Living Memories

 This month when I visit my mother, 98, who has been in hospice for five months is emotionally draining.  Yesterday when I shared this with two women in private conversation after a literacy meeting, they shared their perspectives.  "My mother has been gone four years.  Each time I visited my mother during end-of-life stages, I felt I would soon be orphaned", one remarked. Another shared, "My mother has had Alzheimer's for the past 15 years.  I do not feel like I have a mother anymore", another lamented. 

And just the day before a friend reflected, "I am so glad you have your mother one more day."  This exquisite woman maintains a home in CO while caregiving for her mother in GA where she continues her professional life as an academician.  God bless my friends who continue to travel or follow a passion with art lessons and chorus while caregiving for their husbands with Alzheimer's going on four years.

But I digress from my feelings.  At 71, I am fortunate to be active in the academic and business environments - albeit part time, though I cannot do anything part time.  With the housing bust my home fortunately is rented at present though it sat empty and then devasted by tenants the remaining years.   Spiritual armor has protected me as I concentrate on fulfilling my life and being there for my family, friends, and reading mentees.


Hopefully, that spiritual armor will protect me through the next phase of life with expected loss though I love my friend's saying, "98 going on 120" in referencing my mother.  I want to enjoy each day, tucking treasures in my suitcase like a book a grade school friend wrote that I can share with my mother.  I will also bring her a Jewish calendar remiscent of the ones she hung on a kitchen cabinet in my parents' condo in S FL.  Birthdays, anniversaries - recorded year after year, remembered with just the perfect card, her thoughts underscored at time as I find myself doing for emphasis.

Sharing with you has already lightened what was a burden ten minutes ago.  In less than two weeks my friend will drive me two hours from the mountains of NC to Charlotte to board my flight.  One of devoted brothers and/or my sister-in-law will pick me up at the airport where construction is anything but straight driving.   We will visit alone and together, laugh as our family always has done, not ridiculing but sharing slices of life.   I will be able to praise staff personally - this woman from a distance - does she really care?   Yes, she cares hourly, prays daily, and includes you in her prayers.


It's Sunday when I usually phoned my mother in addtion to mid-week calls since my father's passing fifteen years ago.  Today, we cannot hold a conversation long distance, not even the 3-minute conversations to save money, a carryover from the Depression.  She cannot read even large-print books but hopefully will be able to recognize me.   I see a "grabber" in a TV ad and feel a tinge of sorrow that I never purchased one for my mother.   I choose to remember how she drove up from Ft. Lauderdale to Boca by herself to be with my brother and me.  My brother was right to encourage her to stretch herself as my daughter did me after a sudden loss.

Please feel free to share your comments anonymously, if you wish, or write to me at evelynasher@charter.net.  Together, our journeys will be sweeter.

Meeting Room vs. Waiting Room

In 2002 I advocated for geriatric care consulting in physician practice waiting rooms. Though there was interest from one practice in Gainesville GA, physician staffing berthed the concept to the back burner. Before the plethora of cell phones we have today I envisioned patients and caregivers having access to phones where they could resolve issues during their long wait.   Having a geriatric care consultant or social worker in the waiting room could relieve anxieties as people shared their social concerns.  

http://www.fastcodesign.com/1664797/six-ways-to-improve-doctors-waiting-rooms

What if a caregiver could discuss a transportation issue or be able to inquire about a resource to lessen his/her burden(s)?   What if elders looking after each other could have a smile or be directed for funding to remodel their home so they could age in place?   What if the environment in a physician's practice was friendlier and encouraged storytelling in a corner?  Yes, away with those wide screens and listen.   Patients have so much to share, wisdom, character, and strength.   Many with family scattered around the country or globe would benefit from socialization, lessen health concerns, thwart disease.

The People's Pharmacy recently conducted research on drugs with more side effects than benefits.  Conversation and listening are more beneficial to one's health than prescription drugs.   What is your best waiting room experience? What if, in an hour or two wait, a trained professional could help you write or edit an oral or written legacy to your children?

Elder Law and 529 College Savings Plans. How does that affect me?

We plan and God laughs.  

Intentions are quickly dashed with diagnosis of Alzheimer's.
http://www.post-gazette.com/pg/11142/1148064-28-0.stm

This article makes a strong case to constantly review and work with professionals who understand elder law, financial products, and their consequences.

