Help Aging Parents: Partnering With Parents in Healthcare

Do we help aging parents by becoming parents to our parents, especially when they are of sound mind? Are we supporting feelings of control and independence--feelings that help parents age well? In this past Tuesday's post family members basically took over--either to persuade or make a unilateral decision regarding very serious health care for aging parents. That made me pause.

In the first example, the stroke victim was not able to advocate for herself initially. Someone had to step in if the outcome was to be any better than the ultimate nursing home option her doctor envisioned. She was never left out of the loop, however. She knew the reason for each action, presented in a way that offered hope--so she wouldn't lose the will to fight to regain as much normalcy as possible.

In the second example, family members put great pressure on the colon cancer relative. While not feeling well, and do doubt having countless thoughts about well-being, comfort, life and death (to name a few), the relative was of sound mind and did see the merits of getting a second opinion....even if it meant a long plane ride.

As we impart information and try to help older and aging parents accept our advice and recommendations, we have a better chance of success when we pull them in psychologically to work with us--assuming they are mentally capable. And it seems to me, even when they don't seem mentally capable, keeping them in the loop at the least shows respect and at the most could possibly activate something positive from within.

With that in mind, having called attention to best hospitals and best specialty departments, it makes sense to realize not everyone will/can take advantage. As a fall-back position--or even a front-line position--it makes sense to know which are the best hospitals in aging parents' and grandparents' hometowns.

To fill this need the Hospital Quality Alliance, run by the Centers for Medicare and Medicaid Services, run a website:http://data.medicare.gov/ According the AARP's June 2010 bulletin, it measures and records patients' outcomes from local hospitals.

The site links to different sections that compare hospitals, tell you how patients with certain conditions fared after hospital care, whether they had to be readmitted within 30 days, and the death rates in certain cases. The quality of care they received during a recent stay is also provided from answers to a survey. Only hospitals that have agreed to release this information to the public are included in this government data site.

In answer to: "I just moved to a new area. How can I find out which hospitals are considered the best in town?" the AARP Bulletin's "Ask the Experts" section provided the above information. Seniors obviously care, but may not know where/how to find this information.

Add this to the objective information that adult children might want to provide to help their parents age well. lt's good information to have when aging parents decide to move; and may even figure into a decision about where to move. And of course it helps prevent having to scramble for hospital information during an emergency.

Helping Aging Parents Find The Best Hospitals

When there's a serious medical emergency it's probably safe to say few aging parents live near a hospital specializing in whatever caused the emergency. Most of us--even those who live near and help aging parents--don't know the particular specialties at hospitals located nearby. A sudden emergency may leave little time to do the homework.

Three no doubt common scenarios follow, involving different situations and actions taken. All happened in my family; all caused great concern; all turned out well. All present strategies to help parents age well.

#1--Mother's stroke experience: initially memorable for the emotional stress; equally memorable for the relief and sense of some control we felt, once we found out--and got her to a place-- where she could obtain appropriate treatment.

It began with phone call. Parents in California for the winter. Mother's speech sounded "funny." Phoned my brother with concerns and a plea to fly to California immediately if possible (he was moving into a new home that day). He got there quickly, phoned saying Mother was on her way to the hospital. I should fly out asap.

When I arrived at Mother's bedside her speech was still garbled. Dinner was on a tray. She was eating the food with her hands. I've forgotten other details. A terrific nurse updated me and said Mother's physician would be in early the next morning with test results. We learned they had limited the "damage;" there was nothing more they could do. Mother could go home later that day or the next with a caregiver, or go to a nursing home. Dad would be unable to manage her care alone... a nursing home would be in inevitable at some point.

I knew I needed time to think. Decided I wouldn't get a caregiver for that day. Knew Mother was safe spending another night in the hospital. I called a NY friend knowledgeable about medicine. After some research, he phoned back. He said to get her out of that hospital, which lacked neurology expertise, and to a neurologist at UCLA asap, and gave me a phone number. With great difficulty I got an out-patient appointment for the next day.

The next morning we picked Mother up at the hospital and drove to UCLA with films and reports. UCLA had newer technology. New films were taken. The extent of the damage was clearly pin-pointed and Mother was given different medications, a prescription for physical therapy, and an appointment to return in a month.

