I'm Just Sayin'

After reading a recent post on a Senior Housing Forum written by Steve Moran (Senior Housing Industry Blogger and regional business development officer for Vigil Health Solutions, I felt a surge of frustration. It appears that journalists continue to attack the assisted living profession, pointing fingers and citing one or more isolated incidents or rehashing issues long since resolved.  I applaud Mr. Moran’s defense of the company under fire, and I quote him as saying, “ I hate these stories because they hurt real residents, real staff, real seniors, and real families.’ As a former Executive Director of Assisted Living Communities, I appreciate Mr. Moran’s concern. The culture of a community is very fragile; a crafty, supposedly candid exposé discourages residents, their caregivers, and those in the industry who spend their lives dedicated to caring for seniors.

In my opinion the media, writers and publishers are the only ones that benefit from the negative publicity.  As a good story is rarely told, the disparaging articles create confusion and fear at a most inopportune time.    It is imperative that the residents in a community, who are physically and emotionally vulnerable, feel safe.  They must be confident that their caregivers and allied staff will provide whatever assistance they may need at any given time.  Moreover, families must trust that their caregivers will do what they say they will do. 

“Life is all about choices,” and assisted living provides options to seniors who would otherwise be left alone in their homes comforted only by their TV’s and the volunteer courier who delivers a meal.   Inside a community, people may choose how interactive (or not) they will continue to be. Even better, they may choose their personnel journey to enjoy life within a protective environment despite their physical infirmities.   We live in a fast paced technical world making it impossible to care for our parents as in previous generations.  Our family units are often scattered geographically.  On the other hand, a parent, who lives with their children, may still spend most of the day alone while their caregivers are scrambling in different directions trying to keep pace with their jobs and ever increasing daily responsibilities.  

The majority of assisted living residents enjoy individual apartments with private baths.  They are surrounded with their own furniture and keepsakes representing their fondest memories.  Nearby, down the hall or in the social areas, they may discover neighbors with similar issues and interests.  No more worries about mowing the lawn, grocery shopping, or house cleaning.   In an assisted living community life is about living in the moment and enjoying it.  A lifestyle director, with a cheerleader’s enthusiasm, is on hand to encourage even the most dissident to play bridge or cribbage, celebrate birthdays, or attend educational forums.  Communities design programs that include outside excursions and offer residents an opportunity to engage in philanthropic activities.   Subsequently, for some, the interaction creates a surrogate family where through friendship and love, one can feel alive again.

The negative pictures presented by the news media are discouraging to all of us who work or have worked in a community.  I am confident that I can speak for the other dedicated administrators when I say that each one does his or her best every day, 24 hours a day, and 7 days a week.  It is a priority to ensure that every resident receives the best and most personalized care possible. Keep in mind that a director doesn’t do it alone. During my tenure, I was blessed with dedicated department heads whose efforts far exceeded their job descriptions. None of them escaped without uncompensated overtime, and they worked as a team curtailing emergencies that included fires, floods, and natural disasters.  As managers they filled in for call outs, and they remained on call day and night to solve problems (big or small).  Despite the demands of their personal lives, they willing came to the building to address an issue that otherwise would have escalated.    And Resident Care Directors, directors of nursing, were free from their responsibilities only when they were out of the country with no connecting bars on their cell phones.  

My entire staff included care associates, housekeepers, lifestyle partners, maintenance assistants and wait staff. They worked with the residents daily on a close and personal basis, and they were acutely aware of who needed extra attention or supervision.  I can also boast about individuals who worked extra shifts, and those who shuffled between departments performing double duties to compensate for a shortage of staff during illness and call-outs.   Those same individuals often skipped breaks and delayed meals to maintain the highest quality of care.  Every day they volunteered hugs to ease pain and offered unsolicited, soothing words of comfort.

The stories referencing the mishaps reflect a miniscule segment of the day to day living in a community.  “Every morning, close to a million American seniors wake up in their assisted living community, have an active and engaging day in a safe, independent and social environment.  Those same residents have the opportunity to go to sleep that night eager to greet a new day,” said Rick Grimes, President of the Assisted Living Federation of America (Business Wire July 24, 2013). “That fact may not make for a sensational headline, but it’s the reality of assisted living.” 

