Elder Hallucinations Can Be Scary!

My mother hallucinated last night -- these are bits of the scary part of caring for an elder parent. From the living room, I heard her say, "I don't want any more orange juice." But as far as I knew, we were the only ones in the house.

I went it and asked about the juice. She said the nurse was making her drink more orange juice. "Which nurse," I asked, playing along. "The one right there." Okey-dokey. "How 'bout some water instead" Okay, she said.

My mother's on a mimumum amount of medication compared to many her age for which I am grateful. These hallucinations -- her mother, my Daddy, her old bosses, folks coming to a dinner party -- were more prevalent at the skilled facility, when she wasn't being talked to and engaged all day long like she is here at home.

So, I guess if I were alone, I'd make up friends, too. The first time it happened, I freaked out, but was told that it's typical with forms of even mild dementia.

Just as long as all she's looking at is a nurse wanting to give her orange juice. If the bad guys come, I might have to pull out my imaginary guns.

Durable Powers of Attorney, Powers of Attorney for Healthcare, and Advanced Medical Directives--The Law

One of THE most important issues to talk to your parents about is their executing a Durable Power of Attorney -- (POA) or (DPOA) in some states, an Advanced Medical Directive and Power of Attorney for Healthcare.

If your parent has a stroke, heart attack, or is unconscious for a period of time, these documents must be in place to make your helping them as easy as possible so you can focus on loving them through it and not the attending medical legal issues. Any good attorney can prepare all of them for you. Please do it now before a sudden healthcare matter arises.

The Durable Power of Attorney will allow you or whomever your parent appoints to make decisions, pay their bills, handle conversations with Medicare and insurance while they are out of commission. I usually recommend a POA that does not require a physician's determination of the incapacity of the elder. But parents need to understand that the POA can be used even when they are fully conscious, so there are some safeguards I put around that, which we will discuss later.

Advanced Medical Directives tell your parents' physicians what they want done or not done for them if they're in a critical state: life support, a Do Not Resuscitate Order, etc.

A Medical Power of Attorney for Healthcare gives you or the person your parent appoints the ability to make health care decisions for them in their stead.

It's hard to face those decisions as a child, but much easier if you've had the conversation ahead of time about what your parent wants to do. Then you'll know you're carrying out their wishes, difficult as it may be.

Elder Care Transportation--A Much Needed Business

When my mother was in a skilled nursing facility (SNF), one aspect of her care that was very important was her transportation to and from doctors' appointments. Although we were blessed at her facility to have an on-staff medical director who came to her room, there were several referrals he made to specialists who would only see us in their offices.

Over the course of a year, we went to a neurosurgeon (and back and forth to the hospital for testing and eventual surgery to implant a shunt), to the endocrinologist, and to the radiologist.

None of this would have been possible in a regular car. My mother could only be transported in a wheelchair, and for that we need elder care transportation -- a large van with an elevator lift and safety belts to hold my mother (and me) in place.

Some services were great, others terrible. There is such a need for caring, professional transportation services for the elderly--it's a huge market, and not one necessarily well-served. In this economic age, many folks are looking for businesses to start. This could be a great one if you care for elders and run it well! If you're interested in some information that may be helpful, see Elder Care Transportation.

Some drivers went so fast my mother would scream; others treated her with tender loving care -- they were the best!

Just Published on American Chronicle

Just published -- American Chronicle Gifting to Qualify for MediCal - Medicaid Eligibility - Unfair For Seniors? - Part 1 Medicaid Eligibility

My Mother -- Hospice's Comedienne!

My mother is now home with me and comfortable, have the caregiving schedule worked out, and now lots of great time to write.

So, this is the best part, I've learned my mother is a lie-in-bed comic. As context, she has short-term memory issues, but that mind is still sharp even with its limitations.

As sad as last week was with all the tragic deaths in L.A., I was startled when after watching three days of coverage from morning to night, my mother turns to me and says, "I think Michael Jackson has died."

