Sunday, December 30, 2012

Pet Tales

Pet Tales
There are numerous articles written for seniors that suggest caring for a pet may reduce stress and contribute to better health.  Purina (in an article on the AARP website) brags that seniors with pets have lower blood pressure and even claim that simply petting an animal can lower ones heart rate.  Experts also speculate that people with dogs live longer, because they are forced to walk at least twice a day therefore benefiting from the exercise.  But for most of us, pet therapy extends way beyond its apparent clinical advantages.
My miniature schnauzer, Raleigh, and I share a symbiotic relationship; she is dependent on me to keep her healthy and secure, and I am grateful to have a companion who offers unwavering love and loyalty.  She comforts me just by being in the same room, and she in turn feels secure knowing I am nearby.  I feel needed, yet I receive far more than I give.  We share kisses, and she tolerates my hugs.   Raleigh is bright and alert, as well as clever and resourceful.  She is my friend.
Pets were always an important part of my assisted living families.  Cats and dogs were the most popular, but in my community in north Florida, we unexpectedly inherited a parrot.  When our parrot-owning resident died, she left Hazel to our care, and although the parrot created somewhat of a nuisance and burdened the staff, our residents liked and enjoyed her.  Hazel was a talker and often conversed without discretion.  Visitors were amused and charmed by her unfiltered remarks, and despite her bi-polar personality, she became a popular mascot.  She appeared to be content, but I have no inclination if Hazel remembered or pined for her original owner.
Cats are wonderful for a group setting such as assisted living.  Often arrogant and unfriendly except to their master or mistress, they cause very little fuss when confined to a single apartment.  They are not gregarious, and typically remain loyal to their caregivers.  I once chased a fugitive cat up three flights of stairs, but for the most part, when I entered the apartment, I only got a glimpse of a tail quickly disappearing underneath the closest sofa.
 Our cat owners worshipped their feline friends.  One such was Margaret, a lovely lady who had lived with us for only three months when her companion, Lucy, an American Domestic, with a pretty little black and white face disappeared from the veterinarian’s office while boarding.  Stupidly, one of the veterinary assistants gave Lucy to the wrong owner. When an unknown gentleman came to claim his cat, he was handed Lucy.   It was never determined how the gentleman failed to recognize that the cat was not his was, but Lucy knew immediately.   While he was carrying her across the parking lot to his car, Lucy determinedly tugged and twisted her body out from under his arm.  Once her paws hit the ground, she hastily scampered off into a nearby group of trees and disappeared.   
Margaret returned, eager to see Lucy. She went straight to the clinic.  She expected to see the cat she had missed while away, but instead the veterinary technician confessed the tale of Lucy’s fate. 
 Margaret hibernated while she grieved the loss of her friend.  The staff and I visited her apartment frequently, and for over a week the dietary department sent her meals to her apartment.   I personally called the clinic praying that the episode was all a huge mistake and that Lucy was hiding somewhere in the kennel, but no, Lucy was indeed lost. Finally, as time began to heal her broken heart, Margaret reunited with her community friends.  She spoke of Lucy over and over again, always with sadness and often on the verge of tears.  Several weeks went by, and neither Margaret nor I ever expected to see Lucy again.
Then, unexpectedly, the front desk notified me that that I had a call from the guilty veterinarian.   Without the least bit of remorse, he told me this story; Lucy refused to go home with the stranger. (Seemed to me, the cat was smarter than the doctor.) After breaking loose, she cleverly hid among the trees behind the vet’s office.  During the time she was missing, nearby families in the adjoining neighborhood had been feeding her.  She had been living as a stray until that morning when she had been rescued by a concerned young woman and returned.  The young woman had presumed from Lucy’s well kempt appearance that she was not a stray, but a lost cat. 
I quickly gathered up Margaret and drove her to the clinic to retrieve Lucy.  It was a toss up who was happier or more relieved; the resident who had pined for her missing friend, or the cat who had stalwartly survived hoping to be returned to her favorite companion.  And then I had a few choice words for the vet, “x$#+!*@#”.
Dogs are also popular with our residents.  In some communities there are often rules about size and weight, but in mine I was customarily more concerned about temperament and friendliness.  Much of the time medium or larger dogs are calmer and gentler.  Several of my residents grumbled when I allowed a giant schnauzer to move in.  They said he was too big.  Since they could find no other complaint other than his size, I ignored them.  The schnauzer was a perfect gentleman, seldom barked, and never approached a resident without an invitation.  He was far more docile than the bickering Chihuahuas whose barking could often be heard disturbing the peacefulness of our lobby.
At my community in central Florida Elaine moved in with an overweight, floppy- eared beagle.  She was younger than many of our residents, so despite the rambunctiousness of the breed, I was sure Elaine could care for her pet.  Besides, Mr. Brown Dog was older, and his drooping belly prevented him from jumping too high or friskily bolting out the front door.  A problem did arise when we discovered Mr. Brown Dog was covered with fleas, and those fleas soon took up residence in Elaine’s carpet.  I arranged for pest control to remove the fleas from the apartment, but knew it would be useless if Elaine did not remove them from Mr. Brown Dog.  Elaine called her son to assist her, but she was brusquely dismissed.  Her son refused to take the dog for a flea bath or grooming and alluded to relocating Mr. Brown Dog to the dog pound.
Having owned and loved a dog most of my life, I was horrified.  I could not imagine Elaine without her cherished beagle, especially if she thought her son would have him euthanized.  I knew I was straying beyond my responsibilities as a director, but I ignored company policy and personally accompanied Mr. Brown Dog to visit my dog Raleigh’s veterinarian.  He enjoyed a long overdue flea bath, and his shots were brought up to date.   A day later, I returned him to Elaine and a flea free apartment.  And yes, we all lived happily ever after.
I continue to encourage pets both for children and seniors.  Miss Pepper, my first miniature Schnauzer, raised my son to become a better human being.  She taught him both responsibility and compassion. Seniors benefit somewhat differently.  At a time when seniors are lonely and often overlooked because their children are busy raising their own children, a pet, oblivious to the frailness of an elderly body or the confusion of an aging mind, can share a warm hug and instill a welcome sense of belonging.    
I saw a cartoon on Facebook this week.  A psychiatrist is prescribing to his patient stretched out on the provincial office chaise.  “Go home and let your dog lick your face.  Dog saliva is the most effective antidepressant you can get without a prescription.”  I couldn’t have said it better.

