Keeping the Peace in a Nursing Home

I belong to Hospice Community Forum and just had a discussion with an “11th hour volunteer.” An 11th hour volunteer is a person who sits at the bedside of the dying, usually when death is imminent or within 24 hours or so. They are very much akin to a death doula.

Well, he brought up the issue of creating a peaceful environment, which can be especially challenging in a nursing home. To all the nursing homes out there, most of you do a great job … but, there are some situations that nobody should have to endure, especially when he is dying.

‘Keeping the peace’ in the room of a dying person is paramount. I have found that there is a certain level of noise that is acceptable in any public place and nursing homes have theirs as well. It is far different then what should be happening at a death bed vigil. I have had a lot of luck asking for the roommate of the dying to be moved if they are loud, need loud TV, or in anyway disturbing to the dying and their family. If the roommate is not willing to change their behavior or go to another room for the interim, the nursing homes I have dealt with have been willing to move the dying and their family to a private room.

After physical comfort, environment is so much a part of a peaceful passing. That is why we are there–our presence blending with theirs. In a perfect world we would all get to have loving, peaceful surroundings. What brings me joy in this work is that I am part of creating that. It may not be what I wish it was, but I know that I’m part of the solution in bringing as much calm as can be.

Sometimes a nursing home may need a little nudge in peacefulness. I have had luck putting up a sign on the door to knock softly and keep the lights off. It is amazing how much a little sign will do. Also the family can inform the charge nurse that they want nobody coming in the room unless to provide peri care or room cleaning. If that is not enough, ask for a doctor’s order for this. Ask the staff to help you. Ask each person you see to be proactive in helping you give your loved one a peaceful death. Look them in the eye and ask. Most of them will love to be part of caring in this way.

So now the roommate is quiet or you are in a room by yourself, but the lights flashing from the TV may be disturbing depending on the person. Would you want the news on if you were laying there dying? or The Price is Right? or The Jerry Springer Show? I am serious. Remember that hearing is the last sense to go and your loved one is being affected by all the energy in the room, whether it be flashing lights, hearing, smells or emotion.

Some other things: make sure soiled bed pads and briefs are out of the room immediately; apply your loved one’s favorite scent on them or in the room somewhere; play favorite music; play books on tape. My suggestion is to have some type of soft sounds–the ocean, forest or river noise–something to drown out the noise of the facility. It will not do it entirely of course, but it may help.

Please remember that the nursing home is it’s own little world and anything that you want to be different, you are going to have to be very proactive about getting. Most people who work in the nursing home want to please you and care for your loved one too. Very caring people are drawn into this line of work and are very deeply affected when someone they have cared for is dying.

If you have experiences in how your loved one was able to have a peaceful death in the nursing home, please let me know. What did they do or you do to make it so?

Palliative Care and the Elderly

An article, “The TLC Model of Palliative Care in the Elderly: Preliminary Application in the Assisted Living Setting” in the Annals of Family Medicine, describes 5 barriers to palliative care with the elderly who live in assisted living facilities. We can definitely generalize this to most situations where the elderly would benefit from palliative care.

Basically, the 5 barriers to palliative care for them are:

• the perception that palliative care is only terminal care.
• palliative care is defined as mutually exclusive of cure directed treatment.
• the decision if palliative care should be the sole form of care is not ” … negotiated among patients, family members, and providers … “
• making treatment choices is given more importance than discussing the reality of life with a chronic debilitating illness
• palliative care is treated as an either/or decision instead of an integrated part of the treatment plan.

In a nutshell, palliative care is appropriate and possible regardless of which disease process a person has, what the prognosis is or what cure directed treatment choices a person makes. Palliative care should be interwoven concurrently with cure directed treatment. It can either be used with treatment intended to cure or as the sole form of treatment.

Palliative care (regardless of other treatment plans being used) optimizes quality of life and when your energies are not spent coping with pain, nausea, breathlessness, fatigue and the immobility (among other things) resulting from this, there is more energy to cope with the manifestations of the disease. When a person is comfortable, they eat more, sleep better, not as fatigued, not as depressed and at least have the possibility of enjoying their day.

Rehab in the nursing home

Check it out.

There are many things that make up good care in nursing homes. It definitely is a team effort and it takes the whole team to make a really great one. Next to quality care by the nurses and certified nursing assistants (CNAs), is the quality of the rehab department.

