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

Alzheimer's Test is Back, No Surprises

September 3, 2011

Mom's tests for Alzheimer's are back, and last week we went to see Dr. Shyam Moudgil of Lakeside Neurology in Grosse Pointe. www.lakeside-neurology.com He asked us (me) general questions and read the CT report. Then he scooted his seat over to Mom, facing her.

He leaned in as he asked her a set of questions about time and place. She passed.

He tested her upper body strength. Not bad. He watched her take a few steps -- with assistance.

He asked her to do some simple math -- take 3 away from 20. 17, she said. Good. Now take 3 away from 17. She thought and sighed and said she didn't know.

He gave her a piece of paper and pencil and asked her to write a sentence. She thought and sighed again. She looked up at him, frustrated.

 You're a tough doctor," she said. Then she scribbled on the paper and handed it to him.

He read: "Share my seat."

"That's a sentence," Mom said with confidence. And she was right. I smiled, remembering diagramming those declarative sentences on the blackboard in elementary school.

When Dr. Moudgil left the room to read the film of her CT scan, I told Mom I liked her sentence.

She wasn't interested in my complement. "I knew he wouldn't do it," she said.

"Do what?"

"Share my seat. I knew he wouldn't because there's not enough room," And she tried to scoot over a little in her chair as if trying to make room.

I smiled. She didn't. "I know you think I'm losing my mind," she said. "That's why we're here."

In July, I wrote about taking Mom for CT brain scan http://www.brightstarcare.com/grosse-pointesoutheast-macomb/2011/07/20/alzheimers-going-for-the-test-awaiting-the-results. Unsure of what was causing her dementia -- Alzheimer's, weak heart, lack of oxygen, a stroke -- I wanted more information.

Alzheimer's, the sixth leading cause of death in the United States, continues to steal away our parents and grandparents. Some research is pointing toward genetic trends. The number one risk of Alzheimer's is age. The number two risk is family.

Dr. Moudgil returned and reported he saw "nothing out of the ordinary." No tumor, no bleeding, no sign of stroke. "So what's going on?"

"Her symptoms fit Alzheimer's," he said. www.alz.org That's the most definitive he could get. Because Alzheimer's cannot definitively be diagnosed without

"Not vascular dementia?" I asked. I was sure her weak heart was the culprit. A smoker for 50 years, Mom has congestive heart failure.

"No, there's no sign of stroke."

But, Dr. Moudgil said, her brain is shrinking. And apparently, he finds that pretty normal.

He noted my discomfort with his nonchalance. "Look," he said. "The body and brain are built to live only so long, and we're living longer. If we all lived to 140, 100% of us would have Alzheimer's."

We talked about drugs to slow the process, but agreed not to. Dr. Moudgil explained that he considered such drugs important if they can delay the move to a nursing home.

"But that doesn't seem to be an issue in this case," he said.

"You're right," I said. I know: "Never say never." But I can't imagine why Mom would ever need to move to a nursing home.

I know many exceptional caregivers. Thankfully, they're finding their way to my business, BrightStar of Grosse Pointe / Southeast Macomb. They're going through my rigorous testing and hiring processes as well as a thorough new employee orientation -- all supervised by my Director of Nursing, an expert RN who demands the best from them.

It won't be long until I entrust one of them with my mother.

n  Anne Marie Gattari is president/owner of BrightStar of Grosse Pointe / Southeast Macomb, providing top quality care to seniors, children and disabled in their homes. Contact: 586.279.3610; am.gattari@brightstarcare.com; www.brightstarcare.com/grosse-pointesoutheast-macomb

http://www.brightstarcare.com/grosse-pointesoutheast-macomb

Walking Together

It was a glorious late summer morning at the Detroit Zoo on Saturday. We were all in our purple shirts, smiling for the camera. Mom sat in her wheelchair, surrounded by my sisters, Barbara, Theresa, Shirley, and me. We were there for “the walk” – but most important we were there together.

How profound, I thought, as Barbara and I made our way to the opening ceremony for the two-mile walk. This is the first time since January that we did anything social together. It was Mom’s dementia that caused the riff eight months ago, and it’s that same dementia that brought us back together this morning.

The Walk to End Alzheimer’s is something we can all agree on. We were there to help raise funds and awareness for the sixth leading cause of death in the United States, for the disease that affects five million Americans, for the disease that is stealing the future of our loved ones. http://www.alz.org/walk/

The Walk to End Alzheimer’s is going on 600 communities around the country this year. The walk at the Detroit Zoo is one of 21 in Michigan.

Though we don’t know if it’s actually Alzheimer’s that is causing our mom’s dementia, we know that the limitations are the same. And my sisters and I want to be part of the movement that is trying to do something about it.

