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A few short stories/scenarios to help me make my point.

Scene – Close up on Mom who is in her chair and on the phone with her son about 5 states away. Assuring him she’s taking her meds, she’s eating, she really has little to no struggles. Her biggest frustration is getting out to the store. Laughing at the stories he tells her about her grandkids. Comparing them to him as a child.

That holiday time of year is upon us. Families preparing to come into town and see their loved one they have not seen all year or two with the pandemic. Which in my position translates to award season. The award for the most compelling phone performance goes to Mom. The Phone calls went well. Mom is eating good, shes cooking things she has not in years. How does this become a busy season for me? I meet with families and try to understand what is happening at home, understand their loved ones needs. Show them the community and in most instances move forward with an admission. These award seasons are my busiest times of year, feel like I need a red carpet leading into my community.

When Moms son and his family arrive from out of town for the holidays they notice moms fridge is pretty empty and not that clean, there’s some questionable items in there too. Her house is not only not clean it’s falling apart. While you’re sitting on her recliner and thinking about what your next step is you notice a few pills on the floor around her chair. Her bedroom has a strong urine odor (she can not always smell it)

How can this be? She’s been cooking food I haven’t eaten since I was a kid, why is she so thin. Wait, was she lying? How did I not know that? Why is she not being honest? It is not until his wife starts pointing out that she needs a care plan in place before they leave that he realizes she right.

They begin calling home health care agencies, the pricing blows them away. She can’t afford $25+ per hour, they can’t afford to pay for the aid. Mom is also not comfortable at all with someone in her home touching her things, telling her what to do.

Her daughter in law suggests calling senior living options. He begins making some calls in the garage while his wife helps mom with laundry. The call is made to someone like myself, an appointment is set. When we meet most often than not they were not excepting to show up for the holidays and find out every call was a lie, an elaborate performance. Once I sit down with her son and his wife and they have gotten through the initial shock of what Moms life is really like. I hear and learn all about moms or dads amazing phone even Skype performances. (Some stories I even imagine mom bowing in my head at the crowd clapping and screaming Bravo!!! )

And the Award for the lead female performance goes toooo- Mom

We all like to live our lives a certain way. For the most part we do not like when other people tell us how we should live, eat, clean etc. Mom in this scenario is just doing what most of us would do. Try to keep our lives in order and in a manner we are used to. Everyone has their own way. No she didn’t always live that way but this is what she’s become accustomed to. She’s trying to keep her head above water, prepare and eat three meals a day, clean her house, take all her medications, errands etc. She is doing this to remain in her home, remain independent and remain the matriarchal figure you know and love. She does not want her family to think she’s struggling. No one wants to hear that they failed and an aid is being brought in. Some strange woman she does not know to tell her how to eat and tidy up her house. She certainly does not want this woman touching her things or reporting back to her children. It’s unfamiliar and scary.

Even though Dad who lives in New York notices that he is forgetting things and he is not himself lately. He is still going out for a drive to run his errands because he does it almost everyday and “nothings going to happen, nothing has ever happened.”

There are some things in life that we just can not believe until we see or experience it ourselves and even then for some it’s “not going to happen again” Dad does not know that he’s about to get confused and lost. He wouldn’t go if someone told him that was about to happen. Unfortunately that’s not how life works. We can’t tell the future and we for the most part think we can do what we want until we physically see or suffer the consequences of not being able to do that anymore. Dad swears he is just a few blocks away, the car got turned around he’s lost his sense of direction. He continues to drive until he gets on the right course home. The family is beyond thankful to the The police officer in Pennsylvania that pulled him over for a broken tail light. He wasn’t expecting a confused senior from New York in his day, but he’s trained to work with him. Thank goodness Dad had his wallet and the officer was able to call his family. When his daughter arrives at the Pennsylvania precinct she is shocked to see how disoriented her Dad was. How did she not see that coming?

And the Award for Lead Male performance goes to Dad!!!

