Senior Health Specialists? Geriatricians? Where are you?

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The heading from an Associated Press story by Matt Sedensky, “Who’s going to take care of our aging population?” should wake ALL of us up; not just us Baby Boomers, but ALL of us because at this stage of our world’s existence, no one has created a magic elixir that cures old age and dying.

Talk to anybody who is in med school, or considering med school, ask them what specialty they would like to focus on and you’ll hear: orthopedics, pediatrics, heart disease, cancer treatment – all worthy fields but I would venture to guess that not one of whom you ask that question has said, Geriatrics or Senior Health.  “What about geriatrics?” I ask them.  “We’re living longer so you’ll ALWAYS have a job taking care of a civilization that’s fighting to stay alive as long as it can!”  They don’t buy it, especially since Geriatricians are  one of the lowest paid medical specialties amongst the medical community.

Square Dancing class at my town's Senior Center.

Ugh!  Who wants to deal with the wrinkly, saggy, hard-of-hearing, loud complaining geezers among us?  Not very many according to the linked article above.  According to Mr. Sedensky’s research, there is roughly one Geriatrician for every 2,600 people 75 and older.  No wonder people can’t find a doctor who specializes in Senior Health!  I facilitate an Alzheimer’s Caregiver support group in my town wherein these family members expound on their frustrating efforts to locate a doctor who: a) will spend the time needed to have a productive appointment with their aging parent; b) who knows enough about elder health issues to suggest a treatment that will provide quality of life for the patient; and c) who has a medical staff that is sufficiently trained to interact with their elderly patients.   Unfortunately, the General Practitioner or Internist quite frequently provide the same treatment, and the same method of communicating, to their elderly patients – even those with Alzheimer’s or other dementia –  as they do their patients in their 20’s thru 70’s.  That just won’t cut it.

Older patients have more complex conditions – and more of them.  If a medical professional isn’t accurately trained, he or she might discount an elderly patient’s symptoms as those expected during the normal aging process and therefore offer no effective treatment.  “What can you expect at your age Mrs. Jones?  Be glad that you’ve lived this long!”  I know – that sounds really callous – but I dare say too many elderly patients are treated dismissively, and as a result their quality of life decreases greatly.

My wonderful Dad, pre-Alzheimer's, on my wedding day.

Think about it my fellow Baby Boomers.  Are you willing to be dismissed just because your doctor doesn’t know what the heck he’s doing?  I know that all of us have been to doctors who we’ve “fired” because of their lack of understanding and/or their failure to provide proactive treatment.  The vulnerable adults among us might not realize that they have choices.   They might not feel confident enough to challenge the highly educated medical professional to whom they have entrusted their lives.  Who loses in that equation?  We all do.  If our aging relatives don’t have appropriate medical care options at this time in their lives, why do we think that there will suddenly be an influx of Geriatricians to treat us when we’re their age?

Maybe this is a lost cause for us but it doesn’t have to be that way for those coming up in the aging ranks behind us.  What are your thoughts about this glut of Senior Health professionals?  How can we hope to live in a world where quality of life – something we value greatly – is an unreachable, yet much desired goal?

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Advocacy starts with the smallest effort to make a difference

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I was touched by the following quote that appeared on Lark Kirkwood’s Elder Advocates site a few years ago:

Do all the good that you can, in all the places you can, in all the ways that you can, at all the times you can, to all the people you can, for as long as you can.  – John Wesley

I want to add the following sentiment which has become a sort of mantra for the way I conduct myself:

We can begin by doing small things at the local level, like planting community gardens or looking out for our neighbors.  That is how change takes place in living systems – not from above – but from within, from many local actions occurring simultaneously.  – Grace Lee Boggs

It only took 3 people to raise $100’s at a garage sale for the local Alzheimer’s Association.