Our lives have been touched severly since we realized that Mom can’t live alone. She can’t conduct most of her necessary daily activities by herself without getting into trouble.

I wrote in my June 18 blog about the disagreement my siblings and I had over the level of care we believed Mom needed after Dad died 15 months ago. (See For the True Angels, It’s a Calling). This was no small disagreement. It ripped Barb and I apart after spending more than a year talking and visiting and planning and caring for our parents together. I missed her and told her so in a text one morning. “I don’t feel the same way,” she texted back.

Now, as we walked through the zoo with thousands of others in purple shirts, some with photos of elderly loved ones on their shirts, I felt that was all behind us. A little later we helped Mom into the car, folded her wheelchair and put it in the trunk, I knew a bigger fight lies ahead: the fight to end Alzheimer’s.

n  Anne Marie Gattari is owner of BrightStar of Grosse Pointe / Macomb. 586.279.3610.  am.gattari@brightstarcare.com; http://brightstarcare.com/grosse-pointesoutheast-macomb

Services for Older Citizens: At Your Service

Services for Older Citizens: At Your Service

August 22, 2011

Since its birth in 1978, Services for Older Citizens (SOC) has always been a visitor in someone else’s home, renting space, says Director Sharon Maier.

Not for long. In about 18 months, Grosse Pointe and Harper Woods senior citizens will be able to settle into the remodeled Newberry House in Grosse Pointe Farms – and call it their own.

SOC (http://socservices.org) just moved from the Neighborhood Club, which is undergoing its own renovation, to temporary space on the third floor of Henry Ford – Grosse Pointe (known still as Cottage Hospital).

“The idea for a permanent building came from the community,” said Maier. “We had a task force of community members who completed a feasibility study. They drew up a plan of what senior services should consist of in the future – and where they should be located.”

The result is a beautiful three-story building with ample space for simultaneous social, leisure educational and fitness events and activities.

Most communities around the country have senior citizen centers. But those in Southeast Michigan seem to be especially strong. For a complete list of all senior centers and many additional services in Macomb County go to http://www.macombcountymi.gov/seniorservices.

Like SOC, Senior Center of the Shores (www.scsmi.org) and Clinton Township Senior Adult Life Citizen Center (http://www.clintontownship-mi.gov/seniors) have permanent, full-time staffs as well as networks of committed volunteers. These centers serve as the go-to place for seniors and their families looking for resources and answers.

SOC’s Information and Assistance Line (313.882.9600) and St. Clair Shore’s Helping Hands (586-498-2339) not only provide information, but follow up to ensure the question was adequately resolved.

Maier tells about a recent widow who called with a simple question: how to turn on her gas fireplace. Maier sent one of her interns over to show her. SOC volunteers are social work students from Wayne State University and Baker College.

Senior citizen programming is continually evolving as experts recognize what works for one person might not work for another. Just because an elderly woman might not enjoy a big party as she once did, doesn’t mean she isn’t social. For her, a one-on-one relationship with a center volunteer or an in-home caregiver might work better.

My mom, is a good example of that. Once an expert dancer who used to lead my dad across the floor in a sassy fox trot, she more often than not prefers to stay home today. But watch her eyes light up when a visitor stops by.

With SOC’s new home comes a renewed dedication to the changing needs of our seniors. With some 8,000 Grosse Pointe and Harper Woods citizens using one or more of SOC’s services last year, Maier is understandably eager to get settled.

She says they are about half way to reaching their $3 million fundraising goal to renovate the Newberry House. Construction will begin as soon as they reach $2 million.

Meanwhile, SOC marches on. Its pair of annual auctions to fund daily programming and services is scheduled for Sept. 15 at the Detroit Yacht Club and Sept. 30 at the Grosse Pointe Yacht Club. For tickets or to make a donation, call the SOC office at 313.882.9600.

n  Anne Marie Gattari is owner of BrightStar Care of Grosse Pointe / Southeast Macomb, provider of in-home care for seniors. She can be reached at 586.279.3610; am.gattari@brightstarcare.com; http://brightstarcare.com/grosse-pointesoutheast-macomb

Rose: A Study in Successful Aging

Two weeks ago, I wrote about what it means to age successfully. After watching my mother-in-law on the dance floor last night, I’m doing so again.

Rose Gattari, of Warren, Mich., could be the poster child for successful aging.  “I want to say that I’m very blessed, I feel lucky,” she says. “I thank God every day for giving me the capacity to do the things I love to do.”

In a few weeks, we’ll be celebrating Rose’s 82^nd birthday. Ask her how old she feels and she’ll tell you – not anywhere close to her age.

That’s the key, researchers say. All the rest of it is important; exercising, eating right, staying active, engaging socially, and not having a chronic disease or illness. Rose does all of that. But the key to her success is feeling younger than her chronological age. And believing it.

