Tuesday, June 28, 2011

An Uncomfortable Topic ... Part 2

Abuse concerns come when least expected

Elder abuse is a complex issue to tackle. Unfortunately, it’s more common than many believe. Now I’m a firm believer that a person can find the statistics to support almost any claim and the statistics I found are quite varied and I could frankly terrify you with some.  But let’s put the numbers aside - I’d rather talk about people.  The fact is that  elder neglect and abuse is out there and it may be affecting someone you love. 

My hope is that if you’re reading this, the thought of such has been far from your mind. You’re the caregiver who has been bending over backward to try to offer the best care possible to your loved one. But if as in my last post, with "Ellen” and her mother Mary, if the thoughts are coming to mind that something is just not right, this may help. 

Also, as a conscientious caregiver, you may be just the person who can help a friend to ease fears or take action with a bit more information than just suspicions shared over a cup of coffee. 

In the next few posts we’ll look at some types of abuse, signs of abuse, and what can be done to stop abuse.
The World Health Organization offers this definition:

     Elder abuse has been defined as a single or repeated act, or lack of appropriate action occurring within any relationship where there is an expectation of trust, which causes harm or distress to an older person. Elder abuse can take many forms including physical, psychological and sexual abuse, financial exploitation, neglect and self-neglect,medication abuse, abandonment, scapegoating,and marginalisation of older people in institutions or social and economic policies.”

For our purposes, we’re not going to address social and economic policies.  We’re going to look at what can be going in within a home or facility environment. The basic issue here starts with one of trust.  

reasonable or not?
 Whether care is offered in a personal home or a facility/institution, there is the assumption of trust that a certain level of care will be maintained. One issue that causes caregivers grief is “reasonableness.” It’s one of the widely defined terms that factors into any care situation.
            Is it reasonable to expect that mother will not have bruises on her arms?
            What if mother is on medications that cause her to bruise easily?
            Bruising, to levels excessive to a ‘healthy’ person, would be reasonable depending on the circumstances.

The definition of reasonable changes with a person’s physical condition and all the different factors:  underlying health issues, medications, and mobility concerns that factor in.  

            This is where it’s important to get the facts, such as Ellen did where her mother was concerned. 
            In her case, was it reasonable for her mother to not remember having eaten meals?
            Well, the next question to ask would be…
            Did her mother have dementia or memory issues?
            Not to her daughter’s knowledge. 
            Then no, it was not reasonable for her mother to not remember having eaten meals.
            Next course of action? 
            Verify meal plan and see if there could be an onset of dementia.
            Such was very difficult for a long distance caregiver and most certainly the signs of possible neglect or abuse are incredibly difficult to discern from a distance. However, when you take in the ‘reasonable’ factor, many caregivers second guess their suspicions only to suffer terrible guilt later when they find actual abuse has taken place. 
            The key to discerning truth - be involved and ask questions.  If you, or your loved one, are not satisfied with the answers, ask more questions. 

Next up:  where to go for help

Note:  Due to family vacation schedules and additional research time needed for this series, I did not post last week but will be back on schedule now... thanks for your patience! 

Friday, June 17, 2011

An Uncomfortable Topic ... Part 1

I’d like to start a new series on a topic that’s uncomfortable for all caregivers - elder abuse. I’ll  share with you a story told to me to give one example of the unexpected abuses that often happen to the aging.
Is it time to address neglect or abuse?
I met a woman (we’ll call her Ellen) who was traveling with her family. She shared that she’d recently brought her 81 year old mother (Mary) to live with her after she’d experienced an abusive situation at the hand of Ellen’s sister (Sally). 

Ellen lived in Arizona. Sally in Nevada, and their mother, Mary, in Las Vegas with her second husband. Ellen and Sally’s stepfather died and it was decided that it was time that Mary have someone to live with for support. She’d been through a long haul caring for her husband and it had taken its toll. Mary also had several health issues of her own, particularly back pain. 

With Sally living close, Mary moved in with her and Ellen helped get her settled at Sally’s. “I told Sally that she needed to do this for our mother,” Ellen said.
The move was traumatic, yet all proceeded and Ellen would call and check on her mother regularly. Over time, red flags started popping up in the conversations. Mary didn’t remember eating but remembered dreaming about eating and waking to find herself chewing air. Her bowels weren’t working properly. She’d had a lot of back pain and though Sally had taken her to the doctor, the medicine seemed to been knocking Mary out. 

