Caring for Elderly Parents

[bioteacher]

I currently work in billing for long term care pharmacy and deal with many different homes of differing levels of care. My advice to all of you comparing facilities: call the homes and see how long it takes to pick up. Don't call just during business hours, but during evening hours, too. Do you get to talk to a live person or are you routed though numerous phone menus? Does the person picking up actually say hello? (You'd be surprised at how often I get someone to pick up and they act like the phone is a new invention.)

When I'm calling, it's to talk to a particular nurse for a patient. You won't have that angle. So make up a name and let them figure out you got a wrong number. Play dumb, then apologize for the wrong phone number. Do this over several days and weekends. Don't rule out weekends. Many facilities bring in temporary help to cover weekends. The staff there might work part time at 2-3 different homes as they try to scrape together a full-time paycheck. They won't know their patients as well, which might be another red flag. Do they answer the phone, too? Or do they ignore it because it's "not their job?"

I am totally serious here. If they don't have the staff to answer the phone (when calls may be from a pharmacy with questions about medications, or from a family member wanting to know if Love One is coping with hip pain/ current illeness/ etc.) they don't have the staff to take care of your loved ones. Having to let the phone ring a few times is fine. Having to call and call and call because the phone company's computer comes on and says, "No one is answering your call. Please try again later." and dropping the line? That's a huge red flag in my book. There are some facilities it takes me half hour of trying off and on to finally reach a live person.

This is a simple screening step you can use that will bypass the tours, brochures, and best-foot-forward sales pitch.

Hugs to everyone on this thread. I expect to be here myself within a few years and dread it.

[lightning]

I currently work in billing for long term care pharmacy and deal with many different homes of differing levels of care. My advice to all of you comparing facilities: call the homes and see how long it takes to pick up. Don't call just during business hours, but during evening hours, too. Do you get to talk to a live person or are you routed though numerous phone menus? Does the person picking up actually say hello? (You'd be surprised at how often I get someone to pick up and they act like the phone is a new invention.)

When I'm calling, it's to talk to a particular nurse for a patient. You won't have that angle. So make up a name and let them figure out you got a wrong number. Play dumb, then apologize for the wrong phone number. Do this over several days and weekends. Don't rule out weekends. Many facilities bring in temporary help to cover weekends. The staff there might work part time at 2-3 different homes as they try to scrape together a full-time paycheck. They won't know their patients as well, which might be another red flag. Do they answer the phone, too? Or do they ignore it because it's "not their job?"

I am totally serious here. If they don't have the staff to answer the phone (when calls may be from a pharmacy with questions about medications, or from a family member wanting to know if Love One is coping with hip pain/ current illeness/ etc.) they don't have the staff to take care of your loved ones. Having to let the phone ring a few times is fine. Having to call and call and call because the phone company's computer comes on and says, "No one is answering your call. Please try again later." and dropping the line? That's a huge red flag in my book. There are some facilities it takes me half hour of trying off and on to finally reach a live person.

This is a simple screening step you can use that will bypass the tours, brochures, and best-foot-forward sales pitch.

Hugs to everyone on this thread. I expect to be here myself within a few years and dread it.

Wow. This is great advice. Thank you.

[mamselle]

I suspect I'll be joining this thread soon. My mother isn't particularly elderly, but she's diabetic, in heart failure, and was hospitalized this year for a bout of sepsis she is refusing to talk about. Usually she only does things like that when it's bad. I don't know how much longer she's going to be able to keep working.

I'll probably be joining to thread too at some point. My mom is 86, in reasonably good physical health -- can still walk, see, etc. She lives in her own apartment in a charity-run retirement home where staff can ensure residents take their meds, etc. My mother-in-law is 81, still can walk around, but has some old age conditions that aren't managed very well. We've just submitted a citizenship application for her, and the process will probably be a nightmare -- she's Arab, Muslim, and doesn't speak English. My wife has been making trips to the homeland twice a year to check up on her, and she also comes here on a tourist visa. But she's now too old to make the trip on her own, and my wife is getting fed up with going back and forth. Hence the citizenship application. I'm not looking forward to her residing with us, which is probably what will happen.

Do you have a separate set of rooms she can call her own? Not just a bedroom, but a sitting room, attached bath, and small kitchenette area? She, too, may want privacy (or have food requirements or strictures she would want to oversee herself).