 I could never predict, what might happen on any given day in my community. My staff and I had to be prepared for almost anything, and we had to react appropriately.  My communities averaged at least 120 residents (67 percent average over 85 according the National Center for Assisted Living), and often their needs were as unpredictable as a Florida hurricane.   We made every effort to maintain the momentum, but at times, something would inadvertently fall through the cracks.  When it did, we did our best to immediately address the problem and to learn from the experience.

A series of unusual events prompted my introduction to assisted living.   After counseling prospective families and residents as a leasing agent for less than a week, I understood that I was finally where I was supposed to be. In less than 6 months, I eagerly accepted the position as executive director.  Now that I've retired, I feel obligated to add my personal observations to offset the infamous journalistic abuse, and to dedicate this post to the hundreds of employees, residents, and families who helped to make my career a success.

P.S.  I have included some URL’s to highlight the good times and good smiles shared in three assisted living communities.  

‪
http://www.youtube.com/watch?v=-gE-6ALGcOAival 

http://www.youtube.com/watch?v=EtRvFZUSnDk

http://www.wimp.com/residentsperform/

Father (in this case Mother) No Longer Knows Best

Just recently, I conceded to myself; I am a senior.  I have avoided the admission for more years than I would like to admit, but after all, I still shop in the Junior Department, I feel as young as I ever did (no stiff joints or aches and pains), and it is unlikely that my behavior duplicates that of my peers (I still listen to Metallica for god’s sakes).

I accept that I have changed since my husband died.  My heart is heavier, my step a little slower, and my sense of humor less frivolous.  Without my PC (Prince Charming Post June 2013), my life lacks the invisible energy that exists between two people amiably in love; it is flat.   I miss the intangible magic spark he created that made me smile for no reason, and I long for the charm and warmth of my PC’s words even when we were merely discussing the weather.  Yes, I am exceedingly grateful for the precious memories, but as any widow will agree, it isn’t enough.

In the meantime, I have a wonderful, loving son of whom I am exceedingly proud.  But, since I returned to Florida after closing my home in Canada, he has appointed himself as the deputy in charge of motivating Mom to do what it takes to “get happy.”  He has welcomed the unconventional “role reversal” without hesitation, and he is not the least bit reticent as he assumes the duties of the pseudo parent.  He invents innovative ideas about how and what I should do to quickly return to my “old self “so to speak, and he doesn’t hesitate to share them with me in a lengthy text or email.  It hasn’t yet occurred to him that my “old self” doesn’t quite exist as he remembers it.  He lectures me about my attitude, my financial future, and he warns me about the consequences of my social failures. He refuses to entertain the idea of my getting a new Scion FR-S sports car as a distraction - it goes too fast. Yet he insists that I go out more, and all I’m suggesting is that maybe a little speed is what I need.  Finally, he scolds me in a series of prolific text messages when he senses I am ignoring his advice. Admittedly, he is probably right in most instances, and I appreciate that he is acting out of love and with only the best of intentions, but I am struggling to find my new path, and right or wrong, I am feel I am old enough (and still young enough) to make my own choices.

Lately, this subtle skirmish between us has triggered familiar memories of my assisted living days.  So often there is a huge disparity between what an adult child thinks a parent should do and what a parent actually wants to do. Frequently, the pressure from the adult child takes precedence over the desires of the parent.  “Mom, you’ll never be happy in the studio apartment you chose.  Look, I know you’d be much more content in the lovely two bedroom the nice lady showed us. I told her we’d take the two bedroom.”  Or, “Mom, I think you should start playing bridge again.  You know you and dad always played, and I don’t understand why you won’t at least give it a try. So, I begged the activity director to take you to play in the community foursome.  It will be good for you.”  And this one, “I brought you several really good books, Mom.  I just can’t believe you don’t read anymore.  You used to always have a book in your hands, and now, you won’t even turn a page.  By the way, I just signed you up for library book club. You’ll enjoy it.” Ahhhh yes, these are just a few simple examples of how Mother no longer does or knows best.

During these conflicts adult children don’t recognize that they unconsciously impose hypothetical objectives on us rather than realistic ones. As we age, we may be intimidated by the space of a larger apartment, it can be difficult to muster the intense focus it takes to follow a bridge hand, and one may find reading can be a meaningless chore as eyesight fades and distractions thwart concentration.  As the years pass, our requirements change as well as our expectations, and often what we need and want doesn’t always conform to what others want for us.  And often trying to make everyone happy, we regress and do as we're told.