I’m so encouraged by the different types of advocacy that I’ve witnessed across this nation.  Some advocate for the elderly, some the disenfranchised or marginalized, others advocate for the humane treatment of animals.  Whichever the focus – it’s all about advocacy.  The good news is that whether a person lives in Redmond, Washington, like myself, or Washington, DC – we are all making a difference in each of our small corners of the Universe.  Imagine if everyone did just that.

Instead of having the mindset that the only things worth doing are those which are grandiose and news worthy – and therefore believing that you have nothing to offer – do what you can, with what you have, and your impact will be grand.  Many small, positive actions add up to great advances in the betterment of our world.

Regardless of your age, you can make a difference in the lives of others.  If you’re looking for something to do, consider helping an elder or two.  Let’s face it, unless death comes early for us, we’re all going to enter the elder category at some point in the future.  You may someday benefit from someone else’s tender loving respect and care.

Senior Citizens are NOT children!

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An epidemic has taken hold of this Nation.  Adults 70 years or older are being infantalized.  Adult children have decided that their parents can’t do anything without their guidance.  Service employees, e.g. restaurants, retail store clerks and the like, feel compelled to talk down to their Senior customers.  Caregivers in long-term care (LTC) facilities further degrade the residents with baby talk.  These residents downsized their living space; don’t downsize who they are by treating them as anything other than who they are: intelligent adults.

Only you can put an end to this epidemic.  If it is not eradicated by the time you reach the Senior Citizen age, you too will be subjected to its horrors.

Adult children.

Mom moves into your house because of a financial or medical reason, and suddenly Mom has no say in what goes on in her life.  Everywhere she turns, her son and daughter-in-law are bossing her around in the guise of trying to do what is best for her.  Mom wants to stay up late reading or watching TV and she’s told she should go to bed.  Mom wants to do this activity, or that activity with friends outside of the home and she’s told not to leave the house because the son and daughter-in-law want to make sure she doesn’t get into any trouble.

PA-LEEEEEZE!!!!!

Your Mom raised you and somehow you turned out o.k.  She must have been a good parent, teacher, guidance counselor, child supporter, you name it.  Just because she is living under your roof doesn’t mean she’s lost her right to have a say in matters that go on in the household.  Ask her opinion from time to time.  Let her somehow contribute to the functioning of the household, e.g. day-to-day participation in household functions, helping you with decisions you’re making about your own lives.  Doing so will restore her pride and make her feel less superfluous.  It’s quite o.k. to be concerned about her well-being – you should be – but you can do so without suffocating her.

Service employees.

My mother with my daughter Erin, circa 1976.

Why is it that wait-staff, retail sales clerks and the like feel an immediate need to speak super loudly to a Senior citizen customer?  In my work with the elderly, I made this very mistake by talking loudly to a LTC resident I had just met.  She finally interrupted me, put her hand on my knee and said, “Irene, I’m old; not deaf.  Please stop yelling at me.”  So simply lower your voice and don’t call her a pet name such as “Sweetie,” “Hon,” etc.  I’ll never forget my mother’s phone call to me many years ago when she was barely over 70 years old.  She went to the Dept. of Motor Vehicles to renew her driver’s license.  After filling out the paperwork and getting her photo taken, it was time for her to leave with her newly issued license.  The DMV clerk then said quite loudly, “Now Sweetie – before you leave, make sure that you have everything with you that you came with.”  My mother called me that evening, both angered and in tears, bristling at the way in which she was treated.  In my mother’s eyes, the DMV clerk downsized her intelligence and abilities and that thoughtless act forever changed my mother as a result.  Please treat your Senior consumers with respect and with dignity.  They know they are older than you are – you don’t have to remind them of that fact with your ill-placed attitudes and gestures.

An aside:

Here I am, 58 years old, with my hubby. Only HE is allowed to call me Dear.

