don't answer your calls or return messages or if their tone of voice or body language screams, "I'm not interested.  Don't talk to me!"   But pushiness isn't always such a bad thing.  I remember working with a single woman in her 90s who had a heart condition and other severe medical problems but who was alert and oriented.  She loved her condo, but realized she would need more care as time went on.  She visited retirement communities, but kept stalling and stalling on this difficult decision.   Later, after moving in and settling in comfortably, I asked her, "Do you think I was pushy during the time you were deciding about moving?  I waited for her answer.  "No, not really.  But maybe a little pushy.  But not too much."

Thursday, January 11, 2018

Senior Care Referral Agents--How We Spend Our Days

One of my favorite children's storybook authors, Richard Scarry, wrote an immensely popular book in 1968 called, "What do people do all day?"  In it, darling animals build houses, fly planes, keep house and grow food.

People ask you and me, perhaps in different words, "What do you do all day?"  I am a senior care referral agent, and I help families find the right choice in in-home care, assisted living or adult family homes.

I'm not alone.  At Silver Age Housing and Care Referrals, where I work, we are a team.  Each member has an area or areas of expertise:  occupational therapy,  caregiving, ombudsman experience and finance.  We share knowledge, benefitting our clients.

There are approximately 70 senior care referral agencies in Washington State. Like the characters in Scarry's book, we keep busy helping families.

Ever day, all day, we do the following:

SUPPORT--This is the social work part of our job.  When a family member calls us, the first thing we often ask is, "What's going on with  your loved one?"  Then the story--and they are nearly all different--comes tumbling out.  Mom had a stroke, is in rehab, and needs a more permanent home.  Dad has been caring for Mom and his health is now failing.  Mom lives in Illinois, and daughter has been using all her frequent flyer miles and cash to fly back and forth.

Bottom line, placing a loved one is one of the hardest things a family can do.  It's hard because it's our mother, or father, or other loved one for which we're making the decision, not simply a client. And it's hard because this might be their last home on earth.  Very often professional help can make the job easier.

Another thing  that helps:  the referral agencies' services are generally free to families.  The communities pay a commission to the agency on move-in.

TEACH--A senior care referral agent is a vital source of information.  At Silver Age, we know which communities accept Medicaid, which specialize in heavy care and which are located in the family's desired locations.  We provide a list of questions to ask when touring communities, and we tour alongside the family.  We have questions that we feel are especially important to ask; the family will think of others.  They are experts on their loved one; we are very knowledgeable about assisted living communities and adult family homes.  We inspect them before touring with a family and we check to see which places have enforcement letters from the state and may not be worth touring.

INSPECT BUILDINGS AND EVALUATE PROGRAMS  People often ask me, "Are you a Realtor?"  There certainly are some similarities.  Like a Realtor, we keep abreast of what's available.  Depending on the client's desires, we will search for communities with full kitchens, two bedrooms, or patios.  Finally the community has to be a good financial fit for the client. So in many ways we are like Realtors.   But there are differences.  Care needs--both physical and cognitive-- are a huge concern for many people.  Memory care is another potential issue.  For still others, an active social program is a must-have.  For most families, the key issue, besides availability of care, is the vital interaction of residents with staff.  Many people compare searching for  an assisted living or adult family home to looking for a college, private day school or kindergarten.  The building is important, but it's not everything.  Caring, knowledgeable staff are what matter most.

Need some help with obtaining housing and/or care for a loved one?  Contact Silver Age Housing and Care Referrals.

Saturday, December 16, 2017

A Group Legacy Letter to an Aging Parent--Does it work?

Five eldercare blog posts on a single subject?  I never thought I'd do it.  But here goes.

This is the fifth post on the subject of "A Legacy Letter," a gift you can give the elder in your life. A Legacy Letter is similar to a tribute at a funeral, but the recipient is alive, reading the letter or having the letter read aloud to them. A  Legacy Letter points out the recipient's key qualities, and uses  examples and stories to "show" a well as "tell the story."

Christmas is a great time to write and present a Legacy Letter.  But other occasions work as well:  Thanksgiving, Valentine's Day, a special anniversary, or a big birthday.

The letter is usually written by one person.  But last October, the idea dawned on me to make the Legacy Letter a group effort. The upcoming big occasion was my mother-in-law's 90th birthday which fell on Thanksgiving this year.

How would the group letter idea go over with the two Boomer children and five grandchildren? I emailed them an assignment to answer "What qualities stand out in Grandma's life?"  And what contributions has she made to us and to others?" 

Stories highlighting Grandma's contribution were essential. 

Believe it or not, everyone made their deadline!  Our daughter prefaced her contribution with  , "Mom, I'm so glad you asked us to write this!  For the last two weeks in between errands and other tasks, I've been thinking about Grandma and the memories we've had."  More importantly, she and the others said wonderful things about Grandma Margie.

Imagine the look on Grandma's face when her son--my husband--began reading the letter.  Here are a couple of excerpts:

"You have been my cheerleader as long as I can remember...always standing behind me, encouraging me and cheering me on."

"I have treasured the many memories I have made with you both growing up and as an adult....I remember running around the Kirkland house and eating canned peaches and ice cream.."

The scene reminded me of "Queen for a Day."

For more information on Legacy Letters, contact Melanie Vetter, Health Advocate, at Well Fleet Circle.

Thursday, November 30, 2017

Faith and Dementia: One Man's Story

I often have the privilege of attending assessments for seniors moving into adult family homes.  Last spring I got to meet Bill, 83, his daughter-in-law Jennifer and Sylvia, RN, the nurse.

"Does faith play a vital role in your life?" Sylvia asked.

It's a question worth asking for all of us, whether we work with seniors, are an adult child of a senior, or are seniors ourselves. 

Bill's answer to the faith question?  What? I don't understand."  His blank look told me it wasn't just hearing loss that kept him from comprehending.  The nurse was speaking clearly, and he had heard the other questions.  But that word--faith--tripped him up.  It had slipped away from his word bank. 

"Faith" is abstract and that category of noun often is the first to be lost to dementia.  Concrete nouns are remembered longer and better.  So how do we translate faith into a concrete noun that makes sense to Bill and others with dementia?

Sylvia tried another tactic.  "Is religion important to you?"  Bill's response was the same.  No dice.  Blank stare.

Bill's daughter-in-law Jennifer tried a crack at the question.  "Do you believe in God, Bill?" Bill relaxed,  a glimmer of recognition crossing his face.  I could tell they were making progress.

Jennifer continued her query into Bill's soul.  "You know Jesus, don't you?"  Suddenly Bill lit up.  "Jesus, oh Jesus!" 

"I don't think He is very happy with me now.  I haven't done much for him lately." 

Jennifer responded, "None of us has done much for Jesus.  But He loves us anyway,  He loves you, Bill.  He loves you!"

Note:  My role as a senior care housing and care specialist with Silver Age Referrals in this assessment was to provide support to the nurse and family.  Jennifer, the family member, led into the discussion of God and ultimately Jesus.  As professionals, we ask about faith as we see an openness on the part of the family or the senior.  And sometimes exciting things happen!

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