Organizing the Elderly

Or, alternately,

Using the Skills You Have to Expand Your Circle of Influence

I wrote this while I was still out West with Mom. I think one of the reasons it was so important for me to go was because I felt like I had so little control over the situation from across the country. Also, my local sister was letting herself get into a situation where she and her family felt overwhelmed. Being local, she must carry the brunt of things, but my other sister and I do what we can.

There are things about this situation that I’ll never be able to control: the AFIB and the Pulmonary Fibrosis are living beings unto themselves, being tended to by her doctor; and her stubbornness is unlikely to change at 75. But there are things I can help with that fall into my area of expertise: efficiency.

Take Care of the Caregiver

As they say on the airlines, put your own oxygen mask on first before helping others.

The first thing I wanted to do was put some things in place to shift work off my local sister, because she translates stress as illness (as many of us do) and we can’t have her getting sick!

So I interviewed dog walkers and household assistants. And put the ones Mom already had on a regular schedule. There is no reason to be calling the dog walker at 1 pm when you want her to walk the dogs at 4 pm that same day – put a schedule in place so you don’t have to think about it. And, since the dogs make my sister crazy, let’s have the dog walker come later in the day so the dogs are calm when my sister is there.

I also interviewed a second caregiver to come in the evening, keep Mom company while she eats dinner (and make sure she remembers to take her pills) and that she gets in/out of bed safely – at least until she rebuilds muscle tone and can downgrade to a call pendant.

My sister is very organized – she collected all the prescription information, medical history, nurse’s orders, etc. into a file organizer, got Mom set up with an am/pm daily pill box that sis refills weekly, and is organizing her bills, taxes, and paperwork. So I was glad to find a couple of things she hadn’t gotten around to organizing and help with those.

Reality Check

The next thing I wanted to do was meet the doctor and make sure he knew about Mom’s emotional symptoms. Mom had been sleeping in, taking long naps during the day, not sleeping well at night, not eating enough to feed a canary, and had not really been leaving the house. Her only social interactions had been with my sister’s family, her caregiver, and occasional friends and family, mostly by phone.

Also, her “sudden” decline in health made her wonder if she was ever going to get better. None of which she was sharing with her doctor. So when we went to the doctor, and he mentioned that the doctors at the ICU thought she might be depressed and she said, “Oh, no, not really,” I spoke up.

I guess I was a little blunt because the doctor told me I was. All I did was list off her symptoms and tell Mom that if a friend my age had those symptoms, I’d call it depressed, and the doctor asked me what I did for a living. But he ended up prescribing a very low dose of antidepressant and that  helped. Mom barely hinted to him at her concerns about her stage of life and he reassured her that her heart and lungs weren’t the issue at that point, that it was more her lack of weight and muscle tone.

That also seemed to make a difference to her attitude about eating, although she needed to hear it six more times to believe it. He also arranged for a social worker to visit the house and help Mom figure out how to get more socially engaged and do some longer-term planning about fun things, not just wills and things.

One Version of the Truth

A third system I implemented was to establish a single notebook and calendar for all Mom’s caretakers to share. Mom’s assistant is terrific about writing daily notes, photographing them and texting them to us. But the rest of us hadn’t been as good about taking thorough notes and sometimes my sister was present for doctors / nurses / PT / dogwalkers / home-repair people; sometimes it was my brother in law; sometimes my other sister or me, if we were visiting. Details were getting lost.

So now there is one place where we can all take notes about what Mom’s feeling, how she’s eating, what was said at each appointment — and to catch up on what happened when we weren’t around.

Make Choice Easy

The last system I’ve put into place had to do with menu planning. Like many of us, when Mom is asked “what do you want for breakfast/lunch/dinner,” her mind goes blank.

Mom has always been a healthy and a light eater – one way she maintained her beautiful figure all these years – but she needed to pack on the calories and her assistant, who is also a healthy eater, had been catering to her love of healthy fruits and veggies. Healthy, but it’s not going to help you gain weight.

So one afternoon, when Mom was mildly hungry, we made a list of foods that she found appetizing for each meal and specified the added fats and proteins that the nutritionish said she needed to add (buttered cinnamon roll; hot cereal made with evaporated milk, not water; chocolate for dessert at lunch and dinner).

That way, instead of her assistant choosing on Mom’s behalf, she can hand Mom the menu and let her choose. This also enabled my sister to do batch-cooking for Mom ahead of time, taking a couple of hours to whip together potato salad and re-heatable portions of casserole for Mom to eat with her assistant throughout the week. This helped with Mom’s appetite and it also gave her an easy choice that she could make when she was too depressed to make any other choice.

Depression is an illness of inactivity: the way out is to take action. When you’re really depressed, sometimes you can only take small actions. But those small actions help with the depression so you can take bigger actions.

Being there and using my interviewing, organization, communication, and – um – bluntness skills reduced my stress as well. I was able to take control of a few things and feel like I was doing something to help. Which meant I felt better when I got home again a few days later.

***

While I was writing, Mom asked what I was doing. I told her I was sharing my experience about how so many friends and colleagues my age are going through situations where their parents are going from independent to interdependent and how I was hoping if I shared my experience of applying my professional skills to the situation, it might help them.

She recommended a couple of other related topics that I could write about; so I’ll explore those in days to come.

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