When you are looking for a place to take dad, talk to the head of the rehab department. It’s OK to get the tour by the administrator or the admissions/marketing person, but talk to the rehab department head too. Take time to spend with them, ask for an appointment. Go look at the gym. Do your homework; get familiar with the terms and the goals of care for the condition he has. If dad is not currently receiving physical/speech/occupational therapy, ask what it would take for the department to get involved with dad’s care outside of an injury. Ask them what programs they have for residents who are not on what we called “skilled services.”

When it boils down to it, the level of care is pretty much the same wherever you go. You have the same type of care at all of the nursing homes. It’s the quality that makes the difference and don’t let the chandeliers and pretty carpet make your decision for you.

Checking out the rehab department is important whether or not dad got a hip replacement, knee surgery, etc. Nursing homes are now instituting what they call ‘nursing rehab’ programs. These programs are at no cost to the resident. They are not delivered by the skilled therapists, they are delivered by ‘restorative aids.’ These aids are CNAs who have special training by a skilled therapist. I’ve seen very good results with this program.

So even if dad has nothing from which to recover, find out what the nursing home offers to assist dad in maintaining the function he has now.

Parenting Your Parents: The Joy of Creating New Memories

by Jim Comer

When we are parenting our parents, it is only natural to dip into the past. The old days are familiar territory and we feel safe there–as long as we are careful which memories to unwrap. While the past may be comforting, don’t neglect the possibilities of the present.

History isn’t something that happens to someone else. Everyone has stories worth telling and memories that should be shared.

Mining our parents’ past is not expensive. It takes only time and energy. With a few taped interviews, vintage pictures and period music, you can create a homemade video that will honor and thrill your parents. If you have no technical abilities, get some high-tech help. Hire some clever teenagers with too much time on their hands.

I interviewed my father on a simple audio tape recorder about his early days. Since he was terribly deaf, I had to shout the questions, but it was a small price to pay for what I learned.

He told me about his trip to Europe on a tramp steamer when he was just seventeen. He was in Germany in 1930 and saw Hitler speaking at a street rally. For a few months during The Great Depression, he serviced slot machines that had been won in a poker game by the newspaper editor in Waxahachie, Texas. In the late thirties, he ran a service station in corpus Christi and one of his best customers was the madam of the town’s premiere bordello.

Dad was in Italy when Rome was liberated and got to stand on Mussolini’s balcony. He was invited to join a group of Catholic pilgrims who had a private audience with the Pope Pius XII. The pope noticed my father standing off to the side, walked over and introduced himself. When he learned that Dad was from Texas, he said, “Texas! Can you tell me why they pour concrete down the hole when they dig an oil well?” My father spent ten minutes telling the pope about oil fields. Not bad for a Presbyterian.

Find out what’s important to your parents about their past and get them talking about it.

In our family, World War II never really ended. During three years in the Army Air Corps, my father kept a journal that covered his combat missions out of England in 1943 when the casualty rate was eighty percent. After the war, we kept hundreds of handwritten pages in boxes as we moved from city to city. When Dad retired in 1974, Mom and I urged him to turn the journal into a book. It took five years to get him started and another five to complete the manuscript. I edited at least six drafts and eventually we honed it down to two hundred and twenty pages. In 1985 Combat Crew was completed. Dad contacted a local publisher who said it would cost $15,000 to print 1,500 hardcover copies. For a conservative man, that sounded like $150,000. I assumed the book would remain unpublished. Surprising to everyone, Dad spent the money.

When the books were delivered, I organized a book-signing party in Dallas and arranged an interview in The Dallas Morning News. They gave Dad a full page with a color picture. To our amazement, the books sold out in six months. A friend sent a copy to a New York literary agent who sold it to William Morrow & Company within 2 weeks. Dad’s book was published internationally in hard cover and paperback and has been read throughout the world. Today used copies sell on the Internet for up to $100.00.

Life does not take place on television. Whenever possible, even if it’s a hassle, get your parents out of the house.

Every May there is a Central Texas Air Show, with re-enactments of World War II battles and an appearance by a B-17. Naturally, ad and I never missed one. The field is hot, dusty and crowded. There are screaming children and a blaring sound system. It’s not my favorite day of the year. Within twenty minutes, I am tired and cranky, but Dad is in heaven.

