Tuesday, March 29, 2011

Aging Parents: Ornery, Difficult, Unappreciative?--2 Will the Family Function Like a Mobile?

hanging mobile - Wilco
....A continuation of last Saturday's post, with concepts and strategies to help aging parents and adult children untangle a frustrating relationship.

Concept #3  Tolerating disrespect, reinforces it. Allowing disrespectful behavior helps no one.  We learn this from day one if we're teachers. When there's a bully in the classroom (to use a dramatic example), we must use our skills to stop the bullying immediately.  Why? If the bully is allowed to continue, the bad behavior is reinforced to the point that it becomes part of the bully's "normal" behavior--and eventually becomes expected behavior.  The bully becomes unpopular to most and his/her "victims" suffer. Teachers may be understanding and caring; but they can't allow disrespect.

O.K.  You get it.  Now back to Jean (featured in Saturday's post). Jean shared her situation with one of our Senior Advisors over a period of time. Our Senior Advisor's response to her: “You’re not in good spirits any more, you’re not happy. You have a husband and a family. I know you’ve said you’d feel guilty not doing for your parents like you've been doing.  But when you’re not respected, you don’t have to feel guilt.”

Hearing this from a respected older person whose wisdom Jean highly valued was affirming. It was also the equivalent of supportive ammunition and Jean "got it."

So Jean is slowly disengaging.  She doesn't jump to fulfill her parents' wishes.  She no longer says she’s available at every request to drive them; she doesn’t cut off a phone conversation with friends when her parents call on the other line. While she still does for them, she's not at their beck and call.

The result: Her mother didn't fire the last cleaning person, in fact she's enjoying having the cleaning person around, according to Jean. And some of the errands Jean used to do are now taken over by her brothers or sister-in-laws, all of whom get along well.

hanging mobile - Vector
Concept #4.  The family is like a mobile.
I learned a bit about "family systems" through experts' presentations as part of inservice training during my years at the high school. The "family as a mobile" concept helped explain many things.  Note how the beautifully-made mobiles hang in perfect balance. Similarly each family member must do his or her part to keep the family functioning in balance.

If one member is aggressive, for example, another must pull back to maintain the balance.  While one is ill, another takes over some of the responsibilities temporarily.  In a divorce, absent one parent, the remaining family members must do extra to make things work. (One of the most respected researchers in the field reported "even 8-year-olds can vacuum.")

True to the concept, Jean gave up some of her formerly must-do responsibilities and her aging parents readjusted, bringing in others to maintain the balance.
*                        *                           *                              *                          *
People's personalities don't change much (short of trauma or therapy) and things will probably never be perfect, yet Jean is relieved of guilt, some responsibilities, and has more time for herself and for her family. Meanwhile her parents have learned that they can no longer depend on her so heavily but can take the initiative to make their lives work. Doesn't this help parents age well?
hanging mobile - Quiet Ending
Quiet Ending

With many thanks to Rick for permitting me to use these photos of his mobiles.  
Visit his website,
to view more of his exciting work
Also visit my other site: http://helpparentsagewell.com.  More resources and information

Saturday, March 26, 2011

Aging Parents: Ornery, Difficult, Unappreciative?

Aging parents' dispositions can be put on a bell curve: pleasure-producing dispositions at one end, pain-producing at the other.
Bell Curve: Parents' Disposition

Unfortunately pain-producing is the norm for some aging parents. They are demanding, critical, never satisfied.  Adult children living near-by usually bear the brunt of this no-win situation which seems to offer no easy way out.
While changing behavior is difficult, understanding the concepts below can help aging parents and adult children untangle themselves:1.  Back to childhood.
2.  Families cater to the most neurotic members.