There have been many advances in stroke treatment since. I know Mother benefited from some because the neurologist said some were not widely used yet. I also know: a month later the improvement was so dramatic most people wouldn't have known she'd had a stroke. Nor did she have any further strokes.
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#2. A family member, also living in the west, was diagnosed with colon cancer there... advanced: stage 3--maybe close to 4. Treatment was about to begin. "Not there," said my husband, who wanted to check Sloan-Kettering and knew we could be supportive if the family member came back. Indeed Sloan-Kettering had top colon cancer people. Convincing someone to come all the way to NY, however, isn't easy. It's easier when offered as "leaving no stone unturned"--making the trip to get a second opinion. That works.

While chronic health issues complicated things, Sloan-Kettering took charge: a top oncologist; an 8+ hour surgery performed by a top surgeon (who had done this countless times); a while to recuperate in NY. Instructions for additional "whatever" were given to the doctors in the west. Routine check-up visits show the surgery was a success.....and we think insurance covered everything.
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#3. Then there was Dad's "heart event" in California shortly after his 76th birthday. At the movies he began feeling dizzy. He went to the theater lobby and sat down on the floor. One of the personnel came over to see if he was alright. He wasn't; his blood pressure was low. Paramedics were called. He was taken to the hospital where his internist practiced. While it wasn't the right hospital for my mother, it had a first-rate heart team whose surgeon did heart surgery on a former president a few years later. Dad had 5 bypasses on a Friday and went home the next Wednesday. He aged well, lived to be 94, and his death was not heart-related.

So how do we generalize? When helping aging parents is a part of our life and our parents live long enough, the odds of serious medical problems necessitating hospitalization are great. Getting parents to a hospital with the appropriate highly experienced specialists, can up the odds for a successful result that helps parents continue to age well...and medical insurance may make it more affordable than one might think.

Aging Parents, Best Hospitals, 16 Specialties: 5 Reasons to Use Them

 Mt. Sinai Hospital Ranked #1 in Geriatrics--2010-2011

Mt. Sinai Hospital's Geriatrics Department, started by Dr. Robert Butler in 1982, (last Tuesday's post) was ranked #1 this week in the latest US News & World Report's "Best Hospitals" issue (August 2010). An additional 49 hospitals' geriatric departments complete the list. 

Fifteen other specialty departments are also ranked. And Johns Hopkins Hospital ranks #1 as the top hospital in the country--having 15 of the 16 specialties ranking at or near the top. US News & World Report compiles this list every year (and has done so for over 20 years) "to guide patients who need an unusually high level of hospital care" (which includes high-risk patients).  Isn't this of enormous benefit to help aging parents?

Life takes on a more delicate balance as people age.  Making well-informed decisions ups the odds in our efforts to help parents age well. 

5 reasons to consider the best hospitals' specialties to help aging parents

1. Approximately the same time is involved, be it for procedures done in excellent hospitals or less than excellent hospitals; with excellent doctors or less excellent doctors. Only the outcomes may be different.   
2. Quality of life is at risk; the more experienced the hospital and medical professionals are (the more times they've done your parents' needed procedure) the better the odds to have encountered  and handled well unexpected problems.
3. Older people don't bounce back so quickly. Patients lose independence in hospitals. It's important they gain the confidence to feel some control. Ideally professionals working in the best hospitals' specialties departments should have done "it" (what ever your parents' medical situation is), worked with "it," handled "it"--over and over and over. Thus, they instill confidence in you and your parents based on countless experiences with the expected and unexpected.
4. It takes hard work to recover well from certain procedures.  The skill of the professionals following a procedure is a significant factor; it helps aging parents in their recovery and in regaining a positive outlook. And it's so important for these senior citizens to push themselves to move forward so they can get back to normal--so the hospital experience doesn't take them down a notch.
5. And yet--there are emergencies when we do what we must in a hurry. And there are times when we know the decisions we make are crucial and we may get only one chance to do it right. But even then, the professionals in the best hospitals can come to the rescue.  
   

Have you had this experience? 

Two true stories will bring the "best hospitals" theme to life in this coming Tuesday's post. One an emergency (stroke); the other a well-thought out (after arguments and pressure) plan to treat advanced colon cancer. While not planned at the outset of the each health crisis, the best hospitals figured prominently in both. In the meantime, US News & World Report is at your newsstand now.


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Robert Butler, MD 1927-2010: Helping Aging Parents--Yours and Mine

Every aging parent today and every child with an aging parent today has, I believe--whether aware of it or not--reaped benefits from Dr. Robert Butler's work.  He brought the subject of "aging" and an awareness of our biased view ("old geezers") to the forefront in the mid-1970's and worked tirelessly throughout his life to research, impart information, and influence policy that ultimately changed attitudes and the way we support old age.