Dad who is steady, put together, stuck in his ways, routines. His family noticed some little things here and there but almost no signs leading to this. His daughter knew he’s not been himself but she never imagined this would happen. Quite the opposite she thought taking him out of his daily routine would hurt him.

This is a traumatic day for Dad and what illness he is struggling with. This trauma Dad may not be able to shake , in fact it can create a whole new level of confusion for him. He needs a plan, he cannot just be driven and dropped off home. He needs a 24/7 plan in place right now.

If something feels wrong to you, if you notice something with your loved one. The best thing you could do besides sitting and talking with them about what they’re feeling and experiencing is to get them to a professional that can get to the bottom of things, diagnose your loved one and get the right medication and care plan in place. Until this all comes together you need a plan today, your going to sleep at his house or he’s going to sleep at yours. Either way someone’s having a sleepover until a plan is in place for the long term.

What’s next would be having care in place while your at work, what your cooking when you come home to them at night. When you help to bathe her etc. who’s staying with them while you run errands. Siblings taking turns sleeping on Moms couch at night or until they get a solid 24/7 plan in place, home health aids at home or a senior living community.

When we imagine what will happen when we can’t live/be alone is that you’ll stay with your family. Well the reality is your family may not have a spare room, too many stairs, they work, their children’s extra curricular activities, nights out. I see some sibling have Mom at their house this week, her sons house next week and back and forth. While this may be an amazing plan and solution for some families, it is not ideal for all families and not ideal for all seniors. There can be many factors to consider. Like Mom does not want to keep moving each week. It’s exhausting her. She feels like a burden. She wants her own space. Her loved ones notice her confusion and forgetfulness is progressing with switching houses weekly.

Caregivers want to do the right thing by their loved one. Often times caregivers are trying to respect their wishes and not be put in a “home.” Until something happens to break this cycle which is often caregiver stress. (Future blog on caregiver stress)

Often times it is stability that will help your loved one. A stable environment, a consistent daily routine, medications (all of them) scheduled and on time administered to them. Three well balanced meals, hot showers, fresh air on walks, a fun activity schedule of things to do when they want to socialize with people their own age. Having their meals with other seniors their age discussing topics they each find interesting. Is this a senior center, an adult day program, bringing home health aids in or a senior living community that will bring stability and routine to your loved ones days will depend on your loved, their needs and it will depend on how much more the caregiver can take.

Most seniors play Starring roles in their own lives when they try to mask or hide what they are struggling with. Some are upfront about it to their family and friends. Either way they are depending on someone to help them get a 24/7 plan in place. A senior living community can offer everything and more your loved one may need in one place. A variety of visiting physicians, well balanced meals served in a dining room, medication administration, activities they enjoy, live entertainment, trips out, grounds to walk or sit and enjoy the beautiful day. The right community is almost like living in a senior resort.

Try to recognize little or big things about your loved ones changing health status. Try to have a friend or neighbor stop in to see them when you can’t. Your parent ensured you were safe 24/7 when you were a child and now it’s your turn.

If you feel exhausted and run down by being your mom’s caregiver then be your Moms daughter again and consider all the options that can bring her the quality of life, care and assistance she needs and deserves and most likely a senior living community checks all those boxes. Now when mom has quality of care and quality of life you in turn will have peace of mind.

Up next- Senior Care & Living options 105: What’s are the costs associated with care? I don’t qualify for Medicaid. Wait, Do I?

Having a loved one with Dementia or Alzheimer’s can take a lot of patience. There are so many emotions surrounding your parent, loved one, friend having dementia. It is not typically a surprise to your loved ones. You have brought it to their attention or they have been noticing something is off for a while now.

Recognizing there’s a problem:

The first step is to ensure the senior has a safe system in place 24 hours a day, 7 days a week while you get through step 2.