When I was 58 years old, a couple years ago, I picked up some items at my local grocery store and used the self-checkout counter to purchase my groceries.  As I was leaving the store, the retail clerk said, “Thanks Dear!”  A male customer who was older than me also went through the self-checkout at the same time but that retail clerk didn’t say a cutesy name to him!  Oh Boy – she didn’t know what she had just started.  I didn’t make a scene.  I left the store, wrote a letter to the manager and included this blog entry/article with a suggestion that he update his store training to include my suggestions about how to treat Senior Citizens.  He wrote me back to thank me and stated that he planned to provide updated sensitivity training to his staff.  BRAVO!

Professional LTC caregivers.

Oh boy – I see this a lot.  Caregivers who, God bless them, have a job that not many of us would willingly perform – especially at the low hourly wage at which they are paid.  I admire you and I respect you.  You’re a better person than I because I don’t have what it takes to do what you do.  But please address your patients/residents by their given names.  I would even go so far as to suggest that you call them by their surname until they give you permission to use their first name.  “Good morning Mrs. Smith.  It’s so good to see you today!”  That’s a far more respectful greeting than the following:  “Good morning Sweetie Pie.  Let’s get you ready for breakfast, shall we Hon?”  YUCK!  God help the person who addresses me that way when I reach my Senior years.  I’m a friendly person at heart, but I too would bristle at any condescending treatment directed towards me.  (And considering how I reacted to the cutesy name directed at me in the supermarket a few years ago (above) I may not be quite as civil in my later years.)

BOTTOM LINE FOR EVERYONE CONCERNED.  These Senior Citizens with whom you have contact survived the Great Depression and at least one World War.  Surely they have the ability, and the right, to be treated with respect and given the benefit of the doubt when it comes to making their own personal decisions.  Don’t take away their ability prematurely.  Eventually they may not have the ability to function independently, but it doesn’t do them any good for you to hasten the time in which that may happen.

After my most recent post, I decided that some humor was in order.

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These guys rob a bank wearing gorilla masks.  As they’re getting away, a customer pulls off one of the robber’s masks to see what he looks like.

The bank robber says, “Now that you’ve seen me, you have to die,” and he shoots the man dead.

The robber looks around the room.  Everyone is looking away or covering their eyes.  “Did anyone else see my face!?”

An Irishman in the corner slowly raises his hand.  “You saw my face!?”  “No, but I think my wife might have got a wee peek.”

When your loved one with Alzheimer’s no longer recognizes you.

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Imagine, if you can, sitting next to your spouse of 25 or more years, and experiencing for the first time that she no longer recognizes you.  As a matter of fact, she’s quite scared of you, fearing eventual harm, and backs away, even screaming, because you’ve become a menacing figure in the room.  Or your father, who you have diligently visited at the facility several days a week for a couple years; he looks at you with a questioning glare and asks, “Who are you?  Why are you here?”

You can’t imagine this scenario unless, of course, it’s happened to you.  I’m talking to you, the new-found stranger in your loved one’s life, in the hopes of softening the blow that the above scenarios have landed on you.

Oftentimes during the course of our loved one’s dementia, we’ve managed to find the humor in some of the ongoing episodes, e.g. observing your wife as she stands in front of a mirror, carrying on a one-sided conversation with her new BFF; or your husband’s acceptance of you as a nice lady and all (even though he doesn’t recognize you as his wife), but he tells you he’s not gonna have sex with you because he’s already married; or perhaps you’re admiring the outfit your mother has chosen to wear for the day, only the bra and panties are worn on the outside of her blouse and pants and it’s time to take her to church!  Kind of funny, right?  But these odd behaviors take on a whole different light when, by their very nature, they cut you off from the loved one with whom you have shared so much history.

My dad's final resting place - one month after my last visit.

I first learned that my father no longer recognized me when I walked into his Oregon hospital room – he had been admitted with an ongoing prostate issue – and after spending a good portion of the day with him, he stood up to shake my hand and said, “Well Jim, it was nice of you to drop by but I have things to do.”  Needless to say a) I’m his daughter; and b) my name is Irene.  My 89 year old father was five years into his dementia by that time – and as it turned out, only one month away from dying – but the good news is that I had just experienced a really wonderful day with him and I felt very close and in-tune to him.