“81,” Rose says. “It’s just a number. When people ask my age, I make them guess. Many say 65. I laugh, but honestly, that’s how I feel.”

On Friday, Dr. Peter Lichtenberg of Wayne State University’s Institute of Gerontology, spoke at the Active Aging Summit in St. Clair Shores. He shared some common theories on what separates the successful from the unsuccessful when it comes to growing old.

He spoke about findings like SOC: Selectivity, Optimization with Compensation; MOVA: meaningful, organization, visualization, association; and Automatic versus Effortful Processing.

As I scribbled notes, trying to translate the scientific concepts into simple ideas that I could write about, I realized all I had to do was consider a day in the life of Rose Gattari.

She walks between two and five miles a day on her treadmill, depending on the season. In the summer, she keeps it two miles, leaving time and energy for the outdoors. Rose keeps her late husband’s garden going, but scaled it back to be manageable. She cuts the front lawn, but not the back.

In the winter, she takes out the snow blower and clears her own driveway – but only when the accumulation is under four inches.

This is what Dr. Lichtenberg means by Selectivity, Optimization with Compensation. Successful agers select what they’re good at and focus on it. No multi-tasking here. They optimize the activity by compensating for the changes in their ability. In other words, they cut back. They don’t quit.

Rose kept Papa Remo’s huge garden for several years after he died. Even though she could rely on her children to help maintain it, she knew in her heart that it was too much. This year she made the decision to sod over most of it. She went from 26 tomato plants to 12 and planted a fraction of the lettuce, swiss chard and cucumbers.  

Rose is also a member of the Warren Symphony’s board of directors, responsible for filling the concert programs with advertising. She runs two committees of WARE: Warren Association of Retired Employees. And she jumps at the chance to babysit any of her young grandchildren.

She gets it all done through a combination of loving the activity and staying focused and organized. Everything has a place in Rose’s home. When she walks through the door, she hangs her keys on their hook. As she’s planning to leave for a meeting, she places everything that goes with her near the door.

She has amassed a personal library of articles, notes and memorabilia from a lifetime of community work and church volunteerism – with every piece of paper filed and easily retrieved. She’s done the same with photos and keepsakes from school years and athletic accomplishments of her six children and eight grandchildren.

This is what Dr. Lichtenberg means by MOVA: Meaningful, organized, visualization and association.

For Rose, many of these practices come naturally. It’s just the way she does things. For the rest of us, who have to work at being organized and staying focused  – there’s still time.

“The brain doesn’t work as fast as you grow older,” Dr. Lichtenberg said. “The amount of information we can process decreases. And it’s harder to inhibit distractions.

“But the brain has plasticity, and we can improve and maintain memory skills through discipline, exercise and training. It’s never too late.”

-- Anne Marie Gattari, am.gattari@brightstarcare.com , 586.279.3610, BrightStar of Grosse Pointe / Macomb

Goodbye Mrs. Ruh

Monday we say goodbye to Mrs. Ruh. Our long-time neighbor died last Friday. She was 90. My daughters and I loved her like she was our own. And in a sense she was. Mrs. Ruh has two very attentive adult sons who took good care of her. But we were “her girls,” she’d like to say.

Mrs. Ruh was my friend and the girls’ third grandmother for more than 20 years. She was smart and kind, stern and reliable. When I needed a last-minute baby-sitter, she was always there. When the girls needed a bandage or an ice pack, she was there for them too.

As she aged, Mrs. Ruh didn’t slow down, not much. Rather, she seemed to come to a screeching halt. One day we were having a normal conversation. The next, we weren’t. It’s striking how quickly her dementia progressed.

“Alzheimer’s is the thief that robs us of the people we love. It is creeping into our lives and stealing our future.” That’s how the Alzheimer’s Association puts it. I don’t disagree.

Helen Virginia Ritter was born in Elvins, Missouri, in 1920. She and her husband moved to Detroit after the War, and she practiced nursing here for more than 30 years, the majority of that time at Saratoga Hospital on Detroit’s eastside. 

Proper, serious-minded, stern and disciplined. That was Mrs. Ruh – so different from my unruly Italian family, I loved the contrast – and eventually my girls did too.

As children, however, they didn’t appreciate her unbending rules. One of my favorite memories is of her lightly poking at their legs in my kitchen, making them straighten up and sit tall at the table. I, of course, could never get such proper alignment out of them.

Mrs. Ruh was matter-of-fact on the outside and full of love and grace on the inside. She looked after her late husband’s “old aunt” who lived nearby and had no family of her own. She tried not to cry when her beloved Boxer, Daisy, died, but only a new pup brought back her smile.