The second step is getting a diagnosis which will provide answers as to what has been going on with your loved one. The wait time to see a Neurologist can be months and months long. While you wait you should have the senior see their primary physician. A primary physician has often taken years to get to know your loved one and has had a long time to establish a relationship with them and one of trust. They will most likely run some blood work and/or urine test to see if there is any simple underlying condition causing the senior to be more confused, forgetful basically not themselves. (*More below on some examples of these underlying conditions below)

Physicians often see a glimpse of their patient. They are very routines visits and your loved one can be exactly who they always are at their visit. A primary physician may prescribe a medication to slow down the progression of a memory impaired resident, it may or may not be all they need or all the doctor can really do until you see a specialist. Also keep in mind a primary physician sees all ages of people and works with a basic approach to medicine. In that glimpse of seeing your loved one I have often noticed they do not like to “side” with the family initially on what’s happening unless something or a scary circumstance brought them there. They are not so happy about taking away someone’s freedoms based on a glimpse of a visit. (Which is why you may notice their resistance to take away a seniors drivers license or agree to an assisted living type environment if the senior is not on board) with no substantial situation to bring them there. Also important to note are the times you are not at the visits with their doctor and your loved one tells their doctor how their son is too busy for them, their daughter has her own family and has little to no time for them. “They are trying to stick me in a home.”Their physician has some sympathy for their patients and often sides with their independence. I personally think they do not want to be the one to take those freedoms away from their patient unless necessary. Not to say all general practitioners are this way but the majority tends to be reserved in their approaches.

Having a Geriatrician which is a doctor that works solely with senior citizens can be a bit more reassuring as they recognize all of their symptoms and take a more aggressive approach until or if a specialist is seen.

Here are some scary and what may seem like drastic scenarios but very common occurrences with someone that has dementia or Alzheimer’s and lives alone.

1. Mom had a kitchen fire forgetting the stove on. She has left the gas on and Fireman responded and neighbors are nervous she’s going to kill them.

2. Dad was found by police 3 states away when he only went to get lotto at our local deli.

3. My uncle is knocking on the neighbors doors in his building at 2am and the doorman said he is dressed and ready to go to work at 3am nightly now.

4. You are starting to notice on your visits that your loved ones mail is piling up which in turn results in their bills not being paid for some time now. Sadly this list can go on and on but in an effort to keep it simple I will just provide a few.

I meet with so many families that say my loved one had some forgetfulness but the last week or two they are unrecognizable and now they have full blown dementia.

This can be a UTI- urinary tract infection and antibiotics can help A senior to return to their normal self. For some this is a traumatic situation and they may not return fully to themselves but will come pretty close. Dehydration and poor hygiene are just a couple of the reasons a UTI can happen to someone. A UTI can be very scary to the senior and their loved ones. They can appear very disoriented, confused, they can hallucinate etc. For a first time caregiver they like most people and sadly some. Doctors do not always recognize that a UTI can have this severe of an effect on someone. I often ask families to go back to the hospital, the doctors office and insist they do a urine test. This is not always the answer but more often than not when someone has such a sudden shift a UTI has a good chance of being in play.

A senior being on a new medication can also present some misguided signs of a memory impaired resident and may need to revisit that with their physician immediately.

A traumatic event such as loosing a spouse, a good friend. Family moving away, depression, a pandemic or in which the senior is isolated in their home can all impact the residents frame of mind.

Isolation leads to depression leads to dementia. Which my profession has been preaching for years and years and now in this time of a pandemic more and more people can recognize how true this actually is.

The third step is to figure out a short term plan until you have things figured out or a long term plan depending on your loved ones needs. Is it a home health coming into the house for a few hours or do you need a senior living community right off the bat, perhaps you consider a respite (a short term stay) in senior living until you get more answers. The answer is really different in each situation. Be Careful!! Whatever situation they are in is going to progress or something is going to happen to force your hand in having care in place.

This cycle of events is common in most every situation. The senior wandered out, the neighbor found her at the store, sent to ER, sent home. Then the senior drove to church but wound up confused in traffic and hit a pole. To the ER, to home? Maybe not home anymore. Repetitive trips to the hospital will have the social worker there and doctor typically move you to rehab in an effort to hold you longer until a next step is in place. Not every senior can go home because the physician does not feel they are safe alone. It is then the reality of a doctor saying you need 24/7 coverage at the home or a senior living community.

