In the past week, I have had three clients open the door and cry when they saw me. In the past week, I have had to repeat these five words over and over “I am not a psychologist.” I am an attorney and a gerontologist. I have seen a lot and know a lot, but I have no training in how to counsel people who are in an understandable emotional upheaval about their spouse, a sibling or a parent. Yet, despite this clear statement of my abilities and training, we proceed.
I tell my clients, just like I told them when I represented them in court, that they hired me so that I could take the pain away from them by solving their problems. In other words, I would take the pain from their bodies and hoist it onto my shoulders, they are broad. When I leave, their tears are a distant memory. I feel proud and there is an affirmation of the line of work that I have chosen.
This week, I am taking my father to a surgeon so that he can have his bladder removed. He is 81 years old and has a very aggressive tumor. There is no one knocking on my door. My shoulders are already burdened by the woes of others, or shall I say the gifts of others. Through my clients, I have learned to: avoid having regrets, set healthy boundaries, self-love, the language of letting go and much more.
I have, with the agreement of my spouse, offered to have my father live here while he recovers. I will have no regrets because I will be there for him in his time of need. I will hire help so that I am available for my husband and children and clients. I will not blame myself for taking time for myself, and I will learn to start letting go of someone whose ultimate fate is not in my hands.
These promises that I make to myself are the key to surviving transitions and losses. The beauty of being involved in helping people care for their loved ones is that every day I have an opportunity to learn, pass on my knowledge and learn some more. Now, I get to use my knowledge to help my family. For that, I thank all of you whose tears dried upon my shoulders.
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Seminar Update:
The seminar at the Hotel Huntington Beach went very well. I am grateful for the panel and their expertise. For those of you who missed it or couldn’t find the Hotel Huntington Beach, this is what you missed.
First, in an effort to figure out whether or not it is safe to age in place, we explored some assistive technology. The CapTel phone was introduced. This device has streaming captions of the conversation a relatively big screen. There are some public benefits that enable you to get this for free. If you want to know more about his just click on the CapTel icon on my homepage. Jay’s Hearing is a fixture in Long Beach and Orange County. He has been in business for many years and he is truly an expert in assessing hearing loss and finding solutions to hearing deficits.
We had a doctor talking about fall prevention, in short, his advice get in shape and keep in shape. NuVision also had some great technology for the vision impaired. I highly recommend checking them out if you know someone who has any type of vision loss and is looking for a solution.
Monica Bush from ResCare discussed what to look for when hiring an in home caregiver. ResCare has some great technology available as well. They have a device that enables a family to watch what is going on in the home. You can just click on their icon to see more. HomeWatch Caregivers of Huntington Beach was also there. The owner of that facility used to be a fire fighter and is very dedicated to the health and safety of our citizens!
In the spirit of aging in place there was an in home dental company. How cool that they will go to your home or your parents home with before and after pictures to quell any suspicion that this service is too good to be true. They are called homecaredentists.com Google them!
Oxford Home Health discussed how one can qualify for in home health care under Medicare as well as how Oxford has been in business with the same owner since the 1960’s. Oxford can be contacted by clicking on their icon. Greater Newport Physicians was also there. This medical group provides services to a wide range of people in Orange County.
Huntington Terrace Assisted Living was there. It is a beautiful, three-story community situated on three acres of meticulously landscaped grounds and gardens. I toured this facility and it is very nice especially with the renovation.
A representative from The Covington of Aliso Viejo shared information about this Continuing Care Retirement Community. A CCRC offers a broad spectrum of care and services to foster good health, fulfillment, and spiritual well-being in the lives of older adults. The Covington offers three levels of care: Independent Living, Assisted Living, and Skilled Nursing. In addition, The Covington also provides care for those with memory impairments in The Courtyard. A CCRC reduces the likelihood of relocation stress syndrome which can and does affect an older adult’s often delicate psyche.
This is a short list of items covered and experts involved in my last seminar. There will be an expert on dementia care at my next seminar on Saturday October 23, 2010 in Irvine at the Hilton as well as an expert on public benefits, MRS Specialists. It is a do not miss. I hope to see you there!
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How did I get Mrs. B to go to the hospital? I drew a chart of where she was when I first met her, where she was the previous Friday, where she wanted to be and where she was…. knocking at death’s door. It went from the peak of a mountain to the valley. I called 911 with her blessing.
One of my recommendations in my initial report was that she organize her paper work. It was scattered about her desk and should an emergency arise, it would be difficult to present the appropriate paper work without a frenzy which is exactly what I was thrust into when the paramedic asked me for her Medicare card.
Mrs. B had pneumonia. She was placed on antibiotics. She spent three weeks in the hospital. Both of her daughters came in from various parts of the world. So many friends came that I had to put visitation restrictions on her door. She is a fighter.