Friday, November 2, 2012

The Humpty Dumpty Syndrome

A friend of mine had a serious fall over the weekend.  She was lucky.  Her injuries, although serious, were not life altering. Although my friend was young, falls are frightening at any age; for aging adults they can be a death sentence.

According to an article posted by the Communicable Disease Center in Atlanta, Georgia, “among older adults (those 65 or older), falls are the leading cause of injury death. They are also the most common cause of nonfatal injuries and hospital admissions for trauma.” In my assisted living communities, falls are tracked like meteorologists track hurricanes.  Every time a resident hits the ground, the cause and effect of the fall is reported, and the resident, injured or not, is assessed and evaluated for at least three days following the accident. 

 A resident who falls frequently is considered “at risk,” and must be assessed by a physical therapist or a primary doctor. When appropriate, a professional will recommend a change of lifestyle such as the use of a walking assistance device.    Falls are so critical that they are discussed every morning at the daily stand up meeting, and every department director is notified when a resident falls with or without an indication of injury.

Not long after entering the field of assisted living, I worked diligently to recruit a new resident, Irene. We became fast friends during that time, and I was devastated when she fell a few days after moving in.  She had gotten up early in the morning and pattered barefoot into the bathroom.  When her bare feet hit the cold tile, it surprised her enough to throw her off balance, and she toppled hitting the edge of the commode on her way to the floor. 

The nurse on duty responded to the ringing call button to find her in extreme pain, unable to move the left side of her body.  The nurse was positive Irene had broken her hip.  I arrived at work just as the emergency medical team was wheeling her to the waiting ambulance.  I stopped them a moment to squeeze her hand, wish her well, and assured her we would wait impatiently for her return.  I was totally unaware the ordeal she faced once she was admitted to the hospital.

Irene’s surgery and hip replacement was only a very small part of her recovery.  In order to walk again, she had to embark on a long journey of arduous recuperation. Once she finally left the hospital she was a patient at a nearby rehabilitation center for close to eight weeks.  Each day she endured strenuous physical therapy that sapped her strength and hurt her tired body.  The family kept us informed, but their reports during her long siege were discouraging.  Irene was depressed, confused, and suffered serious memory loss. She hated the pain she experienced as the therapists forced her to continue her exercises. She often refused to participate, choosing to sit in her room and withdraw from socialization.  Her progress was slow, and for a while we feared she would not be strong enough to return to our community.  If Irene did not come to the plate and comply with her therapy, she would spend the rest of her life in a nursing home.

Someone from our staff called or visited weekly.  We sent cards and gifts hoping we could encourage her to continue fighting.  Finally, after several weeks she seemed to gain enthusiasm and reached the level of competency that would allow her to return as an assisted living resident.  She would never again be able to live as an independent resident, but would remain in her apartment receiving the necessary assistance.

I excitedly anticipated Irene’s return, but I was dismayed when I greeted her at the door.  I was not prepared for the change both physically and mentally that had taken place.  Irene had lost weight, her face was strained and her eyes were dull.  She looked at me as if we had never met, when in fact we had spent days and weeks together preparing for her to move into her new apartment.  I was shocked to see my friend so lethargic, and I was appalled that a once totally alert, fun, intelligent lady had been reduced to such a sad, unhappy woman.  Her memory loss was significant, and her confusion obvious.

I learned later that Irene’s cognitive ability was compromised by the anesthesia given during her surgery.  Many patients, as they age, are effected by the sedation and are rendered mentally less functional than before surgery.  These altering effects may or may not dissipate over time.  For Irene, the later was true. 

Since then I cringed every time my team reported a fall.  Often what appeared to be a simple loss of balance could not only be life altering, but life threatening.  Some falls cannot be prevented; hips have been known to break before the fall.  Others can be deterred with a little common sense and proactive thinking.   Eating well, vigorous exercise, and maintaining a safe and uncluttered living environment are key elements.  

Proactive fall awareness is important.  It is impossible to prevent every occurrence.  My friend’s recent fall could not have been predicted or avoided.  A bar to assist her in the bathroom was improperly installed and gave way.  Nonetheless, the infamous “f” word should stay foremost in our mind.  As we maneuver ourselves through a somewhat unsafe and difficult world full of obstacles, we want to stand tall and keep our feet on the ground.

Wednesday, September 5, 2012

The Greater Good

The Greater Good ?

Stan was a tall, thin, lanky man.  He appeared shorter than his measured six feet, because he stood with his shoulders and head bent.  He sported a wild whiff of gray hair on the center of his head and a pair of thin wire rimmed glasses that rested precariously on the very tip of his nose.  He was quiet and reserved, yet congenial. He interacted with the other residents, but usually only at meals and during special events.

On the afternoon he moved into our community, he rode his bike from his home only blocks away, while his daughter directed the movers.  Independent and active, he pedaled his way along the sidewalks and residential streets, through our front door and into our lobby.  He showed up ready and eager, in his mid eighties, to become a new resident.

For months Stan rode his bike everyday.  He signed out at the front desk right after breakfast, and he would return just in time for lunch.  During the summer, the afternoons in Florida were extremely hot, so Stan would find a rocker in the shade by the gazebo, and spend the afternoon staring at the trees and watching the birds.  He loved to be outside.

