Valentine's Day: Keep It Simple for Your Aging Parent

When your aging parent was in school, Valentine's Day was a big deal. It still is for many of us. And it's only two days away. What is a simple gift for your parent that they will love and that won't break the bank?

A card with a hand-written note is simple.  My husband sent one to his mother in Arizona.  She loves letters. Not junk mail.

Abby Durr of Silver Age Referrals shares some other ideas:

A cupcake, a flowering plant or a jar of candy to share. A book, if they like reading and you know what kind of books

A puzzle - there are certain ones for people with dementia. Preferably one that is personal. If they like birds for example, a bird puzzle.

A hand towel for kitchen or bath.

A wide brimmed sun hat

Warm mittens

All natural hand cream- for someone who doesn’t have dementia. 

A visitors journal 

Water coloring kit, if they would appreciate it. 

Coloring or activity book.

Bathrobe or slippers

Gift certificate to get their nails done 

Anything from the Alzheimers store

In Memory Care, the Mantra is 'Keep it Simple'

A few days ago I was flying from Phoenix to Seattle thinking about memory care.  Why? Because my mother-in-law lives in memory care and because I've worked for years with families seeking memory care.

From what I've observed, the memory care mantra is "Keep it Simple." Seniors with memory loss may often experience anxiety, and the fewer the complications the better.

SPACE--The room should be uncluttered.  That means a bed, a dresser, and an easy chair or two, one for the resident, one for a guest. One reason for the uncluttered look is that elders with memory loss are often at risk for falling.  Keeping clear paths may minimize falls. Regarding the dresser: it's best to have clothing and other essentials occupy only a couple of drawers. That way, if a purse is lost, a resident has fewer places to look.

DECOR--If possible, the room should have pictures on the wall, including ones the resident is familiar with from his or her past.  A familiar bedspread, throw pillows and possibly an afghan may help bring a sense of "home" to the room.

SCHEDULE--Most memory care communities are consistent about meal times. That's good.  A person with dementia often has much better long-term memory than short-term memory.  They may remember that lunch is at 11:30, since that's lunch time every day. They may not remember that what they had for breakfast or if they had breakfast.

STAFF--Consistency in staff is great!  If the resident knows that Bing is the one who helps her go to the bathroom and that he is kind and caring, she will experience less anxiety.

VISITS--This is a hard one. Families can't always come at the same time, or they might have to skip a visit for a day, a week or more.  Calling staff ahead of time to announce your arrival is helpful.  Also, some residents have trouble saying "Goodbye" without tears, major tears. One family I know schedules the visit an hour or so before lunch. They end the visit with the resident going to lunch and forgetting the tears.

These ideas on simplicity involve both staff and the family.  It's a team effort!

Do you have an aging parent? Or work with seniors? Here's a hero to emulate.

Who do I want to be like when I grow up? Good question. I'm already grown up. And so are you. For me, I want to strive to be like Msimangu. He is one of the lead characters in a favorite book by Alan Paton. It's called "Cry, the Beloved County."

So what does "Cry, the Beloved Country" have to do with the elderly, the group of people I rub shoulders with every day?  Plenty.  It deals with racial secregation of the worst kind. Today we tend to segregate by age, not so much by color. But separation for any reason is wrong. And sinful. "Cry, the Beloved Country" illuminates that sin, but also the redemption that can be possible through love. Msimangu is a big part of  that love.

Back to the story. The book is set in South Africa, during apartheid, the period of strictest separation between races. Stephen Kumalo, a parson, is a frail old man, living in a tiny drought plagued village.  He is loved by his people but life is hard.

One day Kumalo gets news that his only son, Absalom, has been charged with the murder of a white man.  He must go to Johannesburg, the city of crime, to find his son and others in his family who have disappeared earlier, including his sister.

Fortunately Reverend Msimangu, enters the scene. With a combination of wisdom, energy and compassion,  he becomes the old man's  emotional and physical shepherd. They wind through the sin-filled city, searching for Kumalo's loved ones.

Msimangu stands by Kumalo in the face of many losses. Kumalo discovers his sister has become a prostitute. His brother John, a hater of whites, lies to blame the sole responsibility for murdering a white man on Absalom. In truth, John's sons were also involved. Absalom will be executed. John's sons face a lesser sentence. Kumano struggles with forgiveness. Msimangu offers support.

