Archive for the tag “help”

Choices for the Future

I find many ideas for blogs while I’m at the airport waiting for my flight. It’s a great place to people watch. Usually I see older adults interacting in ways that inspire me—an older woman helping a mom entertain her little children. A man who is stooped and old but tries to give up his chair to a pregnant woman. Sadly, during my last trip I watched the actions of an aging man that was disappointing on so many levels.

Directly across from me in the waiting room sat a large older man—perhaps about 70 and at least 90 lbs or so overweight. He was on his cell phone talking with a business colleague about a meeting they were going to attend. During his conversation, he ate two large candy bars. As soon as he hung up, he dug into his travel bag, took out his insulin pen and injected himself.

What do young people think as they watch people like this man abuse his body knowing their generation will be taking care of him and others like him who chose smoking, drinking and overeating? I think most of us embrace the beautiful older man or woman down the block who is independent and taken care of him/herself but who is wearing out with advanced years. However, it difficult to feel very good about giving time, money, healthcare etc to those who don’t respect their own bodies.

I was embarrassed for the man at the airport, for me and for the boomers he represents. We are a big group of 78 million people in the US alone and every Nation is struggling with resources as this pig moves through the python. There has to be some accountability for those who don’t care about the future. I wish I had answers.

~ Susan

Breaking Bad Habits

Breaking Bad Habits

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You found the right assisted care facility but can your parent stay there long-term?

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Be very careful when you help your parents move to an assisted living facility because they may be kicked out just when they settled in and think of the place as “home.”

Why?  Assisted care is just that—“assisting” a person who isn’t doing well at home and needs help with what are referred to as “activities of daily living” or ADLs. These include bathing, toileting, dressing and transferring (from bed to walker or wheel chair, etc) and help taking medications. Think of ADLs as the “personal” chores of day-to-day life. The assisted care staff is more “custodial” versus the “skilled” care of a nursing home. However, an RN is often on staff of the assisted care facility and able to administer some procedures such as insulin injections multiple times each day if needed. The decision about what is offered can vary from facility to facility and the monthly fee usually increases with escalating care needs.

When searching for the right facility for clients, most have said they will even keep the elder if they should suffer Alzheimer’s or other types of dementia.  As long as the client isn’t on an IV or some type of advanced procedure, they would be able to live out their life within the assisted care facility. This is important to older adults and their adult children because transitions are extremely difficult for elders. I’ve known of cases where within a few days or weeks of such a move, the very healthy elder died. The move was simply too much to absorb in a life already filled with losses.

Since few older adults will require skilled care provided in a nursing home, the assisted care facility should ideally be their last move. If they suffer a fall or pneumonia or other disease or injury require skilled care, they may be required to move to a nursing home for a brief stay to recover but then they should be able to return to their assisted care facility.

However in a two situations we recently experienced with elders we knew, the elder was asked to leave the assisted care facility. In these cases, it was determined by the assisted care facility administrators that client’s level of care had escalated and now required skilled nursing care that could only be provided in a nursing home.

On the outset, while sad that the elder must move again, it seems reasonable if the care required had truly gone beyond what was normally provided in assisted care.

However, in each of these cases, the children of the elder and the elders themselves stated that while they needed more support dressing or transferring, etc, they weren’t on IVs, in a coma or requiring advanced medical procedures or experienced nursing beyond medication management.

What these cases had in common was that each of the elders had outlived their personal financial resources and had transitioned to Medicaid support which pays less than the rates typically charged by facilities. In both cases, these facilities said they would keep clients who began as private pay and moved to Medicaid so they couldn’t ask the clients to leave based on the change in finances. However, they could make them leave if they could prove the elder required skilled care. I found it interesting that in two cases mentioned, the assisted care facility had been taken over by a large chain. One can’t help but wonder if the new owners wanted only private pay clients in order to maximize their income potential.

In both circumstances, the elders and/or their adult children filed a grievance and both won their cases allowing the older adult to remain in the assisted care facility.

If you think it’s possible that your parent could outlive her resources when moving to assisted care, be sure you understand the facility’s policies about Medicaid. Additionally, if your parent is asked to move, you can and should appeal.  As part of this process, get an ombudsman involved. If you are in Oregon, go to: http://www.oregon.gov/LTCO/Pages/index.aspx. If you are in any other state, Google “long term care ombudsman in XXX [your state]” or call the local Area Agency on Aging (AAA).