Six months after he moved in, Stan began to suffer from shortness of breath and overall weakness.  It became harder and harder for him to pedal his way through the neighborhoods.  He still left every morning after breakfast, but the bike remained locked to a post by the door.  Stan could no longer maintain his balance while riding, so he abandoned the bike and began to walk.  

He walked through the neighborhood, and he walked through the near-by school -yard.  He walked to Wal-Mart, and he walked to Chili’s for a glass of ice tea.  He would walk back for lunch, but in the cooler weather he would be off again in the afternoon exploring the residential areas surrounding the community.

Then came the fateful phone call.  A gentleman found Stan sitting in his yard.  He was confused and disoriented.  Familiar with our community, the stranger called to inquire if we had lost a resident.  “He says he’s forgotten his way home. He seems frightened.”  Stan had traveled several long blocks, so I got in my car and fetched him home.

It was a sad day for all of us.  We felt that Stan should no longer roam the neighborhoods alone, and we were apprehensive about the huge impact the confinement would have on his wellbeing.  My director of nursing and I met with his daughter and explained what happened.  We cautioned her about Stan’s vulnerability now that he demonstrated progressive dementia.  Although she was concerned for his safety, she was convinced he would suffer more if we forced him to stay inside.

 The following day, Stan came to me and begged forgiveness.  “Stan, there is nothing to forgive.  I’m worried about your safety.  What if no one were willing to help you? “  “Walking is my life,” he pleaded.  “Please don’t keep me inside – it’s all I have left.”

My director of nursing and I, along with Stan’s daughter racked our brains for ideas.  Finally his daughter bought a pre-paid cell phone.  She purposely programmed only one number, that of the community, and taught him how to dial if he should become lost again.  The concierge also made him a badge with one of our business cards, so that if he needed assistance from a stranger, it would be easier for someone to determine where he belonged.   Our staff made sure he never left home without both identifying items.

The cell phone was a workable solution, although not once in the next several months following his first incident, did Stan ever have the need to call.  But, it was inevitable that his good fortune would not continue forever.  He was at Wal-Mart one afternoon listlessly wandering the isles when a manager spotted him.   He identified Stan by the badge we insisted he wear, and called to inform us that our resident had been there for several hours.  “He appears lost,” the manager reported. “When I asked him if he wanted me to call for someone to come get him, he didn’t seem to understand what I meant.  I think you should have one of your employees come and escort him home.”

That was the end of Stan’s walks.   His daughter, refusing to curtail his need to explore, took him home to live with her.  She thought it best if she supervised him herself.   I agreed with her that Stan would die a little bit each day if he were forced to remain inside, so I suggested that she employ a private daytime companion to accompany him so he could continue to enjoy his excursions.

Stan’s circumstances brought up a disturbing question that haunts many of us in senior care.  Where is the fine line that divides quality of life from quantity of life?  When does it become cruel to become so protective that a person is removed from all good and familiar ways of being just so that they can remain alive?  Those of us in senior living accept that every situation is different, but we frequently ask ourselves those questions.  Of course there are no viable answers.

I don’t know what happened to Stan after he moved from our community.  I only hope that his life ended outside on a sunny day, and that he was enjoying the way of life he knew and loved.

Friday, August 10, 2012

The Assisted Living Community's Role as Advocate

I am always saddened by the turmoil that often affects families who are struggling to solve the unexpected problems that surface when caring for an aging parent.  Searching for an affordable or practical solution can be emotionally and physically overwhelming.  At present, there is no easy to follow recipe or a color-coded set of instructions, and those looking for answers are “shooting from the hip” while juggling the thousands of other things they are expected to handle in their daily lives.

Perhaps I am prejudiced, but I regard most assisted living communities as, not only providers of room and board for seniors who cannot function independently, but as resources for valuable information.  It is universal that those who work in the industry are committed to finding a safe place for prospective clients even if it means recommending a competitor down the road.  Every situation is different, and those who represent the multitude of communities, agree it is important that each individual is placed in the appropriate setting.

Recently Susan, a friend of a friend, asked me for advice. She sounded quite frantic when she related her father’s current situation, and I listened intently while she described the unusual circumstances.  Susan’s Dad was 81. He was undergoing chemotherapy for an aggressive cancer.  He lived in Denver, Colorado, and was currently married to a women 17 years his junior.  Still employed, his wife was busy pursuing her career in Richmond, Virginia, while he fought to survive his cancer in Denver.  When the anticipated side effects of the chemo infusions began to sap his strength and cognitive ability, his wife seemed unwilling to return to support him.  Somewhat incontinent, too weak to cook, and unable to shower, he was deteriorating rapidly.  Fortunately for him, he had two daughters who immediately flew to Denver to respond to his call for help, but unfortunately for them, they no idea what to do or where to turn once they got there.

I assured her I would make some calls to see how I could help.

I knew instinctively that Susan’s father would be suitable for respite in an assisted living community.   Someone who needs assistance for a week or two, or even three, may move into a fully furnished room or apartment to receive the same care and support as a long term resident.  A daily rate is charged instead of a monthly one.  This is referred to as a respite stay. ** I was confident that Susan’s father would benefit from this during his treatments, and he would also be happy knowing he could return home once he regained his strength. 

 As I promised Susan, I called a community in Denver owned and operated by the company from which I recently retired.  I explained Susan’s dilemma to the Director of Marketing.  As I expected, the young man with whom I spoke offered to help.  He contacted my friend that same day.

I heard from Susan later in the week.  She was relieved and grateful.  She was in the process of moving her Dad into an assisted living community for a respite stay close to the hospital where he was receiving his treatments.  While there, he was going to finish his chemotherapy.  Then, Susan and her Dad would reevaluate his options and agree on the next step.  He may well elect to remain in his new community.

