Putting Pen to Paper in the Time of COVID-19

Putting Pen to Paper in the Time of COVID-19

To write a letter is human, to receive a letter, divine
—Susan Lendroth

Four years ago, I downsized. Living in an apartment house, I am now part of a community, not a formal one, but one with a passing hello in the lobby or weather conversation in the elevator. However, it was my relationship with our fifth-floor neighbor that went beyond the hello and the weather. Meg was of an earlier generation, there was no computer in her home and only the most basic of cell phones. In lieu of these items were plenty of paper and pen.

Given the generational gap, Meg was a woman of notes. Invariably, they would be slipped under our kitchen door. They varied in nature, telling us she would be visiting family, wishing us a happy Thanksgiving or my favorite, letting me know how much she enjoyed looking at my hanging geraniums that she could see from her living room window. In our three years as neighbors, I left my computer and iPhone behind. From my side of the hallway, it was a note thanking her for taking in our newspapers or a holiday card with an accompanying note. There was something so special about our across the hall communication. These notes were acts of thoughtfulness. Sometimes on a random piece of paper or other times on a real piece of stationery, especially when Meg’s birthday rolled around. The common characteristic that each of our exchanged notes shared was gratitude.

As much as I delighted in having Meg across the hall, I knew that a woman approaching her ninetieth birthday with an array of minor health problems, should not be living alone. Her children, also knew this. Meg would tell me in her soft voice, that while she understood the logic of a move to assisted living, she was saddened to leave her beloved New Rochelle where she was born and raised her family. Inevitably, acceptance trumped resistance. We had said our good-byes many times, voicing how fortunate we both were to have each other as neighbors. I returned home one day, the wreath that changed with the season was off Meg’s door and Meg was gone.

In the weeks following Meg’s move, I sent a note, bringing her up to date on what was going on with my family and inquiring about how she was doing. In return, I received a lovely card from Meg. A few brief sentences, with her ever-thoughtful sentiments.

Quoting Phyllis Theroux, a writer based in California: “to write a letter is a good way to go somewhere without moving anything but your heart.” In these times of COVID-19, where going anywhere is done with an abundance of caution or not at all, a note not only moves the heart but let’s those we care about know they are remembered.

The Art of Listening: Achieving Successful Communication

The Art of Listening: Achieving Successful Communication

As Aging Life Care specialists, we are called upon to provide an assortment of services. The needs are as varied as the families we are helping. We continuously strive to be experts in our knowledge of homecare, entitlements, senior residences, elder law attorneys, and providing skilled and supportive counseling. But we are only effective if, throughout our dialogue with families, we listen. Effective listening combined with effective communication sets the foundation for successive and successful outcomes.

The art of listening, sometimes referred to as “active listening” requires two essential tasks. First, that we as care managers, listen, making a mindful effort to hear the words that seniors and their families are saying. Second, we must concentrate on what is being said establishing a virtual stop sign that leaves no room for our own assumptions and prejudices. We cannot assume or anticipate conclusions. With these two tasks as starting points, our listening is enhanced by four other components.

We listen mindfully, putting aside any distracting (as opposed to professional beliefs) thoughts. We listen without having an inner dialogue that will have an automatic response to a situation that is verbally evolving.

We listen without interrupting, knowing it may disrupt a client’s train of thought, especially if the person is cognitively compromised. A semi-smile (think Mona Lisa) or an encouraging “uh-huh,” lets the person know we are with them, we are listening.

We ask for clarification at the appropriate time. Siblings may finish telling of their conflicting feelings about what they each think is best for mom, and we reply: “So let me make sure I understand.” It is that clarification that allows for modification and affirmation.

Finally, after all information has been shared, the Aging Life Care specialist summarizes what has been said and listens for what has not been said, the latter perhaps a clue to the issue at hand.

Our listening skills remain strong as we adapt to the challenges brought on by the COVID-19 virus. Historically, families have sought the guidance of an Aging Life Care specialist as they pondered whether a parent would be better served in assisted living or remain at home with help. Now, families are asking our guidance as they question if a parent should return home or remain in their senior residence. Whoever would have thought? Thru this crisis, we will stand strong with our families, listening deeply and fully, a north star during uncertain times.

