Saturday, February 27, 2010

Gathering Around Grandpa, Kids and All

The whole family gathered together that Christmas. As soon as I unwrapped "Tuesdays With Morrie,” my teenaged sons snatched it from my hands.

Tim and Jason started reading because they loved its author, the renowned sportwriter, Mitch Albom. They continued because the story of Albom’s renewed relationship with his college professor gripped them. Though set in the midst of suffering and death, the book exuded life. And yes, I finally got to read it.

Across the living room sat another reason for their interest in “Tuesdays with Morrie.” Grandpa was slumped in an oversized chair, his body sapped from the radiation he’d undergone to fight cancer. He’d lost so much weight! The unspoken question was, “How much longer will he live?”

During the next few days, I would ask the boys periodically, “What do you think of the book?” “What are your favorite parts?” They both liked Morrie’s non-funeral, a celebration of life where friends gathered to honor him before death.

In the ensuing year—Grandpa’s last on earth--all of his grandchildren showered him with love. Some gave hugs, others kisses, still others phone calls. But I’d like to think some of that contact came because of a little book called “Tuesdays with Morrie.”

How have you encouraged your children to be part of your aging parent’s world, even during difficult times? Author Doug Manning in "Parenting Our Parents" said he brought his grown son with him when he visited his father in the nursing home weekly. Three things happened: his aging father got a visit, which he needed; Doug and his son had some bonding time and third, Doug's example may mean that his son will visit him when he is old.

"Parenting Our Parents" is unfortunately out of print.

Monday, February 22, 2010

Tips on Choosing a Nursing Home

Question: Your aging parent is in the hospital, and will need rehab in a nursing home. The discharge planner asks, “Where do you want your parent to receive care?” If you’re like many of us, you don’t have a clue.

Here’s some help:

Check out the Nursing Home Ratings page on the Medicare.gov website. For the last few years, the Centers for Medicare and Medicaid Services have published a quarterly nationwide rating of nursing home quality. Each health care center receives a rating from 1 to 5 (5 is best) in several categories, plus an overall rating.

Category 1 is recent nursing home state survey results. That includes the routine annual inspection visits plus any special visits due to poor quality..

Category 2 is staffing ratios. This refers to the number of nursing staff on average for each resident.

Category 3 is referred to as quality indicators. Two of the many indicators are the percentage of residents with bed sores or with severe to moderate pain.

The overall rating is most important.

To search for a nursing home:

1. Go to Medicare.gov and find the homes in your area. You can search by name, city, county, state or zip code.
2. Compare the homes, especially their overall quality score. You’re wanting to look for 4s and 5s. It’s extremely rare for a nursing home to receive all 5s. Once in awhile even an excellent home will rate a 2 or 3 in one category.
3. Visit yourself. The website has a lengthy checklist which might help some people. I prefer to ask fewer questions: How long have your Director of Nursing and Administrator worked together? “What is your staff turnover rate?” Look for smiles—or lack of them—on residents and staff. Are staff hanging around in the halls or actively engaged with the residents?
4. Other places to contact include your Long Term Care Ombudsman and your State Survey Agency. And of course, your friends.

Tell us about your search for a nursing home for your aging parent.

Saturday, February 20, 2010

Keep the Faith--Your Parent's and Yours

For fifty years, Daddy preached the gospel. As a minister, he dedicated babies, married star-struck couples and performed funerals. His sermons lifted congregations to heaven. In the twilight of his life, though, this man of God worried he was going the other way.

“I’ve been a phony. I’ve done so many things wrong. I don’t know if God can ever forgive me,” he repeated again and again. Halfway across the country, I listened by phone to his laments. What could I say?

My own pastor told a similar story. His mother, a minister’s wife, was plagued near the end of her life by anxiety over her eternal destiny. “I just can’t hold onto God,” she said over and over. “I just can’t hold on.”