When Ellen asked Sally about the issues, Sally was defensive. “Look, I never asked to be a caregiver. There’s food in the house, she can eat when she wants and I’ve taken her to the doctor.”

Please note:  This story came to me from Ellen’s perspective, gleaned from several hundred miles away through phone calls. But hers is not an uncommon situation for long distance caregivers.

Ellen suspected neglect and abuse. Yet her mother should be safe with her own daughter, Ellen’s sister, right? When Ellen confronted Sally and none of Sally’s take on the situation gave Ellen peace of mind, and the disturbing conversations with her mother continued, Ellen took action. She went to Nevada to pack up her mom and bring her to Arizona. Though the transition was again difficult, Ellen knew she’d made the right choice.  By the time of her mother’s ‘rescue’ Ellen and Sally were not on speaking terms and now, many months later, they still aren’t. Claiming her sister’s difficult personality as a contributing factor, Ellen is at peace with where things are because now she knows her mother is safe. 
“One thing I did was slowly wean mom off all those meds with the help and advice of a friend who was a nurse.  Mom’s mind cleared quickly and she could tell me more of what happened and tell me how she was really feeling,” Ellen shared.

Ellen found new doctors for her mother who did thorough checks and found the cause of the back problem - tiny fractures in her back (something that is more common in the elderly than many realize). According to Mary, the doctor she had in Nevada had just given her pain medications without a physical exam or x-rays
and scans. She never knew what medication she was on or why.

Now, Mary is on very little medication for pain, taken as needed. She eats planned nutritious meals and her digestive troubles had cleared. When I met Ellen, she was traveling with her mother and a niece and all were having a great time.  

So what does this say?  Unfortunately this scenario isn’t uncommon. Whether Ellen’s take on the situation was exaggerated or not, I don’t know, but I suspect not with the additional details she shared. 

If you have stories to share, please do.  Here are some questions we’ll look at in weeks to come. 
  • So what is elder abuse? 
  • Where does it happen and what does it look like?
  • What can be done to prevent it? 

Friday, June 10, 2011

Gifts to share – Keeping eyes off ‘self’ helps keep a positive perspective throughout the aging process, Part 3

Remember that the goal of this series is to remind all that giving to others helps take the mind off self, while strengthening feelings of self-worth and independence. 

Perhaps you aren’t yet in the position where you call yourself a caregiver, or, your beloved senior is very independent (let's call this level 1 care).  You start noticing that s/he is beginning to retreating from the world. As people age, the tendency is that their worlds become smaller based on a closer knit group of friends, activities, and interactions. Some they feel their bodies changing and not being quite so obliging to an adventurous spirit. 

For me, the awakening to the small-world concept came when my mother announced one day “Well, we’re done traveling.”  We were having a simple conversation about interesting places to see one day and that comment stopped me dead in my tracks.  At the time, I was just entering peak travel years, thinking of places I’d like to see and see with my husband and children.  My mother seemed to be saying “we’re done living.” Sometimes our definition of living differs from those we care about. For me, living and dreams of travel were synonymous. 

Delivering meals to others - a way to give back

For Mom, living meant other things. Being involved in her community had become more important to her than travel. It’s about priorities. The red flag for caregivers comes when there are no more priorities being made. Whether from grief over a spouse dying, or loss of friends, participating in activities that make a person feel connected to others while having a sense of accomplishment are very important. Help your loved on take their eyes off themselves and become involved. Doing so before their own physical limitations may set in establishes a positive behavior and will encourage problem solving to continue those activities when some start showing 

If you find your loved one starting to retreat from life a bit, first talk about it. Start reminding her that she’s got many talents.  Sometimes getting involved in volunteer work takes a boost of confidence. Then take out pen and paper and get to work:
  1. List interests -  build ideas
  2. List skills - build ideas for community connections
  3. List friends’ activities - positive peer pressure can go a long way
  4. List family activities - grandchildren are great motivators!

