Can an Adult Senior Remain at Home? …That is the Question

Can an Adult Senior Remain at Home? …That is the Question

As an eldercare consultant, I am familiar with the statistic that close to 90% of adult seniors, have expressed a desire to remain in their homes for as long as possible. The terminology in the world of eldercare is “aging in place.”

My lack of surprise about aging at home, while corroborated by AARP, has its source in the adult children who visit my office frustrated that their parents feel there is no compelling reason for them to move out of their house. A typical scenario as described by a son or daughter: no bathroom or only a half bathroom on the main floor, stairs that must be ascended or descended to get to the kitchen, no direct access to the outside without holding on to a hand rail that is unstable accompanied by a walkway that is crumbling, nonstop repairs both large and small.

Sitting across from these adult children, I understand their unease. They are often wakeful at night, distracted at work, consumed with the responsibilities of calling the plumber, roofer or making sure a path has been shoveled after a snowstorm.  I also know from talking with adult seniors the comfort that comes with continuing to reside in a lifelong home. Change is never easy or welcomed.  So, what’s an eldercare consultant to do?

For this consultant, the major consideration is safety. There is no compromise on this issue. To ensure this safety there are three necessary requirements. First, the willingness of a parent to agree to whatever modifications should be made to the house. First, the readiness of the parent to accept home care if necessary and first, the financial wherewithal and/or community support services to achieve these outcomes.  Yes, they are all number one priorities.

To this end, I frequently visit the parents in their home. Often, mom and dad need to be heard and understood, with a focus on empathy. Once they know I understand their situation, it is easier to start to effect change. The secret is small steps. With each step, it is validating their willingness to undertake necessary changes. That validation provides the incentive for the next step until a safe living environment is accomplished.

But please don’t think I come with a magic wand. Sometimes the ideal, or even close to it, becomes unachievable. It may be the staunch autonomy of a parent or it is the symbiotic relationship of husband and wife who create such a strong wall (yes, this one is achievable), that adult children, the family favorite, or even this eldercare consultant cannot convince them that they are putting their safety at risk. Then Father Time steps in and removes aging at home as a choice. A fall, noncompliance with medication, or one of those all too frequent storms we’ve been having here in Westchester County, may result in a whole new aging in place definition and destination.

From Hospital to Home:  Post Hospital Syndrome

From Hospital to Home: Post Hospital Syndrome

Recently I addressed the Post-Acute Care Continuum in White Plains, New York. An organization whose goal is to educate and share best practices in post-acute care and care transitions. I was asked to speak about how geriatric care managers can help to ensure that patients return home and remain home beyond the initial 30-day period. Of course, we do not want our clients to return to the hospital at any time, but there is a reason for the specific 30 days.  In 2013, the United States Department of Health started to penalize hospitals for re-admission of patients within thirty days. The Department of Health wanted patients to be discharged responsibly with adequate follow-up care, hence this law was enacted.

Because of this act, the rate of 30-day re-admission has dropped from 20% to 17%. But often, while the reason for hospitalization has been addressed, the consequences of a hospitalization are just being felt when our clients return home. Dr. Harlan Krumholtz, MD of Yale-New Haven Hospital refers to this return as the Post Hospital Syndrome. He attributes this re-admission within 30 days to five major factors:

  1. Sleep deprivation: The patient is in a new environment. The illness combined with being in a different bed, in a different place will impact on cognitive and physical performance. A situation of perpetual jet lag has been created.
  2. Malnourishment: Certain tests and procedures require nothing by mouth for the day or evening prior. And if the test is cancelled and then rescheduled, another period goes by without nutrition. This results in protein-energy malnutrition. The consequences of such a scenario is that wound healing is impaired, there is a chance of increased infection and one’s immune system is compromised.
  3. Pain and discomfort: For any of us, especially those dealing with pain in the hospital environment, pain can lead to sleep disruption, mood disturbance, impaired cognitive functioning and may also impact on the immune system.
  4. Altering medications: Stopping one medication and adding another can have its impact on cognition and physical functioning: too much of a medication, too little, the wrong medication, an allergic reaction to a medication. A patient’s body becomes a roller coaster of experimentation in an effort to cure.
  5. Deconditioning: Time in bed for rest can put a patient at greater risk of accidents and falls. While physical therapy may take place in the hospital, Dr. Krumholtz questions if there is still too much inactivity. The result being once the patient returns home he or she is at greater risk for developing blood clots.

As discharge approaches, what must be done is a TOTAL evaluation of the patient. This evaluation should go beyond the reason for hospitalization. Attention must be given to sleep, nutrition, activity, strength and how all symptoms are treated and managed. As a geriatric care manager, it is my responsibility to observe, question and advocate for clients whose care has been entrusted to me.

A Flower and a Shower: Caring for Someone with Dementia

A Flower and a Shower: Caring for Someone with Dementia

Several years ago, I put a new bathroom in our new home. When it came time for the shower, I described to the salesman the type of showerhead I was looking for. “It’s called a sunflower,” he said and off we went to the display.

