Are you like most folk this time of year who are well on their way to making their Christmas gift list? I think about it—a lot. Getting to the point of being able to check names and items off the list is another matter. I have the most trouble with the seniors on my list because most of them have most everything that they need or want. A lifetime of accumulated household items and nic-nacs (which my mother affectionately refers to as dust collectors) already occupy shelves and tabletops. So, what to do…

How about delving into the drawers and shoe boxes to find a few pictures that you know hold special memories for you and that special person on your shopping list? Once you find the pictures you have several options. Grouping photos together collage fashion or adorning them with scrapbook trimmings is a place to start. Write up a couple of family stories that go along with the pictures, or come up with clever captions. Photos could be paired with other special mementos long tucked away in dresser drawers like a dried flower, a military medal, a wedding or anniversary announcement. You get the picture (oops, no pun intended).

This kind of gift cannot be found in any mall or catalog. It speaks straight from your heart to theirs. Watch their faces, especially their eyes, when they see what you have given them. There will be no doubt that you have honored them and shown your love in a way that they will treasure forever. And though you are technically the giver in this scenario, I dare say that you are also the receiver.

Here’s to a very giving holiday season!
Connie

No one lives very long without losing something or someone dear to them. The pain can be paralyzing, especially at first. As senior adults become more and more senior, they inevitably lose more and more friends, family members, and pets. I guess I am more acutely aware of how deep the hurt can be, how empty one’s days can feel because I have lost two dear pets and one very special senior adult all in less than two weeks time. Getting through the first days that followed each loss made me reflect on the impact of grief.

Grief hurts—not just at the heart and soul level. It hurts physically. Eyes are red and swollen from tears, the throat feels constricted, limbs ache and feel heavy almost to the point of being immobile. Grief takes a toll on mental and sensory functioning too. Decision-making is almost impossible. Conversation may be going on around you but little is absorbed. Appetite is dulled and sleep patterns are disrupted. The other thing about grief is that it is not one of those all or nothing experiences. It comes and goes in an illogical and often unpredictable pattern.

So, be mindful and sensitive to older adults who tend to deal with significant losses in their lives way more often than younger folks. Realize that with each loss their support system shrinks and their own mental/emotional reserves are depleted. What can you do to help? Be there. Listen. Let them talk about the loss. Let them vent their emotions. Validate their need to grieve. Share stories about the lost person or pet. And tomorrow or next week or a month from now when they need to go through it all again, let them. Chances are that pretty soon the heaviness will lessen, good memories will ease the pain, and your support will help fill empty spots.

Looking for brighter days ahead,
Connie

A few weeks ago I wrote about getting rid of guilt. For those caring for an older adult, guilt comes when we think we can never measure up to what is needed or expected. On the other side of the guilt coin is resentment. The kind of resentment I’m talking about today is the kind that comes from feeling put upon, unappreciated, or manipulated. I love how S. Hein breaks the word down to examine the root meaning. “In certain languages, Spanish and French for example, sentir means to feel, so re-sentir, or resent, means literally to feel again. We feel resentful till we take some action to help remedy a socially unhealthy situation.” It is kinda crazy that we would re-feel and re-feel something that feels so bad, huh?

Like trying to get rid of guilt, wrestling with resentment is often a one-day-at-a-time process—but it is one that is absolutely necessary. Believe me, I’ve learned that if I let it, resentment poisons relationships and can live on in my head and my heart long after the source of the resentment has left this world. For me, an important part of coping with resentment is recognizing the choices I make in the relationship and taking responsibility for them. I am not powerless in the situation. It may not be easy, but I can choose to set limits and boundaries. I can check out my secret thoughts against reality. I can choose to take care of myself. Doing so means that most days I win the wrestling match. When I am less mindful there are days when resentment takes me to the mat and holds me down for the count. Ouch!

Finally, as caregivers we all owe it to ourselves to and to those we care for to take a moment to breathe, to check out our own emotional status, and to take action when you sense resentment is creeping into your care relationship. Everyone benefits in the long run.

Wishing you good feelings,
Connie

I wonder if it is just an American thing, or if giving up driving is a hot-button topic in other places?  The age-related changes that can compromise the ability of an older adult to operate a motor vehicle safely are well documented.  But, hey, those are just facts.  Getting a handle on the feelings older adults have about their driving rights is tantamount to telling Vol fans that the Florida Gators will take over Neyland Stadium as their home field from now on.

