Tea with a Purpose

Tea with a Purpose

Too much coffee and tea can be a good thing. Let me explain. A few days ago, after visiting a client at White Plains Hospital Center, I stopped by their recently opened café for a cup of coffee and a freshly made gluten free blueberry tea cake. The hospital is known for its good care and the café is now following in that tradition, albeit gastronomically.  As for the tea cake, it was delicious. I do not have food allergies, but a weakness for a good piece of plain cake.

Twenty minutes later, I arrived in Harrison, New York at the home of a nearby client.  The taste of the coffee was clinging to my palette and I secretly wished I had bought another of those sweet treats for later. Hearing the bell, Helena reluctantly opened the door, always suspicious of who is knocking (not a bad thing). Recognizing my name, she let me in. Sometimes I am sequestered in her foyer for the visit and other days I am escorted into the kitchen. Today was a kitchen day. We started our conversation and then, as it progressed, she asked if I wanted a cup of tea. Did I really want to forgo that lingering taste of coffee for tea?  Truthfully, no, but I happily accepted.

Why did I say, “Yes” when I could have just as well said “No?”  It all has to do with purpose in one’s being. It’s a life quality that starts to wane as one gets older. You’re told to stop driving because you had a couple of fender benders. So now you can’t visit your home bound friend or be a volunteer driver for Meals on Wheels. And then the greatest upset of all, your spouse passes away. No one to cook that special dish which brought such accolades despite its simplicity.  Such was the case with Helena. There was no longer anybody to make that cup of tea for, so how could I ever think of saying, “No.” I sat at the kitchen table and watched her take the crackled and stained mug out of the cabinet.  Water boiled, she carefully handed me my tea, mystified as always, that I take it plain.

The act of making the cup of tea for this geriatric care manager, was both an act of kindness and the momentary gift of purpose. As for the taste of the coffee no longer lingering on my palette, it was surpassed by the opportunity to return to Helena a memory of time sweet, if not sweeter, than my blueberry teacake. It was a very good visit.

Mi Casa Su Casa…Not All the Time

Mi Casa Su Casa…Not All the Time

Mi Casa Su Casa, “my house is your house.”  With a bit of variation, that is what a caregiver, who thought she was doing the right thing, said to this Aging Life Care specialist. There was only one problem, Winnie, my client, had no interest in achieving that feat. She wanted her house left alone, just as she wanted to be left alone.

The story went like this:  It was Cinda’s first day on the job. She wanted to do what she could to make a good first impression. But in her need to succeed, she was not taking into to account the wishes of my client. For starters, it had taken more than six months to have Winnie just be willing to try a caregiver. She told me that little by little she could get her cleaning, cooking and grocery shopping done. It just takes longer, is what she said. A fall reluctantly changed her mind. A caregiver was necessary.

Resistance met necessity when Cinda arrived. I interviewed her prior to her starting the position.  I talked with her about how fiercely independent Winnie was and how,  for this relationship to succeed, Cinda had to ask before doing anything. On the first day, after the introductions, I left. It was a six hour shift.  Within ten minutes of Cinda’s departure, I got a call from Winnie instructing me to notify Cinda that she is not to return.  I couldn’t blame her.

She explained that without asking Winnie, Cinda started to wash top shelf dishes, the china that is saved for special occasions. Following up with Cinda I asked what she was thinking. She told me with genuine sincerity, she wanted to help to make Winnie’s home as spotless as hers.  I reminded her of our discussion, ask before doing. Cinda was asked not to return.

When an Aging Life Care specialist, or anybody who is going to work for an adult senior, enters their home, the first step to success is respecting the home which is another way of saying respecting the person who inhabits that home.  It is a house filled with memories and mementos. But most importantly, indefatigable people trying to hold on to what they have left…their dignity, independence and their ability to self-direct.  Winnie has gone back to doing her chores at her pace. And her house has returned to being her home.  As for me, calls are accepted, but her door has yet to be reopened.

When A Parent is Fine: Five Strategies for Keeping the Status Quo

When A Parent is Fine: Five Strategies for Keeping the Status Quo

Sometimes I do a family consultation and after many questions and no red flag responses, I tell adult children, continue what you’re doing. Count yourself and your parent(s) as fortunate, but, like a good scout, be prepared.

So what is it I am saying?  It’s something like car maintenance. No squeaking brakes, or dashboard lights on, but you bring your car for maintenance.  Some older adults, if you excuse the analogy, are just like that. Blessed with good health, realistic about their needs, they can remain safely in their homes.

So for the parent who is fine, I do suggest five strategies to help keep that status quo:

  • A medic alert pendant or bracelet. Particularly, one that has a fall alert built into its sensor. Unlike the commercials, there is no need to dial the phone, the sensor picks up on the fall and calls the designated numbers.
  • A current list of all medications.
  • A notation of any medications a parent is allergic to.
  • If there is a DNR, I am referring to a Community DNR, (different than a hospital DNR) it should be prominently displayed.
  • A daily check-in call. Such calls allow for the adult child (or designated caller) to pick up on the slightest of changes in a parent’s cognitive status. Infections in older adults travel at lightning speed with altered mental status one of the hallmarks that something is wrong. Urinary tract infections are notorious for causing this altered status.