Might help a bit with the preservation of everyone's sanity,...it could work very well, but I can see the potential pitfalls, too....

M.

[spork]

Unfortunately no, we don't have the mother-in-law apartment. But I don't think it would matter if we did have one, for cultural reasons. The norm is to be much more social than I'm used to or even my wife prefers.

[irhack]

Wow, Spork that sounds really tough (I was thinking my 1,000 mile Uhaul journey was tough but it's going to be a breeze comparatively speaking.) Hang in there! It's good you're working on this now before her health is too bad.

[wellfleet]

Good luck, spork--that sounds challenging, particularly the language issues.

I live with my mother. My husband, son, and I moved into her house three years ago, after my dad died. It's actually working out great for us, but that's in part because everyone's been enthusiastic about this being a good thing thing to do. We relocated here from across the country, and giving the cost of housing in this charming coastal town, any option that did not involve a multi-generational household was likely out of reach for us, money-wise. My mom doesn't need much specialty care yet, but she has mobility issues that mean she probably shouldn't be living by herself at this point. My spouse is a nurse practitioner who spends a lot of his clinical time with patients like her, which is very reassuring for all of us. My teenage son and his grandmother now have a much closer relationship than ever before, which is great.

Spouse cooks for everyone and mom deals graciously with the fact that he's reorganized much of her kitchen and makes her eat salad. The house layout makes it easy for her to keep her own space while we often congregate elsewhere, and we're about to make the available space bigger, which will be lovely. Our being here should allow her to stay in her own home until/unless she ever needs around-the-clock skilled nursing care, and we'll still be very close by if that ever happens.

She is our only living parent and we both have been able to make this work with jobs, etc.. We all love this location, which is a huge bonus. Mom would have come to us, if that's what we had wanted to do, but we're all glad that this is working out.

I gave up tenure for this. So far, no regrets.

[spork]

A problem that looms larger than lack of separate living space is the fact that bedrooms and bathrooms are up a flight of stairs. Luckily my wife's sister lives not too far away on the first floor of a triple decker that she owns. So as my mother-in-law's mobility deteriorates (she gets gout, for example) she will probably -- assuming she's in the USA all the time at that point -- be forced to live there. But my sister-in-law is single, and both she and my wife work, and they are already juggling schedules to ensure that someone is with their mom almost all the time (I fill in as needed).

[irhack]

Well, mom's in the hospital, in her home state 1000 miles away. Seems to be an infection (maybe UTI) that has spread, she also has fluid in her lungs, but we are still waiting for more testing. Thank goodness she has help coming in daily, if not frankly she could be dead already, she said she was fine Sunday but Monday she was barely coherant. Today she sounded more like herself on the phone, and was aware and able to tell me what's going on. I'm waiting for more information before deciding whether/when to go out. I hate that she's so far away, it will be good to move her to my town, hopefully she recovers quickly.

[mamselle]

You probably already know this, but UTIs in older patients manifests as a kind of reversible afebrile dementia in which the body somehow doesn't raise its temperature to clobber the infecting bacteria, but the mental processes are affected instead (anyone with a more clinically accurate explanation is welcome to step in here!).

Usually, getting the infection gone fixes the mental status changes, so it would make sense that she'd be more coherent after some rounds of antibiotics.

But while they're confused, they're vulnerable to all kinds of things (my grandmother would leave the gas on, or call to say she was out of bread when she had two loaves mouldering in the fridge) so, yes, closer and more frequent supervision is probably also a good idea.

M.

[irhack]

Well, the hour is upon us. I'm flying to homestate this weekend and bringing mom and her cat via uhaul back here. Please cross your fingers for us! I'm sure it will be an interesting journey, followed by many more interesting experiences.

[Thursday's_Child]

irhack, I wish you a safe & boring trip!

[reener06]

Just returned from a trip to drop daughter at college (yay) and stayed with in-laws and then my Dad a few days. More stressful with both than I wanted, and my 88 year old Dad is definitely slowing down.