To be blinded by sentiment is human nature.  So, at the risk of being labeled un-American, I am going on record as advocating mandatory diagnosis-based re-evaluation of driving skills to be included in whatever Health Care Reform plan our wise government finally crafts.  If physicians can be reimbursed for addressing end of life choices, then by all means, let’s reimburse them for addressing this living life issue that also has measurable financial implications for our nation’s health care system.

I shudder to think how many seniors who are still driving are taking Aricept, Namenda, Reminyl, Exelon, or other medications that by virtue of being prescribed indicate a diagnosis of some form of cognitive impairment.   It is time for legislation to address what physicians don’t or won’t do. Lawmakers should mandate that a diagnosis of cognitive impairment means driving skills must be evaluated.  If the older adult refused to follow the physician’s recommendations, the physician would notify the agency that licenses drivers (an unmandated avenue available to physicians right now).  In Tennessee this means the older adult would be required to go through the licensing exam again – not really a big deal considering how serious the consequences of impaired driving can be.

Of course, my opinion is likely to be unpopular with physicians as well as some seniors.  I am unapologetic.  I suspect that if such measures really were included in Health Care Reform legislation, it wouldn’t have a prayer of passing anytime this century.  That leaves the ball of responsibility squarely in the court of individual physicians who need to carefully consider their charge of “First do no harm.”  The subject may be volatile, but this remedy is too necessary, too potentially life-saving, to ignore.

Wishing you safe travels,

Connie

Lots of the older adults I deal with have pets. In most cases, and not too surprisingly, the pets are at the very center of their lives. The owner gets up or goes to bed according to the animal’s habits. Talk about the tail wagging the dog… Scheduling meals, outings, or even deciding where to sit in one’s own home, all bend to the perceived needs of the pet.

Sometimes I’ve found these considerations sweet, sometimes amusing, often annoying. As I have become a more experienced care manager I’ve realized how many times the choices that are made ostensibly to suit the animal are actually clues to the thoughts, feelings, or general life views of the devoted owner.

Take, for example, the woman whose backyard picket fence is reinforced with chicken wire because one of those pickets might break, the dog might squeeze through, or someone might reach in and the dog would be gone. In this case it is a direct reflection of the woman’s own feelings of vulnerability to the threats of the world that lies beyond her double locked doors and shuttered windows.

Actions truly do speak louder than words. Clearly this is so with pets and their owners. Watch. What you see may help you better understand older adults in your life. And don’t forget to bring along a pet treat or two while you’re at it.

Celebrating special life events validates that our lives have counted for something. Two such occasions in my own family would be my recent 34th wedding anniversary and my husband’s Aunt B’s 90th birthday. Both were mile markers worth getting excited about for sure. At 90 my husband’s Aunt B had loads of people around her to celebrate her life and her love. Their presence and their stories bore testimony to a life that has mattered and continues to matter to others. Aunt B experienced living proof that her walk on this earth has counted for something. Are there people you love that need to know they have counted for something in your life? Look for a way to “celebrate” the difference they have made to you.

SCC will celebrate its 10 year anniversary in October. For the last few months we have also been in the throws of office remodeling. It has forced us to sort through literally everything in our office. As I looked at the names on case files of all the older adults SCC has served over the years, I became acutely aware that SCC’s walk in this world has truly counted for something. Many times our clients begin to feel like an extended family. It is not unusual for the children of the served older adult to stay in touch long after the professional relationship has ended. It is both gratifying and humbling to put my hands on every name on every file and remember….

On October 29th, SCC will mark our 10 years in the Geriatric Care Management field with an open house. Readers can consider this a formal invitation to celebrate with us. I look forward to seeing each and every visitor who comes to share as we mark the success of the business and energize our vision for the future. There is no denying that the owners of SCC will also be celebrating the satisfaction we carry in our hearts from the many hours of past service to seniors in our community.

Thankfully,
Connie

Not too long ago I conferred with another professional who was seeking care planning advice in regard to his mother. The man is a doctor, quite accustomed to transforming a set of symptoms into a diagnosis. He prescribes the appropriate treatment and his patient is restored to health. Not surprisingly my doctor friend hoped I could “prescribe” a successful course of intervention for his mother. He wanted a checklist or decision tree that would tell him precisely when his mother should no longer live alone. He wanted to be sure he could make the right decision at the right time without having to second guess himself. A tall order to be sure. Unfortunately I could not give him the irrefutable lab result parameter he wanted. I could only give him symptom clusters that might point to a “diagnosis.”

