Author Archives: jstarkweather

Finding The Right Doctor

by Judy Starkweather

When my Mom moved to Atlanta, I needed to find a new doctor for her.  I received a recommendation from someone at the Assisted Living Facility where she would be residing and made an appointment. After each visit, however, I had to make additional appointments with specialists, which meant carting my 91 year old Mom from one to another. It was tough since I was working full time. My mother wasn’t very helpful. She was always saying “Why are you taking me to another doctor? I’m sick of doctors!”

I learned that the Assisted Living Facility had a doctor who did “house calls” at the facility every Thursday. It sounded convenient, but the doctor always arrived at different times, so I seldom got a chance to connect with him and he eventually stopped coming to the facility all together.

Continue reading

Protecting Your Parent From Falls

by Judy Starkweather

It took awhile to convince my mother that her walking was shaky enough to warrant a cane, but once we did, it worked out well. She selected a clear acrylic one that garnered lots of compliments.  She grew to like it not only for steadying her gate, but also as a conversation piece and fashion statement!

When mom’s falls became more frequent and she needed a walker, it was a much tougher sell.  It wasn’t until she went into Assisted Living and they required her to have one, that we actually made it happen. It was equipped with wheels, a seat she could sit on if she got tired and a basket below to hold items she might need during the day. We also purchased a “purse-like” cloth bag that hangs over the front of it for easy access to things like cough drops and kleenex. My sister and I felt good knowing that my mother could now get around more independently and eventually she learned to like her new “wheels.”

Continue reading

Teach Your Parents Well

By Judy Starkweather

I was taking my 94-year-old Mom out one day and feeling stressed. My job and the caregiving were getting the best of me. When we arrived at our destination, I got out of the car, went around to get her and as always, reached over to unbuckle her seatbelt. In a moment of sheer frustration, I said “Gee Mom, you’d think a college graduate could learn to unbuckle her seatbelt!” We laughed a bit, but she knew my fuse was shortening by the second.

The next day, I decided to show her a way that I thought would make it easy to accomplish this task. I had to take into consideration the limited ability she had to turn her body enough to even see the buckle. To my amazement she exclaimed, “No one has ever shown me how to do that before!”

Continue reading

Does Your Parent Drink Enough Water?

This story was contributed by a reader who wishes to remain anonymous. It addresses the importance of hydration in our parents’ overall health & safety. 

On several occasions my sister and I noticed that my Mom’s dementia would get worse. We worried that this was the “beginning of the end” of her mental competency. I recall when she started holding a terrible grudge against one of our favorite caregivers at her Assisted Living Home. The caregiver’s name was Jane, but she insisted on calling her Alice! She would relay to me that “Alice” would take showers, try on her clothes and entertain men in her apartment when she went to bed. We tried to convince her that she would never do these things, but she stuck to her story and accused us of being very naïve when we didn’t believe her!

When we took my Mom to her primary care physician, we’d routinely review all that was going on at the time, which often included falls and the worsening dementia. The doctor would check her urine and come back with the report that she had a UTI (urinary tract infection). We learned that the infection was the result of dehydration, which in turn caused her dementia to get worse.  She told us that it could also be a contributing factor to her frequent falls.

We were happy that an antibiotic would clear the infection and therefore her dementia and we had struggled to find ways to minimize her falls, so this was an important discovery.  Her doctor indicated that the juices, sodas, coffee and Ensure my mother liked weren’t anywhere near as good as “plain ole’ water,” for staying hydrated. She suggested we try putting Crystal Lite in it to make it taste better. It took time, but eventually grew to like it and drinks it all the time now. We buy 8oz bottles of water and pour the small packs of lemonade-flavored Crystal Lite into them and shake it up well. She likes to drink it with a straw. We make sure there is always a bottle by her side, but don’t have to remind her to drink it as much as we used to. 

Dehydration can have debilitating consequences in the elderly. Watch for signs like confusion, irritability, low urine output, dry skin, constipation, dizziness, hypotension or infection. They could be indicators of dehydration, which can lead to falls, stroke and renal failure. Better yet, do whatever you can to get your parents into the water habit right now!

Medicaid Yields Hardships As Well As Benefits

One of our readers has submitted  a guest column regarding his experiences with Medicare. The names have been withheld by request.

My mother was never very affluent. So when it came time for her to move into an assisted living facility for the treatment of Alzheimer’s disease, she was not financially prepared for it. Eventually, we had to turn to state Medicaid for assistance, but we were very surprised at the restrictions imposed on her finances.

In our state, at the time my mother applied for assistance, a person could have no more than $1500 to her name in cash and assets. Since my mother had more, we (believe it or not) had to sell off all her assets and give the excess to the state government for use in paying for Medicaid. The excess, and any income she had, including Social Security, was to be used first to cover costs before state help kicked in.

