Prepare or Beware

This is a rewrite of an article that I wrote for a small trade journal in New Jersey in September 2002.  The information is still relevant:

The nightmare began when your mother fell and broke her hip.  She had a hip replacement, and later spent several weeks in a facility receiving intense physical therapy.  Then, during your final discharge conference the social worker delivers the “final blow”.  “Your mother can no longer live alone.  She will need some kind of daily assistance.”  The social worker continues. “If you return her to her home, you or someone will need to stay with her.”  You remind her that you work full time, often till late at night.  “There are professional services that can help, “she answers. “They range from companies who specialize in caring for seniors in their homes to the assisted living communities that are cropping up all over the country.” 

Now you begin to panic. You promised you Mom you would NEVER put her in a nursing home.  She receives only the minimum social security and there isn’t much in her savings.  Medicare is paying for her therapy at the rehab center, but that will stop in only a few days.  Once Medicaid stops paying, the social worker quoted you a private pay fee of $260 a day until you can make a decision.  You struggle to hold back your tears as you are hit by the enormity of the situation. She is your mother, and suddenly she needs your help. You have no idea what are you going to do?

This is not an isolated incident.  Day after day, as the director of an assisted living community in Florida, I hear similar stories from adult children and care takers.  Almost daily, I meet families who do not prepare for the unpredictable effects of  aging either to themselves, or as adult children, to their parents.  In 2002, over 16 million adults in this country were over the age of 75.  Statistics proved that 50 percent over the age of 75 had at least one disability, and almost 72 percent over the age of 80 had difficulty with daily living activities such as dressing, bathing, eating and walking.  These numbers are increasing rapidly. People are living longer and as they get older, the probability increases that during their lifetime they may have to accept some sort of assistance to live. 

It is impossible to discount the media coverage of nursing home neglect and the adverse care suffered by seniors.    Understandably, there is a fear of living where one is concerned about abuse or abandonment.  The best solution is for a senior or adult child to explore the options that exist while they are healthy and strong.  It is prudent to create a plan that covers the contingencies if one is no longer able to live independently.  What will happen if there is a loss of mobility or memory, deafness or even blindness?  Leaving these questions unanswered leads to frantic choices, family feuds and decisions clouded with emotion.

Getting families to broach the subject is easier said than done.  Dr. Michael McGee Ph.D. and Executive Director of the Center for Senior Stress in Tallahassee, Florida described the dilemma that exists between parent and child.  “The parent, afraid of worrying or burdening their children, avoids the discussion.  Aware that they are getting older, they have no information to assist them.  As parents, they fret about the financial obligations for them and their children, the loss of familiarity, and the fear of having to rely upon their offspring.  The adult child on the other hand, not wanting to infringe on their parent’s rights, also struggles with this emotional turmoil and lack of knowledge.  Unfortunately, they often fail to recognize the frailties in the ones who have raised and nurtured them.   Neither is prepared to face the ambiguity of the role exchange.”

Dr. McGee indentifies the signals to take actions, such as the onset of poor eyesight that prevents driving, loss of hearing or subtle confusion.  Who goes first?  Dr. McGee feels parent are waiting for their children.  He advises adult children to approach the subject first. 

“Open the lines of communication well before there is a crucial need with a big family meeting” urges Twyla Sketchley, an attorney who practices elder law in Florida.  She advocates addressing the legal issues early.  “Admission to the E.R. or the Intensive Care Unit is not the time to call for a durable power of attorney.”  Once the discussions begin she advises “attach yourself to a least one professional.  Whether it is a lawyer, a doctor or a psychologist, choose someone you trust to guide you when you need it.”  She discourages relying on Internet sites, for those are often ineffective, especially if applying for some form of government aid.”

  Ms. Toni Nelson, MSW, whose company Continuum Care counsels adult children and seniors emphasizes, “Let your family know that it is not bad or unusual to need assistance.  We are all interdependent in one way or another.”  Ms Nelson also recommends making a Plan A and a Plan B.  “Plan A, of course, is living at home healthy and happy with no assistance.”  Plan B is just in case that does not happen. 

When making Plan B. Ms. Nelson cautions, children should allow their parent the same freedom to make decisions that their parent gave them.  Therefore, the guts of the plan need to be acceptable to everyone.  She explains that Plan B is for “ years down the road,” and helps not only to understand a parent’s wishes, but also to give them time to digest it, visualize it and accept it in their mind.  “It will be a much easier step if you ever have to implement it.”

