Intro to Assisted Living

A lot of people think assisted living is the same as a nursing home.  Nothing could be further from the truth.  Many nursing homes tend to be a dreary place because the people living there are patients who need regular care and have limited mobility.  People in an assisted living facility are referred to as residents and treated as such.

A resident in assisted living has their own room or sometimes a shared room.  Newer facilities are constructed similar to a hotel environment.  The rooms are generally smaller than the average apartment but there are numerous common areas like in a hotel.  Older facilities may be a converted house with more of a group home feel. 

Residents are encourage to get out and socialize in the common areas and are usually required to have their meals in the dining room.  There are activities throughout the day to entertain and stimulate the mind.  My mother's facility even had happy hour 6 days a week with soft drinks, wine and beer.  Those folks sure loved that boxed wine!

A good facility will bring in entertainers on a regular basis.   At my mother's facility the lobby and other rooms would be absolutely packed when a popular entertainer was performing.  Sometimes my mother had to be forced to go these events but she always said how wonderful it was after she went.

Many facilities will provide transportation to doctor appointments and shopping on a weekly basis.  The good ones will also schedule field trips to get the residents out in the world.   They might go to a local concert, go sightseeing or, in some cases, plan a trip to the beach and allow the residents to put their toes in the ocean. 

I'll have a lot more to say about assisted living but I am a huge advocate of such facilities.  My mother resisted moving out of her home but after a short time in her new home, she was so glad she made the move.  In talking with other residents at her assisted living facility, I think at least 90 percent adjusted well to their new surroundings and decided it was a lot more fun that living alone.

Texting for Seniors

There's no reason seniors can't text like everyone else.   The difference is that their abbreviations may mean something different.  Have a laugh as you read through these texting definitions for seniors.

ATD - At the Doctor's

BFF - Best Friend's Funeral

BTW - Bring the Wheelchair

BYOT - Bring Your Own Teeth

CBM - Covered by Medicare

CUATSC - See You at the Senior Center

DWI - Driving While Incontinent

FWBB - Friend with Beta Blockers

FWIW - Forgot Where I Was

FYI - Found Your Insulin

GGPBL - Gotta Go, Pacemaker Battery Low

GHA - Got Heartburn Again

HGBM - Had Good Bowel Movement

IMHO - Is My Hearing-Aid On?

LMDO - Laughing My Dentures Out

LOL - Living on Lipitor

LWO - Lawrence Welk's On

OMMR - On My Massage Recliner

OMSG - Oh My! Sorry, Gas

ROFL...CGU - Rolling on the Floor Laughing...Can't get Up!

TTYL - Talk to You Louder

WAITT - Who Am I Talking To?

WTFA - Wet the Furniture Again

WTP - Where's the Prunes

WWNO - Walker Wheels Need Oil

Hope these help!
GGLKI - Gotta Go, Laxative Kicking in

Dementia and Alzheimer's 101

I was talking with a friend whose 83 year old mother is experiencing some signs of dementia.  For many, this becomes an emotional topic and, for some, causes more concern than physical ailment.   This post will provide an overview on dementia (as well as Alzheimer's) but you can expect more posts on this important topic.

First off, there is a lot of confusion about what is dementia and what is Alzheimer's Disease.  The two are very similar and, in many cases are indistinguishable.   In both cases, the patient exhibits short term memory loss and a decrease in cognitive skills.  At this time, the only way to conclusively distinguish between the two is during an autopsy but there a number of simple tests a Neurologist can perform to draw a reasonable determination if it is Alzheimer's.   It is important to do this because there are some promising drugs on the market that will slow the progression of  the disease (more on that in a future post).  My mother was diagnosed with Alzheimer's and fortunately, by working with a good Neurologist, it never progressed to the extent that it could have.

Many older people can suffer from dementia at one time or another.  Some of the reasons for temporary dementia can be a urinary tract infection, dehydration, hospitalization, certain medications or anything that disrupts their normal routine.  This type of dementia may often diminish or go away when things go back to normal.  