She enjoyed Theresa’s and Catherine’s dance recitals and choir performances. She took pride in their good report cards and peppered her fireplace mantel and refrigerator with their pictures – right alongside photos of her own grandchildren.

The same age as my own parents, her health declined along with theirs. Though her dementia came on later than my mom’s, it progressed much faster.

Every time the girls and I visited in the past year, there was less of Mrs. Ruh. She tried hard to hold on to a few facts about Theresa’s first year in college and Catherine’s summer job.

What is happening to our aging loved ones? Why must we lose so many of them months or, in some cases, years before they’re gone for good? Why this deterioration of the mind?

Researchers around the world are trying to answer those questions. The Alzheimer’s Association continues to keep the issue in front of us so funding and medical advances will follow. This month begins a nationwide campaign to raise money for more research. The Walk to End Alzheimer’s on Aug. 27 at the Detroit Zoo is one of 21 walks in Michigan. To register, go to http://www.alz.org/walk/findawalk

Wayne State University’s Institute of Gerontology also is heavily involved in the world-wide race to find answers. It promotes successful aging in many ways – through research on memory loss and other aspects of aging, through community forums and educational conferences, and through its world renown graduate program on aging. http://www.iog.wayne.edu

As we bury Mrs. Ruh, we won’t forget the more than 5 million Americans affected by Alzheimer’s and other forms of dementia.

Funeral service is Monday, Aug. 8, at noon at the A. H. Peters Funeral Home, 20705 Mack Avenue at Vernier Road, Grosse Ponte Woods. Share a memory at http://ahpeters.com

Memorial contributions may be made to Multiple Sclerosis Society http://www.nationalmssociety.org/donate or St. John’s Hospice http://www.saintjohnshospice.org

Successful Aging and What Terrifies Baby Boomers

Aug. 3, 2011

When baby boomers hear the phrase “successful aging,” we sit up and listen. Too many of us know what it means to age “unsuccessfully,” and we’re terrified.

My sister, Theresa, just texted me a photo of Mom after she fell Friday outside on pavement.  The left side of her face and forehead is scraped, bruised and swollen. How she fell is a study in unsuccessful aging.

Mom was standing against a building, waiting for Theresa to park the car. She noticed a penny on the sidewalk and began poking at it with her cane. Theresa was walking back toward the building when she saw Mom bend over, reaching for the penny.  

When Theresa called me hours later to report that the emergency visit found no head injury, we had the conversation we’ve been having for over a year.

“I tell her all the time not to bend down. She loses her balance so easily.” “I know. But she’s just like a little kid. She gets so engrossed in something and has to touch it.” “I know. It’s that stupid cane. She should be using the walker.” “I know, the good one with the wheels.” “I keep trying to insist, but she just won’t.” “I know, she says she doesn’t need the walker.” “I know.” “I know.” “I know.”

Here’s what we know: Our Mom, who gave birth to and raised 10 children, was the quintessential mother and wife of the 40s, 50s, 60s, 70s, 80s and 90s. There was nothing she couldn’t do. “You want something to get done? Ask a busy person,” she’d say when a relative called to ask her to make her famous apple pie for a party, or the church called with another volunteer request.

Between mounds of laundry, she cooked and baked and cleaned. She drove the boys around on their early morning paper routes in the winter. She waited up for the last teenager to get home before locking the door and going to bed. She went to novenas every Wednesday night while Tom was in Vietnam and took dancing lessons with Dad when he returned. She took care of her grandchildren right alongside her own. She coached and counseled innumerable nieces and nephews on parenting.

Then sometime in the last decade Mom stopped. “What do you expect? She’s tired.” Anyone of us would say in her defense. But we all knew it was something else. The less she was called on to do, the less she did.

There’s something else about Mom that I haven’t talked about in these columns. She was a smoker – for 50 years. (At the end of this month, we have an appointment with a neurologist where I’m hoping to learn if her dementia is vascular or something else.)

Dr. Peter Lichtenberg, director of Wayne State University’s Institute of Gerontology, says studying aging today is important because we’re facing an “age sunami.” www.iog.wayne.edu/bio; www.iog.wayne.edu

“Successful aging as a field of study is only about 20 years old,” says Dr. Lichtenberg. “We need a lot more knowledge. There is too little attention paid to problems of older adults and too many misconceptions.”

The Institute of Gerontology (IOG) conducts some of the foremost research on the social and behavioral aspects of aging. One area of focus, cognitive neuroscience, looks at how the aging brain affects thinking skills and how to detect normal from abnormal brain performance.

The IOG’s work contributes to our growing understanding of dementia and Alzheimer’s by educating physicians and their office personnel as well as holding continuing education forums and conferences.

IOG contributed to an online training resource by the Michigan Dementia Coalition for physicians and their office staff to recognize, treat and bill for dementia. The IOG helps physicians partner with organizations such as the Alzheimer’s Organization and the Area Agency on Aging. 