Let’s face it a River will run in the exact same direction for centuries unless you place something there and change the current of the water.

For seniors if you do not break the cycle of events that put them in harms way, the cycle will progress and you are gambling with some serious consequences. A Senior living community that offers memory care can not only keep your loved one safe but also keeping them engaged and socializing with other seniors can change their quality of life and their days more purposeful.

The forth step is happening while you wait to see or have already seen the specialist.

There are so many enjoyable things that can be done with someone that has a memory impairment and in all different stages of their memory loss. Keeping it simple is key.

Always Keep it Simple.

Here are some

Do’s and Don’t’s :

Don’t– open the closet and say “what do you want to wear?” Do – Take out two outfits and say “Do you want to wear this or that?”

Don’t– Say “Hey Dad what do you want to eat?” Do – say “Dad do you want Chinese or Italian food?”

Don’t – say “Do you want to watch a movie? Which one? Do – say do you want to watch this one or that one?

( You get my point) simple choices all day enabling the senior to not be overwhelmed but to also feel included in their daily choices.

Spending some time with your loved one doing things they enjoy doing now and maybe some things they enjoyed doing in the past.

Baking, Gardening, Sewing, playing a favorite card game, put together a making a quilt project or whatever it is that sparks a light in your loved one. Quality time and patience make the world of difference. Maybe it looks differently, maybe she is just sewing buttons onto a material, it does not have to be perfect or even make sense it just feels familiar and enjoyable.

Music therapy can be effective at all stages of memory impairment. Even in the later stages if someone loves music, play their favorite songs. You will notice a difference in a music lover almost instantly.

Someone at the early stages of a memory impairment are battling to hold on to their memories. A large planner, some magazines, a glue stick, safety scissors and a pen/pencil is a great way to look back for seniors. They can cut out a photo of a dog and put it on the day you took them to the dog park, they can put a photo of a pie on the day you baked together. You can help them to make a note so they can look back. I had one family gift their dad an easy to use Polaroid camera and they would put that days photo memory in its spot in their planner. Some use it also look ahead, a Christmas tree on the 25th a birthday cake on an upcoming date to remind them what’s coming up. Simple but keeps them Busy and it’s theirs to manage.

Sensory stimulation are usually baskets or a box of items that a senior can have on their lap. Everyday items, buttons, different fabrics, clothing, items familiar to their past. They can be familiar, relaxing or soothing to someone with memory impairment. Especially in the mid to later stages of the disease. They can boost their self esteem, they can help them to communicate and encourage participation.

Was your loved one a mechanic, a cabinet maker etc. Bring in something safe that you may need their help in fixing or just bring in the old car and let dad work on it (safely) . Some screws, tools and some old cabinet(s). The littlest thing can help someone to feel productive and busy.

Aromatherapy & hand massages, are also both great relaxation therapies

I had worked with an elderly woman whose husband had Alzheimer’s and was living in our community. We probed a bit into his past, things he enjoyed, his daily routine. He owned a landscaping business for over 40 years. Each night after dinner they would sit in their yard, they each had their own chair, they listened to Italian music, ate fresh fruit and admired their garden. We set up his favorite chair in our garden, we played some of his favorite songs, some fresh fruit and his wife sat right next to him and enjoyed that time with him. He said not one word, he was not very verbal at this stage but it seemed to me no words were even needed. He smiled, he appeared less anxious, they enjoyed their fruit, the sun, the garden, their music but more importantly it created a moment for the both of them.

One of the most important things to know as a caregiver is to take care of yourself and be your Moms daughter not her aid. So many families have expressed how happy they were to be who they were supposed to be in their loved ones lives once they moved their loved one into a memory care community or they have found the perfect 24/7 supervision setup at home. Over time a caregiver becomes a chef, the housekeeper, the launderer, the nurse, the aid, the appointment transport, does all of the errands, the finances while they still manage their own life and family. You thought your life was chaotic now. A caregivers schedule will blow your mind.

