Wednesday, October 31, 2012

Gimme the Candy!

To say that there are an abundance of children in my neighborhood would be an understatement. Our house sits on the corner of two cul-de-sacs which, in total, represent 32 children. Halloween is kind of a big deal. Nevertheless, I am guilty of two Halloween sins. First, I turn my lights off before the candy is really gone. Once the stash of candy has run down to the dregs, I flip the light off and retreat to my lazy boy (aptly named) where I work to avoid the stomach ache which will undoubtedly follow the consumption of that many Sour Patch Kids. Second, I lie to my children. My oldest son has a peanut allergy and we therefore must screen all of our children's loot to ensure that there are no peanut candies hiding in the mix. Over the years, my wife and I have taken increasing liberties with the screening process. My kids are now convinced that there are many candies that could potentially spell disaster for people with a peanut allergy. Such as: Gummy Savers, the aforementioned Sour Patch Kids, Smarties, Rolo's, Swedish Fish, Airheads, Nerds, Sweet Tarts, Now-n-Laters,  and anything with dark chocolate in it. These are a few of my favorite things. Following the onslaught of our neighbor's goodwill, the kids all come back home and dump their goodies onto the living room floor where I scour the contents of their respective pumpkins, removing all "risky" items. Safety is important on Halloween.

I thought this blog was about seniors?

Relax, I'll get there.
One of the parts of the natural aging process is the reduction in the body's ability to taste things. This is due to a number of factors such as a reduction of saliva production as well as a reduction in the actual number of taste buds. Frequently, you will see older people dumping unholy amounts of salt, pepper, vinegar, Tabasco, etc. onto everything they eat. They don't decide to begin bathing their food in hot sauce because they have suddenly gone cajun at the ripe old age of 65. They do this because it is the only way they can taste the foods. The reduction of a senior's ability to taste their food has a couple effects which merit words of caution. First, it is no fun for older adults to eat so they don't. The only thing worse than eating by yourself is eating a meal you physically can't enjoy by yourself. Proper nutrition is important at every stage of life but probably most of all for seniors, some of whom are managing chronic conditions. These conditions can be greatly exacerbated by poor nutrition. At Home Instead Senior Care, our caregivers pay special attention to the nutritional needs of seniors and work to make meals more enjoyable. They do this not only through companionship but also by working to make mealtime more of an event. Eating out of microwaveable cardboard container stinks even with good conversation. Setting a nice table goes a long way toward making meals more palatable even if it is only for the eyes.

Ok. But how does this have anything to do with Halloween and your crimes against children?

Hold on to your hats because I'm about to bring it all home.
Riddle: If you are unable to taste anything except for things that are exceptionally salty or sweet and suddenly find yourself with an abundance of Halloween candy, what will you probably eat?
Answer: All of the leftover Halloween candy.
The days following Halloween are great times to visit the senior in your life and check in on the nutrition front. Look to make sure that there isn't a ton of candy left over which could pose a significant health threat in the absence of other foods. Plan a trip to the grocery store to provide nutritious companions if not alternatives to the belly full of Snicker's Minis that will represent the first thing your senior has been able to taste in weeks.

If the senior in your life is unreceptive to this kind of assistance then I would encourage your children to be more insistent about that second or third treat in the basket. Arm them with kind words like: 'It's for your own good,' and 'Because we care.'

Have fun and be safe tonight, dear readers. Happy Halloween!

Tuesday, October 23, 2012

How Does Your Garden Grow?


I find some of my greatest life lessons in my garden. Last year, I built two raised bed gardens in my backyard. I had grand dreams of the food we would grow there. Initially, the garden I made was a thing of beauty. Rich black soil, the smell of fresh mulch, bees buzzing busily as they pollinated my crops. Each morning and evening I would water and preen by hand. In short order, my garden began to blossom. Then life happened. I got busy. I got too busy to continue to spend the amount of time that I had initially spent cultivating my garden. As a result, weeds and bugs began to invade. Before long, the fantastic thing I built was no longer.