One day I came in and she was standing and sitting and standing and sitting. She was trying to work her muscles because she felt as if she would never walk again. Her whole body shook and no anti-depressant could stop it. She was scared. She became nauseous. She vomited blood. Instead of being transferred to the transitional care unit for rehabilitation, she was rushed to the intensive care unit. The diagnosis after two endoscopies? A massive pulsating ulcer—that could burst at anytime and end her life.
In the meantime, her husband was at home with in home care assistance and friends to ensure his safety. She did not communicate to with him. He was scared and sad. I had to find a way to both enable her to release the guilt she was carrying around about his imminent placement in an assisted living facility without directly confronting her and find a way to for her communicate to him before he was taken from his home and moved to another…without his wife of 40 years.
I interviewed Mrs. B’s daughter and a close family friend, a Guatemalan man that they raised and who will be the conservator when things go very south. They told me of the nicknames that Mrs. B and her husband had for one another and memories that would evoke feelings of joy and nostalgia. I set out and wrote a love letter to him on her behalf. Bidding him fair well with love, signed “all my love twinkle.” Mrs. B approved of the content and Mr. B held onto it as if it were laced with sticky honey. Not all lies are bad.
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Within 5 days of delivering the report, Mrs. B asked me to come to her home. She was shadowed by another woman who she sponsored at AA and who was there at our first meeting. We will call this woman, her shadow. At first I was suspicious. It is not just that I have an inherently distrustful nature, it is that I have seen these types linger around frail older adults with assets many times and THEY HAVE DONE BAD THINGS TO MY CLIENTS. In time, I came to not only trust the shadow, but because Mrs. B’s daughters were out of the country, I came to rely on her for doing the things that a daughter would do.
When I arrived, Mrs. B was sitting up in her bed upstairs eating a peanut butter and lettuce sandwich. Because she had to sleep in an upright position, she developed stenosis. She complained of pain. Overall she seemed determined and strong. Mrs. B again reiterated her desire to move her husband elsewhere and the conflict she felt about “institutionalizing” him. The consensus was that she would tour a facility by her home that I recommended. I asked her to articulate her wish list, and certainly regaining her strength was primary. However, it was clear that her mental attitude was an impediment, so we discussed anti-depressants. Being the stoic person that she was, she had stopped taking them.
I spoke with Mr. B, he was bored. Every day that I spoke with him he said he was bored. He had very bad hygiene, could not make his own meals, pick his clothes out or do his own laundry. I came to feel that placing him was the right and kind thing to do. He sat and sat and sat all day without any social interaction.
We had a plan. Mrs. B. would tour the assisted living facility the following Monday. By the time I left, she was up and about and demonstrating her new lift. She looked happy and hopeful. The next Monday when I met her at the facility, she looked like she was knocking on death’s door.
What happened? I kept asking myself this question. Just two days before it seemed like you could swim in her eyes. When I saw her that Monday, she did not look spry and her lids were heavy over her big blues. She could barely get out of the car and I needed to get wheelchair assistance. She had fallen the night before. There was no one there to help her.
The next morning I got phone call after phone call from one of her many friends “Mrs. B… keeps saying she is dying and she won’t let us take her to the hospital or the doctor.” I rushed back from my appointments and cancelled my day. Both she and her husband had fallen the night before and this time she was in terrible pain and scared. He was oblivious. She could barely breath. She was gagging on her coughs.
I gave her two choices I would either bring her to the hospital or I bring a doctor to her. She told this doctor, (a geriatric concierge medical doctor who did her residency in geriatrics) was accused of being a quack while conducting a bedside examination and dismissed her. Now what?
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This story begins 7 months ago when an attorney colleague asked me to call one of his clients who was frail. He knew that I was the person that had the skill set to ensure that she was getting her needs met and that she had a plan to stay healthy and safe. This person was the Magnificent Mrs. MB. Her daughter came in from Canada to assist her after she had a minor heart attack in the hospital after being hospitalized for a bleeding ulcer. One year earlier, Mrs. MB had an extensive and highly invasive surgery because she had esophageal cancer. They used her stomach to re-construct her esophagus and now, for the rest of her life, she must sleep in an upright position. She had COPD and now emphysema and used oxygen.
Mrs. MB is 76 years old and for almost her entire adult life was the care taker for her husband who in the 1980’s was in an automobile accident and suffered minor brain damage. Now in his 80’s he has a rather well entrenched case of dementia. I conducted a mini mental status examination and other standardized test on him that confirmed this diagnosis.
I did not meet with MB then. She did not want to hire me. Distrustful and afraid of change, she rejected her daughter’s pleas.
Exactly one month ago she called me. I went to meet with her. She had the biggest, bluest most alert eyes I have ever seen. They said I can size you up in a second and swallow you. I took her history. I found out that she was a retired psychiatric registered nurse. I found out that she wanted her husband out. She wanted her husband out. She had had enough. She was too frail to care for him and any suggestion of in home care for respite relief or getting him out of the house to an adult day health care center was not going to cut it. As time went on and as will be revealed later, I came to find out why I was being hired to be this seemingly affable man’s henchwoman.
