Friday, December 23, 2011

The "Goodbye" Angel

I was given an ornament at a Christmas party this week.  It was a fragile and delicate angel.  As I tenderly held it in my hand, I said to the woman who gave it to me, “Angels are one of my favorite keepsakes.  I have another very special Angel.  A resident, in one of my communities, crafted it for me from stained glass. We made ourselves comfortable on a nearby couch as I continued my story:

 Harold was a resident in his mid eighties, who never failed to make an impression of one kind or another on everyone that lived in the community. He was frequently loud, and he repeatedly irritated the other residents with his off color, offensive language.  He loved to talk, but he rarely listened.  He was gruff and cantankerous, and often ill-tempered, but he salvaged his disputable reputation by displaying his sweet and generous heart.

Harold was anxious to move in, but before he would become a resident, he negotiated with me to provide him a space in the building where he could continue enjoying his favorite hobby – creating stained glass ornaments.  I agreed.  Too few residents, especially as old as Harold, had satisfying diversions to occupy their time.  It was gratifying to see someone still enthusiastically pursuing such a productive pastime.

I will admit I had reservations about saying yes to his request. Harold walked with a walker. In order to maintain his balance, he had to lean over the center bar between the wheels, and stretch his arms to reach his tools on the table.  I worried he might drop the soder, and if it fell, it might start a fire.

 I spoke with my regional manager, and we agreed that I had to take certain precautions.  With the aid of the Director of Maintenance I claimed an unused corner of the activities room.   We gave Harold a long, heavy table, and then we found a screen to protect the area and to afford him some privacy.   He used a temperature-controlled sodering iron, but we insisted that he use it during regular working hours while a member of our staff was nearby. If the iron were to fall on the floor, someone would be close at hand to quickly retrieve it.  Finally, we supplied an iron stand and safety glasses to prevent any other unusual or unexpected mishaps. 
It was rewarding to witness Harold’s passion.  He ordered glass packs in a myriad of colors, and he bought rings of copper foil.  He worked tirelessly, glued to his table and tools, making flowers, and leaves, and his color filled angels.  He always shared his finished items.  They were gifts for another resident, a family member, or a staff member.

Harold visited my office at least three times a week.  The other department heads teased that he had a crush on me, but I believe it was because I listened to what he had to say.  Over the course of months, he told me long detailed stories of his career as a janitor in the Bronx. He complained incessantly, but I soon sensed that he only feigned dissatisfaction as an excuse to get my attention.  Whatever the motive, I gave him my time, and he accepted it as a precious gift.

As Harold pursued his hobby, he began to specialize in one simple angel silhouette.  He made a few for the soon to be erected Christmas tree, and then presented one to each department head in their favorite color.   When he asked me what color I wanted I, of course, said “blue.”

The day my angel was finished, Harold carried it to my office.  He also brought a small, clear plastic suction cup.  He adroitly sealed the suction cup to the panel of glass that framed my door.  Once the cup was in place, he painstakingly placed the angel on the hook in the center of the cup.  He took a step back to admire his work, and then said with a grim “ I’ve hung your angel.  She’ll protect you.”

 “From people like you,” I shot back, smiling.  Then, I joined him at the door, and gave him a big hug.

The angel hung beside my office door for months.  During that time, the suction cup held, and my angel never moved from it’s familiar spot on my window.

Then in early July, as I slid my key into the lock on my office door, I noticed something familiar lying on the floor beside my foot.  It was my angel.  It was still attached to the suction cup. Perplexed, I assumed it had come unglued during the night and fallen off the window. Grateful the angel wasn’t broken, I leaned over and picked it up.  I didn’t have time to reattach it, so I carried it to my desk.  “I’ll fuss with it later I thought to myself.”

Shortly after noon that day, I received a call from Harold’s daughter.  I knew that two days before, she had taken Harold to the local hospital with mild heart pain.  I was sure his daughter was calling me to report that he was being released and sent home.  When I heard the sound in her voice, my heart sunk.  She was crying.  She told me that Harold had died during the night.  As I turned to hang up the phone, I saw Harold’s angel lying on my desk. I caught my breath.  I thought to myself, “How very strange that it was this particular morning that I had found it lying on the floor.”

I have moved to two other communities since then; I will soon move to a third.  My angel travels with me, as do my fond memories of Harold.  Some might think it was a coincidence that it fell to the floor the night he died, but I sincerely believe, it was a sign from Harold.  He wanted me to know it was time to say “Goodbye.”

Saturday, December 17, 2011

Difficult Decisions and Crucial Choices - The Conclusion

 This is the continuation of Jill’s dilemma regarding the care of her aging Mother, Dorothy.  Dorothy’s memory was declining, and recently Dorothy’s doctor suggested she move somewhere with supervision such as an assisted living community. The family was suddenly faced with difficult decisions.   This is the conclusion to Jill’s story.

It was several months after our initial meeting that Jill and I met face to face again.  During that time, we had numerous phone conversations regarding her mother.  Jill told me that her brother refused to let Dorothy move into a community.  He was adamant that his mother was not going to be “put” somewhere.  He insisted that if she needed assistance that she move back to New York to live with him and his family.   They would care for her.

At the time, Jill was beside herself.  Her mother, who favored her only son, was thrilled to be going home to Syracuse to live with her “baby.”  Jill, on the other hand, was confident that the situation would be intolerable.  Her brother had three children, two of them in their teens, and he and his wife both worked.  Dorothy would be alone during the day.   Their kids attend gymnastics, soccer, or cheerleading practice most evenings, so again, her mom would be alone.  And on the infrequent days when everyone was home, Jill doubted that her mom would tolerate the incessant noise and activity.  Besides, they had no inkling how difficult her care would be.