So much of in-home care is a garden. Initially, we utilize a ton of resources to ensure that we are recruiting and training the very best caregivers available. The background check we run on all our applicants continues to be the most thorough available, the reference checks and drug screening we insist upon have set the standard for in-home care. But that isn't enough. We must continue to water and preen our garden lest the weeds and bugs should invade. This is the new battlefield for in-home care providers.

One of our two core values at Home Instead Senior Care in Chapel Hill is to exceed the expectations of everyone that we encounter. We call it our 4E's. Sadly, the expectations from seniors and their families are fairly low. They have become accustomed to a certain amount of tardiness, a certain amount of apathy, a certain amount of absenteeism when dealing with in-home care. Their experience with the industry has taught them what they can realistically expect. From day one, we fight against this "assumed reality" with our clients and our caregivers. From birthday and anniversary cards, to our P.E.A.Q. program, to our quality assurance visits, to our on-call policy, to our community involvement-Home Instead Senior Care is working to exceed the expectations of everyone that we encounter. As anyone who is happily married can tell you, relationships do not build themselves. Like gardens, relationships require constant effort if they are to grow.

Monday, October 22, 2012

Engaging the Lost Causes

When caring for people who are suffering from Alzheimer's and other forms of dementia, there comes a time when the person suffering loses the ability to communicate. During typical late stage Alzheimer's, a person may be bed or chair-bound, unable to speak, and in some cases completely unresponsive. Sadly, the temptation is to disengage from the person we love at this point. Why bother talking with them when they can't talk back? Why ask them questions to which they can no longer respond? While this approach is understandable to anyone who has dealt with this disease firsthand, it misses a huge opportunity to continue to connect with the people we care about.

During our Alzheimer's and Other Dementia training at Home Instead Senior Care, we deal specifically with late stage clients. We address the fact that just because the people for whom we are caring aren't able to verbally validate our attempts, we shouldn't be discouraged from continuing to interact with them. We should, however, amend the techniques we use in order to give them the maximum benefit of our involvement.

The techniques we use for late stage clients all revolve around the five senses: smell, touch, taste, sight, and hearing. These senses unlock a world of memories for the clients that we serve that we may never truly realize. For all of us, there are certain things which take us to another time and place.

-If I smell Cinnamon Butter Cake, I am transported back to my grandparent's house in Woodward, OK. I can see the large front door they had swinging open as my brother and I bound out of the car after a long drive up from Texas and into their waiting arms.
-The feel of a saxophone in my hands brings back memories of long band bus trips and cold competition mornings.
-The taste of tamales paints a portrait of Christmas in San Antonio that no artist could ever come close to rivaling.
-The sight of pictures of my kids in their toddler years brings smiles to my heart that last all day.
-If I hear the song "Two Princes" by the Spin Doctors, I find myself sitting in the back seat of Jana Davis' car on the way to school. She was a beautiful flute player in the high school band who as a senior agreed to give me a ride as a freshman so that I wouldn't have to ride the bus.

None of these journeys you can go on with me. For our dementia clients in their late stages, you can't go where they are headed either. You may never get the validation of knowing that you have given them the memory tool to take that mental trip. But we do not care for those in our lives in order to attain some personal validation, we care for them in order to provide them with the best possible quality of life. And on that mission, we never give up.

Friday, October 19, 2012

A Turn For the Worse

If I had a nickel for every time I heard the phrase "Since she has been at the hospital, Mother's dementia has taken a turn for the worse," I would be a very wealthy man. The idea that hospitals cause dementia is an amazing phenomenon to me that way too many people accept at face value as a universal truth of aging. Hospitals do not cause dementia. Granted, with the size and confusing layout of most hospitals even I forget how to get back to the parking garage from time to time. The fact that so many seniors never have the opportunity to return home from a hospital stay due to the mysterious "dementia monster" attacking them upon admission is troubling. The fact that this absurd logic is never even challenged is downright maddening.

