An old friend called a couple of days ago looking to find some way to help her mother after she returned home from a back surgery. It was an odd call full of questions from her and sound answers from me (or so I thought...) but I don't think she got the answers she wanted from me. Long story short, my friend can't realize that her mother probably needs the professional care of LPNs, RNs or CNAs after surgery. She wants to keep her mother in her own home rather than use the available resources to ensure that her Mom is safe and well tended during her recouperation. She seems too proud to admit that her mother needs the additional assistance of professional care givers.
Here's the scenario:
Friend's Mom is 84 and has severe osteoporosis; so bad that she broke three ribs trying to lift a 10 pound chicken from the freezer and thus the need for surgery. She lives alone, goes to mass each morning and walks 2 miles a day. In the past year she has been hospitalized and recouperated at home after a severe bladder infection and again after surgery to repair cracked vertebrae. The vertebrae surgery required a brace that was nearly impossible for her to get off and on by herself and limited her movement and increased her risks of falls. Friends Mom had bad experiences with pain medication; she was either allergic or took too much but because she was home recouperating alone, no one knows for sure. She woke up on a soaked kitchen floor with buckets, cups and plates all around her and no memory of what happened. There have also been some instances when Friends Mom got lost when she travelled to an unfamiliar part of town; it's small enough that she should have been able to find her way to familar territory.
My friend hoped to work out a schedule with her siblings (think no cost to Mom) but they all have commitments to jobs, kids in school and in-laws that need support during chemo and surgeries as well. Her dependable and responsible siblings used their available vacation time for Mom's previous recouperation so had none left to use.
My first response was : Let Medicare pay for time in a rehab center (nursing home). (They pay for 100 days, 3+ months of rehab care after surgery or hospitalization).
I thought my friend would have a herd of cows right then and there! You'd think I suggested throwing her Mom out the car door at high speed. It went something like this: (Explicative)...Mom can't go to a nursing home! She's not one of those old ladies! How could you even SAY that?!! My second suggestion was to contact a home health care provider to go by 3 to 4 times a day but at nearly $16 per hour that was out of the question as well.
In all honesty, Friends Mom IS one of those old ladies. She is quite frail, needs someone to ensure she eats and taked meds regularily. She also needs companionship and, most important of all, she needs some skilled nursing care (think professionally trained) and rehabilitation to get back on her feet after this surgery. She will ONLY get that at a nursing home or from home health care aides. If you can afford the care at home, by all means, do it, other wise take advantage of the Medicare policy and let your elder get the care s/he needs. 100 days is a long time to recoupe from a surgery and she would probably would not be there long but she's likely to recoupe faster with the care they can provide. Rehab centers or nursing homes are well prepared to deliver 3 meals a day, medications, physical therapy, bathing and toileting assistance. These are things that we just can't do well at home if we're helping out as our busy schedules permit. Our Elders deserve the full attention of professionals if we aren't able to do it.
To be sensitive to my friend - She has deep love and respect for her Mom. She wants to be supportive, she feels guilty and knows her Mom will feel best emotionally at home. Yet,she expects too much of local relatives who can't be there and she is unable to travel to help due to her own job. I can say, based on my own failure to act, denial is really easy but can cost Mom a lot in the end. There comes a time when our elders need our help in spite of our own preferences, pride and aversions. Let go of the stigma that nursing homes are terrible. Most of these facilities realize that the payments they get from Medicare are important and reliable revenue; they won't screw it up. Their employees also enjoy knowing that they can help elders get back on their feet and WANT to see them go home because it means they did their job well and had a success. They are proud of the kind care they can provide; we just need to swallow ours and let them do their jobs for our elders.
Tuesday, June 23, 2009
Friday, June 19, 2009
Brother wants to move mom in
As I expected, I got "the call" from my brother the other day. He wants to move my mom into his home. I must be painfully honest here, this brother and I have rarely got on well. While his initial intent is probably good, he has a way of trying to weasel things to his benefit and it usually turns out poorly for all involved. He is trying to be sensitive to our past and began this discussion with a voice mail: "I want to have a nice friendly conversation...." I dreaded returning his call but it turned out well. We agreed to discuss the idea and I told him it's my responsibility to play devil's advocate and look out for what's best for mom.
I had considered this scenario - Mom living with them - but it only lasted a few minutes then I dismissed it as unwise. I know just what my brother is feeling, we don't get along because we are very much alike in some respects. We both want to help family, we both want to make Mom's money last as long as possible; we both feel a sense of obligation to try and make her last years as happy as possible. That said, there are practical considerations that we must consider.
I had considered this scenario - Mom living with them - but it only lasted a few minutes then I dismissed it as unwise. I know just what my brother is feeling, we don't get along because we are very much alike in some respects. We both want to help family, we both want to make Mom's money last as long as possible; we both feel a sense of obligation to try and make her last years as happy as possible. That said, there are practical considerations that we must consider.
- First is the amount of help Mom needs. I don't think my brother realizes just how much mom CAN'T do for herself anymore. Holding normal spoons and forks is hard given her weakened hands and failing dexterity. He is not the one who would help Mom; the burden would fall completely on his wife. Mom also has no chronic problems like diabetes or heart disease that would speed her passing. Aside from arthritis, her heart, kidneys, liver, digestion, etc.. are all good. She could live another 5 years or more. That's a long time to help someone who needs so much.
- Second are personalities involved. My brother will not be the primary care taker; his wife will be the one who helps Mom. My sister in law and mom probably could not get along under the same roof. Mom is very intelligent and logical; she has years of experience doing many things and she wants to be involved. She also doesn't understand that others need to feel that their methods are meaningful too. I just know Mom would end up criticizing sister in law and it would sound insulting. Feelings would be hurt, anger would result and then resentments would build.