3.  Tolerating disrespect, reinforces it.
4.  The family is like a mobile.
We begin with Concepts #1 and #2 and conclude on Tuesday with Concepts #3 and #4. But first meet Jean.
Jean is a stay-at-home mom in her 50's. She's married, with two school-age children, two siblings--and an aging mother and father-in-law who "run her ragged" and show no appreciation. Her brothers work in downtown offices thus, are unavailable on weekdays; so parents "know" the boys are “off limits” (although they do help out on weekends when asked).
Being a good daughter, on a weekly basis, Jean has transported these parents (who drive but sometimes "don't feel like it"), cleaned (they manage to fire every cleaning person Jean finds for them), and she spends countless hours on the phone with them (they phone daily--at the least--when they have nothing else to do).  Jean cooks and delivers meals--or invites them to dinner--when they don't feel like cooking, takes them to doctors' appointments and lays out and explains their medications (which they don’t always take).
She's at their beck and call, wearing herself to a frazzle as she dashes between Little League, swim meets, music lessons, grocery shopping, house cleaning, dinner fixing etc. etc.  Her husband, most patient and caring, is showing a bit of resentment.  Jean's parents are relatively young and he envisions this situation going on forever.
#1. Back to childhood.  Parents and children establish patterns of behavior way back; it's difficult to break old patterns.  If children were always expected to cater to their parents, the pattern--the game so to speak--has been well established. The parents are accustomed to being catered to by their children.  Those are--and have been--the game rules over many years, evidently never renegotiated.
In addition, children, regardless of age, are always their parents' children. (Many disagree with adult children saying they become parents to their parents--I'm one, but that's another post.) It's common for children to want to please parents.  And they usually feel responsibility if catering to a parent was an expectation or a duty from early on.
#2.  Years ago, while doing research for my divorce book, a priest told me that families cater to the most neurotic member, something he had learned this during training in social work.  Undoubtedly some impossible parents are/were neurotic and have experienced a lifetime of being catered to.
We try to help parents age well.  It involves helping them to maintain legitimate independence and, in this case, involves extricating their adult children from a difficult, thankless, possibly manipulative situation. Tuesday's post, with concepts #3 and #4, provides understandings and strategies to make this happen.

Visit my other site: http://helpparentsagewell.com     More resources and information

Tuesday, March 22, 2011

Help Aging Parents: The Doctor-Patient Relationship

I read the cover story, "What Doctors Wish Their Patients Knew," in the March 11, 2010 Consumer Reports magazine with interest and an eye towards helping aging parents. It's excerpted in the above link; the additional major points follow:
1. The  importance of the long-term doctor-patient relationship. Research suggests patients who frequently switch doctors have more health problems and spend more on care than patients who stay with one doctor.
2. The importance of following--and being able to follow--doctors' advice or treatment recommendations. Patients need to  feel comfortable expressing any doubts or concerns to doctors about treatment, side effects or other health-related issues.
3.  The importance of keeping a diary or log of treatments, medications, tests, procedure, health issues. Interestingly, in this age of electronic medical records, we learn that 89% of the doctors interviewed in Consumer Reports want patients to know "that it pays to keep track of your medical history."
4.  Two people remember things better than one. In addition, a person who isn't feeling well may not have the best judgment, thus going to a doctor's appointment with someone is recommended.  Can't we conclude, then, that it's helpful when an adult child (or a friend or relative) accompanies aging parents to doctors' appointments (assuming parents don't mind)?
5.  Time with the doctor is precious, so coming to the appointment with questions written down and prioritized makes the most of the time allotted.  I found faxing questions ahead of an appointment saved precious time after mother had her stroke and we went for follow-up appointments. You might ask if emailing is preferred.
There's an additional piece connected to "What Doctors Wish Their Patients Knew"-- "Finding Dr. Right," copied in its entirety in the above link.
As we try to help parents age well, finding the right doctor can make all the difference. I continue to be an advocate of geriatricians for older people. Geriatricians have a specialty in geriatrics and treat patients 65 and older. They work with primary care physicians; an older person need not give up his/her primary care doctor.  If you're unfamiliar with geriatricians, here's a link to a previous post:http://helpparentsagewell.com/2010/09/13/update-on-best-hospitals-geriatric-division-visit/. I think Karen's letter at the end says it all.
And visit my other site: http://helpparentsagewell.com for more information and resources 

