Book Review: Courageous

Posted on May 21, 2014 by Barbara Harper

Courageous is a novelization by Randy Alcorn of a movie by the same name written by Alex and Stephen Kendrick and produced by the same church that produced Facing the Giants and Fireproof. I’ve never seen the film, but when the audiobook was on sale I decided to check it out.

The basic theme of the book is encouraging fathers to be men of integrity and to take the responsibility to raise their children in a godly manner as well as mentoring other young men. The story follows four men who are policemen and a fifth who is not on the force but becomes a good friend. Law enforcement has to be one of the toughest jobs on families, so I can see why the authors chose that profession for their characters.

A couple of the fathers are on the right track but need guidance and wisdom and maybe a little course correction, at least for one of them, before major trouble hits. One means well but is alienating his son with his lack of involvement and interest. Another fathered a child in a former relationship but hasn’t seen mother or child in years. When a tragedy strikes one of them, it sends repercussions throughout their whole group.

A subplot involves a gang that is wreaking havoc in the town of Albany, Georgia, their various encounters with the police force, and one fatherless wannabe gang member in particular.

Though the premise of the story is a good one, the writing is driven more by the points the author wants to make than by the plot or the characters, an accusation often aimed at Christian fiction. Nevertheless, the points are good ones, and if you think of it more as an extended parable or sermon illustration than a novel it’s a little easier to take.

I enjoyed a phone interview with Alcorn at the end of the audiobook in which he discussed the ramifications of expanding a two-hour screen play into a full length novel, when usually the process goes the opposite direction. I appreciated, too, the point he made that a film will reach many people, but when people read a book, they’re spending 10 or more hours with it and thus the principles involved have a longer time to affect the reader’s thinking.

One little quibble I had with the story involved the resolution that the fathers all eventually sign. One father came up with it after studying out what the Bible had to say about being a godly father, and when he told the others about it, they wanted to sign it, and eventually word of it and promotion for it went out to the whole church. The resolution sounds like a good thing in itself, but like so many of these kinds of things, the emphasis shifts to it rather than the principles behind it. After the resolution, instead of a character saying, “I can’t do this…” or “I must do this…” because of Biblical instruction or principle, they say I can’t or I must do such and such “because I signed the resolution.” When I was composing this post in my head before sitting down to write, my mind went to various scenarios where we tend to shift our focus to the tool rather than the reason for it: starting a Bible study program to aid in reading and understanding the Bible, and then getting caught up in the tenets of the program rather then delving deeper into the Bible, or having an accountability group to encourage one another in a certain area, and then experiencing a subtle change in our thinking to want to look good in the eyes of the members rather than growing in holiness before God. Small groups are not my favorite thing, but I do acknowledge they can be beneficial, and I acknowledge that they work best if everyone in the group participates, yet that participation doesn’t mean that every member must say something every meeting. I tend to say something if I have something to say, but sometimes I’m processing, sometimes I’m still on the point made ten minutes ago when the rest of the group has moved on, etc. Once when I hadn’t said anything in a couple of meetings, our group leader spoke to my husband and wondered if he should call on me during the meetings – perhaps he thought I was shy and needed the encouragement to speak out (though calling on a shy person in public would NOT be an encouragement to them!) My husband, thankfully, said that would probably not be the thing to do. Then a few days later, our leader’s wife called to ask me to do something for an upcoming activity, in what seemed a subtle attempt to “get Barbara involved,” when I was involved and participating all along, even if I wasn’t saying anything. That kind of thing puts pressure on a person to feels she has to dream up something to say every week so people don’t think she’s unspiritual, which is totally fake and, again, turns the focus on the tool (getting everyone to participate by making everyone speak in small group) rather than on the reason the group is meeting in the first place.

Please forgive the rabbit trail. 🙂 I don’t have a problem with the resolution itself (or any of these other tools), but with this tendency to focus on the tool rather than using the tool to help us focus on the Lord. I did also appreciate a point Alcorn made in the phone interview, that this book and film are not “the” tools, but just some tools that churches or groups could use. Most churches who preach and teach anything about godly fatherhood would incorporate the principles in the book, but it helps some to have a vehicle like this in which to do so, and that’s primarily what the authors wanted to do: to provide a film and book that would be food for thought and and encouragement to people in their walk with God.

I finished the book a week or two ago but had wanted to see the film before writing this review. However, there is no telling when I might get time for that, so I wanted to go ahead and get this review up. I thought the audiobook narrator, Roger Mueller, did a wonderful job reading the book, but I could have done without the dramatic music between chapters.

(This will also be linked to Semicolon‘s Saturday Review of Books.)

Update on our little guy

Posted on April 17, 2014 by Barbara Harper

Thanks so much for your kind words and especially prayers for our new little grandson. As I mentioned earlier, he was originally due in late June. He will probably be in the NICU for a couple of months, or until he meets certain milestones (maintaining body temperature, breathing well on his own, being able to eat on his own, etc.).