- Third is money. Brother suggested that his wife (sister in law) quit her part time job and Mom pay them the same amount each month to live with them. Seems easy enough but they fail to consider that sister in law can leave work and stress then come home to relax. If Mom lives with them it's a 24-7 commitment. Brother and family are also not the best at budgeting; I know that soon they'd be asking mom to "help" round out their finances with extra money. They would not intend to take advantage but it always seems that something goes unpaid - the electric bill, the phone bill, the water - it's inevitable that they'd look to Mom for help and that's not acceptable. She's avoided helping too much thus far but living there would mean greater pressure and resentments on both sides. She doesn't help, they resent her and her prescence. If she does shell out more cash; she resents them and feels used.
- Fourth is respite care for Mom. Brother has diabetes; sister in law has problems with knees and feet. They also babysit their 2 year old grand daughter. I live in another state so could not easily get there for emergencies and stay without advance planning. There is no one to stay with mom if they need a break for more than a few hours. They deserve some vacation time. Who would do this? How long could they go without a break? What if one of them has a medical emergency ? Their kids will want to be with their parent not staying with grandma.
- Fifth are the conditions of their home. They live in a small place that is elevated by steep steps. Mom could not get in or out without a lot of help. Neither brother or sister in law can carry Mom; special ramps or something are required. There are no bars in their bathroom or shower. Door ways and halls are not wide enough for a wheelchair and remodeling is not practical. I feel the home is cramped for two people, a third with special needs would be so cramped as to cause great stress and inconvenience.
Signs your parent needs "adjustment"
Two main objectives to keeping your Elders at home are enabling them to do as much for themselves as possible and ensuring their safety. Often they will make minor adjustments for themselves to help get things done but we kids and grand kids we also need to OBSERVE and ACT to enable their day to day activities and be safe.
Be patient and prepare to do things like this often or RE-do them often. I see things during every visit that I can change for Mom to help her do things more easily. As she grows weaker, we often address the same problem again and again. When she began to have trouble doing laundry, we got front loading washer & dryer. Six months later stairs were becoming difficult and were impossible with an arm load of clothes, so we did a minor remodel and moved the new machines from basement to the kitchen. Three months after that we had to install a shelf to create storage for the laundry soap and softener at arm height so she didn't have to reach up or bend down to get at it. Within a few more months, she could barely lift wet items from the washer to dryer but she kept at it one garment at a time. She wanted to do it for herself so we enabled that through a lot of work and effort on our part. Remember if you care about your parent, Aunt, uncle or friend, you will help them to help themselves.
Here's a list of things that we did at Mom's that enabled her to do for herself and be safe. Be sure to read later posts with aging in place tags for more ideas:
Be patient and prepare to do things like this often or RE-do them often. I see things during every visit that I can change for Mom to help her do things more easily. As she grows weaker, we often address the same problem again and again. When she began to have trouble doing laundry, we got front loading washer & dryer. Six months later stairs were becoming difficult and were impossible with an arm load of clothes, so we did a minor remodel and moved the new machines from basement to the kitchen. Three months after that we had to install a shelf to create storage for the laundry soap and softener at arm height so she didn't have to reach up or bend down to get at it. Within a few more months, she could barely lift wet items from the washer to dryer but she kept at it one garment at a time. She wanted to do it for herself so we enabled that through a lot of work and effort on our part. Remember if you care about your parent, Aunt, uncle or friend, you will help them to help themselves.
Here's a list of things that we did at Mom's that enabled her to do for herself and be safe. Be sure to read later posts with aging in place tags for more ideas:
- Opening cans of food :
moderate difficulty: get an electric can opener
more difficultly: buy foods with flip top lids - Soda cans or bottles: Get Open Sesame - a multi-tool for cans and bottles. It works on flip top soda cans, twist off caps and has a magnet for storage on the fridge.
- Opening jars:
moderate difficulty: use rubber gloves, one to hold the jar and one to grip the top
more difficulty: use under the counter mounted devices; these grip the lid while the user turns the jar, using rubber gloves to grip the jar is best. I don't have a specific name or source for these; I've found them in catalogs, dollar stores - I saw them in all kinds of places when I didn't mean to buy one and ordered one online when we did need it. - Stairs: often going down is more dangerous than going up - my Mom seemed to have equilibrium problems when looking DOWN and decending at the same time. Ensure that railings are tight and strong enough to hold up under a lot of use and a lot of weight. Can you install railings on BOTH sides of the stairway? Consider a ramp for short rises like from the back door to the yard. The most sure fire safe thing: get your Elder on one level - eating, relaxing, sleeping, bathroom and laundry. There are also more spendy solutions like the lift chairs that ride up and down on a railing; I've seen this only once and it was quite an expensive solution. I'd prefer to sacrifice a formal dining room or living room to get my Mom on one floor.
- Medications and pills: This is one of the touchier issues with elderly folks. Often Elders underestimate the importance of keeping up with medications for a variety of reasons. This is another key issue to consider whether an Elder can no longer live alone.
moderate difficulty: make a schedule by time and put it on the fridge, get a pill box labeled by days of the week or even morning, noon and evening. Fill it for them weekly.
more difficulty: Call them with a reminder or hire an aid to visit regularily and remind them to take their meds. Sometimes aides cannot give meds due to liability but they can check the pill box and the schedule and "help your Elder remember" with gentle words. This person should also report back to the family if the Elder refuses, the pills in the box don't coincide with the schedule or other issues crop up
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.
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.
Subscribe to:
Posts (Atom)
Posts