I must note that Susan’s dad did not move into the community associated with my former company.   It was too far from the hospital where he was being treated.  Instead, the resourceful Director of Marketing solicited a competitor in a more favorable location. It is the goal of the company to ensure that each person is “safely somewhere,” and I applaud the Director of Marketing for fulfilling that obligation.  

I am convinced that networking is the key to finding viable solutions for adult children.  Senior agencies that serve as advocates, the Department of Elder Affairs, hospital social workers, or primary doctors should and could be resources for information.  In the meantime, I urge those with questions to contact their neighborhood Assisted Living Community.  If they cannot help, I’ll bet that they know someone who can.

***Different communities offer different options for respite regarding minimum length of stay.  Some may even offer a credit toward a month’s rent if someone converts to become a permanent resident.  Often families will take advantage of respite while they are on holiday.   The vacationing caretaker can enjoy peace of mind when Mom or Dad is too frail to travel.  In addition, respite also opens the door to those who hesitate to relocate to an assisted living environment.  Burdened with the memories of placing their own parent in a nursing home, current seniors are unfamiliar with the amenities and congenial atmosphere apparent in the majority of assisted living communities.   After a short stay interacting with others who share the same infirmities, a person will often realize that being social and participating in creative activities is better than living in an empty house, sitting alone watching TV, and seeing no one except the friendly person who comes to deliver meals on wheels. 

Wednesday, July 25, 2012

Viera’s Vignette

I first noticed her straw hat lying on a chair next to the table in the corner of the coffee shop.  Not knowing whom it belonged to, nor really caring, I walked past it and sat down with my friend to drink my coffee and chat.  While we were intently discussing the future of the baby boomers, my attention was diverted.  Out of the corner of my eye, I could see an older women leaning on a cane and struggling to balance a large cup of coffee.  She was maneuvering her way through the line of people waiting and heading to the table where the hat sat waiting.

I turned my head to see that the woman was quite thin, but not frail.  She didn’t seem confident, but she didn’t appear timid.  She was nicely dressed in a mid length camel brown skirt and a collared matching blouse with sleeves rolled to the elbows.  A multi colored striped cotton belt was tied in a knot, just below her waist.  She had brown hair, streaked heavily with bands of dull gray that she had twisted loosely into a bun at the back of her neck.  The woman was somewhat attractive, not pretty, but she conveyed the presence of a handsome European matriarch.  I guessed her to be in her early eighties.

 As she wound her way through the tables, her mouth was moving as if she were engaged in a conversation, but she was alone, and no one was nearby to hear what she said.  One may have described her as “strange,” had they not taken into account her age. She plopped in the chair next to the hat, and gave a deep sigh of relief.

 My friend paused mid sentence, when she realized I was no longer listening to her.   “I couldn’t help but notice that older women at the table near the window.  She’s here alone,” I said hoping that explained my lack of commitment to our conversation.  My friend turned her head to see the woman I was studying.  We had been engaged in a conversation concerning our neglected senior population, and we silently shared the irony of my unexpected diversion. 

The two of us studied the woman.  We saw her begin to stir her coffee, then stand, reach for her cup, grab her cane, and walk slowly back to the condiments bar.  She poured some half and half into her cup and made her way painstakingly back to the table.  Again, she looked relieved to be safely seated.

We continued to watch her.  We were not being rude, but we were fascinated by her determination to maintain an air of self-sufficiency.
We saw her pull out a clear bag of cookies that were tucked away in her purse.  Her head turned to the tables next to her, first right, then left to see if anyone noticed.  We felt sure she was unaware of us from across the room.  She quickly opened the zip lock bag and pulled out three very plain wafers.  After patting the plastic bag flat, she placed her cookies one by one beside her cardboard cup.  She then leaned back, smiled to herself, and began to nibble at her cookies and sip her coffee. Meanwhile, she continued to carry on a conversation with whomever she imagined was with her.

My friend and I returned to our conversation and forgot about her for at least a half an hour.  Then as I was walking to the refuse can to throw in our empty cups, I saw that the woman was also getting ready to leave.  She eased herself up by using her cane as support.  Then she reached to retrieve her straw hat.  She leaned her cane on the edge of the table, and with both hands, placed the hat on her head. She pulled it precisely to the center of her forehead and tugged the brim to tilt it slightly to one side.  She grabbed her cane and with careful strategic steps, she left.

My friend and I stood outside for several minutes finishing our conversation about seniors and about being seniors.  We bemoaned the fact that as we get older men don’t turn their heads any more, and others just walk past us as if we didn’t exist.  We have reached a stage in our lives when we feel almost invisible.  With a sigh of  “Oh well, it is what it is,” we hugged and parted.

When I pulled from my parking space, I was surprised to see the same older woman from the coffee shop.  She was walking back and forth; her head rotating from side to side as if she were a spectator at a tennis match.  One hand was pressing the top of her straw hat to keep the wind from whisking it from her head, and the other was struggling to balance her wobbling cane.  She was frowning and talking to herself.  Considering her wild gestures and the frantic look on her face, I guessed that she had lost her car.

I slowly pulled up beside her.  I rolled down my window, and I yelled, “Have you lost your car?”  “Yes,” she cried. I could see that she was on the verge of tears.
 “Get in. I’ll help you find it.”
She hesitated, then after a second or two, she nervously reached for the door handle.  “This is just awful…this is just so awful,” she repeated anxiously.

We drove down all the aisles where she thought she had parked.  She described her car - a dark gray Volkswagen.  She repeatedly rattled off the license numbers hoping the information would help us.  After three circles around the parking lot, we did not find her car.  “Let’s go to the other side,” I suggested.
“No. I’m positive I parked near this door,” she argued as she pointed to the front of the coffee shop.

“I don’t see it here.  You’d still be near the door on the other side, I coaxed, but at a different angle.”

