Thank you for returning to this multi-part series on long-term care residents’ rights. At the bottom of this article, you will find links to the previous five postings. As this is the last in the series, I want to advise my readers that I have in no way covered every topic that could be covered in a series such as this one. I have, however, covered complaint topics that quite commonly occur in long-term care settings. In most complaint categories, more than one residents’ rights law has been violated. For the most part, I have only mentioned one aspect of the law that addresses the rights violations.
Today’s topic covers the umbrella topic of dignity and quality of life. Without exception, every rights violation is an infringement of a resident’s dignity and a detriment towards enhancing the quality of life residents should expect to experience. The same holds true whether that resident lives in a “Champagne and Chandelier” facility or a “Generic Brand X” facility. Regardless of how fancy, regardless of how bland, the same rights are afforded to all residents. All situations listed in this six-part series assume a resident is cognitively capable of making his or her own decisions.
Breakfast in bed, pee on the side
I rolled over in bed thinking I might get a few additional minutes of sleep, but those potential minutes were rudely interrupted by the assault from the room’s overhead light, the hustle of someone rushing into my room, and the abrupt raising of the head of my electrically powered bed. I don’t know if you’ve ever tried to remain curled up on your side while half of your bed is put at a 90 degree angle, but trust me, it’s not possible and it’s not comfortable.
“Hey, Gloria, time for breakfast. Come on, open your eyes and sit up so I can give you your breakfast tray.”
I’ve lived in this nursing home for three months now and every time one of these care people talks to me, they call me by my first name, and in my eyes, that’s a sign of disrespect. “First of all, I’ll remind you that my name is Mrs. Lewis, and second of all, I absolutely cannot eat the morning meal prior to going to the bathroom. Please help me to the toilet and then I’ll have my breakfast.”
“No can do, Gloria, you’re just one of forty other patients I have to personally deliver meals to this morning. You should have thought of that earlier and asked one of us to take you to the toilet before we started delivering meals.”
“But I was asleep, and besides, I told the head nurse many times that I require toileting assistance and that I require it before my morning meal. How many other times must I make this request?”
“I don’t know, how many?”
I looked at this uncaring individual and pleaded with her. “Please won’t you take me to the potty? My bladder is ready to burst!”
“Look, I’m already running behind. Just go in your pants, that’s what your nighttime diaper is for any way. Sometime after your breakfast, someone will clean you up, but it won’t be me. After I deliver all my trays, my shift is over.”
Imagine, if you can, not having the opportunity to use the bathroom after a full night’s sleep, and trying to enjoy a meal that is placed before you. Then imagine not being able to hold it any longer and peeing yourself and sitting in it for who knows how long. The above scenario is real. A family member of mine experienced this exact scenario. I also am acquainted with a gentleman who, after asking three times in a half hour period to be assisted to the restroom so he could evacuate his bowels, he was told “Go in your pants. I don’t have time to help you right now.” That neglect does not preserve a person’s dignity, nor does it promote quality of life.
42 CFR 483.15 Quality of life. A facility must care for its residents in a manner and in an environment that promotes maintenance or enhancement of each resident’s quality of life.
(a) Dignity. The facility must promote care for residents in a manner and in an environment that maintains or enhances each resident’s dignity and respect in full recognition of his or her individuality. See also Washington State law RCW 70.129.005 and RCW 70.129.140
What follows are a few other frequently occurring scenarios found in LTC residential settings:
Visitation policies: residents have the right to receive visitors of his/her choosing and a facility must not interfere with such access. There is no such thing as visiting hours, regardless of the LTC setting. If an adult son’s work schedule is such that he can only visit before 8 a.m. or after 9 p.m., reasonable accommodation must be made to facilitate his visit.
Choices regarding schedules, clothing: regardless of LTC dining room and meal hours, a resident has the right to receive meals outside of those hours. For example, if a resident is not an early-riser, he should still be able to acquire a suitable breakfast meal; this does not mean that he has full access to all that was offered prior to the “end” of breakfast hours, but he should still be able to eat breakfast items. A peanut butter & jelly sandwich does not qualify as such – unless, of course, that’s his choice. Unless a resident has turned over the responsibility of making daily clothing choices to a staff person, a resident must be given the opportunity to make clothing choices that are important to her. Clothing choices promote individuality. Each of you reading this article dress as you please; that shouldn’t change just because you move into an institutional setting.
Isolation & seclusion: punishment to a resident for perceived misbehavior in the form of prohibiting participation in dining room meals and/or activities of his choosing, is not appropriate and is a complete violation of a resident’s rights. A better response to behavioral issues is to discern the cause of said issues, e.g., depression, medication anomalies, medical conditions such as a urinary tract infection (UTI). Resolve the cause, and you resolve the effect.
Series links: Part 1, the right to make choices that are important to the resident; Part 2, admission polices, waivers of liability; Part 3, eviction and discharge process; Part 4, substandard and neglectful care; Part 5, accepting or rejecting medical care.
With the Holiday season upon us, many of us will be at family gatherings of our choosing, or perhaps not of our choosing. The focus of these jokes: mothers-in-law.
David is finally engaged and is excited to show off his bride-to-be. “Ma,” he said to his mother, “I’m going to bring home three girls and I want you to guess which one is my fiancee.” Sure enough, two days later, David walked in the door with three girls following behind him.
“It’s that one,” said his mother without blinking an eye. “Holy cow,” exclaimed David, “how in the world did you know it was her?”
“I just don’t like her,” she replied.
A presser in a tailor shop arrived one morning wearing a good-sized diamond ring. One of the tailors noticed the sparkler and asked about it.
“My mother-in-law gave me a thousand dollars just before she passed away. She said that when she dies, I should buy a beautiful stone. So I did!”
I was at a magic show when after one particularly amazing trick, someone screamed out, “Wow, how did you do that?”
“I would tell you,” answered the magician, “but then I’d have to kill you.”
After a moment’s pause the same voice in the crowd screamed, “Can you tell my mother-in-law then?”
Integrity, n.1 the quality of having strong moral principles; 2 the state of being whole;Concise Oxford English Dictionary, 11th Edition, 2004
Integrity, n. the quality of being honest and fair; the state of being complete or whole; Merriam Webster
I respect the law and I respect the attorneys with whom I have worked and/or done business. What I don’t respect, however, is when ridiculous legal loopholes exist, and those legal loopholes are taken advantage of to the detriment of others.
Here’s my story. I was attacked by two dogs while walking in my neighborhood on May 7, 2014. While the dogs were in active attack mode – barking and chomping at my feet while I concurrently screamed at the dogs to leave me alone – the owner of the dog, whom I could hear but not see on their property, never came out to discover what the ruckus was all about. Then one of the dogs bit me, and shortly thereafter, both dogs retreated back to their property. I yelled to the owner, whom I still couldn’t see, “Your dog just bit me!” To which she replied, “Sorry.”
I chose not to approach the offending dogs’ house to confront the owner because quite frankly, I was afraid the dogs would consider me an even greater threat than when I was on the opposite side of the street from their house. Instead, because I was still able to walk, I hiked the remainder of the way to my house, cleaned my wounds, and headed to a hospital emergency room. After being treated, I returned home and filed an online complaint with my county’s animal control division.
The dog owner hired an attorney to fight the vicious dog charge and the inherent requirement to keep the dog contained at all times when outside. The attorney postponed the appeal hearing three times. The most recent hearing date was to be November 17, 2014. I planned on attending the hearing, even though I had submitted the following to the appeals court: 1) online official complaint with photographs of my injury; 2) my supplemental statement augmenting the county’s complaint form; 3) ER medical records documenting my treatment; 4) a receipt from the hospital where I sought treatment for my portion of the visit, $50.
The legal loophole was created the day after the incident. An animal control officer interviewed me at home and the dog owner at her home. Immediately after the latter, the officer gave the dog owner a 2-page handwritten citation summarizing the incident and detailing the infractions: 1) two unlicensed dogs; 2) two dogs at large; 3)two dogs without up-to-date rabies vaccinations; and 4) having a vicious dog on the premises. Biting a human being = vicious dog. When the investigating officer returned to the county animal shelter, he inputted all applicable information electronically into the shelter’s database. The written citation which was personally handed to the dog owner who signed the citation as proof that she had received it, did not specify which of the dogs bit me; the electronic citation did. That discrepancy voided the credibility of the animal control citation process.
I’m kidding, right?
A settlement was reached between the dog owner’s attorney and the county animal control agency stating that the dog containment order was rescinded and the vicious dog designation was removed. The attorney would agree to all the citation fees – totaling $850 – if animal control would give the dogs/dog owner a clean record in the matter. Animal control agreed. Keep in mind, part of that $850 was a $500 vicious dog citation. The dogs were vicious, there’s no question about that. The fact that the attorney agreed to let his clients pay all the fees speaks to that, as well as the fact that the dogs’ behavior satisfied the legal requirement to meet the definition of vicious.
