Angelos - Summer 2017

When the Time Comes

Elizabeth Downing, Delta Gamma-Western Kentucky 2017-06-19 09:32:04

Will you be ready? I watched my mother on her daily trips to the nursing home where her mother resided. Never wavering in her faithful care, my mother nevertheless sometimes felt as if she had failed my grandmother. She had promised my grandmother she would never place her in a nursing home, but her care had become too much, even for our family team. Years later, when my father became housebound, my mother cared for him almost single-handedly. My four siblings and I tried to help, but my father wanted only his bride of 65-plus years to see him at his most vulnerable. He trusted her hands above all others. Five years after my father's death, my feisty, independent 92-year-old mother dragged herself across her kitchen to call and tell me she had fallen and thought something was very wrong. Frightened that she might have a head injury, I was almost relieved to learn the something "very wrong" was a broken hip, requiring hip replacement surgery. My family knew the steps we took when our mother came home would determine her quality of life for the rest of her life. My experience running a caregiving service reinforced our determination to take the safest and smartest steps going forward. Over her protestations, we provided our mother around-the-clock attention divided between our large family and caregivers from my service. We could not have chosen a better course for our family, but we were prepared. We had traveled this road more than once. We were veterans. Families face decisions every day about how to do what is best for everyone as they or loved ones grow older. Family dynamics twist and turn and sometimes break. What has been approaching as clearly and predictably as the tide coming into the shore suddenly seems surprising and unwieldy. How did we get here so fast? What do we do now? According to the Pew Research Center, 10,000 Americans are turning 65 every day. Five million Americans are currently diagnosed with Alzheimer's disease or a related dementia, and the Alzheimer's Association says the number could reach 16 million by 2050. This means thousands of questions about preparedness, where to live and wishes for care and the end of life. While the process seems overwhelming, the resources are many. The more we educate ourselves and prepare for contingencies, the less stressful the process will be. Maribeth West Farringer, Beta Tau-Vanderbilt, serves on the board of the West End Home Foundation, which provides grants to support senior services, and she recently retired from a 26-year career as executive director of the Council on Aging of Greater Nashville in Nashville, Tennessee. The council's mission is to identify issues related to seniors and their caregivers and to serve as an impartial voice in working for cooperative solutions. Maribeth's journey was personal as well as professional. Her mother died from Alzheimer's disease and some physical frailties. Six days later, her mother-in-law died from lung cancer and Lewy body dementia. Maribeth was an only child, thus was on her own in handling her mother's care and financial and legal issues; however, her husband was one of three children who needed to function as a family team. Maribeth benefited from the knowledge garnered through her work, serving and advocating for older adults. Maribeth believes we – government, faith communities, families and the medical community – must commit to helping seniors remain as independent and engaged as possible. Otherwise, we may be swept under by what is sometimes referred to as the "Silver Tsunami." For family members, Maribeth advocates seizing opportunities to speak with our loved ones about their vision for their lives. If dad's neighbor moves to assisted living, the opportunity arises to talk to your father about what he wants in a context that isn't forced or awkward. If Aunt Sue passes away, there might be an opening to talk to mom about her end-of-life wishes. Educate yourself about hospice care and palliative care to better help mom make her decisions. When a church or community organization is hosting an informational session about Medicare, Medicaid and VA benefits, an entire family can take advantage of the educational windfall. The choices available when someone's needs begin to evolve are vast and varied. For many years, multigenerational family living was the norm. A swing toward communal living – retirement communities, independent and assisted living facilities – began in the late 1980s and early 1990s. Today, with people remaining active, engaged and in relatively good health longer – and with the structural improvements and assistive devices available to make aging in place safer – many older adults are choosing to stay at home as long as they possibly can. When choosing to age in place, individuals often look to services that provide personal care assistance and home help. These services exist everywhere and are as different from each other as are the individuals who manage them. Learning how to evaluate and choose a service to assist someone aging in place is crucial. Have a checklist of questions ready now. Then, when the time arises, whether it is prompted by an emergency like my mother's fall and broken hip or by the slow recognition that a little help will go a long way in helping someone remain in their home, you will be