I turned toward the east side of the lot.  We drove up one aisle, and as we drove down another I knew immediately we had hit the Jack Pot. To our right was the 2008 gunmetal gray Volkswagen.

“Is that it?”  
Tears welled in her eyes.  “Yes.   Oh, yes.”
After she thanked me again and again, “ I said, “My name is Karen.”
“My name is Viera,” she said with a heavy Germanic accent.  “Thank you, Karen.  You are very kind.”

She opened the door and got out.  I waited until I was sure she had started the ignition, and then I waved and drove away.   I couldn’t help but wonder how many others had seen her wandering and searching for her car, or to them, like most seniors, had she been invisible?

Sunday, July 8, 2012


 Facing the Dilemma of Dementia

Many of my residents live in their own “special” world.  Their minds have changed in mysterious ways.  It isn’t relevant whether it is Alzheimer’s Disease, dementia, or a vascular deficiency that is altering their thinking.   The end result is often the same.  Our loved ones remain in their own familiar body while their personalities morph into people we don’t recognize.  Occasionally, this different person is content, at ease and accepting of the new place that their mind has taken them.  But, more often than not, the new place is confusing and frightening.

Virginia is a charming and attractive.  She has a fluffy cloud of white hair that is bright and shiny and thick.  Her eyes are hazel brown, clear and bright; her glaring eye contact never timid. Virginia is kind, lovable, polite and accommodating.  Her biggest challenge is her memory.  She cannot retain a thought for more than several minutes, and she uncontrollably and incessantly repeats the same questions time after time.  If someone politely answers each question, that answer is lost to her in less than a minute or two.

Virginia is obsessed with spending time with her daughters and returning to her home.  Although she admits she is happy and feels secure in the community, she is focused on her former life as a mother and caregiver for her children.   Nervous and uneasy, she searches frantically for phone numbers to contact her family.   Sadly, after speaking with one of them, she will not remember a few minutes later.  Unwittingly, she will compulsively call again, and again and again.

At a time when Virginia should feel relaxed and content, she is forever anxious and apprehensive.  She cannot sit for more than 5 or ten minutes.   Unsettled and nervous, Virginia paces the living room and entryway.   She cannot focus on bingo, exercise, crafts, or even professional musical entertainment.  She is obsessed about being away from her girls every minute of every day.

Virginia was a dedicated grade school teacher.  When she becomes agitated and frustrated we distract her with various word games.  She will sit for a short period recalling her English skills to concentrate on word puzzles and anagrams.  Her attention spam is short, but her beaming smile symbolizes her success when she is able to focus and complete one of the puzzles.  From time to time, Virginia will
 solicit the staff for chores to assist them. We keep a ream of multi-colored paper at hand.  Feeling useful, she adeptly sorts the colors.  She returns the organized stack to us not recalling that she had finished the same task the day before.

Virginia’ solicitation for attention can be somewhat irksome, but she is a welcome sweet addition to our community.  It takes patience and understanding to join her world everyday, and it is emotionally trying to watch her always restless and troubled; we strive to keep her content. 

It troubles me to watch Virginia.  Not because she is confused, nor is it because she needs above average supervision.  Her universe is small and getting smaller.  Virginia cannot find a space in it where she is content.  She was a great mom, a woman with an above average intelligence, and a truly nice person.   I cannot eradicate the dementia, but I wish that I could help her find some special place in her mind where she can peacefully finish the rest of her life.  I regret that I can’t.

Friday, June 8, 2012

Life is a Gamble

I often take prospects on tours through our community.  Yesterday a woman about my age came to inquire about placing her mother with us.  As we wandered through the activity area, a group of residents were playing beach ball volleyball.  The noise and laughter were contagious.  My visitor was amused.  “They’re having fun,” she smiled.  I shook my head in agreement.

A few minutes later, seated in my office, she said, “I wonder how I’ll behave when I reach their age?”  I laughed out loud.  “I think everyone that works here asks themselves that same question--every day.  It is so very hard to predict just how we’ll accept getting old. “

“ I joke a lot.   Some days I assume I’ll be an exemplary resident; on the more trying days I am determined I’ll be the community terrorist. Regardless, I’m convinced one survives the process much easier with a positive attitude.  If you’re able to accept the changes that take place physically and mentally, you’ll be happier and more content.  I’m convinced it is all about attitude.”

As I spoke, the memory of a former resident flashed through my mind. She was a perfect example of how a positive half-full, not half-empty attitude, can affect the quality of one’s life.

Millie was not as chronologically old as many of our residents.  She was only in her late seventies. The majority of the residents living in the community were somewhere in their mid to high eighties.  Millie had Parkinson’s disease; her body was disfigured.  The muscles in her hands quivered, and her face was contorted by sporadic tremors.  Every physical movement was tedious and painful.  The disease ravaged her limbs and torso, but it never diminished her spirit. 

Millie was an inspiration to me, to her fellow residents, and to the team that assisted with her care.  She was a Jewish transplant from New York.  She spoke with that familiar New York accent, and although she missed New York, she was content to live in South Florida as she was close to her kids.

In the two years that I knew her, I never heard Millie complain.  She had good and bad days.  When the pain distracted her, she didn’t share her distress, but her eyes lost their sparkle.  She became quiet and less cheerful as she struggled to keep her discomfort to herself.

Millie, in spite of her disease, was a character.  She loved to tease the staff and the other residents.  She had trouble talking because her mouth and tongue were slightly distorted, but she continued to say things that made everyone chuckle.  She loved to surprise her peers with a clever or risqué remark, and she giggled joyfully when they reacted with obvious embarrassment.

