The Moving Conversation

We often consult with the families of seniors who are resisting a move, so today we’ll talk a little bit about that conversation.  We call it “The Moving Conversation.”  Facing the need to get help with daily activities is difficult and almost always emotional.

Timing “The Moving Conversation”

Families who have been dealing with the issue for a long time may have had many conversations, without reaching resolution.  Sometimes, they’ve postponed having the conversation at all, until a crisis happens.

Our suggestion is to begin the conversation at the first sign that daily activities are not going well.  Spoiled food, an empty refrigerator, unopened mail, or stacks of unwashed dishes might be indicators.

We also suggest opening the discussion when the elderly person is relaxed.  Holidays may seem like a convenient time for “The Moving Conversation” with the folks, but in our experience that is usually not a good choice.  We advise finding a time when not much else is happening.  Make sure that everyone can  focus calmly on the key issues triggering the concern.

Processing the reality

For several years now, a family we know has had conversations off and on with their mother about the possibility of moving to a senior facility.  Every so often,  the mom will say something like, “I can’t ever move to one of those places.  They never let you shower more than once a week.”  Or, “I can’t move to one of those places.  They never have gardens.”

When she says these thing, the daughters have been reminding her that she knows that her statements just aren’t true, then they give her counter-examples.

But, recently, the youngest daughter put her foot down.  She said, “Mom, if you don’t want to move, please just say you don’t want to move.  It’s OK.  I’m just tired of hearing these made-up reasons for why you can’t move, so please stop inventing them.”  They all had a laugh, the mom included.

Key issues

The most common issue that has triggered moves for our clients is one or more obstacles in the current home.  It’s too big, it has too many stairs, or maintenance has become too burdensome.  Sometimes, the issues include other safety or health concerns.

Losing the ability to drive is a common trigger for considering a move.  Care facilities usually have great transportation alternatives, which residents can use instead of driving.

In some cases, health issues have become too difficult to handle in the home.  We sometimes receive referrals from home care agencies who have clients whose needs have grown to exceed the agency’s capabilities.

Setting the tone

Probably the best advice we’ve heard about how to have a successful conversation about this is to keep the focus on the issues, and to treat seniors as the adults that they are, with respect and love.

We’ve also found that “The Moving Conversation” extends over a long period of time.  It isn’t always a one-time event.  It can happen over time and through many smaller talks.  The hardest talk is that first one, so it’s good to remember that that first talk does not need to end in consensus.

Here’s an article that we found in Everyday Health that also has some useful tips on this topic: http://www.everydayhealth.com/senior-health/easing-the-transition-to-assisted-living-or-nursing-home.aspx
We provide free consultations to anyone faced with starting “The Moving Conversation.”  If you’d just like help thinking through your strategy, please give us a call on (415)  758-7097.
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What We Value: Dealing with “Stuff”

In our line of work, we deal with the question of an item’s value every day.  What makes something a treasure to one person and trash to another?  Why do we invest so much emotion in our belongings?

Changing values

One facet of this is that people often attach more value to their things as they grow older.  They also continue to value things that no longer serve them any purpose at all.

An example of this is Libby’s mom’s collection of dress patterns.  Her mom hasn’t sewn for at least 30 years, and styles have changed.  The patterns aren’t old enough or interesting enough to be antiques.  Some are torn or may have pieces missing.  A younger person would discard them or at least give them away.  But, Mom likes having them.

Changing tastes

Another interesting facet of this is that people’s tastes sometimes change as they age.  The house Libby grew up in had fairly modern furniture for that time period.   But, now her mom has replaced all of that with heavy, old-fashioned items and covered them with crocheted doilies.

We have an elderly client who can’t enter her dining room because it is completely packed with her mother’s stuff.  Our client will never use that stuff, she is just having trouble parting with it because it was her mother’s.  This is a common issue.

One of the subjects we often have to navigate is how best to present a home for sale (or lease).  Younger buyers can have trouble seeing past that dark, heavy furniture to imagine how open a house would look with lighter furniture with cleaner lines.