Unfortunately, there is a vast difference between the initial parenting role and the new one adopted by the adult child.  When raising a son or daughter, there was a memory of our own behavior when we were young, no matter how distorted or faint it may have been, there was usually some vague frame of reference. “Wow, I think I remember doing something almost as stupid when I was in school,” or “Yep, I recall my dad grounding me when I got my first speeding ticket.”  When we were advising a child, there was an ambivalent benchmark that guided our decisions and influenced our feelings. Not so when the son is under forty thinking for the mom who is 68.  He can’t say, “Mom, when I was 68 all I wanted to do was play shuffleboard, or “Ya, when I was your age I couldn’t wait to join the bingo game at the club house.”  No matter how he tries, he can only imagine how I should behave at my age – there is no recollection.

So how do we bridge this gap that exists between us at the moment?  Mostly, I listen, I smile, and I agree to everything he says, and then I tell him exactly what he wants to hear.  Then, once all is said and done, I proceed to do exactly as I please -  after all, it worked for him when I was the parent, didn’t it?

A Bitter Pill Indeed

A Bitter Pill Indeed

 In August of 2011, a man, who I will refer to as “My PC” (short for Prince Charming), “winked” at me, from out of the blue, on my Internet dating site, and in the time it took for my impulsive “return wink” to soar to its destination, I had changed my life forever.

Our friendship began with the first paragraph of the first email, and in a matter of days we had bonded within our personal cyber space. Our soulfully written journals confessing our failures, lauding our successes, clarifying our expectations and divulging our dreams introduced us from the inside rather than from the eye catching outer shell on the outside. We were honest and candid in our writings until our commitment to meet face to face was merely a formality - a visual confirmation that we resembled the photo shopped mug shots we’d posted online. 

Our first encounter, amidst a batch of traveling tourists and business executives smack dab in the middle of the Orlando airport, was a whirlwind of emotion.  Festooned in all black with a sassy straw fedora on his head, my PC sauntered toward me like a man with a mission. My heart was bursting with delight the second our eyes met and our hands touched, and with one long, strong powerful hug our future was cinched.  The Prince Charming I had set my heart on in my teens had walked into my life, and the bucket list romance that we had set out to find was headed for takeoff.

 Strolling, hand in hand, to the restaurant where we had agreed to have lunch, a non committal date just in case one of us needed to jump ship, I bonded instantly with this tall, lean person whose wide, handsome smile swept me off my feet.  During our lunch we laughed and teased, and sniggered between stolen kisses. The sparks flashed between us like static electricity, and if there were other diners within our immediate space, we were oblivious to their existence.  Our waitress, in her mid forties, sent amused side-glances in our direction.  After all, we were in our sixties (neither of us looked it, I might add), and her smiles told us it made her day to serve two seniors misbehaving with such frivolity.  

Now, I must clarify that Mr. Right was definitely from the wrong side of the continent.  He lived in Ontario Canada, (which is why we met at the airport) while I was a sun worshiper from central Florida.  And yes, we understood that a long distance romance is a vigorous challenge, but we adopted a nothing ventured, nothing gained attitude and bravely cast aside our misgivings. 

For six months we commuted between the two extremes of hot and cold.  My PC for obviously reason traveled south during the colder months, and I planned my visits north around the warmer weather.  Our world rocked.  We shared a love of writing, laughed until it hurt, and marveled at the physical chemistry between us. The word snowbird took on a whole new meaning - Life was good.

Then, one day during a Florida stay, I rushed home from work (I was an Executive Director at that time) expecting dinner on the table and a cold beer, but instead I found my PC pacing the kitchen, the shimmering twinkle in his eye dulled by anxiety and fear.  Earlier that afternoon, he had discovered blood in his urine, and his anguish was cemented across his face like an effigy.  He tried to rationalize the symptom as the result of a morning run and for all practical purposes; we both felt that a ruptured vessel was a reasonable explanation.  But, the traces of blood continued, and we knew in 48 hours, it was time for him to return to Canada to at least confirm that we were overreacting.