Millie seldom missed an activity or an outing.  She enthusiastically attended the exercise class every morning.  She struggled with the repetitive movements, but she determinedly worked until the class ended.   When the life-style director took the more adventurous residents outside the community on weekly excursions (out to lunch, to the beach, and for picnics in the park), Millie was always happy and ready to go.  She had difficulty getting on the bus. She had to pull herself up the stairs, slowly and carefully using only her arms, but she was determined she would not be left behind.  I admired her gumption.  There were residents in the community who had few to no disabilities that seldom left their apartments.

Millie did have one amusing addiction.  She loved to gamble.  Every other month, a group would go to the casino just a few miles from the community.  Millie was first on the bus and the last one to board on the return trip.  Some months she won, and some she broke even, but I don’t remember her ever coming back in the red.   One afternoon I was in my office when I heard a hubbub of loud happy voices in the lobby.  Curious, I went to see why everyone was so excited.  There was Millie, surround by residents and staff, beaming and smiling from ear to ear.  She had won a $1000 at the slot machines.  I had joined in the excitement of congratulations when a resident turned to me and said, “She’s so lucky.”  “No,” I answered.  “She’s not lucky.  God is just smiling on one of his angels.”

Wednesday, May 23, 2012

No Complain – No Gain.

I am always confused and disappointed when a resident moves out of the community because they are dissatisfied with our customer service.  I am especially frustrated when I discover that the events that precipitated the move could have been easily remedied.  I would much prefer to have a family member call or stop by my office with a long list of complaints, than disappear without giving me the opportunity to address the things that displeased them.

Several years ago I transferred from Tallahassee to a new community in South Florida.  The first day in my office, before I even had time to collect my thoughts, the phone rang.  The caller, irate and upset, was a young woman who said her name was Evelyn.  Without warning, she began bombarding me with strong words and harsh complaints.  Then, minutes after calling, she physically appeared at my office door waving her arms and threatening to call her lawyer.  She was rattling on about an incident that involved her mother, Irene.  

To avoid a yelling match, I calmly and quietly led Evelyn into my office.  I sat facing her in the two comfortable chairs that I saved for visitors rather than hiding behind my desk.  I told her to repeat her story slowly so that I could take notes.  Admittedly, at the time, I was irritated by her attitude, and categorized her as rude and demanding.   But now, in retrospect, I appreciate that, despite her methods, she was challenging me to correct what she felt was a serious shortcoming in the community. I now realize that by complaining she was giving me an ideal opportunity to win her confidence.

I listened while she told me her concern.  At dinner the previous evening, one of our wait staff had given her mother, Irene, who was a diabetic, a cup of regular ice cream rather than the sugar-free.  Irene knew she should eat only the low sugar or sugar -free desserts that we have available from our kitchen, and the server, who was trained to monitor the food offered to diabetics, should have known not to give Irene the bowl of chocolate ice cream.  Instead, when the server offered it to Irene, she accepted it without a word, and according to her table- mate, who tattled on her, Irene relished it without reservation. Luckily, she suffered no serious consequences, but the error needed to be corrected.  I promised Evelyn I would investigate the situation immediately.

After speaking with the Dining Services Director and the employees who worked the shift in question, I surmised that the system of tracking diabetics was broken. In the kitchen there were pictures posted of the residents who suffered from diabetes, but there was no way to identify them in the dining room unless the servers knew the residents personally.  The server in question was new, and therefore did not recognize Irene. 

Residents often neglect to tell their waiter they should be restricted to sugar free options (what could be better than big dish of chocolate ice cream?).  If an unseasoned server is not familiar with the residents who are diabetics, a resident could easily sneak by with a choice that may or may not be life threatening.  It appeared it was not unusual for a diabetic to receive a dish of the wrong ice cream.

My Dining Services Director decided to put an inconspicuous small white doily between the cup and saucer at each place setting where a diabetic sat.   The doily alerted the server the resident was not to have an excess of carbohydrates or sugar filled deserts.  The solution, inexpensive and simple, solved the immediate problem.

The second solution presented itself inadvertently.  Due to a high demand in the scorching summer heat, the kitchen ran out of the traditional ice cream.  The staff filled the requests for ice cream with the sugar free rather than disappoint anyone. No one seemed to know the difference.  From that day on we ordered only the sugar free.  No one was the wiser and everyone was much healthier. 

Evelyn and I had our good and bad days throughout her Mother’s tenure at our community. Despite the ups and downs we became good friends. The two of us worked together diligently to ensure that her Mom was happy and satisfied.

Yesterday, I received an unexpected notice from a resident’s son saying that he is moving his father to another community.  He did not offer an explanation in his letter, just an end date for his father’s residency.  I was surprised, and I felt I had been blindsided. The son had never come to the Director of Nursing or me. He never brought any concerns to our attention. In fact, I asked him daily as he passed through the lobby, “Everything going OK?” “Just fine,” he would answer. Of course, I called him immediately upon receiving his note, but he was not forthcoming with any details.  I am forced to accept that I am losing a resident without any idea of the reasons why.

Consistently meeting the needs of over a hundred residents is one of the toughest aspects of my job.  I continually face the challenge of finding creative solutions to numerous new and different problems. I cannot do that without our resident’s family members and loved ones being honest about our performance.  I need to know about small problems before they become big ones.  It sounds trite, but communication is the key.  My philosophy:  “How can I fix it, if I don’t know it’s broken.”

Neither of the above mentioned solutions were necessary in my present community.  My current Director of Nursing and my Dining Services Director have a precise method to track diets.  My story occurred years ago in a different community in a different city. 

Thursday, May 10, 2012

Mother’s Day Model… 95!

Mother’s Day is just around the corner, and I lovingly recall one of the more memorable traditions that we shared with the mothers and daughters in a community in northern Florida.