Please share your concerns, discussions with family members on this issue, and resolutions.  Thank you!

Online Tools for Care Coordination

Keeping track of medical history, shopping for alternative living arrangments, and discussion of financial planning under one roof is efficient.  Too many surprises with end-of-life decisions could be avoided with these tracking tools.  For those tracking their own histories ensure that someone you trust has access to your records and will follow-through with those choices.  Why was my friend surprised that two sons rather the father less literate were named executors of their mother's estate?



The following is the mission statement of eCare Diary taken from its website that is recommended by professionals in the senior care industry:

"eCare Diary is a website created based on the founder’s, John Mills, experience as a caregiver for his father who suffered from Parkinson’s Disease. Having spent over 20 years working in the health care system, John found coordinating long term care to be difficult because of the lack of good information. eCare Diary provides comprehensive information, tools and resources to help those seeking and providing long term care. A unique feature is our Care Diary, a set of online tools designed to make coordination of care and sharing of information easy amongst family members and other caregivers. eCare Diary also has a comprehensive database of nursing home and home care services, guides on long term care financing and information on important health care documents everyone should have. The site will continue to grow and more information and tools will be added in the months ahead. We hope eCare Diary helps simplify your situation by providing you the tools and information you need."

Sodium Reductions Might Not Affect Heart Health

According to an article written in Time magazine, they've been doing research in Europe that proves that lower sodium intake might not actually help heart health in the long run. Studies have shown that people who have high blood pressure or heart disease would benefit from lowering salt intake. However, in a study of more than 3,500 people who didn't have heart problems, the ones who had the highest salt intake were the lowest risk for heart disease-related death. The study was done for more than eight years and those with the highest sodium levels only had a 0.8% death rate. Those with low sodium had a 4% death rate.

All the unique things that the health science world is doing today never cease to amaze me. It's like the blog that I wrote awhile back on senior safety and wellness, which talked about how education is so very important to your health. COPD symptoms can be reduced with exercise, Alzheimer's can be staved off with walking, and now apparently sodium isn't going to be terribly bad for your heart. But why is this?

According to researchers, while salt intake does affect blood pressure, it doesn't increase the risk of hypertension or a death related to heart disease. It apparently doesn't have as much of an effect as they thought, and is much less of an issue. The American Heart Association is still hard at work trying to convince people to lower their sodium intake just for the sake of their health, but there's apparently less of a connection to heart health than was previously thought.

The study does have its flaws, of course. The volunteers were all younger, so the follow-up might not have been effective enough due to the age at which these heart issues usually occur. Either way, it is a complicated issue that people have to face and learn about for themselves. Nothing is more important than being educated and you really need to read up. Medical science never ceases to impress me with its findings, but this just goes to show that you have to get the details before you tip the salt shaker.

Mary Albert is a health advocate at Lifestyle Health Guide, where she contributes regularly on health issues and medical alert systems.

Fragile -

  From vantage points of rockers, chairs, and benches residents and guests in senior communities can breathe fresh air in South Florida or countless other alternate living accommodations across the country.   Onlookers become immune to emergency vehicles; when faced with emergency they are grateful to the medic team for transfer to the nearest medical center.

Emergencies know no boundaries.  Responses come at the most inopportune time - while caregivers are packing for a short or long-awaited trip, during traditional holiday dinners, dressing for graduation or one week after return from a parent who now exhibits different behavior.   

Last week's phone call to my mother's  line brought comfort with description of a grandson's visit, reminiscing through family albums.  This week, with stattaco emails sharing my mother's emergency hospital stay, dismantling of her apartment, and decision making for another stop on her journey, I know not to call.  I can only hope that someone will read the Mother's Day message I posted a few days ago as the card shop lacked the words to express the gratitutde for every opportunity I had been given.

Distance, early retirement, and maintenance of my home that has been on and off the market for four years have fostered challenges in long-distance caregiving.   I am grateful for my siblings' devotion the past 18 years and do what I can in communicating through reminiscing with my mother.  Everyone has a talent in the caregiving pyramid.  Please take a minute to comment and share your long distance or dominant caregiving experience.

Living Well

Girl trip anyone? My friends' trip was not born of grade school, high school, or university reunions.  These women, authors in common, a nurse practitioner, photographer, and retreat coordinator met in our mountain community about eight years ago.  Their husbands or partner fostered their interests at home while these adventure-seeking dames explored Peru.   