Thinking ahead

What’s difficult is figuring out what will be valuable down the road.  Libby grew up in Bakersfield when Buck Owens and Merle Haggard were launching their careers.  The places they performed back then were dangerous, old, and dingy, and have since been torn down.  Should they have been preserved for historical reasons?  Should Libby preserve those old dress patterns?

Normally, we don’t have much time to spend with each item as we help sort through a client’s household.  Often, we’re called in because a crisis has occurred and the sorting has to happen very quickly.  Ideally, we like working slowly through the inventory with our clients, but that’s often not possible.

Contrasts

People’s ability to deal with this issue as they age varies widely.  An example of this is Robin’s parents.  When her dad was having serious health issues last year one of the key things he wanted to accomplish was to get his things organized in case he did not survive.  He was very concerned about leaving behind a mess for his wife and children, even though he was in the midst of his own health crisis.

Robin’s mom, on the other hand, is very uncomfortable with anything remotely related to her own mortality.  This includes any discussion of downsizing.  Robin and her brother will someday inherit an enormous collection of stuff from her, including an extensive Precious Moments collection.

Our recommendation

We strongly recommend sorting through your belongings early and often to avoid letting that “stuff” get ahead of you.  Libby keeps a large paper bag in her closet and when she notices that an item of clothing is no longer serving its purpose, for whatever reason, it goes in the bag.  When the bag is full, it goes to charity.

Differentiating between what is valuable and what is not becomes increasingly difficult as we age, and it is very difficult to do quickly.  Staying on top of the clutter can make getting through the crises of life a whole lot smoother.

 

Being Grownups

Today, we thought we’d simply pass along a passage from a book that we read recently that struck us a particularly relevant to our business.  We loved “Back When We Were Grownups” by Anne Tyler.  Here’s an excerpt:

Chapter Three

“As soon as I sort my belongings I’m moving to a retirement home,” Rebecca’s mother said.  “I already know which one.  It’s just that I need to get my belongings sorted first.

They were sitting in Rebecca’s mother’s living room – Rebecca in an armchair, her mother on the couch.  Her mother wore her usual outfit of pastel polyester top and dark knit slacks with the creases stitched down the front.  She was eighty-seven years old – a little cornhusk doll, straw-colored and drily rustling.  Rebecca had outweighed her since early childhood, but she had always considered her to be a sturdy woman.  It came as a shock to picture her in a retirement home.  “What’s made you think of moving?” she asked.  “Are you having health problems?”

“No, not a one.  But Church Valley isn’t like when you lived here, Rebecca.  After they built that mall out where the duck farm used to be, why, seems we just got hollow at the center.  Downtown isn’t even downtown anymore.  So I signed up for a unit at Havenhurst, but I don’t know when I’ll get there with all these belongings to sort.”

Rebecca glanced around her.  She didn’t see any evidence that her mother had started yet.  Not that there was much to do – this was a small house, fastidiously tidy – but every object had the glued-down appearance of something that had stayed in the same position for decades.  Two hurricane lamps were spaced symmetrically on the mantel, an Oriental vase was centered in the front window, and the table at Rebecca’s elbow bore a shrinelike arrangement of three gilt-framed photos, a candy dish, and a bowl of faded silk flowers.  If she were to pick up, say, her parents’ wedding photo and set it down again, she knew her mother would be over in two seconds to readjust its location by a fraction of an inch.

“Maybe I could help,” she said.

“Oh, no, thank you,” her mother said.  I won’t forget what happened when your Aunt Ida tried to help.  It took me days to undo what she had done!  And some things I could never undo.  For instance, she threw away an entire sheet of postage stamps; three-cent postage stamps.  I wasn’t aware of it at the time because I was out of the room, fixing her a snack.  That’s how it is when people try to help: they need snacks and cups of tea, and before you know it you’ve gone to more trouble than if they had stayed at home.  I brought out a plate of those peppermint patties that she’s always been so fond of, and then she told me she was on a diet.  I said, ‘What do you mean, a diet?  I’ve been nagging you all your life to diet and it didn’t do the least bit of good; so why would you take it into our head now that you’re in your eighties?’  And Aunt Ida said -”

“But the stamps…” Rebecca prodded her.  Then she wondered why she’d bothered, since the stamps were not the point of the conversation.