For five years, the Community Lifestyle Director, Sarah, and I planned a traditional tea along with a non-traditional fashion show on the Friday afternoon before Mother’s Day.  We hosted a high tea with scrumptious crumpets and scones and a fashion show featuring our residents. We sent out hand written invitations and dressed the dining room to resemble an elegant English tea parlor. We patterned a runway around and between the dining tables, and I acted as the commentator, always prepared to eloquently describe each unique outfit a resident was wearing.

At that time, I moonlighted at Casual Corner Women’s Fashions, so each year the store generously volunteered to provide the clothes. Sarah recruited the six ladies, 
(Walkers, canes and scooters acceptable) who were willing to parade through the large dining room and proudly display the donated items. 

The week before the event, Sarah and I accompanied our “models” to the store located at the nearby mall.    She and I swooped through the racks of woman’s clothes, carefully choosing fashions that would suit the various tastes of our illustrious crew. The dressing rooms were chaotic as the ladies tried on the dresses, pants, skirts and blouses that appealed to them.  It took at least a couple of hours to find the perfect fit with the perfect appeal, but eventually, each of our residents left the store content that they would look and feel “stunning.”

 Marion was a small quiet woman who modeled for us for each of the five years.   She was 90 years old at the first show, and she was 95 for the last.  She appeared frail, but she wasn’t.  She had been decorated for her courage and strength during her career as a nurse in the U.S. Army.

During those five years, Marion headlined our fashion show.  The clothes she modeled were simple, not fussy; she carefully chose them to fit her frail thin frame. She walked slowly, taking each step cautiously and deliberately.   She possessed a contagious “can do” attitude when making eye contact with the audience.   Everyone applauded her gumption as she circled through the crowd. She was the oldest model in every show.

“You are my inspiration,” I would tease her.  “I want to be just like you – a stunning 90 year old model.”  The next year I repeated,  “ a stunning 91 year old model,” and so on until I left the community convinced that my goal had been set at 95.

Recently, Marion celebrated her 100th Birthday.  I doubt that she is modeling, anymore, but I haven’t changed my mind.  I still aspire to follow in her footsteps.  At 95 I want to be a “stunning 95 year old model” just like Marion.

Monday, April 2, 2012

Saving Takes on a Whole New Meaning

Saving seniors in the surrounding community is a goal for many of us who work with seniors.  In every city, there is a selection of elderly men and women who are alone and neglected.  They may be home bound, unable to shop for food, and often lack the basic necessities to keep them safe and healthy.   Often, it is a family member who lives out of state, or a state agency, or a civil servant such as a fireman or a policeman who alerts us that a person is living in a precarious situation.  In these cases, it is our goal to find a suitable way to assist or relocate any senior we feel is in jeopardy.

Recently, to reach out to those who may have shown an interest in our community, my associates and I have begun to make home visits.   Most often we drop by to find an older person who is lonely, but moderately happy, biding time vacillating between living at home and moving.  On rare occasions, we encounter someone who desperately needs to relocate, and we do our best to find an appropriate place for them to live.  Even if we need to recommend a community other than our own, we feel it is our duty to find a safe environment for seniors in need.

Eva was one such person. I met Eva through a concerned neighbor, Sylvia.  Sylvia, whose mother lived at our community, stopped by my office late one afternoon.  She was concerned about an older woman who lived across the street from her.   She described the women, Eva, as self-sufficient although somewhat reclusive.  According to Sylvia, Eva was known throughout the neighborhood as  “the collector.” 

Sylvia painted a visual picture for me of the outside of Eva’s home.  She described the carport.  It was filled with 20 or more plastic bottles; each containing various levels of a clear liquid, set side by side, outlining a path to the front door.  There was a collection of empty terra cotta flowerpots, chipped and broken, scattered among the bottles.  Also, there were faded and dented aluminum pie tins strewn throughout, while several half empty bags of cat litter leaned against the cement walls of the house.   The front porch, she said, appeared to be a buffet for stray cats that lived in the nearby woods. The steps were lined with various flavors of cat food in half-filled plastic dishes. 

Sylvia admitted she had never been on the inside because she was afraid to venture further than the doorway.   She was intimidated by the shadows of boxes, old paper bags, and unrecognizable stuff stacked from the floor to ceiling.  She was concerned that Eva might fall, as the pathways appeared narrow and cluttered. “I imagine the poor dear doesn’t eat well,” Sylvia lamented.  “I’ll bet the stove is hidden under piles of junk. ”

“Does she have family, I asked.”  Sylvia pressed her lips as if struggling to control her anger.  “There is a son,” she answered, “but I don’t see him there much.  I know she is a cantankerous ole soul, but I would think that he’d at least help her clean the place up.”

“Your friend Eva’s a hoarder.” I explained. “She’s compulsive, and she can’t help herself.  I doubt that her son can get her to part with any of her treasures.  Would you like me to look in on her one day next week?”

“Oh yes,” she sighed.

My assistant and I visited Eva the next week.  As soon as she opened the door, I knew we had begun our next “good Samaritan” project.  Sylvia was correct in her description of Eva’s home.   From the door I could see that the entire two-bedroom house was stuffed with useless articles – old newspapers, plastic grocery bags, magazines, and various antiques from a former life.  Eva welcomed us; she seemed genuinely happy to have visitors.  We cautiously stepped inside the messy foyer, but we did not continue further. After a short conversation, I sensed Eva’s loneliness, and guessed that she was hopelessly submerged in her world of “things” and feeling lost and helpless.

For weeks, I appeared uninvited on Eva’s doorstep, which was still cluttered with cat bowls, at least once every ten days.  Each time I brought a gift; home made cookies from our kitchen, lunch complete with salad and dessert, or a big cardboard box to fill with items for the trash.  I was patient but persistent, and eventually I was able to convince Eva to visit a near by independent living community. I accompanied her to ease her discomfort.   She met residents who were social and friendly, and she liked the casual and affable surroundings. Slowly, after returning for lunch on more than one occasion, Eva began to recognize the benefits of moving to a happier place.  In fact, within a month after her initial tour, she signed an agreement to move into one of their studio apartments. 