When someone is outside of their home surroundings, such as in the hospital, it's a very confusing time for them.  Don't be surprised if your loved one doesn't remember you were there the day before.  Don't expect them to remember what they had for a recent meal.  This is all normal even if it is upsetting to witness.  If they have recently started on new medications in the hospital, there's an even greater chance of them experiencing dementia.

If the elderly person is in familiar surroundings and their routine has been consistent, it's time to check for dehydration or a urinary tract infection (UTI).   Another friend of mine, whose mother still lived in her own apartment, seemed to be getting worse in terms of memory and confusion.  I asked my friend if her mother had been checked for a UTI and she said she would ask the doctor to check that on her mother's upcoming appointment.  Guess what?  She had a UTI.   After treatment for that, her mother's dementia improved.

If your loved one doesn't remember something or is confused, the natural inclination is to correct them or remind them what really happened.   It's frustrating for them when they can't remember something.  Don't add to their burden by arguing with them.   I've dealt with a number of seniors who would start telling stories that made absolutely no sense.  I watched their family members give them the third degree and everyone ended up more frustrated than necessary.   I believe in "going along for the ride".   The story may make no sense but it's at least good to hear them talk.  If my mother forgot something I used to remind her what happened and then move on.  Maybe tomorrow she'd remember it or maybe she wouldn't.  My only objective was to keep track of her behavior so I could work with her doctors to solve short term issues and make sure longer term issues were being tracked.

Bottom line is that dementia is extremely common in the elderly.   Your job is to determine if it's short term and needs action (dehydration and UTI), if it's middle term and will correct itself when circumstances revert back to normal (hospital visit) or if it's indicative of a longer term problem that can be managed with treatment (Alzheimer's).  Keep track of changes in behavior and discuss with their doctor.  Much more on this topic in the future.

Doctors - The Bad

As with most older people, particularly women, my mother had to see her doctor on a regular basis.  She had been going to one doctor for a number of years and he was her cardiologist and primary care physician.  The biggest challenge was that he constantly overbooked.  When my mother saw him, an hour wait was the norm and more than that was not unusual.  It was a bit better when she met with the Nurse Practitioner but the doctor always seemed to want to check in and see how she was doing.  That would cause more delays.  In reality, we all believed he wanted that two minute consultation so he could bill more. 

At one point, my mother needed to have her pacemaker replaced.  This required monthly office visits until the battery was in the red zone or insurance wouldn't pay for it.   My brother or sister-in-law had to take her every month for almost a year and each trip consumed hours of their time.  The doctor could have easily had the device monitored by a phone hook-up but then he couldn't bill as much so he chose to waste the patient's and family's time.

When my mother finally was ready to get the pacemaker replaced, it fell to me to deal with it since my brother was suffering from advanced stages of his cancer.  The surgeon who would perform the operation required sign-off from the primary care physician as is normal.  Unfortunately, her primary care physician decided to put her through extra tests including a stress test.  If you aren't familiar with them, it's a procedure that last a couple of hours.  Most PCPs don't do the test themselves but, of course, my mother's doctor likes to do things most doctors don't do in order to increase revenue.  Her doctor only did these tests two days a week and so I picked a day when she could get in early.   Her appointment was scheduled for 8:30 am which was the second appointment of the day.

When we go to the office, the receptionist advised us there were running about 30 minutes behind schedule since they had a problem setting up the machine.  The patient who was ahead of us went in about 40 minutes late so they were fairly accurate.  By the time my mother went in, it was about 90 minutes past her scheduled time.   I don't know where the extra 50 minutes went since the only person ahead of us was 40 minutes behind schedule.

Normally a stress test includes a treadmill with the doctor supervising.  In my mother's case, this part was skipped since she could barely walk without a cane, let alone walk on a treadmill.  This should have made things move more quickly but a process that should have taken two hours wasn't finished until FIVE HOURS after her appointment should have begun.  Ok, so they were behind 30 minutes because of the machine problems but it took 3 hours longer than it should have and she was the second patient of the day.  To say I was fed up with this nonsense was an understatement.