One year he suffered a fall and had to use a walker. He was in pain and I convinced myself that he couldn’t handle the long trek from the parking lot to the runway and wouldn’t be interested in going. Secretly I was relieved. Nevertheless, I didn’t want to make the decision about attending the show without asking him. I said, “Dad, do you want to go to the air show next weekend?”

He said, as he did so often, “what did you say?”

I repeated the question at triple volume.

With exquisite timing, he replied, “oh, I don’t know, Jim…”

There was a long pause. ” … only if you want to go.”

It turned out I was ding to go.

On the day of the air show, he put on his Eighth Air Force cap and jacket despite the soaring temperature. I planned ahead and got us a reserved parking space and asked for a VIP golf cart to take us directly to the B-17. I also brought a folding chair. Sure enough, when we got to the airport we had a parking spot close to the gate.

I got Dad’s walker out of the back seat. Slowly we made our way to the entrance. When I told the ticket-taker we needed a ride for a World War II veteran, he almost clicked his heels. I was impressed, but shouldn’t have been. It took three walkie-talkie calls before they finally got the golf cart to us. By that time my ever-impatient father was griping about the wait.

I loaded Dad, his walker, and folding chair on the cart and climbed in the front seat. The driver was a soldier from nearby Fort Hood. As we drove off, an enormous lightning bolt struck nearby. In my concentration on logistics, I had ignored the dark sky and ominous black clouds. I told the driver we wanted to go straight to the B=-17 because Dad had flown seventy-six combat missions in World War II.

“Seventy-six!”

“Yep.”

“But didn’t they send those guys back after twenty-five?”

“Dad volunteered for a second tour of duty. Mother almost divorced him.”

“Seventy-six!”

The young soldier turned to my father and said, “sir, I want you to know you are my hero.”

Dad gave him a smile and a kindly nod that meant, “I have no idea what you just said, but I’m sure you meant well.”

“He can’t hear unless you yell. He’s deaf.”

Our driver reached to the depths of his diaphragm for vocal support and screamed, “sir, you are my hero!”

Everyone within a hundred yards heard him, even my father. The thunder was booming as we rolled on to the runw3ay. For the first time I focused on the impending downpour.

“Get as close to the B-17 as you can.”

“No problem.”

He drove past the STAY OUT signs and headed for the Flying Fortress. Dad brightened visibly as he saw the plane’s familiar outline.

“There she is!”

Lightning flashed again and I felt the first raindrop. Our driver was not deterred. He drove directly under the right wing just as the sky opened up. There was a twenty minute downpour of biblical proportions. All 10,000 air show attendees were soaked to the bone, but not us. As he had been sixty years earlier, Dad was sheltered by the wings of a B-17.

I jumped out, opened the walker, got Dad out of the golf cart and prepared the folding chair as if it was a throne. For a moment I saw my father as he must have looked in 1943; lean, strong, blue eyes shining, and his whole future ahead of him.

Dad sat serenely as the rain swept around us. The plane’s crew soon heard that a veteran of seventy0psix missions had joined them. They climbed out of the plane and lined up to shake my father’s hand. One of them asked for an autograph. My father beamed as he signed his name.

When the rain stopped, we made our way slowly across the drenched field. We sat in our folding chairs amid the soaked grass surrounded by planes of his departed youth. We didn’t say much because perfect moments don’t require words. However, I coudn’t miss the look of joy on my father’s face. And to think we almost hadn’t come.

_________________________

Jim Comer is a writer and speaker in Austin. His book, “When Roles Reverse: A Guide to Parenting Your Parents” was published by Hampton Roads and was a finalist in the Texas Writers League Awards for Best Non-Fiction book of 2007. His website is www.whenrolesreverse.com and he speaks to groups throughout the country on elder care.

Questions re: Alzheimers

This is another excerpt from THE ALZHEIMERS ACTION PLAN, a new book “… combining the insights of a world-class physician and an award-winning social worker…

GETTING OTHERS TO UNDERSTAND

Explaining Alzheimer’s to friends and family, including to those who have Alzheimer’s, is never easy and always important.

