Mother's Day Gifts in Aging Families

Mother’s Day is coming up on May 12. This is one of those ritual holidays that families with aging members can celebrate, making Mom feel special. These rituals can mean so much more when parents are older. Bringing the grandchildren and having them make and deliver handmade cards is a great contribution. You could all make a big sign to tack somewhere in Mom’s home saying “Happy Mother’s Day.” My grandchildren, my dad’s great grandchildren, make things for him most holidays, and these are the items that please him the most. One year they made a paper mobile with pictures of his favorite things including his cat Nod, a bagel and a football. We have given him coffee cups with grandchildren’s pictures on them, pictures that you can order from Kodak (http://www.kodakgallery.com/Welcome.jsp) or Snapfish (www2.snapfish.com/). When they were little, my daughter made their simple prints of their hands and framed them with an inexpensive frame.

Technology is another great gift to give your mom. CEIVA® Digital Photo Frame (www.ceiva.com) is a digital photo frame that is connected to a telephone or DSL line. It can be placed in Mom’s residence. Long-distance family members, or even local family members, can upload photos to the frame at any time from their own computers if they subscribe to the PicturePlan® service. Your mom can wake up to different family photos every day, and relatives from all over can send them as well.

Here is a great idea from Julie Menack’s chapter on long-distance care providers, in my new book Care Managers and the Aging Family (Jones and Bartlett), out this summer. If you are long-distance caregiver and cannot visit on holidays, Barbara Friesner of AgeWise Living168 suggests that that you might want to send a holiday in a box. This is a fun way to share the holidays, particularly if the care recipient resides in assisted living or a nursing home. This is a way that all ages can participate in communicating with your mom. Friesner suggests that the long-distance caregiver consider doing the following for the care recipient: A mother’s day box might include a sign saying “Happy Mother’s Day” that you or your family make or buy. It could include candy if your mom can eat that—maybe her favorite kind. If you can’t send flowers, include silk or plastic flowers. Have the grandchildren make an old-fashioned wrist corsage out of paper flowers. Call the facility and ask if you can get gift certificate for her to get her hair done. Find out if they are having a brunch to celebrate Mother’s Day, and make sure your mom can attend. Buy her a new dress for the event and put it in the package. Have your children or grandchildren make individual handmade cards.

Set up a time for a phone call that is good for both of you. If possible, call in the morning or early evening when your mom may be feeling lonely. And, of course, make sure everything arrives well in advance.

If you can go and see Mom in person on Mother’s Day, you can check up on your aging mother’s safety while you are there. Sometimes, during your visits, you may hear alarm bells, like piles of junk mail or consistently dirty clothes. Below is a list to take with you when you go to Mom’s house on Mother’s Day, or any holiday. If you do find worrisome signs, this is a good time to call a geriatric care manager to assess your mother.

Clutter in the house
Unpaid bills
Evidence of missed appointments, getting lost, or wandering
Weight loss
Poor grooming



Have a happy Mother’s Day.

Widowhood

The death of a spouse is one of the most searing events that a human being can experience. My new book, Care Managers and the Aging Family (Jones and Bartlett), out this summer, has a chapter, “Dying, Grief and Burial in the Aging Family” by Diane Le Van and Gwen Harris. It covers widowhood.

After a husband or wife dies, the remaining partner faces relentless hurdles. Joan Didion’s brilliant novel The Year of Magical Thinking is a masterful account of the desolation wreaked on the remaining partner’s life. Many times survivors are left in poorer physical health. They report taking more medication. Starkly, widows and widowers risk a higher rate of placement in an institution such as a skilled nursing home—the place they most dread.

Widowhood also takes a terrible toll on mental health. Like Didion, who tries to keep her mental balance when her partner of 40 years dies, widows and widowers struggle with a frail psyche, as if the death of a partner gives rise to their craziest thoughts. Didion admits to not wanting to give her husband’s shoes to Goodwill because she secretly believes he is coming back to wear them. Widowhood brings depression, and for some, this is a true clinical depression, where a cloud of coal smoke descends over the survivor. Suicide rates spike among the recently widowed, with men being in the greatest danger.