Saturday, March 19, 2011

Aging Parents, Happiness, and Spring's Little Things That Can Mean A Lot

Help Older People Age Well in Spring: 6 Ideas
1.  A big help, especially for older people who live in one of the 47 states that go on Daylight Savings Time and find technology difficult: checking that allclocks were set ahead last weekend and if not, offering to set them. Ditto for those clocks (ie. a clock up on a wall in the kitchen) that require ladders to reach the mechanisms.
2.  Especially in states that have bad winters, spring brings thoughts of nature, and gardening, and opportunities for thoughtful acts that bring happiness to older people.  Ideas: gifting a new pair of gardening gloves, seed packets, a flowering outdoor plant (primrose perhaps) for a temporary indoor touch of spring; or a flowering indoor plant that blooms year-round such as  Oxalis (Lucky Shamrock).  It's in stores now because of St. Patrick's day.  What about gifting a bird feeder or bag of bird or thistle seeds in climates where bird feeding continues for a while; or helping to clean up the yard and flower beds (or sending a grandchild to help)? Gardening help may be a big job, but doing something together with children and grandchildren is a gift in itself for aging parents.
3.  More sun and warmer days make getting out easier.  The Philadelphia Flower Show ended last weekend, but the New York Botanical Garden'sOrchid Show continues through April 25th. Friends said it's the most beautiful ever. I agree. A large parking lot is set aside for handicap-stickered cars. The Conservatory is a bit of a walk, but on a nice day wheel chairs make access easy (didn't see any walkers). Check out Orchid show link above.
4.  While flower shows seem to be more popular with older people (many older men and women at the Orchid Show and Philadelphia Flower Show), regional events, that include flower shows, are another option for aging/older parents. Examples: http://www.ncazaleafestival.org/ (N.C);  http://www.sfgardenshow.com/ (in San Mateo, Calif.);  http://www.yankeemagazine.com/issues/2011-03/features/spring-festivals/all ("everything" coming up in New England, courtesy Yankeemagazine). Check local papers for big events as well as the small garden clubs' flower shows.
5.  Spring brings the beginning of baseball season.  Taking aging parents to a game--be it major or minor league or grandchildrens' games--is a wonderful outing in nice weather, especially for baseball fans.  Busy mothers and fathers often try to get to the last innings of a game, even if they can't make the beginning.  This may be a perfect time-frame for aging parents who tire easily.
6.  Unusual entertainment: if you read this blog by--or on--March 20th, the vernal equinox--the first day of spring, at around 7:21 pm EDT, day and night are about equal in length.  Due to gravity forces you should be able to make an uncooked egg stand straight up! And that's our last idea for "Spring's Little Things." They help parents age well by adding something fun, thoughtful, enriching, different--happiness to their lives.
Tomorrow I hope to have an egg-standing-on-end photo right here! And here it is 3/20/11!
Visit my other site: http://helpparentsagewell.com
Same blog, additional resources

Tuesday, March 15, 2011

Aging Parents and Happiness: Little Things That Mean A Lot

My friend and former colleague (in her mid-80's), who sent the NY Times Science section piece on Happiness (last Saturday's post), also wrote me the following last summer:
"The other day I was struggling to express to you that older people who are free of pain can experience an almost euphoric delight in small treats.
Time goes so quickly, with most of the day absorbed by maintenance activities, like dressing and doctor-visiting, that the few moments of pleasure assume great importance and intensity. Perhaps the absence of a future, with its attendant worries and burdens, serves to intensify delight in the moment."
What are "small treats," the little things that help aging parents experience "an almost euphoric delight?" They are, no doubt, the unexpected and thoughtful, or planned and thoughtful, often simple acts of caring.
For example, when picking up Sr. Advisor, R, to drive her to physical therapy a few days ago, sitting on her kitchen table I noticed--at the moment R began to tell me about--two beautiful clear containers of yellow roses and daffodils with slices of lemon floating around the stems, plus a pretty, yellow, opened box of home-made pastries. A bright yellow and white ribbon lay near.
The flowers were recycled from a dinner party one of R's neighbors had attended; the pastries were baked by another neighbor, who loves to bake. Each gift, an unexpected small treat--conveying caring and thoughtfulness.
You could see R's delight as she talked about them and the women who brought them over to her home. While she is always gracious and appreciative that I drive 25 miles to take her to rehab 10 minutes away, the little things--the small unexpected treats--give more of a "lift."
Similarly asking older people ahead of time if we can take them grocery shopping/to a movie/lunch-- or come for a visit or go on a short walk with us--gives them something to look forward to.  The "little"--the frosting in this case, is the thoughtfulness of asking ahead. It's something to look forward to. The "thing" itself is the cake.
Can we think of  "little things/small treats" that add happiness to an older person's life? Flowers from the yard? Something to eat? Flavored water? The often-forgotten Root beer or Ginger Ale of one's youth? Or that wide rubber band that makes opening a jar easy? (See 12/7/10 post:"When No Big Deal Means a Great Deal.") If something at the store is 3 Whatevers for $5, why not get 3 and give one to an older person who would enjoy it?

As we try to help parents and older people age well, the possibilities for adding happiness by treating them to thoughtful "little things" is limitless.

Please visit my other site: http://helpparentsagewell.com--same blog post, meet my Sr. Advisors, check sites and blogs I like and more.