For others at life’s end, faith shines like a beacon. Reverend Everett Seymour spent his last two weeks in the nursing home where I worked. Gravely ill, he nevertheless spoke about God to everyone. “God bless you,” he told the staff, “you are doing such a wonderful job.” Pastor Seymour phoned people up whom he thought weren’t “tight with God,” asking them to visit him. One on one, he made one last effort to lead them into the fold.

You may recognize your parent in one of these people. Why is it that faith wavers for some, and soars for others? I don’t know. Nor do I understand while still others fall somewhere in between. In my dad’s case, I believe the Parkinson’s that robbed his body of function and strength also ate at his soul.

So how do we children deal with a spiritually anxious—or evangelistic—aging parent? In both cases, we listen. Hearing them out is the biggest gift we can offer. We acknowledge their feelings, positive or negative, and empathize. But we don’t stop there.

We speak the truth. The same truth they taught us as children so many years ago, in word, in deed, in song. God loves them. No matter what. My pastor responded to his mother who said she couldn’t hold onto God, “Mother, God is carrying you.” In my Dad’s case, as he neared death, the prayers, Scripture and hymns gave him the confidence that God held him tight.

How has your parent’s faith changed—or remained the same? How have you been able to nurture it?

Monday, February 15, 2010

You, an Advocate? Ya Betcha!

Janice is an advocate. Looking across my desk in the nursing home where I worked in a management role, she began her story.

“I visit on Saturdays, and often arrive at 2 pm. A few times Dad hadn’t been shaved, and his sheets were wet. How can I complain without being labeled a trouble maker?”

I was a bit puzzled. This was an excellent nursing home. Janice’s concerns were real, though, and needed to be addressed.

Perhaps you are an advocate for your aging parent, or know someone who plays that role. If your parent lives in an assisted living facility, a nursing home or adult family home, you’ll address issues from lost socks to missing dentures to poor care. Your job is to speak on your parent’s behalf to the person who can help. Here are some guidelines.

1. Pick your battles. In a nursing home or assisted living facility, clothes get lost. Don’t sweat it; either do the laundry yourself or shop at thrift stores, to reduce replacement costs. Move into action, though, if care needs aren’t met—if mom has lost five pounds in a month, for example. Janice, in the example above, was playing her role appropriately when Dad wasn’t shaved or changed until afternoon.
2. Choose the right person at the right time. In a nursing home, don’t address the problem with a nurse’s aide. He or she doesn’t have the authority to make changes. Instead, make an appointment with the charge nurse and only go to the Director of Nurses or Administrator if the issue persists. I asked Janice to express her concerns to the Nurse Manager.
3. Show appreciation first and then state the problem. Nursing home staff work hard and need positive strokes. Be truthful in pointing out the good such as “I can tell your activities director enjoys her job. In fact, all of the staff seem to like working here.” When you begin to address the problem, stay on track; don’t digress. Keep your temper and work toward resolution, not blame. Your goal is to work together to find a solution.
4. If things improve, phone to say thanks. “I want to thank you so much for moving mom to a different room. She likes her new roommate.” Those kinds of statements will be music to the ears of hard working nursing home management.
5. If all else fails, consider moving your parent to another facility.

Perhaps you have some other tips. Or stories about your own advocacy efforts. Please share them.

Advocacy 101: Working For Your Parent

Chances are good your aging parent will need an advocate—someone to work on his or her behalf. If you’re nominated, you may end up in the office of a physician, a financial planner or possibly a nursing home charge nurse. You’ll glean information, offer your perspective and if needed, spark positive change.

According to educational materials produced by E. Joy Kane, PhD, elder advocacy involves three parties: the person in need of help (your parent), the person who has the knowledge and/or resources (you, the advocate) and the power broker (the person who can make life better for your parent.)

Many adult children shine as advocates. One son stands out. Several years ago he sat across the table from me. His mother wanted to live in HUD housing, and as the retirement community’s admissions director, it was my call to determine if this was a good fit. But one big obstacle blocked the way. His mother had "forgotten" several appointments and when I called to reschedule, she didn't recognize me.

Her son acknowledged Mom had been diagnosed with dementia. I walked a fine line. Denying housing would violate the Americans With Disabilities Act. But would this woman be safe in independent living? I expressed my concerns.