 One of the biggest fears is not having enough money.  Local senior centers, retirement communities and investment firms frequently hold seminars to outline some of the newer options.  Long term insurance and annuities are fast becoming popular, and many are available to older seniors who thought they had missed the opportunity.  Objectively, itemize the cost of living at home.  Often food, taxes insurance, maintenance and utilities will add up to a large portion of the cost of renting in a community.

Become familiar with the resources in your neighborhood.  Independent retirement communities and assisted living facilities are fast becoming popular.  Smaller areas may have private homes for seniors needing assistance, and private help, although expensive, may be more appropriate in some settings.  Don’t be afraid to visit, have lunch or attend a function at a community even if you never intend on using their services.  If nothing else, you will enjoy the free food, and if by chance you are forced to follow Plan B, there will be less fear of the unknown.

Many seniors are living in homes not customized for poor eyesight, stiff bodies crawling into bathtubs or unrestricted pathways for wobbly legs and bodies.  There are no pathways for assistance appliances such as walkers and wheelchairs.  It takes courage to face these situations early on, and to prepare for the unpredictable.  The families who plan ahead will lessen the likelihood of having to make rash decisions during an emotionally stressful time, and in turn assure their loved ones a better opportunity for a safer happier future.

Karen Pinney is the administrator of a large independent and assisted living community in Tallahassee, Florida.  She has been assisting senior in the health care industry for over 15 years.

Moving Mountains May be Easier

Helen was stubborn.  For over two years her son had encouraged her to move into an apartment or a retirement community, but she adamantly refused to follow his advise.   She was comfortable and content in the home she had maintained for over 20 years. She intended to stay there until she died.

It is an honorable ambition to want to live at home independently. Helen’s son did what he could to support her desire, despite his having to be on call in case she needed him. She could no longer drive, so she depended on her son to take her to the grocery store, the bank, or to her numerous doctor appointments.

As the years passed, keeping up the house became more stressful for Helen.  She complained that the household chores sapped her energy. She could no longer balance on a ladder to reach the top of the windows to wash them, nor could she push the vacuum cleaner without her arms and shoulders aching.  Her son did all the yard work, but he traveled out of town for his job. The grass and weeds grew fast in the summer, and Helen nagged him when the yard showed the sad signs of neglect.

Helen’s greatest pleasure was feeding the squirrels and the birds.  It was a daily ritual.  Every morning Redbirds and Robins, and an occasionally feisty Bluebird would gather outside her patio door seeking a handout. Helen would toss them seeds and bread crumbs, chatting contently as if they understood her.  

Helen never experienced a crisis or a fall, but one day, “out of the blue” she said to her son, “I’m ready to move.”  Astonished, but relieved, he took her to visit several communities and senior apartments.  It didn’t take long for her to decide, based on her income, which community was the most appropriate.

Once Helen signed the rental contract, she began to panic.  “How will I ever deal with all this stuff?” she wailed.  “I can’t sort, pack, and box the dishes or the pots and pans.  What will I do with the furniture?  It won’t all fit in the new apartment.  I’m not going,” she declared.   “Call the sales lady immediately and get my money back.”

Her son, a friend of mine, had already offered to help, but he was discouraged. He called me, and I could hear the frustration in his voice.  “She won’t listen to me, he complained.  “She needs to throw stuff away, and she won’t hear of it.  Everything I suggest ends up in an argument.  I don’t want to cancel the move; this is the best thing for her, but the way it’s going, I may not have a choice.”

“I have a perfect solution.” I said.  “You need to call Mrs. Beckworth.”  She does nothing but move seniors.  She will easily win your mother’s confidence because she is sincere and caring.  She will guide your mom through each phase of the move.  Eventually, she will pack what items she and your mom decide to take.  Then she will dispose of the things that are unnecessary, and finally she will schedule the truck and the movers.”

“How much will it cost?” he asked.

I avoided his question.  “Then,” I continued, “she will also execute the very last phase, and probably the most effective--that is the unpacking.  When your mom enters her new home for the first time, everything will be in place. The clothes will be folded neatly in the drawers, the pictures will be arranged on the walls, and the drapes will be perfectly hung.  You can’t beat it.”