As we strive to help aging parents, we need to recognize that Dr. Butler pioneered the groundwork to help older people, then created, built and led organizations aimed at helping every senior to age better. To that end, let me share a personal experience as it pertained to helping my parents age well.

I remember, probably in the early 80's, a friend telling me about a group who met at Mt. Sinai Hospital in NY, to talk about aging parents and family members.  I was asked if it interested me. Of course it did. I was acutly aware of living far from my parents who were aging and was also sensitive to aging parent/grandparent issues in my counselees' families.  On the other hand, my Helping Children of Divorce book had been accepted for publication and my job at the high school plus family responsibilities made another commitment impossible. Never-the-less Mt. Sinai and "aging parents" remained on my radar.

In 1982 Dr. Butler founded the first department of geriatrics at a US medical school (Mt. Sinai's). I heard Robert Butler's name again and again. I also heard the term "geriatrician" but couldn't differentiate it from "gerontologist." It wasn't until the late 90's when my mother suffered (and recovered from) a stroke, followed by a fall in an unlit movie theater and a difficult recovery, that I understood the difference.

After receiving a phone call that Mother was dying and making long-distance, ultimately successful efforts to change her doctor to a geriatrician at a research/medical school hospital in Oregon, Mother made a miraculous recovery. Reason: a geriatrician who, among other things arranged to have Mother's catheter removed (it made life easier for the caregivers), and rebalanced her medications (she was small and was taking doses probably appropriate for an NFL tackle). I was "sold" on having a geriatrician as part of a team to help every medically-needy aging parent in the country.

I subscribed to a Tufts U. health newsletter in 2002 and read in an interview with Richard Bennett, MD, (a Johns Hopkins geriatrician and professor of geriatric medicine) that: "geriatricians have special training in diagnosing older people, whose disease symptoms may differ from those of younger adults...and that they may work harder to treat other problems often dismissed as inevitable (in older people) such as incontinence or memory loss" and that they are often part of a team.

Unfortunately, geriatricians are few in number compared to the aging population. 

• Reason: becoming a geriatrician requires additional years of training and not many medical schools offer this specialty; Mt. Sinai of course does.  
• Reason: $.  Geriatricians make far less than other specialists. 

So while the need is great, the number of specialists is small.

The NY Times (July 7, 2010) obituary section published many tributes to Dr. Butler.  I quote from the end of the (Washington DC) Leadership Council of Aging Organizations'  tribute: "Dr. Butler did as much as any leader in our time to advance the cause of protecting and helping older people in America and throughout the world.  His gifts remain beyond his lifetime."
 
As we try to help our parents age well, we recognize Dr. Butler's gift--to our parents now; to you and me in the future. 

For more information check out:

• When Do You Need a Geriatrician?, which I find very complete because the writer even "dug up" Dr. Bennett's comments.
• Dr. Butler's NY Times obituary

Also take a peek at my new site:http://helpparentsagewell.com  same blog+, (homepage still not finished)

Aging Parent. New Romance. Support? Protest? Ignore?

The more we invest ourselves in something--the harder we work at something--the harder it is to let go.  It's also more difficult to see things objectively.  But it's often a part of life as we try to help parents age well.

While some think the aging father discussed last Saturday is doing just fine, thank you, others have questions. Some can identify with and understand a devoted daughter's inability to think objectively about the benefits another woman can bring to an aging father's life--especially when she's much younger. 

One  adult daughter explains how her older father was revitalized by his relationship with a much younger woman.  From a rather "blah" aging widower, not wanting to leave his apartment unless necessary, he gained energy, loved "to be on the go." He was like a new person according to this daughter. They had the younger woman to thank.

Another woman tells of a man in his 80s who lived (unmarried) six years with a woman young enough to be his daughter--until health issues associated with aging began to catch up with him. The 50-something-year old woman still had many good years ahead and decided she didn't want to be tied down.  The man had six wonderful years with the younger woman, according to this pragmatic woman, years he wouldn't otherwise have had. She suggests if the devoted daughter can "wait it out" chances are the relationship could dissolve like the one just described. Easier said than done perhaps.