 Four months had passed after Dorothy’s move to her son’s house in Syracuse, when Jill called me. She was frantic.  She told me that three weeks ago, her mom had slipped on an icy patch while climbing the front porch steps to her brother’s house.   Dorothy fell and broke her right arm.  After three days in the hospital, her mom was admitted to a rehabilitation facility to undergo physical therapy to recover her strength.   Although her injury was not life threatening, Dorothy’s confusion had increased.  Her lack of concentration made it difficult for her to remember her body strengthening exercises, so her HMO insurance denied the facilities request to extend her time for more therapy.  Dorothy was being discharged in ten days, and Jill’s brother felt she needed too much supervision to return to his home.

“Can you still take her? I could tell she’d been crying.  “ I will have to go get her in Syracuse, but I want to bring her back to you.”

We had little time, and lots to do before Dorothy could move into the community.  Jill had to complete the state paperwork with Dorothy’s doctor in New York, and I had to confirm with the social worker at the rehab facility that she was still appropriate for assisted living. Dorothy’s social security was not enough to cover the community expenses, so Jill applied for Medicaid Diversion. The Medicaid would pay for the extra care that Dorothy needed.  Medicaid, combined with Dorothy’s Social Security is enough to pay for a companion room.  It would take several months for the money to come from Medicaid, but Jill’s brother offered to supplement her payment until then.

I urged Jill to hire one of the local movers that specializes in moving seniors.   I assured her that they would not only pack for her, but would dispose of the items that Dorothy no longer needed.  While Jill was in New York getting her mom, they would move the necessary items from Dorothy’s home in Florida into the apartment that I had chosen for her.  They would unpack, organize her clothes in the closet, replace the items that go into drawers, put her few kitchen items in the cupboard, and hang her favorite pictures on the walls.  They would put each item in place
so that when Dorothy walked through the door, she would have a beautiful new place to live.  “Trust me.” I encouraged. “It’ll be money well-spent.”

When Dorothy finally arrived I was shocked by her appearance.  She had aged considerably in the last few months, and with her arm in a cast, she could barely manipulate her newly acquired walker.  She looked weak, and she seemed sad.  I sensed her age had caught up with her, and that she was having a hard time accepting her recent injury and new infirmities.  I hugged her, but she didn’t return my affection.  “My daughter made me come here,” she barked.  “I want to go home to my house.”

“Yes Dorothy,” I understand. “When you get stronger, that may be a possibility.  In the meantime, we hope you will try to call this home.  We want you to feel comfortable.  Come.  Let me introduce you to your new roommate.”

“I don’t want to live with anyone, “ she scoffed.  “ I won’t be here long, you’ll see.”
I walked with her as we slowly reached her apartment.   As I began to knock, the person on the other side opened the door.  “Madeline, you remember Dorothy.  She is going to share your apartment.”

Jill was waiting in my office; tears were running down her face.  “She is so angry with me.  We hardly spoke on the plane.  I can’t seem to do anything right anymore.”

“Don’t be so hard on yourself, and don’t feel guilty. Go home now.  Give her some time to adjust.  If you remember, I warned you this would be one of the hardest decisions you would ever make.  I had a male client who compared caring for his mom with a divorce followed by a bankruptcy; he felt dealing with his Mom was far more threatening.  I could only assume the poor man had already experienced all three.”  Jill smiled at last, grabbed a Kleenex and headed for home.

Three days later, Dorothy appeared at my office door.  “Everyone here has been very nice to me.” she said leaning on her walker. “Far nicer than I imagined, but living here isn’t my cup of tea.  I have packed my things, and I am going home.  Please call my daughter to come and get me.”

“I’m so sorry,” I said calmly.  “Jill works during the day, so I won’t be able to contact her until after dinner.  Go have lunch, play bingo, and enjoy your afternoon.  I’ll call her later this evening.”

 I never called Jill, and as the days passed, Dorothy forgot our conversation about moving out.  A care aid had discreetly returned her clothes to her closet, and her toiletries to the bathroom.  Dorothy never mentioned leaving again.  She and Madeline became inseparable.  They joined the book club, they played dominoes; they participated in the word game trivia, and together they took the trips to Wal-Mart. Dorothy was often still confused, but Madeline was always on hand to assist her.  The ladies continued to sit with Charles during their meals, and it was not long before they gladly welcomed another new resident to the table who was also from New York.

Jill’s relationship with her mom remained delicate.  During Jill’s visits, Dorothy made her daughter feel guilty for bringing her to our Community, and she continued to speak harshly to her. When Jill was not visiting, she was sweet and amiable. Jill tried everything, but there was no compassion to Dorothy’s treatment of her only daughter.  Eventually they reached a compromise, but their relationship was never the same.

Jill and I knew she had done the best she knew to do. There is no moral to this story because when it comes to finding solutions for parents, there is no right or wrong.  “Doing the best you can,” means just that.  There is no magic wand to make everything all right, and there are no absolute solutions. 

 If a genie appears one day to grant me one wish, it will be that adult children will begin to recognize that their parents will eventually age.  Preparing for the future, rather than reacting to a crisis, will make their lives and their parents lives easier.  It will be a win-win for all of us.

Sunday, December 11, 2011

Difficult Decisions and Crucial Choices Part 2

Part 2

Jill was visiting my community.  Her mother had declined mentally over the last few months.  Jill was now forced to admit that her mother might have reached a point in her life when she could no longer live alone.  Jill needed some answers to her questions about the next step for her mom.  She called me looking for options. This is a continuation of our discussion during her first visit to our community as outlined in my previous blog entry. 

 After I got us both a cup of coffee from the kitchen, we sat facing each other across the table in my office. 

“Is your Mom aware that her memory is slipping? “ I asked.

Jill hesitated for a moment pausing to find the right words. “Yes,” she said, “and no.” The day she couldn’t find her way home, I could sense her fear.  She didn’t say anything, but her voice was panicky.  We didn’t talk about the episode again.   On the other hand, I have often heard her mention that she forgets a lot, but she doesn’t seem to take it too seriously.  I think we both have been living in denial.”