“The thing is, I didn’t know that she’d thrown them out.  There I was in the kitchen, waiting on her hand and foot, and meanwhile Ida was in the living room merrily discarding my stamps.  When I went to look for them later in the week, I couldn’t find them.  I phoned her.  I said, ‘Ida, what did you do with those stamps?’  ‘What stamps?’ she asked, innocent as an angel.  ‘That sheet of stamps in my desk drawer,’ I said.  ‘There’s not a thing in that drawer now but dried-up ballpoint pens with advertising on them.’  And Ida said, ‘I hope I didn’t throw them away.’  ‘Throw them away!’ I told her.”

“I said, ‘Where did you throw them away?’ and she said, ‘Now I’m not saying for certain that I did, you understand,’  ‘Where?’ I said, and she said, ‘The recycling sack under the sink, maybe?’  I said, ‘No.’  I said, ‘You didn’t.’  I said, ‘You couldn’t have.’  Because I’d gotten rid of that sack on paper collection day.”

“Luckily,” Rebecca said, “they were three-cent stamps.”

“A hundred three-cent stamps, might I add.  What we’re saying is, my sister threw away three dollars.  And I told her as much.  ‘Fine, I’ll pay you back,’ she said.  ‘Next time I come over to visit, I’ll bring three dollar bills.’  Which is so exactly like her, isn’t it?  I said, ‘Now, what on earth will that accomplish?  You’d still have wasted three dollars, and all for nothing.  We might as well have burned it; that money’s simply gone.  Turned to paper soup at the recycling plant.'”

Rebecca started jiggling one foot.

“So I’ll just do my sorting on my own,” her mother told her.  “Never let it be said that I’m unable to learn from experience.”

And she tucked her chin in modestly and gazed down at her lap, while Rebecca recrossed her legs and started jiggling the other foot.

Structured Family Caregiving

We recently heard about some interesting new programs that have been adopted in a few states: Structured Family Caregiving.  These programs compensate family members for caring for their elderly relatives.  They allow those elderly family members to remain in their homes.

Description of Structured Family Caregiving Programs

In 2013, Healthcare Finance News reported on this topic.  Their article contains a nice summary of the thought behind these programs:

http://www.healthcarefinancenews.com/news/disruptive-innovators-structured-family-caregiving

The intent is to reduce Medicaid and Medicare costs by helping seniors remain in their homes.  The stipends are not large, but they reduce the financial burden for a family member who takes time off of work to care for an elderly relative.

Target market

These programs are designed for individuals who rely on government programs such as Medicaid and Medicare.   They provide a support structure for the caregiver, both professional and financial.

Innovative states

The states currently trying out this new idea are:
  • Connecticut
  • Indiana
  • Louisiana
  • Massachusetts
  • Ohio
  • Rhode Island
In 2012, the Massachusetts program alone saved between $130 and $140 million in government dollars.  We expect that the amount has significantly increased since those savings were calculated.
Here’s some reporting on Indiana’s program:
https://www.payingforseniorcare.com/medicaid-waivers/in-structured-family-caregiving.html

Seniorlink is the for-profit company that operates the Massachusetts program.  Their program requires a registered nurse and a social worker as part of the care team.  The program pays the caregiver around 25% of the prevailing nursing home rate, not a lot of money.  For low-income workers sometimes that’s enough.

Suggestion for California

Here in California we have a rapidly aging population, but California has not yet jumped on this bandwagon.  We’d love to see that happen, Sacramento!

Spring Cleaning for Seniors

During the month of April, we are offering a “Spring Cleaning for Seniors” special.  We are enthusiastic about putting things in order and keeping homes clean and healthy, and we’d like to take that show on the road.

Martha’s approach

Here’s what Martha Stewart has to say about spring cleaning: http://www.marthastewart.com/267295/spring-cleaning-checklist

Our approach

Not all of us can meet Martha’s standards, but we can decide which areas at important for us.  In our experience, the key is to meet with the client first to determine which areas are of particular concern and focus on those areas.

Spring cleaning for the elderly goes beyond eliminating dirt and encompasses a review of safety issues also.  Items that may have been previously acceptable can become hazards as we age.  Area rugs are a prime example of this, since they can present a tripping hazard for the elderly.

