Holiday Elves Keep Traditions Alive for Elderly

This weekend, my daughters, Theresa and Catherine, my mom and I made homemade ravioli for Thanksgiving. Ravioli are part of our Thanksgiving tradition, as is having some 30 family and friends for dinner. So no matter how busy we are, the ravioli get made.

Theresa, a sophomore at the University of Michigan, came home for the weekend to help get us in shape for Thursday. She and Catherine, my 16-year-old, not only took the lead in the kitchen, but they readied the basement for big table setting, which takes place Wednesday night and is an event in and of itself.

As the girls and I whirled around each other this weekend and Mom mostly sat and watched, I thought about when Mom's own frenetic holiday preparations began to wane.

It's almost 10 years since Mom made her last batch of Christmas cookies to send to our out-of-town siblings. This baking extravaganza took the better part of a week. Then there was the activity of packaging them up and taking them to UPS, which was Dad's job.

Too consumed in our own frenzied lives, my sisters and I didn't try very hard to convince her otherwise. In fact, we were almost relieved.

Not long after, Mom decided to forego "the manager," which was (is) her single most source of joy at Christmastime. Mom's manager was built over years. Beginning when I was in college, Mom bought more pieces every year until she amassed nearly 50 pieces. They are large and beautifully painted statuettes of the Mary, Joseph, baby Jesus, the three wisemen and their camels, shepherds, farm animals in various positions and an angel. She'd arrange them just so in front of an arrangement of poinsettas and evergreen branches. Strings of white lights lit up at night.

That's when my sister, Theresa, and I stepped in. The cookies we could give up. But the manager was a must.

The holidays are often the first thing to go when an elderly parent finds things getting too unmanageable. The decorations are limited, the baking is drastically reduced
and the shopping might stop altogether.

And when it does, there's always a little bit of joy that seems to get chipped away. But it doesn't need to be.

Personal and companion caregivers can become your parent's holiday helpers as well during this special time of year. Don't hesitate to ask your homecare agency about it.

At BrightStar, we're launching a special holiday preservation program called "Your Personal Elf" to help our elderly citizens keep their traditions alive for their families.

They can provide transportation and escort services to the shopping mall. They can help wrap gifts. They can grocery shop for baking ingredients and help with baking. They can help put up decorations.

We can do as much or as little as the family desires. We want our seniors to continue enjoying these important traditions for themselves as well as their families.

-- Anne Marie Gattari, president of BrightStar of Grosse Pointe / Southeast Macomb, can be reached at 586.279.3610; am.gattari@brightstarcare.com

Ageism and the Cane

Nov. 14, 2011

Last week, Fran Schonenberg, host of Services for Older Citizens' cable show, invited me on her show to discuss the sensitive topic of when an elderly citizen might need help in his or her home. Before the taping began, Fran and I were getting acquainted and she struck me as a perfect example of what it means to age successfully. www.socservices.org

Fran is vibrant and beautiful and fiercely independent. At 82, she cherishes her ability to do for herself and credits a regular fitness routine with keeping her strong and steady. She's been hosting the S.O.C. cable show at Grosse Pointe War Memorial for more than 20 years.

When I asked if she ever considered a walking aid as an extra precaution against falling, her face turned serious. "My friend says, 'Once you use a cane, people think you have no brain.'"

My heart sank. She's so right. How many times I've been in a restaurant with my mom and the waiter asked me for her order. Or we've been to one of my girl's dance performances and the usher asked me if the handicapped seating was sufficient.

There's still an argument between us before every outing over taking the wheelchair. "People think..." she says, and, rudely, I inevitably cut her off. "What do you care what people think. Would you rather not go out at all?"

Too often, she nods.

Despite her dementia and other health issues, Mom knows ageism. She's known it for a long time, and not until Fran put it to me so bluntly did I truly see the indignity of it all.

The pervasive stereotype is that the older person is a burden to society. As the cost of healthcare rages on and the aging boomer population gains momentum, this stereotype is likely to continue.

The best definition of ageism comes from Columbia University's International Longevity Center, which published one of the most extensive reports on the issue in 2006.  www.mailman.columbia.edu/academic-departments/centers/international-longevity-center/publications

"Ageism, the denial of basic human rights of older persons, is one of the most pervasive prejudices across human society. Although ageism is less acknowledged than racism or sexism, it is a harmful prejudice that negatively affects older Americans, who experience widespread mistreatment, ranging from stereotypic and degrading media images to physical and financial abuse, unequal treatment in the workforce, and denial of appropriate medical care and services."

Tangible age discrimination can be fought with the force of law -- and it is. But our personal attitudes toward aging are so insidious that they actually contribute to our parents putting themselves at risk by avoiding the use of necessary walking aids because they fear "what people will think."