We were lucky in that her living facility had staff who were very helpful in navigating the state’s legal system. Other facilities may not be as prepared. But we realized while it was happening that my mother was essentially becoming a ward of the state—not that we expected her to recover, but in effect she no longer had an independent future.

In retrospect, we could have tried to have her “gift” the excess assets to her relatives (up to the federal tax-exempt limit) before applying for Medicaid, but even that strategy is difficult, since in our state, Medicaid looks back three years to figure net worth, to ensure the person is cognizant enough to understand what she is giving away. Who can say three years before Alzheimer’s care is needed that it is inevitable?

Think carefully about your parent’s future. It’s much better to be prepared for the possibility of having to use state Medicaid than to have to deal with it suddenly, as we did. If a long-term care insurance policy is an option, you should investigate it.

Keep in mind that Medicaid, although a national program, is also governed by individual state law and the requirements and services vary from state to state, sometimes greatly. But the best advice, if you anticipate that your parent might need it in the next few years, is to learn as much as you can about the program where you live, and prepare your parent’s finances so s/he gets the most help for the least impact.

Becoming Your Parent’s Hospital Advocate

If you’ve never been an advocate for an elderly person when they land in the hospital, there’s a learning curve.  I found this out the hard way when my Mom ended up in the hospital after a fall. What I thought would be a two-day ordeal at best, turned into seven challenging days.

I first discovered that since my Mom’s physician wasn’t associated with the hospital she was in, they assign an internal doctor called a “hospitalist” to manage her treatment. And if I didn’t catch him in the morning when he did his rounds, trying to get information from anyone else on the staff was nearly impossible! Shortly after she got out, we changed physicians to one that was associated with this hospital. Now she will manage her care if and when Mom has to go in again.

One morning when I walked into her room, a caring hospital worker told me that my mother needed more supervision. He said that she had gotten up early in the morning and walked over to sit down on a chair across the room! When I begged her not to do that again – we didn’t even know if she had a hip fracture yet – she calmly exclaimed, “Well, at least we know I can still walk!” 

It was then I noticed that only three of the four rails on the bed were up.  Her nurse informed me that I’d need to get orders from the doctor to put all four rails up. This totally baffled me, but I got the orders and put them up when I left that night. The next morning I found out that Mom had tried to climb over the side rails and fell out of bed in the process! Fortunately she wasn’t hurt. It was only then I discovered the reason for not putting all up at the same time – apparently it’s been proven that more people get hurt trying to crawl over the rails than if they actually get out of bed without them! The only thing left to keep her safe was to put her in wrist restraints at night.  I struggled with this one, but there was no other choice.

I also learned that if your parent suffers from dementia, it’s likely to get worse in the hospital, simply due to confusion that comes from being in such a different environment.  During the day, my mother’s manifested itself in a very sweet and humorous way. At one point she told me that the surgery (which she didn’t have) had gone well and they worked on her breasts while mending her hip and she couldn’t wait to get the bandages off to see the results! At night, she would become agitated and paranoid. I discovered that this is called “sundowner’s syndrome.” She refused to eat one evening, because she was sure that her food had been poisoned. It wasn’t until one of the nurses told me that this was very common, that I stopped wondering what was going on and accepted this as a temporary problem.

Ultimately it was determined that Mom hadn’t broken her hip and they were able to get her blood pressure back to normal so she went back to her assisted living home. Had I been armed with more knowledge on hospital procedure and the effects of a hospital stay on the elderly, it would have made a difficult situation much less difficult.

 

 

“Tough Love” Can Payoff When Moving Your Senior

The following story was contributed by reader Laura Robertson

When I became my uncle’s caregiver, I was faced with making the hard decisions for him – decisions that had to be made but were against what he wanted to do or thought he wanted to do.  Like struggling with having to move my uncle from his home to an assisted living facility.  I beat around the bush, trying to make him feel that it was his idea and tore myself up emotionally.  Nothing seemed to work.

When I finally told him he had no choice and that I was there to help him pack, he accused me of taking him to prison and told me my mother would be ashamed of me for treating him this way!  He told me that I must hate him and that he had never thought I could be such a cold-hearted, hateful person. To think that is the person our daughter called “Granddaddy!”

My husband and I moved him anyway and for the first three, if let me in his apartment at all, he wouldn’t talk to me.  The big time silent treatment broke my heart.  He even stopped eating.  But every day I made the trip to visit and face his loathing, silent stare.  I thought I had made the worst mistake of both of our lives.  We had moved him to be cared for and to give him a chance to have a happier life, but it was hastening his decline.

When I went to his apartment on the fourth day totally distraught, he met me at the door to his apartment, smiling and shaking his head in disbelief as he said “Did you know they will make up my bed for me every day if I ask them to?  And all I have to do is ask and they’ll give me ice cream, too!”   The anger was gone, he stopped talking about going home as much and he dove heartily into the desserts.

We practice “tough love” with our children. The same process can be applied when caring for your aging parent or relative. It can be painful, but there is a good chance that if you persist, things will turn out much better than you imagined.