30. “How do you get your friends to understand that just because you have Alzheimer’s, you’re not deaf and dumb?”
—A sixty-year-old woman with Alzheimer’s

It might surprise people who don’t have the disease, but this is a very common and devastating problem for people with early Alzheimer’s. Friends and family make wrong assumptions about your capabilities, which makes trying to adapt to Alzheimer’s even more difficult. Here are some pointers on what to say.Your friends will probably follow your husband’s or children’s example, so start with family first. Explain very directly that:

• although you repeat yourself because you can’t remember who has heard your stories, Alzheimer’s doesn’t make you deaf or dumb (speaking loudly, for example, is completely unnecessary)
• you still enjoy going out, say, to dinner, museums, shows, or shopping, but you do better in familiar places earlier in the day or with a companion
• you would appreciate rides to places and reminders about events
• hosting or coordinating activities has become too stressful, but you would enjoy helping with them
• you hope everyone can ignore your mistakes and laugh with you at the crazy things we all do, to varying degrees, as we age

For more advice, contact the Alzheimer’s Association about joining an early-stage Alzheimer’s support group, either online or in person, where you’ll get lots of tips (and sympathy) from other members. The association also has materials illustrating how to talk to and offer dignified help to people with Alzheimer’s.

31. “How can I explain to my five-year-old why his grandmother keeps calling him by his father’s name?”
—A thirty-three-year-old daughter-in-law

Answer his questions simply and matter-of-factly. Children often surprise adults with their acceptance of differences. Read more

Alzheimer’s Action Plan…1

A representative from St. Martin’s Press contacted me about this new book, The Alzheimer’s Action Plan. I’ll be bringing excerpts of what they sent me for awhile. I thought I’d start with the following.

APPENDIX A: STAGES OF SYMPTOM PROGRESSION IN
EARLY THROUGH MODERATE ALZHEIMER’S DISEASE

By Lisa Gwyther, M.S.W, ACSW

 

This isn’t a tool that doctors use for staging patients, but it should give family members an idea of what happens to people with Alzheimer’s as the disease progresses. Doctors use other tests for determining what stage the patient is in.

FIRST STAGE (MILD OR EARLY STAGE)—LASTS TWO TO FOUR YEARS LEADING UP TO AND AFTER DIAGNOSIS

Symptoms and Examples
• Recent memory loss—repeats stories and questions.
• Confusion about places—gets lost on way to work; arrives at wrong time or place.
• Loss of spontaneity—becomes withdrawn and uninterested.
• Mood / personality changes—becomes anxious about symptoms; avoids people.
• Poor judgment—makes bad decisions.
• Takes longer with routine chores—forgets grocery list; loses things; constantly rechecks calendar or clock.
• Trouble handling money and paying bills—forgets which bills are paid.

SECOND STAGE (MODERATE OR MIDDLE STAGE)—LASTS TWO TO TEN YEARS AFTER DIAGNOSIS

Symptoms and Examples
• Increasing memory loss and confusion, shorter attention span—can’t remember visits even though the visitor just left.
• Problems recognizing close friends and / or family.
• Repetitive movements.
• Restless, especially in late afternoon and at night—may get up at night and wander.
• Perceptual-motor problems—difficulty getting into a chair, setting table for a meal.
• Difficulty organizing thoughts or thinking logically—mixes up day and night.
• Can’t find right words—makes up stories to fill in memory blanks.
• Problems with reading, writing—can’t follow written signs.
• May be suspicious, irritable, fidgety, teary, or silly—may accuse children of stealing, spouse of infidelity.
• Loss of impulse control—curses, tactless, may undress at inappropriate times or in wrong place.
• Gains and then loses weight—forgets when last meal was eaten, may gradually lose interest in food.
• May see or hear things that are not there.
• Needs full-time supervision.

THIRD STAGE (LATE OR SEVERE STAGE)—LASTS ONE TO THREE YEARS

The third stage, which we don’t discuss in this book, is when the person’s abilities deteriorate significantly and nursing-home care may be required.

From The Alzheimer’s Action Plan by P. Murali Doraiswamy, M.D., and Lisa P. Gwyther, M.S.W., with Tina Adler. Copyright (c) 2008 by the authors and reprinted by permission of St. Martin’s Press.

Creating a Roadmap

by Kristi Curry

If someone asked you if you have your affairs in order, what would you say? Do you sit back and relax in your favorite chair knowing that you have met with your attorney and your instructions are clearly mapped out, signed and notarized. Take notice, you may not be as prepared as you think.