We also like to spend some time reviewing the “lares and penates” in the household.  Libby likes to refer to this as the “stuff” in the house.

Often we find that elderly people hold on to more of this stuff than they need.  In many cases the amount of stuff becomes so overwhelming that in interferes with the person’s quality of life.  We love sorting through that stuff and then dealing with it.

Barney’s “Clean Up” song

Just for fun, here’s the Barney Clean Up song: https://www.bing.com/videos/search?q=barney+clean+up+song&qpvt=barney+clean+up+song&FORM=VDRE

Now it’s time to put away everything that we took out

When the place is nice and clean it makes us feel so proud

We always clean up, clean up to show we really care

We always clean up, clean up ’cause we like to do our share

After we have had our fun, playtime’s coming to an end

We sure know it helps a bunch if we can all pitch in

We always clean up, clean up to show we really care

We always clean up, clean up ’cause we like to do our share

Call us

Give us a call on (415) 758-7097 and let us tell you about our “Spring Cleaning for Seniors” special!

 

 

Dominoes, anyone? The importance of elder hobbies

How do you plan to spend your time in your elder years?  In the busyness of our working lives, we may not give this question the thought it deserves.  Elder hobbies are important.

Some of the activities we enjoy in our youth may not always work for us as we age.  Not everyone can continue to go deep-sea fishing into their 80’s the way that Robin’s mother-in-law did.

But, those hobbies and interests are important.  They keep us moving and our brains engaged.  In many cases they have a social dimension.  They make us healthier.

Charity work

Many of us plan to invest our time in supporting our favorite non-profits after we retire.  Libby’s mom raises funds for her local library.  Robin’s mom donates to several different animal rescue organizations.

Part of the challenge with volunteer work is that it is just that, and the other workers are also volunteers.  Their work may not be professional, they may not work reliably, or they may have unrealistic expectations.  But, the work can be rewarding.

Games

A couple of popular games available to seniors in San Rafael are bocce and pétanque.  Both are similar to bowling but are played on courts, rather than in an alley.  The rules are simple and so beginners can learn to play very quickly.  They require very little physical strength, but a steady hand is helpful.

Some of the local elder communities have serious bridge clubs.  We’ve heard that the dominos and poker clubs can get pretty heated, too.

In her spare time, Libby likes to play games on her phone, which she highly recommends.  Her favorites are Words with Friends, which is like Scrabble, and she pays a trivia game called Quizduell with a friend in Germany.  She’d love to have you challenge her!

Arts and crafts

We are all artists, although some of us just might not have found our métier yet.  Watercolor might not be for everyone, but just about everyone can appreciate the fun of creating Jackson Pollock knock-offs.

One of Libby’s friends immediately dove into ceramics when she retired.  She had always enjoyed it as a hobby, but after retirement, she was able to go into it full-time.

Knitting, crocheting, and sewing can also be satisfying.  Libby’s mom knits all of her own socks for comfort.  She also always has a cozy blanket in progress to give to a local sailor with a little baby.

Reading

Whether on paper or on an electronic tablet, books are wonderful, and book clubs can be motivating.  Finding a group with the same interests and taste helps make it fun.  Marin County has some excellent libraries.

Have fun!  However you choose to spend your time: ENJOY YOURSELF!

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Thoughts on Elder Suicide

We’ve recently been hit with some hard news about a friend, which has caused us to think about a difficult topic: suicide.

This topic is especially pertinent to seniors, since the percentage of suicide deaths for seniors is higher than the general population.  Older adults make up 12% of the US population, but account for 18% of all suicide deaths

Statistics

Suicide is the 10th leading cause of death in the US.  Every day, we lose 121 people to suicide.

Females attempt suicide three times more often than males.  However, males are four times more likely than females to die by suicide.

Rates of suicide deaths and attempted suicide vary considerably among demographic groups, whites having the highest rates.

The ratio of suicide attempts to suicide death in youth is estimated to be about 25:1, compared to about 4:1 in the elderly.