Patience can be a virtue and especially if you are now a caregiver to someone with dementia. Don’t bicker and insist they are wrong. Five minutes after trying to convince Dad of something he does not see you are still a bit aggravated but Dad is not upset he’s moved on. The caregiver is left annoyed with him not understanding what the reality was, he’s not!

Simple ways to connect can mean the world of difference for some seniors, their struggle and their families.

Keep it Simple!

Up Next -104: Award Season is upon us!! I mean out of town family comes in for the holidays… The gig is up … 🤷🏻‍♀️

“The Power of Choice”

There are some things in life we have no control over. When you buy a house or rent an apartment, you look around the area, check the neighborhood stats, search for what you can afford. After looking at houses and apartments you finally walk into the one and say,

“I could be comfortable here”

When you go on vacation, you search for a safe, affordable vacation where you can relax and have fun. You choose where you live, often times where you’ve worked, you choose what you wear, what you eat. I mean let’s face it when a waiter asks, what we would like to order we do not ask the person at the next table, “What do you think I should have?” You have been making multiple life choices every single day for yourself since were a child. Good or bad you’ve made them. You have worked three quarters of your life to get to Retirement. Why when you finally arrive into your senior years and may be in need of someone caring for you, do you not want to be the one to decide on where you want to live?

We probably all know the answer to this but how many of you have gone senior living shopping? It is a rare occasion that I work with a senior and they say “I’ve been looking forward to this for years, sign me up.” Does it have to be a goal to move to senior living? No. But for as long as you can remember, you’ve chosen for yourself. More often than not, I would even go as far to say that 90% of seniors I have moved into senior living communities over 17 years did not reach out to me. They didn’t go online to look senior care or living options up (or their email would’ve triggered a referral at some point to me via a referral service.) Google is not a friend to all seniors. They didn’t call my community for information (which we know because a community would keep record of your initial call) They didn’t take a stroll up our block and stop in to get information. They actually look the other way in an effort not to feel they can relate to any of our residents sitting outside. Ignorance is bliss, let’s face it.

90% of my admissions happened because a child, a niece, a cousin, a friend, a lawyer or even a banker reached out because they noticed something is wrong. Often times the person they are calling about had a fall and broke their hip or their hip broke and they fell, wandered out in confusion and is in the hospital or rehabilitation and cannot return home. This can be for a multitude of reasons. Some of the many reasons someone can not go back home would include your house steps, your bathroom is on another floor, you need assistance with your ADLs (activities of daily living). You can no longer keep up with the cleaning and maintenance, you can no longer safely take your medications, the doctor at the hospital or rehabilitation does not feel you are safe by yourself, you can no longer cook for yourself (and no cereal and sandwiches are not balanced meals.)

Sometimes your loved one recognizes there’s an issue, most times they are being told you can not return home without 24/7 assistance in place or they need a senior living community. I can count on one hand how many times a social worker or doctor in a hospital or rehab told me, the senior actually suggested senior living for themselves. Let’s face it this is a chaotic time. You were not expecting to not go home and you certainly were not expecting anyone to tell you what you can and can not do.

Either way in these situations it’s happening and whoever is reaching out to me is going to choose for you. They are going to choose the community they felt good about. They are going to choose what kind of room they think you will like, what you can afford, who will assist and care for you. They are just trying to help you, they most likely have a family, a job and stress of their own. This is a very chaotic and stressful situation for everyone involved, more importantly the senior. Chaotic, traumatic events can lead to even more issues. All of your life you’ve been choosing and this most likely being the most important choice of them all and you often in those situations without research and/or a plan will have no choice.

I am not saying seniors should be skipping into communities in their area. There are some things that may be important to you, like that,

“I could be comfortable here.” feeling.

What feels good to you may be different for who is choosing for you.