What's so ironic, is that we're all headed there. Maybe that fact alone will help us all “think” a bit differently so our parents can use their canes without shame. And that’s just for starters.

Anne Marie Gattari, president of BrightStar of Grosse Pointe / Southeast Macomb, can be reached at am.gattari@brightstarcare.com; 586.279.3610; http://www.brightstarcare.com/grosse-pointesoutheast-macomb

Making the Day Cheerful

 

Everyone has favorite childhood memories. And for us adult children of parents with dementia, those memories are ever so precious.

Here’s one of mine: A bunch of little kids kneeling on high stools around the kitchen counter watching in awe as Mom scoops handfuls of flour and Crisco onto the bare counter top. Her hands are a flurry of activity, patting the ingredients into a mountain, making a crater into which she pours the milk, pushing it this way and that until she has a perfect consistency ready for rolling out. Every once and a while, the milk would break through a crack in the dough mountain and make a little white river along the counter top.

Mom was a baker like none other. Apple pie, lemon meringue pie, banana cake, banana nut bread, cinnamon rolls, biscotti, cannoli – all from scratch. All made and consumed so fast, the mixer never was put away.

So I had the idea over the past few weeks that Mom would enjoy baking with her new caregivers as she settled into my home. I set out the ingredients for apple pie on Suzie’s day. I left Mom’s handwritten recipe for Italian Biscotti on Shanai’s day. And when Mariah came on Saturday, I pulled out the Cocoa can and suggested chocolate cake.

“Let Mom guide you through the recipe,” I told each caregiver. “I’d like to see how she does.”
The girls welcomed the task and agreed it was a good way to engage Mom in a familiar activity – and get her away from the TV.

Companion care in the home should do just that for the elderly. Whether they have dementia or not, their day should be interesting, cheerful and satisfying. BrightStar caregivers are trained to learn about their clients and develop activity plans that complements the plan of care developed by our Registered Nurse.

“Be a detective,” I tell my caregivers. “Find out what puts a twinkle in their eye.”

Knowing a person’s hobbies and interests and what they were during their worklife, gives the caregiver an important set of “tools” to take their care to the next level. After assisting with necessary daily activities (bathing, dressing, toileting), the best caregivers become creativity coaches.

Mariah suggested a soft ball and play dough for a client who is afraid to leave her wheelchair for fear of falling — again. By gently tossing the ball back and forth, the client is beginning to build confidence and has since taken a few steps with her walker.

Faye made a tiny pillow out of military-printed fleece for her dementia client, a former Marine in WWII, who loves to hold and rub the soft fabric as he tells her his war stories.

With Mom, it had to be baking. And baking it is. The apple pie, the Italian cookies, the cake — all from scratch, all made from memory — looked a tad different than the picture-perfect desserts Mom used to make.

But they tasted exactly the same, and Mom was proud to serve them to us. In my book, that is what caring for the elderly is all about.

-- Anne Marie Gattari, 586.279.3610. am.gattari@brightstarcare.com; http://www.brightstarcare.com/grosse-pointesoutheast-macomb

Mom Leaves Long-time Home, Gradually

Oct. 24, 2011

On Saturday, Mom and I went back to her home in Clinton Township after two weeks of her staying with me. She slowly rolled her walker through the chilly living room headed straight for Dad's room, the sunniest room in the small condo. She put on her brakes and looked around.  Then, still leaning on the walker, she looked straight at me with a heavy saddness: "I never knew that once someone died, we'd never see them again."

I started to say the thing about heaven. But I knew at that moment Mom, even though she's a devout Catholic, could not be comforted. In the couple weeks she had been with me and my family, she had asked to go home every few days. So we made a date to return there on Saturday, to clean out the refrigerator, to pick up a few things, to make sure everything was in order. That's what I said. But Mom had a different idea. She went looking for Dad.

In the 18 months since Dad died, it has become harder and harder for me to enter the condo. Even during the months that Mom had a 24-7 live-in caregiver or when we gathered for a family dinner, I wanted to leave almost as soon as I arrived.

Now, packing up Mom's clothes and emptying out the pantry was more than I could bear. Though nothing definitive was in the works, we all understood that Mom likely wasn't going back to the condo to live.

After Dad died, she had been adamant about staying in her own home. We did what we could to grant her that. But as her dementia progressed and she became more fragile, staying with one of us made more and more sense. And, this time, Mom didn't oppose. Almost too readily, she agreed to leave her home of 25 years, the home she and Dad had "downsized" into after the last of us had left them empty-nesters in a house that was too big and becoming increasingly unmanageable.