Warning signs

In the elderly, some of the warning signs can be:

  • Loss of interest in favorite things or activities
  • Cutting back social interaction, self-care, and grooming
  • Breaking medical regimens (diets, prescriptions, etc.)
  • Experiencing or expecting a significant personal loss
  • Expressions of feeling hopeless and/or worthless
  • Putting affairs in order, giving things away, changing wills
  • Stock-piling medication or obtaining other lethal means
  • Preoccupation with death
  • Lack of concern about personal safety.

For years, Libby had a great aunt whose favorite refrain was, “This is the last time you’ll see me.”  She eventually died of natural causes.  The hard part is figuring out when those types of statements imply suicidal thoughts.

The most significant indicator is an expression of suicidal intent.

Prevention

Some things that can sometimes be helpful to say include:

  • Are you considering suicide?
  • Let me/us be hopeful for you until you are ready to be hopeful again.
  • I know this is difficult to discuss.  When you are ready, would you be open to my helping you find other people to talk with who understand?
  • I love you and won’t abandon you.
  • What can I do to help?

People considering suicide often isolate themselves and refuse interactions.  The challenge is overcoming that barrier to have a real conversation with that person.

Summary

Suicide is a very difficult experience and leaves a trail of broken hearts behind it.  Everyone who loved that person feels guilt and pain.  Our hearts particularly go out to the families affected by suicide.

Pneumonia and the Elderly

Libby’s mom recently went through a frightening case pf pneumonia, which led us to find out more about it.  We learned that one out of 20 instances of pneumonia is fatal, so it is a very serious matter.

What is pneumonia?

Pneumonia is a lung inflammation, but can have a wide variety causes, including bacteria, viruses, fungi, or other organisms.  Fluid pours out of the infected part of the lung and blood flow to that area decreases, reducing oxygen levels in the bloodstream.

The potential complications of pneumonia include low blood pressure, kidney failure, and bacteremia, an infection that spreads to the bloodstream.  Many of the complications can be fatal, especially for frail patients.

Symptoms

Since pneumonia is caused by more than thirty types of organisms, symptoms can vary.  Some of those symptoms include:

  • Malaise or weakness
  • Cough
  • Green or yellow sputum
  • Pain in the chest
  • Confusion or dizziness
  • Fever or chills
  • Shortness of breath

In some cases, the patient may not display any of these symptoms, but could just be sleepy or lethargic.  Sometimes loss of appetite is the only indication.

Diagnosis

Tests for pneumonia include:

  • Listening to the patient’s lungs for:
    • “Rales” (bubbling sounds)
    • “Rhonchus” (rattling sounds)
  • Pulse oximetry test of blood oxygen levels
  • Chest x-ray or CT scan

Once pneumonia is identified, the patient’s phlegm or blood can be analyzed to determine which organism is responsible for the infection.

Pneumonia in the elderly is most often caused by bacteria or viruses.  The streptococcus (or pneumococcal) pneumonia bacteria is very common.

Usually, viral pneumonia is less severe than bacterial pneumonia, but its complications can include bacterial pneumonia.

Treatment

Viral pneumonia usually heals without medication, provided the patient rests, eats healthy food, and takes in plenty of fluids.

Bacterial pneumonia is treated with antibiotics.  A mild form of pneumonia, mycoplasma or “walking pneumonia” is also treated with antibiotics.

Most pneumonia patients heal at home.  Medications can ease fever, aches, and coughing.  However, because coughing actually helps rid lungs of infection, coughing should not be suppressed entirely.

Complications

Complications that can arise from pneumonia include:

  • Bacteremia: A potentially deadly infection that invades the bloodstream and can infect organs
  • Pleurisy: Inflammation of the membrane that covers the lungs (pleura)
  • Empyema: Infection of the fluids from inflammation
  • Lung abscess: A pus-filled cavity in the infected lung area.
  • Acute Respiratory Distress Syndrome (ARDS): Severe injury to the lungs due to pneumonia or respiratory failure.