The owners were penalized, why should I still care?
Because the only penalty they received was monetary. My neighbors and I did not benefit at all from the dissolution of the matter. The vicious dogs are not required to be contained on their property and there will be no vicious dog record of this incident should they ever get cited again. If the vicious dog designation had been honored, the repeat offender fee would jump to $1,000 just for the vicious dog designation.
I guess when you don’t have a choice in the matter you gradually come around to liking life in the assisted living “community” as the staff at this facility like to call it. When I couldn’t get around my old place without the constant threat of falling in the neighborhood or falling asleep at the wheel of my 1994 Mercury Sable, I took my son’s advice as gospel, and let him move me five miles from my lady friends, and ten miles from the Baptist church I had attended for God knows how long.
Now, my only option is to attend an ecumenical service in the activity room each Sunday – it more or less satisfies those who rely on some sort of ritual to get them through the following week – and I have a completely new set of lady friends with whom I eat every meal.
It must be baseball season; for lunch today, the dining room is decorated with red, white, and blue crepe paper and the centerpieces contain a miniature bat and ball placed “just so” surrounded by a pile of sticky Cracker Jacks that we’re told are not edible, but I try one anyway and add credibility to the admonishment by spitting it out into my napkin.
Lord have mercy, we even have a special lunch menu from which we can choose what apparently is considered food one would eat at sporting exhibitions: hot dogs, hamburgers, fries, all served with a gigantic phallic-looking dill pickle on the side. Now, don’t act so shocked. The young people don’t think us older folk know what the intimate body parts are called and that we would never know what to do with them even if we did, but let me tell you, my group of lady friends have a laugh or two over things of a sexual nature. We’re not dead yet and most of our memories of such things are still intact.
The four of us ordered the chili dog special and got caught up on all the latest news since the previous time we saw each other. About ten minutes later, my meal was served, followed by everyone else’s, and the young server said, “Bon appetite!” But something was horribly wrong. Before the gal got too far away, I beckoned her back to the table. “Sweetie, what is this pile of dog-poop looking stuff on my plate?”
“That’s your chili dog.”
“My lady friends ordered the same thing I ordered and yet look at each of theirs: a hot dog is nestled into a bun, smothered by chili, cheddar cheese, and a few onions. My hot dog, on the other hand, looks like a pile of poo!”
The waitress addressed me, and therefore all the other ladies at the table. “We have a Special Menu report the kitchen & wait staff are required to review before each meal. There was an entry for you stating that all your food must be pureed because you’ve been having difficulty swallowing. Evidently, when you went out to dinner with your son a couple days ago, you almost aspirated on a piece of flank steak. Remember? The Maitre d’ of that restaurant had to Heimlich you. You could have choked! You won’t choke on pureed food – or at least we hope you don’t – so that’s what you have to eat. Doctor’s orders.”
My lady friends looked embarrassed for me and pretended that this youngster wasn’t talking about my health issues in front of everyone within hearing range. But that’s not the only thing that’s bothering me right now: I want to eat a chili dog that looks like the rest of the chili dogs on the table so I decided to tell the server. “I’m sorry, remind me of your name, sweetie?”
“My name is Jessica.”
I picked up the plate of poo and shoved it towards her. “Jessica, please toss this mess in the trash and bring out a real chili dog, and while you’re at it, I want a hefty serving of French fries as well.”
“I can’t do that Mrs. Bellamy, I’ll get in trouble.”
“You’ll get in trouble if you don’t provide me with the food that I’ve requested. Please take this plate away from me, my arm is getting tired holding it up.”
The youngster took my plate and with the other hand, signaled her boss to join her in the kitchen – no doubt to report my aberrant behavior. My lady friends, however, applauded my assertive efforts, and offered me a bite of their dogs while I waited for mine to be served.
Mrs. Bellamy’s pureed diet was prescribed by her doctor; as such, it is now a part of her medical profile at the assisted living facility in which she lives. Mrs. Bellamy chose to ignore her doctor’s orders – certainly her right whether she lived in her private home or this public facility. Residents at LTC facilities have the right to refuse prescribed treatments such as restrictive diets, medications, or physical therapy to name a few. As cognitively capable adults, they have the right to go against doctor’s orders, fully understanding the risks of not abiding by such orders.
42 CFR 483.10
(b) Notice of rights and services.
(1) The facility must inform the resident both orally and in writing in a language that the resident understands of his or her rights and rules and regulations governing resident conduct and responsibilities during the stay in the facility…
(3) The resident has the right to be fully informed in language that he or she can understand, of his or her total health status, including but not limited to, his or her medical condition;
(4) The resident has the right to refuse treatment, to refuse to participate in experimental research, and to formulate an advance directive as specified in paragraph (8) of this section; …
(d) Free choice. The resident has the right to –
(1) Choose a personal attending physician;
(2) Be fully informed in advance about care and treatment and of any changes in that care or treatment that may affect the resident’s well-being; and
(3) Unless adjudged incompetent or otherwise found to be incapacitated under the laws of the State, participate in planning care and treatment or changes in care and treatment. See also Washington State law RCW 74.42.040(3)
Additionally, Mrs. Bellamy’s medical condition should not have been discussed in front of everyone within hearing distance: her lady friends, other residents seated adjacent to Mrs. Bellamy’s table. The HIPAA Privacy Rule also applies in LTC settings. Jessica, the server, violated Mrs. Bellamy’s right to privacy by talking about her medical condition.
My mother was the quintessential social butterfly but not in the way one might imagine. Her social involvement didn’t include tennis or golf, nor did it center on being seen at extravagant galas around the city. My mother, Joan Young, socialized with the homeless, the hungry, and the vulnerable. Mom was a volunteer extraordinaire whose monthly calendar was filled with opportunities in which she would donate her time, her resources, and her compassion.
One of her most time-consuming, but most gratifying volunteer venues, was as an activity assistant at Shady Rest Nursing and Rehab Center. That same venue is now her permanent home where she’s lived the past month and a half since a massive stroke robbed her of the ability to speak or move her limbs. We think she understands what we say to her because oftentimes she’ll get a twinkle in her eye that appears to relay some sort of connection with us. The experts say she most likely still recognizes us, but even if that is not the case, I hope the presence of smiling, happy visitors go far towards improving her quality of life.
The last few days, however, mom was withdrawn, and more often than not, she slept through my visit. Because I live within close proximity of the Shady Rest, I visit her almost daily. Dad and his wife live another state over, so although they were on speaking terms prior to mom’s stroke, speaking to anyone isn’t really mom’s strong suit right now. I don’t mind carrying the torch for mom; she’d do the same for me.
After four days of a significant reduction in alertness, I talked to the head floor nurse to discuss mom’s change in condition. She assured me that one can expect sudden changes in levels of cognition after the assault that was placed on her body as a result of the stroke. The nurse told me to toss my cares aside and trust the Shady Rest staff with mom’s care. “She’s in good hands, Robin. There’s no need for you to worry. If there is ever anything that needs medical attention, be assured we’ll take care of her.”
But they didn’t. Three days later, I noticed a fetid smell as soon as I entered her room. At first I thought that perhaps mom had gone Number 2 in her adult diapers but when I lifted up the sheet that covered her body, I saw she wasn’t wearing any. But oh my God, the smell was even worse. I looked behind me to see if anyone was looking, and seeing that the coast was clear, I gently rolled my mother’s body away from me and discovered the source of the stench: an oozing, red and green sore about the size of a quarter on her left buttocks. I couldn’t help myself; I ran into the bathroom and threw up the lunch I had eaten prior to arriving.
Then I pushed the Call Button which is supposed to summon a health worker post-haste – or so I was told when mom first moved in. Three minutes ticked by: no response. I pushed the button again, this time walking to the doorway of mom’s room to look up and down the hallway for signs of incoming staff members. Not a soul in sight.
I left my mother’s room in search of a staff person and landed in front of the nurses’ station. I pounded on the counter, “Hello! I’m Robin, Joan Young’s daughter. I called you twice from my mom’s room.” That’s when I heard, for the first time, a sound that in the past always seemed to be an indeterminate background noise: the persistent dinging of Call Button tones from various rooms on the floor. A quick glance up and down the hallway also showed lights blinking above numerous rooms that coincided with each ding.
I pounded the counter again and pointed at the LPN sitting at a computer. “You, follow me.”
“Miss Robin, I’m finishing up a report, I can’t leave my desk right now.”
