Thursday, February 18, 2010

What's the "best truth" for our elders? The state of denial ain't so bad....

I regularly read several online publications about care giving and lately I really want to smack a few authors and a whole lot of commentors.    A very common question is "How do I get Mom or dad to stop asking to go home?"  or - "How do I get my dad to be nice" or "How do I get Mom to face reality?"   There's always some dope who comments like this:  "If you respect your parent, you'll tell them the'll make them see that they need help."..."Tell them their behavior is unacceptable; force them to change." 

( Some major eye rolling and HEAVY SARCASM intended) - Yea, right... obviously they do not have an elder in their life and they've never spent more than a day or so helping an aged and sick loved one.   That is the absolute WRONG advice.  WRONG, WRONG, WRONG!!!!!! Nothing will make your elder and you - but ESPECIALLY YOUR ELDER -  more miserable.   I've been through this over and over with uncles, grand parents and now with my own parents.  It is a rare - I REPEAT A RARE elder, who is realistic about their situation and their abilities.  To force them to face reality is simply the cruel, mean thing to do.    The truth is harsh and inevitable - joints, eyes and hands all failing; blood pressure and blood sugar up and down; lungs or kidneys working at greatly dimmished capacity;  bones that will break with the most minor fall - the inability to make new memories and someday, relatively soon, choices about life support, caskets, cemetery plots and burial clothes  - this is the truth, this is the reality.  Simple but fearful and painful.

In our culture we insist on truth. We place great value on it; we equate truth with respect.  The two do go hand in hand but not in the case where you are dealing with an eldery (and perhaps demented) person in the last stage of their physical life.   The truth of their situation is too much to bare.  They can't understand that they need multiple medications to maintain their existence.  They want to be where life meant the most - at "home" where they felt loved, comfortable and surrounded by the things they earned for themselves.  

We - their loved ones, family and friends  - are not comfortable with this truth - that they are failing, that they are frustrated, that we can't fix it.  There is no logic, there is no pill, no amount of therapy that will help. So  why tell them? Why make them understand the gravity of their situation?  We will only have to say it again and again. They won't remember so we only frustrate ourselves.  We can only make their current existence more tolerable. We can only love them as best we can.   We can help them live in a state of denial and it's okay.  It's the respectful thing to do; it's the loving thing to do.  We tell them that "home" is there just as they left it, waiting.  We tell them that when they're better, we'll help them get there. We lie and it's okay.

Years ago my uncle was dieing from lung cancer but in his mind, he would re-couperate. He'd get disability and have all of his time free.  He would set up his dream wood working shop and make lovely furniture.  We knew the outcome; he had only months, most likely weeks, to live. His surgeon called me one day angry that he was not "moving through the stages to acceptance" of his terminal condition.  My reply:  "Why is that necessary?"  The surgeon could not answer.  He could not tell me how my  uncle would benefit from the harsh reality that he would soon die.  I and my family helped my uncle live his lie.  We watched videos of New Yankee Workshop and discussed wood working techniques.   We read wood working magazines with him, we planned furniture.  Each visit he had hope and looked forward to something.  He was not a spiritual man but I know deep down inside he knew his fate.  He was distracting himself with another truth - he kept his mind busy dreaming of what he'd do at "home".   After all of these years, I know he is "home" and he's busy in his wood shop. He is in the home he dreamt of during that final time of his life.  I'm glad we helped him live that lie because it meant that we laughed, continued to share and that he felt good about every one of his last days.

Mom's better and new teeth are in the works

After several days of illness, Mom is on the mend; her teeth however, are gone for good.    After calling for several days, I finally got her on the phone today and she sounds much much better. I am so relieved.   They have not found her bottom denture so we assume it was tossed into the garbage.   The social worker at the nursing home will make an appointment with the denturist, arrange to get her there in their van and tell me whom to call about payment.   I used to feel pressure to make all of Mom's appointments and then be there to go with her - I've given that up.  These facilities - assisted living & nursing homes - are getting paid REALLY well so they can do it.   I have decided to take FULL ADVANTAGE of their expertise.  I will ask that they arrange these sorts of things and then get Mom to the appointments.   They have the knowledge of providers in Mom's home town, they have the van with the doors and safety equipment to get her there easily.   They also have people who will go with her if I or other family cannot make it.   It's one less thing to stress me out and thus I can be more carefree in my conversations and visits with Mom.

I decided not to make an issue out of the missing denture because Mom was due for a new one anyway.  I believe the loss is their fault, their staff should be more aware of things like that but it's an understandable mistake.  The denture was wrapped in tissue and Mom probably didn't tell the aide what it was when she said, "please put this away...". The aid was likely more concerned about safely getting mom to bed or to the toilet since it happened while Mom had upset stomach, a cold and diarrhea. 

Old people often need dentures every few years even though they don't get them.   Without teeth the bones that make up our gums gets smaller so there is nothing there to hold the dentures in place - thus the need for all those commercials for denture goo, pads and gels - "adhesives" is the proper term I guess.  Mom refuses to use them.  She might not have a choice after this next appointment. 

Monday, February 15, 2010

Mom's latest dilemmas - three illnesses at once and lost teeth

Talk about bad days, Mom's had a whopper yesterday .  She sounded bad on the phone and bravely said, "I feel a bit better than I sound, and I'm on the mend."   Long story short, she has a urinary track infection, a cold and diarrhea.  To top things off, she's lost her bottom denture.   These infections leave her weak so she requires assistance to get in and out of bed and to and from the toilet. She hates being so dependent on someone else.  Though she's weak, her spirit sound strong.  I'm relieved about that anyway.

Lost dentures are pretty common in nursing homes.  Residents take them from each other. If someone's tired they just take them out and put them down, leaving them in weird places.  In Mom's case, she was trying to be polite. Her lower gum hurt so she took them out, politely put them in a tissue and handed them to an aide.  She asked the aide to "put these away for me..." - they most likely ended up in the trash.  She didn't want to hand some ugly teeth full of spit so she put them in a tissue.  I called the nursing desk today, a Monday, and they were unware of the missing teeth. It's been 7 hours and they still can't find them.  So now the question - who pays for the replacement teeth?   Honestly, I don't care - it's really a minor thing to fuss over when I'm more worried about these infections.  She needed a new bottom plate anyway so this just means it happens sooner than later.

I'll work with them to ensure she gets "soft" foods until she's able to get to a dentist for replacements.  I'll also try to talk with Mom even more to make her feel better, to understand that we'll deal with the new denture as soon as possible and let her know she's loved.   It's about all we can do for now.

Moving a parent to your state could cost A LOT!!

Before moving your elderly parent to your state be very careful about finances.   If your parent requires financial assistance from the state for medical expenses or long term care, you might NOT be able to move them.   Assistance programs like this are intended for STATE RESIDENTS, not transplants from other locations.    Your parent might have to establish residency in the state BEFORE they are eligible to get any assistance.   Each state has different residency requirements so check those out thoroughly before moving your elder.

The best advice I can offer is to move your parent close to you BEFORE they might need the assistance - long before.  If you don't do this, you might have to pay their expenses or have them live in your home until they establish residency and qualify for assistance.