You may remember the recent billboards on Michigan highways: WorriedAboutMemoryLoss.com, directing online traffic to the Alzheimer’s Association. www.worriedaboutmemoryloss.com; www.alz.org.

This ongoing research and education helps us all. Whether it’s today or tomorrow, we will all be affected by some sort of aging issue – medical, social or economic.

More than 40 million people in the United States are aged 65 and older. That number rises to 53 million in less than 20 years and 89 million in 40 years.

If our generation doesn’t age more successfully than our parents are doing, the social and economic consequences could be unimaginable. The good news is we may have more control over how well we age than we once thought.

“Being engaged both physically and mentally; doing what you can to reduce the impact of chronic disease. These are all important aspects of successful aging,” explains Dr. Lichtenberg.

There’s no one simple answer. There never is. But we know so much more than our parents did about reducing risk and remaining independent. It’s our collective responsibility to give it a try.

n  Anne Marie Gattari, president, BrightStar of Grosse Pointe / Southeast Macomb, serving seniors, children and disabled needing care in their own homes. 586.279.3610; www.brightstarcare.com

The "Business" of Caring

July 25

I just returned from Gurnee, Illinois, where my leadership team and I spent a week of training preparing to open BrightStar of Grosse Pointe / Southeast Macomb. With me were Susan Miruzzi, Director of Operations; Bobbie Soeder, Director of Sales; and Sandra Hardy, RN and Director of Nursing. Each brings a long and successful career to her respective position. I’m blessed to have found them and am eager to introduce them to you in upcoming columns.

But as I sat in the classroom studying our advanced office IT system and reviewing winning sales strategies, I kept thinking about the most important staff members of my new organization – the caregivers.

Two weeks ago, my team and I held a job fair for caregivers and nurses at our St. Clair Shores office. More than 130 applicants came through our doors, many with years of experience caring for family members or neighborhood friends. Others had just completed Certified Nursing Assistant programs at Dorsey Schools or Macomb Community College.

The process for hiring caregivers at BrightStar is arduous, as it should be. It’s designed to help us find the right employees to fill these special jobs. We require on-line and in-the-field testing as well as background checks and drug testing. Lengthy interviews are followed by lengthy orientation. Once hired, our caregivers will keep current with in-service training from experts in gerontology.

None of this should surprise you. All home care agencies should design such rigor into their hiring practices. And many do. But what sets BrightStar apart from so many other agencies is what we call “RN oversight” and “Guaranteed Compatibility.”

Each and every home my BrightStar agency is invited into will be reviewed by Sandra Hardy, a Registered Nurse in the Detroit area for more than 30 years and an expert in critical care. After assessing the client and his or her environment, visiting with the family and conferring with the physician where necessary, Sandra will write a “plan of care” for the client.

The caregiver will follow that plan to ensure the client is receiving everything he or she needs – and more. The plan could include a social event such as a walk around the block or a medical treatment requiring Sandra or one of her LPNs – and everything in between. 

But before we assign that caregiver, we’ll consider the client’s interests, personality and health – because we guarantee compatibility. If we get it wrong, we’ll make a change. No questions asked. And we won’t wait for the client to ask. By then, it’s too late.

A few months ago, my sisters and I fired one agency and hired another to care for our mother. Mom had told us she was simply “tolerating” the women caring for her, and we made the change. It was one more step in an already difficult process. Everything about getting care for your parents is hard. Coming to the realization that it’s needed. Figuring out who pays. Making the decision to finally do it. And interviewing various agencies.

Inviting someone into your mother’s home to help get her washed and dressed, to make her breakfast, to keep her company – when you can’t be there – is one of the most emotional decisions a family will ever make.

As I prepare to open my new business, I know balancing the books and planning the sales calls are important. But what keeps playing over in my mind is how the day unfolds in your mother’s home. I see a caregiver, concerned and kind, understanding intrinsically that though the calendar says chair yoga at 11 a.m. the senior center, your mother would rather stay home and pick flowers in the garden.

I hope this gives you, the daughter or son, the peace of mind you so badly need and deserve.

n  Contact Anne Marie Gattari at am.gattari@brightstarcare.com; 586.279.3610

Avoiding Family Disputes, Easier Said than Done

A new book on estate planning is coming out soon with an enticing title, “Blood & Money.”    

Sounds like the stuff of a made-for-TV drama: rich family fights tooth and nail for the riches of their deceased parents. I assumed it wouldn’t apply to my family’s experience after Dad died last year. There was drama alright, but no money.

But author Mark Acceturra says my experience is more common than you’d think. “It rarely is about money. It’s more about control.”