I tossed all protocol to the side, walked behind the counter, pulled the computer mouse out of her hand, jerked her chair back and tilted it forward. “Come with me, now.”
That seemed to work but I didn’t take any chances. I held her hand and pulled her down the hallway into my mother’s room. “Do you smell that?” And then I pulled down the sheet on my mother’s bed, gently rolled her away from us and added, “Do you see that?”
“Oh my, Mrs. Young has a bed sore.”
“Ya’ think? This sore didn’t just materialize in the past three hours ya know. It’s been festering.”
“You could be right.”
“No, I am right. I want you to summon the head of nursing and I want you to summon her now. Tell her to meet me in my mom’s room, ASAP.” The LPN didn’t move, so I pushed her out the door. “Go!”
*****
The bed sore – or decubitus – had yet to go bone deep. Had that been the case, mom would most likely not have recovered from the infection. As it was, her health never returned to its previous state, even with the excellent care she receives at a different nursing home, thirty miles away from where I live. Sunnyside Nursing Home wasn’t as fancy as the other place, but obviously, looks can be very deceiving. What my mom saw as an activity assistant volunteer was far different from what she experienced as a patient. When we chose Shady Rest as her new home, we did so without the benefit of readily available resources that would have provided red flags as to the quality of care provided. We figured, “Heck, mom loved volunteering at Shady Rest, why look any further?”
Shame on us.
Joan Young was the victim of willful inaction that caused a potentially fatal injury to her person. Joan’s inability to verbalize or express her pain and discomfort, other than the withdrawal and malaise eventually recognized by her daughter, put Joan at even greater risk of serious health decline resultant from the unattended bedsore. Facilities must assure that a resident’s body is routinely turned to different and varied sitting and lying positions in an effort to prevent such bedsores. In addition to bedsore prevention, if Joan had been diligently cared for – for example, if her ongoing bathing and care plan had been strictly followed – any skin abnormalities would have been immediately noted and attended to and infection could have been avoided.
42 CFR 483.25 Quality of care. Each resident must receive and the facility must provide the necessary care and services to attain or maintain the highest practicable physical, mental, and psychosocial well-being, in accordance with the comprehensive assessment and plan of care …
(c) Pressure sores. Based on the comprehensive assessment of a resident, the facility must ensure that –
(1) A resident who enters the facility without pressure sores does not develop pressure sores unless the individual’s clinical condition demonstrates that they were unavoidable; and
(2) A resident having pressure sores receives necessary treatment and services to promote healing, prevent infection and prevent new sores from developing. See also Washington State law RCW 74.34.
Some of you readers might be thinking, Well, if her daughter had been more attentive, she would have noticed the sore earlier or Why didn’t she say something about her mother’s malaise right away instead of waiting several days? Being an armchair quarterback is a very easy position to play. The very unfortunate – yet somewhat understandable – attitude of some family members and/or patients is: This is a licensed facility staffed by medical professionals; who am I to question their ability to take care of my mother? The answer to that is obvious: even when a family member moves into a long-term care setting, you must continue to exercise your role as family advocate. I understand the relief one feels of trusting ones care to a staff of professionals, but the unfortunate truth is sometimes that trust is misplaced.
Part 5 of this series will deal with a resident’s right to make choices about their own medical treatment. Part 5 will be posted on Friday morning, November 21.
A woman brought a very limp duck into a veterinary surgeon. As she laid her pet on the table, the vet pulled out his stethoscope and listened to the bird’s chest. After a moment or two, the vet shook his head and said, “I’m sorry, your duck Cuddles has passed away.” The distressed woman asked if he was sure, and he replied, “Yes, your duck is dead.”
“But you haven’t done any testing on Cuddles. He might just be in a coma.”
The vet left the room and returned a few minutes later with a black Labrador Retriever. The dog stood on his hind legs, put his front paws on the exam table and sniffed the duck from top to bottom. He then looked at the vet and shook his head. The vet left the room with the dog.
He returned to the room, this time with a cat. The cat jumped on the table, delicately sniffed the duck from head to foot, sat back on its haunches, shook its head, meowed softly, and strolled out of the room.
The vet looked at the woman and said, “I’m sorry, but as I said, this is most definitely, 100% certifiably, a dead duck.” The vet turned to his computer terminal, hit a few keys, produced a bill and handed it to the woman.
“A hundred fifty dollars!” she cried, “$150 just to tell me my duck is dead?!”
The vet shrugged, “I’m sorry, but if you had just taken my word for it, the bill would have only been $20. With the Lab report and the Cat scan, it’s now $150.”
The first weekend of October, I attended my first writer’s conference, a conference that inspired me to live a life filled with high risk writing. The risk? I might get rejected.
I entered two contests within a week of returning home. Alas, I found out on Wednesday, November 12th, that I did not win the Writer’s Digest Dear Lucky Agent contest. This was a contest wherein a writer’s completed – but not yet published – manuscript is front and center. Entrants submitted the first 200 words of their manuscript and a one-page query letter that provided an “elevator pitch” type of synopsis of the completed work. Three winners were chosen from a field of many; those winners won the privilege of having the first 10 pages of their manuscript critiqued by the agent judge of the competition.
As soon as I discovered that I had not been chosen as a winner for that contest, I entered another one. I sincerely believe that the more you write, the better at writing you become. I’m counting on that to be true. I am now researching other contests to enter so that my high risk writing career will have a better chance of taking off.
I’m not done yet!
I’m not ashamed that I didn’t win the very first writing competition that I entered; I’m happy that I had the guts to take a risk.
Stay tuned; win or lose, I will provide updates on every contest that I enter.
“What do you mean I have a week to move my father? For what reason?”
Raymond Ortiz, the Easy Breezy Group Home owner, situated himself in the plush chair in which he was sitting, opened up the manila folder that was on the desk in front of him, put on his reading glasses, scanned the piece of paper inside, and then closed the folder. “I know this seems to be coming out of the blue, but the staff and I have decided that your father just doesn’t fit in with the rest of the residents. They, and us, would be happier if Harold wasn’t living here.”
I couldn’t believe what I was hearing; dad had lived at this group home for three months without a complaint from anyone, and now this? “What specifically has he done – or not done – that renders him an unsuitable resident? What do those notes in my dad’s file specify as the reason?”
“You see, it’s not as simple as that. Your father hasn’t complied with the way the other residents live, and let’s not forget, they were here before him.”
I was having a hard time controlling my temper. Through gritted teeth I said, “Specifics, please.”
“For one, he wakes up earlier than the other five residents – sometimes as early as 6 am – and in the evening, he insists on staying up well past 10 pm. His early morning schedule disturbs those who are sleeping, as does his late night schedule. I’m sure you can understand that sleep is a very important aspect of our residents’ healthcare and when that is jeopardized because of just one of our residents, we have to take measures to accommodate the majority.”
“Wait a minute, you mean to tell me that the other residents’ schedules are more important than my father’s? That’s utterly ridiculous. Tell me, is my father doing jumping jacks in the middle of the living room with the stereo blaring while everyone is asleep?”
“Now you’re being silly.”
“No, Mr. Ortiz, now I’m getting angry. If dad isn’t making a ruckus, why the concern? My father has always been an early riser – moving in here shouldn’t require that he change that feature of his life; same goes for staying up later than the others. His end-of-day routine has always involved sitting down with a good book and reading – sometimes for hours on end. What’s so disruptive about that?”
“Two things, really. He flushes the toilet, which of course makes noise, and the resident on the other side of the bathroom hears the flush and his sleep is disturbed. Also, the evening caregiver has evening chores to do and afterwards, lays down on the couch to be rested up for the next day’s activities. He can’t sleep while your father is still awake.”
I closed my eyes and tried to compose myself. “Look, when my dad moved in, you made a point of telling us that Easy Breezy is his home, just as if he owned the place, just as if he’d lived here all his life. Kind of like, ‘Mi casa es su casa’ and I took you at your word. Nothing you’ve said today jives with that sentiment, and I’m quite sure that nothing you’ve mentioned is grounds for throwing him to the curb. First of all, I know you have to give written notice and it has to be given with more notice than you’ve given me, and I’m damn certain your flimsy reasons won’t stand up to legal scrutiny once I’ve looked into this.”
“Now Ms. Reilly, no need to get all huffy about this. That’s just the way it is; majority rules.”
I stood up, slung my purse over my shoulder and said, “We’ll see about that Mr. Ortiz. I’ll be back.”
As Ms. Reilly surmised, any notice of discharge must be made in writing and must be provided at least 30-days from the date of discharge from the facility (said requirements stated at length in 42 CFR 483.12.) Federal and State governments make it very difficult for administrators/owners to move a resident out of their property. As stated in the CFR below, there must be a very valid reason, e.g., health and safety of individuals are in jeopardy, and certainly that is not the case in the scenario above.
