For seniors — and for those with seniors in their lives…

A heartwarmingaccount of a former helicopter mom and now a helicopter daughter on taking care of Dad!

http://www.nytimes.com/2015/09/10/opinion/how-i-became-a-helicopter-daughter.html?ref=todayspaper

Interesting article, though a bit troubling in some aspects. Example: << It’s also hard to overlook that the people doing the heavy lifting in both cases tend to be women. One much-trumpeted study showed that elderly fathers with grown daughters live longer than fathers who only have sons. (The same did not hold for elderly mothers and their daughters — no surprise to anyone who has been a teenage girl or the mother of one.) >> (Note that the study she mentions is based on a sample population of about 4,000 church members.)

I didn't understand that reference in the article, to tell you the truth. What have teenage girls got to do with it?

It's a reference to the clashes that often happen between teen girls and their moms. It was an unnecessary crack on the author's part.

PeggyC said:
I didn't understand that reference in the article, to tell you the truth. What have teenage girls got to do with it?

There were a few statements by the author that made me flinch, although by and large I found the article interesting.

Reading this as a senior is terrifying, but required reading for caretakers.

An Aging Population, Without the Doctors to Match
By MARCY COTTRELL HOULESEPT. 22, 2015

WE talk a lot these days about what constitutes a good way to die. There’s also much discussion about the art of healthy aging.
But largely absent from the conversation are all the people between the two. People who aren’t dying but who grow more frail. People who have significant health concerns. People who suddenly find themselves in need of care.
People who are, by and large, miserable.
We have a name for this part of life in our family. We call it “the land of pink bibs.”
In his 70s, my father, a highly respected orthopedic surgeon, developed Alzheimer’s. Later in the course of the disease, he broke his hip. One day when we visited him at the nursing center, about six months after his accident, we found him sitting in a row of patients all wearing pink bibs, left on after they had finished eating. Like the others, his head was bent toward his lap; though his eyes were open, they were not focused on anything. His shoulders slouched, like a rag doll’s, and his mouth hung slightly ajar.
We were not prepared to see him like this.

“Oh, not a stroke,” the nurse said. “He is fine. He’s just on a new drug — a mood stabilizer. He was becoming violent to the aides. Patients often get like this when they have Alzheimer’s.”
We were suddenly confronted with decisions about his care that we didn’t understand. Many families face similar questions: Do we move Mom out of her house to assisted living? Dad is so forgetful and argumentative, does he have dementia? Do our parents have enough money to hire a caregiver — and do we? When should we move them to a nursing home? What kind of care will they need when they get there?
These are difficult questions. Yet when you look around for help, you find there isn’t much to be had.
Why not? Most health care professionals have had little to no training in the care of older adults. Currently, 97 percent of all medical students in the United States do not take a single course in geriatrics.
Recent studies show that good geriatric care can make an enormous difference. Older adults whose health is monitored by a geriatrician enjoy more years of independent living, greater social and physical functioning and lower presence of disease. In addition, these patients show increased satisfaction, spend less time in the hospital, exhibit markedly decreased rates of depression and spend less time in nursing homes.
Our family witnessed the value of geriatric care firsthand.
After seeing my father slumped in his chair, we reached out to a leading geriatrician and researcher, Dr. Kenneth Brummel-Smith of Florida State University. After listening to me recount my father’s health history (his broken hip and significant arthritis), Dr. Brummel-Smith suggested that the cause of his behavior might have been pain. The doctor explained that, of all the suffering that goes with dementia, pain is one of the most common and least recognized, simply because patients can’t express themselves.
Dr. Brummel-Smith urged me to have my dad examined by a local geriatrician, whom he recommended. In a week, the new doctor came to the nursing home. Dr. Brummel-Smith’s suspicions had been right. Despite my father’s broken hip and history of arthritis, he was receiving nothing for pain. Immediately, the geriatrician put my father on a regimen of 1,000 milligrams of Tylenol, three times a day. He discontinued the mood-altering drug. After that, my father’s behavior rapidly turned around. His quality of life vastly improved. He could look around at his surroundings. He could converse. He could smile when we played music for him.

