Is it Walking or Wandering? Ten Pointers to Put Caregivers in the Right Direction

Is it Walking or Wandering? Ten Pointers to Put Caregivers in the Right Direction

One of the most frequently asked questions of this eldercare consultant is: What is an appropriate residence for my family member? To be effective in this role, it not only entails a thorough assessment of the adult senior but also refresher visits to long standing residences and visiting those residences that have opened since Covid.

A “mix and mingle” recently brought me to Briarcliff, New York to a new residence that is exclusively devoted to residents with dementia. An impressive feature was the enclosed outdoor space where residents can “wander, “as my guide pointed out, or, as I would like to think, where residents can “walk.” So, what’s the difference?

Wandering implies that the person’s actions are aimless or purposeless, putting them in danger to themselves. Stepping outside on a stormy day, making one’s way over to a busy intersection or leaving the house in the dark of night. But in other situations that wandering is walking. It has a purpose; since it is difficult for the person to communicate feelings or needs verbally, it is up to caregivers, sometimes with the assistance of a professional or organizations such as the Alzheimer’s Association to figure out the reason for a loved one’s walking. While the explanations can be plentiful, the Ohio Council for Cognitive Health provides some direction as to why a person with dementia is walking continuously:

Pain: the person may be in pain and not able to express the pain.

Medication: the person may be experiencing medication side-effects that cause agitation.

Noise: the room may be too noisy or overstimulating

Boredom: If the person is bored, he or she may walk as something to do.

Toilet: The person may be searching for the bathroom and is not able to find it.

Lost item: The person may be searching for something that he or she believes is lost. This item may or may not exist.

Hunger: The person may be hungry and not realize that he or she needs to eat.

Confusion: The person may not recognize their own home and may want to go somewhere that they think is home.

Habits: The person may be trying to continue a long-standing habit such as going to work.

Sleep disruption: Restlessness or changing sleep patterns can lead to confusion between night and day. A person may wake early, become disoriented and think it is daytime and leave the house for work or a walk.

And this eldercare consultant’s suggestion, it comes from my favorite tee shirt which shows a pair of Birkenstock sandals. Beneath the sandals is the quote: “All who wander are not lost.” I would like to adjust that quote a bit and say all who walk find tranquility in the moment. The assurance of putting one foot in front of the other in uncertain times.

As Rare as Venus Passing Across the Face of the Sun

As Rare as Venus Passing Across the Face of the Sun

On June 5th and 6th 2012, the world was able to witness planet Venus passing across the face of the sun for about 6 hours causing a small black dot to appear on the sun’s surface. This event will not reoccur until 2117. I didn’t see the passing in 2012, and I can confidently say I will not see it in 2117. Yet in my world of being a geriatric consultant, I did see something equally as extraordinary. A senior adult called this Aging Life Care® Consultant to inquire about my services and how I might, one day, help her. A senior adult inquiring about help for herself, as rare as Venus passing across the sun.

This call was a first for me. I was accustomed to counseling adult children in such matters as dementia, in-home and residential alternatives, and overcoming parental resistance. I asked Isabel (not her real name) what prompted her call. She explained that her adult children lived at a distance, and she wanted to prepare for whatever the future may hold. She was 84. There was nothing compelling going on at the time, so I described how I could potentially be of help. A year later, I heard back from Isabel. She asked that I come to her home so that she could meet me and vice versa. Two years passed before I heard from her again, this time she asked if I could help her find a companion for a couple of days a week. Because I had done what we call in the trade, “a meet and greet,” I had a good idea of what type of companion would work best with her. Luckily, she was available, and the match was a successful one.

The passage of time brought conditions that required more care and eventually the need for a fulltime companion. None of this lessened Isabel’s astuteness to her needs, especially her hearing loss which was impacting on the activities she enjoyed in the community and with friends and families.  I am accustomed to seniors finding less effective and more irritating hearing solutions telling others: “To just speak louder.” Not Isabel. In keeping with this proactive senior, she headed to an audiologist to be fitted for hearing aids. They have helped, but even with regular adjustments, not to the degree she hoped.