Editor’s Note:  For more information on moving Seniors from their home, there is a good book called “Moving Your Aging Parents” by Nancy Daniel Wesson. The cost is $24.95 + shipping and can be ordered at http://movingyouragingparents.com.

Keeping Mom in Her Home

One of our readers submitted a guest column for those trying to handle the many tasks involved in caring for aging parents.  Names have been withheld by request.

One of the hardest moments a family may have to face  when their parents get old, is telling them it’s time to move out of their home. That day might come for us, but for now, thanks to the support of her children and modern technology, we’ve been able to avoid it.

My mom has always been able to manage the two-story home plus basement, she has lived in for many years. But as she gets older, her spinal stenosis (a condition in which areas of the spinal cord narrow down, causing pressure on the cord and the adjacent nerves) is making it difficult for her to walk up and down stairs. This condition is exacerbated by problems with her heart.  We heard that in cases like this it’s helpful to install a stair chair or stair glide.  This is a device in which the person sits in a chair that glides up and down along a metal rail attached to the stairwell wall, thus providing comfort as well as safety.

Our preference was to install 2 stair chairs, one to the basement where the laundry and food pantry are located, and the other up to the second floor where bedrooms are located.  We got lots of resistance but after a hard sell on our part, Mom relented, at least partially.  She conceded to one stair chair from the first floor to the basement.  Thankfully, she liked it.  It allowed her to continue her normal daily routine.  But she was adamant that we not install one from the first to second floor.

After she fell in the kitchen one day, we decided it was time to take the next step to insure her safety, as well as her quality of life.  Again, the stair chair to the second floor was strongly resisted.  Her fear? That it would detract from the look of her beautiful home for visitors who came in through the front door.  Her underlying reason, we suspected, was that the installation of this second chair was one more unwelcome indicator of age and dependency.  Again we met her resistance with respect and common sense.  Her ability to stay in her home has to come with some accommodations.  Mom’s health and safety are simply too important.  Our family made the decision and purchased the second stair chair over her objections.

To be honest, the day it was installed I was nervous about going to my mother’s house. But  when I got there I found out that she’d already used the lift three times! And because it was so helpful to her, she began to think that it was not that bad-looking after all.  But best of all, it has paved the way for any future amendments to the home as her needs evolve.  Next time may not be so hard.

Note: Stair chairs usually cost two thousand dollars or more to purchase and install. Some do come with color coordinated rails instead of chrome, to match the décor of the home, but this detail can add several hundred to more than a thousand dollars more to the price. In most cases these devices are not covered by insurance or the government. For more information, do an internet search using the key words “stair chair,” “stair guide” or “stair lift.”

Don’t Give Up On Hearing Aids!

By Judy Starkweather

There came a time when I thought that my Mom’s hearing had become so bad that I’d never have a phone conversation with her again. This made me both sad and frustrated. I was sad that our phone chats had come to an end and frustrated that it would now be tough to convey even a simple phone message to her.

There was more than one issue preventing a “normal” phone conversation. First, she didn’t always wear her hearing aids, and if she actually happened to get one or both in that day, this didn’t mean that the batteries weren’t dead!  Secondly, cognition became an issue as her dementia increased. Even though she might be having a “good day” in that regard, she would often forget to push the blue volume bottom on the phone we had purchased for her, which was specially designed for the hearing impaired. If her hearing aids weren’t in or weren’t working, she would fail to hear my  desperate pleas to “Push the blue button!”

We weren’t really sure that the new hearing aids would help, but the audiologist felt they would.  She informed us that we could return them and get a full refund within a month if they didn’t. It wasn’t easy to convince my mother to purchase them. First, they’re expensive. Hers were $5,000.00 and they aren’t covered by insurance. Second, she doesn’t like change and third, at 94, she wasn’t clear it made good sense to spend the money. She said on more than one occasion, “I’m not sure how much longer I’ll need hearing aids.”

My sister, Jean and I finally got her agreement to make the purchase. The audiologist suggested that we get the same type as she had before so the adjustment would be easier. We quickly noticed an improvement in her hearing. We were glad we had finally taken a proactive role to improve my Mom’s quality of life and felt we had succeeded in getting at least some of our sanity back!

Jean also suggested that we add more structure to the maintenance of her hearing aids. We marked every Wednesday on the calendar in her apartment as the day to change the batteries (whether they needed it or not) to keep them working as well as they could. We also made a note to clean her hearing aid filters once a month.  We had found that at times, even with new batteries, she still couldn’t hear and found out from the audiologist that it was because the filter was dirty (full of ear wax). These are both simple procedures, but ones that are easy for busy caregivers to forget, unless they’re marked on the calendar!

Ultimately Mom’s hearing and cognition will never be great, but getting updated hearing aids and adding these 2 simple procedures have been a big help. Now she normally hears us when we tell her to “Push the blue button” so there is a much better chance of having at least a short phone conversation!