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. 

The "Goodbye" Angel

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

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

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

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


 I spoke with my regional manager, and we agreed that I had to take certain precautions.  With the aid of the Director of Maintenance I claimed an unused corner of the activities room.   We gave Harold a long, heavy table, and then we found a screen to protect the area and to afford him some privacy.   He used a temperature-controlled sodering iron, but we insisted that he use it during regular working hours while a member of our staff was nearby. If the iron were to fall on the floor, someone would be close at hand to quickly retrieve it.  Finally, we supplied an iron stand and safety glasses to prevent any other unusual or unexpected mishaps. 

 

It was rewarding to witness Harold’s passion.  He ordered glass packs in a myriad of colors, and he bought rings of copper foil.  He worked tirelessly, glued to his table and tools, making flowers, and leaves, and his color filled angels.  He always shared his finished items.  They were gifts for another resident, a family member, or a staff member.

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

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

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

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

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

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

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

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

Difficult Decisions and Crucial Choices - The Conclusion

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

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

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

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

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

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

I urged Jill to hire one of the local movers that specializes in moving seniors.   I assured her that they would not only pack for her, but would dispose of the items that Dorothy no longer needed.  While Jill was in New York getting her mom, they would move the necessary items from Dorothy’s home in Florida into the apartment that I had chosen for her.  They would unpack, organize her clothes in the closet, replace the items that go into drawers, put her few kitchen items in the cupboard, and hang her favorite pictures on the walls.  They would put each item in place

so that when Dorothy walked through the door, she would have a beautiful new place to live.  “Trust me.” I encouraged. “It’ll be money well-spent.”

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

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

“I don’t want to live with anyone, “ she scoffed.  “ I won’t be here long, you’ll see.”

I walked with her as we slowly reached her apartment.   As I began to knock, the person on the other side opened the door.  “Madeline, you remember Dorothy.  She is going to share your apartment.”

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

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

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

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

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

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

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

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

Difficult Decisions and Crucial Choices Part 2

Part 2

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Difficult Decisions and Crucial Choices    Part 1

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

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

Then yesterday, while they were shopping for groceries, her mom had mistaken Jill for her own mother, Jill’s grandmother.  She remained confused for several seconds before she snapped out of it and recognized that Jill was her daughter.   There had been other incidents, but Jill had brushed them off as simple signs of old age – nothing serious enough for concern.
 
Suddenly, the doctor is saying the changes may not be so simple after all.  “What does this decline mean?” Jill asked cautiously

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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