Yesterday, on the Fourth, I'm trying to get her to understand what day it is. She runs through the days of the week -- no, that didn't work. So, I say, "What day is the Fourth of July?" Her response, "On the Fourth of July."

Later I ask her again what day it is -- it's a beautiful, sunny day in Southern California, clear and gorgeous, unlike last year's Fourth of July Fog -- this time she says it's Christmas Eve. I say, "Look out the window, does it look like it could be Christmas Eve? It's the Fourth of July." She says, "Well, it can be both the Fourth of July and Christmas Eve." "Why do you want it to be Christmas Eve?" I ask. "So that I can get presents."

So then I am telling her today that before she came home I went out to shop, after checking with some Twitter friends about the best sofa bed to put in her room -- a plug for "American Leather" (but the sofas come in wonderful microfiber colors, too, and no springs!) so that I or a caregiver could spend the night with her. She tells me she loves the color. I explain how the first store we went to didn't have the right size or color. The second store, praise the Lord, had the twin size in exactly our color, but didn't want to sell it off the floor. It would take five weeks to order and deliver, but my Mother was coming home at the end of the week.

I told my Mom this morning I knew when I saw the sofa that the Lord had it there ready for us and they would sell it to us, which they did. She says she loves it and it looks beautiful in the room.

Then my mother asks for candy. I say, "You're always talking about candy!" "No, I'm not, I was just talking about sofas!"

Love your parents and bring them home if you can. You don't want to miss the magic moments.

Blessings, Jane Allison
http://yourelderlawadvocate.com
http://twitter.com/janeallison

P.S. As I am writing this on the sofa in her room, my mother calls out, "Throw me the flipper" -- our term for the TV remote. Then she quickly follows it up with, "But don't hit me." Fortunately, it was already by her side, no chance for that!

My Mother's Homecoming

Coming Home

Bringing a family member home after a stay in a skilled nursing facility (SNF) or rehabilitation center, or directly from the hospital, can be an overwhelming challenge emotionally and physically. If you are going to be a caregiver either in your own home or your parent's, to minimize emotional overload you need a plan. I'm going to give you one. First, let me share my story, and then I'll recommend what to do.

My Mother's coming home tomorrow at 2 p.m. "Home" I've learned over the last three years is wherever your loved ones are. I have been traveling from my "grown-up" home in Virginia to my "childhood" home in California, looking after my 86-year-old Mother (only child of only children). It's been a joy, but whenever I leave one place, I say "I'm going home." This last trip I decided both are home -- so I now refer to them as "the ocean" and "the farm."
My mother's coming home tomorrow at 2 p.m. is real for her. This has been her main residence or second home in California for over 30 years. I've been a nomad in it as I have come and gone to look over her care and be with her in a beautiful (we have been blessed) skilled nursing facility close by. But it struck me one night as I lay in my nomad state watching TV that she was doing the same thing several miles away, so why shouldn't we be doing it together? She has been in the facility for three years. They had taken great care of her. When I left to go to the farm after her first hospitalization, I worked hard to get caregivers for her at home who would care for her in my absence. She wasn't really sick, just immobile and afraid to be touched. She graciously growled at every lovely lady who came in, and I again knew in that moment, if I left, she'd kick them all out, so it was back to the facility, which kindly took us in.

Fast forward three years and she's been well cared for. Her mind is still sharp. Yet, she had come to the point where all she wanted was to lie in bed, be left alone, not eat (except for the chocolate I brought ever day) and said repeatedly she was living too long. In our care plan discussion, the lovely hospice social services lady, Paula, told me to be prepared, that it was not unusual for women to just start shutting down until they pass away.
Then a funny thing happened on the way to "home." My mother rallied. Three days before the scheduled departure I get a call from wonderful, Kit, the Head of Nursing. "I've got the greatest news. Mom has been up in her wheelchair, sitting in the Activities Room, taking all three meals in the dining room" -- which she had always called the "old people's room" and refused to go into, preferring meals in her room. I'm told the staff in amazement is calling this the "Awakening of Mrs. Lee."

