Elder Care

Dad is still trying to find reasons not to move to an assisted-living facility (ALF), but I'll talk about that another day.

Today, I want to talk about me (and, by extension, some of you in a similar situation).  I have been caring for Dad since last May, and it will be this May when he moves to ALF.  There is a chinese curse "May you live in interesting times", because "interesting times" times are not easy.  It has been an "interesting" year...

I tried to think a couple of months into the future for my planning for Dad to move to an ALF.  But I planned a month too short.  Dad is having real problems right now rather suddenly and there is no where for him to go for a month.  You don't have to suggest in-home care, I'm looking into that.  And anyway, this is for others.

My point is that a month is so short a time normally, but a very long time when you are caring for an elder who needs professional care "now".  I'm not comparing myself to others.  Some people are more able to care for others than I am.  But whenever you really think "next month", think "I really should have found a good place last month".  It is so easy to think there is time, and then the day is on you.  It happens far more suddenly than you expect.

And this is a thing you seldom get to learn from for better decisions in the future.  Elder care is (usually) a one-off event.  A parent takes the care of a spouse and then that parent needs care him/her self.  That's you doing that part.  No matter what you think, how many books or newspaper articles you read, you won't be prepared.  You cannot understand dementia, and you cannot understand what it means for a person in your house who can't (please don't jump on me if you are "differently-abled") just walk around. 

Your elder parent will go from difficulty getting out of chairs to a complete inability to stand up at all in just a week.  He/She will very suddenly discover that the time it takes to get to the bathroom only 30' away is longer  than nature allows.  It just happens one day.

No one wants to send a parent to an ALF, but trust me, a month too soon is better than a month too late.  April will be a very difficult month here.  So, for what it's worth, some thoughts on things I wish I had known..

1.  Visit local ALFs months before needed.  Bring the elder.  Take pictures of the place.  Pictures provide familiarity.
2.  Get the Dr evaluation form early and bring the elder to the Dr before required.  The difference in the Dr evaluation from one month to the next can be very informative.  A geriatric Dr is best.  He/She can tell changes in abilities better than you can.
3.  Most ALFs are good, but some are more good than others.  Your elder can help you decide which suits him/her better than you can.  I didn't allow my Dad to be involved.  That was a mistake.
4.  Bedrooms matter.  Size is important.  Your elder will think of the bedroom as a primary living space.  Even if that is not the primary living space.
5.  It's "I need to talk to you", not "we need to talk" when The Conversation occurs about moving the elder to the ALF.  Explain the household situation calmly, and emphasize the elder's care.  Your own stress and tiredness are YOUR problem, not his/hers.  Stick with the elder's physical needs, not the mental ones.  The elder is SURE his/her mind is fine, but does know about physical problems.  Stay calm through endless (and repeated) questions.  There will be many.
6.  Discuss the move daily.  Repetition helps.  They forget.
7.  Get the elder new clothes that fit well.  Everyone wants to make a good initial impression.  Seriously, have you ever seen an elder with good clothes?
8.  Talk to the ALF staff about minor details.  Ask them what residents want that no one thinks of.  They know.   Sometimes its just chocolate chip cookies in the bedroom for late night snacks.  With a nice note from the child.  Or maybe a reminder of how to make a martini.
9.  Schedule visits.  Routine is very important to elders.
10.  Remember that The Conversation is NOT a debate; it's a decision.  Your decision.  There will be "you are kicking me out".  But it really is your decision.  Accept that.  You are doing what is best for your elder.  Keep it in terms of what care your elder needs, not whether you love them.  Of course you love them.  But don't allow that to be the discussion.

I am not feeling guilty now.  I've done what I could and it is time for professional help.  Professionals know how to help an elder better than I can in the last stage of life. When you have been caring for an elder, sometimes the hardest thing is to let go.  Be willing to let go...

Heck, when Dad falls down, I don't really know the best way to pull him back up.  But trained staff does.  I don't really know how to answer his really weird questions.  But trained staff does.

About all I can think of for now...

