Saturday, June 6, 2009

Decline, like growth, happens in spurts

I find myself talking with the PARENTS of my friends more and more these days; they are dealing with the same parental situations as me. I was born when my parents were in their early 40's, they soon had grand kids near my age. Most of my friends parents are active, healthy and have done a lot for themselves. They are often shocked at things their parents do or can no longer do for themselves. I am not. At an early age, I saw and helped my parents with my very elderly grand parents.

Over the past year one thing has come up again and again from family to family - grandma or grandpa changes a lot during the 3, 6 or 12 months since the last visit. It seems that, like little kids who have growth spurts, elders decline in spurts as well. Within 6 months my Mom went from preparing simple meals like soup and a sandwich to being unable to open a can of soup with a conventional can opener. (We got an electric can opener but after another 6 months she was too weak to lift a 14 ounce can.) Her grip went from knuckle crunching to slight, like that of a six year old. Two years prior this, stairs suddenly became a huge problem. She feared going down stairs and going up she would take one step at a time putting both feet on a stair before tackling the next one. Our solution was to put in a ramp to the yard; we moved all of her living to one level of the house the year before.

My Mom's decline demonstrates the need to OBSERVE and ACT. If you are trying to keep your Elder in their home, look for ways to help them do as much as possible given their limits. Prepare to make adjustments often and make sure they are safe. Here's a minor example but one thta means a lot to Mom: She likes a cold Pepsi every afternoon. When I saw her pry open the top of the aluminum soda can a butcher knife I found some plastic gizmo's that fit over the tab and enable the user to lift it to open the can.

Often as our Elders age eating becomes a problem and is something that family must watch closely. Elders will TELL you they are eating well but often they are not. They compromise and eat what is at waist level - donuts, sandwiches for example. They forget how long left overs sit in the fridge and eat spoiled food. Mom's inability to make a meal for herself was a primary factor in our decision to move her to Assisted Living. I dropped by at lunch time to visit and Mom said, "It would be nice to have some warm soup." Translated this means, she can't prepare it for herself and she'd like me to make some lunch for her. It was rare that I visited Mom on a weekday and I suspected she was growing weaker. I told her we'd make it together so handed her a can and the electric opener while I got a pan and some sandwich fixings. I watched her struggle to get the can in the opener for a few minutes. Soon I blamed the opener as to clunky to help her save face. I fixed lunch and we had a nice visit. I left convinced it was time to move her.

Making decisions for Mom means risking her anger and hurt

Mom has changed, she is no longer the realistic practical mom I grew up with. She is whining, complaining about minutia like the texture of pasta, toast that's too light and watery soup. She refuses to get out and meet others; she makes excuses not to walk or talk. I must accept that she will not make decisions for herself any more, that we must decide on her behalf.

Dealing with this change is the hardest part of helping my Mom. She is the one who convinced me to take a class in logic and explained abstract math concepts of algebra. To realize that our roles have completely shifted is difficult. It means admitting that she is dependent on me to make most of her decisions. It means that even though I discuss things with her, I might make a decision that is contrary to her wishes. She can still understand a smart argument for or against something yet her emotions always seem to win out. She can't always apply reason and it's difficult for me to comprehend how that can be.

I am afraid to make these decisions because it means she might be hurt or angry with me. I feel guilty because I feel manipulative. I know what needs to be done and must get her to come to the same conclusion, some times that means telling half truths or filtering the information I provide to her. It's for her own good I suppose but it doesn't mean it feels good to me.

Wednesday, June 3, 2009

Talk of "home" is ladies last..

Sometimes a simple act has great significance to an elder. Whether they are at home, living in a facility or hospitalized, just a few moments of time spent can lift their spirits for days.

I spent the last week of May in my home town and saw Mom every day. On the way to her room one afternoon I saw a very elderly lady struggling to get comfortable in her chair. Feeling bad, I sat next to her to ask if I could help. We easily began a conversation and it turned out that we had some connections. Fay, age 93, turned out to be the aunt of my cousin and she grew up in the same small Hoosier town as my husband.