When we met with the surgeon, he agreed that he had heard a lot of bad things about my mother's cardiologist/primary care physician.  They were both in the same building and he saw all the same patients so he had a good perspective on things.  He gave me a recommendation for another doctor and suggested we wait until after the surgery to make a change.  In the past, my mother had fought with my brother about changing doctors because she just didn't like change.  By the time I got involved, she was more than fed up and agreed to make the change.   It didn't hurt that she wanted to accommodate my wishes since I was the son she never saw.  I have a feeling she thought I wouldn't show up if she didn't do it my way.

I'm sure along the way, I'll relay more on this doctor but for now trust me when I say he was not concerned with wasting his patients time if it meant more money in his pocket. While he was knowledgeable, I would say he was among the worst doctors I had ever encountered.  In future posts I'll be telling you about the good doctors and there are many out there and I'll tell you about some of them.

Rehab for Seniors 101

It seems like rehab is necessary whenever an older person goes into the hospital.  My mother had two stays in rehab plus I dealt with a number of other seniors who found themselves in rehab.  Let me tell you, there are vast differences in the way rehab is handled.

There is acute rehab and sub acute rehab.  The major difference is in the amount of rehab offered on a daily basis.  Acute rehab is generally 3 hours per day while sub acute is less (often half as much).  The therapy is divided into Physical, Occupational and Speech.   Rehab is generally provided in a rehab hospital (or rehab section within a hospital) or in a Skilled Nursing Facility (Nursing Home).  While a Skilled Nursing Facility can in many cases provide acute rehab, they generally are geared towards sub acute rehab. 

Rehab in a hospital environment is generally for those people who have had surgery or a stroke.  These situations require a higher level of medical care and more intense therapy so the facility will have a doctor monitoring the patient on a daily basis along with the rehab therapists.  When a senior citizen goes into a hospital for other than these two issues, they may need rehab to get their strength or balance back.   In this case, a Skilled Nursing Facility is the best solution.  There are a lot of insurance rules that come into play as well and so the Case Manager at the hospital will let you know which type of facility is appropriate.

Medicare or Medicaid generally allow up to 100 days of rehab treatment provided the patient continues to show progress.  If they plateau (no further progress), they will have to be discharged from the rehab facility.   If they are in a hospital environment receiving rehab, there is additional criteria imposed relative to the higher level of medical treatment.  If the need for medical treatment declines, they will probably be transferred to a Skilled Nursing Facility to continue treatment.

There's a lot more to say about rehab and in future posts you will hear about what to look for in a facility and how to make sure your loved one receives the best care.  

The Cat in the Hat on Aging

How true this is!

How it all began

A good place to start is at the beginning of my journey that allowed me to become a  bit of an authority on dealing with an elderly parent.   I have lived in California for a number of years while my mother lived alone in Massachusetts.   My older brother lived about 30 minutes from her and, since my father passed away about 10 years earlier, my brother had the responsibility of dealing with my mother.  I made my weekly call to see how things were going and did not get involved in her care.  That all changed when my brother developed cancer and could no longer look after my mother.   Much of the burden fell to my sister-in-law who was already overwhelmed with working and taking care of my brother.   It was late summer 2009 when I became more involved in my mother's care and soon thereafter began two years of frequent cross country trips that eventually turned into twice a month events.   Along the way, my brother passed away and I had to persuade my mother to move into assisted living.   I met some horrible doctors and some amazing ones.  I met some mediocre care givers and some true angels.  I supervised my mother's stay in rehab after her fall and took care of selling her house and cleaning out 55 years of clutter.  

I'm going to share with you how I dealt with my mother through persuasion, salesmanship and, once in a while, resorted to guilt trips.  After all, my mother thought she was the expert on laying a guilt trip so I learned from the best. 

I have to say, the journey was life changing but I was glad I was there because an elderly person needs someone to be their advocate in dealing with all aspects of their life.   I enjoyed the role even though there were many stressful times - all of which I'll walk you through.  

Along this journey, you may shed a few tears, you'll probably have a few laughs but most important, I hope you learn how to cope with the role reversal that occurs when your parent suddenly becomes your child.  Please feel free to offer your comments along the way and be sure to bring up any issues you may need help with as you deal with your own parent or other relative.  Hopefully I'll be able to make your own journey just a little bit easier.