Hope is dashed time after time. Kumalo's sister agrees to return to the village but later flees in fear back into prostitution. Absalom's girlfriend becomes pregnant. Absalom repents and the two marry not long before Absalom's execution.

More loss.  Absalom's new wife abandons her tiny son to return to a life that while evil, is known.  And Kumalo goes home, with a little boy, his grandson, whom he and his wife will raise as their own.

The ending offers Kumalo hope. He discovers that the white man whom his son killed was the son of the plantation owner living above Kumalo's village. The younger man, too, had a son who is now living with his grandfather.  Now there are two little boys: one white and one black, who will grow up knowing each other.

Msimangu is my favorite character. Impatient, hot-headed, he pulls Kumalo through the city and through the system. He is a tough love sort of a guy, who is generous with his time,
compassion, and money. He gives Kumalo his lifetime savings, to help him with expenses of the trip and raising of his grandson.  When Kumalo thanks him, Msimangu responds,  "I am a weak and selfish man, but God put his hands on me, that is all." 

As I go about my days, working with seniors and their families,  I want to be like Msimangu. "I am a weak and selfish person. but God put His hands on me, that is all."

Happy New Year!

One Family's Story: Miracle at Life's End

I work with families, helping them find what will likely be their aging parent's last home. If I pay attention, I can see miracles at work.

 I don't mean miracles like the parting of the Red Sea, as in the story of Moses. I certainly don't mean turning water into wine or raising the dead. At life's end, though,  happenings occur which can hardly be explained other than a miracle, at least to those who believe.

Often, thankfulness encircles a miracle. We express thanks, we look around and mysteriously we're open to seeing life with new eyes, a sort of miracle all in itself. Some people call it Serendipity. And afterwards, the miracle can continue through the expression of thankfulness.

One day about a month ago, I finished touring a family at Sunrise of Edmonds, an assisted living and memory care community. I hadn't been there in quite a while. My clients went their way. I went mine. Halfway down the hall I spotted the son-in-law of a resident and family friend whom I had helped move in here a year before.  The resident's name was Morrie.

"Alice, Morrie passed a little while ago.  But Bunny is still there." Bunny was Morrie's wife.

Should I knock on the door or leave the family alone?  So I asked, "Would Bunny mind if I came in?"

Soon I was ushered into the room and greeted like I was family.  I was filled with thankfulness. Bunny was inscribing the back of a beautiful watercolor painting she had done years earlier.

"All of the caregivers here have been wonderful.  This painting is for Morrie's favorite caregiver. I want to express my special appreciation. She had a smile for him every time she saw him."

For me, this little glimpse of love and appreciation in the midst of loss was a miracle.  I didn't come here often, but I showed up that day and was blessed.  I left with a thankful heart.

Legacy Talk: This Time It's About Me, the Grandma!

A legacy is the sum of the values and of works of our lives. Usually when I use this word, I think of older seniors, usually our aging parents.  But this year, on Thanksgiving Day, the shoe was on the other foot. My 15-year-old granddaughter asked about my legacy.

Kylie didn't use the word legacy. But in a way, she did. Her English teacher asked the class to interview an adult family member two generations older.  In the process of our conversation, back and forth, we learned more about what was important to me in life. I was honored to be asked to contribute.

These are the questions. Use them one of two ways: to spark interest in legacy in your aging parent, or ask younger members of the family to use them on you.

1.  Please tell me one of your positive memories of childhood and why it is special to you.


2.  What has one of your life challenges been? .
,

3.  What is one action of personal empowerment you've taken in your life on behalf of yourself or somebody else? (Something important that you are proud of, little or big, that made a difference?)


4.  What is your favorite piece of art and why? (Book or poem, short story, painting, sculpture, piece of music, dance or architecture, gardening/landscape, quilt/textile art, recipe?)


5.  What is one piece advice you have to give me?


If you try these questions, I'd love to hear about what you learned.

On Bending the Rules and Saying 'Goodbye'

I'm not a renegade, at least not too much of one. Sometimes, though, rules can and should be bent.

For example, if a friend or loved one is close to passing, and another friend wants to come to the hospital to visit, can they?

For confidentiality reasons, nurses, social workers and other medical professionals can give little information to people other than the agent (power of attorney) and selected family members the patient or family has chosen. The nurses or social workers may tell you they can't answer, or they will divert your question or be silent.