It took another three months before we were able to relocate Eva and one of her cats to her new apartment.  Her son was helpful, but to some degree his hands were tied.  Eva ignored every suggestion he made, and even became combative when he attempted to sort and disperse some of her belongings. Finally, I introduced him to a professional who specializes in moving seniors (See my earlier Blog -Moving Mountains May be Easier Jan 15, 2012).  I knew that an objective third party was the only answer.  Parents often become resentful when their children try, even with the best intentions, to tell them what to do.

The community where Eva rented her new apartment offered to share the moving expenses, enabling Eva’s son to hire the professional senior movers I had suggested.  They painfully and tediously sorted through Eva’s eccentric possessions.  Finally, after several long arduous days they successfully extracted her from her home with only the items she needed.  Once she was settled in her new apartment, Eva quickly forgot about the things she was hoarding. The movers were then able to get rid of the rest at Goodwill, a large storage unit, and of course, the community dumpster. 

I periodically received reports about Eva’s progress from the director of the Independent Community.  It was surprising how quickly Eva adjusted. According to the Director, Eva participated in activities and became one of their more active residents.  Of course, housekeeping monitored her room closely, and encouraged her to discard her worthless items before they became a nuisance. 

Sylvia, my resident’s daughter, returned to visit with me from time to time, to inquire how her old neighbor was faring.  I loved giving her the gold star reports.

In early November, I asked her “Did you know Eva was an artist?”

 “No,” she replied. 

“Well, apparently she has blossomed and revitalized her talents.  She just won a Christmas Card Design competition.  The Corporation that owns her community sponsored a contest. They chose the Christmas scene that Eva drew to send to their professional clients.”

 I grinned as Sylvia’s face broke into a smile.  I leaned across my desk to enjoy the moment with her.  “It feels good, doesn’t it, to realize that some days, it is actually possible to make a difference.”  

Saturday, March 17, 2012

The Price of Guilt

Guilt is a powerful word for being such a short one. It is a word I hear almost every day either from an adult child, a spouse, or a resident.   

Guilt often seems to supersede all other emotions.  Despite the fact that adult children are juggling many things in their lives to satisfy a parent, the children still feel guilty because, in their minds, they are still not doing enough.  Many residents feel the same because they believe their children are doing too much to make them happy.  Of course, there is the other extreme; the parent who blames their children for “putting” them in a community and is therefore determined to make their children suffer for it.

I once had a resident whose son moved her in and out of every community in the city.  He was trying so hard to please her that he would relocate her each time she became dissatisfied with the community she was living in.  He had recently remarried, and his guilt stemmed from his inability to take care of his mother at home. He was a loving and faithful son; he was convinced that he was doing the right thing by moving his mom, Marion, at her whim. When Marion became dissatisfied, he dutifully packed her belongings, paid the extra entrance fee, and settled her into a new apartment in a neighboring community. This happened on average twice a year. It was inevitable that after a few years he ran out of nearby places to take her.

My community had been one of the stops on her list.  Marion was a cantankerous old lady who was never satisfied. She complained that she didn’t receive appropriate care, and she grumbled that the food was uneatable. She groused over the color of the carpet in her apartment, she threatened to sue if the care staff was not at her beck and call; she criticized anything and everything that came to mind.  It was not surprising that the staff soon became resentful. They avoided her when they could and despite their commitment to customer service, they had a hard time responding graciously to her nasty behavior.

I spent a lot of time with Marion, defusing the outbursts she had with our care aids and wait staff – hoping my patience and kindness would convince her that we had her best interest in mind.  I was somewhat successful, and she did eventually trust me.  But, I was unable to keep her from manipulating her son, and eventually she gave me her thirty- day notice.

I tried speaking to her son Kevin. He was extremely friendly, obviously intelligent, but it was impossible to penetrate his denial concerning her behavior.  I needed him to join our team and to work with us.  I beseeched him to stop responding to her constant whining and support us in our attempts to please her. My employees were dancing in circles hoping to win her affection, but he refused to admit that his mother’s e behavior was excessively unfair.  His guilt was so all pervasive that it clouded his decisions. 

Several months after Kevin moved his Mom, I heard through an associate that Marion had been sent to the hospital and would not return to the community where she was presently living.  Strangely enough, not sure what prompted me, I called Kevin.  “Marion can come back and live with us again,” I offered.  His silence betrayed his surprise, and after a few seconds he said, his voice somewhat choked “I will ask her.”

Despite the protests from my staff, Marion returned. Her new apartment was near my office, so I visited regularly.  We became close friends. She had softened somewhat, although her exterior remained hard and tough.  She even thanked me for taking her back.  “I didn’t think anyone liked me,” she admitted. “We didn’t,” I told her candidly.  “I just felt that, despite what you thought of us, we did a better job of caring for you than our competitors.  You are entitled to good care, despite your attitude. “

Soon after her return, her health declined. After only a few weeks, our nurse admitted her to Hospice.  She died in our community.

I had one last conversation with Kevin. He still harbored the guilt. He admitted how sorry he was that he had not stood up to his mom. He regretted that he succumbed to her constant nagging. He realized his willingness to move her so frequently made it impossible for her to make friends or become a member of an assisted living family.   “When I told Marion you wanted her back,” he admitted, “she cried.  She couldn’t believe that someone actually would tolerate her enough to invite her to return.” 

“Your Mom was tough,” I answered.  “She wanted you to prove your love for her by focusing on her and giving her your full attention. The only way she could do that was to manipulate your time and energy.  She coerced you to pack her things and move them again and again.  She knew how to push your buttons.”

“I didn’t know what else to do; I wanted to make her happy,” he said regretfully. 

“And did you?” I asked.

“No,” he said sadly.