Mark is an elder law attorney who has been helping families plan their estates, administer their trusts and resolve difficult family disputes for more than 30 years. “Blood & Money” is his fifth book. (248-848-9409 www.elderlawmi.com)

I visited Mark in his Royal Oak office earlier this month to learn more about his services and tell him about my new home care agency. BrightStar of Grosse Pointe / Southeast  Macomb will open August 1, providing care to seniors, children and the disabled in their own homes.

As he talked about the dysfunctional dynamics that often erupt among siblings upon a parent’s death, I cringed. I thought about the arguments, the accusations, the ugliness between my sisters and me in the days following Dad’s funeral last year, and I wanted to cry. We argued as we cleaned Dad’s room, often turning off the vacuum cleaner to make a point. We argued as we packed away Dad’s clothes for the Salvation Army. We argued as we tried to plan what comes next for Mom, for us.

“What appears as greed and pettiness is really a symptom of the survivors' struggle to feel loved and important,” Mark explained.  “The fight for money and things - Dad's watch, Mom's wedding ring - is not about the object or the money itself, but about what they symbolize: importance, love, security, self-esteem, connectedness, and immortality.”

That’s it. Feeling loved and important. Dad was a good man with a big heart. But he was simply ill-equipped to father such a large family. His answer to everything was work. He owned several small meat markets on Detroit’s eastside over the years and spent more time with his customers than his 10 kids.  

Attorneys like Mark understand that settling the tangibles of inheritance is the easy part. In his book, Mark sets out to explain the psychology behind why siblings fight at this tender time in life and offers a guide to families and their lawyers to help them prevent what he calls “family-splitting inheritance disputes.”

“It’s a mistake to dismiss the quarreling heirs as simply greedy or petty,” Mark says. “I try to go beyond and to understand why families do vicious combat even while they are still joined in grieving.”

Feeling loved and important. As most of my siblings, I did my fair share of battle with Dad over the years. But never, ever did I doubt his love. And no one made me feel more important. (A side story: about six weeks before he died, I went to pick up Dad from the rehab center for a dentist appointment. I tried to be discreet as I approached the social circle of about 20 elderly residents taking turns sharing their stories. As I disengaged the brakes of his wheel chair and quietly backed him out of the circle, he held up his hand to the group. “Hey, everyone. This is my daughter, Anne Marie.” I smiled at the group and tried to keep moving. But then, they stopped me in my tracks. They started to applaud. Dad was grinning ear to ear.)

My family’s dispute after Dad died was about who would hold power of attorney over Mom’s matters – both medical and financial. In 1984, Dad and Mom entrusted me with that responsibility for each of them. In the ensuing years, my parents assumed that “that was that” and nothing could be – or would be – challenged.

Now, my sisters convinced Mom that the legal documents should be re-drawn with the responsibility shared. When I balked, they latched out: “Why should it be just you? Why is it always you!”

As I think about what transpired over the days and weeks following the funeral, I could throw the biggest pity party ever. How could they be so cruel? How could they be so, so …  You get the idea.

But truthfully, I have no cause for self-pity. In fact, I realize now, as hard as it is to admit, my sisters were right to question things.

In the process of writing his book, Mark did considerable research in social psychology, gerontology and neuropsychology, interviewing experts in each discipline.

Perhaps if we had been counseled by an attorney like Mark before Dad’s death and Mom’s progressing dementia, we would have been able to have a rationale family discussion with real direction from our parents. After all, that’s who this is all about.

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

Alzheimer's: Going for the Test, Awaiting the Result

Mom struggled to get onto the table and lie down as the CT technician instructed. After positioning Mom’s head just so, the technician escorted me out of the room, went to her command station and began flipping switches.

I watched with mixed feelings from the hallway as Mom moved forward on the conveyor through the center of a giant-sized, donut-like machine. The machine slowly circled around Mom’s head dragging red rays of light with it.

Should I be doing this? What’s the point? Is this needlessly hard on her?

At my request, mom’s physician, Dr. Rudyard Dimson of Clinton Township, ordered a set of tests to try to determine if Mom’s dementia is related to Alzheimer’s or something else.

We went to Henry Ford Macomb Hospital for blood work, a urine sample and a CT brain scan. While it wasn’t a grueling set of tests by any means, I understood the reluctance of families to have their loved ones tested. Intellectually, I believe it has to be done.  But emotionally, it’s a different story.

"The mental anguish of living with a diagnosis would most certainly be as debilitating as the disease itself; especially if it was wrong. Sometimes, ignorance is bliss," wrote a reader in response to a recent New York Times article on advances in Alzheimer ‘s research.

One of my sisters expressed the same sentiment when I asked what she thought about having Mom tested.  I was persistent: “It could very well not be Alzheimer’s,” I said. “The dementia could be related to her weak heart.”