Did it feel weird for him to call me a name not mine?  You betcha – especially since it was a male name – but let’s face it, my hair is pretty darn short so maybe I reminded him of a friend of his and that’s the name that came to him first.  Unfortunately, his incorrect identification of me only happened once because the next time I saw him, he was in a coma dying from prostate cancer.  What I would have given for many more opportunities to have passed off as his friend Jim.  It was not to be.

The loss we experience with non-recognition.  I think the biggest loss that is felt by family members is that their loved one no longer shares the same family history.  No longer are we able to talk about old times; no longer can we reflect on the road trips, the Holidays, or the day-to-day memories that make a family unique.  Nope – we’re on our own and even if we have other siblings with whom to share these stories, it’s just not the same.  Imagine being the only child and your last remaining parent no longer has the ability to be a part of the stories and histories that keep your legacy alive.  That’s a difficult pill to swallow to be sure.  There are no amount of condolences, hugs, and “I’m so sorries,” that will take away this very real pain.

I think the only gift I have to offer those experiencing this scenario is to say that only YOU can provide the love that your father/mother/spouse/sibling can receive.  A caregiver can’t take your place; a well-intentioned volunteer can’t take your place.  Only you can transmit the familial love that will make a difference in your loved one’s life.

Whether your name is Jim, or sweetie, or heh-you: please know that you hold the only genuine love that can make a difference in your loved one’s life.  If you can believe that – your visits might be a little less painful when you’re no longer the acknowledged spouse, adult child, or sibling of your loved one.

Caregiver Guilt

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Do you feel as though you don’t visit your loved one often enough at the long-term care (LTC) facility in which they live? Try to acknowledge that guilt is a feeling that may not necessarily reflect an accurate reality of how attentive you are towards your loved one.

The local caregiver.

Many people have expressed their concerns to me that they’re just not doing enough for their loved one who lives in a LTC facility. Even when a caregiver visits Mom several days a week, the caregiver still feels guilty for not making more of an effort to be there for her.

Guilt is a valid feeling – I believe all feelings are valid – but the feeling of guilt may not accurately reflect what is going on. Let’s face it, most of us are hard on ourselves. The old adage, “we’re our own worse critic” came about resultant from generations of people who unfairly beat themselves into the ground.

At a recent gathering I attended, a woman expressed how guilty she felt for not visiting her mother more often than she thought appropriate. Another person, also a caregiver, suggested that this person ask herself whether or not she felt she was doing the best she could in this situation. “If you are, then perhaps your feeling of guilt is based on emotion rather than reality.” Whether five visits a week or one visit a month – if that’s the best a person is able to do, then it’s sufficient.

Some of us caregivers simply need to cut ourselves some slack. Even when the loved one we’re visiting has no concept of the passage of time and is not able to discern whether they’ve been visited as recently as the last hour or as long ago as last year, we still berate ourselves for not being there more frequently.

Caveat: I need to add that even if your loved one doesn’t a) recognize you, and b) can’t quantify the passage of time, you are still a wonderful addition to that person’s life.  No staff caregiver can take your place when it comes to providing a loving presence for your Mom who lives in a facility. Just being there with a smile, a hug, and speaking words of compassion can do wonders towards brightening Mom’s day.

The long-distance caregiver.

One of many walks my father and I took around his facility

My biggest role as a caregiver was that which I performed long distance for my father who lived in a dementia unit in a Southern Oregon assisted living facility. I felt like I was doing something truly valuable for him while I was there but as soon as I boarded the plane for Seattle the guilt enveloped me. Usually, the first night of my return was spent crying because I felt I had been impatient with him, or I acted flustered when I had to answer a question that my father had already asked me no less than two dozen times prior. I relived every moment of my visit, criticizing this and that about what I did, or didn’t do. I was a wreck. I had to talk myself into believing that dad did have a good time and dad was genuinely happy to see me, and by golly, I didn’t do that bad of a job as a caregiver daughter.