To this geriatric care manager, the notion of a sunflower showerhead, AKA a rainfall showerhead, suggests something very soothing. But enough about what I imagine. From a practical point of view, a shower for a person with Alzheimer’s Disease can sometimes take on an entirely different aura. Why can bathing be such a challenging task?

For some, it is the loss of independence. A caregiver or a family member is now either in the bathroom or outside the door. Privacy is trumped in the name of safety. Especially challenging when the aide is female and her client a male. Also, the person with dementia may not recognize that something is wrong, and becomes agitated, even belligerent. Why are all these people telling me what to do?  The senses may also contribute to this encounter. The water streaming out of the showerhead or the spigot, can be frightening to the person with dementia. Even the sound of the water can be unsettling. Stepping into a bathtub may bring a fear of falling.

The following strategies may help to reduce the stress of bathing:

  1. Choose the right time of day. If the person is experiencing sun downing, mornings may be the preferable time.
  2. Use a strength based approach. Have the person help in the bathing process as much as possible.
  3. If a person is resistant to a bath, try bringing in some favorite music or say something like: “a short bath and then a big scoop of strawberry ice-cream.” A reward system works well.
  4. Know thy self. If you have had a long day, put off the bath.
  5. If these strategies fail, try some non-rinse body soap and shampoo.

The explanations for why a person resists bathing is as varied as the person. By exploring various techniques combined with the acceptance that what is not achievable today may be resolved tomorrow or the next day, brings a degree of calm to an otherwise unsettling illness.

A Doctor’s Simple Request

A Doctor’s Simple Request

In the last weeks of Helene’s life, she entered Calvary, a hospital devoted to end of life care or as Calvary likes to say, “where life continues.”  A short distance from her home in Pelham, New York and my office in New Rochelle, as her geriatric care manager, I visited regularly.  While I could easily acknowledge that my visits were to support her caregiver who was there daily, I also knew my final good-bye was not far off.

But before my good-bye came, there were conversations with clergy, the social worker, nurses and the sharing of information with the family. The reputation of Calvary has always been stellar so I was not surprised by their responsiveness to Helene’s needs and my queries.  What I was not prepared for was the request of her palliative care doctor. It was not medical history or questions about next of kin, but a simple request to see a picture of Helene in the years prior to her decline.  I could not think of a doctor, in almost three decades of practice who ever made such a request.

As my relationship with Helene had extended over seven years, I was beyond eager to share pictures and tell stories. The doctor was an enthusiastic listener.  There was the photo of a just finished visit to the beauty parlor, another of Helene showing me the house in which she once lived and one of her oldest grandchild standing proudly by her side. Her life as a magazine illustrator was also shared minus pictures.

As geriatric care managers, we are usually called into service when there is a life changing event. While our attention is focused on a presenting issue, we are always mindful that a lifetime preceded the current situation. Illness alone does not define the person. The doctor in his thoughtful gesture understood this and let me tell Helene’s story one last time. Sometimes I think it was for my benefit more than his. Nevertheless, his patient became a person and my good-bye, when it came a week later, was softened by his simple request.

Our Parents: Their Resistance our Frustration

Our Parents: Their Resistance our Frustration

This Aging Life Care consultant is giving you a test:

The question: Why do your adult parents love to say “No” to their adult children?

  1. Because they like to be in the driver’s seat, even thou they may no longer be driving.
  2. Because they like things just the way they have been for fifty years, and change is just not necessary.
  3. Because they have lost so much of what they were once able to do, that they are going to hold on to what is still in their clutches?
  4. All the above.

If you have answered all the above, chances are you are whirling around in the vortex of the caregiver cyclone.

 Question two: What are the correct reactions to such a situation:

  1. Damn it! They were always stubborn and now it’s getting worse.
  2. If feel so guilty making them move out of their home, but I just can’t do it anymore.
  3. They make me so angry, I’m ready to just walk away and let them do whatever they want.
  4. All the above.

If you again answered, “All the above,” I now know for sure you are in the thrusts of the caregiving role.

Resistance by parents becomes more common with loss. It is an instinctive reaction to try to hold on to what you can when you know control is slipping away.  Counselling adult children, I have found three effective strategies for handling this struggle:

  1. Say it once. After the second time, it becomes nagging and will distance parents from further discussions.
  2. Pick your battles. It is more important that mom see her neurologist once month than getting her hair colored so she looks likes the mother you want to remember.
  3. Use the “escape hatch” approach to areas where you would like to see change. Ask dad to “try home care for just two weeks, we can always make a change if it doesn’t work out.”

As an Aging Life Care consultant, I have seen how frustrating the resistance of adult seniors can be. Yet, none of us have been old so how can we possibly understand fully what our parents are going thru. With empathy and employing the three strategies, perhaps we can come a little closer to lessening our parents’ resistance and, in turn, our frustration.