Saturday, March 12, 2011

Help Aging Parents: Happiness

A former colleague who retired shortly after I began my counseling career has been a mentor and good friend over many decades.  In her mid-80's, she is both an aging parent and a parent who has aged well.  A former revered English teacher, she reads widely, writes beautifully, and offers blog ideas from time to time.
On a day when Japan is mired in devastation from the earthquake, the northwest is being pounded by heavy rains, parts of New Jersey are still under feet of water, and a terrible bus accident has closed a highway near me, my friend's contribution, "HAPPINESS MAY COME WITH AGE" (June 1, 2010 NY Times Science Section), seems like an uplifting theme--especially because the subject is old/older people.
While "aging" and "growing old" usually connote a not-to-be-looked-forward-to, less-happy-than-younger-people stage of life, the results of a large Gallup poll, reported in the Times, seem to fly in the face of this reality.  The poll's 2008 telephone survey of 340,000 people age 18-85 found that people 85-year-olds are happier than 50-year-olds!
My friend emails me this link. Check it out and note that the findings are respected by researchers in the field.
Definitely it's food for thought as we try to understand and help aging parents and relate to older people in general. Now I wonder--Can we take heart in the fact that "stress declines from age 22 onward, reaching its lowest point at 85" and "worry stays fairly steady until 50, then sharply drops off?" And what about the other findings? This recent research is something to keep in mind as we try to help parents age well--AND also think about ourselves.

Visit my other site: http://helpparentsagewell.com.  Same posts, additional resources.

Wednesday, March 9, 2011

What Aging Parents Need to Know About Inpatient Rehab and Short-term Care Facilities

...And What Children Can Do to Help Their Aging Parents From Day 1

Senior Advisor, R, has been out of the rehab facility for a little over a month, but returns twice a week for out-patient physical therapy. I took the opportunity to interview M, Director of Nursing, at this "A"rated facility, wanting to pose questions that I thought would help others.

Admission advice?
1.  Have at-the-ready: ID, Medicare card, Insurance card. If a POA is involved, the facility needs it asap (within a few days).
2.  If parents come in an ambulance from another facility, all possessions that were in their previous room are transported to the facility.
3.  Because they are going to be up and dressed every day, they will need appropriate clothing (shoes, sweater etc.), personal care items, and all meds from home (including vitamins).  As M says: "Every pill."

Then what?
1. A doctor, following Medicare guidelines, will do an evaluation within 72 hours.  It should be sooner than that unless the parents come in on a weekend--then it's a wait until Monday.
2.  Emotions can run high at this point. People need to understand that the skilled nursing staffing ratio is not the same as in a hospital (where it's probably 1-5).  More likely it will be around 1-16. So expectations can be unrealistically high at the beginning.
3.  The doctor (who is there each week, but not each day) may only see the patient, after he/she is stable, once a month.  However, the skilled nursing staff is the "eyes and ears" and regularly conveys patient information though telephone conversations to the doctor.
4.  That said, according to M, "patients have more contact with the staff than in a hospital." I'm thinking probably because their needs are different.

What additional information helps aging parents if shared?
1. Knowing about parents' individual needs and routines --do they use a night light, have sleep apnea, unusual sleeping patterns (a farmer accustomed to getting up at 4am, for example will want an earlier breakfast if possible), are they incontinent etc, etc?
2.  In answer to my questioning as to whether certain personality types fared better, M gave me surprising information.  "If they've had anesthesia, they may be like a different person.  Anesthesia is probably the most crippling for this population.  It has to wear off and usually hasn't when they come to us."

*                    *                    *                  *                *                                       
My experience: while Senior Advisor R was in the rehab facility, we realized communicating with the staff, when appropriate, got things done in a timely fashion, whether we or R initiated the discussion.

R's take: upon admission to a rehab facility one must make a complete adjustment. One must accept the way things are. "It's not like a hospital--not like having someone at your beck and call when you ring the call-button, says R," adding "It's not real nursing (except for those who must have it).  Asking the hardworking staff for more than one's entitled to only incurs frustration for both patients and attendants. Realizing this early, helps. Indeed some people make themselves miserable wanting more than the staff can provide."

As we try to help parents age well, if a rehab facility should enter the picture, draw upon R's wisdom regarding the saying she learned in rehab: "We're not here to help you, we're here to help you go home." That's the important thing to focus on," she says.

Visit my other site: http:''helpparentsagewell.com--same blog, additional resources

Tuesday, March 8, 2011

Aging Parents: What You Need to Know About Inpatient Rehab Centers

...And what rehab centers need to know to help aging parents

An interview with the Director of Nursing for the inpatient rehab and skilled care facilities where R spent 4 months will fill this space tomorrow.  Sorry post delayed a day, but I think the wait will be worth it.

