How Bubbie Got Her Groove Back

Sometimes a small change in routine can make a big difference.  After long discussion, my mother-in-law started using a weekly pill organizer. This simple little box, and some common sense questions to her physician,  made all the difference in the world.

How Bubbie Got Her Groove Back bubbie 300x204My mother-in-law (we called her Bubbie) took twelve different prescription medications, three types of eye drops, two stool softeners and three vitamins. Some medications were taken once daily, some twice, some with meals and some before bedtime,  for a total of 19 pills each day.  Although she had
a number of chronic conditions which required medication, she lived independently, was an avid computer solitaire player and read 2-3 books per week.

Bubbie understood her conditions and the importance of medication compliance, so she was careful to take each medication exactly as directed on the prescription bottle.  She managed her medications just fine, except it seemed more and more that her medications managed her.

One prescription bottle, scheduled for noon, said, “Take on an empty stomach.”  Another pill due at noon said, “Take with food.”  A medicine to be taken with breakfast called for two additional dosages six hours apart.  Since breakfast at her senior residence was served at 8 AM, she took these pills at 8 AM, 2 PM and 8 PM.  Another medication to be taken three times daily said “Take every eight hours.”  Her doctor told her to take this “when you wake up.”  Since she woke at 7, she took the first pill at 7 AM and subsequent pills at 3 PM and 11 PM. She went to sleep around 9 PM, so she would set her alarm for 11 PM. In order to be  compliant, Bubbie was taking pills at 7 AM, 8 AM, noon (before lunch) and noon (after lunch), 2 PM, 3 PM, 5 pm (before dinner) and 5 PM (after dinner), 9 PM and 11 PM. She constantly focused on her next medication dosage; the responsibility was burdensome and depressing.  Her medication schedule made her feel sickly and became an impediment to her going out and doing things (“I have to be home to take my medicines”). She became increasingly insular and self-absorbed.

When we suggested to Bubbie that she was being overly rigid with her schedule, she showed us the instructions on the prescription bottles.  She wanted to be a “good patient” and was adamant that the schedule had to be followed to the letter. Plus, like many people her age, Bubbie would never dream of questioning the  pharmacist or the physician.

I have long believed that bad events sometimes lead to surprisingly good outcomes, and so it happened with Bubbie. When an infection caused her to be hospitalized, my husband and I made an appointment with Bubbie’s physician to talk about her medication schedule.

We showed the doctor, who had prescribed most of the medications, what Bubbie’s daily routine looked like and how it impacted her quality of life.  The doctor had never thought about the cumulative effect of taking multiple medications, or dreamed that someone would take directions so literally. “Isn’t there some way she can take her medications just four times daily?” we asked.

To our delight, the doctor grouped all 19 pills into four administrations, instead of the previous 10. “What about the instructions on the prescription bottles?”  we asked.  The doctors assured us that the adjustments would not reduce the medications’ effectiveness, and made notes in Bubbie’s chart to revise the instructions on future renewals.  Although initially hesitant, Bubbie agreed to the adjusted, doctor-approved medication schedule. We found a weekly pill organizer with four sections per day, and Bubbie agreed to give it a try.

After that, I took over Bubbie’s prescription renewals and filling the weekly pill organzier. We knew the change in medication schedule made our life easier and hoped it would improve Bubbie’s life as well. We were not prepared for the changes we saw.

Bubbie was delighted to have the burden of refill management and pill sorting removed from her shoulders. With just four administrations daily and the pills already sorted for her, Bubbie began to see herself as less sickly and started going out more.

We asked ourselves what our take-aways were from this, as family members. Our first learning was that seemingly small changes can make a big difference in people’s lives.  When Bubbie saw herself as less sick, she acted less sick. This has big implications. Studies show that people with positive perceptions of their health live longer than those with negative perceptions. We also realized that we needed to be active advocates for Bubbie with her medical team.

As for Bubbie, she was one happy camper. She continued to carefully manage her medications, but her medications no longer managed her.

Helping Tiger Age in Place

Helping Tiger Age in Place tiger photo 169x300My cat, Tiger, is 21 years old. That makes him 101 in cat years. As he has gotten older, many things Tiger used to do have become hard for him, so we’ve responded by helping him age in place.

Tiger walks slowly, very slowly. His legs are bowed, his back is crooked, and his once powerful hind legs are wasted.  Years ago, Tiger easily leapt into the air. Now, he needs help getting on and off my husband’s chair. Externally, Tiger is very changed from the strong young cat he was. Internally, though, Tiger seems much the same. His favorite pastime is still sitting quietly on Bill’s lap, giving and receiving love. As we noticed physical changes in Tiger, we began to think about what we could do to help him remain independent and injury-free. In addition, we felt badly each time Tiger failed at something he had once done so easily; we worried that he was embarrassed, and we wanted to preserve his dignity. Tiger has always had a lot of dignity. So we began to implement a series of aging in place modifications.