His breathing is doing pretty well. He was born crying, which all the doctors were surprised at with a preemie. That was a really good sign. They did put a tube down his throat the first day to put some medicine down in his lungs to keep them expanded, and he was on a CPAP for a few days which, if I understand it correctly, pushes air in something like gentle breaths. But as of Tuesday he was on just oxygen in a tube under his nose. He forgets to breathe every now and then until they stimulate him in some way, but overall he is doing well in that regard.

He’s a little jaundiced now, not unusual for even a full term baby. I don’t know if that is a little more critical for him since his liver isn’t fully developed yet, but they have him under a special light to help with that.

They put in a feeding tube yesterday to start giving him some formula, just a miniscule amount at first, to see if his digestive system handles it okay. Then they’ll gradually increase the formula or breast milk while decreasing his iv fluids. They say it will be a few weeks yet before he’s developed the skills to suck and then swallow and breathe all together without choking.

The first neonatal doctor who talked to my son and daughter-in-law said this will probably be more of an up and down journey, with highs and lows, good days and bad, rather than one of continual steady improvement. So far everything is going well, but it will be a long journey.

I’d appreciate your continued prayers for all of them: for the little guy, that he’d continue to improve and get to go home as soon as possible. for Mom as she recovers herself, for Dad as he tries to keep up with everything, for both of them as they pray and watch over him. I was thinking of my daughter-in-law last night in the sense that usually, when you have a newborn, you get to stay home in your pjs and cuddle and get to know him. Instead she is going out to the hospital a couple of times a day for several hours while still recovering and trying to get going with the breast pump, and she’s not able to hold him (other than just for a few minutes one day). Would appreciate your prayers for them for strength and stamina as well as grace for everything involved. They are doing well, but as the doctor said, this will be a long haul.

I did get to go to the NICU one night and then again this morning, and was able to touch him and talk with him. The rule in the NICU is that no one else can visit the baby unless a parent is there, so I have to coordinate going with when they are there (which is fine, because I want to see them, too. 🙂 ) and when someone is here to care for my mother-in-law. We had just cut her caregiver’s hours back a couple of weeks ago, mainly for financial considerations, so that limits what times I can go out. I may be able to get permission to see him by myself, but I’d still like to go when my son and d-i-l are there, too, as much as possible.

At this point I am not showing his face or sharing his name or any vital statistics on the blog, partly because I haven’t had a chance to ask his parents how they feel about it, but partly because things are just so vulnerable right now. My own kids were older when I started a blog, so as long as I wasn’t too specific about our location, I didn’t have a problem sharing pictures or their names. But it is different with a baby. 🙂 However, I’ll give you just a glimpse:

Isn’t he sweet? 🙂

Thanks again, so much, for your love, care, and prayers.

Someone decided to come early…

Posted on April 14, 2014 by Barbara Harper

My little grandson, due late June, decided to make an early surprise appearance today!

He was crying as he came out, a good sign. But they will probably have to keep him in the NICU for possibly a couple of months.

Would appreciate your prayers for the little guy and the new parents.

I will probably not be on the blog for a few days 🙂

Adventures in Elder Care: Helping Parents As They Age

Posted on April 10, 2014 by Barbara Harper

Before I wrapped up this series, I wanted to share some odds and ends thoughts about helping parents as they age. This list would probably vary from person to person because parents age differently: we know a man well into his 80s who stills travels internationally and just got remarried a couple of years ago, but both of my parents had serious health issues in their 60s and died before they turned 70. Some parents are pretty self-sufficient as a rule whereas others need a little more help. Some want help, some don’t. These suggestions arose primarily from our own experience of seeing my mother-in-law through the last dozen years or so of living alone, then not being able to live alone, then going from assisted living to a nursing home to home with us. Some arose from friends’ experiences. By all means tailor any of this to fit your situation. I’d welcome any suggestions or experiences you’d like to share in the comments.

1. Have “the talk” – about finances. It’s hard to say when this should be done, but it should be well before finances become an issue and before any kind of dementia has set it. I’ve heard of some with dementia who thought their kids were “after their money” when they tried to work out power of attorney and such when the parent could no longer handle their own affairs. Some parents will be on top of things and will initiate the conversation with you (which is preferable). One suggestion would be to ask your parents as they get close to retirement how they’re set for the coming years and what their preferences would be if anything should happen to make them unable to take care of things.

In our case, my mother-in-law was the one who handled the finances in her marriage, and after her husband died she was happy to give her oldest son power of attorney. When she moved here, power of attorney was given to Jim since he would be the one actually handling her finances, paying for assisted living, supplies, etc. He got a joint bank account with her name and his on it so either of them could write checks. For years she wrote checks for church and for Christmas presents, but he wrote checks for bills. She would sometimes ask about how things stood but seemed content with how things were being handled.

