Inside Elder Care

Inside Elder Care is practical-help blog you might want to read. It's at http://www.insideeldercare.com/. At the top of the blog, you'll see three categories of blog posts: Aging in Place, Assisted Living, and Caregiving. As you click on each category, the content changes accordingly. Check out other topical links on the page, too. A nice variety of topics includes info on legal/financial issues.

Inside Elder Care also offers resources by state:
http://localmarket.insideeldercare.com/
In addition, this page includes Featured Topics such as Alzheimer's Treatment, Private Caregivers, Nursing Homes, Dementia Care, Stress-Related Therapists, and others.

Fall Back

This is the weekend we chant the Spring ahead, Fall back ditty that helps us remember to set our clocks back an hour. As I twist the tiny, gold, ridged knob on my watch, I continually lose my grip. I mean, really, could they make those knobs any tinier? At least I don’t have to start over each time my fingers slip.

These days, I seem to be falling back way more than springing ahead. Just today my mind drifted back to days, and probably many childhood years, when my father held my chubby little developing hands in his big strong hands and twirled me in the air. I can almost see the sea of white clover swirling below. This was the same clover Dad asked us to pull out of his backyard lawn, the same flowers we tied into long clover chains and sometimes necklaces and crowns. All my siblings remember, too, when Dad held our hands and directed us to walk up his legs so that he could help us do back flips. What prompted these memories was my birthday card for my father’s 91^st birthday, which is tomorrow. Below a gauzy film, a father and daughter were silhouetted, he swinging his little girl in the air.

The card praised the father for giving the child wings. Although I cannot imagine myself soaring with wings, I can imagine myself running—and in more recent years, walking vigorously. For these abilities, for what I have done in my life, I can thank my father’s inspired teaching, timely encouragement, and boundless giving of self. My not winging into fame, fortune, or fabulousness is more rooted in my preference for weeding and creating clover chains. Had I chosen to back-flip off a mountaintop, Dad would have been there to cheer and/or catch me.

Dad soared though. At least in my mind he was exceptional. Did your father enter every tennis tournament open to seniors—and win many? Did your dad take up roller-blading when he was 70? Athletic trophies aside, my dad had character, sometimes was a character, and was always a gentleman. Even now in the nursing home, when a fellow Alzheimer’s patient loses her way and wanders into Dad’s room, he is so polite that his aides marvel at what a gentleman he is despite irritation at the invasion.

Yesterday at the 91^st birthday party, my sister scooched close to his wheelchair, held his hand and stroked his pale, bony forearm while lauding his teaching influence. She told him one of her classmates is now a math teacher because he’d been inspired by Dad, his math teacher in high school. As she told Dad this testimonial, he beamed. Once an extraordinary wordsmith, he has very few words left now. As he smiled his signature toothy grin, he made a sound like a cross between a hum and a purr. He might not even have understood the story, but I think he knew my sister had said something smile-worthy, and he perhaps understood he had done something good. Tomorrow, his actual birthday, I’ll be feeling airborne remembering Dad.

Spring ahead, fall back. Look ahead, look back. Hope ahead, thank back. Learn a lesson, rewind. Soar today; in a flash, tomorrow will be yesterday. No turning back the clock.

The Nearest Doorknob

Last Wednesday’s red blouse and black jacket hang from the bathroom door’s outside knob. Thursday’s teal sweater and scarf hang from the bathroom door’s inside knob. My lavender jacket never made it into the front closet. It is still on that doorknob. Wednesday’s beige canvas tote bag and Thursday’s Monet’s Water Lilies tote bag remain suspended on my office doorknob.

A quick scan of our house’s heavy-laden doorknobs hints that last Wednesday and Thursday still haunt my mind and challenge my energy level. Two emotionally and physically draining back-to-back 12-hour days reverberate into this week. Today, four days later, sheer determination to move on, to have a life (what is it I do, again?) will hang my clothes properly in closets or toss them in the dirty clothes basket. Deciding what to do with the contents of the two tote bags will be more difficult.

In one, a skinny note pad contains notes I scribbled in my mother’s internist’s office, where we went last Wednesday so that he could clear her for knee replacement surgery in two weeks. There my mother reported to him that she’d had heart-attack-type symptoms that very morning. With that game changer, suddenly we were on our way to the hospital. But not before the doctor had patiently explained cardiac vs. coronary, leg swelling, and unstable angina. The doctor’s and my mother’s pronunciation of the cardiologist’s name left me wondering how to spell it, so I got that and his phone number and wrote that down, too—just in case.  