It is not one single thing that throws widows and widowers into mental and physical spirals, but a long set of waves that can be unrelenting, beating against the survivor’s life. The widowed must cope with that rip in mortality, the death itself, making funeral arrangements, then setting out in the world with only half of their social self intact. Who will bowl with me, when we used to be in the league with couples? Cards to our daughter will have to be from “me” instead of “us.” Will I be a sore thumb at dinner parties like the ones we used to go to? Whose foot will I touch at the end of the bed each night?

Didion quotes Gerald Manley Hopkins, referring to the agonies widows and widowers have to face: “Oh the mind has mountains: cliffs of fall / Frightful sheer—no man fathomed.” Widowhood can force a survivor into economic straits, wreaked by lost spousal pensions, half of the social security gone, and so often, little savings to offer a safety net. Then the survivors must face the household tasks the partner used to do. Who will mow the lawn? Who makes my dinner now? Who will reach that top shelf I cannot stretch to?

Widowed men adapt to the loss of a spouse more jaggedly than women. Both suffer loneliness. Family, especially sisters, are a soothing balm at this time, and the support of kin can be crucial to getting a widower through.

Sometimes it is not the things you would think that mark the loss. An old friend of mine from college is staying with us while he transitions to living in California. He’s a poet, and so my husband and I have gone to several poetry readings here in Santa Cruz in the last month. On Sunday we attended a reading where the poem below was read. Sometimes, only poetry can really say something for you. “Surprise Ending” by Barbara J. Rios (bjrpoet@yahoo.com) describes widowhood through silence.

Surprise Ending

It was a noisy house, filled
With years of runaway laughter
Toddlers chasing after cat or dog,
Lists to make groceries to buy,
Husband’s weekend run to hardware stores
And home again to endless chores.
Work and school, playing sleeping,
Years of jumping and dancing
crying, comforting, talking

Grown children now busy and away;
Husband dead—he missed
The drama of my hearing loss.
Leisure hours I always wished for
Are not enough to fill the empty space.
I never dreamed I’d be alone
This long in such a quiet place.

Barbara J. Rios

Those Scary Entitled Families

Have you ever met or been related to someone who feels “entitled”? How about your oldest brother, the dentist, who feels entitled to do almost nothing to help care for your aging mother because he is a dentist and you are only a housewife?—“You have more time than I do and my job is much more important, so you take care of Mom.”
Women think men feel entitled. They complain that men come home and kick off their shoes and feel entitled to turn on the TV and have a beer after a long day’s work. Women, on the other hand, come home after that long day’s work and care for the kids, make dinner and many times care for their aging parents.
Yesterday I did a presentation in Walnut Creek on the “entitled client.” My audience, the staff of an upscale senior facility, serve these entitled clients and wanted to know more about how to deal with these very hard-to-handle families with older members.
Everything I know about entitled clients I have actually learned from Claudia Fine and Nick Newcombe, who wrote a chapter in my new book, Care Managers and the Aging Family (Jones and Bartlett, out this summer). Fine and Newcombe are the wise professionals who first described these older families many years ago.
Entitled clients always expect certain outcomes. They believe they always get what they want. These clients, sometimes full of themselves, not only have preexisting fantasies that they will always get what they want, but they have “magical thinking” that makes them believe their wish is your command. “I expect you, the geriatric care manager, to be on call 24/7 to fix anything that goes wrong with my mother—I hired you, therefore I own you” goes the thinking.
Professionals in aging—social workers, nurses, and gerontologists—who work with these difficult families generally see three categories of entitled families. The first are narcissistic entitled families; the second are rich and famous entitled families; and the third are people with a social welfare model that makes them feel all senior services should be delivered for free or low cost.
These folks are generally from very wealthy families. In the US they would be that upper 5% or even 1%. The narcissistic entitled family usually has an old / old parent (over 85) who has a history of mental health problems. This history of mental illness has made Mom or Dad view themselves as a blazing sun at the center of the universe. Their kids were Pluto, revolving around them somewhere out there in the icy recesses of the solar system. These rich and famous entitled clients have usually been very bad parents. Their children, now ’60s baby boomers, are chickens that have come home to roost. The adult kids have no idea how to care for their aging parents because they were never cared for as kids. Now six decades later not only do they draw a blank on caregiving, but these adult children from Pluto also question why should they should care for their mom or dad, who never took care of them.
The next level of the entitled family is the rich and famous. These are families that have great wealth and fame. They purchase everything. They have butlers, maids, attorneys, private cooks and nannies. Everything in their lives is done by someone else, including raising their kids. When these wealthy and well-known folks become older and they need care, their children have no idea how to care for them because those parents delegated the care of their kids to boarding schools and nannies. Therefore, the adult children of these people, who may be like the Joan Crawford character in Mommy Dearest, hire a geriatric care manager or expert in aging to help find care for their parents. However, the adult child has this attitude: “I hired you, therefore I own you.” Just like the butlers, maids, and other servants they grew up with.
The third type of entitled client that professionals in aging run into are believers in the social welfare model. These folks believe that all health care, even though we do not yet have universal health care, should be provided for free. The old old parents grew up during the Depression, with or without the New Deal, and don’t want to spend money on any senior services. They believe that these should all be provided at low or no cost, and they refuse to accept help if they have to pay for it. They actually feel demeaned when they don’t get those services for free.
Next week I will talk about how social services and health care professionals can deal with these hard-to-handle clients. I will also discuss how adult children of these very difficult parents can get some help for their entitled mom or dad.