Since Tiger can no longer jump onto my husband’s chair, we installed a three-step pet ladder so Tiger could get on and off the chair on his own. At first, Tiger distained using the ladder, but when attempts to jump resulted in falls, he quietly adopted it as his normal method of access. We built similar steps to and from a sunroom window, and while Tiger seldom goes outside anymore, when he does, he uses these steps rather than jump the 18 inches.

Some months ago, we noticed that Tiger was urinating outside the litter box. At first, we wondered if he had become confused, which can happen to old cats. Then we guessed that perhaps Tiger could no longer step over the 5-inch high walls of the litter box. We cut out a special entrance to the litter box with a one inch high lip, and Tiger immediately began using it. He wanted to continue his former behavior; he just needed some modifications.

We’ve changed other things for Tiger as well. To keep his weight up, Tiger gets a can of wet food every night – a welcome change no doubt from the dry food he has eaten his whole life.  So far, it’s working. Tiger tips the scales at 7 pounds—good for a very old cat. Like many old cats, Tiger has kidney problems and drinks huge quantities of water to compensate for his failing kidneys. As a result, the litter needs to be changed daily, and we’ve surrounded the entire litter box with paper since Tiger sometimes misses the actual entrance.

Tiger loses great quantities of hair, and because of his arthritis, he can no longer groom himself properly, so we brush him each night. We know that Tiger has cataracts in his eyes,  his hearing is impaired and his meow is scratchy, but in our eyes, he remains a handsome elderly gentleman.

We sometimes think about how Tiger spends his days now, as compared to his youth. He still naps in the sunlight, enjoys watching birds on our front porch and sits on our lap every night. Although he cannot do many of the things he used to do, it seems to us that the essential Tiger – the sweet, loving cat we have always known –is still there, and that Tiger has a good quality of life.

As I think about Tiger, I can’t help but make comparisons to how I would treat an elderly family member, or how I would want to be treated myself. I would want to be as independent as possible, in a familiar environment that maximized my dignity and minimized the impact of my impairments. I would want to be surrounded by people who accept me for who I am, even though I may be different in many ways from who I once was. I would want a good quality of life, where I could continue to do the things that are important to me. And like Tiger, I would want to give love as well as receive it.

So in addition to being the best cat in the world, Tiger has even taught me lessons on how to age.

90% of Aunt Betty

90% of Aunt Betty thoughtful old lady2 300x2001“Margie Dear, I am moving and I need your help.” So began the call from my 91-year old Aunt Betty. Never mind that I have used my real name, Margit, for 38 years. To Aunt Betty, I will always be Margie.  Betty has buried three husbands, and her only daughter, my first cousin, died at 20. So I went to Florida to help her move from a large 2-bedroom apartment to a retirement community.

Betty had moved into the community on Monday, taking only two suitcases.  New furniture had been purchased for the apartment, because she had brought none with her when she moved from Philadelphia 8 years earlier. My job was to help her go through her belongings at the old apartment, identify what she wanted, and have it brought to the retirement community.  In short, I needed to help her sort through and downsize. No problem. After all, I am a Senior Move Manager.  But I am also, I discovered, a niece, and throughout the weekend, these two different roles collided.

Like many of my clients, Aunt Betty had a hard time parting with items I knew she would never use. Sometimes, I could cajole her into letting something go.
“But I loved this lamp,” she said, pointing to a 40-inch tall lamp that was still in its shipping box from 8 years ago. “Well, not enough to use it for the past 8 years,” I replied. She laughed and said, “You’re right.”  These interactions – I refer to them as reality checks– were easy, because they did not diminish her as a person.

It was harder when we looked at large serving dishes.  “I may have a dinner party,” she said. Betty is very frail. She uses a walker and qualifies for independent living only because Bea, her aid, is with her 6 days per week. I couldn’t say to her, “Betty, you haven’t made a meal for yourself in months. “ She does not need to be reminded that reality is cruel. It was similar when we went through clothing she insisted she might wear someday. I couldn’t remind her that she wears only pants with elastic waists so she can pull them up herself, and that they need to be full enough to accommodate the disposable underwear she now uses. Some memories and images of ourselves need to be preserved as who we once were.

Even though much of what she wanted to take would never we worn or used, I knew there was space for it in the new apartment. Her decisions didn’t have to be perfect or wise, but they were her decisions, and the Senior Move Manager in me accepted that. Later that day we met with a Move Management colleague whose staff would handle the packing and transport of clothing and other items after I left.  When I took my colleague aside and said, “If you find any clothing that is torn or stained, discard it,” I was horrified. I would never say that about a client’s belongings! Suddenly, I was no longer a Senior Move Manager, I was a family member. The ease with which I had lost professional objectivity and slid into expediency was alarming. Yet, I understood why adult children are so often pulled in this direction. They’re coping with their own mixed feelings about their evolving role and added responsibilities, as well as with changes they see in their parents. When expediency wins, it’s not from lack of concern, it’s from lack of time.