Her front room with the ocean view is all ready to go, new bed (not a hospital bed, you need a special bed~more later), a lovely sofa bed to sit in by day and hang out with her all night if necessary, all my "little girl" furniture of which I was most proud has been taken away to make room for this new era in our lives.

My mother's coming home tomorrow at 2 p.m. -- from now on that's where I'll be hanging with one-half of my family at "the ocean." What joy.

I want you to have the same experience -- with or without the ocean. Here's what you need to do:

1. If your loved one is in a SNF, hospital, or rehabilitation facility, sit down about a week before you are planning to bring your parent home, listen and ask lots of questions!

2. If your parent is on hospice, hospice will offer a hospital bed at no charge. The standard in the industry says they are unbearably uncomfortable. If finances are an issue, you may have to take the bed. It is a blessing hospice even provides all that they do. If you are able to spend some money, I recommend checking into a nursing home bed distributor. Some of those beds are better than others. I worked directly with my "team" at the nursing facility (they have connections, you just have to ask and push) to arrange for a top-of-the-line bed to rent for $150 per month. The bed can also be purchased. The IMPORTANCE of this type of bed is that it moves the body in all different positions, crucial to prevent bedsores, and allows the bed to go all the way to the floor if your parent has a tendency to fall. Hospital beds don't go to the floor.

3. Hospice will also provide an eating table that goes over the bed for meals and holds drinks during the day, a wheelchair, oxygen, and a hoyer lift, which takes us to #4.

4. There are different sizes and kinds of hoyer lifts. You will want to talk to hospice about what they can provide, or check on your own -- Google "hoyer lifts" -- to find the right one for you. They will aid you in lifting Mom or Dad out of the bed and putting them in an armchair or wheel chair. You need practice, so ask the facility to show you how it works and practice with your Mom or Dad before they come home.

5. Finally, but equally important, finding caregivers to support YOU! You cannot take care of your parent 24 hours a day -- it is a physical and emotional impossibility. Watch out or the bed your Mom or Dad vacated might soon be yours! Reputable, trustworthy, bonded caregivers are the key. Ask your facility for whom they know to be the most trustworthy caregiving agencies. You will want to interview the caregivers and introduce them to Mom or Dad. If one doesn't work out, don't hesitate to ask for another. This is the most important step--you are entrusting your parent's life to another so that you can get out and have some recreation time, etc., AND you want someone in your house you can trust while you're gone. Put any valuables away. No matter how great we believe someone to be, we never truly, truly know them, especially in this setting.

You can do it. Loving your parent through this difficult time is a challenge, but will give you those special moments you will treasure forever. Corny to say, but love is a powerful thing, and serving your Mom or Dad at this time in your life is healing to them and a gift to you.

Loving Your Parents Through Healthcare Turmoil!

I am so grateful to my followers on Twitter (http://twitter.com/JaneAllison) who have responded to my question about what they would do if their Mom or Dad were suddenly hospitalized. Most of the answers came back in one variation or another, "I would be there and love them and look out for them."

In an earlier Post here I discussed the matter-of-fact details of what to do when your loved one is hospitalized (see Post "Help! My Parent's in the Hospital!"), but right now I want to focus on what many of my fellow twitterers commented on -- being there and giving love.

For some of us, that's easy. The process is hard, which is why I want you to be prepared by reading the hospitalization Post to the right if you haven't already. I want to make it easier for you to navigate the health care tumult. From an emotional standpoint, many of us would immediately come from love ~~ I want to be there ~~ I want to help.

For others, the relationship with our folks may itself have been tumultuous. Perhaps rightly we feel that our needs were not met, that our parents did not love us the way they should have or been there for us when they could have. So, when the call comes to jump into the "hospitilization/time to take care of Mom or Dad and put my life aside for a period of time" fray, you may find those hurts resurface and your tendency be ~~ not me, let my brother or sister worry about it, or I'm really too busy right now with the kids and work, or they're in good hands in the hospital.

