It has been a rough couple of weeks for the assisted living as far as census goes. I have had 1 empty bed since the first of the year. Last month I had a lady fall and break a hip and she did not recover well enough in rehab to return to assisted living. One lady has a daughter who is getting a divorce and decided to move back to town and have her mother come live with her. Then in the last 2 weeks I have 2 residents die very suddenly. And finally, one other resident's dementia is progressing to where he needs to go to the nursing home.
Even though the owner assures me this is part of the long term care industry, it makes me really nervous. I know that we have to make money to keep the building open. On the one hand, I am trying to trust that God has a plan and He knows what He is doing. When I look back over the admissions I've had over the past couple years, they seem to come out of the blue. I feel like this is what God has called me to do and so far He has always made sure there were residents for me to care for. But trust is difficult when you are not in control and it doesn't look like there are any takers waiting on the waiting list. I guess that is why they call it faith.
So I was walking my dog one morning. I frequently use that time to pray, but I admit sometimes my mind wanders. I was thinking back over the previous day. I had another resident who was thinking she needed to go to the nursing home, but she really wanted to stay in assisted living. I spent a lot of time with her that day, reassuring her that we could provide for her needs. While I was in there talking to her, she complained about pain in her knees. She has Icy Hot she puts on her arthritic knees to help the pain. So since I was right there, I offered to put it on her knees. While rubbing that on her knees, I saw that her legs and arms were really dry. So after the Icy Hot, I got her lotion and rubbed lotion all over her legs and arms. As I did it, I was thinking about how our elders have so infrequent touch of another human being and what a gift it was for me to be able to do this one small thing. As I rubbed her legs, I remembered back to some of the residents I took care of when I was working my way through college as a CNA. When I left work that day, I had felt the greatest sense of accomplishment, not in completing paperwork, but in those brief 10 minutes of really connecting with another human being. So as I was walking the dog, I had like a thunder bolt of a thought cross my mind. I was praying of course for God to send residents so I won't lose my job. But then the thought hits me, what the world sees as success is not necessarily success in God's eyes. Real, eternal success is the difference I was able to make in that one woman's life with ten minutes of my time.
Oh,that I could keep that perspective always. The doubts and the worries sneak in and get me off track. But regardless of how many "beds" are full, I hope I can keep my focus on what really counts. Not only for the residents and families I am responsible for at my job, but for eternity and ultimately in God's eyes.
Saturday, April 26, 2014
Saturday, April 19, 2014
Resolving Relationships; The good and the bad
I've had a very concrete example the last couple weeks of why it is so important to have a psychiatrist involved with anyone who has dementia. I have seen over the years symptoms that could qualify as either depression or dementia, written off as the dementia progressing. I have a resident at the assisted living who falls in this category. But if you take the time to dig and because he has a psychiatrist that knows him well, we were able to correctly diagnosis and treat depression. His apathy, wanting to sleep much more including falling asleep at the table, and lack of interest in previous activities would seem to indicate the dementia was progressing. That is unless you knew that these symptoms began to appear just after he had a conversation with an estranged son.
You think sometimes that the same things hold true for everyone. The friends of this resident as well as myself thought, oh if only he could be in contact with his son again. That would make him so much happier. So pretty much out of the blue, this son contacts the resident. And for a time, he really was very happy. He talked about his son moving back to the area, living in his house and them becoming close. Then the weeks go by without another phone call and we see the symptoms begin. The resident is not as active or in the usually jolly mood. He seems to want to just sit in his room and sleep. Then another phone call and almost immediate improvement. I don't know what was actually said and what might have been wishful thinking. But the resident was under the impression the son would be in town in 4 days. So guess what happens when 4 days pass and no son. Again the symptoms begin and increase to where we have serious concerns about him falling because he seems so sleepy all the time. Absolutely no medication changes during that time, so it can't be blamed on medication. Someone who did not know him well would probably assume it was the dementia progressing. Thankfully he has the support of people who encouraged him to get the help of the psychiatrist. With medication changes, he seems to be improving slowly, but improving.