Aging Hoarders and Ms. Havisham

The Institute on Aging in San Francisco http://ioaging.org held a groundbreaking conference on hoarding last week. Over 300 people from the San Francisco Bay Area and other parts of California came together to hear main speaker Emily Saltz, LICSW, CMC, Director of Elder Resources (www.eldres.com), Newton, Massachusetts, a hoarding expert, and Patrick Arbore, EdD, Director of the Elderly Suicide Prevention and Grief Related Services, Institute on Aging (www.ciis.edu/lifelong/sp05/ce03.html), talk about hoarding. This was followed by workshops on varied hoarding issues like animal hoarding, and how to organize a hoarding task force in your county. It was a seminal conference and opened the lid for us to see the inside world of both hoarders and the social workers, fire fighters, animal control officers, and police officers who respond to these many times wrenching scenes.

Who is hoarder? According to expert Emily Saltz it’s a person who acquires then fails to discard things—say, 30 years of National Geographic—that seem to be useless or of limited value. It is also someone who lives in a home that is so cluttered that it stops activities that those spaces were designed for (a bedroom with a bed where clothes are piled mattress to ceiling, resulting in the hoarder sleeping on the couch). A hoarder is a person who either is significantly distressed or functions poorly as a result of the hoarding (a person who can’t have the plumber or anyone come to the house to fix things because the house is too filled with “stuff,” and worse, their hoarding would be revealed).

Hoarding is also collecting gone mad. Instead of acquiring and discarding, a hoarder just acquires and rarely discards. An example is a person who loves those collector plates that you put on the wall. She orders them over the years but never discards them or puts them on the wall, so every room in the house is stacked with boxes of collector plates.

This a serious problem in our culture, yet it is so underreported that only 5 percent of hoarding is reported to the authorities such as Adult Protective Services. Only 40 percent of hoarders are mentally ill. The rest appear to have personality disorders, with a cluster of symptoms including reclusiveness, suspiciousness, obstinacy and isolating tendencies. About 20–30 percent of hoarders have obsessive-compulsive tendencies, and 20 percent have dementia. It usually begins in childhood or adolescence, and 80 percent of hoarders had someone in their family who hoarded.

The typical hoarder is a woman, lives alone, is socially isolated, has symptoms of anxiety and depression, and has poor insight, so she denies the problems. Hoarding has nothing to do with income; and in fact, Jacqueline Kennedy’s cousins, the famous sisters in Grey Gardens (a film, then a Broadway play, and now coming to you on TV) are hoarders. It has nothing to do with IQ, as the average hoarder has an IQ of 115 or above. Excessive buying or acquiring possessions almost always accompanies hoarding. Acquisitions can be anything from those collector plates, clothes, cats, parts of computers, to TVs. Hoarders don’t just buy them on eBay or the shopping channel but also purchase at Goodwill or tag sales and are even dumpster divers.

This is certainly fueled by our “Big Box” society. I was in Costco the other day while people passed me with huge carts of 50 pretzels boxes, 10 crates of cat food and lifetime supply of Advil. As I walked past the aisle jammed with huge supplies of everything, I thought, this is a metaphor for our culture—“Acquire a lot of stuff.” Hoarders are an American product. Maybe they can’t go to Costco, but their “Costco”might be floor-to-ceiling piles of vintage, now rotting clothes that they have hoarded.