42 CFR 483.12Admission, transfer and discharge rights.
(2) Transfer and discharge requirements. The facility must permit each resident to remain in the facility, and not transfer or discharge the resident from the facility unless –
(i) The transfer or discharge is necessary for the resident’s welfare and the resident’s needs cannot be met in the facility;
(ii) The transfer or discharge is appropriate because the resident’s health has improved sufficiently so the resident no longer needs the services provided by the facility;
(iii) The safety of individuals in the facility is endangered;
(iv) The health of individuals in the facility would otherwise be endangered; See also Washington State law 70.129.110
I hope you have already had a chance to look at Part 1 of this series on LTC residents’ rights. Today’s topic focuses on one aspect of the admission process that oftentimes slips through the cracks unnoticed.
The case of the missing Kindle Fire
“Housekeeping!”
That’s my cue to vacate the apartment and let a staff member clean my place. I turned off my Kindle Fire, placed it next to my reading chair, and opened the door. “I’m so glad you’re here. I love having a clean apartment and always look forward to my weekly cleaning.”
“You are Mrs. Ruth Milliken?”
“Yes, that’s me. Are you new on staff at Fairview Manor?”
“Yes, I am Carolina, I start this week. May I come in and clean?”
“Certainly, I’m heading to lunch so take your time.”
********
It was so nice being able to take advantage of the good weather by having lunch on the patio for a change. I’m going to read a bit and then maybe take a nap; all that sunshine made me a bit sleepy. I unlocked my apartment door, made myself a cup of tea, and returned to my reading chair.
“Oops! I’d swear I left my Kindle right here on the table next to my chair.” I stood up and lifted the seat cushion, thinking perhaps that it slipped between the cushion and chair frame without my knowing it.
“Now this is silly, I know I placed it on the side table.” Just the same, I looked throughout my apartment to make sure I wasn’t mistaken. A sudden realization hit me, “That new housekeeper, she must have stolen it.”
I made my way to the Administrator’s office to report the mishap. “Jason, may I come in?”
“Certainly Mrs. Milliken, have a seat, how can I help you?”
I sat on the edge of one of the visitor chairs and relayed my suspicions about my missing Kindle. “So you see, I’m certain it must have been your new housekeeper, Carolina. She was the only one who had access to my apartment while I was at lunch.”
“Are you sure you’re not mistaken? Was your door locked when you returned from lunch?”
“Yes, it was; at least the housekeeper locked up after herself.”
Jason got up from his desk, retrieved a folder from the large file cabinet behind him, and returned to his desk. “I’m truly sorry you’ve misplaced your IPad.”
“It was a Kindle – the latest Kindle Fire and it was a gift from my daughter-in-law.”
“Okay – Kindle.” He opened the folder and thumbed through a few pages and folded back one of them. “If you’ll look right here, you’ll see that you signed a Waiver of Liability when you moved into Fairview Manor.” He turned the folder towards me so I could read it. “This is your signature, isn’t it?”
“Well, yes, that’s my signature, but you can’t be saying that you’re penalizing me for signing that document. I signed lots of documents that day, fully trusting that everything you placed before me was on the up and up. Let me read that thing.” I glanced through the wording and couldn’t believe what I was reading: Fairview Manor and its parent company, Senior Housing Corporation, accepts no liability for items lost, stolen, or otherwise misplaced.
I looked up at Jason who was comfortably reclining in his executive desk chair. “This is utterly ridiculous; if I had understood what you were asking me to sign, I would have never signed this piece of paper.”
“If you hadn’t, we would have had no recourse but to refuse your admission into our community.”
“But that housekeeper stole my property. You have a thief on staff here.”
“I assure you, every employee hired at Fairview Manor goes through a criminal background check – otherwise they can’t work here.”
“Did Carolina’s background check come back clean?”
“Her State background check came back but not the Federal. She has a clean slate in Oregon, I’m sure the Federal check will come back clean as well.”
I am absolutely stunned; I know the implications. “So she could have committed a crime in another state – which would show up on the Federal database but not the State one – and you let her work here without first knowing if she was cleared?”
Jason had the audacity to shake his head and chuckle. “I assure you, in all my years working in the industry, there’s never been an employee who didn’t pass with flying colors. I’m not worried about Carolina.”
I stood up and addressed the Administrator. “I can’t believe I’ll never see my Kindle again. You can’t possibly think that’s fair, Jason.”
“My hands are tied, fair or not.”
All employees working with vulnerable adults are not permitted to work in a facility without a completed criminal background check.
42 CFR 483.13
(c) Staff treatment of residents. The facility must develop and implement written policies and procedures that prohibit mistreatment, neglect, and abuse of residents and misappropriation of resident property.
(1) The facility must
(i) Not use verbal, mental, sexual, or physical abuse, corporal punishment, or involuntary seclusion;
(ii) Not employ individuals who have been
(A) Found guilty of abusing, neglecting, or mistreating residents by a court of law; or
(B) Have had a finding entered into the State nurse aide registry concerning abuse, neglect, mistreatment of residents or misappropriation of their property; and
(iii) Report any knowledge it has of actions by a court of law against an employee which would indicate unfitness for service as a nurse aide of other facility staff to the State nurse aide registry or licensing authorities.
(2) The facility must ensure that all alleged violations involving mistreatment, neglect, or abuse, including injuries of unknown source, and misappropriation of resident property are reported immediately to the administrator of the facility and to other officials in accordance with State law through established procedures. See also Washington State law RCW 70.129.130
The admission process into a long-term care facility is stressful on residents and their family members. What they fail to realize is that the resident agreement they sign, and all other sub-documents of that agreement, are legal documents: some of them binding, others not. As such, it is a very good idea to read them ahead of time and even have them reviewed by an attorney or legal advocacy group. Most states do not permit Waivers of Liability to be a part of the LTC admission process. Administrators, however, oftentimes succeed in slipping that document into the ream of documents residents must sign. The good news is that such waivers are not enforceable; the bad news is that residents assume that because they signed a Waiver of Liability, they have no recourse when their personal belongings are stolen by staff and/or other residents.
Washington State law RCW 70.129.105 Waiver of liability and resident rights limited. No long-term care facility or nursing facility licensed under RCW 18.51 shall require or request residents to sign waivers of potential liability for losses of personal property or injury, or to sign waivers of residents’ rights set forth in this chapter or in the applicable licensing or certification laws.
Since the Waiver of Liability is not enforceable, the flip side of that is that the facility is liable and should either replace Mrs. Milliken’s Kindle Fire or provide the funds for her to purchase a new one.
Part 3 of this series will deal with the discharge/eviction of a resident from a long-term care facility. Part 3 will be posted on Friday morning, November 14.
Syndicated columnist, Leonard Pitts Jr. did it again: he wrote about issues that most of us are very concerned about and at least for this one reader/writer, he spoke for me. The above article addresses the precise way that I feel – and that many others feel – about red versus blue. Here’s a few quotes from the article that you should take the time to read in its entirety.
First a quote from President Obama, a quote that he premiered ten years ago and reiterated after the recent mid-term elections:
“I continue to believe,” said President Obama, “we are simply more than a collection of red and blue states. We are the United States.”
Now a few paragraphs from Mr. Pitts’ article addressing that statement:
“People for whom everything is about politics tend to forget that most of us do not see the world that way. Red or blue, left or right, most Americans simply want a government that works, that gets things done, and a nation that stands for something, that means something in the world beyond just a parcel of land where a bunch of people live. This is why Obama’s words electrified 10 years ago; they seemed to connect people to ideals larger than their own lives.
“And it is why the same words seem flatter than left-out cola 10 years later, the hope of larger ideals having been sequestered, government shutdowned, PAC’d and gridlocked down into a sobering realization of how truly small American politics can be.
“Cowardice squared off against cynicism Tuesday [2014 election day] and cynicism won. But there is something wrong when those are the only options on the ballot.
“We are supposed to be united states, the president says. But there are too many days lately when a sentiment that once grounded and ennobled feels fanciful and unlikely.”
And now my statement:
Whether we’re talking about State/local government or Federal – year after year, too many employees of each have failed to do their job. These employees don’t work behind desks in the hallowed walls of government; they square off on the football field where at least two opposing sides refuse to give an inch for fear that the opponents’ goals might be reached.
And I might add, goals that could very well benefit the American citizenry, but are turned down simply because the other team proposed them.
Gloria was all alone. It was two months since her dear Herbie had passed, and she just couldn’t seem to move on.
“Listen here, Gloria,” said her good friend, Barbara, “maybe you should go see a psychic? One of my friends did after her husband died and it made her feel so much better knowing that her dearest was happy.”