And Today

Today, Dad is fighting the move.  The bedroom will be too small, he won't like the food, he will be a minority, the staff won't be friendly, etc.  I will have him talk tomorrow to my sister who chose the place.

But it won't relieve his fears entirely.  He fears the change, and I understand that.  He is happy here.  Too happy.  I attend to his every needs.  What he doesn't really understand is that his needs are growing greater each month.

He doesn't realize that he is reducing his routine every week,  He used to watch any of 5 channels, now he he wants only 2.  His food preferences are diminishing.  He is struggling to get to the bathroom "on time".  He talks bizarrely, but he doesn't realize it. 

Last night, he said that being in an ALF (assisted living facility) in a town 10 miles away from other family was good because he "could bicycle or walk to visit them".  It doesn't get much crazier than that.  He couldn't "bicycle" away from a starving crippled alligator.

And he thinks the move is "too complicated".  OK, it isn't.  My brother and sister will drive down here and my brother will transport the bedroom furniture in his truck and sister will transport Dad.  He can't understand how simple that is to us.

He thinks none of us understand his investments.  I have been filing his investment papers for a year and arranged for his income taxes twice now.   I know them by heart better than he does.  He insists I can't possibly know "that stuff".  Well, of course I do.  10 years ago, he did too.  But not now.

This is going to be harder than I thought. 

I am reluctant to have him visit the place.  Yes, he might think it wonderful. But he is more likely to find trivial faults.

So, drive him 2 hours up to visit the place and 2 hours back, or not?  Pros and cons... 

The Decision

Well, the decision has been made.  An assisted living facility (ALF) has been chosen, I have forms to fill out, Dr appointments to make, etc.  The family has found a good place near most of them (out of my area).  Entry is available May 1st.

I am sad about all of this, of course, but relieved as well.  Dad needs more attention and care than I can continue to give without slipping into martyrdom.

There are so many things to plan. 

That doesn't mean that the several conversations with Dad were easy; they wern't.  But it does mean that HE accepts that he is going to need more physical assistance soon than I can provide.  I discussed that the precise costs depended on the level of care he needed and he asked what those were.  Oh thanks for smooth tranisitions and killer arguments...  When I said that the monthly care costs depended on whether someone could dress, bathe and use the bathroom themselves vs someone who couldn't, he blurted out "but pretty soon I'LL need that help"! 

And then he realized he was needing assisted living care soon.  I discussed waiting lists and the benefits of being where there was proffessional assistance just BEFORE he needed it.  He accepted that he needed to go to an ALF.

There are many more family members where he will be moving to than there are here (just me here and 6 where he is going).

He hasn't given up the struggle.  He raises trivial arguments.  It will be so complicated to move (no), he has so many billing addresses to change (no).  He needs to approve the bedroom (well, no, but only because its better than the one here).

He says he trusts my sister's judgement on the place (except he doesn't really).  He is afraid of something that I haven't gotten him to talk about yet.  We will discuss this again in the early afternoon when he is most alert.

My main purpose is to keep his focus on the positive aspects of moving to a good ALF.  The longer it goes with him accepting that he will be moving, the better it will be.

There will be some more awkward conversations the next few days, but every day without him saying "no" will be a good one.

The Last Years

The past couple of months have seen a substantial decrease in Dad’s ability to comprehend the world in general.  I am putting it that way to spare having to give all the details of previous posts.  He just doesn’t understand much of anything these days.  He has brief bursts of comprehension that make thinks awkward. 

He asked me today why he was having so much trouble moving around and why it was so hard just to get dressed.  He asked why he couldn’t understand documents and bills he gets in the mail.  Dad always taught me that honesty was the most important thing in his life.  I’m learned that well. 

I told him that his muscles are getting weaker and that his mind was not as sharp as it was 50 years ago.  Surely those are obvious things.  He said “No, that’s not the problem; I must have a disease”.

How do I explain his “disease” is just old age?  As in the plant analogy, I see Dad’s leaves falling everyday.  There aren’t many left to fall.  When I try to explain that he is “just plain old”, he denies it saying he is just fine.

