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