So that’s how, on the next Tuesday, Gloria found herself in a dim room with a crystal ball and a psychic talking in a calm voice.
“Is he here?” asked Gloria.
“Yes, I sense him,” was her reply.
“Can you ask him if he’s happy?” Gloria asked hesitantly.
“He’s putting his hand to his mouth like he wants to smoke,” said the psychic.
“Oh, of course, he needs a cigar. Herbie can never last more than a few hours without a cigar. I guess they don’t have cigars up there. Did he say where he is or how I could get a cigar to him?”
“Hmm,” said the psychic, “I can’t seem to get that question across to him.” After a brief pause the psychic added, “But then again, he didn’t say anything about needing a lighter!”
Since Baby Boomers and their family members face the possibility of arranging long-term care (LTC) housing for a loved one, or will be on the receiving end of long-term care, I am providing information related to what one can and should expect while living in a LTC setting. This will be a multi-part series wherein I provide a real-life scenario, and the Code of Federal Regulations (CFR) citation applicable to that scenario. Since I live in Washington State, I will also provide the applicable State statute, and I encourage those living in other states to do an internet search for “long-term care residents’ rights in your state” in order to locate your local laws. All scenarios assume that the resident in question is cognitively able to make his or her own decisions.
My kids aren’t the boss of me!
I’m so excited, my soaps are about to start and I have the whole afternoon to myself. I’m looking forward to seeing how they’re going to get rid of Sami. She’s been on Days of our Lives since she was a young teenager; that’s a long time in soap opera years. I’ll just wheel into my bedroom, get my knitting basket, and set myself up in front of the television.
All right, now I’m ready; it’s time to tune in!
There’s a knock at the door, drat, right when my first soap is about to start. “Come in!” Oh no, it’s that perky activity person. When they interviewed candidates for her job they must have had a perkiness contest as one of the criteria for hiring. I’ll see if I can get rid of her real quick-like. “Hello, Ruby, what can I do for you today?”
“What can you do for me? Don’t be silly, it’s what I can do for you that matters, Mrs. Tanaka. We’re showing a movie in the main living room that I’m sure you’ll like. It’s called, 101 Dalmatians, won’t that be great?”
A movie about dogs instead of my soap operas? Not going to happen. “That’s okay, Ruby, I’m happy just watching my TV shows. Maybe some other time.” Now I’ve gone and done it, Ruby looks baffled, not sure how to change the course of her task.
“Mrs. Tanaka, I was told to wheel you to the living room for the movie and not take ‘no’ for an answer.” She pulled a piece of paper out of her smock’s deep pocket and showed it to me. “Look right here. It says, ‘The family has requested that their mother not spend an inordinate amount of time in her room and that she attend at least four activities per week.’ It’s already Thursday and you haven’t even been to one event this week. We have to make up for lost time.” She bent over my wheelchair, unlocked the brake and positioned herself behind it.
“But I don’t want to see the movie, I want to watch television. I love my soap operas and today’s the last day Sami is going to be on Days. Please, I don’t care what my children have requested, I’d really rather stay in my apartment.”
Ruby leaned over, picked up my yarn and needles, and placed them in my knitting bag on the floor. “Come on, I’m sure you’ll like it once you get there.” Pushing with all her might, Ruby escorted me out of my room, thus bringing an end to all my plans for the afternoon. Those children of mine have no right meddling into my private life. “Ruby, whose opinion matters most: the person who lives at this assisted living facility, or those who don’t? This isn’t fair; don’t I have rights?”
Mrs. Tanaka was coerced to go somewhere she didn’t want to go; because she was confined to a wheelchair, her ability to stand her ground by refusing to attend an activity was compromised. Additionally, although this resident can get around her apartment in her wheelchair, wheeling herself long distances is very problematic for her; as a result, once in the living room she would require assistance to return to her room, rendering her a captive audience.
42 CFR 483.10 The resident has a right to a dignified existence, self-determination, and communication with and access to persons and services inside and outside the facility. A facility must protect and promote the rights of each resident, including each of the following rights:
(a) Exercise of rights.
(1) The resident has the right to exercise his or her rights as a resident of the United States.
(2) The resident has the right to be free of interference, coercion, discrimination, and reprisal from the facility in exercising his or her rights. See also, Washington State law: RCW 70.129.140
Mrs. Tanaka has the right to make choices that are important to her. She wanted to watch television – not attend a kids’ movie. Regardless of what her adult children want, Mrs. Tanaka’s rights trump theirs.
42 CFR 483.15 Quality of Life A facility must care for its residents in a manner and in an environment that promotes maintenance or enhancement of each resident’s quality of life.
(a) Dignity. The facility must promote care for residents in a manner and in an environment that maintains or enhances each resident’s dignity and respect in full recognition of his or her individuality.
(b) Self-determination and participation. The resident has the right to:
(1) Choose activities, schedules, and health care consistent with his or her interests, assessments, and plans of care;
(2) Interact with members of the community both inside and outside the facility; and
(3) Make choices about aspects of his or her life in the facility that are significant to the resident. See also Washington State law RCW 70.129.140
Note: there are even more legal citations applicable to the above scenario; a quick search of 42 CFR 483 on the internet provides all laws relating to long-term care residents rights. If you or a loved one need assistance regarding LTC residents rights, contact your local LTC Ombudsman office which can be located at the National Long-Term Care Ombudsman Resource Center.
Part 2 of this series will deal with the illegal practice of requiring residents to sign a Waiver of Liability prior to being admitted to a facility.
Two things stand out to me from this very happy video: those who willingly join in to dance on the train, and those who won’t allow themselves to do so. The latter look down, try – in vain no doubt – to continue reading, and in so doing, miss out on what could have been the happiest they’ve been in some time. I hope I’m witness to this type of window of happiness in the future; you can be sure I’d be one of the first to get up and dance. Good times!
Australian Peter Sharp wants you to get into a social groove on your commute.
Sharp suited up and arranged to meet eight of his friends on a train car in Perth, Australia. When their train pulled into the station, Sharp got on and got ready to get down.
“Hey, guys, I don’t want money,” he announced to his seated friends and the commuters in the car who were still unaware of what was about to take place. “I just want to spread a little bit of happiness. So I’m going to do that today by starting a small dance party.”
Then Sharp started the music, and one by one, his friends — and the amused commuters — joined in on the fun.
“We were totally blown away by how instantly people started to smile, laugh and get involved,” he told The Huffington Post via email. “We had a 60-year-old woman…
Think of how you feel with the title of this article: Your aimless life. Now discern how you feel with the statement, Purpose in life. There’s no comparison, right? If the word aimless made you feel lost or empty, there’s a reason. The Oxford English Dictionary, 11th Edition, 2004, provides the following definition of aimless: adj. without purpose or direction. Not much can go right with that way of living.
In contrast, let’s look at the definition of purpose from the same dictionary: n. the reason for which something is done or for which something exists.
One can conclude therefore, that a person without purpose has no reason to live. That’s downright depressing, but that’s the point.
The above article from a recent Seattle Times issue highlights the benefit of reduced medical costs when a person successfully defines their purpose in life. Instead of focusing on reduced medical costs, however, I’d like to look at the less tangible – but more important – benefit of being in good health as a result of living a purposeful life. It’s amazing to me that just living and carrying out ones life with intention equates to being healthier than if one lived without any meaningful direction.
When a person enters retirement there is an initial exhilaration in not having to go through the drudgery of an 8 to 5 work day. Quite frankly, it would feel darn good not having to do anything you don’t want to do. Eventually, however, you might feel like you’re just drifting through that time of your life. You need to have a reason to get up in the morning that surpasses the joy of lingering over the morning paper and sipping a cup of coffee.
Don’t get me wrong; I’m not saying that you’re supposed to line up a new job, hang up your retirement sweatsuit, and return to the employment drudgery from which you escaped. I’d never promote that idea but I will stand by my belief that unless you have direction, you’re not going to be as happy – and as healthy – as you can be. Purpose and direction will mean something different for each of you.
Fulfilling long ignored house projects that will assure you and yours a safe and comfortable place to live for years to come? Fabulous.
Try your hand at growing your own vegetables and sharing with your neighbors or a local food bank? Delicious.
Volunteering for an organization that aligns with your world beliefs? Go for it.
Become a freelance writer ? Sharpen your pencil and get started.
What matters is not what gives you purpose, rather, that you put feet to that purpose. If it satisfies your life and gives you an added reason to get up in the morning, you’ve received the benefit that a purposeful life can provide.
It’s really as easy as that. You have many years ahead of you, make them count for you and make them count for others.