I have started to visit assisted living facilities.  The first one, Morningside House was GREAT, but I see after looking over the details that they will soon get him to over $10,000 per month from the initial $5300.  The add-ons are outrageous.  They will charge him $1379/month for managing his 3 simple pill medications, $25/month for getting his meds (which cost only $2.50), $70 for every transportation to a DR, and they make a fortune for incontinence.  Its a wonderful place, but they will drain every dime from his pocket and discharge him when he is broke.  And Dad would never accept the basic cost anyway.  I had such high hopes for Morningside House until I (and my sister Susie) starting getting into the details.

I have an appointment with a simpler group house later today.  Sister Susie says the professionals she has talked to (she is professionally related to that work) say those are often much better at half the price, and Dad might accept that cost. 

I know a bit more after the Morningside House visit about what to look for.  Activities are good.  TV rooms are good.  But daily physical care for dressing and hygiene, basic meals, and assumed pill-giving are probably more important. 

Its hard just thinking about giving a parent over to assisted living care.  Telling your elder that it is time is harder.  Making the move is harder still.  I’m still just on that first action.

A Meaning

You may have guessed that yesterday’s post was an analogy.  If you did (and I have never quite learned subtlety) good for you.  Not everyone will... The seeds and young flowers and saplings are the children we raise.  The Fall is the time we change from raising our children to beginning to care for our parents. The Winter is the eldercare time, where we must care for our parents (disclaimer, I had no children, but at 16 to18, I did a lot to raise a new sister). 

Helping to raise my young sister was a joyful experience.  I changed more diapers than most real Dad’s back in the 60’s, did more baby-sitting than most teenage girls, pulled out bee-stingers, bandaged more scraped knees, and played more 4-8 years games than any teenage guy I ever met.  I didn’t mind it a bit, and I was a better guy for it.  I saw that flower grow and thrive.  She died in her “late Summer” of a genetic problem she was born with.  We were always close.

But Summer changed to Fall over the years, and first it was Mom who’s health failed.  It was rapid.  But now I have Dad, at 90.  He lingers like the old mature trees that keep managing to continue as they grow older, failing.  I have a tulip poplar that I have loved for 26 years.  It was mature when I moved here (like Dad).  It is failing (like Dad).  This Fall, it actually sent out a few new leaves out of season.  It is dying (like Dad).  It it trying hard to stay alive (like Dad).  But it is failing and there is nothing I or anyone else can do about it (like Dad).

The Garden

The Seasons

In the Spring, flowers and saplings appear.  Maybe they were your own seeds, maybe you got them elsewhere; it doesn’t matter.  When they are yours, you give them food and love and care.  It is joyful seeing them grow.  Every day, they seem more promising.  You can imagine how much sturdier they will be next month.  You can imagine how they will adapt to nature and thrive.  As you watch the first leaves opening, you can imagine the glorious beauty they will display one day.  And they do thrive.  Each month you see the changes and the changes are wonderful.

In the Summer, they burst forth with flowers.  You may be a bit tired from all the work involved, but it is worth it.  You are proud of what you have accomplished, and you are proud of them.  They really did most of the growing themselves, but your work mattered too.  You did your best to keep the weeds away, sometimes you supported them while they grew upright and healthy.  You made sure they had everything they needed that you could give them.  They are mature and beautiful!  You still try to keep some weeds away, but they are mostly doing great without your help.  Maybe there are a few fallen leaves, but they are in their prime and some new leaves grow.

You are changing from the nurturer of young plants to the protector of older ones.  It takes some time to realize this, but you do your best to adapt to the change.  As a gardener, you do what you must as best you can.

In the Fall, things are not going quite so well.  The bloom is off the flowers, they droop a bit, and they need bit of unexpected help from time to time.  But that OK, because they are still doing well overall.  In the late Fall, things are not so good.  They feel cold at nights, they aren’t flowering or growing new leaves, and the stalks and limbs are hardening.  In fact, the leaves are starting to fall

In the Winter, the leaves start to fall and are not replaced.  Flowerstalks become dry and bare.  The old trees slow down their activity.  The end of their season is coming, slowly at first, but relentlessly.  The last leaves fall from the trees; the last flowers die and fall.  No amount of care and assistance can stop that.  Eventually, a day comes when all activity ceases.  You face the sad truth that an end is coming in spite of all you do.