New Help in Choosing a Nursing Home

New Help in Choosing a Nursing Home

Selecting a nursing home here in Westchester County, or beyond, is filled with a myriad of emotions. Sometimes the decision is made easier by the fact that the complexity of care needed can only be met in a nursing home. Other times, it is the exhaustion experienced by the caregiver that necessitates entering a nursing home. And still, other times it is for rehabilitation and the stay is short term.

Regardless of the scenario, the process of selecting a nursing home can be daunting. Many times, the person is in the hospital and the discharge planner will hand a family member a list of nursing homes and ask them to select three. You may well know three great Italian restaurants in the area, but nursing homes are a different story. Over the years, as an elder care consultant, I have learned the good, bad and ugly about the residences in Westchester County and have guided families accordingly.

In conjunction with my assistance, the Center for Medicare and Medicaid Services (CMS) provides a helpful guide in the form of Nursing Home Compare. This five-star quality-based system, not unlike how hotels are rated, allows a person to compare various factors that, in their totality, lead to a better level of care and consequently a higher star rating.

Enhancing the need for consumers to learn as much as they can before selecting a nursing home, in October of 2019, CMS announced that it would add a new icon which is a red circle with a white stop hand in the center. This icon, seen below, alerts the researcher that the nursing home has been cited for abuse which has caused resident harm within the past year. Their star rating will be capped at two stars and only if the facility goes without an abuse citation for one year will the icon be removed.

While the abuse icon is another step to motivate nursing homes to look at the quality of care they are providing, experience has taught me that the absence of an abuse icon does not necessarily mean the absence of abuse. Visit at off-hours, smell, observe and talk to staff and residents. A difficult decision can be made a little easier.

Nursing Home Abuse Icon

 

End of Life Decisions: A Broken Promise

End of Life Decisions: A Broken Promise

As a geriatric care manager, in the early part of my journey with senior adults and their families, I ask about advanced directives: a living will, power of attorney and a health care proxy. There will be one of three responses: 1. No, my mother refuses to talk about these documents. 2. We are planning to go to an attorney or 3. Yes, there has been a designated POA and health care agent.

If you fall into the number three category, it may be with relief that you have these documents in place. As the health care agent, you have had the “discussion” and understand the wishes of the person you will represent. You are certain that you can march forward through the complexities of end of life decision making. Yet for some, when the time arrives, that confidence becomes clouded by doubt. It’s not unusual. Such was the case for Lorraine, Anne’s daughter.

Anne, my client of nearly five years, confided in me with weekly regularity that she wanted to die. She knew she was losing her memory and was humiliated by what was happening. Other indignities followed. An extremely anxious person, the only comfort she took was that Lorraine knew her wishes and would do right by her.

Lorraine did not visit her mother with any frequency despite living just over the Westchester County border in Connecticut, a thirty-minute trip. Watching these meager visits and equally few telephone calls, I was sure that when Anne’s doctor called Lorraine to suggest hospice care, she would readily agree. To my surprise, Lorraine would not acquiesce. She acknowledged to me that she knew what she was supposed to do as her mother’s agent. The problem was she could not bring herself to make those final decisions about stopping advanced medical treatment, nutrition, and hydration. “Who am I to make those decisions?” she said to me. I wondered, was it unspoken hope or unease?

Anne lingered with time becoming the final decision-maker. In the days before Anne’s death, I said to Lorraine, with no suggestion of judgment, that she would carry with her whatever decision she made. I recognized that those who generously take on the role of health care agent do so with a full heart. But sometimes, good intentions can be superseded by last-minute questioning. Doubt fogs the road we thought we could readily take.

ADL’s and IADL’s: The Alphabet of Assessing an Adult Senior

ADL’s and IADL’s: The Alphabet of Assessing an Adult Senior

Where does this geriatric care manager start when a family is eager to help an aging parent?  The answer is an assessment. It is a bevy of questions that are asked to determine how best to approach the issues at hand. Some of the questions I ask are unique to the situation, but others are basic: Activities of Daily Living aka ADL’s and Instrumental Activities of Daily Living aka IADL.