As it turns out, the next day was when  the roles of Senior Move Manager and family member most collided. I had arrived Saturday morning and Betty and I had worked throughout the weekend. It was 8 PM Sunday evening when we arrived at her new apartment with a load of pictures and other items in the car.  Since Betty walks very slowly, I dropped her at the door and suggested that she start toward her second floor apartment while I unloaded everything onto the hotel dolly kept in the lobby for such purposes. When I reached the apartment 15 minutes later, there was no answer. Worried, I began walking through the hallways.  I found Betty on the first floor. “I got lost, I couldn’t find my apartment,” she said “Then I got so tired, I had to sit down.” “Your apartment number is on your walker and also on the keys around your neck,” I gently reminded her.  “I know, but I just couldn’t figure it out,” she said.  And then I realized, I was no longer the Senior Move Manager; I was family.

Like so many family members, I had come in for a weekend determined to get things done in the time frame I had allotted, and I had put my need for productivity ahead of Betty’s need to rest or enjoy my visit. I wanted to be finished; Betty wanted us to have time to talk.

The Senior Move Manager in me emerged again as I reflected on what I had seen and inadvertently, caused. Betty had moved on Monday, a transition that was both hard and emotional. She barely had time to adjust to her new environment, when I swooped in and created two incredibly long, emotional days. I was exhausted; I can’t imagine what she must have felt like.  As a Move Manager, I know that stress, emotions and anxiety take a particular toll on seniors, a toll that often manifests as memory loss and disorganized thinking. Whatever cognitive status Betty had before the move, what I had observed Sunday night was Betty under the worst conditions.  I had caused it, and I should have known better.

When I visited Betty Monday morning, I apologized for exhausting her so much over the weekend. “Oh honey, I just feel so badly that you worked so hard,” she said. And there she was, the Betty I knew, parenting me, rewarding me for coming down to help.  Yet, in her next sentence, she was confused about whether she was in Florida or Philadelphia. The juxtaposition of the old Betty and the new Betty was sobering.

In the days that followed, I alerted family members who might call that Betty might not be herself for a while. I explained that the stress and emotions of the move had taken a toll, and that with time, I was hopeful she would rebound and be more like her old self. And in fact, in recent phone conversations, she has sounded more like herself.

Yet Betty is aware that she has changed. “My memory has gotten so bad’ she said recently, clearly disturbed, “I am not the person I used to be.” To dispute what she knows to be true would be condescending. I want her to know that even if her cognitive status is changing, she is still the same person to me, and that I still love her. “I have noticed a change from months ago,” I responded. “I think you are about 90% of the Betty I know, and that’s OK with me.” Betty smiled. I think being 90% of Betty was OK with her, too.

Helping Parents Sail Upwind

Helping Parents Sail Upwind Sailing Father Son 300x199In sailing, the technique used to move upwind (or against the wind) is called “tacking.” Although tacking is actually a combination of vector mathematics and boat design, to most of us, it refers to the concept of making forward progress by zigzagging rather than moving forward directly. For adult children helping their parents transition from one home to another, tacking can be a very useful concept.

I met recently with a woman in her early eighties. She suffered a stroke last summer, and a few months later, she lost her husband. They had planned to move to a nearby retirement community, and my client decided that she wanted to continue with that plan even though her husband was no longer with her. As she recuperated from the stroke and dealt with the loss of her husband, one of the tasks that gave her great pleasure was planning her new home, a large two-bedroom villa separate from the main building on the retirement campus. She worked with a decorator and implemented a number of changes that made the villa her own. Both financially and emotionally, she was invested in the villa.

For nine months after her stroke, she was not permitted to drive. Shortly before her planned move, she underwent an evaluation to confirm her ability to resume driving, and was crushed to learn that she did not pass. Without driving, her children argued, moving to a villa detached from the main building was a mistake. She would be cut off from activities and opportunitiies for socializing — key factors that had motivated the decision to move in the first place. It was likely that she would need to move again within a few years, to an apartment within the main building. Wouldn’t it be better, they maintained, to move just once?

While I understood the children’s point of view, I saw the issue through different eyes. In less than one year, my client had lost her health, her husband, her ability to drive, and now she was leaving her home of forty years. The villa had been something to reach for and move toward, something in which she had invested time, energy and passion. Now her children were suggesting that she lose that as well. How much can a person lose at one time?

My client clearly preferred the villa to the main building. I hoped her children would support her decision, and fortunately, they did. If and when my client moves from her villa to an apartment at some point in the future, the difficult transition from the family home will already have been made. She will change spaces, but will be staying within a community that she already calls “home.”

The lesson here, for both adult children and Senior Move Managers, is to remember this sailing metaphor — how moving forward in the face of a strong wind requires going from side to side, not straight ahead. Sometimes getting parents or clients to agree to move requires supporting a decision that is less than optimal, but may be the decision that is accepted. Keeping this perspective will reduce conflict and improve the quality of  interaction for all involved, because faced with formidable obstacles, going sideways is sometimes the most straightforward path.