Tag Archives: caregiving

Aging Parents and Tough Love; You Can Do This!


toughlove

Adult children of aging parents often struggle when the time comes to step in and assist with decision-making. The moment you realize your roles have reversed and you need to provide your aging parent with the support and care they need versus what they want.  Sometimes this happens gradually; sometimes the hospital is asking where you want your mom or dad discharged to and you haven’t a clue what to say.

It’s not easy…

It’s not easy when you know in your heart that your aging parent needs more help. Their home is a mess and you detect the smell of urine or their doctor is indicating a move to assisted living or worse yet the nursing home, is in order. Of course, your aging parent will have nothing of it and you’re left holding the bag of worries.  It’s difficult to balance their safety and their wishes when the two don’t coincide. The denial runs deep and you want to scream at the top or your lungs. You beg; you plead but it all falls on deaf ears.

I’ve been there…

Last year about this time my dad was in ICU in acute renal failure. it was clear to me early on that discharging right back to home was not going to be a good choice {read about the dirty details here}  yet that’s all he talked about; going home. I knew in my heart that if he didn’t get some inpatient rehab { i.e. nursing home care} that he would be back in the hospital within 2 weeks, if not 2 hours. I also knew in my heart that he was going to say “thanks but no thanks” to the nursing home idea, which he did.

Presenting it with clarity and compassion…

I was brutally honest {choosing my words very carefully} with my dad about what was happening and very clear about why he needed to go to the nursing home for a while. This piece of the tough love equation is easier for me because of my background but, with all my years of experience and know how, this was truly bringing me to my knees and pushing my inner child buttons like you wouldn’t believe. But I stayed the course by remaining clear and compassionate. I told him I loved him, I knew he was scared but that he’s was going to have to trust me on this.

Tough love doesn’t always feel good…

I will never forget the day my dad was wheeled out of the ambulance and brought in to the nursing home. The look on his face brought tears to my eyes and I seriously wanted to run away. Instead I ran to the door he was coming in so he could hear my reassurance that he was going to be in and out of there before he knew it. To be honest with you, I wasn’t convinced that was true but he needed to hear those words. Even as I write this, there’s a knot in the pit of my stomach and I’m tearful.

Tough love sometimes feels good…

My dad did make it out of skilled rehab {the nursing home} and continues to live at home with the support of his grandson. By stepping in and making that decision to strongly influence {force} my dad to spend time in the nursing home, I made sure he got the care he needed to be as independent and self-sufficient as he can possibly be at this stage in his life. When he talks about being in the nursing home, he admits he didn’t like it one little bit but he also doesn’t express any resentment about the experience; this is all I ask for.

I want you to know this…

Tough love is an issue of setting boundaries with our aging parents and doing what we know is right for them. It’s not always easy but if done with clarity and compassion tough love can make the difference between your aging parent being in a position that puts them at risk versus them getting the care they need so you can both sleep at night…

 

RELATED ARTICLES AND RESOURCES

Clarity Session to Help You Help Your Aging Parent

Aging Parents: My Personal Story

Transition to Senior Living Not Going Well? Don’t Give Up!


I wrote earlier this week about how difficult it can be adjusting to a senior living community and being the old new kid on the block. As a geriatric care manager, families often turn to me for help with this issue so I want to share with you the professional resources I turn to for help with my clients who are struggling with a transition.

My “go to” resources to help my clients struggling with a transition (drum roll please) are  Occupational Therapy and Counselling. By the way, both of these resources can be accessed under Medicare B with the cost of the co-payment so both are resources worth knowing about and exploring…

Occupational Therapy: I refer to an Occupational Therapist (OT) when I notice my client has some physical limitations that are interfering with their independence. Examples would be limited ability to use the phone, dress themselves or pour a glass of milk. I also refer to an OT when I suspect memory or cognition may be a factor in the transition. Perhaps your mom or dad are really struggling to reorient themselves to their new community.

An OT, can assess your aging parent and identify limitations and create a care plan to optimize functioning in those areas. They can also assist with adaptive equipment, room arrangement, cabinet organizing, orientation strategies and exercises designed to assist with increasing strength and mobility. The bottom line is an OT will create a care plan this is designed to maximize your aging parent’s independence. This can help with a new sense of well-being and confidence which naturally would make the transition a little easier!

Finding resources: ask the administrator of your senior living community, physician, local elder care network directory, yellow pages (if you can find one) or google: occupational therapist, Medicare B, outpatient, name of your city.