With her mood now wavering and her age passing 88, we spoke about how the diverse world she was accustomed to was receding. Her family suggested consulting with her doctor about an anti-depressant which Isabel thought might be helpful (Again, I am more familiar with the response: “who needs that, I’m not crazy”). Not surprisingly, Isabel also asked me to recommend books about getting older. I mean getting older…. the real McCoy. Step aside Nora Ephron. The vicissitudes of accepting that you have less days on this earth than more. And with some research I shared three books with Isabel that would support what she was feeling.

  • Still Here: Embracing Aging, Changing, and Dying 
  • Growing Old: Notes on Aging with Something Like Grace
  • Helping Yourself Grow Old: Things I Said to Myself When I Was Almost Ninety

 Currently, Isabel and I chat on a regularly irregular basis. Sometimes short because a Zoom is about to start, other times longer. She leads me. I always like to know what she is reading, and we exchange names of books we have enjoyed. Truth be told, some of her nonfiction book recommendations are beyond my comprehension.

As an eldercare consultant I have always felt in the giving, there is receiving. It is so much the case with Isabel. And when the opportunity presents itself, I always remind her that she is my role model. I am not waiting for Venus to pass across the sun.

An Aging Life Care Specialist Goes Underground

An Aging Life Care Specialist Goes Underground

We Aging Life Care specialists ask a lot of questions. Most pertain to the medical, social, emotional and the home environment. Now we are going even deeper in the home and descending to the basement.

Why the basement you ask? Because in some homes, across all fifty states, evil may be leaking from the ground. It’s colorless, odorless, invisible and can only be detected by testing. This mysterious element is called radon. It is a radioactive gas that comes from the decay of uranium found in the soil one’s house is built on. It typically moves up through the foundation to the air and enters one’s home through cracks, walls, construction joints or gaps in the foundation around pipes. A home traps radon inside, where it can build up. The ventilation and the air flow patterns in a house will affect how much radon will be pulled into different areas of the house. The age of the home, does not make a difference. According to the United States Environmental Protection Agency radon is the leading cause of lung cancer in non-smokers in the United States. The higher the radon level in a house, and the longer the exposure period, the greater the risk to the occupants.

Apologies for the scare, but the good news is that radon levels can be measured and if remediation is necessary, there are solutions. The place to start is with A Citizen’s Guide to Radon, published by the EPA. In a nutshell, the average radon concentration for homes in the United States is 1.3. It is when the radon levels, goes beyond 2 picoCuries per liter (the EPA will explain the jargon) that thought should be given to resolving the potential problem. While you can hire a professional tester to determine the radon level, you can easily start with buying a do it yourself test kit available in hardware stores or online. You can also call: 1-800-SOS-RADON (part of the EPA). This testing method consists of a small charcoal canister. The radon in the air is absorbed on the charcoal and the decay products can then be measured by a laboratory. The laboratory cost is usually incorporated in the cost of the canister. It is suggested by the New York State Department of Health, that two separate charcoal canister measurements be used before deciding to correct the situation. If mitigation is necessary the most common method is to have a vent pipe system and fan installed, which pulls radon from beneath the house and vents it to the outside. More information is available from the EPA at 1-800-55RADON.

So, why this article on radon? This past January was officially declared Radon Awareness month. But beyond this, often, as Aging Life Care specialists, we turn to our personal experiences when they can enhance the lives of those we help. Some years ago, with great excitement we closed on our dream weekend home in the woods. Surrounded by nature, deer leaping thru the woods beyond, a welcoming lake for rowing and swimming, what could be better? The answer would have been a tent for camping had we not taken care of the high radon level that was noted in the inspection report. As Aging Life Care specialists, it is our goal to keep our clients safe at home. Checking for radon is another step to ensure their safety.

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