Other considerations:            

• As we try to help aging parents it makes sense to ask ourselves "what's the goal?"  Parent's needs/wants or adult child's needs?
• A special and close relationship with a parent is priceless. Shouldn't the daughter keep that thought "front and center" and let everyone happily move forward?
• If the girlfriend's age bothers the daughter, does she also realize that a younger girlfriend can be a big help to an aging parent? AND no doubt she'll take over some of the responsibility that would otherwise fall to the daughter (who in this case is a far-away living daughter).
• If there's a concern about inheritance issues, assuming the aging parent is of sound mind, there's nothing legally that can be done. However...
• If a child feels comfortable having a conversation about prenuptial agreements, and understands monies can be put in a trust for the younger woman's lifetime with the remainder going back to his family after her death, that's a possible conversation. But details should be checked with an attorney to be certain of facts before such a conversation takes place.
• Concern about a "gold-digger" or less-than-desirable "girlfriend?" One can always try Googling or--at the extreme--hire a private detective. This could legitimately be considered as "helping an aging parent" when there are seemingly valid reasons for concern.

Although aging parents may do things that we are skeptical of, they are still our parents. We are still their children. If they are of sound mind, is it better to let go of efforts to control things that don't endanger life and limb or their finances? Or should we, in our effort to help our parents age well, direct that energy towards making them happy?

What do you think?

Share your thoughts.  Leave a comment.
 
(Please use the gmail address at right if comments don't work.)  

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The homepage is not yet finished, but we're getting there. 

3-Day Weekend--Things Learned

I have now learned not to write a post that poses an important question, on whose answers the next post depends, over a three-day holiday weekend...not, at least, if the blog posts are written on Saturdays and Tuesdays.

Readership, I guess, can be expected to be down over such weekends. Hopefully with additional days off, caring children who live near parents and upon whom most of the responsibility usually falls, can take a break from needing to help aging parents or can plan something fun and different for them.

Even better, for children who live near, would be for at least one far-away living sibling to come and relieve that sibling upon whom most of the responsibility falls. Francine Russo explains --and this is my "take"--that it means a lot for a sibling to take the initiative (obviously without being asked) to plan to visit aging parents at a time that can free up the other sibling for a few days. And what could be better than a 3-day holiday weekend!

This not only gives the near-living sibling some time off, but signals that the far-away living sibling understands and appreciates what is being done on a regular basis to help their aging parent(s).

Until Saturday when we return to the aging father, his young girlfriend and devoted daughter---

Help! My Aging Father is Going With a Much Younger Woman

How do we feel when a widowed or divorced aging parent finds a new love?

When we love our parent and we're focused on helping parents age well, what happens emotionally? Are we happy? threatened? suspicious? Now add these specifics: the father is seventy-something-years-old and his girlfriend is four years older than his devoted daughter.

This is the situation and while not the norm, it's probably not that uncommon. With the help of senior advisor, Dr. Bud, MD (psychiatrist), some information and thoughts follow.

We know this daughter's hurting. But, according to Dr. Bud, it's not her problem. "It's a problem she's going to have to deal with," he says. I like that phrasing. My instinct would have been to say "It has become her problem." Dr. Bud's response suggests there's a solution..doesn't just leave it as a problem hanging out there.

Injecting a girlfriend into a family's dynamics no doubt requires getting used to under most circumstances. But the adjustment can be tempered by the knowledge that having a girlfriend, in and of itself, should be a positive as we think about helping aging parents. It's an additional and important connection that adds, we can assume, vitality and interest to an aging father's life.

Indeed we've discussed in previous posts the fact that relationships help aging parents to stay engaged. "Social connectedness" is identified as one of the three lifestyle factors that are the most significant predictors for healthy aging,"according to the MacArthur Study on Successful Aging, (which studied people age 70-79). Further proof that relationships help parents age well.

So we ask: would the daughter's feelings be the same if the girlfriend was a more appropriate age? This age thing is a problem that's out of the ordinary scheme of things. Dr. Bud calls it "a violation of expectations." (I guess it's similar to our belief that children shouldn't die before their parents.)

Other questions we're wondering about:

• Is she worried she may lose her father?
• Is there concern about inheritance?
• Is the girlfriend a "gold-digger?"
• Does the daughter fear her father will be taken advantage of?

We will have suggestions in Tuesday's post. In the meantime you may have had--or know of someone whose had--a similar experience. Please weigh in with comments (to helpagingparents@gmail.com if the comments section doesn't work for you). A devoted daughter, who's hurting, is out there.


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Resources relating to the three lifestyle factors: social connectedness , UCLA's summary of the MacArthur Foundation report, Successful Aging