Now let’s break these down just a little more. 
  1. When you build a list of interests, dig deeper into how those interests may find outlets in volunteering in the community.  If Mom likes to read, ask her if she wants to participate in the ‘adopt a shelf’ activity at her local library.
  2. Mom may be an excellent typist.  See if she’d like to volunteer a couple of hours each week to type up the church newsletter or bulletin.  If it’s all done on computer and her skills came from years before computers, it might inspire her to take a class so she can apply her skills in new ways.
  3. What do her friends do that she thinks is cool.  Really - everyone pays attention to what their peers are doing - it’s an ageless concept.  Does her neighbor work at the Soup Kitchen every Friday or deliver Meals on Wheels? Could Mom get a partner from her neighborhood to deliver Meals on Wheels? 
  4. See what volunteer activities Mom might want to do at your son’s school.  If she doesn’t live near you or other family members with children, encourage her to check out the local elementary school volunteer program - she helps a school and she’s ‘up’ on the latest interests of children the same age as her grandchildren.. It gives them something to talk about! Or check out a foster grandparenting program.
 Staying busy and involved helps keep the mind and body active. It helps stave off a mental and emotional retreat that often comes as people fear the limits the aging process might impose. Try to encourage your loved ones to stay active… and put the living into their lives.  

Meals On Wheels is a national program where people of all ages take hot meals to elderly, often who are shut-ins and have no family members to help them.  This is a great venue for seniors who can be active to give back. 
For more tips and ideas on senior volunteering check out Senior Corps

Thursday, June 2, 2011

Gifts to share- Part 3 – Keeping eyes off ‘self’ helps keep a positive perspective throughout the aging process

Level 2 Care:  Senior does not drive or limits driving

Let someone else take the wheel....  

Often a caregiver feels that coordinating a social life or volunteer activities for a loved one with limited or no ability to drive is impossible. Not so. In fact, coordinating such for a senior can free time the busy caregiver needs to handle some errands or tasks on his or her own and foster new circles of support.

One example is my mother's. She lost the majority of her vision when she was in her early 60’s. She still had an active mind and many abilities but could not drive. My father took her to the crafting meetings held at a church in town. She could no longer sew, but could help stuff the animals the sewing group made to give to children in the pediatric ward at the local hospital. Her skills and willingness to help were needed. Feeling that she had something to offer was important to her sense of well-being and self-esteem. When deliveries were made to the hospital, others in the sewing group picked her up to go along. While she was involved in crafting activities, Dad ran errands and spent time researching at the local library. It worked well for them, but what if you’re a harried caregiver and aren’t in the flexible schedule retirement stage my Dad was in?

As in Mom's case, it may be that there are others in the group who drive who are willing to pick up those who don’t. Social bonds can also form that extend beyond the volunteer activity. Often the connections made during volunteer work extend beyond the focus of the group and serve to offer support to the group's own members.  By that I mean that if you take Mom to a Saturday service group at a local church, she’ll meet people there with whom she’d feel comfortable in other situations and who may be willing to pick her up. Letting others take the wheel when your loved one can't is an important option to consider. It frees you up to attend to your life needs and fosters valuable peer interactions you simply can't provide. Mom going shopping, attending concerts, or going out for meals with these new friends may be an added benefit that comes along the way.
How to get started: Help your loved one find his or her outside interests by asking about hobbies from their youth. What classes did Mom enjoy most in college? What sport did Dad love in high school? By spending time delving into joys of the past, you brainstorm possibilities for enhancing the quality of life now. Call ahead to potential volunteer agencies to set up the right connections and find out when the related groups meet. If you find the group meets during the day when Dad can drive, great! If not, you can brainstorm with your support group ways that you can facilitate getting him to those meetings. Offer to be chauffeur for the initial outing or two. Having you along may help ease social concerns as well as navigation fears. It’s very likely to be an interesting adventure for you, too.  For instance, if Mom wants to talk with the head of volunteers at the local theatre to see if she can help with costuming, you’ll get an insight into a local community organization you may not have had time to investigate before. Once the initial contacts are made, Mom has her outlet, both for socializing and feeling needed and productive and the theatre has a seamstress! 

Golden Nugget:  Take note of the new friends and contacts your caree is making and keep a list of their contact information as well as who might be able to help in a pinch. These peer groups will often provide support for you, the caregiver, if your loved one ever has a health crisis. At the very least, these new friends will want to know if Mom can't make it to a meeting and might need their encouragement!