Dr. Cathy Lysack of Wayne State University's Institute of Gerontology recently completed research on the phenomenon of downsizing, the act of moving from one's long-time home into a smaller, more manageable space. She says the move is especially poignant because the elderly know it's likely their last. And she cautions well-meaning adult children to slow down, listen to their parents and make accommodations for whatever they want to take.

When it was time to leave, Mom asked only to take only a couple of photos of her and Dad.
Two hours earlier, Mom walked into the house sad, confused and looking for Dad. Now, as she left, she was lucid and present and reasonable.

Perhaps having the luxury of easing out of one’s long-time home rather than making a quick and final move, is a blessing. We can’t know for sure. But given that these are our circumstances, I choose to look at it that way. A blessing. What else can it be?

-- Anne Marie Gattari, 586.279.3610, am.gattari@brightstarcare.com

Moving Mom, or Not

Oct. 17, 2011

Dr. Cathy Lysack spent much of this year sitting in the living rooms of Detroit's elderly listening to their stories as they prepared to move out of their long-time homes into smaller, more manageable, quarters.

What she heard will be the subject of a compelling speech entitled, "Moving Mom Means More than Packing the Dishes," on Thursday, Oct. 20, at 4:30 p.m. at the Grosse Pointe War Memorial.

Dr. Lysack, a researcher at Wayne State University's Institute of Gerontology, is presenting her findings at my grand opening celebration of my new senior home care business, BrightStar of Grosse Pointe / Southeast Macomb. The event is free and open to the public.

"What makes downsizing in late life unique is that it could be their last move," Dr. Lysack says. "Thinking about it in this way brings the distant horizon of their end of life closer into view and they ask: 'How much future do I have, and do I want to have it in a new place?'"

Often the move is more traumatic than it needs to be because well-meaning adult children inadvertantly create emotional crises. The family may be pushing for the move out of love and caring. "But from the older person's point of view, it just doesn't always feel right," Dr. Lysack said.

Her advice to adult children: Slow down, listen and be honest with yourself about who the move is really for. "Moving one's parents goes well beyond the simple taks of packing up her set of dishes," Dr. Lysack said. "And sometimes the solution may be to not move at all and provide the assistance they need in their own homes."

Are there ways to "downsize" in place? If the home is too large and upkeep too much, can a Certified Aging in Place Specialist remodeler make sensible modifications?( http://www.capsremodeling.com )

If your parents need help with some of their daily activities, can you give yourself the gift of peace of mind by finding compassionate home care professionals?

The answer may very well be 'no' to both and moving is the best decision. In that case, Dr. Lysack says, consider what makes your mother or father feel like a whole person -- not necessarily what makes the most sense.

Dr. Lysack likes to tell the story of a woman whose new home was too small for her sofa and her piano. She took the piano.

Good for that woman's family. It appears they were really listening to their mother.

Anne Marie Gattari, 586.279.3610, am.gattari@brightstarcare.com; http://www.brightstarcare.com/grosse-pointesoutheast-macomb

Stopping the Hospital Revolving Door

In a year from now, in October 2012, Medicare will begin penalizing hospitals when their elderly patients, once discharged, are readmitted within 30 days. The penalty will be equal to 1 percent of their total Medicare billings and will rise to 2 percent in 2013 and 3 percent in 2014.

A report on hospital readmission rates released last week by the Dartmouth Atlas Project found that readmission rates haven’t improved since 2005, due in large part to uncoordinated and inadequate follow-up care by physicians and the discharging hospital.

The report, “After Hospitalization: A Dartmouth Atlas Report on Post-Acute Care for Medicare Beneficiaries,” says 1 in 5 Medicare patients return to the hospital within 30 days of discharge. www.dartmouthatlas.org/downloads/reports/Post_discharge_events_092811.pdf
The annual cost of avoidable readmissions stands at $17 billion, according to the U.S. Centers for Medicare and Medicaid Services (CMS).

“Hospitalized elderly are some of the nation’s sickest patients, and they enter the hospital with the hope for not only short-term improvement, but also long-term benefit,” the report states.

As a country, we need the cost savings, and we’ll take it. But what does this mean to each of us individually? I hope it means the hospital revolving door stops spinning for our parents.
Skeptical, are you? I don’t blame you. The healthcare industry has been trying to reduce what it calls “readmits” for many years.

My own experience exemplifies the lack of success: Between October 2009 and January 2010, my mom was shuffled back and forth between one hospital, two rehab centers and her own home eight different times.

But I believe this time might be different. I want to believe. Financial incentives aside, hospitals and other healthcare providers are beginning to work in tandem on “care-transitions” programs as outlined by the CMS.