Harsh mountain winters motivated other friends to rent a condo in Naples from their friends who took advantage of the real estate bust and upgraded their home. Joining them for our regularly scheduled Friday lunch with ten others, one friend laughingly admitted, "We did not miss you at all.  We had the best time in Hawaii for my birthday - the children surprised us with birthday decorations for our cruise cabin.  We had the best winter.   Turkey, more travel to my aunt's 95th birthday, then Hawaii."    How fortunate for this couple (she traveled  to Turkey with her sisters).


"Live fully" is the signature with which a favorite relative closes her correspondence.   That can translate to knowing when it is time to sell the house and enjoy a retirement community.  With those with smaller pockets that might mean selling the one-bedroom condo on two floors and moving to a one-floor ranch within her price range and delight in a two-car garage to make winters more manageable.  Another with wanderlust and a fixed income lives with high cost of energy bills, caregiving, and maintaining a home that remains on the market in another state. An arm-chair traveler for now.  Romance was intimated by another answering a personal ad for a mountain gal.   Advice?  Don't sell the house.


What travel experience is on your bucket list, have you recently enjoyed, or remains in your memory?

Ethical issues

  At the personal invitation of my geronology professor Dr. Rita Gugel, the founder of National Association of Professional Care Managers (NAPGCM) visited our class at Lynn University in the early 90s.  Within the next few years I enlisted the help of a professional geriatric care manager to address a caregiving situation that ultimately provided opportunity for my second husband's distant four children to care for their father, albeit long distance.  "I won't come until my father is situated", are the dispassionate words heard from one son.  

Wanting to do the right thing, I found a level of care that mirrored Mr.S.'s lifestyle, ensured he was settled and visited from time to time in the assisted living community and hospital to ensure staff knew there was someone local who observed his care. 

The one-hour assessment by the professional care manager was the best $200 I ever spent.  My children deserved me to present in their lives and share their joy.

And now it is time again to call on professional care management, to call on professionals who are familiar with levels of care for dementia and ensure transition sans physical and emotional challenges of family, near and distant.  Far too personal when it comes to a parent.   "I just cannot do it anymore" echoes from various challenges within a family including finances, introduction of extended family with different history.  


The terse words of management eager to make way for "healthier" residents are 360 degrees of the welcome less than two years ago.   Ethical issues in discharge, a webinar offered by SeniorBridge this month, is one that professionals in aging need to hear. Consider discharges from hospitals, rehab centers, and communities.  What is the appropriate setting, timing?   What has been your experience in handling transitions of family members or close friends.  Did you handle the move(s) yourself ? Did you call on a professional care manager?   If so, what is a positive experience or one that could have been improved?  Share with us so others can benefit.  

Why I Love My Doctor- We're Not Dead Yet

When I retired, I moved back to the area where my children grew up so that I could be closer to my family. As such, I had to go through the motions of changing everything. I changed doctors, most notably. I spend about 3 to 5 hours a month at the doctor, which doesn't sound like a lot but it sure isn't a walk in the park. Since I'm there a lot for checkups and other tests, I need a doctor that I feel comfortable with and can trust. I made the mistake of hiring the first doctor that I found, and quickly realized that I needed a better solution. The mistake? Let me explain.


I had been spending the day with my daughter, who just insisted on riding along with me to my appointment. She likely wanted to see and hear for herself that I was (or was not, perhaps) healthy. So I conceded and she came along. Mind you, this was only the second time I had been to see this doctor. I could have been his mother, too. He was fresh out of medical school and you could tell. But that day, it was painfully obvious that he'd missed the course on bedside manner and patient communication.

He came into the room, talked to me, talked to my daughter, and went about his business. As the appointment went on, I began to notice that he spent far more time talking ABOUT me to my daughter, as if I wasn't even there. After about 20 minutes, I was exasperated. I looked him straight in the face, excused myself, and said

"I'm not dead yet, you know."

He got a startled look on his face, and chuckled, as if I was joking before walking out of the room. In the process of finding my current doctor, whom I love dearly, I went through about 5 or 6 who all did the same thing. I made it a pet project, of sorts, and took my daughter along just to prove a point: doctors tend to treat older people like children who can't understand them. We understand just fine. As a health advocate, I am advocating for better education on patient communication. We ARE the patients, after all.

