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.

Besides the Queen, Every Woman Needs a Pocketbook

Besides the Queen, Every Woman Needs a Pocketbook

At one moment or another, we have all wondered what the Queen of England carries in her pocketbook.  Certainly, she does not need a driver’s license, a credit card or loose change for parking.  But there it is, firmly implanted in her hand.  For our female clients, the necessity of that pocketbook is also a must. But perhaps for different reasons.

Let me tell you about Madeline. She has mid-stage dementia. One day, as she left her home for a doctor’s appointment, she realized she had forgotten her pocketbook. I was the designated driver, and I could hear her ask for her pocketbook as she descended the steps from her home. Lillian, the caregiver said, “you don’t need your pocketbook.” My window went down and I told Lillian to go back inside and get Madeline’s pocketbook. I knew it was only going to be a matter of time before Madeline asked for it.

So why does a person who is not going to actively use her pocketbook need it?  There are 5 reasons as I see it:

Because a lady has always carried a pocketbook.

Because a woman feels secure when she holds it in her hand or sees it on her walker.

Because even with dementia, a lady may want to reapply her lipstick or check her hair.

Because a woman wants to feel in charge, as she always has, and pull out a few dollars and treat everyone to ice-cream.

Because we, as care managers, care givers and family have a responsibility to help “the Madeleines” retain their dignity, even when they don’t recognize something is missing.

This geriatric care manager thinks of each of her female clients as royalty. And as such, while her handbag may not match her outfit, each lady will surely have one firmly clutched in her hand or placed in the basket of her walker when she leaves her house to greet the world.

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.