Hoarding is the bane of the aging family. Fifty percent of the referrals made to Adult Protective Services are for self-neglect and hoarding. As we age we move into our last decades with sometimes thousand of pounds of unnecessary possessions. Older people may have been collecting their “hoard” for 70 or 80 years with no one telling them that this is a problem. They are confronted in old age by family and sometimes neighbors, who “smell” the hoard.

Or the traumas of widowhood or any of the severe losses of old age may trigger the need to hoard. There is actually a dearth of research and training in hoarding, which made this conference so revolutionary. As Patrick Abhore said in his presentation, it is really not about the “stuff,” no matter how cataclysmic the view of 40 emaciated pets or wall-to-ceiling newspapers may be. It is really about what is going on inside that older person that needs to be confronted. One of the most moving parts of the conference was listening to two hoarders, who have joined the wonderful Hoarding Alliance of Marin (www.helpinghoarders.com/taskforces.html), talk about their “hoards,” but most of all their inner needs for them.

For those of you who have read Dickens’s Great Expectations, think of poor Miss Havisham, sitting in the “airless room that was oppressive and hidden.” Pip, the main character, looks at her dust-covered, spider web–encased table from her long ago aborted wedding feast. In the center is a horrirific centerpiece “overhung with cobwebs, speckled legged spiders with blotchy bodies running in and out of it, mice running in the walls in the background, revealed to be her long ago wedding cake.” Like any hoarder,Miss Havisham has an aching story to tell. She has kept this moldy, dirt-encased, bug-infested wedding feast for decades after being abandoned at the altar. Her beloved fled, and she became an isolationist who was full of despair. She was a mean secret hoarder. (Hoarding is sometimes called Havisham syndrome.) But at the heart of her “hoard” was her long ago abandonment, a step away from her wedding, where her long-lost husband-to-be fled. It wasn’t about her “stuff,” it was about her heart.

Jersey Visit

Last week I reentered my past, stepped back into New Jersey, land of my birth, and hung out with my now aging family. I left Jersey long ago, pulling away from that sticky web of family and my oldest and dearest friends. I have spent 30 years here in Northern California, land of second chances, reinventions and dreams. I had retooled myself and thought I had severed the East Coast ties. I had become a whole new persona, an expert in geriatrics and a professor in aging, a mother of California childen and grandchildren, and a proud resident of the Golden State.
But like a turtle, I brought my shell. I grew up by the Atlantic City boardwalk and moved to the only boardwalk on the West Coast. I was raised in Atlantic City and moved to the resort town of Santa Cruz, where people stream out of San Jose instead of Philadelphia to cool off, get some rays, have their kids hit the waves.
Just like that turtle, I thought I had left my family far behind. But they were deep inside me, in my bloodstream and my genes. That shell of mine that goes wherever I go, is made of them.
So last week in Atlantic City I was with my Cress cousins, and I reveled in being with them. They may be firefighters and telephone operators, but I am just like them. I am loud, cynical, sometimes off-color, fast-talking, and nostalgic for those deep Jersey roots. We shared the memory of our grandmother, who was a dazzling, political lady, and our grandfather, who was a bookie. We reminisced about our parents, and friends who got in a lot of trouble. When my cousins talked about Mike Dougherty, John Dooley, and Jackie McCarren, sometimes-bad Jersey boys from the ’60s, I knew the same people they knew. It was a leavening moment for me.
I then went to a poetry reading at Rowan College, my alma mater. It used to be called Glassboro, and when I went it was the college of second chances, and a poor high school student like me could get in. But they had this sublime English faculty, all wanting to avoid the publish or perish of the University of Pennsylvania. They taught me how to think and played a large part in creating who I am today. My old friends and now poets Janet Hamill and Patti Smith read, and I joined an audience of 900, drawn by Patti’s rock and roll Hall of Fame persona. But we are all just like my cousins—Jersey kids, coming from a tough little state that we all still love. It was great to be with my oldest friends and know, like all of you, that when you see a person who is embedded so deeply inside, 40 years melt, throwing you back to the place you left four decades ago.
Now I am back with my California children and grandchildren. But I am reconnected to my past and brought back to what I really am—a hard-edged girl from New Jersey who is now a good half Californian.