As for her, she wanted her life back, she wanted to be social again and herself entertained moving into a nice assisted living facility. She had been an alcoholic and for the last 20 years a valued mentor to many suffering from that disease. Her social life centered around those functions. In order for her to accomplish that, it was clear that she needed major nutritional counseling. She was very thin. She needed a lift put into her home to assist her with the 15 stairs to her room and grab bars installed. And, her legal affairs had to be put in order. Her estate plan was woefully outdated.
This seemed like a very easy case, one that my initial retainer could cover. I went back to my office, wrote a report with my recommendations and findings and summarily delivered it. One of my recommendations was that she re-consider moving her husband. I thought that she was underestimating the value of having a routine every day suddenly evaporate. It could be lonely and isolating. Certainly she could get some relief through the adult day health care center or in home care. However, I would come to find out that there were people lining up to be at this woman’s side, every day, all day.
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Episode#003 – Professor Rose talks about how some female neighbors have manipulated his stepfather into parting with assets and how he fell victim to a late night television land sales scheme.
For the complete Mike Rose Series, click here.
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Episode #002 – In-home care is a great solution for those who want to age in place. Professor Rose’s stepfather did not want to go to an assisted living facility.
For the complete Mike Rose Series, click here.
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Episode #001 – Professor Rose, relays the struggle he had with balancing work and the obligation he felt to care for his step father.
For the complete Mike Rose Series, click here.
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“Vitnesses schmitnesses, I saw you blinking at those boys you shlut.” This is what an elderly woman said to me after her 90 year old husband backed into my car despite my intense honking efforts in the Junior’s Delicatessen parking lot.
The “boys” were actually young men who were simply giving me their cards as witnesses for my insurance company because the woman’s elderly husband kept asking me why I hit him.
If you ask the person from whom you are taking the keys “to drive or not to drive” the answer is almost always a resounding yes. This is especially true if the driver is a man, once strong, macho and in charge of himself and the world.
Continue reading To Drive Or Not To Drive, That Is The Question?!
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Raise your hand if you think that you should buy a worthless piece of property for $50,000 off an infomercial. Well if you are 85 years old, live alone and forget to take critical medication than the answer is, I guess.
That is precisely what a client’s father did this year. That was just a couple of days before he went into the hospital because of severe dehydration. Thereafter, he ended up in a nursing home to rehabilitate for three weeks.
When he got home and learned of his shopping spree, he was outraged and in complete denial. There was just no way that this fiscally responsible man would have done that.
Ahhh, those pesky IADLs (Instrumental Activities of Daily Living)—medication management, what a drag. This gentleman is on seven medications all of which have to be taken at different times throughout the day.
How could this have been avoided? Continue reading Not Taking Your MEDS…Can Be Expensive!
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The other day something unusual happened. I received a call from an 88 year old woman who needed my advice about her daughter in law’s pushy (for lack of a better word) behavior.
Fearing that she would be institutionalized against her will, she wanted to know what her rights were. When I got to the woman’s house, she and her middle aged care-giver, greeted me with a warm smile and a welcoming gesture.
As she spoke of her daughter barging in, her eyes began to tear. The daughter, the wife of a son who passed away in his twenties, had begun a campaign to rid the home of the caretaker and the cat that the caretaker brought in and to place my client into some form of assisted living.
The daughter had even gone to a doctor’s visit where she made not so subtle illusions to the house being in a state of filth and disarray and run over by pets.
Concerned, the doctor had a social worker come to the home. The social worker reported that the house and living conditions were in perfect order.
Later that day, the grandson barged into the home and removed the cat that my client had come to love, insisting that my client had allergies and that she simply forgot about them.
My client was afraid that she would be snatched and institutionalized when she went to put her garbage out. Was this a paranoid delusion? Was the care giver up to no good?
Or, was this a case of elder abuse?
My findings were that my client’s mental capacity was very much in tact. Furthermore, she was very happy with her caretaker and wanted a pet. I spoke with my client’s doctor who agreed.
To this day, I do not know what her daughter in law’s motive was. Although she was in the will, placement of my client into an institutionalized setting would deplete her inheritance. My suggestion was two fold.
First, I could have the family participate in a family mediation to have everybody’s concerns aired and my client could assert her right to independence and autonomy, she could make her 80 year old sister a proxy under a durable power of attorney for health care or she could voluntarily submit to a conservatorship over herself. Short of that, she could get a restraining order.
That seemed a bit extreme. When I followed up with her she told me that she suggested to her daughter in law a cooling off time. They will meet in a couple of weeks to smooth things over with or without my mediation.
Empowered by two professionals assessment that she is not incompetent, I suspect that my client will now be in a position to assert her boundaries that she created over 88 years on this planet.
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