Many people think that they have done all they can with their legal documents in place. What they don’t realize is that the administration of an estate can be extremely taxing on their executor and/or families if details have not been documented or communicated. Lives today are complex and working through the details of settling an estate can be taxing on your family and/or executor. Essentially, your executor has to understand and deal with almost every aspect of your life, from your valuables, to your finances all the way down to your pets.

Stop and think about it for a minute. Take a look around your home. Someone is going to have to manage the disposition of all of your belongings. That classic car rusting away in storage waiting to be restored as a project in your retirement years can be left to a relative; however, you have just handed off your prolonged project to someone else who may or may not have the resources to work on it. Your heirs will have to store it, sell it or start a project not on their schedule. Your hobby project just became someone else’s obligation.

What about your pets? People often forget that they have pets that will need a home if they pass away. I know a woman who is currently the owner of her deceased mother’s poodle, Peeper. (they call her Peeper for good reason) The dog gets excited and wets her wooden floors frequently. Peeper also escapes her home frequently and plays “catch me if you can” with all concerned. For someone who is not keen on pets, this is not an ideal arrangement. I always advise my clients to make sure you plan ahead for your pets and communicate that plan with a potential owner so you don’t hand someone an unappreciated, sentimental obligation.

As you ponder the idea of what your family might have to do if you should unexpectedly pass away, consider a documenting a few very important items that are commonly overlooked-

• Online Accounts don’t always have a paper trail. These accounts such as online banks, investment accounts and even gambling accounts with current balances can easily be overlooked. Online banks such as ING and Emigrant Direct do not have physical branches and are becoming more popular due to their competitive interests rates on checking and savings accounts. Start by thinking about how many accounts, usernames and passwords you use everyday. Do you have a list of usernames and passwords somewhere that can be readily located? It’s a touchy subject to keep them private, but let someone know where they are.

• Valuable items without proper documentation can easily be mistaken for garage sale wares, thrown out as trash, or donated. People can get pretty creative when hiding their valuables. I have seen stock certificates and bonds that have been tucked away in books, jewelry hidden in a mixer, buried safes with questionable locations, and even money wrapped in food containers. Almost everyone has a hidden stash of mad money or valuables that can easily be overlooked if they have not been documented. Let your trusted secret out to a close friend or your family or better yet, make a note of it and place it with your estate documents.

• Specific instructions on the disposition of personal items to specific individuals are often subject to individual interpretation. There are more and more disagreements between family members when things have not been spelled out clearly. For example, jewelry descriptions can be confusing. “The diamond ring Aunt Perla left to me should be left to my daughter, Janie and my mother’s engagement ring should be left to my other daughter, Julie.” Suppose there are 4 diamond rings in the jewelry box. Over time, the memories fade as to which is which and when it comes time to pass them along, there is conflict as to who gets what.

Passing conversations with heirs also create many gray areas. Time, circumstances and emotions change so previous conversations along with their intent can and probably will change over time. Provide as much detail in writing as possible on your personal items to alleviate any conflicts later on.

• Safe deposit boxes in banks are often forgotten along with the location of the keys. This is more common than you think. People should be applauded for thinking ahead to safe keeping of valuables and estate documents, but they neglect to think through the next step. Laws regarding access to bank boxes when a person passes away differ state by state and they are getting more and more stringent with the involvement of Homeland Security. Check with your bank manager to ensure that your executor and the people that will need access are able to get into your box quickly.

• Automatic bank authorizations for various memberships, churches, on-going services and even investments, are making our lives easier. They automatically deduct a monthly amount and put it towards an intended cause. Ask yourself, “if I pass away, do I want to keep $250 going to my nephew’s college fund or will my family need it?” There are numerous financial situations put in place while we are alive that need to be “adjusted” for the survivors. Spell out your current automated financial arrangements and the plan for them after you are gone.

Remember, the more detailed the roadmap you leave behind can make your passing what it should be, a day of remembrance for family and friends, not a time of organizational and financial panic.

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Kristi Curry is the owner of Survivorship Now.She works with clients to create comprehensive plans for death and disability. She offers planning services to individuals, small groups and companies with a focus on individual needs and circumstances. Her goal is to help her clients prepare for the inevitable by focusing on the family and executor needs when the time comes. Survivorship Now is a planning resource and does not provide clients with legal or financial advice. However, she emphasizes that the financial, legal and logistical aspects are key ingredients to a successful plan. You can find out more about survivorship planning at www.survivorshipnow.com.