And here’s something to consider, from the book The One Thing by Gary Keller:
Purpose may sound heavy, but it doesn’t have to be. Think of it as simply the ONE Thing you want your life to be about more than any other … Pick a direction, start marching down that path, and see how you like it. Time brings clarity, and if you find you don’t like it, you can always change your mind. It’s your life.
The attached article from Parade Magazine is a fabulous example of how a person can recreate their life – regardless of ones age, circumstances, or lot in life.
If you’re seeking a new direction in your life – or perhaps are in the process of recreating yourself – I’ve found that it’s easier to know which direction you should go if you’re already in motion. The world may have been created in a week, or zillions of weeks; either way, a lot of energy went into that creation and the world-in-process was not a stagnant one. As for you – you are never too old to try something new – as long as you’re willing.
Trial and error approach. I constantly look for ways to improve myself (a task that will always keep me busy) in an effort to increase my influence on the community around me. But if I wait around for some sort of change to occur, I’m going about it in the wrong way and believe me, I’ve experienced enough trial and error to write a book on the subject. The trial and error approach can work, however, if in doing so we discover what doesn’t work for us in our attempts to find what does.
Living or playing to your strengths. My life’s direction was greatly influenced by Marcus Buckingham, one of the world’s greatest authorities on employee productivity. He suggests that to make your greatest contribution, it’s best to play to your strengths most of the time. I have taken to heart Mr. Buckingham’s strong caution against veering off ones strengths path. After all, when I’m creating a new me, why would I choose to do the lame-o, same-o with all of its inherent dissatisfaction? That’s like doing the same thing over and over again, expecting different results. That has never worked for me, how about you? In addition to playing to my strengths, I try to play to my passions. As a person who’s not getting any younger, it makes sense that going forward I should avoid activities that drag me down and weaken me. Instead, I should run to those activities for which I am most impassioned and inspired.
Find your niche and go for it. I know what I like to do and what I’m good at so I try to consciously remain open to opportunities that directly relate to those strengths. I thoroughly enjoy working with an older population of adults but I know what part of that experience I’m able to do, and what I’m not able to do. In 2013, I retired from my work as a volunteer certified Long-Term Care (LTC) Ombudsman – an advocate for the rights of vulnerable adults. As an Ombudsman, however, I knew my limits on “clinical atmosphere” so during my ombudsman career, any involvement with the older population excluded my participation in a nursing home or hospital environment. Throw me in the midst of adults living in assisted living or dementia residential settings, however, and I will make new friends and earn the trust of everyone with whom I come in contact. Add to that, with my enjoyment and effectiveness as a public speaker, I used that strength to provide talks to professional care staff, and to residents & their family members, on what it means to protect the rights of seniors who are not able to protect themselves.
Recognizing an open door when you see one. We are constantly bombarded by information whether through social media, radio and television programs, or even mini-publications such as Parade Magazine. As we wade through all of that input, it’s helpful to be alert to what that input might be trying to tell us. Sometimes the information brings to light an opportunity that will utilize both our skills and our passions for the benefit of others. But I’ve discovered that not every door that opens is the right door. I have to be extremely careful when considering a particular opportunity, because sometimes I’ve sensed an open door through which I’ve thought I should walk, only to find that it was the wrong door for me. If I don’t look before I leap, e.g., research the project, consider all of its requirements, measure whether or not I’m able to fully commit, I won’t be doing myself, or those connected with the project, any favors. It is worth my time to weigh all options; to write a list of Pros and Cons; to ask trusted individuals for their opinion and then make an informed decision. If this new opportunity that I’ve carefully considered allows me to play to my strengths and my passions, everyone benefits and there are few, if any, casualties along the way.
What about you?
Each of you has a talent or a skill-set that can be used long after you’ve officially “retired” from the workforce. Think about it: you spent years as an employee or business owner using that talent – why put it to rest? Finding new ways to utilize your life’s work is good for you; it brings a fresh outlook on what you’re still able to accomplish, and equally as important, might prove beneficial to others as you stretch your wings in your efforts to make the most of your talents.
Okay all you 60 year-old or older fabulous people. Here are some Questions & Answers that some of you may relate to:
Q: Where can single men over the age of 60 find younger women who are interested in them? A: Try a bookstore, under Fiction.
Q: How can I increase the heart rate of my over 60 year-old mate? A: Tell him you’re pregnant.
Q: How can I avoid that terrible curse of unsightly wrinkles? A: Take off your glasses.
Q: Seriously! What can us women do for Crow’s feet and all those wrinkles on our face? A: Go braless, it will usually pull them out.
Q: Why should people 60 years-old or older use valet parking? A: Valets don’t forget where they park your car.
Q: Is it common for 60 plus year-olds to have problems with short-term memory storage? A: Storing memory is not a problem; retrieving it is the problem.
Q: As people age, do they sleep soundly? A: Yes, but usually in the afternoon.
Q: Where should 60 plus year-olds look for eye glasses? A: On their foreheads, or the last place they left them … if they can remember.
Q: What is the most common remark made by 60 plus year-olds when they enter antique stores? A: “Gosh, I remember all of these things!”
I wrote an article not too long ago, talking about how we hurt people without words: https://babyboomersandmore.com/2014/10/16/what-we-say-without-words/. This story, however, shows what words and actions can do to a person. Fortunately, the author of the article knows better than to believe the cruel words of an imperfect human being.
Naked, I stood at the closet doors with the lights on and made myself ready. I took a deep breath and positioned the mirrors so I could see all of me. I consciously worked to remove my self-believed inner image. I opened my eyes and looked very carefully at my body. And my heart lurched at the truth: I am not a young woman anymore. I am a woman well-lived. My body tells of all the years she has carried my spirit through life.
I am a 59-year-old woman in great health and in good physical shape. I stand five-feet, nine-inches tall and weigh 135 pounds. I wear a size six in both jeans and panties, and my breasts are nowhere near my navel. In fact, they still struggle to make it full-up in a B-cup bra. My thighs are no longer velvet and…
Several years ago I took a class with the ominous sounding title, Death and Dying. That was a topic with which I was very comfortable so I signed up for it and enjoyed it immensely. There were many things offered relating to wisdom gained as we age and how best to live before we die, but the following advice was the best of all:
Cherokee wisdom – Two Wolves
An old Cherokee chief was teaching his grandson about life… “A fight is going on inside me,” he said to the boy, “it is a terrible fight, and it is between two wolves.”
“One is EVIL: he is fear, anger, envy, sorrow, regret, greed, arrogance, self-pity, guilt, resentment, inferiority, lies, false pride, superiority, and ego.”
“The other is GOOD: he is joy, peace, love, hope, sharing, serenity, humility, kindness, benevolence, friendship, empathy, generosity, truth, compassion, and faith.”
“This same fight is going on inside you, and inside every other person, too,” he added.
The grandson thought about it for a while and then asked, “Grandfather, which wolf will win?”
I was coming back from visiting my son in Miami and I pulled into a rest stop to use the bathroom. I just sat down on the toilet when I heard a voice coming from the stall next to mine.
“Hey! How’s it going?”
Although I was quite surprised, as I wasn’t in the habit of conversing with people in toilet stalls next to me, I answered him. “I’m fine, thanks for asking.”
“What are you doing?” asked the same voice in the next stall.
To be honest, I was a bit taken aback by the brazenness of this guy, but I would never ignore anyone so I calmly answered, “I’m relieving myself.”
Then I heard the same voice again. “I’m gonna have to call you back. Some wise-guy in the next stall is answering all my questions.”
Brian’s stress level was at unsurpassed levels. His wife Maggie was in labor and Brian was sure it was time to head to the hospital.
Brian grabbed the phone and called the doctor. “My wife, she’s ready, should we check into the hospital?”
The doctor tried to calm the poor fellow down. “Just try to relax and tell me how much time elapses between the contractions?”
“Maggie,” Brian screamed at the top of his lungs, “How much time in between each contraction? … Ten minutes? OK … Doc, ten minutes in between the contractions!”
I attended the Write on the Sound writer’s conference in Edmonds, Washington October 3rd thru 5th. I participated in numerous workshops – most of which were very beneficial. One of the challenges I heard many of the instructors tell us wannabe authors was to enter as many writing contests as possible.
Put yourself out there; take a risk; keep writing.
That sentiment really resonated with me. Since returning home from the conference, I’ve already entered one contest and have two more lined up for which I’m preparing submission pieces. And I’m stretching myself by trying new genres. Case in point: I submitted a 3,000 word short story called Variant in the Horror genre. Shocking, right? Winners of that Writer’s Digest Popular Fiction Awards contest won’t be announced until the end of the year.
Later this week I will be entering the “Dear Lucky Agent Contest” by submitting only the first 200 words of my completed novel, Armed for Bear, (current working title) plus a query letter. Winners of that contest will be announced early November.