As happens so often, what happens at work for me strikes a chord with what is happening with my Mom. For the last couple months, she has been talking about her estranged brother. There were issues after the death of my grandmother. Greed and feelings of not being loved as much as the other were probably the root of the problem. The result was a restraining order against my uncle to not have contact with my mother. Now, I can tell, this relationship fissure is on her mind. She tells me she has dreams about her brother.
My Dad searched the internet for contact information and came up with incorrect information. I had a long shot to reach my cousin and had success. So, as usual, I rope my brothers into the situation. My analysis, having worked in hospice for a few years, is that mending broken relationships can be a very important part of spiritual healing in the last days and years of a person's life. One brother contributes that there should be no trust at all of the uncle based on past behavior. Probably a true statement. The other brother, who happens to be the middle child, has a middle view. He advocates conservative contact, setting ground rules to protect our mother as much as possible. Given what happened with the resident at work, I'm not so sure now what the "right" answer is. Fortunately, my solution is to chicken out and leave the decision up to my dad. Of course based on some other experiences at work, I realize the decision really isn't for me and my brothers at this point anyway, but that is for another note.
I think we would all wish for broken relationships to be ended and to feel positive resolution before we leave this earth and have no more opportunities to resolve things. But at the same time, we live on a broken earth filled with less than perfect people. Trying to resolve opens you up to possible hurt as well. Why is it I feel like the more experience I have, the less I think I know? Now I just hope my Dad doesn't ask me any advice on what he should do since I have so neatly dumped the decision in his lap.
You think sometimes that the same things hold true for everyone. The friends of this resident as well as myself thought, oh if only he could be in contact with his son again. That would make him so much happier. So pretty much out of the blue, this son contacts the resident. And for a time, he really was very happy. He talked about his son moving back to the area, living in his house and them becoming close. Then the weeks go by without another phone call and we see the symptoms begin. The resident is not as active or in the usually jolly mood. He seems to want to just sit in his room and sleep. Then another phone call and almost immediate improvement. I don't know what was actually said and what might have been wishful thinking. But the resident was under the impression the son would be in town in 4 days. So guess what happens when 4 days pass and no son. Again the symptoms begin and increase to where we have serious concerns about him falling because he seems so sleepy all the time. Absolutely no medication changes during that time, so it can't be blamed on medication. Someone who did not know him well would probably assume it was the dementia progressing. Thankfully he has the support of people who encouraged him to get the help of the psychiatrist. With medication changes, he seems to be improving slowly, but improving.
As happens so often, what happens at work for me strikes a chord with what is happening with my Mom. For the last couple months, she has been talking about her estranged brother. There were issues after the death of my grandmother. Greed and feelings of not being loved as much as the other were probably the root of the problem. The result was a restraining order against my uncle to not have contact with my mother. Now, I can tell, this relationship fissure is on her mind. She tells me she has dreams about her brother.
My Dad searched the internet for contact information and came up with incorrect information. I had a long shot to reach my cousin and had success. So, as usual, I rope my brothers into the situation. My analysis, having worked in hospice for a few years, is that mending broken relationships can be a very important part of spiritual healing in the last days and years of a person's life. One brother contributes that there should be no trust at all of the uncle based on past behavior. Probably a true statement. The other brother, who happens to be the middle child, has a middle view. He advocates conservative contact, setting ground rules to protect our mother as much as possible. Given what happened with the resident at work, I'm not so sure now what the "right" answer is. Fortunately, my solution is to chicken out and leave the decision up to my dad. Of course based on some other experiences at work, I realize the decision really isn't for me and my brothers at this point anyway, but that is for another note.
I think we would all wish for broken relationships to be ended and to feel positive resolution before we leave this earth and have no more opportunities to resolve things. But at the same time, we live on a broken earth filled with less than perfect people. Trying to resolve opens you up to possible hurt as well. Why is it I feel like the more experience I have, the less I think I know? Now I just hope my Dad doesn't ask me any advice on what he should do since I have so neatly dumped the decision in his lap.