If this is you, I want to share with you a different paradigm ~~ encourage you to look through another framework at the needs of your Mom or Dad at this critical stage. We have all heard it, parents do the best they can. In my opinion, some do, some don't. But the reality is that when they are in the hospital, they are vulnerable. When they are facing end-of-life care issues, they are vulnerable.

This vulnerability may come out in anger and attack because they are scared and losing control of their bodies and their lives. But I want to encourage you the best you can to put aside any pains or grievances that remain in the relationship and SEE THIS AS AN OPPORTUNITY to reach out in love to your parent at this critical time. If they send missiles back your way, ignore them. If they are uncooperative (and chances are they will be at some point), ignore that. Be with them, tell them you love them if you can, just sit with them in silence if you can't. BE THERE.

It may seem unbelievable, but this time of your parent's life can be a wonderful opportunity for you to love, for you to be healed, for your Mom or Dad to heal from what they may know, though may not want to admit, they did to you. Elders spend a lot of time in bed contemplating their lives. Be gentle, be kind, gather up your strength and love, the best way you can. Resist the temptation to flee. If nothing else, just BE THERE BY THEIR SIDE. That will demonstrate your unspoken love.

I have seen amazing people who carry past hurts on the inside be healed in beautiful ways just by being with their parents in the hospital, assisted living facility, nursing facility, or at home. Wonderfully unexpected moments may transpire between you and Mom or Dad. Some laughs, some tears, but overall you may find a contented joy. As much as you love your spouse, there likely is no one on this earth who knows you the way Mom or Dad does. You know each other, for good and bad, in a very deep way.

When you get the call, or if you are with Mom or Dad when they fall and have to get them to the hospital, forget yourself and reach out to them in love and understanding. Sit with them through the process. "Being there" can be the greatest love of all.

Blessings, Jane Allison
http://yourelderlawadvocate.com/
http://twitter.com/JaneAllison

Help! My Parent's in the Hospital! Five Things You Must Do IMMEDIATELY!

Have you gotten that call in the middle of the night telling you that your mother who is 2,000 miles away has fallen and is in the hospital? Has your father come for a visit and had a slight stroke? These circumstances can interrupt your everyday life and send you into a state of panic and fear. THE MOST IMPORTANT THING TO DO WHEN YOUR PARENT IS HOSPITALIZED IS TO PUT YOUR PANIC AND WORRY ASIDE AND SHIFT INTO WARRIOR MODE. Here's what you need to do.

1. Don't panic. It is natural to be fearful and overwhelmed when your mother or dad is rushed to the hospital. Accept your feelings as natural, but put them aside right away. YOU ARE YOUR PARENT'S BEST ADVOCATE. If you live far away, immediately call a friend who can go to the hospital and be your liaison on the ground until you get there. You will quickly get frustrated and angry trying to get information about what's happening with Mom or Dad unless you have someone on the scene looking out for YOU and letting you know what's going on. If you can't get to the hospital, there are also elder care advocates like myself who can be your eyes and ears and fight through the system so your parent gets the best care.

2. Contact your mother or dad's physician immediately. As a side note here, it is very important that your parent have a general internist physician (preferably a gerontologist if you can find one) WHO IS WILLING TO FOLLOW YOUR PARENT TO THE HOSPITAL IF NECESSARY. This is obviously something to arrange now, before any unforeseen hospitalization occurs.

Many hospitals now promote to patients a new system of "hospitalists" -- these are physicians who only work at the hospital and don't have a private practice. The problem with this is that your parent will be a new patient to the hospitalist and you might not have the same hospitalist every day. WHAT YOU WANT IS YOUR PARENT'S PHYSICIAN WHO KNOWS YOUR PARENT'S HISTORY TO VISIT THE HOSPITAL EVERY DAY AND DIRECT YOUR PARENT'S CARE! This is very important for the continuity of care for your mom or dad and for your comfort. A hospitalist might not pick up on something about your parent that his or her own physician would because of their history together.