I handed her a brochure that profiled our community.  The pages inside listed the prices and what they included; there were also floor plans of the apartments. I began to explain. “You will see a list of services inside that you can read at your leisure when you get home.  They are self-explanatory, so I won’t waste your time discussing them with you.  I'd like to emphasize there are things that the flyer can’t illustrate: the intangible advantages to living in an environment where other people suffer the same memory challenges as your Mom.  To begin with, she will be more relaxed and content knowing she's surrounded with people who occasionally display the same type of forgetfulness.”  

 “The residents will often compensate for one and other’s shortcomings without realizing it.  Their conversations may seem repetitive to you and me, but for them they're new and interesting.  They're accepting of each other and are willing to offer assistance and encouragement.  As an example, when one forgets a room number, there are neighbors to remind and even direct that person to their front door.  If your mom fails to show up for meals, her tablemates will alert a staff member. They may go so far as to admonish her if she doesn’t eat well.  On the other hand, our care staff will access her every time they interact with her, and the director of nursing will alert you if there are any unexpected changes.

“Another advantage,” I continued, “ is that your Mom will have a social network.  Statistics prove interaction with others delays dementia by almost 70% or more.  Our activities include word games and stimulating trivia that will also motivate her to think.  You may even be surprised in time to witness a significant improvement in her memory.  Once we urge her to use her brain again, she may become more like her former self.”

I could feel that Jill was impressed, but still hesitant.  I also understood that she was at the very beginning of her investigation.  We shook hands as she headed for the door.

 “I'm relieved to see you have become proactive rather than reactive.  You have a much better chance of finding a happy solution for your mother that will accommodate both your needs.  I'll be in touch in a few days.”

Two weeks later Jill brought her Mother, Dorothy, for lunch.  Dorothy was extremely suspicious.  I took them to my office, where I asked Dorothy to tell me a little about herself.  Her body was rigid, and she refused to look at me.  She focused her eyes on the wall behind me while she spoke.  She told me she was from Syracuse, New York, and she had moved to Florida after her husband had retired from Kodak.  Her son still lived up north, although her daughter and son in law had relocated not long after Dorothy and her husband were settled. 

Dorothy was not the least forthcoming in her answers.  I had to ply her with question after question to entice her to talk.  I looked at Jill.  The stress she was feeling was acutely visible on her face.  “Mom, isn’t this a pretty…”   

“I cut her off before she could finish.”  I knew her mom wasn’t stupid.  She knew what her daughter had in mind, and at the moment, she wanted no part of it.  I didn’t want Jill to make her more defensive. 

“Come Dorothy.  It's time for lunch. I have a special place reserved for you and Jill”

I had advised my dining services team that we were having guests.  As we entered the dining room, one of the wait staff walked up to greet us.  “You must be Dorothy,” the young lady grinned as she spoke.  Dorothy, surprised at the use of her name, managed to force a smile in return.  The young women took her hand and led her across the dining room.  “Come with me,” she said.  “There is someone I want you to meet.”  

The young waitress lead Dorothy, with Jill a few steps behind, to a table near the window.  Two residents were already seated - a man in his late eighties and a woman who I knew to be over 90 years old.  The two were tablemates and ate together at every meal.  The man, dressed in kaki slacks and a beige and green plaid shirt, stood up and pulled out the empty chair to his left.  “Hello Dorothy,” he said as she sat down.  “My name is Charles. This is my friend Madeline,” he pointed to the women sitting next to him. “We understand you are from Syracuse.  I’m from Buffalo, but Madeline is from just outside Syracuse - a small town called Walton.  Do you know it?”

I left them at that juncture, promising to return after lunch.

An hour later I returned to find Dorothy and Madeline still engaged in conversation while Jill sat patiently, finally smiling a little. 

“Dorothy,” I'd like to show you our community.  “I'm  such a show off, I'm always dragging folks on a tour.  Would you humor me for just a few minutes?” 

As we walked, I introduced Dorothy to the residents we met along the way.  Staff members, already alerted that a visitor was coming, chimed “Hi Dorothy” when they saw us coming. As we entered the elevator, a gentleman was leaving.  He had his over-fed dachshund in tow. “Does he live here?” Dorothy asked.  “Yes. His dog, Snooks, lives with us too.  I believe I remember Jill telling me you had a dog.”  She shook her head to say yes.

 I showed her the model of the one bedroom apartment.  It was decorated with furniture and intimate personal accessories to appear occupied.   A potential resident could easily visualize its promise from the well-placed furniture and appealing artifacts. I sensed from the expression on Dorothy’s face that she was beginning to appreciate what she saw.  I never once suggested that she move in.

I showed them back into my office.  I began to question Dorothy more directly.  “What would you like to do with the rest of your life?” I asked her.  She once again became defensive.  “Live in my house until I die,” she barked.  I shook my head in agreement.  “What if it became impossible for you to live there?” I questioned further.  She looked at me intently.  “I know I forget once in a while, but no matter what my daughter tells you, I'm still able to take care of myself.”   She glared at her daughter who sunk slowly into her chair.

“Besides, Dorothy continued.  “There's no way I can afford all this.” 

“And if you could?” I asked.  She looked at me intently, but she didn’t answer.

Jill and Dorothy left soon after our short discussion.  Jill mentioned before leaving that her brother sill lived in Syracuse.  She would call him immediately and have a serious discussion.  I sighed.  Jill had a long journey ahead of her, and there was only so much I could do to help.

Find out Jill’s decision and Dorothy’s future in the next few entries.

Sunday, December 4, 2011

Difficult Decisions and Crucial Choices    Part 1

If the doctor had said to Jill, “Your mother can no longer live alone.   You need to find an assisted living community or hire a personal care taker,” Jill’s decisions, although difficult, would have been easier.

Instead, the doctor said, “Your mother is physically healthy for her age, but I notice a significant decline in her memory since her last visit.  That decline may or may not continue. ”  Jill felt a sudden surge of panic as she heard those words. In the last few weeks, on more than one occasion, she had experienced her mom’s lack of focus.  Just last week her Mother had phoned her crying. She had lost her way while walking her dog and didn’t know how to find the house she had lived in for over thirty years.  Jill was able to “talk” her Mother home with a few simple directions, but the incident left Jill feeling uneasy.