Ten years earlier, my PC had been cured of prostate cancer (if anyone is ever cured), and occasionally there is a reoccurrence of the disease that is frequently detected through hematuria (blood in the urine).  Although I refused to admit that cancer was a possibility, my PC feared the worst.  He had fervently scanned the Internet, and his research led him to believe he was a prime candidate for another cancerous setback.

Sadly, my PC was right, but the malignancy did not originate in his prostate. No, it was an ugly distended tumor in his bladder.  We were even more devastated to learn he had a stage IV with numerous enlarged lymph nodes stretching from his bladder to his lungs.  The prognosis was deadly, and in a matter of minutes our sunny future tumbled to a rolling stop like a top on a tile floor running out of spin. 

Our lives entered the persona of the cancer world…. The carefree, frivolous days were gone, as were our dreams of becoming aging, sassy residents in one of my ALF’s.   After the initial lab results were in our hands, everything we did from that millisecond forward - exercising, eating, reading, researching was to thwart the demon, and we concentrated and focused on little else other than saving my PC’s life.

We married as soon as Florida could issue a license, and with my heart full of love and commitment, I packed my bags and moved to Canada. From June through August, my PC struggled to survive the ravaging effects of Chemotherapy. Each week was a test of his commitment to living. He challenged the nausea and the mind-altering fatigue with true optimism, and day after day he fought the depression to focus on our future of golden days and velvet nights.   

Despite the suffering and the physical turmoil, he ultimately became the Poster Child of the Chemotherapy Department.  He clung to his quick wit and innate sense of humor. His body was fighting to heal itself, but he still managed to crack a smile before each round of treatment and say,  “With a crowd like this, you’d think they were giving out free beer instead of deadly chemicals.”

When we learned the results of the CT scan in August, we were thrilled.  My PC’s response was better than the experts expected, and it seemed as if we were given a new lease on life.  We began to live our lives as if we had a future.  Although, looking back, the elephant was always in the room, and the “what if” of the dormant cancer never strayed far from our thoughts.

And then it happened.  It started with a slight dry cough, but as the days passed, my PC's lungs became so weak he had to fight for every breath, and at night, his chest gurgled with excess fluid.  To avoid the teeth chattering winter, we had migrated to Florida, but I insisted my PC pack a bag and return to Ontario and his awaiting medial team.  After a CT scan at the London Sciences, the prognosis from our close friend and doctor took our breath away and shock replaced our threads of optimism; my PC’s time had narrowed to months, maybe even weeks.

I lost my PC on February 26^th in 2013, and my pain is no longer acute, but chronic. For over fifteen years I comforted residents and family members who had recently lost loved ones, but at the time I hadn’t yet experienced a level of grief so intense that it scars your gut.  Now, after my PC’s death I get it, and the empathy I have for others is no longer impersonal but sincere and heartfelt.

I returned to Florida (the Canadian snow almost did me in after only one winter), to continue my job of living.  Stuffing boxes and suitcases getting ready to move, a close friend of my PC’s, who was grieving as well, passed on the advice her doctor had given her.

First, she asked me,  “If you were able to take a pill that would eliminate your pain, take away the loneliness and restore your to a women full of joy and happiness, would you take it?  Don't answer until I finish,” she warned. “You must understand that there are permanent side effects.  Once the pill is swallowed, all memories of the person you are grieving would be erased.”

In an instant, I recalled the loving image of my PC smiling as he leaned down to kiss me, and I replayed in my head the sound of his loud, hearty laugh while he teased me unmercifully.  I remembered the electric sensations through my arm as he held my hand and the feeling of security in his ferocious hug.    I would loose what was most dear to me in exchange for a smattering of tearful mornings and weepy lonely nights.

I answered without a second’s hesitation. "NO."  My memories of loving and teasing and living in tandem with a man who showered me with the wholeness of an unconditional love (I never even felt that from my parents) were too precious to be lost.  My PC enriched my life with his intellect, his humor, his creativity, his optimism and his energy.  His family of friends became mine and for the first time, I felt the acceptance I had craved since childhood. I never want his memories, or on some days his transcendental presence, to disappear, even if it meant I would live life free of the nagging sadness.

I have come to realize, that in the end, grief is unavoidable, and I had to ride the crest of emotion and pain like a buoy in the surf, or my PC would not only be lost to me physically, but spiritually.  I know, for me, it would not be an even trade.

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.

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.

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.

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.