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