Writer in the making
Additionally, today I wrote the first draft of a short story that I’ll be submitting later next month. The story must begin with the following sentence, “I knew it was a mistake the moment it was over.” This was a fun piece to write because it can only be 750 words or less. It takes lots of discipline to slim down a story so that it’s still entertaining and says what it’s supposed to say.
Wish me luck as I keep on submitting pieces!
Just like the lottery, you can’t win if you don’t enter.
An elderly gent was invited to his friend’s house for dinner one evening. The friend was impressed by the way his elderly buddy preceded every request to his wife with endearing terms: Honey, My Love, Darling, Sweetheart, Pumpkin, etc.
The couple had been married almost 70 years and they were clearly still very much in love. When the wife was in the kitchen, the friend leaned over and said to his old buddy, “I think it’s wonderful that after all these years, you still call your wife those loving pet names.”
The old man hung his head. “I have to tell you the truth, I forgot her name about 10 years ago.”
I was recently encouraged to write about the power of words; not the power of words to heal, but the power of words to harm. Harmful words abound in many arenas, but this article only discusses such words in relation to those suffering from a serious medical condition.
Take it from me – and from others who have experienced the same reaction as me – there are certain “pithy little aphorisms” (a phrase from the article Where Words Fail, Washington Healthcare News) that should be avoided at all costs:
things could be worse
time heals all wounds
I know exactly what you’re going through
God won’t give you more than you can handle
Let me stop right there. In the article referenced above, the author, Fred Grewe, goes so far as to say that the above biblical platitude is sadistic in nature. Keep in mind, Mr. Grewe is a Board Certified Chaplain and he’s the one who considers that particular bible verse as such. The person who hears it wants to say, “Are you shi_ting me? You mean not only is my health failing greatly, but I’m also failing at what God chose to give me? Where’s the encouragement in that?” Let’s go on. Number 1 in the above list is true, things could be worse than wasting away in excruciating pain with no one there to comfort me in my last few days of life on this earth, but I’m having a hard time coming up with one at the moment; maybe you could come back to me in two weeks. Oh, wait, I’ll be dead by then. I’ll skip over number 2, it rarely brings comfort to the person who hears it.
Number 3 is a selfish, arrogant, misinformed, bullsh_t statement that couldn’t be true even if that very same person was suffering from the very same illness as the one to which that statement was made. Oftentimes, however, the follow-up statement goes something like this, “My dog had cancer too – it was horrible” or “I had the flu last week, I feel your pain.”
If you can’t say something truly encouraging, such as “You’ve got this” – which, by the way, is an effective, worthwhile three-word supportive comment – don’t say anything. That’s right, shut up. If your location prevents you from physically being with the person who is suffering to offer some sort of tangible help or encouragement – by all means, send them a card, but do so without saying something that will hurt or piss off the person who receives it. And consider this idea: a humorous card might actually be the best panacea for that person’s shi_ty day. I’m not suggesting you make light of a person’s suffering, but chances are they’d appreciate something that doesn’t mimic many of the sad, cookie cutter, greeting cards out there.
I say/preach all of the above not because I’ve done things perfectly in my sixty-one years of life – not by a long shot. But I am saying the above because I don’t want people I love, and the people you love, to be on the receiving end of some powerfully harmful words.
Lincoln, a young man, wanted to get his beautiful blonde wife, Lucy, something nice for their fifth wedding anniversary. He decided to buy her a cell phone. She was all excited, loved her phone and the husband explained all the features of the phone to her.
The next day Lucy went shopping. Her phone rang and it was Lincoln. “Hi honey,” he said, “how do you like your new phone?”
She replied, “I just love it, it’s so small and your voice is clear as a bell but there’s one thing I don’t understand.”
An out-of-towner drove his car into a ditch in a desolated area. Luckily a local farmer came to help with his big strong horse named Buddy. He hitched Buddy up to the car and yelled, “Pull Nellie, pull!” Buddy didn’t move.
Then the farmer hollered, “Pull Buster, pull!” Buddy didn’t respond.
Once more the farmer commanded, “Pull Coco, pull!” Nothing.
Then the farmer nonchalantly said, “Pull Buddy, pull!” And the horse easily dragged the car out of the ditch.
The motorist was most appreciative and very curious. He asked the farmer why he called his horse by the wrong name three times. The farmer said, “Oh, Buddy is blind and if he thought he was the only one pulling, he wouldn’t even try.”
Caregivers, this one is for you. You are not perfect, you are not an angel, but you ARE a hero. Stop beating yourself up, acknowledge your limitations, and move forward. This article shines a light on some of the not-so-great moments that occur on the caregiving journey, and it offers alternative responses that will smooth the way for you.
“Once bitten, twice shy.” The Chinese and Japanese proverb has a variant: “One year bitten by a snake, for three years afraid of a grass rope.”
How does one who is as imperfect as myself apply this Proverb without writing an article that goes on and on into perpetuity? All of us can think of circumstances in which we fail to learn by experience and continue doing the same stupid/inadvisable thing over and over again expecting different results. As I said, my life is rife with examples, but this article centers around caregiving – especially as it applies to caring for someone with Alzheimer’s or other dementia. CAVEAT: I would never write on something about which I had not experienced. I’ve been there. I’ve done that. I’ve paid for my mistakes.
I’m so tired of my spouse/father/mother asking me the same question over and over again and supplying her with…
Being prepared, well in advance of needing to be, will serve you well.
All our lives, we set out on new adventures having prepared for them to the best of our abilities:
First day of school;
The start of a new job;
Preparing for a first date;
Wedding preparations;
Organizing a Holiday meal;
Even something as mundane as putting together a grocery shopping list.
Painting courtesy of Mary Riesche Studios
We know how to be at our best, and being at our best means painstakingly and carefully preparing for important events in our life. You didn’t personally have the option of preparing for your birth, but you do have the option, right now, to prepare for your death.
Carpe diem.
What does it mean to end our life on our own terms? This doesn’t have to be a controversial topic. I’m not talking about assisted suicide/right to die matters. What I am talking about, however, is the importance of each of us to spell out in painstakingly and carefully prepared language, all that you want done – or not done – when you are determined to have an irreversible fatal disease.
Death is such a taboo subject.
Why is that? None of us will avoid the inevitable, but many of us avoid laying down our wishes regarding that final time in our lives. The subject matter of the attached article relates to medical insurance companies reimbursing medical professionals for end-of-life counseling provided to their patients. I repeat, this counseling is not controversial. As Ms. Harrop states, “Critics of end-of-life discussions argue the doctors would ‘push’ patients to end their lives prematurely. Why would doctors do that? Where’s the financial incentive in losing a patient?”
The report Dying in America calls on Congress “to end the ‘perverse’ financial incentives that rush fragile patients into invasive medical treatments they’d prefer to avoid.” That being the case, it seems to me that counseling a patient about their dying wishes hurts, more than helps, the physician’s bottom line, so forget the nonsense about doctors encouraging patients to die sooner than later. That’s just hogwash.
“Meanwhile, there’s evidence that for some very ill people, a palliative approach may extend life longer than industrial-strength medicine.” And certainly ones final days without the poison of chemotherapy that has no prospect of curing a cancer, would be far more comfortable than if that therapy had been employed. “In a study of terminal lung cancer patients, the group that chose hospice care actually lived three months longer than those subjected to hard chemotherapy.” Again, that would be a more pleasant exit from this life than suffering the ravages of a chemo treatment that is not curative in nature.
“An end-of-life talk with a doctor spells out the options. Patients can use it as a basis for filling out an advance care directive – a form listing which treatments they would want or not want.” And let’s not forget that such a document only comes into play if the patient can no longer speak/express his or her wishes regarding their care. An advance care directive is a legal document and as such, spells out when it can be put in motion, and when it can not. If ever there’s a time when you can benefit from being a control freak, your final days is it.
This legal document is not just for the older population.
Once you’re considered an adult, you can decide what you want regarding your life. Don’t wait until it’s too late and someone else decides medical matters without your input.
Equal time for the male and female Baby Boomers out there:
A guy was reading his paper when his wife walked up behind him and smacked him on the back of the head with a frying pan. He asked, “What was that for?” She replied, “I found a piece of paper in your pocket with ‘Betty Sue’ written on it.” He said, “Jeez, honey, remember last week when I went to the track? ‘Betty Sue’ was the name of the horse I bet on.” The wife shrugged and walked away. Three days later he was reading the newspaper when she again smacked him on the back of the head. He asked, “What was that for?” She answered, “Your horse called.”