Now what do I do with these notes? I’m thinking I need to organize and update the file folder I began several years ago with contact names and numbers for my parents—and since "medical events" happen more frequently now, it may be time to keep this folder in my car, not in my desk at home. The medical explanations I’ll compose into an e-mail to my siblings, file it in my Mom and Dad folder online, and pitch the little scrap of paper. Okay, on to the next tote bag and note pad …

A little wider note pad has my note to self to go to my mother’s house and bring back a medication the hospital’s pharmacy does not carry, her shawl, and her dental floss; the cardiologist’s case for searching for a blockage and time of Thursday morning’s angiogram; and Mom’s questions for the nursing home staff at Dad’s care plan meeting Thursday afternoon. In this tote bag I also find an extra photocopy the nurse took of my mother’s list of medications. [Somewhere I jotted the nurses' compliments of my mother, but I can't find that note now. I remember two compliments, though: perfect patient and so organized.]

Same basic decision on these notes: Share the cardiologist’s info with sibs and keep the meds list with me for future hospital visits when my dear, brave mother might not be able to give this information herself. I hope that day never comes, but with recurring heart attack symptoms now in the picture …

A full-sized sheet of paper holds Mom’s and my questions for the nursing home staff—and their answers about Dad’s condition. The back holds the hospital nurse’s detailed discharge instructions for my mother. When she can shower next, how often to vary positions, when to start doubling one medication, what time of day to take another … and if a hard, black bruise shows up, call the cardiologist, but if she feels pain in her calf, call the internist. It’s too much—even now, this list overwhelms me. My mother is mentally sharp; I hope she remembers all this advice, and from our phone conversations since Thursday’s homecoming, she seems to have. She probably conscientiously read all the papers in the thick yellow discharge folder, just as she had read all the knee-replacement-prep papers.

What’s the best destiny for this paper? In today’s phone call to Mom, I’ll review the discharge advice, just in case. And although I relayed the report on Dad to my out-of-state siblings when I called them Thursday to report on Mom’s angiogram, I think I’ll put it down in an e-mail, too, and pitch the paper.

Last but not least, I fish the hospital’s Visitor Guide from my tote bag. Wait, two Visitor Guides, one from Mom’s hospital stay last month. (Sigh.) These definitely go in the wastebasket. With all the eldercare health scares of recent years, I’ve memorized that hospital’s map and cafeteria hours.

After an intense event such as hospitalization, the processes of re-entry into normal life and assimilation of new information and new circumstances remind me of corporate experiences like coming back from a marketing conference with 3-inch 3-ring binders heavy with workshop notes or like leaving a management meeting with new directives. You have to figure out changes, new routines, new approaches, and often you don’t have energy left for such thought. For me, eldercare has been part-time care with hours increasing as my parents hobble toward their mid-90s. Those of you whose parents live with you have a full-time job (perhaps in addition to a paying full-time job.) Whether part- or full-time, the job entails figuring out what to do with the stuff tossed onto the nearest doorknob.

I haven’t even talked about emotional stresses hanging on my heart’s doorknobs after last Wednesday and Thursday. Just a few examples …

• ·         Seeing my mother’s cheek muscles pulse and eyes tear when her internist told her he wouldn’t clear her for the knee replacement she had so hoped would improve her quality of life
• ·         And Thursday morning before the angiogram, seeing her holding her forehead due to severe pain caused by a medication
• ·         Hearing my normally unbelievably courageous mother wonder aloud why she couldn’t just fall asleep and not wake up
• ·         Sobbing with my mother Wednesday night over Alzheimer’s robbing her of having her husband at her side in her times of need over the past 9 years; instead her needs have had to take a back seat so she could be at his side for all his dementia-induced crises  
• ·         Choking on the thought that perhaps the most loving thing to say to Dad now might be, “We’ll take care of Mom,” and to Mom, “We’ll take care of Dad” to free them from holding on. Yet their very holding on is such a transcendent testimony to love. Are we even ready to take full responsibility for one of them without the other? Only by God’s grace will we be ready for the inevitable.

Amid disappointment, helplessness, and grief last week were also moments of joy and laughter. My one local sister’s presence Thursday was an absolute godsend. Strong emotions and physical fatigue linger, but without my sister to share my load and the encouragement and prayers of God’s people, and beautiful dinners prepared by my husband, my doorknobs would still be burdened with last week’s detritus. Now if you'll excuse me, I have some doorknobs to free up.