So the day before leaving for our up north July 4^th weekend, I wheeled Mom from one end of the hospital to another in search of answers.

I learned through discussions with the knowledgeable (and compassionate) people manning the Alzheimer’s Association help line that the disease cannot be definitely diagnosed until after death when the brain can be closely examined for certain microscopic changes. (24/7 Helpline: 1.800.272.3900; e-mail: info@alz.org  www.alz.org.)

Rather, it’s a “diagnosis of exclusion.” Tests are ordered to rule out other problems that can cause the symptoms:  inactive thyroid, vitamin B-12 deficiency, malfunctioning kidney, stroke, mini-strokes.

CT scans can show certain changes in the brain, such as a reduction in size, that are characteristic of Alzheimer's disease in its later stages.

And the “Heart-Head Connection” is also to be considered, according to the Alzheimer’s Association.

“Some of the strongest current evidence links brain health to heart health. Your brain is nourished by one of your body's richest networks of blood vessels. Every heartbeat pumps about 20 to 25 percent of your blood to your head, where brain cells use at least 20 percent of the food and oxygen your blood carries.

“The risk of developing Alzheimer's or vascular dementia appears to increase as a result of many conditions that damage the heart or blood vessels. These include high blood pressure, heart disease, stroke, diabetes and high cholesterol.  Some autopsy studies show that as many as 80 percent of individuals with Alzheimer's disease also have cardiovascular disease.”

Mom has a very poor heart. We’ve know that for some years. To walk across a room without oxygen leaves her breathing heavy, trying to “get some air,” as she says.

Yet, her ability to walk seems to improve at inopportune times. The middle of the night, for instance.

During our July 4^th family gathering on the Rifle River in Arenac County, cousin Joan heard sizzling coming from the kitchen at 3:30 in the morning. She ran up the stairs to find my mom with a frying pan filled with oil and the gas on high. Mom was making herself an egg.

So many feelings ran through me when Joan retold the story later that morning. Frustrated, angry, sad, ashamed and afraid.

Many Alzheimer’s studies are focusing on genetics and are coming up with a link. “Genetic research has turned up evidence of a link between Alzheimer's disease and genes on four chromosomes. . . a gene on chromosome 19 has been linked to late-onset Alzheimer's disease, which is the most common form of the disease,” according to the organization.

As I await Mom’s results, I think about why I wanted the tests in the first place. Tina, the Alzheimer’s Association help line expert, put it this way:

“The number one risk factor for Alzheimer’s is age. The number two risk factor is family,” she said. “If your parent or sibling has it, your chances go way up. We want to know because we want to plan. But also, because when they find the vaccine, we want to be first in line.”

n  Anne Marie Gattari, am.gattari@brightstarcare.com ; brightstarcare.com, 586.279.3610

Helping Dad Die

My brother, Mike, and I agree: It was a privilege to help our dad die. Taking care of Dad the last days of his long life changed our own lives and brought us even closer together.

Mike and I are one year apart and have always shared a special bond -- despite his living across the country in California for most of our adult lives. So I was relieved when he volunteered to come home immediately upon hearing that Dad had been admitted into hospice. Mike would provide a sorely needed strong back (my sisters and I were able to do less and less for our 200-pound father) -- and moral support.

I expected Mike to arrive, listen to my summary of Dad’s condition, roll up his sleeves and wait for my instructions. I was dreaming. Mike is strong willed, opinionated and righteous. Sort of like me. He had his own idea of what should be going on with Dad. And it wasn’t dying.

Mike arrived on a Sunday, six days before Dad died. That morning, as he helped Dad to his feet from the recliner, Mike grabbed the walker and coached him to march in place. “Dad, lift your legs, it will make you stronger. Then you’ll be able to walk better.”

“What are you doing!” I tried to push Mike away, and he instinctively did the same to me.

We both calmed down enough to get Dad to the bathroom and back. Then we went in the garage to “talk.”

“Don’t you get it? Dad is dying.” I said, probably too matter-of-factly.

"You’re encouraging him to give up,” Mike protested.

“Mike, you’re not helping.” I stormed out of the garage as Julie, Dad’s hospice nurse pulled up.

Julie had the glow and kindness of an angel, as did all of the nurses and volunteers we met from Seasons Hospice (866.752.0009) http://www.honoringlife-offeringhope.org/

Julie was also beautiful, and my dad didn’t hide his crush.

When she sat next to him and rubbed his arm, he asked her for a kiss. She didn’t hesitate. Then she took out her stethoscope and listened, reporting aloud that the “crackling” sound was progressing. She squeezed his wrist, his ankle, his abdomen and noted the imprint her fingers left. She took his blood pressure and indicated that it was lowering.