Copyright © 2008 Survivorship Now. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed. If you would like to know more information about survivorship planning, visit www.survivorshipnow.com or contact Kristi Curry of Survivorship Now, 1613 W. 6th Street, Suite D, Austin, TX 78703, (512)771-8530.

Becoming an Optimist

by Dr. Mara Karpel.

Dear Dr. Karpel:My children accuse me of being negative and pessimistic. They say I always “see the glass as half empty.” I’m 67 and I feel that I’m realistic. I have several chronic illnesses and have had a hard life. What is there to be positive about? I’m writing to you at the insistence of my daughter, who wants me to ask if there’s any truth to the idea that my negativity may be the cause of some of the hardships I’ve faced and if there’s any truth to the fact that seeing “the glass as half full” can help me to live out the rest of my years in better health.

My question is, even if what she says is true, can you teach an old dog new tricks?

Dear Al:Yes, yes, and yes… if the “old dog” is willing.Dr. Martin Seligman, a very well-known psychologist, found through his research that depression stems from a pessimistic mindset. Pessimism is a tendency to always see the negative side of things and to believe, in most situations, that no matter what you do, you have no power to improve the circumstances, seeing “the glass as half-empty.” Seligman found that optimism is good for you in every way that pessimism is bad for you. Optimists persevere and persist in the face of insurmountable obstacles, they carry on even when it may be futile to do so, and they don’t know the meaning of the word “quit.” This positive attitude, he found, is good for both your health and your state of mind. In his book, “Learned Optimism,” Seligman teaches pessimists to become optimists.Back to your questions:1. Can pessimism make you sick or cause greater hardships in your life?· Pessimism causes a weakened immune system, leading to a greater likelihood of becoming ill. Also, pessimists are less likely to seek medical advice when ill or follow recommended regimens of diet and exercise because they think, “nothing I do really matters anyway.” · Pessimists are less resilient than optimists following a negative life event. For example, pessimists are more likely than optimists to die within the first 6 months following the death of their spouse.· Pessimists are less likely to seek and keep social supports and friendships, leading to social isolation. Social isolation leads to depression.2. Can a positive attitude lead to a happier and healthier life?· Optimism boosts the immune system, fends off chronic diseases, and keeps one in a better mood and state of mind EVEN IF being optimistic is “unrealistic.” How many “miracles” have we heard of when someone refused to believe that they wouldn’t recover from a so-called “incurable disease”…and they, in fact, recovered? · Optimists are more likely to stick to healthy regimens of diet and exercise and they are willing to seek medical advice when needed. · Those with a positive attitude about aging live on average 7.5 years longer and are happier and healthier than those with a negative view of growing older. 3. Can you learn to be optimistic, even if you’ve always been a pessimist? Yes. Here are some suggestions from Dr. Seligman’s book to turn your attitude around:

• Don’t obsess about unpleasant events. If something unpleasant has occurred, before you spend time thinking about it, do something you enjoy to get yourself into a better feeling state. Then come back to the problem with the goal of coming up with a plan to improve the situation in some way. With this approach, you’ll be more likely to think of better, more creative solutions.

• “Thought stopping” is a technique for stopping the negative obsessing of pessimism. Wear a rubber band around your wrist and whenever you notice you’re having repetitive negative thoughts, snap the rubber band as a signal to STOP and change your thoughts to more positive ones.

• Disputing your negative thoughts. Ask yourself, “Where is the evidence that this is true?” Look for alternative explanations rather than assuming the worst. Ask yourself, “If I hold onto this belief, what good does it actually do for me? What harm does it do to me?” This might motivate you to let the thought go.

Tips for a quick attitude change:

• Exercise: Exercise causes your brain to release endorphins, which are natural pain relievers and mood elevators.
• Eat well: Your body and your mind need good nutrition to function well.
• Get enough sleep.
• Practice relaxation. This reduces stress, which creates a more positive attitude AND it gets your brain to release endorphins.

1. Breathe in slowly. Say silently to yourself, “One.” Breathe out slowly. Say “One” (or any other word). Do this several times.
2. Listen to relaxing music.
3. 3. Listen to a CD with nature sounds…or go out into nature and listen to the sounds

• Laughter ALWAYS turns a bad attitude into a good one!