More tomorrow...

Assisted Living Facilities

I researched local assisted living facilities and eliminated most of them as places Dad wouldn't like.  Some were for active seniors, lots of visits to the shopping malls and bingo games.  Others were holistic medications or foods Dad does not like.

I narrowed it down to 2.  The one I visited today was a very professional place.  The one I will visit tomorrow is a small group home.  The place today seems perfect.  A personal bedroom/bathroom and community TV rooms, dining rooms, activity rooms, etc.  Seriously good onsite health care, transport to local Dr of choice, individual meals at common eating areas, groups living/TV rooms.

Own rooms ranging from 2 in a space to 2 full bedroom apartments.  Friendly caring staff, medical assistants onsite 24/7, etc.  They can easily move Dad from assisted living to the dementia living area when the time comes.I think this is the place.

I saw the staff checking on the residents in the commom TV room area about how they were doing and did they want any snacks, etc.  The staff seemed pleased to be there.  No hulking guys to force anyone around.

Personal attention to meal preferences and not just for medical reasons.  If a resident prefers chicken and pork chops most meals, that's what they get.   Preffered snacks too.  Good medical staff, onsite barber, room-cleaning, laundry, etc included.

Plenty of friendly residents to sit and watch TV with...

Large enough so that there is generally a new place available each month, so no waiting list. and no fee for being on one.

They go by personal Dr intructions (resident's Drs, not staff Drs). individual for each resident.

I think it is perfect for Dad.  I will bring Dad to visit there next week.  They will even give him a free haircut and he will like THAT!

I still feel guilty just planning this.  Like I'm planning to kick him out of the house.  The Morningside House Manager said that was a normal feeling (and I do know that).  But it still feels like kicking him out.  I know, I know.  I'm doing the best I can for him.  He has reached the point where he needs more personal care than I can give, and that's the deciding point.

One nice thing is that the Morningside House is right next to the Safeway I shop at.    That means that I can visit Dad each week and then do my food shopping.  Sounds almost trivial, but having a reason to be RIGHT THERE each week sure makes it part of a routine to visit regularly.  And I can bring him treats from the Safeway.

I doubt that the smaller group house is going to impress me tomorrow.  But I will give them a fair visit.  It might have some advantages.  But I doubt it.

Oh Boy...

Dr appointment for Dad's finger today at 2:30 pm today.  Dentist at 8 am tomorrow.  I go tour one assisted living facility at 2:30 pm tomorrow and another at 2:30 the next day.  Its not going to be "happy days".

Problems, Problems, Problems

First, as always,  I never mean to compare my problems to those who have really SERIOUS problems.  I'm generally fortunate on the REALLY BIG PROBLEMS.  But problems are problems and I get to complain...

Dad fell again a week ago.  One finger was really sore.  He never tells me these things at first.  It was obvious a finger joint was out of place.  So I called his dr and asked what I should do (treatment obviously but I wasn't sure who to go to first).  He said to bring dad to him for a referral to the x-ray lab next door.    I never get the building right!  It is building 11345, and there is a small building between 11340 and 11350.  You would THINK that is 11345.  It isn't.

So I dropped Dad at the curb and parked the car 100 yards away.  When I got back I discovered my error and we had to walk across the enclosure street.  And the buildings on THAT side all have the entrances on the backside of the buildings (Is that dumb or what?). 

Walking is not one of Dad's good points these days, so we had to walk slowly.  A friendly passerby offerred assitance and helped.  When we got to the street-side of the building I thought we wanted, I saw a open door, so I brought Dad in there as a shortcut.  Someone in there got a wheelchair for Dad and brought us right to the front desk.  It was the xray lab! 