A wife was making a breakfast of fried eggs for her husband. Suddenly her husband burst into the kitchen. “Careful,” he said, “CAREFUL! Put in some more butter! Oh my gosh! You’re cooking too many at once. TOO MANY! Turn them! TURN THEM NOW! We need more butter. Oh my gosh! WHERE are we going to get MORE BUTTER? They’re going to stick! Careful. CAREFUL! You never listen to me when you’re cooking! Never! Turn them! Hurry up! Are you CRAZY? Have you LOST your mind? Don’t forget to salt them. You know you always forget to salt them. Use the salt. USE THE SALT! THE SALT!
The wife stared at him. “What in the world is wrong with you? You think I don’t know how to fry a couple of eggs?”
The husband calmly replied, “I just wanted to show you what it feels like when I’m driving.”
Last year I replaced all the windows in my house with those expensive double pane energy efficient kind. This week, I got a call from the contractor complaining that his work had been completed a whole year and I had yet to pay for them.
Boy, oh, boy did we have an argument. Just because I’m blonde doesn’t mean that I’m stupid. So I proceeded to tell him just what his fast-talking sales guy had told me last year. He said that in one year, the windows would pay for themselves.
There was silence on the other end of the line so I just hung up, and he hasn’t called back since. I guess he was embarrassed.
Humbled, grateful, overjoyed! Not just because I was nominated for the Very Inspiring Blogger Award, but also because I’ve inspired someone, hopefully many someones. Talking to a wall is not a very gratifying experience; if my blog is merely an electronic version of that, I will have not reached my objective: to help, encourage, and lighten your load while on this aging journey. Thank you Kay for the nomination!
Kay Bransford of Dealing with Dementia nominated me for this award. If any of you readers have yet to follow Kay’s blog you need to get to it. I will nominate several bloggers for the same award, following the Rules provided below:
Thank the amazing person who nominated you and provide a link to their website;
List the rules and display the award;
Share seven facts about yourself;
Nominate 15 other blogs and comment on their posts to let them know they’ve been nominated. I failed at listing 15, not because the blogs I follow aren’t worthy, but because my blog-following count is a limited one;
Proudly display the award logo on your blog and follow the blogger who nominated you.
Seven facts about myself:
1. I’m not ashamed to say that I’m a Baby Boomer and have been for awhile. Turning sixty was easy, however it got a wee bit more difficult at sixty-one …
2. I was born in Pasadena, California and have lived a great length of time in Los Angeles, California; Honolulu, Hawaii; Anchorage, Alaska, and the greater Seattle area of Washington State – my current and final home.
3. My favorite people – other than my loved ones – are anyone older than me – preferably senior citizens who’ve claimed that title for quite some time. This third fact about me directed most of my worthwhile adult career and volunteer pursuits: senior housing industry manager, Alzheimer’s Association caregiver support group facilitator, and Certified Long-Term Care (LTC) Ombudsman for the State of Washington.
4. I have posted over 480 articles on my blog since starting it in 2011.
5. I am currently writing a novel that focuses on the caregiving challenges faced by those who are the primary caregiver for a loved one. Through real-life stories, the reader will learn more about the disease and its effect on everyone it touches. My hope is that by putting a face on this disease – showing what it looks like in everyday life – more interest will be generated to prevent, treat, and cure Alzheimer’s disease, a disease that is always fatal, and for which all of us are at risk.
6. I have three daughters (one of my own and two of my husband’s) and two sons-in-law (one who married my own daughter and one who married my husband’s youngest.)
7. My family tree: I have two siblings, an older brother and sister. My father died from Alzheimer’s complications in October 2007 at the age of 89; my sister-in-law died of the disease in the summer of 2012 a few months before her 70th birthday9.
And that’s why I do what I do.
Nominees for Very Inspiring Blogger Award:
Mary Riesche Studios, Vacaville, California. This artist has drawn and painted since she could hold a pencil. She has tirelessly pursued her craft through every chapter of her life. She raised four children while her husband was in the military – living numerous places in Europe and the U.S. as a result – and that never stopped her from painting. When her four children were out of the house, she and her husband adopted a teenager from Russia, bringing the number of children to five. She’s a trooper, to say the least. It took her a while to have an empty nest. I hope you’ll visit her site to see a representation of the type of work she produces.
Catching Up to the Disease, by blogger, Don Desonier. The subtitle for this blog is Transitions in Dementia Caregiving. Don’s wife died of early-onset Alzheimer’s at the age of 69 on July 4th, 2012. This blogger knows something about being a dedicated, committed caregiver, and on top of that, he excelled at being the very present advocate for his wife of 25 years.
Dementia Poetry is an in your face journal of a daughter-in-law’s disease journey with her mother-in-law, in the form of extremely well-written poems. The subtitle for her blog is: The Politically Incorrect Alzheimer’s Poetry Blog.
Theresa Hupp’s blog, Story and History, is a moving journal of a family’s life covering past, present, and future. But that’s not all: Theresa is a fabulous, published author. I’d say I’m jealous, but friends, and that’s what I consider Theresa, don’t turn green with envy – at least they shouldn’t. Theresa, you nominated me for the Versatile Blogger Award in February of 2014, but I already received that award a couple years ago so I’m not going to claim it again, but I thank you profusely for nominating me.
Not My Original Plan, a blog written by a woman in her thirties who is the caregiver for her mother who has dementia. This is a very inspirational blog – how fitting for this award! – and I strongly suggest you check it out and follow it ASAP.
Not Quite Old, by blogger and author, Nancy Roman. The subtitle for her blog is Gracefully Aging with Resistance. The way Nancy writes – filled with extraordinary humor, will keep you engaged and wanting more.
Let’s Talk About Family. Lori’s blog family history starts with her mother’s failing health and death, and continues with her father’s life as a widower who eventually moves into an assisted living facility (ALF). Her blog is one that I never miss. You know how you can manage the notifications you receive so that you get a notification e-mail immediately, daily, or once weekly? Her blog is one of those that I receive immediate notifications – I can’t wait any longer! is the way I treat her blog. If you are not yet following Lori’s blog, get to it!
Jill Weatherholt, Pursuing a Passion for Writing, is a site that inspires me because while working full-time, she’s still committed to writing and what she writes is well-worth reading. Thank you, Jill, for being an online inspiration to this aspiring author. Jill started the blog to create a community for other new writers and shares her publication journey – something all wet-behind-the-ears writers need to read and be encouraged by.
10 Legs in the Kitchen is a fabulous cooking blog but a whole lot more. Stacy’s anecdotes add “meat” to every posting and provide humor and insight, not just darn good recipes. I met Stacy at a writer’s workshop in Seattle.
Yellow Mum Blog, by Wendy in the United Kingdom, documents the loss of her mother to cancer, ten weeks after diagnosis. What she writes is a journal, but in many respects, it is a guidebook for the rest of us in our grief.
A Swift Current, Letting our Parents Go, Hallie Swift’s blog is one to which many will relate. Whether your parent’s departure is a gradual one – such as is the case with Hallie’s mother due to dementia – or a sudden departure by way of a fatal accident, letting go is hard to do – oftentimes more painful that we believe we can handle.
With the Holiday season upon us, many of us will be at family gatherings of our choosing, or perhaps not of our choosing. The focus of these jokes: mothers-in-law.
I respect the law and I respect the attorneys with whom I have worked and/or done business. What I don’t respect, however, is when ridiculous legal loopholes exist, and those legal loopholes are taken advantage of to the detriment of others.
Gloria was all alone. It was two months since her dear Herbie had passed, and she just couldn’t seem to move on.
“Hey, guys, I don’t want money,” he announced to his seated friends and the commuters in the car who were still unaware of what was about to take place. “I just want to spread a little bit of happiness. So I’m going to do that today by starting a small dance party.”
Think of how you feel with the title of this article: Your aimless life. Now discern how you feel with the statement, Purpose in life. There’s no comparison, right? If the word aimless made you feel lost or empty, there’s a reason. The Oxford English Dictionary, 11th Edition, 2004, provides the following definition of aimless: adj. without purpose or direction. Not much can go right with that way of living.
Several years ago I took a class with the ominous sounding title, Death and Dying. That was a topic with which I was very comfortable so I signed up for it and enjoyed it immensely. There were many things offered relating to wisdom gained as we age and how best to live before we die, but the following advice was the best of all:I was coming back from visiting my son in Miami and I pulled into a rest stop to use the bathroom. I just sat down on the toilet when I heard a voice coming from the stall next to mine.
Humbled, grateful, overjoyed! Not just because I was nominated for the Very Inspiring Blogger Award, but also because I’ve inspired someone, hopefully many someones. Talking to a wall is not a very gratifying experience; if my blog is merely an electronic version of that, I will have not reached my objective: to help, encourage, and lighten your load while on this aging journey. Thank you Kay for the nomination!
Living: the ultimate team sport 