If you use these techniques enough, they might become habit…and EVEN YOU can turn yourself into an optimist… someone who sees the glass as half full! Are you willing to give it a try?

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Dr. Mara Karpel is a licensed psychologist and talk show host, providing services to adults of all ages, specializing in older adults and caregivers. For more information, to schedule a lecture, or to submit questions for this column, go to www.DrMaraKarpel.com or call toll-free in the U.S. and Canada: 1-800-285-5130. Any information or advice offered by Dr. Karpel is not intended to provide an alternative to professional medical or mental health treatment or to replace or supersede the advice of your physician or mental health specialist. Dr. Karpel does not assume responsibility for the misuse of any of the advice given in this column.

Where Will Mom Live?

During the last couple of days I’ve been staying with a family, spending time with their mother. Throughout this time a lot has been going on and based on my observations, our discussions and their preferences, the family has decided she will be going to a personal care home tomorrow.

Most people talk about independent living, assisted living and nursing home communities and many prefer the bigger institutions for a variety of reasons. For those who don’t, there is another long term living arrangement not often spoken about; my guess is it’s because people don’t have much experience with it. It is the personal care home (defined as an unlicensed assisted living facility of 3 or less residents). Most are more affordable than in-home 24 hour care and most are financially comparable or less expensive than other long-term care arrangements. Just as in any long-term living community, each personal care home is as unique as the owner. A friend of mine owns a few and I was just in one of them the other day.

It was dinner time when I walked in and it felt like I was at my grandmother’s house. I loved the smells of food cooking, hearing the dryer running in the background with that nice laundry smell and the normal sounds of living in a home. The peacefulness felt good.

There are a few unique things about the care in Jonea’s homes. Along with her geriatric experience, she has many years in the hospice world and is a wound care specialist. She also applies her knowledge from the complimentary medical arts, bringing in western and holistic modalities to the symptoms that present during this time (this blending is a growing field called Integrative Medicine).

What I really love about her homes is a person stays in the same place from the minute they arrive until their death. There is no moving around from facility to facility based on the changing levels of care that are inevitable at the end of life. If they decide to change rooms, the move is a few feet away and the environment stays the same. This is how many personal care homes are, you stay in the same place as you age, what they call ‘age-in-place.’

The quality of care in any of the long term situations is dependent on the organization of the facility, the daily schedule of care, how they are able to tend to each person’s individual needs and from my experience, it is in the quality of the lowest paid and often the most poorly treated employees in the place—the CNAs (certified nursing assistants).

The CNAs spend the most time with each resident. They are the ones that get them up in the morning, tend to their toileting, bathing and grooming needs. They get them dressed for the day, feed them and keep their rooms tidy. They are the ones that are responsible for making sure that a person’s briefs are changed regularly and that the briefs are removed from the room as soon as possible and taken to a utility room. The tenderness and time given to a person is of course dependent on the one who is in direct contact with them. The time the CNA spends on each resident is dependent on the schedule of the day and how many residents are in their care that particular shift.

Another important consideration is the state ratings of facilities; and in my experience, if the ratings are more or less similar; the more valuable information comes from other residents and families. And one of the easiest ways to differentiate places right from the beginning is simply how does the place smell? If you smell urine or feces throughout then turn around and walk out. It is that simple. I don’t care if the place is highly rated, if you smell this it is an obvious indicator that the most basic issues are not being adequately addressed. It is usually because they are understaffed or their ratio of CNA to resident is too high. Know that most CNAs I have worked with take pride in their work and do their best to provide the best quality in care.

Walk where the residents actually live, not just in the beautiful dining and common areas. Watch the CNAs work; observe their attitude. Talk with them and take in how you feel when you are in their presence. Know the turnover rate can be quite high because it is a specialty where people are very much underpaid for the work they do; but go ahead and ask a couple of the CNAs how long they have been working there and if they are treated well. Visit the places where you are seriously considering a couple of times. Whatever consistencies you notice are most likely what it will be like most of the time.

The ratings, the amount of complaints filed with the state, the experience of the residents and families, how a place smells, the energy of the CNAs at each individual location, how fast the medical staff is moving…these are a good place to start in your search for a place for mom.