Then yesterday, while they were shopping for groceries, her mom had mistaken Jill for her own mother, Jill’s grandmother.  She remained confused for several seconds before she snapped out of it and recognized that Jill was her daughter.   There had been other incidents, but Jill had brushed them off as simple signs of old age – nothing serious enough for concern.

Suddenly, the doctor is saying the changes may not be so simple after all.  “What does this decline mean?” Jill asked cautiously

 “You need to be alert to more severe memory loss or changes in behavior,” he responds vaguely.

“Then what?” she asked.  “Well,” he says, “you may want to consider getting her some assistance.  It is up to you to decide when the time is right.”

“Up to me,” Jill thought to herself.  “How can it be up to me?  This is my Mom the doctor is talking about.  She’s the parent - she makes the decisions, not me.”

The drive home from the doctor’s office was a long one. Sadly, Jill knew in her heart that, in less than 5 minutes, her life and her mother’s life had dramatically changed.

 When Jill called the assisted living community where I was the Executive Director to set up an appointment, we agreed on a time later that day.  She arrived early, and when I introduced myself, I could sense that her emotional state was fragile.  I invited her to my office.  “How can I help?” I asked as we sat facing each other across the table I used for interviewing clients.  Her eyes filled with tears as she related the story of her visit to the doctor and shared the details of a situation that I had heard a hundred of times before.

Jill was in a quandary; her mom’s memory loss was not severe enough to warrant a diagnosis of dementia, but it was severe enough that it was uncertain how much longer she could live independently. Jill was confused and apprehensive.  She didn’t know what she was supposed to do.  She worried that if her mother’s memory deteriorated further that she wouldn’t be safe to live at home alone.  Yet, she was convinced her mother would do anything to remain in the house where she had raised her two children.

What should I do?” she pleaded.  “If it is too soon for her to move somewhere, she will never forgive me.  If I don’t move her she may really get lost one day; I also worry she may leave the stove on and start a fire.”

“I am sorry,” I said, trying to console her.  “ I understand that this may be one of the most difficult decisions you have ever made.  I can help by introducing you to my community, and I can offer one of the possible solutions.  I will also give you the names of other communities.  You will want to make a comparison of prices and services.  Use the Internet if it helps, but don’t substitute that for visiting in person.  Pay attention to your feelings, and don’t allow price, services or amenities to unduly influence you. If you choose to relocate your Mom to a community, don’t dismiss the feelings you get as you walk in the door.  If you feel “at home” more than likely, she will too.

 “What about someone to live with her, or come in during the day” she inquired.

“Of course there are many reputable agencies.” I answered. “I will be happy to give you several pamphlets with contact numbers and information.”

I continued, “It is essential that you allow your mom to be a part of your decision.”  “You don’t need to go into great detail about your intentions.  As you narrow your community search, accept their invitations for lunch for you and your mom.  Your Mom will enjoy the attention.  Don’t pressure her by explaining that you want her to make a choice.  Allow her to enjoy the excursions as an adventure.  Luckily, it appears that time is on your side.  This gives you the opportunity to build a relationship with the communities that are high on your list.  Your mother’s choices are clouded and prejudiced by the images of HER mom in a nursing home. As she interacts with the residents and staff during her visits, she will begin to understand that assisted living today is much different.”

“If you consider a home help agency, include your mother in your personal interviews with a potential caretaker.  Watch for the interaction that occurs between them, and pay close attention to how well they seem to relate.

“Be careful not to get angry with your mom if she objects.  Assure her you understand how difficult it is for her to accept that a change may be in her future; empathize with the threat she feels about loosing her independence.  On the other hand, it’s essential that you don’t let her dissuade you.”

I offered to show Jill our community.  I was sure she would be pleasantly surprised. The dining room was exceptionally impressive.  It faced a courtyard filled with tropical flowers and greens, and the colors used for flatware and table decorations echoed the oranges, reds, and greens of nature’s d├ęcor visible through the windows.  The living room, the game room, the library and computer lab were also engaging.  Our apartments were spacious and tastefully decorated; the building resembled an expensive hotel  - certainly not a facility.

The staff members we encountered along the way were kind and friendly to Jill.  The residents we saw were busy with various activities.  Two ladies were concentrating on a jigsaw puzzle at the game table, a foursome was playing bridge in the game room, and a few less industrious people were contentedly watching the people come and go in the entry.

“Let’s go back to my office.”  I handed her a brochure as we sat down.  I asked, “Do you have a list of priorities for your mom’s future? What can I do to assist you with your dilemma?”  She appeared overwhelmed by my questions. I put my hand on her arm.  “Let's get us a cup of coffee.  We’ll explore this problem together.”  As I left my office and walked toward the kitchen, I understood that Jill, like thousands of adult children, was feeling lost and alone.  I was confident that, over time, I could assist her in finding a viable solution.

(I will expand upon the solutions for Jill in the next several entries)

Sunday, November 27, 2011

Greedy Children

I received the summons early on a Friday morning.  Although I had been involved as a bystander in other sibling disputes, this was the first time I was asked to testify in a custody case for a resident. The young ladies who were named as plaintiffs in the suit were sisters; daughters of a sweet, quiet, resident named Hazel.

Hazel lived at home with a caretaker, until coming to live in our community six months ago.  Her mobility and her memory had declined since her husband had died two years earlier.  For her safety, her daughters had hired a caretaker to attend to her shopping, bathing, medication, and nutritional needs five days a week from early morning until after dinner.

Not long after her husband’s death, Hazel had been awarded a large sum of money in a legal settlement.   The girls judiciously retained an attorney to disperse the money intended to subsidize Hazel’s care.  Of course, they were also the beneficiaries, each girl scrutinized how and why every penny was spent.

The sisters had been enemies for years, but they become possessive of Hazel once she became a widow with an inheritance. The argued ferociously and viciously with little or no consideration for the effect it had on their Mother.   They hired lawyers to petition for custody, each vying to act as her legal guardian.  The daughters spent thousands of dollars on legal fees and thousands of hours attending court hearings.  Eventually, an emergency temporary financial guardian had to be appointed from the Department of Elder affairs to protect Hazel during the painful on-going process.