Counselor or Psychologist: I refer to a licensed clinical social worker (L.C.S.W) or psychologist (PhD) for counselling when my clients are exhibiting signs and symptoms that may be related to depression or intense anxiety about their move. I may even arrange this resource before the move if there is social history of mental illness, depression or difficulty with transitions. For some older adults and families, this can be a tough sell because of the stigmatization attached to mental health but trust me when I tell you it can make a world of difference for your aging parent to work with a counselor to help with this transition.

Finding resources: ask the administrator of your senior living community, family, friends, physician, local elder care network directory, yellow pages (if you can find one) or google: social worker, counselor or psychologist, Medicare B, name of your city.

Five Keys to Success

1) Physician’s order; both are Medicare B benefits and will require a physician to sign off and provide the order. Make an appointment for your mom or dad and attend that appointment!

2) Communication; don’t just ask the doctor for the order. Provide information that will lead them to understand the service is needed. i.e. “dad is having a difficult time getting dressed ” or “mom is tearful and isolating herself since the move”.

3) Positive spin; both are short-term disciplines so encourage your aging parent to be open to the help as it may just keep them in their apartment versus a nursing home (tough love).

4) Utilize both; you could certainly utilize both these disciplines at the same time. Two disciplines are better than one. The focus is very different so why not?

5) Flexibility; typically an OT can come to the senior living community but not always. You may have to arrange transportation to a counselor. Either way, flexibility will be needed.

Don’t hesitate to ask for help from either of these resources if your aging parent is struggling with their transition to a senior living apartment. A clarity session with me may help as well; during a clarity session we can strategize specific interventions for your aging parent and I can help you define which resources will be the best for you and your aging parent.

A little intervention early can make a BIG difference…

RELATED ARTICLES:

Aging Parents: Understand and Survive Their Transition!

Autonomy in the Retirement Community: Geriatric Care Manager’s Role

Aging with Autonomy in the Retirement Community

Coping with the devastating affects of Alzheimer’s Disease?


For all aging families out there coping with Alzheimer’s Disease, this one’s for you!

eleanorrooseveltindex

Bill Cosby Encourages You to Forgive Yourself!


billcosby

 

I get a little uncomfortable when I see children of aging parents helping in an attempt to atone for past mistakes…

You can still help but understand that coming from a place of trying to “make up for” past transgressions puts you in a precarious dynamic from the get go.

Forgive yourself and move on!

Aging Parents: Open Your Prison Cell and Be Free


iStock_000013733071Small

There are times I’m working with a client and just for fun I throw out the topic of forgiveness. I may say something to the effect of “have you ever considered forgiving your mother for what she’s put you through?” or “perhaps you could consider forgiving your brother for not being here to help you”.

The response varies from silence to a look of utter disgust, as if I’d just confessed to being a mass murder…

Then I qualify what I’ve said in terms of the suffering I see in a person’s eyes, the pain they express or the chaos that’s swirling around and the choices that have to be made about the care an aging parent needs to receive. Holding on to resentment towards an aging parent while at the same time trying to help them puts both of you at varying degrees of risk.  So consider letting go of it for your sake and for your aging parents’ sake but ultimately know this…

Forgiveness is not something you do for your aging parent or toxic sibling; forgiveness is something you do for yourself.

One of my favorite books on forgiveness is “Forgiveness is a Choice” by Robert D. Enright, Phd and in it is one of my favorite quotes on forgiveness…

 “Unforgiveness, bitterness, resentment, and anger are like the four walls of a prison cell. Forgiveness is the key that opens the door and lets you out of the cell”

Consider releasing yourself from you prison of anger and resentment towards your aging parent and free yourself of the toxic dynamics that tie you down.

The choice is ultimately yours…

Aging Parents: Healthy Boundaries and Support


Elderly Lady with Alzheimer's Disease

Setting healthy boundaries with aging parents requires developing a network of both formal and informal support. Informal resources are friends and confidants that you can rely on either in a physical way or an emotional way. Perhaps you have a friend that can take your mom to the hair dresser once a week; a friend that can set you straight about setting boundaries and practicing forgiveness. Informal support is a must but can only provide the basics of what you and your aging parent may need. Consider establishing a formal support system that will assist you in helping your aging parent get their needs met and create healthy boundaries for both of you.

Your formal support system is created by working with professionals in the field of elder care and geriatrics. Whether it’s a non-medical home health agency, a geriatric care manager, the social worker in the nursing home, a support group, counselor or chaplain, you need someone who you can go to with your boundary issues to seek guidance and support. You need someone who you can call and say “I’m at the end of my rope; can you help with mom/dad?” You also need someone who can step in and ensure that your aging parent has the care they need. Professional support will not only provide you with the physical nature of what your aging parent needs but they can also assist you in understanding your aging parents “true need” versus manipulative behaviors that rope you in to stepping over the boundaries.