3. Don't be intimidated by the hospital system. The reality is that hospitals have their own protocols and systems which may work for them, but may not necessarily work for you! You land in a place that's all new to you -- and they've got the advantage. Do not be afraid to ask questions of the nurses, other staff or the physicians. Hospitals tell us that their mission is to take the best care of their patients, but the reality is the only person who will be looking out for the best interests of your parent is YOU or YOUR ADVOCATE.

When my mother was in the hospital, I walked up to the nurses' station behind which about 10 people were chatting away, and the one who was sitting at the desk right in front of me refused to look up. I finally called out, Hello, anybody home? And they all turned in disbelief, but I got what I needed.

4. If possible, keep your parent in the hospital for THREE OVERNIGHTS. True, you do not have complete control over this, that's why the presence of your parent's own physician can be so important, but if your parent will have to go to a rehab facility or go home for therapy, and he or she is on Medicare, Medicare will only pay for follow-up treatment if your parent has spent three full overnights in the hospital. Not days, but overnights.

Don't let them try to push Mom or Dad out too early. If it's legitimate for them to stay in the hospital, make sure they stay. I had a friend who unfortunately did not know the three-day rule at the time, and her mother wanted to leave the hospital early. She needed therapy at home as the doctor prescribed but had to pay for it herself because she did not meet the three-overnight rule.

5. Manage the hospital's discharge planner. Within a day or two of your parent's admission, you will meet the discharge planner, whose job it is to arrange for where Mom or Dad goes and what help they need after the hospital. THIS IS VERY KEY -- if your parent is going to have to go to a rehab facility, a skilled nursing facility, and the three-day rule is met, Medicare will pay for the best or worst facility. IT IS YOUR JOB AS ADVOCATE TO FIND OUT THE BEST FACILITY AND GET MOM OR DAD IN THERE! This will make a world of difference in their aftercare.

The discharge planner will give you a list of facilities in the area. They are not ethically allowed to tell you what the best ones are. Typically, they will ask you to pick three, and then whichever of those three facilities has a bed on the day Mom or Dad is discharged from the hospital, that's where they'll go.

BUT HERE'S THE CATCH -- THERE MAY ONLY BE ONE GREAT FACILITY IN THE AREA. SO HOW TO GET THERE? First, you have to find it. Ask friends, families, colleagues. If you've hired an advocate, they'll be able to guide you. If you're on the ground, go visit the facilities. Ask for a tour of the skilled nursing facility. Talk to the admissions officer at the facilities you like. If one stands out above the rest, keep talking to the Admissions officer at that facility (you won't know exactly what day your parent will be discharged) and tell the hospital's discharge planner that you want your parent to go there.

This is so important and the trickiest part. When you find out (usually the day before) when Mom or Dad is to be discharged, call the facility (or facilities if you're blessed to have several you like) and ask if they will have a bed open the next day. Some hospital discharge planners are wonderful, others are annoying and territorial. They may see you as interfering with "their" job. But put any concerns about that aside, and recognize that they are treading on YOUR territory, where Mom or Dad goes will make no difference to them, it will make all the difference to you. If there's a bed open where you want to go, tell the discharge planner that day -- tell them you've talked to the admissions representative at the facility, there's a bed available, and you want Mom or Dad to go there. DO NOT GIVE IN AT ANY POINT AT THIS STAGE. YOU'VE DONE THE HARD WORK, IT'S TIME FOR MOM OR DAD (AND YOU) TO REAP THE BENEFITS OF YOUR INVESTIGATIONS AND ADVOCACY!

Remember, regardless of your past history, fighting for your parent at this time in his or her life when they may need you most, can become the most rewarding time of togetherness for both of you and lead to great healing, if needed, and joy. It won't be easy, but it will be worth it. Hopefully, with these tips in mind, you can focus on loving your parent to the best of your ability and not on the frustrations that come from navigating unknown waters.

Blessings, Jane Allison
http://yourelderlawadvocate.com/
http://twitter.com/JaneAllison