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Coming from a life long career in education, I believe in teaching by example. The first thing is to recognize the situation and the problem. The possible solutions come later. The following is a short story which may hit home for you or for someone you know. It presents a scenario to be considered. Even if this situation is in your face, you need time to digest it before you can consider an action. Ideas will follow.
As you have been going about the business of your life, have you ever imagined yourself in the job of caregiver – unpaid at that? Did anyone ever mention that you might well end up as principal caregiver for one of your parents? What exactly are we talking about here? Assuming for a minute that it is not your paid profession, this situation has probably always been the farthest thing from your thoughts. If it is your chosen profession, those people are not related to you anyway, so you can go home and forget about them until your next shift. It is not always so easy to put those in your care out of your mind but that is for another article.
Here you are in middle age with a growing family, everyone busy, busy. Suddenly, and I mean with no warning, Mom has a little fall. She is in her eighties now and still very active, living in the house where you grew up. She does kind of rattle around by herself but there are no real problems and you live close by. This is a little bit of a set back. Did she break a hip? Oh well, everyone has hip replacements these days. Not a big deal. It turns out to be a bit more complicated than just the hip. Mom had a slight stroke which precipitated the fall. She is in the hospital waiting for the surgery and your sister, Anne, has flown in from Des Moines. Your brother only lives an hour away. He has come and gone, confident that Mom will be fine.
You and Anne are hovering in Mom's room. She is sleeping. There have been some undercurrents among the nurses about where Mom will go when she leaves the hospital. Of course she will have to have some rehab to learn to walk again with the new hip. A drab young woman dressed in olive slides through the door and introduces herself as Melissa, your case worker. Case worker? In low tones, presumably so as not to waken Mom, she urges you to accompany her to her office, only a minute away down on the next floor. Whatever for? Melissa wants to discuss Mom's 'situation.' What situation? She had a slight stroke, she fell and broke her hip, she's having a hip replacement. That's the situation!
You all troop down to the floor below, somewhat further than just a minute. Melissa offers you and Anne each a chair, herself perching on an uncomfortable looking stick seat. She draws closer trying to be intimate because, after all, this will be a difficult discussion. You can feel it coming. The nurses' undercurrents are coming to fruition. Can't we just get through the surgery first? Well, no, Mom won't be staying in the hospital long and arrangements must be in place. Of course, you had heard that the hospitals kick them out as soon as possible. Insurance doesn't want to pay. There are several good nursing homes in the area and Melissa hands our pamphlets. She suggests you take a drive around this afternoon to inspect a few of them and hopefully make a decision – soon. In an assuring voice she informs you that she will continue to follow Mom. She will always be in good hands and long term arrangements can be discussed at a later date. Long term? Long term, Mom will be going back home, won't she? You seem to have acquired Melissa whether you want her or not. Who pays Melissa? Hopefully not you. The hospital; the government? It turns out that Melissa was covered by Mom's insurance. That is not always the case and it is wise to find out, or so you are told.
Garden Grove Nursing and Rehabilitation Home seems nice. It is clean and doesn't smell like diapers as did the first one – and the second come to think of it. A cheerful young woman clutching a clipboard to her chest prances around the corner in response to a call from the receptionist. She offers glossy brochures with photographs of smiling white haired people in wheelchairs. The tour is brief. There is a dining room with square tables and a grand piano. Further down the hall is the rehab center containing treatment tables, practice steps with rails and a large green rubber ball. Several of the residents are lined up in chairs raising and lowering their arms as instructed by a physical therapist. The resident area surrounds a hospital-like nurses' station. Six or seven vacant-looking people are lined up in their wheelchairs in front of the station. One of them seems to think you are a relative and calls out to you. Your guide rushes you on down the hall explaining that the woman suffers from mild dementia. You peek into a room, a double with a curtain divider, fitted with hospital style beds, simple night tables and a couple of chairs. All very basic. You turn to your sister to ask what she thinks when a loud speaker blares out someone's name. Well, it will only be for a short time until Mom can walk again.
Back at the hospital Mom is awake but not very chatty. Normally she is bubbly and you can't get a word in edgeways. She seems to have aged considerably overnight. She gives you a weak smile and grasps at your hand. Her usually intent eyes are a little vacant until they close again and she is back to sleep. You exchange anxious glances with Anne. The pain medication must be making her sleepy. You are suddenly aware of your cell phone ringing in you purse. As you struggle to find it before it goes to voicemail, in slides Melissa. The call was from your brother. You will have to call him back. Melissa asks your thoughts on the nursing homes. The last one was the best. Melissa agrees and says she will make all the arrangements. You won't have to worry about a thing. The surgery is scheduled for tomorrow and since Mom seems safe enough you decide to go home and return early in the morning.
The surgery was successful and, as you and Anne sit on the vinyl chairs in the waiting room, Dr. P., the orthopedic surgeon, appears as if by magic, to go over the prognosis. During the previous evening you and Anne had an extended conversation with your brother about the nursing facility. There were many unanswered questions such as how long will Mom be there, what will be the costs involved and who will pay. You will try to get to the bottom of these things but just now you are relieved that everything went well. Dr. P. explains that recovery time varies and in Mom's case there are some neurological factors to be taken into account. What neurological factors? Anne reminds you that Mom had a slight stroke. Just as Dr. P. finishes explaining that the neurologist will be stopping by, here comes Melissa.
Again you troop down to her office and take up your positions on the appointed chairs. Like a broken record Melissa goes over the nursing home procedure yet again and, just as she comes to the part where she explains other types of facilities that would take Mom after she is better, the door opens a crack preceded by a light tap. A thin dark haired young man of possible Chinese decent tentatively steps just inside the door. Ah, it is Dr. O., the neurologist. Melissa is clearly relieved as the conversation was beginning to get awkward. Dr. O. wastes no time launching into the possible repercussions of Mom's stroke. The problems are that she will not be able to physically function as before and, more important, her reasoning and judgment may be impaired. In short, she will not be safe to live alone. Not go back to her house? The home she has lived in for so many years. She will be devastated. Dr. O. continued saying that it is too early to assess the extent of the damage. She may not notice that she is not in her home. Of course she will notice, won't she? This news has come as a shock to both you and Anne. Melissa pipes up: there are many assisted living facilities where Mom would be safe and well cared for. Or there is always the possibility that she could move in with one of her children. The shock has now doubled; no, quadrupled. None of you had ever thought that you could have Mom living in your home – permanently! You are speechless. Anne thinks this could be a solution. Of course it couldn't be her; she lives too far away. Your brother would flatly say 'no.' No, you are the best, the only choice. Maybe she could move around from one to another. That's a lame idea. It would never work. With heads hanging you and Anne head back to Mom's room to see how she is doing.
This scenario is one you might recognize. It is only the start of the issues that will arise when you are unexpectedly dealing with care for a parent. No one is prepared. But, the more comparisons you can make; the more stories you read; the more research you do, the better off you will be. Of course, it may never happen to you. But if not to you, it will happen to someone close to you. Your due diligence will come in handy for someone. More to come on this topic.
Maggie Walters is the author of "Finding the Bloom of the Cactus Generation: Improving the Quality of Life for Seniors." She offers consultation and workshops for those caring for the elderly, especially if dementia is involved. Visit to order the book, e-book and resources guide or to contact Maggie.
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