An assistant there offerred to go next door to the DR and get the referral.  I applaud such kind helpful people!  Dad got his fingers xrayed and we were told to go home and the DR would call us.

The DR called and said the finger was broken at the joint.  Not really serious, just put a popsicle stick on it as a splint with adhesive bandages for a month.  It could be taken off for bathing and reattached.

Good Old Dad decided it wasn't worth the bother and it would heal on its own.  I considered my options.  I could beat him senseless and apply the splint, but he could still take it off on his own.  I could drug him and epoxy a splint to his finger.  I could try to scare him into allowing the splint. 

I opted for trying to scare him into allowing the splint (less chance of me ending up in jail that way).  I mentioned immobility from the joint healing fused.  I suggested infection.  I suggested gangrene.  His response was that it didn't seen that bad and he might not live all that long anyway!

The finger is swollen and there are bruises.  He refuses to go visit the DR and I can't actually drag him that far.  I'll wait watchfully.

Then he fell out of bed last night and landed on the same hand.  First time THAT has happened!  I got him back into bed.  Then spent the next hour awake in my own bed thinking of how to build a bed rail that would keep him from falling out yet allow him to get up to go to the bathroom at night.

But the next morning, I needed to go grocery shopping.  No lunchmeat and few veggies. 

Remember I brought Iza and Ayla to the vet Tuesday?  Well, I forgot to close the back of the SUV after taking the carriers out.  The battery was dead!  No grocery shopping today...

I did that last year once and the battery wouldn't fully recharge after being jump-started from a boat battery.  I had to get a new one.  Minor cost, but an annoying process.  I HATE sitting around a repair shop (the dealership) for an hour or two while they do a 5 minute job.  So I tried recharging this baterry.  It got to 63% charged by dinnertime (after the repair shop was closed) and no further!  It's dead.  And tomorrow is SATURDAY, so they will be super-busy. 

I will call them to see if they can replace the battery fast, but I may just go to an auto store and leave the car running while I buy a replacement there.  THEN go grocery shopping. 

I thought of a couple bed rails I can set up tonight, and I'll do that.  Dad is frightened of rolling out of bed again.  I also found some nice ones I can buy online and have delivered in a few days.  Dad is contradictory about this.  Afraid of falling out of bed again, but not willing to allow the more professional bed rail to be purchased.

This MAY be the tipping point of getting him into assisted-living care.  But if he won't spend $80 on a convenient fold down bed rail, I doubt he will agree to $5,000/month for assisted living.  He would be happier in many ways in assisted living and he can afford it just on his monthly annuity, but he is SO CHEAP!  But seriously, he is getting to the point where I can't take care of him as well as professionals could. 

Its time I just TELL him that I am going to visit some local assisted living places and see how good they are.  And then DO it.  I know what he might accept (to the extent that he would accept anything).  A simple bedroom/bathroom unit with a kitchenette for snacks, a common TV room where other residents are there to watch TV with and idle chatter, and meals with others on schedule.

I went and checked the battery charger.  It was still on 63% after 5 hours.  I turned it off and tried the engine.  It started right up, so I drove it around for 30 minutes to give it a shot at recharging the battery fully from the engine.  Safely in the garage, I turned it on and off twice and it seemed to work fine.  I guess I'll just put the 2 boat batteries in the back for possible jump-starting and hope for the best.  I still don't trust that battery.

When I got back, I set up the temporary bed rail I thought about for Dad.  He griped and fussed that it wasn't perfect (while still fearing falling out AND STILL not wanting a commercial version).  He is impossible to please.  But that's not new; he's always been that way.

Farewell Google Reader...

I use Google Reader, and Google is gong to shut it down July 1st.

I deliberately use different services from various providers because I don't want ANY of them to learn TOOO much about me.  I will suffer poorer quality service at the start to avoid control.  In the same way I left Microsoft to go to Apple, and Google Search for Bing, I will leave Google for some other reader service.

Google thinks it is too grand to leave.  They don't know me.  I will accept 2 star service in return for being CHERISHED by some new startup service provider.  And they are out there just waiting for those like me to give them a try.  I'll try them...