VA Heath Care and My Dad

My 87-year-old dad has a urinary tract infection. All you women out there can relate to that sharp burning pain. We seem to be plagued with this more than guys. But for an 87-year-old this was tough. When I got him up to see his great physician at the VA, Dr. Rani Saxena, she was concerned that his blood pressure had dropped precipitously, so she sent me up to the VA’s Menlo Park hospital emergency room to have him evaluated. All of you who have followed my blog know that the thread that has run through this is my own aging family. The main character in our family drama is my father, who had been with us for 17 years.
My dad came to us after multiple and wrenching disasters. The home that he lived in back east had become Poe’s House of Usher. The cursed house, in Ventnor, New Jersey, was washed over by the high tides of the infamous Halloween “perfect storm” in 1991. This was not the first time catastrophe had struck. My brother died in the house, and my dad found him. Several more floods from winter hurricanes called nor’easters engulfed the first floor. The house is on filled-in marsh that writhes up every year and floods all homes that were not built before flood control forced bayside homes to be built on huge pilings. The perfect storm finally put me over the edge as a long-distance caregiver. My husband and I got him onto a plane, and he has lived here in California for 17 years.
Yesterday I came in contact with my own feelings about the possible loss of him, during the physician’s visit at the VA. But what made me feel so soothed and so strong was that I am blessed with the best medical advice we could ever get. I felt so safe in the arms of my dad’s doctor, no matter what happened. How many families with aging members enjoy that?
I did a cameo of his physician, Dr Rani Saxena, in my blog on April 30th, 2007, entitled “The Demise of Geriatricians.” She is compassionate, kind, totally engaged with my dad’s care, and has kept him off all meds. As she said to a Stanford intern who was following her yesterday, how many 87-year-olds take no meds? My dad, although plagued by floods and fire, has a great immune system. He’s pretty much a healthy guy. But this is helped by a geriatrician who understands that he does best with as few meds as possible. Because of the excellent VA system, Dr. Saxena also runs constant tests on him and has a wonderful team. Instead of walking in as a harried physician overwhelmed by having only 10 minutes to see the patient, she has the time to greet him, listen to his opinion although he is confused, talk to me and the family, and make me feel we are a team—me, the doctor and my dad—in getting him better.
She sent him up the Menlo Park VA hospital ER to be further evaluated because he had that drop in blood pressure. There I met yet another team of great medical people. Instead of suffering through an hours-long wait with a very sick man, we were taken almost right away. Policemen from the VA came out to help me with my dad and wheeled him in with incredible courtesy. All the medical personnel, although knowing my father was confused, addressed him directly and asked all questions of him, not me. They took the time to listen to him and his slow and sometimes circuitous answers.
A great example was the physician who first saw him. He respectfully approached my dad and took over 10 minutes to speak with him and patiently ask questions, listen to his answers, and piece together what was going on. He had great backup as the VA computer system allows all physicians to see horizontally and longitudinally every med and all physician’s visit notes and test results in the patient’s electronic medical history.
My dad was finally released at 5 in the afternoon. He’s now home. I am grateful that as he declines, goes down that slope, we both have this great VA system to help us.
In my new book Care Managers and the Aging Family (Jones and Bartlett), out this summer, there is a chapter about helping the aging family in the hospital. My experience with Dr. Saxena and the ER of the VA Menlo Park hospital was just the ideal I described. The medical team was family centered and included me. Most important, they included my dad in the unit of care. He was not a body but a participant. From admissions through the ER stay to discharge, we had a great experience. How many aging families can claim that in the American hospital meltdown of the early 21st century?