Here are some questions they can't routinely answer:
1. What is his diagnosis?
2.  What is his prognosis?
3.  Will the person be transferred to a nursing home or stand-alone hospice building, and if so, when?
4. And of course, how much time does the person have left on earth?  No one really knows, and it's obviously against any hospital rules to be specific about this.

Family often set their own rules about visiting.  On Facebook, they may write, "No visitors, please. He is in pain and needs to rest,"  What they may really mean is they don't want a crowd swarming in their loved ones' room, or a parade of acquaintances coming by and disturbing his sleep.

Before you go, call up the nurse on the floor, and talk, is my advice. Often if you give information about your relation to your friend, you build trust. Then they can tell you in a round about way if it's a good time to visit.

Just last week my son and I wanted to visit our friend whom we'd known for many years.  I knew from Facebook that he might not have much time here on earth.  I called the nurse's desk to see if a visit was appropriate. I gave her lots of detail about how we knew him and that I'd heard he might be transferred to a nursing home or hospice soon.  We didn't want to miss this opportunity. "Can we come?"

Her answer was music to my ears. "Come on down!" I felt like I was on "The Price is Right." I was ready to win the grand prize!

We came. We were quiet. We hugged and told our friend we loved him.  We left a note for his dad, who was taking a break.

Oh yes, we prayed.  I prayed out loud, but I don't have the foggiest idea what I said. Words aren't so important at a time like this. God is. He knows our hearts.

If your close friend is very ill, don't hesitate to try to visit. Speak softly. Don't disrupt the nurses. Come on down!






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You'll know when it's time to whine!

 "My dad is driving me crazy!"  Linda is speaking of her 97-year-old dad. Maybe some of you can relate.

Linda and her brother call themselves " Dad's on-call assisted living support team." She might be immersed in a project at work when "Eldercare Alert" sounds, otherwise known as Dad's cell phone. She gets his panic calls several times a day. So does her brother.  "It's also possible we'll both get a call over the same issue, so we have to circle back and get things clarified."

Dad's needs and issues vary from day to day, with several themes running through: an eyelash stuck in the eye, constipation, food issues, medication issues.  On the good days, including 3 days before Christmas last year, Linda said Dad was a delight. But there are the not-so-good days, too, often related to his refusal to take Zoloft for anxiety. He'll take the medication for a week or two and drop it like a hot potato later, much to the dismay of his children who suffer through his negativity. 

According to his nurse-practitioner, assisted living won't work for him. He’s extremely claustrophobic, will only eat what HE cooks or what Linda and her brother take him every 2 - 3 days from one of 2 restaurants, and he has difficulty socializing. So Linda and her brother are doing all they can to help him stay in his independent living apartment. He does like that.

Last year Dad's is extreme negativity/anxiety/uncooperativeness/stubbornness, led Linda to write a letter to his doctor.  She took it to the staff and asked if they would PLEASE see that the doctor read it PRIOR to seeing Dad. It worked! Now Linda writes a letter to the doctor each time Dad sees him.  

All of this back and forth work is wearing. Linda says, "I’m tired and teary. Maybe I need to take some Zoloft?" Linda wrote this in an email to me and another friend, Joy. The three of us talk long-distance on the phone from time to time. Linda lives in Nashville. Joy and I live in Western Washington State. We've all worked with seniors extensively, and we know that the most difficult ones are often our parents.  Linda says it well: "It’s very frustrating to have felt that I was effective in helping folks adapt to senior community life and get involved in activities, and now to be unable to get the person I love the most to have improved quality of life."

In one of our phone calls, Linda asked Joy, "Do you have any advice for me?"

Joy said something only a friend would say to a friend.  And her words ring true:  "Find a friend who you trust totally. One who you can whine to.  Whine as much as you need to. When you're done, you'll feel better."  I agree.

Mindfulness: It's something for caregivers to think about

When we're stressed, we can do mindless things.

I'm not talking about losing cell phones, or glasses or keys to the car or house. I'm talking about temporarily losing ourselves.  Stress, through caregiving, grief or our own negative thoughts, can make us do mindless things.

The day before my father-in-law's memorial service, I got a haircut. The hairdresser was competent and caring, and the cut turned out well. I  placed some bills into an envelope for a tip, expressed my thanks, and walked out the door. Several minutes later I found myself asking, "Did I pay my bill?" I returned. "I think I may have forgotten to pay.  Am I right?" She nodded. "Has anybody else done that?" She shook her head. Oh my, oh my. I paid. "I'm so sorry. My father-in-law's memorial service is tomorrow. I was thinking about that instead of the present."