By established, I mean a support system that understands the unique challenges you and your aging parents face. From family dynamics and social history to a current diagnosis of Alzheimer’s Disease  a network of informal and formal people who you have met face to face with and established a care plan that will support you in consistently setting healthy boundaries and allow you the opportunity to continue to give time and time again. Keep your support system strong as you travel along your journey because it’s not a question of if you will need them but when you will need them.

Which of your friends can you rely on for emotional support? Can any of your friends provide you with help 2 hours a week or month? Which of these experts is available in your community and who do you need on your team? Which ones can you take a class from to learn more about boundary setting or specific services? How can you formalize your relationship with them to create a formal support system that you can tap in to as needed?

Write the answers to these questions on a piece of paper and keep it handy!

Take ownership of your support team and be responsible for setting those healthy boundaries with your aging parent or loved one. You cannot help your aging family member if your cup is not full and the boundaries are blurred. If not for yourself; do it for them…

RELATED POSTS

COUNSELING AND GERIATRIC CARE MANAGEMENT; WHAT’S THE DIFFERENCE?

AGING PARENTS; LET’S TALK HOME HEALTH CARE AGENCIES!

AGING PARENTS; WHAT IS GERIATRIC CARE MANAGEMENT?

Aging Parents: What is Geriatric Care Management?

Home for the Holidays and Aging Parents


iStock_000016670352_Small

For many of us, “home for the holidays” can be that time of the year we notice something isn’t quite right with our aging parent or family member. Sometimes the signs are obvious; other times they’re not. Here are some red flag warnings that may indicate that your aging parent or family member is at risk and in need of some help.  

  • Clutter and odors in a home that was always neat and clean
  • Outside of home in disarray, uncut grass, need of repairs
  • Weight loss or weight gain
  • Poor grooming by a person that once was meticulous
  • Refusing to go with friends and family on social outings or to doctor appointments
  • Avoiding all conversations related to “how they are doing”
  • Intense mood swings, anger and anxiety
  • Excessive drinking, smoking or eating
  • Unpaid bills, maxed out credit cards, piles of unopened mail, sweepstakes entries
  • Neighbors and friends pulling you aside to voice concerns
  • Unexplained dents in their car
  • Difficulty getting in and out of the chair
  • Bruises or limping that may be the result of a fall
  • Pets uncared for, cat box hasn’t been scooped, matted dog fur, under or overweight pet
  • No food in the house or junk food containers from a person that normally would cook

What next?

In extreme cases; no food, no utilities, delusional or combative parent, severe urine and feces odor, filth in the house, neighbors reporting bizarre at risk behavior. Behaviors and signs that your aging parent is at risk of self-neglect; your best bet, in a short-term long distance visit, is to contact the local Adult Protective Services. They don’t have a “magic answer” but they can start by assessing and attempting to get services in place.

Establish communication with doctors, neighbors, friends and family members. You start this conversation by stating that you are worried. Out of respect, you don’t have to be real specific but voice concerns and ask the doctor, neighbor, friends or family to call you if they see anything out of the ordinary.  It is critical that they all have your phone number (or email) and you have theirs.

Resource round-up. Now would be the time to locate resources in your aging parent’s community that may be able to help you now and in the future. It might be a home health agency, nursing home, area council on aging or a geriatric care manager depending on your aging loved one’s specific need and location. There’s an aging network in place; tap in to it! Also, consider what your informal resources are such as neighbors, churches, friends and local family.

At the initial stage of long distance care giving, I can’t emphasize enough the importance of setting realistic expectations for yourself and your aging family members. What you may feel is helpful; they may feel is intrusive and controlling.  Their solution to their aging challenges may be less than adequate and keep you up late at night with worry. The best solution won’t be created in a couple of days. The key is to find middle ground and take tiny steps forward.  Understand that in many ways your hands are tied. Do the best you can with each phone call and every visit. That’s all you can ask of yourself…

RELATED POST YOU MAY FIND HELPFUL

Aging Parents: Understand and Survive their Transitions

Growing Old: It’s not just About Taking the Right Pill at the Right Time!

Aging Parents: Fast Forward 30 Years

Aging Parents: Let’s Talk About Guilt!


Let’s talk about guilt.

Guilt: feelings of culpability especially for imagined offenses or from a sense of inadequacy.