More Nana Technology for aging families

For the past few weeks I have covered nana technology. I have highlighted many technology products that connect older people to family and friends. I’m going to finish by covering an aspect of nana technology called telemedicine that helps older folks stay where they are and keep track of all their medicines, doctor’s appointments, and health care needs as their health declines.
The last connective device I cover is another item I just love. It’s called CEIVA, a flashy and very functional digital photo frame. It allows digital photos to be uploaded to the frame from family computers anywhere in the world. If you subscribe to CEIVA’s picture plan, it automatically updates your picture frame each day. You can invite friends and family all over the place to send new photos. CEIVA creates a full-color slide show of photos that you can access from a telephone or DSL line.
There are a zillion uses for this. If you are a long-distance care provider, you can place CEIVA in your older family member’s home—say, by the much loved La-Z-Boy—and they are constantly reminded of you and your kids. If your older relative is in a nursing home, where folks tend to be very isolated, CEIVA puts you right there in living color everyday. This product is especially helpful if the older person is confused. If you are in the home with the older person or visit often, you can just insert a memory card in the CEIVA to see your photos displayed. You can subscribe to a picture plan that automatically updates the photos everyday.
I’m getting one for my 87-year-old dad. He lives with us, so he sees me and my husband, Pete, each day. However, I am getting CEIVA so my daughter Kali in LA and my daughter Jill, who lives nearby, can upload photos of grandkids and pet dogs. Jill is the mom of Joseph and Julia, who appear in this blog often, and Kali now has our granddog Finnias. Kali just got married, so kids are not yet in the digital pictures. My dad will be able to view dogs, grandchildren, and great grandkids each day, as both daughters take a bundle of pictures.
On top of that I can upload old family photos for him. He loves to look at old black-and-whites from his past and usually has a messy stash of them in a drawer that he thumbs though. I can upload all of these old pictures with my scanner, and he can see his treasured Atlantic City through CEIVA. Also, my cousins Brad, Joy, and Gary and my nephew Chris can send photos from that very Queen of Resorts, where my dad lived for 70 years. Check out the CEIVA web site at www.ceiva.com.
Now I want to cover telemedicine. This technology can do many things for an older person. It allows a medical source or caregiver to monitor, diagnose, and treat patients from a distance. It also allows an older person to more easily use medical devices. Three of my favorites allow older folks to take their medicines more easily.
The first is called Rex the Talking Prescription bottle. Rex is a very happening guy. This technology allows the pharmacist to electronically record the label information on the older person’s pill bottle in a natural-sounding computer-generated voice. The older person can “hear the prescription” with the push of a button. It’s a great help to visually impaired older people, for example, those with macular degeneration, or just an older person who has a hard time reading that small print (which now includes me). Again, your pharmacist must prescribe this. Find out more about Rex at http://www.accessible-devices.com/scripttalk.html.
Another telemedicine technology that helps older folks read those ridiculously small print prescription labels is called Dignity Pills Bottle. This one is visual, not auditory. Your older family member slips a 3X magnifier onto the pill bottle. Instantly they can read the prescription on every pill bottle in a snap and know what pill they are taking. It comes in four colors and is really inexpensive. Just Google dignity pill bottle.
A final telemed device that I really like is Medic Tag. This is a digital USB device—you can put all an older person’s medical history, emergency contacts, medications and doses, and allergies on a digital memory chip. You or the older person can plug the USB into a computer and load all the information. You can then put the medic alert USB on a keychain, a lanyard around the older person’s neck, or wherever it can be easily found. If your older person becomes unconscious or goes to an emergency room or hospital, the emergency personnel can plug the USB into a laptop and have instant, updated medical information that could save the person’s life.
My dad never drove after his plane was shot down in World War II, and he ended up in a German prison camp. He always took buses. He has lived here for 15 years, and about 5 years ago he fainted on a bus here in Santa Cruz. He was taken to the emergency room of the local hospital, and he told them he lived in Atlantic City. His wallet disappeared in the fall. It took us several hours to find him. With this device he would have been found right away, and the hospital would have had up-to-date medical and contact information. So I think this is on my top-ten list of great nana technologies.
A final top-ten nana technology pick of mine is Lifetime Talking Calendar. A family member can program the calendar on a visit to the older person’s home. The calendar then blinks on each day and gives a programmed reminder, such as for a doctor’s appointment, or to call a relative. This great device is 11 by 9 inches and weighs a little over a pound. It can be mounted on a wall or hung on the refrigerator with magnetic strips on the back of the calendar. It has a repeat button and a large memory that can store 900 messages. It has large buttons like big button phones and can be programmed in several languages. All this comes to you for $39.95. Such a deal, my dad would say.
There are so many other nana technology devices out there that I have not covered. Again, Julie Menack and I are doing workshops in San Francisco and on the East Coast on technology that can help seniors. Just check out my web site at www.agingfamily411.com. Then go to Speaking.