I do have a high regard for those seniors that do research, visit and ask questions. They aren’t planning on moving to senior living but they are planning on where they will move if they have to. They know what areas they want, their budget or whom will take Their Medicaid. Because you are a private pay senior or you have Medicaid. One or the other and no in between. (Future blog on this topic)

If you are not in a hospital or rehab there may still be a need. Families reach out to me everyday for many reasons they feel like their loved one may need the support of a community. Maybe they recently lost a spouse (this is a traumatic time for the remaining spouse) maybe they are finding some medications on the floor near a chair, they notice you can no longer cook, so you are eating sandwiches, easy to grab foods, they notice you’ve been forgetful and they are worried. They come over or fly in from wherever they live to help find the right community and the hardest part of it all is when they then have to leave me and go talk to you about it. They don’t want to but they love you and are worried about you.

The other common occurrence is for couples. They have been together for many years and when one is struggling with health or memory issues. They do everything to keep their spouse/partner with them. No matter what, they want to be together. In a chaotic situation they most likely never saw it coming. They have managed it on their own until now or it is a sudden accident/sickness they were not expecting. Caregiver stress can break the healthier spouse down faster than the one they were caring for. Caregivers have taken on the care and stress of another person when they are seniors themselves. They rarely recognize that it’s happened until they have become sick and/or run down. Now one spouse is in a hospital/rehabilitation and the other is at home. The spouse in rehab can not return home. The spouse at home is relying on loved ones and family in this chaotic situation. What could be worse? Seniors that do not have family or have a niece or nephew far away and they can not or will not be there for you. The caregiving spouse is lost, nervous, convinced no one can care for their spouse but then. The spouse remaining at home alone or scrambling to move to senior living to be with their other half. This is typically a very chaotic situation. It is not one but two people to convince there is trouble on the horizon.

Now they are separated in their golden years, that wasn’t the goal, was it.

Though sometimes it is the goal. Mom is going to get hurt trying to pick dad up when he falls. Dad can’t take Mom snoring. One of them is exhausted because the other spouse suffering with dementia gets up at 3:00 am to get ready for work, if they aren’t on alert and ready to cue them to return to bed, he/she will one day make it out the door (AKA Wandering.) Many seniors move into separate apartments or their own bedrooms. One needs memory care and the other lives downstairs in assisted living and visits every day if they like.

Another common thing I hear is “Oh no, I don’t want to be in a nursing home.” Just an FYI Independent, Assisted Living and even memory care are NOT nursing homes. They are a much more homelike setting with a lot other amenities and freedoms a nursing home can not afford you. But the truth is if you don’t have a plan or recognize things are getting harder you will most likely have a traumatic situation that could then lead to you needing a nursing home. That was quite the opposite of what you were planning in your mind.

Caregivers, the power of choice and remaining together conversation (if that is the goal) can be a powerful tool when sitting and discussing senior living with one or two loved ones. Remember they’ve always been a team and now they are being told they need other people on the team.

I recently had a senior set an appointment, come to the community for information and a tour. I sat with her, showed her around, answered all her questions, she took notes, she had spreadsheets 😉 . When I followed up with her a month or so later she said “I have looked at a few places, I made folders labeled 1-4 in the order of communities I liked depending on what I’ll need, if I need it. I put the folders in my file cabinet and told my son, this is where they are in case you need them.” I commended her on choosing for herself. She didn’t move, she is not ready to or many never move. No one is forcing or pressuring her into anything. Maybe they are inviting her to events at the community. Yes communities invite you to show you what a good time they have, how good the food is etc. I am a firm believer these visits can often ease your anxieties about what you thought senior living was. This is a prime example of a calm search., a calm well thought out decision she’s made to be prepared. She has decided if anything happens and her family or herself needs to make a choice and choose a senior living community, shes the one that chose, because she had the power of choice, the whole time, like she’s always had!

It is not always the case that a senior will need senior living but as the saying goes. It is better to be safe then sorry…

Up Next- Senior Living Care & Options : 103 What are the Costs for Care & Senior Living. I don’t qualify for Medicaid. Wait, Do I?