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Finally, when considering the possibility of moving your parent to a facility, call a geriatric care manager (GCM). We are experienced in listening to yours and your parents concerns and needs and advising about programs and support available that may allow them to stay at home. When moving is necessary for safety, we will help select the right facility that will support safety while also encouraging maximum, capable independence.

~ Susan

 

 

Ten Minutes

Tired from a turn-around trip that began with a 6:15 am flight out of Portland, I waited at San Jose Terminal B, gate 23 for my return flight on Southwest. I had spend much of the past week preparing for the new business meeting that took me to San Jose. As I sat in the terminal following the meeting, I contemplated business, the slow economic recovery, money and retirement. Looking up from deep thoughts, I noted an older man, somewhat disheveled walking unevenly and tentatively toward the gate counter. With shaky hands he withdrew his ticket from his shirt pocket handing it to the gate agent, “Am I in the right place?” She responded automatically, “Yes” and offered nothing else. He looked around and walked towards the empty chair next to me. Knowing he was uncomfortable, I wanted to make up for the insensitivity of the gate agent.

I began, “Hi, are you flying home to Portland or visiting someone?”

“I’m going to visit my son. I haven’t flown in a very long time and I feel so unsure of myself.”

“It’s fine. Together we can listen for the boarding call and then I can show you where to line up. Has it been a long time since you’ve seen your son?”

Tears filled his eyes as he replied, “No, he and his brothers and sisters have visited me often recently. Their mom died three months ago after being on life support for too long.  It’s an awfully hard decision to know when to say “it’s time’ after more than 60 years of a life together. I just couldn’t let go and I think I made her suffer too long.”

 

Filled with his pain, I offered what seemed like empty platitudes, “There’s no way to know when the time is right and no one can guide that decision. It’s something you worked though, and when you were ready and you felt she was ready, you let her go.  There’s no timeline for letting go of the person you’ve loved so dearly.”

His smile of appreciation felt undeserved.

“I’m John.”

“Hi John. I’m Susan. It’s so nice to meet such a brave man.”

With a weak chuckle he said, “I’m not brave. In fact, I know this will sound bad but I’m not sure I will choose to stay around much longer. That must sound awful to you, but each day when I begin to wake and reach over to the empty place on the bed, I can barely breathe. I lay in bed sometimes till afternoon. Just waiting for the pain to leave, for her to talk to me, for something…I don’t even know what. I’m so empty inside.”

Frozen in grief I couldn’t find words, and I knew that nothing I said could answer his need.  Still the energy connection gripped me. His heaviness was now mine as well.

Slowly and painfully I offered, “I don’t judge you. I have told my children that I when I’m done, I’m done. My father died recently—he was 95 and he very much wanted to die for the last two years of his life. It hurt me terribly to watch him. He even asked me to help him die and I could do nothing.  He thought he wanted to die when he was about 85 and my mother died. The first year was the worst.  After that he began going back to church, getting out a little more, and he found he had more life to live. Meaning and purpose may shift for you too.”

“I don’t know. I can’t see beyond today. I don’t really want to visit my son although I love him. It takes so much energy and I’m exhausted. I’m hoping that if I force myself, I might find some relief.  Traveling is hard on me. I’m uncomfortable asking for help or directions. I feel like people look at me like I’m just a helpless old man. I’m getting forgetful—happens when you are old.”

“John, I’m forgetful and I’m 63. I don’t know when this “forgetfulness” started for you but it started for me in my 20’s when I had four children!  It’s not exclusive to being older. It comes about because we accumulate years and years of to do lists, of birthdays, of 85 years worth of schedules and memories we want to hold onto.  People think so many things are old age related when in fact aging begins the day we’re born.”

He laughed and his hand grabbed my hand and he simply said “Thank you.”

The gate agent called for A boarding—my group. I asked John to move closer to the lines and told him that when they called for B boarding he would line up in the first column pointing to where he should stand. Noticing a seat near the line I suggested he sit until it was time to line up. As we walked together, I noticed a young woman making her way toward the seat. Touching her arm I asked if she’d mind if John sat. She nodded to him and said, “Of course not.”

John looked at her slyly and said, “Or I could sit and you could sit on my lap.”  Pleased with himself he lit up and we all laughed.

I was hopeful as I boarded the plane that his momentary joy might be a brief peek into a life of renewed purpose. He is such a beautiful soul and to have him leave this world early would be a loss for all those whose life he touched, including me. Ten minutes with John and my life is forever changed.

Susan Cain, Sometimes weary but recently enlightened life course traveler

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