We all feel it from time to time. It can really paralyze children of aging parents and lead you to make decisions based in fear and toxic emotions not healthy ones.  Those decisions can lead to resentment, which can lead to depression, which can lead you to ultimately not able to care for your aging parent in a healthy way.

Years ago I was facilitating a support group when an older woman who had been caring for her husband, who was suffering with Alzheimer’s disease, spoke. Mary (not her real name) had been caring for Dale (not his real name) for some time and it had been quite a struggle: eloping in the middle of the night, calls to the police, physical behavior etc…

The conversation went something like this…

Mary: I put Dale in a nursing home a couple of weeks ago and I’ve been dealing with this overwhelming sense of guilt. (tearful)

Me: Do you not feel it was the right choice?

Mary: Yes it was the right choice.

Me: Are you happy with the care he’s receiving?

Mary: Yes the people are wonderful and they are good to him.

Me: What do feel so guilty about?

Mary: How good I feel about it all!

Group: Laughter and hugs all around.

The moral of this story: be clear on what you feel guilty about. Dig deeper in to the emotion and understand that you have the right to feel this way. It would have been so easy for Mary to displace her guilt on to the staff at the nursing home or feel anger at her children for not providing more support.

I admire her courage for stating her truth and you can bet she made an impression on me and others at her support group. By clarifying what we feel guilty about we can then make room for the transition to occur, grief to unfold and the journey to continue…

Aging Parents: Put Your Oxygen Mask on First


Concentration

 

When conducting demonstrations on how to use your oxygen mask on a plane, there’s a reason flight attendants instruct us to put our mask on first: if we can’t breathe we can’t help those around us. When my kids were really little, I use to think “there is no way I’m not putting their mask on first”. Our instinct as parents and now your instinct as a child of an aging parent is to put their needs first: to put their oxygen mask on first.  I’m here to tell you over and over: you can’t help your aging parent if your oxygen is depleted…

True Story Time…

I was in the process of discharge planning for a geriatric rehab patient and called her daughter just to touch base regarding the arrangements that had been made and inquire in to how much support she was providing. There was absolutely no indication that there was any tension between the two and I thought it was going to be a quick call to touch base. Boy was I ever wrong…

The conversation went something like this…

Me: I just wanted to touch base to see if you had any questions and to let you know what the recommendations are for your mother. Specifically I need to know if you can transport her back to her apartment and bring her portable oxygen tank to her.

Daughter: {in a nut shell} I’m sick and tired of caring for my narcissistic mother. She then went on to express anger and resentment towards her mother that dated back to childhood grievances. She was agitated, overwhelmed and clearly her oxygen was depleted.

Me: I understand where you’re coming from: It’s really hard to be there for an aging parent that wasn’t there for you when you were a child.

Daughter: {after a pause and heavy sigh} yes, thank you, that’s exactly how I feel. I just can’t do it anymore,  she has run me ragged with her demands.

Me: You know you don’t have to pick her up and you don’t have to bring over the portable oxygen tank.  I can help her figure out how to do it independent of you.  She’s capable of figuring it out with a little bit of support from me.

Daughter: No I’ll bring over the oxygen and I’ll pick her up tomorrow {clearly in a tone that indicated she didn’t want to do this}.

Me: You think about it and I want you to also think about maybe seeing a therapist or counselor {luckily she already had one}. Remember there’s always more than one way of doing this. You don’t have do it all yourself.

I go on about my business of a busy day and a few hours later she calls me back and the conversation went something like this…

Daughter: {in a very clear and calm tone} I’ve decided that I will be bringing over my mother’s oxygen tank but I was wondering if I dropped it off at the front desk if you could take it back to her. I just can’t deal with her drama today.

Me: Of course, I’d be happy to do that for you.

Daughter: I’ve arranged for a couple of my friends that  my mom knows really well to pick her up and take her back to her apartment and get her settled in.  I’ll go over the next day and check on her. Do you think this ok?

Me: Not only do I think its ok but I applaud you for getting your mom’s needs met by taking better care of yourself.  It’s a win-win for both of you.

This story describes so well the concept of putting your oxygen mask on first. By putting her needs first, the daughter was calmer, clearer and got her mother’s needs met that worked better for both of them.  I’m sure this wasn’t the end of their story and I’m sure the daughter had many more moments of oxygen deprivation but I hope she learned a different way of looking at her situation.

If you can’t breathe, you can’t possibly help your aging parent in a way that feels good for them or for you.  Deprivation leads to resentment, anger and depression.

Put your oxygen mask on first…