While waiting for the courts to decide Hazel’s future, the younger daughter, who lived in New York decided independently of her sibling that her mother belonged in assisted living.  She implied that the current care- taker was stealing the money that was proportioned for Hazel’s incidentals, and she alleged the current arrangement was becoming too expensive.  She flew to Florida on the week ends to shop for places in local assisted living communities, and after several visits and numerous phone calls with our sales professionals, she agreed to move her to our community.    To save money, she insisted her mother could care for her daily needs, so she refused all services except for assistance with her Mother’s medication.

Rather than move her life-long possessions, Hazel’s daughter from New York purchased all new furniture and accessories to decorate the new apartment.  Although seeming to be kind to her mother in public, she verbally bullied her  behind closed doors.  She ruthlessly screamed at Hazel, not realizing her rants could be heard in the hallways.  She obsessively tried to control every aspect of her mother’s care; she badgered my staff daily with long distance phone calls from New York.

The older sister lived locally.   She begrudgingly agreed that her mother could try assisted living. Although she did not contribute her time or any furnishings to the move, she criticized everything her sister did from the color of the drapes to the size of the queen bed.  She visited infrequently, and made it clear she felt her Mom had been manipulated by her younger sister.

Hazel made small talk in the presence of her daughters.  She was in the middle of a family war zone, and she struggled to be impartial as her daughters continued to verbally assault one another.  She never seemed to take sides.  Occasionally she would visit my office and share her disparity.  Her daughters were making her life stressful and she was saddened by the conflict.

When the day came for me to appear at the hearing, I was both angry and nervous.  I refused to side with either of the young women; my only concern was for Hazel.  She had happily adjusted to the community.  She participated in many of the activities, and she had made several friends.  The staff appreciated her sweet nature; she soon became one of their favorites. I felt that her continued stay with us depended on which sister won.

The judge (who cleverly deciphered that the money was at the root of the turmoil) postponed his decision until the lawyers provided more financial information.   Not long after the hearing, Hazel’s older daughter convinced her mother that she would be happier at home.  Hazel left our community sharing tearful “goodbyes” with her new friends and moved back home.   The original caretaker was rehired.    As usual, Hazel did as she was told.

The last time I saw Hazel I was visiting a sister community not far from the home of her older daughter.  I recognized her eating lunch in the dining room.  Ironically, her daughter from New York was sitting with her.  She explained that Hazel had only been at the new community a couple of days; her older sister’s idea that she return home had been a huge mistake.  I smiled, but said not a word.  In less than 10 months Hazel had been bounced back and forth three times trying to please her avaricious daughters.   I silently wished she would outlive her money, and neither would be compensated for their selfish behavior.

Sunday, November 20, 2011

Grandpa is Nuts About Driving and Driving You Nuts

Last week an endearing gentleman came in to my independent living community looking for an apartment.  He was 88.  We talked for several minutes; I found him to be vibrant and spry, but also frail. He walked slowly with a cane because his balance was unsteady. Initially, he said he was looking for a new apartment in a place where he could make friends.  He appeared to be lonely.  After we talked for several minutes he confessed, “It is almost time for me to give up the car keys.  It would be helpful to live somewhere that provides transportation.”  I looked surprised, and misjudging the reason behind my surprise, he continued to explain, “ one eye is covered with a cataract, and the other is blurred with half a cataract.  It is becoming very difficult for me to see.” 
I kept my face expressionless, struggling not to react while he continued to describe his infirmities, although I was alarmed that he was still behind the wheel.  I agreed with him that he would benefit a great deal if he lived where transportation was provided, and thought to myself, “ and add to the safety of other drivers.”

The hardest of all judgment calls during the process of aging is to give up the car keys.  It is devastating to loose the autonomy to come and go at whim.  As one gets older, doctor appointments are vital, the liberty of shopping at Wal-Mart is not merely an activity, but an outing, and going out to dinner is a special occasion.  Once that independence is lost, there are few alternatives. Public transportation is limited, and children and friends try to be accommodating, but they have busy lives, and we cringe at the idea of becoming a burden. 

Several years ago, I received a phone call from the Seven Eleven gas station across the street from my community.  The owner was frantic.  One of our residents had backed into a car as he was pulling away from the pump, then edged forward and rammed into the side of another car.  He panicked, shifted into reverse, and hit the original car a second time. “Please come get your resident,” the distraught proprietor pleaded over the phone. My maintenance director rushed to  rescue my eighty year old before he could slam into another vehicle, and a family came later in the day to claim the bruised sedan. 

In one city, the windows in my office faced the parking lot.  Every day I watched residents with walkers teeter toward their cars, pull themselves up, sturdy themselves with their hands against the top of the passenger door, and panting and rasping, manipulate their frail bodies behind the wheel. In their minds, they felt cognizant, alert and physically able to drive, but our minds can paint a brighter picture than our bodies can accommodate.  I knew if push came to shove, there would be disastrous consequences if they had react quickly to prevent an accident. 

 One afternoon I glanced outside to see a resident back into a “no parking” sign.  He did not realize he had hit it, and continued to back up until the sign arched backward.   He pulled forward, vigorously turning the wheel to clear the curb, reversed, hit the sign a second time, and the battered metal leaned sadly just inches from the ground. I ran to warn him, but he'd already given it a third try, and by the time I got there, his tail lights were trailing down the street, too late for me to save the sign from another blow. 

Not long afterward a family member rushed into my office to report, " A white haired older woman just rammed into the car in the space behind her. Then she pulled forward and drove away as if nothing had happened." Keeping the benefit of the doubt in mind, it is possible that the driver didn’t realize there had been a fender bender, but more than likely, she did. She panicked; because if someone discovered her mishap, there was a strong possibility her kids would confiscate her car keys.  The young woman who saw the accident couldn’t (or wouldn’t) identify the driver, but in the meantime, I had to locate the owner of the damaged car, and with my cheeks blushing from embarrassment, report the hit and run.