When she was done and put away her equipment, Dad asked her what he had asked me a few days earlier: “Am I dying?” I waited to see if she’d answer the way I did.

Julie smiled her kind smile and nodded. “Yes, Nat. You are.” I wiped my tears and sighed.

Mike stood in the kitchen, watching and listening. Good, I thought, he’ll take his cue from the professional and we can all be on the same page.

Dreaming again. Instead, Mike called Julie into the garage. “He doesn’t need to hear that!” Mike scolded. “You’re going to make him give up.”

Julie tried explaining that her long experience with hospice has taught her the best thing to do, when asked, is to be honest. It’s disrespectful, patronizing to lie about the inevitable -- when the dying ask. 

Experts agree: “You have to be honest. . . . You have to answer their questions, but don't volunteer information for which they have not asked, because that means that they are not ready for it yet,” said Dr. Elisabeth Kubler-Ross, author of On Death and Dying.

Two weeks earlier, Dad’s nurse from Aquarius Home Health Care (586.576.1955) called me at work to give instructions on how to care for his leg wound. (A month earlier, Dad had fallen, gashed his leg on his walker and was finally home after weeks of hospital and rehab stays. Still, the gash wasn’t healing and edema was moving up his body from his legs.) 

I asked the nurse to repeat the instructions, trying to write them down. She started, then stopped. “Your father is at the end of his life,” she said softly. 

“I know.”

That night, a Friday, when I arrived to spend the weekend as I had most weekends for the past six months to care for both parents, I talked to Dad about hospice.

“Will it rush things?” he asked.

“No, it may actually slow things down,” I said. “You’ll get more nursing care, and we’ll make sure you are comfortable and not in any more pain.”

“Ok, we’ll try it.” 

On Sunday, Dad signed himself into Seasons Hospice care. The nurse explained that the fluid was moving rapidly into his abdomen, that we would see an equally rapid decline and that he would need 24/7 care. Everyone around the table offered what they could do. Brother-in-law Mark volunteered to renovate Dad’s bathroom into a fully accessible walk-in shower.

The kind nurse shook her head. “You won’t get it done in time.” We pressed her for a timeframe. Two weeks.

Dad was 90 years old, the quintessensial Italian patriarch. Strict, demanding and often grouchy, he had his distractors. Even those of us who loved him unconditionally and could laugh about his grumpiness, had barged out of his house a time or two, often in tears and vowing never to return. We always did.

But no one could describe Dad better than himself: “A miserable son-of-a-bitch,” he’d say, waiting for someone to object. When no one did, he’d laugh. 

Of course, there was the other side. “When people think about me after I’m gone, I want them to say, ‘He could be nice.’”

Could be. That was the key. He certainly could be nice. And as I write this, that’s what I’m remembering. The times he was nice. The times he was fun to talk to and made my daughters laugh. The times he reminisced about his colorful youth proudly recounting his love of cars and crystal radio sets. 

Two weeks. It was hard to grasp the time was coming when Dad would no longer be on this earth. It’s not as though we weren’t ready. It’s not as though he wasn’t ready. For the past few years, when asked how he was, he’d answer in his gruffest tone: “Still here.” 

I called my five out-of-town siblings. They all wanted daily updates. Mike made plane reservations. 

For the next week, Mike and I were side-by-side, taking care of every detail that we were physically able to. Mike began to soften to the hospice nurses’ instructions but still hadn’t reached the fifth stage: acceptance.

Dad, however, had. He asked to have dinner with my brother Dennis, with whom he had strained relationship for too many years. He asked for a big, rare porterhouse steak from “the store,” Biondo’s Market (13786 E. 12 Mile Rd., Warren, MI 48088. 585.773.3060), the store he opened decades ago and today is owned and operated by my sister Barbara and her family.

He talked openly about his own death, asking several visitors if they thought he was dying. (Interestingly, he only asked those he knew were strong enough to tell him the truth.) 

One morning, Mike and I entered his room and found him sitting up in bed. “Mike,” he said rather cheerfully, “I didn’t die last night.”

The out-of-towners began to trickle in. Tom, my oldest brother, the dependable brother, the guy Dad leaned on throughout the years, arrived from Idaho on Thursday night, just in time to have a conversation. It may have been Dad’s last real conversation, because later that night, the rattly breathing began and he mostly slept from then on. 

Mike and I continued to work together, but still disagreed on some details: When to give Dad morphine, how much to give him. Whether we should suction the phlegm from his heavy, rattly breathing. 

But when Dad took his last breath on Saturday night with his entire family around him, Mike and I held hands. 

Weeks later, on the phone, Mike thanked me for allowing him the “privilege” of helping our dad die. 

“It was how he wanted it,” I said, not knowing what else to say. “He hit 90. He had all his kids and Mom with him. He was at home.”

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