Activities of Daily Living tell about an adult senior’s ability for self-care. Is a parent able to feed herself? This does not include preparing a meal or even chewing or swallowing the food, it is bringing food to one’s mouth. Dress and undressing without assistance, from underwear to shirt and tie.  Toileting: is the older adult able to ambulate independently or with a walker or wheelchair to the toilet?  Transferring:  can the person independently move from one place to another, from a bed to a chair?  Personal hygiene: can an older person bathe themselves, brush their hair, their teeth?

While the Activities of daily living provide a gauge as to whether an adult can live safely on their own, the Instrumental Activities of Daily Living, are also of important consideration. IADL’s include the ability to manage money this would include paying bills in a timely manner. The ability to go grocery shopping or to use a food delivery service. Getting to and from doctors’ appointments.  Household chores including doing laundry, hand washed or otherwise, and selective house cleaning.

Beyond these two significant areas, an assessment will look at the finances of the older adult to determine if there can be alternate living arrangements or home care paid for privately or thru an entitlement program. Knowing about family support within the geographic area in which the older adult resides is important. The role that can be played by adult children living at a distance. The physical, emotional and cognitive conditions the senior may be confronting, and the ability to take the corresponding medications responsibly. The “story” of the senior’s life. Personality traits, occupation, significant events that may influence how best to approach a parent. Who might it be in the family or beyond the family that may have the greatest chance of influencing the senior?

By combining responses to ADL’s, IADL’s, and the topics discussed above, this geriatric care manager can help families take the first step to bringing a parent to a healthier and safer way of living.  To this end, health care directives and a power of attorney should be in place to ensure that next steps can be taken without complications.

Nurturing the Nurturer: The Use of Doll Therapy for Older Adults

Nurturing the Nurturer: The Use of Doll Therapy for Older Adults

As Aging Life Care Professionals®, when we are asked to assist with securing placement in a nursing home, there are many questions we ask beyond the physical and cognitive conditions that are prompting the move. Primary among those questions is: what was mom or dad’s occupation? Those families who have parents in their mid-eighties and beyond often reply by giving dad’s occupation and the fact that mom was a homemaker.

Remembrances of lifelong professions can be retained long after actual employment or the responsibilities of raising a family have ceased.  Take Gene, a retired fireman who had been diagnosed with dementia.  On the day he arrived at the nursing home, being the conscientious firefighter he once was, he spotted a fire extinguisher and was headed straight to his job. Fortunately, his daughter positioned herself to block his access.

For mothers and wives of this era, the role of family nurturer is often rooted in the person. This is not to say that fathers have not played prominent roles, but for mothers or other women that have been employed in caregiving roles, it is not a job that finished at five. In later years, should there be cognitive loss accompanied by agitation we, as Aging Life Care Professionals, look to guide the family in ways to lessen the anxiety their loved one may be experiencing. Nonpharmacological approaches are preferable. One such method is doll therapy.

Doll therapy is just what it says. It is providing a person with a doll, that she/he can hold, cuddle, talk to, even dress and undress.  The latter helping with finger dexterity and hand-eye coordination. The doll can give a person a sense of comfort and purpose with the goal being redirecting the anxiety and bringing a parent to a sense of calm and contentment. Beyond this, a doll can be a starting point for reminiscence, asking a parent to recall their days as a new parent, bearing in mind that it is the long-term memory that is most vivid.

Research studies have shown both increased happiness and increased social interaction using doll therapy. But doll therapy is not without controversy. Some feel the dignity of a parent is compromised using a doll.  Other concerns are that dolls are demeaning and infantilize older adults. A passerby may look at a person with a doll and remark that the senior looks “cute” holding a doll. Not the way a relative wants their spouse or parent to be perceived.

As Aging Life Care Professionals, our approach is a person-centered one. To each client, we bring a toolbox of suggestions, techniques and resources. While the use of doll therapy is one such example, we customize the guidance, recognizing the unique needs of each client while working together with families to ensure practical and realistic outcomes.