The CMS’s Community-based Care Transitions Program is funding pilot programs around the country designed to improve care transitions for high-risk Medicare patients. This effort is part of the Partnership for Patients, a public-private partnership to reduce harm and improve care transitions.

The Dartmouth authors believe that these programs can positively affect short-term outcomes. But there's more. “The greater question is how they can contribute to, and be effectively aligned with, broader efforts to improve care integration, coordination and accountability across the full continuum of patient care.”

It’s a question I have as well. These care-transitions programs all contain the same elements: follow-up telephone calls from hospitals, better care coordination between physician, hospital, rehab center, nursing home, and Medicare-paid home healthcare services, and better record-keeping.

That’s a good start.

But what’s missing as far as I can see is a commitment to on-going home care services that provide companionship, help with daily activities, and medical assistance for meaningful periods of time.

These are the type of services that BrightSar provides, with qualified, compassionate caregivers who make sure your parent makes and keeps the follow-up doctor’s appointment and is taking his or her medication. Our caregivers also make sure your parent is eating right and getting the right kind of exercise or activity.

In short, private duty agencies like BrightStar can coordinate all aspects of the post-hospital care plan and make sure it is followed. But what gives us the most joy is knowing your mother or father is on the mend and looks forward to his or her day.

And in the best-case scenarios, private-duty home care assistance will already be part of your parents’ daily regime, which can, in fact, prevent that unfortunate and unexpected hospital stay. With each of our cases overseen by a long-time Registered Nurse, BrightStar is looking at our clients holistically. In many cases, we are the care coordinator.

“Care coordination needs to be a continuous process that begins before illness warrants hospitalization, continues when hospitalization is necessary, and seamlessly moves back into the community,” according to the report. “For many patients, particularly for those with chronic illness, the episode of care has no definite end. Innovations in care coordination need to further develop lifelong models of longitudinal care.”

I couldn’t agree more.

am.gattari@brightstarcare.com; 586.279.3610

The Most Emotional Decision: Home Care for your Parents

Sept. 25, 2011

After reading about BrightStar home care coming to the eastside, residents have been calling to inquire about getting help for their parents, their spouses, even themselves. The details of their stories are unique. But the pain and frustration in their voices are not. It is all so familiar. Not so long ago, that was me on the other end of the line.

There's a process we all go through before the caregiver knocks on the door. For some, the processtakes longer than it does for others. It often starts with an internet search or a newspaper article that catches our eye. We do considerable research to learn what kind of care is available and who provides it.

There's companion care -- keeping your folks company and helping with meals and housework. There's personal care for those who need assistance with their daily activities -- bathing, dressing, toileting. And there's skilled nursing care for those with more specific medical needs.

During the research phase, we go back and forth. Do we really need to hire someone to come and do what we can do, what we should be able to do?

Here was how my sisters and I thought for almost two years: "They just need a little company, I can stop in after work on Tuesday." "He needs a ride to his doctor's appointment. I can take a long lunch next Wednesday." "She needs a reminder to take her insulin. I'll tape a note to the refrigerator door and call every morning."

In time, the facts become all too clear: "a little company" really came to mean "Mom can't give herself a shower." "A ride to his doctor" really meant "setting up a series of blood tests and followups for his out-of-whack coumiden levels." "Reminder to take her insulin" really meant "we need to be there every morning to hand her the syringe."

In time, I went from internet searches and newspaper clippings to phone calls. I gathered facts. I did the math. I called family meetings. I advocated for outside help.

Then I went home and tried to imagine what it would be like to open the door to a stranger -- coming to do what I can do, what I should be able to do.

Even after winning agreement from my grumpy, frugal (that's putting it politely) Depression-era dad and my less-than-supportive siblings, I had a hard time taking that final step. Inviting someone into my parents' home to take care of them was one of the most difficult, emotional decisions I've ever had to make.

I understand what my callers are going through. It' a process. And when they're ready, BrightStar is here for them. One hour or 24.

A side note: Michigan has no licensure requirement for private duty in-home care and caregivers are not required to have formal training. To set ourselves apart, BrightStar is pursuing accreditation by the Joint Commission, a national health care watchdog organization that audits hospitals and nursing homes. Additionally, our caregivers are trained Certified Nurse Assistants, insured, bonded and background checked. They report to our Director of Nursing, Anthony Pizzo, a long-time eastside nurse with an extensive background in emergency medicine.

n  Anne Marie Gattari, president / owner, BrightStar of Grosse Pointe / Southeast Macomb, can be reached at 587.279.3610. am.gattari@brightstarcare.com ;  http://www.brightstarcare.com/grosse-pointesoutheast-macomb