But my questions deals with my in-laws. My FIL has lost a fair amount of weight lately, maybe 20 pounds? He doesn't exercise, and was diagnosed with Type II last year and put on Metformin. Since he's lost the weight and his blood sugar is more normal, he's going off it for now. They did all these tests to see why he's losing weight and nothing turned up. Then we show up, and MIL did the cooking, as usual, but so much less food. Like, I was starving every night and secretly snacking on snacks I bought myself b/c there are very few snacks there anymore. She (MIL) is overweight and made a big deal of stating how she eats almost nothing. She really skipped dinner or ate just a tiny bit, and we were gone most of the day while we were there, so I don't know about lunch. Breakfast was very light if at all. She isn't really losing weight, but says she isn't hungry.

I wondered if she could be developing an eating disorder. For context, FIL has always given her a very hard time about his weight while he was always trim. MIL feels awful about her physical body. Neither one exercises. I wondered if this was a way for her to control him by starving him or herself? In the meantime, he's lost a ton of weight.

Am I crazy here, or could this be a thing? I guess there isn't much for me to do about it, other than continue my secret snacking.

[AmLitHist]

Oldest daughter visits MIL every Monday (they watch Jeopardy! together).  MIL is 89 and in great health and lives in an apartment in a nice senior housing for low-income folks; she's just across town from ALHS and me, and ALHS is over there or calls her several times a week.

A week ago, daughter called me in a panic, standing in Grandma's front yard:  "Mom, this apartment reeks of natural gas!  Who should I call?"  I had ALHS go over immediately; it was a toss-up whether our small-town cops/fire department would get their faster than the maintenance manager, so he called the latter. Grandma was having fits with both daughter and ALHS:  "There's nothing wrong!  Don't go calling somebody and bothering them to come out! I don't smell anything!"

The maintenance guy spent over an hour checking everything, pulling out the appliances and checking the connections, used a sniffer, etc. and couldn't find any leaks.   The three of us suspect MIL made something for lunch, turned the burner down far enough that it didn't stay lit but open enough that gas was still coming out.

While daughter was hustling Grandma around, trying to herd her out of the apartment and into the yard, she lost track for a second.  When she found Grandma, granny was in the kitchen with a box of matches in her hand, ready to "prove" that there was no gas in the air by striking a match to "have a look."

YE GODS. (After all my years of drama with my mom--who died ten years ago, by the way--I've told ALHS I'll be supportive of him but I simply cannot do that same kind of hands-on management again.)  At least he had the presence of mind to bring home all the matches when he left her that evening.

[mythbuster]

AmLitHist YIKES! For future reference,at least in my town, you can call the utility directly about a gas leak. I did once and they were at my door in less than 5 minutes on a Sunday. I also might recommend upgrading MIL to an induction burner. It would greatly reduce the risk of flames and explosions.

[the_geneticist]

Just returned from a trip to drop daughter at college (yay) and stayed with in-laws and then my Dad a few days. More stressful with both than I wanted, and my 88 year old Dad is definitely slowing down.

But my questions deals with my in-laws. My FIL has lost a fair amount of weight lately, maybe 20 pounds? He doesn't exercise, and was diagnosed with Type II last year and put on Metformin. Since he's lost the weight and his blood sugar is more normal, he's going off it for now. They did all these tests to see why he's losing weight and nothing turned up. Then we show up, and MIL did the cooking, as usual, but so much less food. Like, I was starving every night and secretly snacking on snacks I bought myself b/c there are very few snacks there anymore. She (MIL) is overweight and made a big deal of stating how she eats almost nothing. She really skipped dinner or ate just a tiny bit, and we were gone most of the day while we were there, so I don't know about lunch. Breakfast was very light if at all. She isn't really losing weight, but says she isn't hungry.

I wondered if she could be developing an eating disorder. For context, FIL has always given her a very hard time about his weight while he was always trim. MIL feels awful about her physical body. Neither one exercises. I wondered if this was a way for her to control him by starving him or herself? In the meantime, he's lost a ton of weight.

Am I crazy here, or could this be a thing? I guess there isn't much for me to do about it, other than continue my secret snacking.

Reener, I think that if your MIL is serving such tiny meals, then that explains FIL's weight loss.  She might be strictly controlling his access to food (for any number of reasons).  If nothing else, encourage him to tell his doctor about how much, or rather how little, he eats.  Maybe a "food journal" with not just what he's eating but also the portions?