Wednesday, April 9, 2014
Full Circle
I spent the day at the annual Alzheimer's Conference. It is a conference put on by our local Alzheimer's Resource Center. In the past, I have gone for Continuing Education Credits. One of the speakers for today's conference I have heard several times at various CEU conferences. I was somewhat dreading the session because I had heard him speak several times before. While he is a good speaker, I figured I would hear the same information I have heard before. After he started speaking, I realized I would get more out of the session if I listened as a caregiver this time and not a long term care professional. I think he had some new information, but at the same time, I heard different things when I listened as a daughter wanting to help my parents, rather than as the professional helping strangers.
He was giving tips on things to remember as a caregiver. One of his tips really hit home with me. He talked about meeting people where they are and really getting to the core of who people are, not the construct of the various roles they have had over the years. It really hit home with me and brought me back to when I first got into long term care. I remember feeling sad that family members could not see the person I saw at the nursing home. Yes they needed someone to help them go to the bathroom, but there were still aspects to really appreciate and enjoy. Because I had not known these residents in their younger, "productive: years, I was able to appreciate them for who they were at that moment. In my 20's as a idealistic young professional, I couldn't understand where the families were coming from.
Now as a family member, I have been watching and "counting" the losses as they have mounted. We all have been measuring what is not there any more, not looking at what is still there. In my own, mid-life crisis of sorts, I have been wrestling with who is the person really at the core, not dependent on my success at my job, at my roles and relationships, but who am I really. So how ironic I have to go to a conference where I finally get it from a stranger that the professional who does so well with strangers, needs to do what I do on the job with my own mother. But then again, another of his tips was to not wallow in regret. So I will take his advice and be thankful that no matter how long it took me to "get it", I have. Now to move on and help my Dad get to that place as well, and my brothers. I thank God for His involvement in my life and giving me the experiences that point me in the direction I need to go.
He was giving tips on things to remember as a caregiver. One of his tips really hit home with me. He talked about meeting people where they are and really getting to the core of who people are, not the construct of the various roles they have had over the years. It really hit home with me and brought me back to when I first got into long term care. I remember feeling sad that family members could not see the person I saw at the nursing home. Yes they needed someone to help them go to the bathroom, but there were still aspects to really appreciate and enjoy. Because I had not known these residents in their younger, "productive: years, I was able to appreciate them for who they were at that moment. In my 20's as a idealistic young professional, I couldn't understand where the families were coming from.
Now as a family member, I have been watching and "counting" the losses as they have mounted. We all have been measuring what is not there any more, not looking at what is still there. In my own, mid-life crisis of sorts, I have been wrestling with who is the person really at the core, not dependent on my success at my job, at my roles and relationships, but who am I really. So how ironic I have to go to a conference where I finally get it from a stranger that the professional who does so well with strangers, needs to do what I do on the job with my own mother. But then again, another of his tips was to not wallow in regret. So I will take his advice and be thankful that no matter how long it took me to "get it", I have. Now to move on and help my Dad get to that place as well, and my brothers. I thank God for His involvement in my life and giving me the experiences that point me in the direction I need to go.
Friday, April 4, 2014
It's About Time
The Caregiver Support Group met yesterday. I had arranged a speaker from the local medical supply company to talk about equipment that is available. After he finished speaking, it was evident the longest attending member needed the support of the group. Since the last meeting a month ago, there had been a major decline for her husband. At the last meeting, he was having more trouble with mobility, but he was still walking. Since then, he had a fall and now he is pretty much bedridden. This caregiver had previously gotten someone to come sit with her husband at night so she could sleep and not worry that he would try to get out of bed and fall. Now, she has 2 shifts of outside caregivers and she takes the 3-11 shift herself. She also has the tremendous support of hospice.