A person must eventually admit that driving is a privilege.    As kids, we can't wait until we are sixteen to receive our driver’s license, but there are no guidelines for relinquishing it when age works against us. "The Muffin Lady” (profiled 11/13/11) had been injured in an accident in which she was at fault.  After that she was afraid to drive and would say, “One should quit driving when one becomes timid and hesitates before pulling into traffic.” Not long after her recovery from some minor injuries, she opted to move into our community.

I have been the tattletale more than once and called a son or daughter to suggest a discussion with a loved one about driving may be imminent. I cannot 
imagine how difficult it must be for a person to be told they are no longer able to drive safely. I am independent as long as I can come and go as I please, and I'll admit that I take for granted the freedom that it allows me.   One of the lessons I have learned from my residents is to plan for the future, and sometime within the next few years I will be obliged to realistically access my own driving skills.   Luckily, it hasn't caught up with me yet, but one dreadful day, I will have to admit, "I'm too old to drive" and as hard as it may be, willingly present the keys to my son.  

Sunday, November 13, 2011

The Muffin Lady

I had been at my new community only a couple of days.  I arrived early that morning knowing I needed extra time to organize my office.  I was bent over alphabetizing the folders in the lower drawer of my desk, when I heard a noise that sounded like someone clearing their throat.  I looked up to see a resident standing at my open door. She was not smiling. 

I rose to meet her, intending to introduce myself.  I had taken only one step when I caught a glimpse of her right arm cocked and locked like a major league pitcher ready to throw.  A mille-second later, I felt an object whiz by my head. I ducked.  I heard a dull thud on the window. Then, I turned to watch a food like substance slide down the glass and plop on the floor.

 “Would you eat that?” the woman shrieked still standing in the doorway.
“Eat what?” I asked, afraid to move for fear she would hurl another projectile my way.
“The muffin. Would you eat that?”  
“I didn’t know it was a muffin,” I answered timidly.
“Exactly my point,” she answered arrogantly. “That’s the worse excuse for a muffin I have ever had on my plate.”
I bent to pick up the smashed, but somewhat in tact muffin.  I turned it in my hand, “Looks like a muffin to me,” I thought to myself, knowing that was not the answer she wanted to hear.

I smiled politely, trying to defuse the moment.  “My name is Karen.  What’s yours?”
“I know your name is Karen.  Everyone in this place knows your name is Karen. We all got the memo. “I’m Mildred.”
Still holding the muffin, I turned to walk back to my desk.  “Come sit down Mildred,” I offered.  “Let’s talk for a minute.”

My conversation with Mildred lasted for almost an hour. She was in her early 80’s, dressed in expensive brown wool slacks, a red silk-like Nehru collared blouse, and a long, chain stitched, ecru jacket sweater.  She didn’t have on make-up, but her earrings, traditional slim hoops, looked expensive.  Her face had sharp features, her eyes were small and narrow, and the wrinkles around her mouth curved downward suggesting that she didn’t smile often.

She talked in bursts - short angry sentences.  She had only been at the community for a month.  Her husband had died on Christmas Day less than a year ago; she had lost her son in a jeep accident less than 5 years ago.  Her daughter, a lawyer, lived near by.

Mildred made it clear that she came to live here of her own accord, but she was also convinced it was the worst decision she had ever made.  She found the food  intolerable. The meat was tough and the vegetables were overcooked.  Coming from California, she preferred al dente. She was not used to eating on a schedule.  Dinner at 5 was annoying.   Furthermore, she was frustrated that the bus driver refused to take her on her personal errands when it was convenient for her.
 As she talked, her voice grew louder with each complaint.  She threatened to write the owner, and she threatened to call the movers to take her elsewhere.   Then, after a pause, and without preface, she became very emotional. “I have nowhere else to go.”   I saw the tears slowly filling her eyes. I was not surprised when she began to cry, but I was not prepared for the, long, heavy, painful sobs. 

Mildred was not angry with me, she wasn’t angry about the muffin, but she was angry about the turn her life had taken.  She left a four-bedroom house with a pool and tennis courts, and she now felt cramped and imprisoned.  She had made no friends, because she wasn’t friendly.  Her relationship with her daughter was tenuous, but Mildred made few gestures to mend it. 

When she was younger, Mildred was the president of her own accounting firm.  She was always the boss and she was always in control. People did what she told them to do.   When she retired, she frequently traveled with her husband.  Mildred had been an active, engaged and energetic person.   At eighty plus, that had changed.  Now she had nothing purposeful to do, she was lonely, and she wasn’t in control of anything – not even the time she ate dinner
Mildred’s self image was worsening, as was her cognitive ability. She could feel her memory slipping, and she hated that.  She was not ready to be old; she felt helpless.  There are no alternatives to growing old, and she, like many of our seniors found it difficult to cope when age compromises both the body and the mind and the future appears bleak.

 Mildred and I became close friends, although she continually tested our friendship with her feisty disposition and forceful manner.   In time, Mildred came to love living in our community, but it was a tough transition for her. I made her chairman of the food committee, and she took ownership of the chair like a drill sergeant.

 I was devastated when two years later she had a stroke.  She recovered and returned to live with us, but the assertive, aggressive CEO personality never returned with her. I sorely missed that lively, spirited, strong willed person I now fondly remember as “the muffin lady.”


Wednesday, November 9, 2011

Walk the Talk and Talk the Walker

Raleigh (my miniature schnauzer that I profiled in my first Post) and I were taking our afternoon walk when I recognized a familiar sound in the driveway near a house we had just passed.  It was the grating of metal on concrete accompanied with a clatter of rocking wheels. Turning to look back, I was not surprised to see an older man using an aluminum mobility walker.   He was pushing it clumsily and incorrectly.  The sound was the legs scraping across the pavement. 