What causes dementia is, in fact, a mystery. Scientists know that the greatest risk factor is advancing age but beyond that the entirety of medical knowledge on the subject resorts to what can be most aptly described as a "best guess scenario."The sudden, rapid progression of dementia is a far less complicated matter to investigate than actual dementia. So allow me.

In the normal aging process, senior's bodies begin to function differently than they did  in younger years. Kidneys do not function as efficiently as they once did. This particular facet of aging, I believe is responsible for a huge percentage of the post hospital rehab admissions today. Imagine this scenario:

A woman, age 94, has lived independently since her husband's death two decades ago. She continues to be fairly engaged in the community and has a caregiver who comes in twice a week to keep her company and assist her with errands and chores around the house. At times, she has troubling recalling certain things but the things she forgets will generally come back to her and do not interfere with her daily life. She is a model for aging with independence. One day she slips and falls while retrieving the mail. Due to the brittle nature of her bones, she fractures her left hip requiring surgery. The surgery goes extremely well, especially considering her age, and the doctors all say that after some quick rehab she should be fine to return home with limited assistance as before. Not so strangely, she begins to show confusion following surgery. It is gradual at first and then increases rapidly. The doctor's offer a simple explanation. Sometimes in a hospital situation, a senior's dementia takes a turn for the worse. AAAAAAAAAAAAAGH!! With respect to the kind hearted medical professionals, allow me to postulate another theory. This particular 94 year old has avoided medications for most of her life wherever possible. She takes a baby aspirin every morning and a multivitamin because an episode of Donahue told her that doing so might reduce her risk of certain cancers. Suddenly, due to her hip fracture, she is being given an anesthetic for the actual surgery, a sedative to help her sleep at night, a medication to prevent constipation, and Oxycodone to ease the pain. When you combine that cocktail with the knowledge that her kidneys are not filtering these drugs effectively, another possible diagnosis presents itself. She isn't suddenly demented. SHE IS HIGH!!

I wish I could tell you that this woman eventually stabilized and was able to return home. I wish I could tell you that she wasn't discharged to a skilled nursing facility where she was administered a daily dose of instant-dementia for the rest of her days. Most of all, I wish I could tell you that her's was a unique story. But alas, I am unable to make any of these statements and instead sit here at the keyboard typing, collecting a nickel for every time that I hear that someone's dementia has taken a turn for the worse.

Thursday, October 18, 2012

Alzheimer's and the Marvel of the Human Mind

Yesterday, I taught a group of our Home Instead Senior Care CAREGivers about Alzheimer's. As part of our C.A.R.E. initiative, we are teaching not only our caregivers but families as well.

As I taught the class, I couldn't help but notice one attendee who was not engaged in the material. After our initial period of instruction, we took a short break where I seized the opportunity to ask why she seemed so distant from the rest of the class. She replied, "This doesn't apply to me. I don't have any clients that have Alzheimer's."

It struck me just how typical that attitude is with regards to Alzheimer's and other dementia. And just how inaccurate. Since Dr.Alzheimer first discovered the plaques and tangles which are the indicators of the disease, there have been great advancements made. 100 years of medical research has brought an end to a number of formerly deadly diseases and chronic conditions. The human brain, however, remains an outlier. After a century of funding and research, scientists still stand in amazement at the marvel of the human mind.

As a Christian, it is my belief that I am not an accidental collection of cells that somehow, after a billion years of trial and error, managed to put themselves together in a manner that encompasses every facet of my functioning body as well as my personality. To take a hard look at the human body and believe that it is simply the result of chance requires, in my opinion, a far greater amount of faith than belief in a creator. I see intricate designs and systems which work in perfect harmony with one another. I see passions, desires, and creativity which make no sense in the scheme of "survival of the fittest" and would have likely been lost throughout the millenia if evolution were the only explanation for our existence. If the brutal battle for survival is solely responsible for our survival as a species then I think we should be a far less compassionate and reasoned people than we find ourselves. I digress.