Again he asked,  “How much will it cost?”  I knew that my friend had a “frugal” reputation, so I continued to avoid his question. “Mrs. Beckworth is busy everyday of the week.  If you expect to get your mom moved by the first, you will have to call her very soon.”

“How much will it cost?” he repeated.

“Every job is different.  In my opinion, she doesn’t charge nearly enough for all that she does.  She will quote you a price once she sees what how much your mom insists on moving. “ 

I hung up the phone and thought to myself.  There are senior movers in almost every city in the US.  There is a website, www.nasmm.org/ that lists the cities and the senior movers who service them.  Often, it is the logistics of organizing the huge task of the move that prevents a senior from relocating to a community.  Although they understand intuitively that they would be happier and safer in their new home, they are overwhelmed by the thoughts of sorting and packing the items they have collected for decades.  It is helpful for them to have an objective third party on hand to lighten the burden.

I didn’t hear from my friend until after the first of the month.  “Did your mom move?’ I asked.  “Yes. Thanks to you and Mrs. Beckworth. She is happy in her new place, and I feel so much better about her safety.  The people there have been very helpful.”

“Great,” I responded.  We chatted for a few minutes, and then as I started to say good-bye and hang up the phone, my friend interrupted, “Karen, thank you.” 

“For what?” I asked. 

“For sending me to Mrs. Beckworth. You were right.  The money I paid her was the best money I ever spent.” 

Coming from a man who squeezed every penny, it was all I could do not to say, “I told you so.”

A Crash on the Road to Independence

We were friends at the first handshake. He had a formidable grip that matched the strength of mine, and his clear brown eyes never blinked;  in those first 5 seconds of our first impression, I predicted he would soon be one of my new residents, and he knew he had found someone he could trust.

Max, a ninety year-old, frail, thin New Yorker, unable to walk, was still able to push himself into the building in a manual chair with the grace and strength of a high school athlete.   Two charitable friends, who had previously befriended him by delivering his meals on wheels, referred him to us. They knew that because of his age and his physical challenges, it was no longer safe or healthy for him to live alone without supervision.

 Max had a catheter that he emptied and cleaned himself, legs that barely supported his boney thin frame, and a quick wit, a clear mind, and a strong positive attitude.  He was adamant about living independently, and I assured him that he would be on his own in this community.  The only assistance we would provide would be housekeeping and three meals a day.  I was able to offer him a private garden studio, with a small porch not far from the pool. He accepted immediately.

Max was an unusual but unusually likable resident.  He was seemed gruff, but was, in fact, friendly. He spent hours on his computer in the library connected to our Wi-Fi, and when he was not surfing the net he raced his power scooter throughout the building and grounds like a NASCAR driver. “Slow down, Max,” I would scold. He pointedly ignored me and continued to roll at the same breakneck speed, his only deference apparent in his offering a sarcastic salute and a Cheshire grin.

 His tablemates respected him despite his acutely controversial opinions. He found fellowship with Tom, another New Yorker; they would sit at the table, long after the meal was done, loudly debating whatever topic they could agree to disagree upon.

Three months ago Max toppled trying to get from his bed to his chair. He fell that dreaded, sometimes deadly, fall that accelerates the manifestations of old age.  His recovery followed the “normal course”: First a surgery that compromised his mind somewhat, probably from the anesthetic, and then weeks of intense rehab that vainly attempted to force his 90 year body to regain the strength to lift, transfer, and ambulate. At ninety, few return to their former mobility, and Max was no different.

Max and I met with a social worker. We three agreed he could not return to independent living.  He was a 90% fall risk, and had to be relocated to an assisted living facility.  He had no money, but refused to accept Medicaid. He did not want charity. His choices were limited.

As the meeting ended, Max put his hand on my arm and his eyes grabbed mine with the same intensity as the day we met.  “I would rather live alone with the chance that I would fall and die, than go somewhere where I am restricted and sharing space just to live a little longer.” 

I held his gaze for a few seconds. “I know, Max; I know,” I answered regretfully.  I squeezed his hand as I left the room. 

I was thoughtful as I walked the long stretch of hallway to the front door. I thought about Max and his freedom to decide where and how he wanted to live.  I was sadden by the knowledge that in today’s litigious environment, it was doubtful that he would be allowed to choose how he would spend the rest of his life.

