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.

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.

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.

When Missing From my Office Isn’t so Bad

When Missing From my Office Isn’t so Bad

As an Aging Life Care specialist, part of my job brings families to my office here in New Rochelle for a consultation. A son or daughter, sometimes a spouse, present the situation. I ask questions, lots of questions and we move forward from there.

With the questions asked I am able to get a broad understanding of the situation. With additional queries, I start to recognize the issues at hand. But, as I always say to adult children, spouses and other relations, we can come up with the best ideas, but they are only as good as the willingness of the person missing from my office.

This willingness is frequently accompanied by resistance from that member not present. It often makes perfect sense for mom not to be present, especially when there is a diagnosis of Alzheimer’s disease or some other kind of dementia. “Why come to see her? I have no problem.” So rather than meet with negativity and the potential for upset, I meet alone with family members. The take away, are the strategies that are developed in the course of our meeting.

Here are three of my favorite strategies for engaging a family member:  1. A strength based approach: speak to a parent by engaging them and asking them what they think. You may receive a negative response, go back and rephrase your request. Once they see their opinion matters,  it lessens their resistance to accept what it is you are suggesting. 2. Make open ended suggestions: the more a spouse feels tied in to their decision the less the chance of acceptance. The idea of a “trial period” for home care or a transition to a senior residence, will make that idea have a better chance of succeeding. 3. Put the blame on you: ask a parent to do something not because they need a companion, but because it will give you relief from worry.

So, the family member of concern missing from my office in New Rochelle, is often not a bad thing. It allows for this Aging Life Care specialist to ask many more questions and permits for more candid answers. The net result being strategies that have a better chance of succeeding.

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.