On the matter of Alzheimer's and dementia, there is very little to show for 100 years of study. At this point, we cannot tell you who is more likely to develop Alzheimer's. We cannot tell you what causes Alzheimer's. We cannot therefore tell you how to prevent Alzheimer's. We are unable to effectively treat Alzheimer's. And we are unable to cure Alzheimer's. That is the reality of this tragic disease. The other tragic portion is the statistical inevitability that each and every one of us will be affected by it.

The greatest risk factor associated with Alzheimer's and other dementias is advancing age. The older you get, the more likely you are to develop symptoms. In 2011, the Alzheimer's Association reported that an estimated 5.4 million Americans of all ages have a type of dementia. Over the age of 65, the number of people with Alzheimer's narrows to one out of every eight. If you live to the age of 85 or beyond your risk of Alzheimer's increases to one out of two.

You may choose to bury your head in the sand and pray that you will not be one of the people struck with Alzheimer's. You may not have anyone in your immediate circle who is currently struggling with dementia. Since half of all seniors who live to be 85 will be stricken with this tragic disease, it is unreasonable to assume that you will not be affected in some way.

Join us for a family education event in Chapel Hill on December 4th and 6th from 6pm-8:30pm. The classes will be held at the Chapel Hill Carrboro Chamber of Commerce office, 104 S. Estes Dr. Chapel Hill, NC. Please RSVP to 919.933.3300 so that we can provide adequate materials for all in attendance. I look forward to seeing you there!

Tuesday, October 16, 2012

The Foul Ball

This is the story of an unbelievable experience I had while caring for one of our clients. It appears as it was published in Fifteen-501 The Magazine.

"As the owner of a senior care company, I've learned that spending as much time as possible with clients keeps me in touch with what I believe to be the heartbeat of our business. While most still live in their homes with our assistance, many clients reside in facilities. For the latter, we provide a much-needed escape from the monotony that can have a devastating effect on the morale of those who, despite their outward appearance, feel no different than they did 40 years ago.

I had the privilege of taking one such client, Mr.H, to a Durham Bulls baseball game last season. Mr.H, who lives in an assisted living facility in Chapel Hill, has moderate dementia. As with many who suffer from this condition, there are things about his life that are clear as a bell and others that elude him: He can't tell you what he did for a living for 35 years or how he came to be in Chapel Hill, but he can tell you what it was like to storm the beaches at Normandy, how cold the water was, and how he prayed that he would make it to the beach before he was shot down because he didn't want to die drowning.

He can also tell you what it was like to watch Babe Ruth take batting practice during the late 1920's, and how the effortlessly the slugger knocked 10 or 12 balls over the fence. In medical circles, they call these memories "moments of clarity." A s a student of history, I don't mind the repetition of stories, so we spent the first five or six innings of the game talking through some of these moments. He asked me several times whether I had ever caught a foul ball, and mentioned how he couldn't believe that in 83 years of attending baseball games he'd never caught one himself.

As the day wore on, the heat finally got the best of us. After the seventh inning stretch, we decided to call it quits. He asked the foul-ball question again as we were leaving, and I replied that we'd have to wait until next time around. At that exact moment, we heard the crack of the bat and both turned to look. the ball floated in the air toward us in almost slow motion, and after what seemed like an eternity, it landed-- literally--at Mr.H's feet. I bent down, picked it up, and handed it to him. He had caught his first foul ball.

The ride back was quiet to say the least. The entire experience was surreal. He spent most of the time tossing the ball between his hands, smiling, quietly uttering, "Eighty-three years. I can't believe it. Eighty-three years."

When we returned to the facility, he shook my hand, thanked me again and began to walk inside. After four or five steps, he turned around and looked down at the ball, then back at me.

"Maybe you can come sometime and we can have a catch," he said. "Sure," I replied. "It would be my pleasure."

I know Mr.H might not remember that I was the one who took him to the game that day. I know he might not be able to recall what teams were playing. I do know, however, that he'll remember the day that he caught a foul ball. I know that as cloudy as his mind might be, that moment has joined the pantheon of Babe Ruth and Normandy, and I was there to see it. I got to see an 83-year-old become just another boy at the ballpark. I watched a man come alive, if only for a moment.