Saturday, March 5, 2011

Aging Parents and Healthy Eating

"What should 97-year-old people eat to stay healthy?"

Who better to ask this question of than Sr. Advisor, R, whose broken hip recovery has been followed in my blog this year.  While the following has worked for R, it may not work for everyone. Nevertheless, R. shared the following in a quick phone call.

First, she eats "very simply." Breakfast consists of oat meal or cheerios, with fat-free milk, fresh fruit, and sometimes toast--raisin bread, whole wheat or milti-grain ("never white bread"). She has 2-3 helpings of fresh fruit daily--sometimes berries or banana with her cereal and/or orange juice with pulp. (Note: frozen fruits and vegetables are frozen at their peak of perfection and are said to have the same nutritional value as fresh--and even more than fresh, if the fresh have been sitting around for a while.)

Living in her own home and cooking for herself, she buys frozen dinners--"Eating Right" (a Safeway product), and "Healthy Choice," (available at most grocery stores).  She especially likes the large variety of dinners "Eating Right" offers. Since the dinners can be expensive, she looks for the sales; sometimes it's less expensive to buy 3 at a time, she says. It's comforting to know she has a supply in her freezer.

She makes a green salad nightly to accompany dinner and ends with dessert. "Eating Right" makes 100 calorie ice cream in new flavors--an alternative to yogurt with fruit.

Now we know R reads labels for calorie count. She also checks grams (g and mg.) of fat, cholesterol, sugar, sodium and fiber. While she has no problems that necessitate reduced sugar or salt, she "never overdoes." That said, she loves candy, "always has some in the house, but eats it in moderation-- 1-2 pieces, depending on size".

The frozen dinners, she says, may have too much sodium for people on sodium-restricted diets.  She has always watched her salt intake because she knows salt isn't good for you, not because a doctor has said she should. So, for example, she prefers low-fat cheese because it's less rich (but also has less sodium and "you get used to the taste"), and lite mayonnaise.

She eats a lot of fish; avoids rich and fatty food. (The frozen dinners she selects are no problem in this regard.) Even if she initially loves the taste, she has learned to avoid food that "gives her discomfort" after a meal, and that's the rich and fatty food...although she loves a good hamburger now and then.  But that's the point, she says, "once or twice--now and then"--not as a regular diet.

R never drank coffee, likes hot tea in cold weather, and drinks a lot of water.  We know older people don't get as thirsty as young people, but still need to drink a lot of water daily to remain healthy (and give medications the best chance to do their job). Check with doctor for daily recommended number of 8 oz. glasses.

We should know our parents dietary restrictions. Making certain aging parents get the nutrition they need is another way we help parents age well.  So we may need to schedule a time to take them to the grocery store on a regular basis. Bon Appetite!

Visit my other site: http://helpparentsagewell.com    Same blog, additional resources.

Tuesday, March 1, 2011

When Aging Parents Must Go In An Ambulance

While R was in rehab I watched emergency and ambulance-type vehicles come and go carrying patients needing rehab: some accident victims; some stroke victims; some, like R, with broken bones who had undergone surgery, plus others.

A sophisticated stretcher-type apparatus hugged these people to its contours, strong men carried all into the automatically opening doors of the rehab facility.

Being curious, I asked one of the attendants, who drove the emergency vehicle and carried the patients into the facility, about the job.  He had done it all--from fatalities at car crashes to transporting the very young and the very old.  He was a big man; obviously strong. He also had a big heart and had been--and still is-- caregiver for his elderly aunt.

"Can adult children do anything to help aging parents needing to be transported by ambulance?" I asked.  His reply "Yes, they need to stay calm and help their parents stay calm." And then he went on to elaborate on how difficult this can be. I share what I learned.

People being transported in an ambulance are always scared, and often in pain.  Fear of the unknown is usually great, although possibly less when one is being taken from the known of a hospital, as was R, to a rehab center where there's a specific program aimed at returning to normal mobility.

The attendant said he does his best to calm patients and their families--makes it much easier for the professionals to do what is necessary for the patient as quickly as possible.  When a patient is agitated, everything is more difficult and when family members add to the stress, it's doubly difficult.

That said, he reinforced how scary it is for the patient.  He shared that he had been in an auto accident and had been put in the ambulance.  No matter the knowledge and experience he had, he was hurting and scared--mostly scared, he said, that because he was so big he might be dropped.  He said he knew how well-trained everyone was, "but when you're in pain and you've lost all control you become scared."

We can help aging parents in this situation; but it's not easy.

Visit my other site: http://helpparentsagewell.com   Same blog, more resources