A Poignant New Year's Day Memory

I started my first position as an Executive Director on New Years Day, 2000.  I say I started on New Years Day, despite it’s being a holiday, because it was the day I arrived at my new community.   I chose to begin that day so I had time to move my miniature Schnauzer Sadie and me into an apartment.  We were relocating from Tampa to Tallahassee, and we intended to live on the property until we found our own place to live.

I was thrilled and excited to begin this new adventure. Previously, I had been working in sales and marketing for an assisted living community, but I had just finished graduate school with a M.S. in Managerial Leadership.  I was anxious to put my newly earned management skills to the test.

On that particular New Year’s Day, Sadie and I arrived at the community in the late afternoon.  Our car was packed to the roof with our personal belongings.  I was anxious to get situated, so I borrowed a grocery cart, that the residents had confiscated from a local grocery store, in order to cut down on the number of trips it would take to unload our things. I piled it high with clothes and over-stuffed boxes. I then balanced Sadie under one arm and wheeled the rickety cart into the building and onto the first floor elevator. 

The previous administration assigned us an apartment on the second floor. When we reached our destination, the elevator doors opened for a moment, but stubbornly slammed closed before I could get the cart moved into the hallway.   I clenched my teeth as I held my unhappy dog and struggled to maneuver the cart over the elevator threshold without being crushed by the weight of the elevator doors.  I hadn’t noticed anyone in the hallway, so I was quite surprised when I heard a cheerful, “Oh my!  Good afternoon.  You must be our new executive director.  We’ve been expecting you.”  And then, like magic, the elevator doors opened, and released me from their clenching grip.

I looked up to see a most beautiful lady pressing the elevator button, who appeared to me as if she had wings and a halo.  Dressed impeccably in an ivory high collared, long –sleeved, satin blouse and winter white wool slacks, I was impressed with her stunning appearance.  Her face was wrinkled gently by 88 years of living, but her bone structure retained its model-like profile.  Her hair was spun white gold and was twisted regally around her head.

Embarrassed by my soiled jeans and wrinkled cotton sweater, I was finally able to steer the cart into the hallway. The woman stood waiting, beckoning me to follow her. “My name is Kathryn. Come, let me show you the way to your room.” She walked a step ahead of me, confidently supporting her weight on her aluminum walker.  Slowly, I followed her down the hallway, pushing my wobbly cart with one hand and squeezing my squirming Schnauzer in the other.

We stopped in front of a room with no nameplate.  “Joe’s been busy redecorating this room for you, “ she said with a sweet southern drawl.  “These hallways can be confusing,” she continued.  “If you get lost, I’m in the apartment beside you.  Feel free to knock.  Looks like you have an exciting New Year ahead of you.  I’ll be happy to help in any way I can.”

“Thank you,” I said gratefully.  As she turned toward her own room, I marveled at her erect posture and her genteel femininity.  “What a lovely women I thought to myself.”

Kathryn and I became fast friends in a very short time.  Every day she would pop her head around the door to my office.  She was always clothed in a tasteful, coordinated outfit; her make-up freshly applied and her hair resembling a French coiffure.   “Hi Karen,” she would say happily.  “Hope you are having a good day.”  On other days, when we both had time, she came in and sat in the chair facing my desk.   During those times she shared her intimate personal stories.

Kathryn had come to the community with her husband.  They had lived in Live Oak, a small town east of Tallahassee.  Typically southern, they were a gentle, quiet couple.  Her husband, Powell, had owned a thriving nursery in Live Oak, and they had raised their three children there.  She remembered a good and loving relationship. 

The couple came to assisted living because Powell, several years older than Kathryn, was declining physically after a series of heart ailments.  He was only at the community six months before he had his fatal heart attack.  Her sadness at losing her life’s partner was apparent to me, but she never allowed that sadness to penetrate her positive upbeat attitude. 

Kathryn was an active resident.  She assisted me with the management of the community country store, and supported the members of the Resident’s Council with their worthwhile projects.  She also joined the greeting committee to introduce new residents to the community.  Her daughter and son-in-law attended our parties, took residents on outings, and also became an integral part of our community family.

The day we lost Kathryn, I was soulfully saddened.  In our numerous conversations, we often teased about my first day and the comical introduction that immediately cemented our friendship.  Since then, on New Year’s Day, I always remember Kathryn; her love and enthusiasm inspired me to become a more effective Executive Director.