I always will.

What companies like Google DON'T realize is that there will always be competitor services, small start-ups that will someday become the IBMs/Microsofts/Googles of the future.

Google has decided that I am not worth their continued support.  If I owned stock in Google, I would sell it tomorrow.  (Disclaimer, I own index stocks and some may involve Google, but I don't know that).

I sometimes wonder how much some internet service providers understand about their users.  Do they really think they have a monopoly on any service?  Do they really think that their users can't move to other providers?

There IS such a thing as thinking you are "too big to fail".  That's exactly the point where a company SHOULD be broken up into constituent parts that compete.

Let's see how much better the parts of Google serve us, the users, when they get broken up into smaller competing units...

And back up your Google blog immediately.  I just did.  See instructions HERE.  Its tricky, but I did it and I'm no genius.  It did take some effort though.

Happy Gardening News!

The tomato seeds are up, the broccoli and cabbage seeds are up.

And I've been OUT in the flowerbeds doing some work!

Those black-eyed susans that I planted near the lower deck have been stubbornly migrating toward more sunlight for years.  So I decided to help them!  Today I dug up a patch of ground in the brightest area and dug out the roots of the maple tree the neighbors wont kill.  I turned the soil nicely and  moved 18 of them there.  (The Black eyed Susans)  I knoew the are suited for the spot because they have been TRYING to get there for years.

It was good hard work.  Up, down, up, down, dig, walk, plant, up down etc etc, etc,  I'll sure feel it tomorrow!  But it was great to DO that. The gardening season has begun outside!

The cats loved being outside with me too.  Marley and Iza ran all over the place and caught 2 mice.  Well, Ayla stayed inside.  Marley and Iza chase her when she is out.  I'm glad for the 2 outside, but I miss all 3 outside.

This is going to be a major redesign of the flowerbeds this year.  I've had too many spots of "6 of this, 6 of that".  I am dividing existing plants to make areas 10x10' of the same ones to get a larger view of the plants in flowers.  AND to leave large areas for annuals that I am growing under lights in the basement.

I used to grow 12 ech salvias, forgetmenots, carnations etc, but this year I have 36 each of many annuals.  And 60 marigolds.  Its hard to go wrong having a LOT of marigolds around here. They bloom fast and dont stop.

But this is going to be a year of dividing and moving around the successful perennials.  My favorite online nursery changed from cheap 6 packs to large individual pots last year tripling the price per plant and I told them I would use what I had instead of paying 3X the price.  So  I am.

I will be dividing the appropriate perennials I have in halves in the next few days and making larger areas of the same kinds.  They may not all bloom THIS year, but they sure will NEXT year!  And I was going in that direction anyway.  I'm liking the idea of larger areas of plants blooming rather than a cottage-garden style of small groups.

The plant-cuttings I rooted last Fall of butterfly bushes are growing well.  They will partly replace the aging existing ones, but I have may more than the replacements, so I think there will be a whole row of new ones in the sunnier front yard area.  Its hard to imagine anything better than plants that bloom from June to frost and attract butterflied and hummers.

I have 2 plants that are invasive,  Monarda and Lysimachia Firecracker.  They are going to be moved to the ridge in the middle of the back yard.  I can mow all around it, so they will never escape.  And they can fight it out to see which ones survive in the limited area (about 60' by 20").  I like the foliage and flowers of both, just not their invasive ways.

With the more open areas after the trees were cut back in January, there will be a lot more sunlight.  Good for the flowers and veggie gardens.  I won't miss the tall junk trees and I'll be planting smaller specimen trees in their place (that won't shade the gardens).  I'm thinking dogwoods, sourwoods, hollies, and star magnolias.  There is NO way they will ever shade the flowerbeds and veggie beds like the sweet gums and tulip poplars did.

And there STILL are majestic mature oaks, sweet gums, and tulip poplars here.  Its not like I cleared the yard.  I just cleared a Summer sunlight path VERY carefully.  I've lived here 27 years; I KNOW which of the trees were shading the garden.  They are gone, all the others remain.