prepared. As you listen to the answers to your inquiries, take note of what questions service providers ask in return. Do they seem concerned about you and your loved one? Do they seem well-versed in the scenario you are providing? Listen to your instincts about their sincerity. Whatever the tone projected by the administrative staff will be carried through the entire organization. The same holds true if someone chooses to live in a facility, whether it is independent living, assisted living, memory care or long-term care. Ask all the questions, from cost and what that cost covers to staffing ratio to fall and infection rates to frequency of complaints to state boards and oversight agencies. All of this information should be freely and willingly provided to you. Take a tour and pay close attention to smells and cleanliness. Listen to conversations between staff and residents. All of these factors are indicators of the culture of the facility. An informed decision is vital to a loved one's health and safety. Through her work as director of pastoral services at Wesley Manor Retirement Community in Louisville, Kentucky, Rev. Dr. Rebecca Church, Alpha Xi-Louisville, has observed that many families experience terrific guilt when deciding whether to place their loved ones in a facility, even if they know they cannot properly care for these family members at home. Rebecca, who also is the author of The Journey Home: Images of Death and Afterlife with Older Adults, believes a large part of the problem lies in families not talking about what they want or making promises that cannot be kept. Sometimes, Rebecca is put in the position of communicating between patients and their families. Rebecca specifically recalls working with a 104-year-old resident who was hospitalized and whose family was leaning toward giving permission for a feeding tube. Rebecca knew the resident had a living will and asked the family if they were aware of their loved one's wishes. They had never discussed it. Rebecca ultimately confirmed with the resident that she did not want a feeding tube and knew that by refusing it, she would die. She asked Rebecca to baptize her and returned to the facility with hospice care. She passed away about a week later on her own terms. For all of us, regardless of age, important legal, medical and financial documents should be in place. Your family should be aware of what you want as you age and at end of life. Everyone over the age of 18 should have a durable power of attorney, a living will and/or health care surrogacy, and a last will and testament. Know the difference between a living will and a DNR (do not resuscitate order) and whether your wishes are reflected by what you have in place. When all of these documents are executed, make sure a trusted friend or advisor knows where they are located. Again, nothing substitutes for preparation. We are all fortunate to be aging every day. We have the opportunity to contribute to society far longer than our ancestors. Seniors have a great deal of wisdom to offer, and intergenerational interaction is key to keeping older adults engaged and active as they age. Acknowledging that aging is part of life, planning for the future can become manageable if not simple. Lay the groundwork now and know a solid foundation can withstand almost any storm. Elizabeth Downing, Delta Gamma-Western Kentucky, is director of outreach for Timesavers Concierge, Caregiving & Chauffeur in Bowling Green, Kentucky. Elizabeth is also an attorney but found her passion in advocating and providing care for older adults and those with special needs. She is the author of Puddles of Perspective, a collection of essays focused on family, female empowerment and teaching younger generations the value of intergenerational interaction. Elizabeth's blog, at, seeks to raise awareness of issues relating to aging and to let people know they are not alone in the journey. The Time is Now You are never too old or too young to have your health-care and end-of-life wishes honored. Gather the following materials and store them safely, making sure those you love and trust will know where or how to access this information. • Health insurance information • Copies of the following documents: ♦ Organ donor card if applicable (The original should be carried in your wallet.) ♦ Birth certificate ♦ Driver' s license ♦ Social security card ♦ Marriage license and/or divorce decree ♦ Deeds, mortgages and vehicle registrations and titles • Advance directives ♦ A living will is a legal document describing the kind of medical or life-sustaining treatments you would want if you were critically ill or injured. ♦ A do not resuscitate (DNR) order says that you do not want cardiopulmonary resuscitation (CPR) if your heart stops or you stop breathing. ♦ A durable power of attorney for health care indicates who can make health-care decisions for you if you are unconscious or otherwise unable to make medical decisions for yourself. • A valid copy of your will • Life insurance policies • Listing of financial and investment accounts and retirement plans • Religious/spiritual affiliation and end-of-life wishes • A family and friends contact list Source: AAA Going Places, For more information, look into these resources: AARP, the Alzheimer's Association (, a local agency on aging, churches, support groups and elder-law specialists.

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