One particular service that facilitates much of the above is the Vial of Life (www.vialoflife.com). The Vial of Life is a program that allows individuals to have their complete medical information ready in their home for emergency personnel to reference upon arrival.

Image result for vial of life images

These small but essential steps can go a long way in helping an adult senior maintain his/her independence and at the same time be safe in their beloved home.

Thinking About a Guardianship? Information to Know

Thinking About a Guardianship? Information to Know

In conversations with family members, when there is frustration regarding a parent’s unsound decisions or resistance to medical recommendations, guardianship is sometimes mentioned. In some cases it is the undisputed route to go. I think about my assessment of Edgar, who, as his dementia progressed, refused to leave his house. It was only his neighbor who could drop off food. His sons, both in agreement that a guardianship was necessary, petitioned the court. The need was undisputed and guardianship was granted without a lengthy court hearing. But in other situations, I have seen how costly and ugly the guardianship process can be.

Article 81 of the Mental Hygiene Law provides the channel through which a guardian can be appointed. My experience has been that usually it is a family member (the petitioner) who initiates this procedure. The request for a guardianship can be sought in one or both areas: 1. Guardianship of the person’s property. This refers to all financial decision making and management.  2. Guardianship of the person. This refers to all decision making regarding the wellbeing of the person.

The decision as to whether the person needs a guardian ultimately rests with the court. In the process of making that decision, there will be an attorney appointed to represent the “alleged incapacitated person.”  There will be a court evaluator, someone who will make an independent assessment of the person and present their findings to the court.  At the hearing, the person bringing the petition for guardianship is usually represented by an attorney. It is that attorney who presents the convincing evidence as to why a guardianship is necessary.  If there are other siblings who are vying or contesting the guardianship, they too may be present at the hearing and represented by counsel.

The cost of legal representation and the court evaluation can be considerable. When family members do not agree, not only does the hearing become ugly and often drawn out, but legal costs swell. In such a scenario, there is a far greater chance that an independent guardian will be assigned rather than a family member. Costly and ugly, I say it again, but this time with the hope that a parent, once declared “incapacitated,” will be properly cared for and protected.

Holding Hands, the Power of Kindness

Holding Hands, the Power of Kindness

There is a nursing home here in New Rochelle, New York I have always respected. Small in size, a caring staff and an owner who takes very seriously the responsibility of providing good care for each resident. I refer families to the nursing home frequently. Is there something “in it” for me you’re wondering?  Just the peace of mind of knowing that a resident’s needs, for the most part, will be attended to. Perfect? No. That’s often a word that eludes those agonizing decisions that often come with the nursing home decision.

And so it was that last week I was visiting with one of my clients at this nursing home. She was in the day room.  Entering Peggy’s world of dementia, we talked about the dog in the room (not there), and her daughter across the hall (in Maine). But truth be written, I was distracted by the woman, perhaps fifteen feet away from Peggy who was crying. Yes, the aide put her arm around her and asked why she was crying. I wanted to tell (a polite word) this aide she was probably crying because she no longer had the words or the necessary intellect to verbalize how miserable she is in her state of tangled confusion.

Neither the aide’s hugging nor the talking were helping. But sitting inches away was another resident. Perhaps a loving mother, a devoted wife? I’ll never know. But I do know that on some level she understood this woman’s pain. Perhaps as she once did for her children, she took both of her hands and extended them slowly into the palms of this tearful woman. Back and forth, around and over she cradled this woman’s hands. And with each movement the tears lessened until a look of calm came over the woman’s face.

Simple acts of kindness. How comforted I was to see that kind heartedness and compassion did not rob the mind of this doting woman, but remained nestled in her heart.

Slow Medicine and Dr. Dennis McCullough

Slow Medicine and Dr. Dennis McCullough

It is not often I can write a blog in an hour. Usually it’s written, reviewed, accuracy checked and making sure I have made my client, who has provided me with a particular insight, indistinguishable from the message I am sharing.

This blog is different. There is nothing to cover up, on the contrary. In telling you of the recent and untimely death of Dr. Dennis McCullough, I am introducing you to the world of “Slow Medicine,” which he pioneered with the publication of his book, “My Mother, Your Mother” in 2008.  Regrettably, dying at the age of 72 he did not have the opportunity to put into practice what he encouraged. Or maybe it is not regrettable. He died a quick death, the result of a heart attack. Nothing prolonged and no heroic measures. He would have liked his death.

The essence of Slow Medicine is kind medicine. Less is more medicine. Often as spouses and adult children we feel compelled to do as much as we can to help a loved get better. Dr. McCullough has asked us to step back,  just minutely out of the box and ask ourselves this question:  by doing additional testing, surgical procedures, adding more medications are we really helping someone at the end of their life?  He faced this personally when his mother went from a nursing home to a hospice care center. Medications, other than those for pain were stopped.  It was here that her dignity took center light, with family and familiar caregivers close by. She was one of the sources for his book. The other being his own experience as a “vulnerable” patient for over a three year period.

I have touched ever so briefly on Slow Medicine. I think Dr. McCullough said it best in “My Mother, Your Mother.”  “Slow Medicine is not a plan for getting ready to die; it is a plan for understanding, for caring, and for living well in the time that is left.”

An untimely death, but an eternal message.