Contributed by Mary Albert, a blogger for a senior lifestyle web site that provides advice for the 55+ age group as well as medical alert reviews

Evasive talk about emotion

Acknowledging my co-authoring a gerontology text entitled Conversations: Effective Communication with the Elderly, my dear friend in her early 80s sent me this article.  http:/www.nytimes.com/2011/03/08/opinion/08brooks.html

How many times do families, like mine, gather and talk about material things rather than about emotion?  My siblings are 65, 75, and 75 - not a typo.  Talk is centered around accessories in the house, golf games, travel, grandchildren, food, the world situation.  Doctors, but not chronic illness.   Cars but not individual financial challenges.  Healthcare but not about Medicare supplements, long-term care insurance - reasons people are working well into their 70s if given an opportunity.   My father, a pharmacist, worked until he was 83, because he wanted to serve the public.

Note in David Brooks' article the range of deep talents which span reason and emotion and make hash of narrower definitions of IQs, degrees, and professional skills.  Brooks cites "Limerence: This isn't a talent as a much as a motivation."  And so some siblings must delay a mortgage payment in order to purchase airfare to respond to crisis, a last opportunity to see a loved one. 

What common threads of understanding or lack of understanding have you witnessed as primary caregiver or a long-distance caregiver trying to keep your head above water while your feelings are being questioned?

Social Networking and Caregiving

My friend has been a caregiver for her mother for sixteen years in my friend's home, including years of raising a young family.  Today she wrote that her mother, at 91, struggled halfway through writing a birthday note to her other daughter who lives a gazillion miles away and was confused with layers of clothing.  Though my friend has chosen not to share her journey with the world others take advantage of new technology whether by choice or by prescription.  

I remember having to convince my public policy professor to accept a research paper on telemedicine in the mid-90s.  Today one can readily access Telemedicine and e-Health as a 10-issue journal and its bi-weekly sister newsletter. http://www.liebertpub.com/products/product.aspx?pid=54 According to its website, "Telemedicine and e-Health covers all aspects of clinical telemedicine practice, technical advances, medical connectivity, enabling technologies, education, health policy and regulation and biomedical and health services research dealing with clinical effectiveness, efficacy and safety of telemedicine and its effects on quality, cost and accessibility of care, medical records and transmission of same."

Elders, caregivers, physicians, staff , and vendors are comfortably assured when virtually assessing, treating and monitoring chronic illness.  A video of an elder's home shared with an Aging in Place specialist can institute low cost modifications (compared to annual cost of assisted living).  Social networks where families can establish virtual support keeps long-distance caregivers informed and aids in decision making.

http://www.igi-global.com/bookstore/chapter.aspx?TitleId=42678

Tell us about your caregiving experience incorporating gerotechnology devices, telemedicine, and/or social networking.

Can You Hear Me Now?

Listening effectively helps caregivers appreciate the present trading past roles and ill feelings for the richness of life through family history. Instead of responding in anger because a hearing loss prevents one from responding appropriately or in a timely manner, try speaking slower so an elder can read your lips. Smiling helps and alleviates fright. Staying with a paid caregiver while he/she becomes familiar with your parent or spouse helps soften the atmosphere with familiarity. The paid caregiver can see how you handle situations, acting rather reacting, and we can learn from them. Some of the best caregivers are professional geriatric care managers who interact with elders and their families, sometimes through mediation, but always with the best outcome in mind. What listening method have you found to be effective? No one can hear you when your head is in the refrigerator or 1/2 way out the patio door ensuring your smoking habit does not injure the house's inhabitants.

Perception and Reminiscence

Communicating with elders is a daily challenge whether it is advocating or having a conversation. Locating documents, making appointments, and reminiscing -- across the spectrum -- takes patience and provides opportunity for clarity and bonding. Just yesterday, when apologizing for pointing a finger as my mother, 95, has done all through life, my colleague said, "Don't apologize, that was not a mean finger."

Communicating with an elder long distance can present challenges of time, lapse of daily contact, hunger to be part of someone's life or unsettled anger. Some families have the means and support to present in their parents' lives.  Others might have financial challenges, distance by miles, business or extended family that requires balanced time.  I write to my mother, 97, faithfully in 20 point font. "Your letters are beautiful and so easy to read", she comments.  A letter can be read ad infinitum and shared with visitors that provides opportunity for reminiscence.   If you have not been able to be physically present, how have you contributed your virtual presence?