And within days, he was able to escape the land of the pink bibs.

But, as relieved as I felt, I could not help wondering: What about all the other people in nursing homes who aren’t as fortunate as my father?
Currently there are fewer than 8,000 geriatricians in practice nationwide — and that number is shrinking. “We are an endangered species,” said Dr. Rosanne Leipzig, a geriatrician at Mt. Sinai Medical Center in New York.
At the same time, the nation’s fastest-growing age group is over 65. Government projections hold that in 2050 there will be 90 million Americans 65 and older, and 19 million people over age 85. The American Geriatrics Society argues that, ideally, the United States should have one geriatrician for every 300 aging people. But with the looming shortage of geriatricians, the society projects that by 2030 there will be only one geriatrician for every 3,798 older adults.
Why such a growing gap between an increasing number of patients and a decreasing number of doctors required to treat them? Geriatrics is a low-paying field of medicine, even though it requires years of intensive specialization. Most geriatricians are reimbursed solely by Medicare and Medicaid, whose rates make it unsustainable to keep an office running. Many medical clinics and geriatric hospital units nationwide are closing down.
For those entering their senior years, according to Dr. David Reuben, a leading geriatrician at the U.C.L.A. Medical Center, a true national crisis is brewing.
A vast majority of Americans have no conception of what lies ahead and — without geriatricians available to provide their health care — how substantially their lives will be affected.
I know. It means that soon we may all soon be in the land of the pink bibs.

I find this appalling. When Mom was in desperate need, we could not find a doctor who had the faintest idea about geriatric care. I think a series of courses in geriatric medicine should be mandatory, because the need is there for sure. And all of us in the growing base of seniors are really screwed if upcoming doctors can't be bothered because the pay is not there. Seriously, WTF?

Seems like in this country if it doesn't make a bucket of money, there is a dearth of professional help. I do attribute this as one of the major flaws of a more laissez faire capitalism.

The cost of medical school make it almost understandable, but why is geriatric medicine so poorly paid? Because many or most elders are on fixed incomes?

PeggyC said:
The cost of medical school make it almost understandable, but why is geriatric medicine so poorly paid? Because many or most elders are on fixed incomes?

Geriatricians are not poorly paid, but the pay pales in comparison with other specialties. Pediatrics & family medicine are similar. Reimbursement rates are set at higher levels for other types of specialists.

There has been some improvement under the ACA, but not enough.

I hope that trend continues, MJH. We are all going to need it, both the older patients and the doctors who treat them. I suppose this also explains why it is so difficult for me to find a really good GP.

The lack of geriatricians, and the lack of information for families about appropriate medication etc., is appalling.

Our family story: When my mom was being released from the hospital, unable to walk, after being flattened by too-low potassium, I was thinking I had to find a nursing home spot (on 24-48 hrs notice, and so few have really good care anyhow!). But her long-time cardiologist took it on himself to step outside his specialty to call me and say, "You know, you could take her home with you." It had never crossed my mind that that was an option, and I certainly didn't hear anything one way or the other from the hospital or from the docs treating her there. As it turned out, with a visiting PT and the daytime help of my darling sister, we were able to care for her till she got back on her feet, about 6 or 8 months iirc.

The whole process is often so opaque, and the professionals seem to know little about what's available outside their own field. When joanne writes about the supports and services available in Australia, I sometimes think I should move there.

I agree with mjc - when my mother (this was about 7 years ago) was being released from the hospital after surgery for a broken hip, we were basically given 5 hours notice to decide which rehab facility we wanted to bring her to (assuming they had room for her). The only guidance we got was a xeroxed copy of a list of places and their addresses - no info, no pictures, no guidance at all. And this was from the discharge coordinator of the hospital! Mom was 94 years old at the time, and had dementia, so we couldn't just put her anywhere and hope for the best. I finally called the wonderful woman who was in charge of her Memory Care facility and asked her opinion of the 3 nearest places and made my decision based on her input. She had dealt with them because patients in the Memory Care Unit had been in each of them and she always made a point of visiting her patients when they were in rehab.