At other times I've been scattered and disconnected from life. Maybe you have, too. We multi-task, engage in continuous thinking, and rehash the past or rehearse the future. Our minds are off-center and we miss what is happening in the present. According to "The Mindful Advisor," by Eric Zook and Stacy Zook, CSA Journal, Winter 2015, 4-12, "This is what causes us to burn ourselves with the iron or stove, drop dishes, or have a car accident."

The Zooks are among the proponents of a mainstream movement called Mindfulness.  It's the art of being in the moment without a desire to change the situation. That means refraining from judging ourselves or the events or people in our lives.  It means staying in the present, neither exaggerating it or denying it. Says Social Worker Jeannie DeSmet, "When we're mindful, there's less need to escape a painful situation. The motivation is to care, not to cure."

The benefits of mindfulness for the caregiver and others are reduced stress, increased immunity and overall health, better concentration, improved creativity and innovation.

One way to aid in mindfulness is to practice deep breathing, which anchors our minds. As we do, we can stop, look, and listen, observing our emotions and paying attention to them.

Set a timer for two to five minutes and bring your attention to your breathing. Just notice the breathing; don't try to change it in any way. Once you have settled into a relaxed easy breathing, count down from ten to zero. Each full inhale/exhale counts a one. Don't worry if your mind strays; just come back to your breathing and start over at ten. Continue this exercise until you can make it to zero at least three times in a row. Then start the next workout session at fifteen.

Other ways to build mindfulness is to pay attention as you walk, drive or eat. The key is paying attention. When you walk, go slowly, outdoors or indoors, using stairwells. Be mindful of the act of walking.

I'm a work in progress when it comes to mindfulness.  I often have a difficult time falling asleep or staying asleep because my mind  races.  Paying attention to my breathing helps me sleep. I also like to walk slowly, taking in the act of my body walking.

Long term nursing beds are in short supply

Last week I did some research on long-term nursing home beds in Seattle.  I wasn't terribly surprised at what I found.

Of the 10 nursing homes I polled, all but two of them had a waiting list of at least a year.  These are not nursing beds in rehab but in long-term care.

So what does a person do while waiting a year for a nursing bed?  Good question.  Nursing bed availability gets more complicated when the elderly person has undesirable behaviors which are not deemed appropriate in a nursing home.  They're barred from admisssion, period.

Another potential problem: While waiting for a nursing bed, an elderly person may be paying $7,000 or so monthly in an adult family home, the most common health care setting that virtually mirrors nursing home level of care.  If people run out of money while waiting for a nursing bed, they may be able to convert to Medicaid funding at their current adult family home. If their home doesn't accept state-funded residents, they will have to move to one which does accept residents on Medicaid.

Further complications:  Almost all nursing homes accept Medicaid, but a few don't. Some nursing homes only accept residents of their continuing care retirement community, but not from the outside community. Others give priority to their continuing care retirement residents, and accept others when there is room.

And one nursing home in the area has a short waiting list for private pay folks and a very long list for Medicaid-funded residents.

Are you thoroughly confused?  I wouldn't be surprised.  I think the moral of the story is this:  If you think your parent will need a nursing home at some point, get on one or more waiting lists early.  In the meantime, find an adult family home to see how that works.

It seems like the long-term nursing beds aren't keeping up with the demand.

Fall is the time to begin thinking about aging parents

A funny thing happens at the start of the school year.  Families begin thinking about their aging parents and see a need for a change.  Fall is a busy  time for Silver Age Referrals, as the number of emails and phone calls rise.

Often the adult child has visited her parent and has seen their home.  Perhaps the refrigerator resembles a petri dish, and the canned goods and packages are "vintage" with pull dates from the turn of the century.

Other danger signs appear from room to room:  papers piled high, throw rugs ready to trip on and a bathroom without grab bars.

"Something is not right."  Those words of Miss Clavel in the children's storybook Madeleine may seem apt for this situation.

Other scenarios can be telling.  Adult children may be caring for their aging parent and realize that they can't do everything.  Or they see that their social butterfly Mom is wilting by being left with only family to talk with.

One of the most difficult situations involves a caregiver spouse, whose workload is unbearable, especially given his or her her age.

Every family is different, and every situation is unique.  At Silver Age Referrals, we tailor the care to the person or persons.  As we discover what makes the person tick and what works for the family, we can come up with good choices for the next step.  

We like what we do, and it shows!