Sometimes I get frustrated because so few people attend the support group. I feel like it is a waste of time. Usually the local paper will print my announcements of the upcoming meeting. This month they did not. But as always when I look back, it seems to be for the best. This caregiver really needed to be able to freely share how she was feeling. She could be honest with the group that her son is no help and she is better off staying away from him than getting frustrated with his lack of support. The other 2 members, as you would expect in such a group, are very compassionate and caring. Not only did they exchange phone numbers so they can talk throughout the month for support, but I had to leave for an appointment and they stayed after I left and talked. I have to reframe my idea of success I think.
So what about time? We are trying to encourage my dad to move he and my mom closer to me so he can have family support. Yet we know it is important for him to be independent. My brother even said when he asked me, "I know you can't predict but how long will we have until she requires more care?"
We talked about that at the support group yesterday. I am asked by families all the time, how long can mother stay in assisted living before she will need to go to the nursing home? How long does someone live with this disease? At least I am comfortable enough with my skills and knowledge now to be okay with telling people, "you can't predict". The above caregiver has said many times, they started trying to figure out what the problem was in 2007 when her husband was complaining about not being able to see. Seven years, that fall right in with the guideline the Alzheimer's Association gives of 8 to 10 years. Who knows how long her husband will live bedridden. When I went to work for hospice, we had a patient who was considered end stage Alzheimer's disease. When I left hospice 4 years later, he was still alive.
Of course it is important to at least have an idea about time so you can make plans. I worry about this caregiver. Can she really provide hands on care for her husband ongoing for years? Right now she has the other shifts covered, but as I well know, employees come and go. Regardless of how many years, how much time is left, how do we invest the time we have now? I wish my parents were close so I could spend time with them. But since they aren't I will do the next best thing and invest time where I can. I will try to do better about not multi-tasking during our weekly phone calls. I will try to do better about sending cards and letters during the week. I guess one of the good things about the sandwich generation is that once you get to my age, you realize the exhausting time raising your children was really relatively short. And now I can see that the time to be able to share with my parents, especially where my mother will remember, will be relatively short as well. Even more than money, I need to invest my time wisely.
Sometimes I get frustrated because so few people attend the support group. I feel like it is a waste of time. Usually the local paper will print my announcements of the upcoming meeting. This month they did not. But as always when I look back, it seems to be for the best. This caregiver really needed to be able to freely share how she was feeling. She could be honest with the group that her son is no help and she is better off staying away from him than getting frustrated with his lack of support. The other 2 members, as you would expect in such a group, are very compassionate and caring. Not only did they exchange phone numbers so they can talk throughout the month for support, but I had to leave for an appointment and they stayed after I left and talked. I have to reframe my idea of success I think.
So what about time? We are trying to encourage my dad to move he and my mom closer to me so he can have family support. Yet we know it is important for him to be independent. My brother even said when he asked me, "I know you can't predict but how long will we have until she requires more care?"
We talked about that at the support group yesterday. I am asked by families all the time, how long can mother stay in assisted living before she will need to go to the nursing home? How long does someone live with this disease? At least I am comfortable enough with my skills and knowledge now to be okay with telling people, "you can't predict". The above caregiver has said many times, they started trying to figure out what the problem was in 2007 when her husband was complaining about not being able to see. Seven years, that fall right in with the guideline the Alzheimer's Association gives of 8 to 10 years. Who knows how long her husband will live bedridden. When I went to work for hospice, we had a patient who was considered end stage Alzheimer's disease. When I left hospice 4 years later, he was still alive.
Of course it is important to at least have an idea about time so you can make plans. I worry about this caregiver. Can she really provide hands on care for her husband ongoing for years? Right now she has the other shifts covered, but as I well know, employees come and go. Regardless of how many years, how much time is left, how do we invest the time we have now? I wish my parents were close so I could spend time with them. But since they aren't I will do the next best thing and invest time where I can. I will try to do better about not multi-tasking during our weekly phone calls. I will try to do better about sending cards and letters during the week. I guess one of the good things about the sandwich generation is that once you get to my age, you realize the exhausting time raising your children was really relatively short. And now I can see that the time to be able to share with my parents, especially where my mother will remember, will be relatively short as well. Even more than money, I need to invest my time wisely.
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