The man looked frightened and moved timidly. The lightweight walker barely supported him. He shuffled his feet as if he didn’t trust it to prevent him from falling.  He wasn’t using it correctly –picking the walker up and placing it a short distance ahead of him, then walking into it; he instead shoved it forward as he walked with it.  I recognized the walker as the generic brand I had seen a hundred times before. l guessed that it was donated, purchased on line, or acquired secondhand, and I suspected that he had not received professional training on how to use it.

Walkers are a way of life in a senior community, and without them, residents would be more apt to fall and injure themselves. According to the Center for Disease Control, one out of three age 65 or older falls each year, and among the oldest segment of that group, falls are the leading cause of injury death.  Therefore, those with weak legs and uncertain balance depend on sturdy, properly adjusted walkers to retain their independence and mobility; few people realize that a walker has to be sized and adjusted, just like a pair of corrective shoes, if it is to be effective.

I recall a resident, Frank, who attached himself to me as his literary mentor.  He fancied that he was a poet, and every day he banged on my office door with a new creation for me to critique.  He was a small, thin man, somewhat frail, and he had recently fallen on two occasions.  His fear of a broken limb or displaced hip had prompted him to became attached to a walker that he had inherited from a former roommate, and he used it faithfully even for short distances. 

Frank was unaware that his walker wasn’t properly adjusted.  The railings on the walker were set so low that he was looking at his feet when he walked, and because he couldn’t see where he was going, he often scraped furniture or ran into people.  He had a bad habit of pushing the walker forward and rambling with it. No one had ever trained him to place it ahead of himself and then walk into it to catch up. To make matters worse, he had attached two lime green tennis balls to the feet.  Temporarily, the balls made the walker’s feet slide easier, but after prolonged use, the bottom of the balls will wear away leaving the metal exposed to the floor. The metal becomes slippery and once weight is applied, the legs will slide like skates on ice.

I pointed out Frank’s problem to Lisa, our physical therapist. She called his doctor asking for an order for Frank to receive training. She discovered that Frank was eligible for a new walker from Medicare, and she arranged to have a shiny new one delivered to him within days.  She adjusted the height so that he would stand more erect, and encouraged him to: “Pick up the frame, place it ahead of yourself, walk into the frame and repeat”.  Finally, she attached the specially designed slides on the legs to facilitate propelling a walker smoothly, and she discouraged him from exchanging them for the lime green tennis balls.

After his training, Frank still came to my office every day.  In fact, he felt so good about himself he often came twice a day. He was more mobile and more self confident, and he appeared stronger and happier

Walkers come in all shapes and sizes and their styles range from what I refer to as the Chevy model to the Mercedes upgrade. Most residents choose to use walkers, especially if their neighbors do. They quickly lose any self –consciousness; they are no longer embarrassed  – even at the age of eighty plus, people like to emulate their peers.


Saturday, November 5, 2011

Taking the Time to Find the Right Time

Late one Friday afternoon, I had to say my final goodbyes to Debbie and Gary when they moved the last of Harold’s belongings from the apartment. Gary was Harold’s father, and Debbie Harold’s daughter-in-law. Harold had lived at our community for 6 months and had passed away earlier in the week while under the care of Hospice. It was not unusual for me to become close to a resident’s family, and I was saddened to realize that, despite our connection, our paths would probably never cross again. 

Prior to his death, Harold, spent weeks in a rehab center receiving intense physical therapy, struggling to regain his strength, hoping to return to his own home. His therapist determined he had reached his maximum physical capacity; his doctor told him that his health would not improve. They concluded that it would be dangerous for him to live alone. Therefore, his dream of returning home was no longer a viable option.

Son Gary lived in New York; his father Harold lived in South Florida. Harold’s moving to New York to live with Gary and his wife was not an option. New York weather would not be Harold’s friend. To complicate things further, Harold lived with a “significant other” that he was not willing to leave behind. Gary had to make other arrangements quickly, because the 90 days of facility care covered by Medicare were coming to an end. Harold’s discharge day from Rehab was pending.

Gary found our community on one of the senior housing search engines on the Internet, and came to us distraught. He was frustrated, anxious, and desperate for a solution although he felt “putting” his dad in a facility was an intolerable remedy. He, like his dad, equated an Assisted Living Facility with a nursing home, envisioning lonely hospital beds, sterile rooms, and bedridden patients. 

As I gave them a tour, I could feel Gary slowly relaxing. I showed him the carpeted dining room with linen tablecloths, the huge circular living room with a large 3D TV, the cozy conversational settings, and the pristine care station where nurses and aids were busy interacting with our residents.  In one of the alcoves, we saw a group of residents contentedly playing dominoes, and fortuitously, in another, we saw one of our Jewish Volunteers leading a chorus of traditional Hebrew songs with some of our large population of Jewish residents. When I explained to Gary that sharing Yiddish folksongs was a regular Friday event, he smiled for the first time. “Dad would enjoy that,” he said softly. “He’s Jewish.”

Time was running out quickly for Harold. Gary and Debbie worked quickly to obtain the necessary paperwork and prepare for the move-in.  Once the furniture was delivered, Gary and Debbie were fastidious in decorating Harold’s new apartment with familiar pictures, a large king sized bed, and a stately antique dresser.  Debbie hung curtains over the generic blinds, and Gary installed a big screen TV.

I wish I could say, “it was love at first sight,” when Harold saw his new home, but that wasn’t the case.  Initially, Harold hated everything; he disliked the community, his room was too small, the food was tasteless, and for several days he resented his girlfriend.  Determined to make him happy, my team of caring professionals befriended him, the care staff overlooked his angry outbursts, and his friend, Roberta, remained loyal as we slowly worked to crumble Harold’s hard wall of anger.

Although he remained essentially a loner, he gradually began to smile.  He occasionally appeared in the common living room, and often joined the Jewish sing-along.  His “significant other” Roberta visited frequently, sometimes spending the night, and she became as much a member of our family as he was. I knew we had succeeded with Harold about two months into his stay. I was circling the dining room sharing my daily breakfast conversations with our residents.  When I reached his table to speak to him, he secretly confided in me, that he was content and glad to be with us. I thanked him, pleased, but suspected, if anyone else questioned him that he would deny it.