I could then relax knowing that he was being well-cared for in my absence; my visits augmented that care, and I could rest on that fact rather than falling back on my guilt. The NY Times article, Being There and Far Away sheds some light on the long distance caregiver’s experience.  I hope you’ll take the time to read the article as I believe it will touch on some topics that all caregivers may experience.

As I mentioned in my Blog entry, Deathbed Promises and How to Fulfill Them take a deep breath and shed the mantle of guilt you’re wearing. It doesn’t do you any good and it gets in the way of you being the best caregiver you can be.  Cut yourself some slack and don’t be so hard on yourself.

Do your best – that’s all that is required.

Solo Caregiving.

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My recent blog, “Caregiving: The Ultimate Team Sport” assumes the person providing care for a loved one has a wealth of family members upon which to draw for support.  When that is not the case it can be difficult to find willing team members to provide that support. This article provides advice to the solo caregiver and to his/her friends, business associates, neighbors, and community contacts.

Garage Sale fundraiser for the local Alzheimer's Association.
Garage Sale fundraiser for the local Alzheimer’s Association.

CAREGIVER: BE BOLD – ASK FOR WHAT YOU NEED.

Those people with whom you have contact probably know that you’re the only one carrying the ball when it comes to caregiving but they can’t possibly understand the degree of difficulty you’re experiencing.  Assuming that to be the case, your friends, business associates, and neighbors may not feel the need to reach out to you with assistance.  Now is the time to be very transparent with them and tell them what you need.

Having dinner with my dad and his late-in-life Bride.

DINING ALONE IS A DRAG – NOW’S THE TIME TO ASK FOR WHAT YOU WANT.

There is no shame in inviting yourself to dinner.  If these are true friends/acquaintances of yours, they will welcome you into their home.  Once you’ve invited yourself a couple times, true friends and valuable neighbors will start to invite you into their dining room on an ongoing basis.  Besides, they’ve probably been wondering what they could possibly do to help you out in your situation and you’ve just presented a very easy way in which they can do so.  Heck – they’re going to cook dinner for themselves anyway; one or two extra people aren’t going to throw a huge wrench into their meal plans.

My wonderful Dad, circa 1960’s, being a jokester.

ATTENTION WELL-MEANING FRIENDS & NEIGHBORS!

I think the rule of thumb in these situations is to assume that your friend the solo caregiver needs a hand with something, so ask him what he needs.  Let’s look at the difference between the following offers of assistance.

  1. “Hey Sam, call me if you ever need some help.”
  2. “Hey Sam, could you use a little extra help around the garden?  I’m all caught up with my yard work and would like to help you in any way I can.”
  3. Hey Sam, we always cook for a crowd and always have some leftovers.  I’d like to give you some leftovers in disposable containers that you can freeze and use any time you don’t feel like cooking for yourself.”

In the 1st example, you’re leaving it up to Sam to feel comfortable enough to inconvenience you (in his mind) with a request for help.  You’re basically forcing him to ask for help.  In the 2nd and 3rd examples, you’ve given Sam an offer of tangible, definable assistance that shows that you really mean it when you say you’re willing to help out.  If neither of those offers fit within Sam’s current needs, you’re still making it easier for him to ask for help with something else: “Wow Larry, thanks so much for your offers but what I could really use is help figuring out the health insurance issues that have kept me awake at night.  How about having a beer with me, and between the two of us, maybe we can make some sense of this mess in which I find myself.”

Friends, work associates and neighbors – your solo caregiver friend needs help and you could be just the right person with the skill that he needs.  Some day you may find yourself in a similar situation and will know first hand how difficult it is to be a solo caregiver.  If it takes a village to raise a child, it must take at least that to help someone with the burden of being a solo caregiver.