But guidance from the hospital? Nothing!

Cody, what memory care facility was your mom in? The facilities my mother was in made no effort to follow up when she was in hospital.

Mom was at Emeritus at West Orange (it's now called Brookdale, I think). She was so fortunate to have a memory care director who was an angel and so committed to her residents. She would come in in the middle of the night to check on the night staff and stayed there when they had storm-related power failures. I know she stayed in a vacant room for 3 nights after Sandy, filling in for staff who couldn't get in and relieving those who also stayed. She has moved up and on to a more senior position with another organization in a different state, but she was simply the best person that Mom could ever have hoped to find. And she was so supportive and helpful to the families of the residents.

cody said:

But guidance from the hospital? Nothing!

I think that they are prohibited by law from making referrals because some bad actors (on both sides) were giving/receiving kickbacks for directing patients to certain facilities.

They can give referrals, but must give at least three, with no specific recs. This is usually done by the discharge planner, most often a nurse or social worker.

All I was given was a sheet of paper with about 15 facilities and their addresses and phone numbers. No description of what they provided, whether they were equipped for dealing with patients with dementia. We were told we had to make a decision that afternoon, so there wasn't even time to drive around and look at them. It was also a bitterly cold day in January, and they discharged Mom at 7 p.m. at night, while it was flurrying. Due to the dementia, nighttime was her most agitated, confused time. It would have been much more compassionate if they could have discharged her the next morning, after a night's sleep and in daylight.

I guess I was unclear about what I meant by "referrals." Yes, they can give names/addresses, but cannot recommend one facility over another. Before the hospital can discharge a patient, a plan of care must be in place.

This article is very difficult to read-- but facing reality is vital.

http://www.nytimes.com/2015/09/27/nyregion/the-fragile-patchwork-of-care-for-new-yorks-oldest-old.html?ref=health

The social worker at the hospital that diagnosed Mom with cancer was almost no help when they gave her the bum's rush. We were reeling from the shock and racing to find the best care we could. I got very lucky that time.

I can recommend an organization called APlaceForMom.com. They are paid by facilities to be included, but the lists they have are lengthy, the phone counsellors are very nice and supportive, and they have a ton of information on the facilities they represent. I found them very helpful, if only to have a calm voice on the other end of the phone and a listening ear while I cried. I can't underestimate how important a friendly, calm voice was at that time.

"a friendly, calm voice"

Yes! In my case, the friendly, calm voice was that of my later-to-be-husband, saying well, they can't actually put her out on the curb. This was after the doc said on one day that Mom would be in the hospital for another week, then the next day a nurse called to say she would be discharged, I'm no longer sure whether it was that very afternoon or the next day. oy

Scary story, but required reading ..

http://www.nytimes.com/2015/09/29/health/near-the-end-its-best-to-be-friended.html?ref=todayspaper

It is really unpleasant and frightening, but everything everyone is saying here argues for having a plan in place before the need arises. This involves shopping for a care facility while your parent is still in place, so that when the inevitable happens, you are prepared. Worse, you have to keep updating your research if things go well and your parent stays healthy!

The Maplewood Health Dept. is having a special program at 2:00pm on Wednesday Sept. 30 at St. George's Church concerning issues of this type. We will plan on taping it and putting it on local access TV. The program is open to everyone. Call if there are questions. 973-762-8120 x4400.

I really really hate the word "unbefriended." I hope "unrepresented" takes over.

Ditto x 10

More downsizing tips..

http://www.nytimes.com/2015/10/03/your-money/downsizing-offers-a-fresh-start-for-older-adults.html?ref=todayspaper

I wish we were closer to true downsizing. But when it comes time to look in our bookcases and closets, things slow down to a crawl.

bookcases are the worst