Four months later, I was standing nearby as Debbie was putting the last of Harold’s things into the van following his death. Debbie and I reminisced about her experiences with her father-in-law.  She enumerated for me the difficulties of caring for an aging parent, and the decisions, not always pleasant, that an adult child is forced to make. She thanked me, “We didn’t know what to do. Your guidance was invaluable.” 

Then as she turned to leave, giving me one long last hug, she smiled. “I have only one regret.” I looked at her questioningly. “I regret that he didn’t come here sooner.” I watched her car, lost in thought, as she slowly drove away.

Tuesday, November 1, 2011

Truly Sad and Sadly True...

As an only child, I was the focus of my parent’s existence. I lived my life to enhance theirs; I was on the honor role in high school, made Dean’s List in college, married, and gave them a brilliant grandson.  Once they got older, I moved to Florida to continue my role as the perfect daughter, but everything changed when I was forced to reverse our roles, and suddenly I became the parent.

As my Dad became mentally and physically weaker, my mother made herself his primary caretaker with a martyr’s diligence.  My proposals to hire outside assistance to lighten her load fell on deaf ears, and despite her complaints of fatigue and a lack of freedom, she persevered in her mission to manage his care. Then, after he died, left without a sense of purpose, she suddenly became needy, depressed, belligerent, and extremely defensive.

Although I desperately tried to help her, she rejected every idea or suggestion. During this time, I had my own set of problems; I was going through a divorce, owned a flower business, and held down a second job to make ends meet. She lived three hours away on Florida’s opposite coast. I found myself rushing across Alligator Alley at least twice a month to respond to her pleas for assistance.

Finally, I packed her possessions and moved her, despite her protests, to the West Coast to live with my son and me. Although she pouted and cried, I continued to harbor an unrealistic expectation that moving her would change her attitude, and that her new surroundings would encourage her to appreciate my company as well as that of her only grandchild.

Oh, how wrong I was! During our final two years together she resented the arrangement I had forced on her and never hesitated to remind me. She withdrew from my son, from both her friends and mine, and she declined rapidly, as much from her attitude as from her physical decline. Nothing I tried seemed to satisfy her. She even hated our dog. In turn, I became resentful, and often failed to hide my feelings. I verbally lashed out at her and she lashed out at me.  There ensued an unhappy dance between the two of us that made both our lives miserable and unhappy. It finally ended when we shared a pitiful "I love you" hours before she died.

 Years later a series of unpredictable events has led me to a career in senior housing, and now, as a manager of an assisted living community, I have discovered that conflict between adult children and their parents is not uncommon. Ironically, I spend my days consoling others, who are just as confused as I was, and gently guide them in making decisions and finding viable solutions.

I am now aware that the Mother, who so resented me and was critical and verbally abusive, suffered her own sense of bewilderment. She experienced the loss of her independence, a diminishing physical presence, and a failing memory. She needed me to understand; I didn’t, and regretfully, I was unable to empathize.

Those needing assistance will increase as our population ages, as will the number of children sandwiched between simultaneously taking care of their kids and their parents.  I am grateful that I have been given the opportunity to help to turn a sad, hurtful episode between my mother and myself into a useful and positive legacy of service to others in a similar situation.  

Sunday, October 30, 2011


As I circled behind my desk and sat down, an uncertain sadness replaced my customary sense of wellbeing. I heaved a heavy sigh, and rested my head on  the palms of my hands.  As my glance circled my office, the space appeared unusually gloomy. I felt that the stress of saying goodbye to another resident was beginning to deflate me; I counted almost 30 goodbyes in the last two weeks. Sadly, as each mounted the steps to the bus displaying our name and address, I felt as if I had lost another member of my immediate family.

 The community was changing direction, heading toward independent living, and I was responsible for closing our assisted living.  In the last two weeks I had been challenged to find new homes for over 50 residents. Today, I said good-bye to four more, and one of them was my friend Millie.

My miniature schnauzer, Raleigh, and I had lived on the sixth floor of my assisted living building for almost two months while I moved our belongings from South Florida.  During that time, we made friends with many of the residents. They were all charmed by my little gray dog. She practiced no age discrimination, and greeted each person with the same happy enthusiasm. Every morning the residents called her name as they stretched their arms over their walkers and wheel chairs hoping to get close enough to pet her. Each had a childhood dog story, their tales often sparked by the wag of my little dog’s tail. “I grew up with a beagle,” Joe would say, “he was with me all through high school. What kind did you say yours was?”  

And Millie? She was our neighbor on the sixth floor; we frequently stopped by her apartment on the way to ours. Raleigh knew the drill. In anticipation of a treat, she bounced and danced, laying her paws on Millie’s hands beneath the arms of the walker, and shared a mutual joy.

Once we moved into our own townhome, Raleigh remained high on everyone’s list of favorites.  She often visited residents in our community, and as always, they greeted her with loving hands and open hearts.

Today, as I soothed and calmed Millie before her trip, who was most likely going to her last home, I was concerned for her well being.  Her breath was labored as she feigned self-confidence, yet her anxiety was obvious to those of us who knew her.

 Finally, after a long arduous day, it was time for her to leave.  As the driver beckoned her toward the bus, she gave me a hug and trudged forward, her walker wobbling across the creviced concrete.  She grabbed the rail and pulled herself forward, but before taking her first step, she turned to look at me. With a broad smile on her face, her voice melodic without a waiver and as strong as if she were about to embark on a trip to Wal-Mart, she sang loudly, “Say Good-bye to Raaaallllleigh.” Then she turned back to finish the trek up the stairs to begin another phase of her almost finished life. I struggled to hold back the tears that were threatening to cascade in rivers of remorse down my cheeks.

So now, back in my office, as the phone rang and the icon signaling another email sailed across the screen, I found myself lost within my own space.  “It’s time,” I thought to myself. “It’s time to quit procrastinating and to initiate the blog I had begun but never finished—full of stories I want and need to share. And thanks to Millie, I knew at once what the first posting would be.