“I live a mile away," he said. "I'll check on her daily, deliver her food and do her laundry. And I'll watch for signs of wandering." He continued, “I know she will need assisted living someday. But for now, we want to give this a try.” His mom moved in. I held my breath. True to his word, though, this son fulfilled his promise, placing her well-being first. I was impressed.

Three tips for advocates:

1. Your primary responsibility is your parent’s welfare. His or her needs are paramount.
2. Don’t take over any duties or responsibilities in the medical or financial areas without consulting your parent. The exception is if they suffer from dementia or are gravely ill.
3. Effective advocacy involves respect for the power broker. Together you can make a difference in your parent's life.(See the upcoming post titled "Me, an Advocate? Ya Betcha.")

Would you like to share an advocacy situation you’ve been involved in? Have you learned any lessons about yourself from working on your parent’s behalf?

Grumpy Old Man--Your Dad?

If your parent blows a fuse, what do you do? Bottle up the hurt? Shoot hoops till you drop? Simmer inside, hoping your anger doesn't boil over, spewing hurt on others?

Dennis and Ruth Gibson offer advice in “The Sandwich Years,” a book ahead of its time. Written in 1989, but certainly appropriate for today, it addresses communications issues, including the appropriate response to an angry parent.

First, try to find the root of the rage. Often anger is a symptom of depression--sadnesses at the inevitable losses of later life, such as death of a spouse or friends. Depression and anger often accompany diseases such as Parkinson's and strokes. Dementia can cause a person to lose his or cool, as well. In these cases medications can sometimes help. But what about the parent who’s been grumpy since you can remember?

We can't change our parent, but we can change our response. To help adult children cope, and diffuse the situation, the Gibsons suggest:

To criticisms (like, “The only person you ever care about is yourself,”)say:
1. “I’m sorry you feel that way.”
2. “Thank you for telling me that.”
3. “I’ll have to think about that.”
4. “You may be right.”
5. “Oh.” Said a number of ways.

To testy questions (like, “Why can’t you be more successful, like your sister?”) say:
1. “Good question.”
2. “I’m not sure.”
3. “I wonder.”
4. “I wish I knew.”
5. “Beats me!”

To any attack, when the time is right, say:
“I must be a terrible disappointment to you.”

According to the Gibsons, “These simple responses give you a way to show respect without capitulating or even defending yourself. They maintain a kind of friendly neutrality."

Do you agree with the Gibsons’ advice? Perhaps you have other coping strategies.

When Communication Screeches to a Halt

If talking with your aging parent is hard, you’re not alone. Therapist Doug Manning in his booklet, “Parenting Our Parents,” admits he and his aging dad were at a roadblock. Their relationship was marked by small talk and silence.

Earlier, they'd enjoyed each other, making excuses to ditch family reunions just to talk, playing endless rounds of golf and taking time to explore big issues. But now, conversation was stalled.

Doug invited his dad on a business trip involving a three-hour car ride. Determined to break the ice, Doug nevertheless let mile after mile slip by without sharing his feelings. Imagine, a therapist who couldn’t talk?

On the way home, Doug finally spoke up, saying something like, “We used to be so close, but lately, we’re not talking. I don’t like our relationship right now. What do you think?”

“I don’t like it, either,” his dad replied, his eyes downcast.

“I want to do whatever it takes to bring us closer,” Doug said. His dad said nothing.

Doug admits their relationship didn’t improve overnight. But he felt relief. He had spelled out the problem and now could work on his side of the equation. And over time, in an open atmosphere, their relationship took a measured turn for the better.

These tips may help break the ice:

1. Admit the problem to yourself.
2. Communicate in love, realizing you may not receive the total outcome you want.
3. Look for common ground. That might mean books, baseball, music. You know your parent better than any one does.
4. Give it time.

Do you or a friend struggle with a relationship with an aging parent? You are not alone. Tell us about it.

Note: Doug Manning's book, "Parenting Our Parents" is regretfully out of print.
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