Fish and Frog, Cat and Dog

The bus behind the Alzheimer’s wing of the nursing home pictures Jesus the Good Shepherd and His little lambs with the caption “Let the little children come to me.” When my father first went into the home in middle stages of Alzheimer’s disease, he had deteriorated to a simple-minded adult who needed supervision in many daily tasks—but I didn’t see him as a little child. For most of his first year there, he carried on simple, thoughtful conversations. I had seen some wrinkly ladies with matted white hair cuddling baby dolls, but mostly, residents slumped napping in wheelchairs. Yes, children nap, but they don’t look crumpled like that. Now I see in my dad, the further he progresses (regresses?) in the disease’s stages, the more childlike he becomes.

Take my visit last Friday, for example. Although I had my bag of tricks containing large color photos and jigsaw puzzles, Dad wanted to play with a wooden puzzle already in the Alzheimer’s hallway. This wasn’t a traditional jigsaw. It was a sound puzzle, a flat wooden block maybe about the size and thickness of a wood cutting board. Cut into the board were eight ovalish indentations. Each piece fitting into these places had an animal picture on it and a small red cylindrical handle. When you lifted a piece out and placed it back, you heard the sound that animal makes.

A few months ago, Dad seemed interested in hearing the names of things, so one way to make conversation was to provide words for what he was looking at. Not so Friday. He showed no interest in my naming the horse or the frog, the cat or the dog. Instead, he entertained himself for about an hour by pulling out pieces and putting them back to make the sounds happen. Mom and I conversed, sometimes including him, but he seemed smilingly content to make the fish burble, the frog ribbit, the horse neigh.

Just before Mom and I wheeled him to the lunchroom, I told him about the Chicago Marathon.

“On Sunday, your grandson is going to run 26 miles!”

Perplexed, worried, and wide-eyed, he asked, “Why?”

Later Mom and I recounted Dad’s ingenuous alarm and laughed heartily. Not that we aren’t proud of her grandson/my nephew. We are, and Dad has always called this young man “our little champion.” My once über-athletic father would have been excited by this feat. Not that we don’t admire self-discipline, healthy pursuits, goal setting, and determination. We do, especially at the level required to run a marathon. It’s just that we don’t understand either why someone would want to run 26 miles, but we pretend we do. Friday’s childlike Dad didn’t pretend.

Thank You

 

My stomach knotted in the grocery checkout line Thursday. The reason for such annoyance mystified me. To everything the cashier said to her, the woman in front of me distinctly replied, “Thank you.” Here is just a portion of their “conversation”:

“Customers aren’t supposed to take the coupons off packages; only the cashier.”

“Thank you for telling me.”

“Your total is $56.37.”

“Thank you.”

“Paper or plastic?”

“Paper. Thank you.”

“Here’s your receipt.”

“Thank you.”

Yipes, lady, how much sugar did you eat for breakfast? You’re about 30 years too young to remember the Pollyanna movie. What is with you? I might well have asked myself what was with me that someone’s simple courtesy would so jangle my nerves. Long before that lady’s conversation ended, I wanted to put my hands over my ears and childishly chant, “I can’t heeeaaar you.”

I forgot about this irritating über-politeness until Friday while visiting my father. When I spotted his wheelchair halfway down the Alzheimer’s wing hall, my steps sprang forward. I bent down to hold his warm outstretched hand, lean toward his smile, and introduce myself.

“Hi Dad! It’s Jane.”

“Thank you.” (Just a month or so ago he would have said, “How nice to see you, dear.”)

“How would you like to go down the hall and work a puzzle?”

“Thank you.” (Earlier this summer, he would have said, “I think I’d like that.”)

“Look at how bright green the frog in the puzzle is!”

“Yes. Thank you.” (Before, he would have simply agreed.)

“Oh look, they’re going to have a party—and you’re invited. There’ll be singing, and you like music.”

“Thank you.” (Not too long ago Dad would have said, “All right” and added, “Yes, I do love music.”

Mystery solved. This explains my irritation in the grocery store. I wasn’t nettled by that customer’s politeness. I was angry at Alzheimer’s disease, the thief that just this summer blindfolded us all, stole in, ransacked my crossword-puzzle-champion, punster-extraordinaire father’s vocabulary, and left only “thank you.” In the past few weeks’ visits to my dad, I had heard repeated “thank you” responses and just figured, well, he’s just recovering from the same respiratory tract infection others in his hall contracted, and he’ll regain some words. I didn’t understand my twisted gut in the grocery store until Friday’s nursing home visit, when I felt wrung out to realize Dad’s other words are gone for good.

Thank you, Lord, that the words you chose to preserve in my father’s end days are kind and gentle words.

Thank you for taking care of him with kind nurses and aides.

Thank you for Dad’s gentleness our whole lives.

Oh, and BTW, thank you for the grocery store lady’s courtesy to that cashier. Despite my reaction Thursday, I treasure kindness and your having ingrained it in so many people in my life.