Prevention

Although pneumonia is transmitted via the air or hand-to-hand contact, if a strong immune system can fight off this infection.  The following steps can keep it at bay:

  • Pneumococcal vaccine:  Helps prevent 23 of the known bacterial pneumonia strains.
  • Hand washing:  Most common transmission is via hands.
  • Dental hygiene:  Pneumonia infections can occur around infected teeth.
  • Good Health Habits:  Exercise, rest, and healthy eating can all increase resistance to pneumonia.
  • Influenza vaccine:  Reduces the virulence of most flu strains, so reduces the risk of developing pneumonia as a flu complication.

Also, anyone susceptible to infection should stay away from patients with the flu or a bad cold.

Preventing pneumonia is always preferable to treating it.  But, if you suspect pneumonia, quick intervention can be a life-saver.

Book recommendation

We recently read a book that we would like to recommend: “Tips for Helping Your Aging Parents (without losing your mind).”  It’s by Kira Reginato, a friend of ours and a talented local elder care manager and consultant.

Here’s her website: http://callkira.com/

Communication binder

One of Kira’s suggestions is to put together a communication binder to be prepared for a potential hospital stay.  Not too long ago, we wrote a blog about Robin’s experience with her father’s health crisis.  We made a similar suggestion in that blog, but Kira’s book goes into a lot more detail.

Some of the items Kira suggests including in that binder are:

  1. A copy of the signed POLST form (original should be on the refrigerator)
  2. A copy of the DNR form (original should be on the refrigerator)
  3. A personal information sheet including:
    • Name, address, and phone number(s)
    • Health insurance information
    • Medical record number(s)
    • Medicare number
    • Social security number
    • Veterans Administration number
    • Primary doctor name, address, and phone
    • Emergency contact(s) name, address, and phone
    • Long-term care insurance company name, policy number, coverage type, address, and phone number
  4. Copies of all heath insurance cards (front and back)
  5. A current, updated list of all medications and supplements
  6. A list of all diagnoses
  7. Copies of power of attorney for health care or advance health care directive form
  8. Blank paper for making notes

When Robin’s father was going through his ordeal, communication between family members was very important, so the blank paper for notes was their way of communicating between shifts.

Personal notes

Another thing we like about the book is that along the way Kira shares insights that she gained when dealing with her father’s long-term illness.  Some of those comments resonate with us as we’ve been in similar situations, and Kira’s honest recounting of those frustrations is reassuring.
Here’s an example from Kira’s diary:

I feel alone here, like I have no support system.  This is a roller-coaster of Dad’s being well then crashing.  In the ER, no one tells you how long you will be there, you wait for hours, unable to move, get work done.  Fragmented day, fluorescent light, awful!

We understand exactly how she felt.

Kira’s book is heartfelt and practical, an easy read, but a valuable resource.  We offer her congratulations on its publication and wish her well in promoting it!

Kira and Libby with a copy of Kira’s new book

Resolutions for the New Year

Before we get too far into the new year, let’s think about what we can do to make this year the best ever for ourselves and our families.  Here are some changes we should all probably make, especially the elderly among us.

Exercise more

The evidence is overwhelming: even the smallest increase in physical activity can lead to huge health gains.  For example, even just a few more steps every day have been shown to help prevent cognitive decline.

Eat better

Incorporating more fresh fruit and vegetables into our diets can help us feel and look better, as well as extending our lives.  Periodic fasting can be helpful, also.

Quit smoking

We almost didn’t include this one because it’s so obvious.  But, we know that it’s also very hard to do.  So, we’ll repeat it again.  Enroll in a smoking-cessation program.  The sooner you get this one behind you, the more your health will benefit.

Secure your environment

Check your home for safety issues and then fix them.  We often visit homes with obvious safety concerns and hear the owners tell us that they knew they had issues but never got around to doing anything about them until they became real problems.

Get checked

See your health care provider regularly and BE HONEST with him or her.  If you drink lots of coffee and almost no water, don’t brag about how you drink lots of water and avoid coffee and tea.  Make a list of topics to discuss and bring the list with you.

Rest

Make sure you get the rest your body needs.  Go to bed at a reasonable hour and sleep until you wake up naturally.  If you have trouble sleeping, figure out why and change your habits accordingly.  Often, sleep issues can be addressed by changing exercise and eating routines.

Get help

Our final recommendation is to recognize when you need help and then to get that help.  If your need has to do with your living situation, then we’d love to be there for you!

 

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