Fay told me as much as she remembered about my cousin and we talked about the old businesses in that small town she remembered so well. She brightened up as she described the cafe where she met her husband and how she worked to send him money after he moved across the country get settled ahead of her arrival. I reassured her that the cafe was still open ( it really is) and I told her about recent renovations at the historic county court house, a relatively new building when she moved west in the mid-1930's. We talked of things she missed about the midwest - huge peaches, lightening bugs, the beautiful fall colors and her family. We also talked about things particular to her home town - traffic at a stand still several times a day as long, long trains passed through, the old brick Catholic Church torn down long ago; the fierce wind and hail that build quickly and pound through town and the flooding that used to happen on the south side of town. I know relatively little about my husband's home town, but the things I do know were the same things that Fay remembered very well. Coincidence?

Fay easily remembered both addresses where she lived so I relayed those to my husband who took pictures of the tiny houses and emailed them to me. Our talk lasted only about an hour but she was truly aware and so happy to make a connection to her friends and family; it was something familiar in a place and time where she outlived all her "new" connections. She mentioned that she had not seen much of her family since moving in the mid- 1930's so meeting someone from "home" was exciting.

Before I had a chance to print the photos and deliver them, Fay passed away in her sleep just two days after our conversation. At first I felt bad that I had not made it with the reprints of her home but I guess that after our reminiscing she decided to go there and see them for herself.

Dealing with visits

Once I got Mom to move, I had a deliberate plan to get her settled, ensure the facility understood her needs then leave town to force her to get acquainted. Leaving her there and leaving town was harder than I expected. I didn't want her to feel dumped, isolated, lonely and despondent - I still don't. But, she HAD to get used to it and I needed a break from the emotional and physical demands of the whole situation.

In mid-April I got mom settled into a studio apartment at an Assisted Living Facility (ALF). I saw her daily for 3 weeks and the time was filled with hanging pictures, labeling clothes, sheets and towels; doctor visits; nail clipping; permanents and visits from other family and friends. Then I left town and promised to return in 4 weeks. While I was away, I called Mom every other day, some days she was fine others she cried and wanted to go home.

As promised I returned to see her and saw her daily for a seven days. It was really rough at first; each visit left me frustrated and in tears because she insisted she can live at home just fine. After 3 days I was a wreck and realized that I was feeling physically ill from the stress. To cope I came up with some ideas that enabled me to visit Mom, spend quality time with her and enjoy her company. I still have to be firm about the reasons she's moved - it is safer, she will get her meds as needed and she will eat better. It's become my internal mantra around mom - safety, meds, food - safety, meds, food - safety, meds, food..... To keep my sanity and be good company for Mom, here's what I try to do:
  • Keep visits short but go often; stay 30-45 minutes, but go visit twice a day if possible
  • Get funny: find a funny story, joke or something like that to share during your visit
  • Read the paper together, helps keep parent current and give you some common ground
  • Go sit outside: often it's the only time they'll get outside is with assistance and some sunshine is good for creating vitamin D
  • Share a crossword puzzle
  • Watch a special program: our favorite are Red Skelton videos and Turner Classic Movies
  • Do projects: re-organize photo albums; I bought a cheap scanner and left it at Mom's apartment. On our next visits we will scan photos; it will give use time to talk about the subjects and people in pictures, capture interesting family histories, names, dates and relationships.
  • Go "out" into common rooms for a soda or coffee and speak with other residents, then introduce your parent
  • Attend events at the ALF like bingo, concerts or other outings
  • Play games; play scrabble, cards, use the facilities Wii for bowling or golf
Think of things that would be meaningful and fun for your parent. Ensure that they are engaged WITH you not watching you. Don't forget to take your parent out to family gatherings, most ALFs will loan wheel chairs for easy transport.