As my friend explained more about his mother, I tried to help him sort out facts from feelings, generate a list of options, and think through the pros and cons of each. It’s the best anyone can do. Needless to say, the conversation ended with him feeling somewhat disappointed but he admitted he was better equipped to make a decision than before he came to me. Such decisions are hard because they involve human factors or value judgments as much as they do quantifiable facts and figures. Even with my years of experience, (which does help), I cannot know for sure, without a doubt, what the right choice is for each client each and every time.

If you face tough eldercare decisions, remember you are not alone. There are lots of folks that have been in a similar set of shoes. Seek them out. Seek out a professional care manager. Look for a local support group. Listen to your heart and your mind. Make the best decision you can, be at peace with it, and move on. It really is the best anyone can do.

Thoughtfully,
Connie

Guilt is a common but unwelcome fixture in relationships between older adults and those caring for them. Caregivers often become guilty when they believe they do not or cannot live up to perceived expectations. But wait. Whose expectations? I really want to see the point values in the caregiving manual. Then I would have a way to help caregivers know when they have met the “good enough” standard. That’s ridiculous, right? So what’s up with guilt? Why are we so susceptible to it? Why can’t we just “get over it”?

I admit that I find myself feeling guilty about my interaction, or lack thereof, with my own mother. The struggle is always over how much is enough? How much time should I spend with her? Is she safe living alone? How much support should I offer? Do I need to be at her doctor appointments? Should I be doing more to assess her driving skills? Should I be monitoring how she manages her money? In creeps guilt.

Just like weeds in my garden, if I don’t stop the guilty thoughts they spread and soon become an overwhelming “fixture” in our relationship. Realistic self-talk helps. I remind myself that like all other aspects of my life, achieving a reasonable balance is key. It is important to balance the demands of my own life, the needs of my family, and my job responsibilities with caregiving activities. I want a healthy relationship with my mother. I want to enjoy our time together. I remind myself that even if I could be with her around the clock, my presence would not make her life “perfect.” And this is all from my perspective. My mother would not be pleased if I were to impose myself into her life only to relieve my own guilt.

Is it likely that caregivers can function totally guilt-free? Probably not. Can guilt be managed? I think yes. I am resolving to recognize my feelings of guilt. I am resolving to consciously weed them out of my perception of my caregiving performance even though I know they will try to creep back in. I am resolving to accept my human limitations. I know I am not alone. Perhaps together, we caregivers can write the Low-Guilt Caregiver’s Handbook. What do you think?

Balanced for the moment,
Connie

Have you ever had to make a choice that, intellectually speaking, you knew was right, but, emotionally speaking, left you drained and disquieted? Sometimes there is no comfort in being “right.” If you have followed the last few posts, you know I anticipated having to make some decisions on behalf of my ward that would have serious consequences. Indeed that time came.

After many days, in fact weeks, of intense medical treatment, the sum of losses outweighed any minimal gains. My ward’s body began to fail in spite of all the treatment. The doctors said further treatment would be “futile.” The choice before me was not only whether to stop additional interventions but whether to remove supports already in place. I was assured that death was certain either way. The variables were how long it would take and the level of pain my ward might experience in the process.

I feel confident that the choice I made for this ward, this human being whose life was in my care for a time, was an appropriate one. It was legally permissible. It was medically indicated. It was labeled as both ethical and in the ward’s best interest. None of those criteria made the weight of the choice any lighter. I am not looking for validation about my choice. I am simply offering human connection to other caregivers who have made difficult choices with confidence but found no comfort therein. May we all find comfort in and through one another.

Peace to all,
Connie

When serving as a conservator in the state of Tennessee, the statues say that decisions are to be made in the best interest of the ward. On first blush it may sound simple. I mean, anybody ought to be able to clearly see what is best–right? What is not so clear is who gets to define what is best and by what standards. I’ve been struggling with this very dilemma. My ward is still very ill–in critical condition, as a matter of fact. At present he is not able to communicate his wishes about anything. Nor did he clearly communicate his philosophies on these matters prior to his hospitalization. Decisions about his care (whether to initiate a certain treatment or to permit a certain procedure) are now a daily occurrence. The procedures are not pleasant ones and my ward does not seem to be truly improving. A gain in one area is offset by a decline in another.

I have the sense that one day soon the medical professionals are going to tell me they have nothing else to offer. If the doctors label my ward as “terminal,” I may have to make the decision to continue or discontinue life support. Even though I think I would be pretty clear about what would be in my ward’s best interest at that point, there is always doubt. It is a very heavy decision.

I will let you know what happens. Until then, any support you may wish to offer will be appreciated.

Soberly yours,
Connie