2. Have the other talk – about end of life issues. This can be a difficult or awkward situation, and some parents will not want to discuss it at all. If something should happen and your parents have not made any living will or advanced directives, all you can do is try to make the best decisions you can. I’d advise you to do some research before having to make a decision in a crisis. For instance, we thought feeding tubes should always be offered if needed, but then discovered there are situations where it would cause more problems than it solved. When my dad needed a ventilator, one sister-in-law was adamantly against them because she had seen people who were for all practical purposes gone, but were kept alive on a ventilator; however, my father only needed one for about ten days. I once felt that CPR should always be performed, but on an elderly person, chest compressions can break bones. If you can gather information beforehand, you’ll be better prepared to make these decisions in a crisis.

3. Sibling involvement. It helps if everyone can be involved in the discussions and decisions that have to be made. Some of these, particularly end-of-life issues, can be especially delicate and emotional. If all the siblings are nearby, it’s best if they can all be involved in a parent’s care, but realistically it does not always work out that way. If the lion’s share of care falls to one sibling (often due to distance), continue to stay involved, show interest, ask how things are going, etc. Abide by their decisions unless there is neglect or abuse. If there is an elderly family member with no children, others need to step in. We knew of a situation where an older lady in our church lived with a daughter who had some kind of mental issues, was a hoarder, had stuff stacked all over the house with only a narrow pathway for the older lady to get around in her walker, had something like 16 cats, some of whom she kept tied on strings in one room, which smelled horrible. When we knew of all this, we tried to help, but found out that unless there was active abuse, there was not much we could do as “outsiders.” Someone called animal control. and they came and took a few of the cats, but that is all. Another lady tried to help the older lady find a different place to live, but ultimately she did not want to leave her daughter. At her funeral when I saw rows and rows of her relatives, all I could think was, “Where have you people been the last several years?”

4. Help where needed, but unobtrusively. Long before parents get to a place where they can’t live alone any more, they might need help here and there with a variety of issues. They begin to lose steam or get to the place where they can’t see well and may not even know of some problems.

We lived 2,000 miles away from my husband’s parents, but the last several times we visited, my husband would seek for something to be done around the house (like rebuilding the roof on the carport, etc.) and suggest doing it while we were there. It gave him and his dad some time to do something together, helped with something that really needed to be done, and kept his dad from climbing a ladder to do it himself. 🙂

We noticed the last several years that my mother-in-law was in her own home that things like dishes weren’t being done as well, not because she was letting them go, but because her eyesight and sense of touch was getting to the place that she didn’t realize she wasn’t doing as good of a job. I’m a bit germophobic, so when I’d drink a glass of ice water with “floaties” in it, I’d get pretty grossed out. This was before the days of readily available bottled water. She didn’t have a dishwasher, didn’t have room for one, and would not have wanted one anyway. We started getting paper plates and plastic cups when we visited, to “make things easier on her” – -which was technically true. There were always piles of dishes after every meal, and sometimes she accepted help, but more often than not she liked to do them – it was her “thinking time.” Having some disposable products did help lighten that load, but it also helped us be assured that we were eating and drinking off clean utensils.

I mentioned earlier that sometimes household help can be hired, especially if the family doesn’t live nearby.

You may need to transfer things like Thanksgiving and Christmas to your house rather than the parents’ home, or at least spend time helping them get ready for it. You have to tread carefully with long-standing traditions like this: some might feel relieved not to have the pressure and work, but some might get their feelings hurt.

I mentioned helping unobtrusively: you don’t want to barge in and take over, or make them feel inadequate. Try to offer whatever help you think might be needed in a way that encourages them rather than demeans them.

And sometimes you just have to accept that things like the housekeeping might be at a lower standard than it once was. The last few years my mother-in-law lived alone, she pretty much let her dog have the run of the place, and every surface was covered with dog hair. It was a nuisance, but it wasn’t a safety or health issue, and his companionship meant a lot to her.

Sometimes helping means insisting on something they may not like. My mother-in-law was very much a status quo person who didn’t like to make any changes. Even when her hearing aid was not doing any good, she insisted it was fine, and we had to gently insist on going to the audiologist to be evaluated for a new one.

Sometimes helping may mean running interference. My mother-in-law had trouble with one physical therapist at the assisted living place (he had a Croatian accent and she couldn’t hear him well, couldn’t understand what he wanted her to do or why). He thought she was just being uncooperative. My husband had to take time to be with them for their first few sessions to help them interpret each other, but after they they got along great.

5. Help them to be as independent as possible as long as possible. At home or even in the lower-ranged assisted living care, there might be tools you can gets or little things you can do to help them be involved in their own care as long as possible: the seven-day pill holders to help keep their medications straight and help them remember what to take when; “reachers” to help them with hard-to-reach items (I use one of these myself!), an device to help open jars (I use one of those, too), etc. My husband tied bits of rope between his mother’s dresser drawer handles to make it easier for her to open them when she began to have trouble with them. He also put easier-to-read labels on the TV remote for the most-used buttons.

There will come a time when they will likely need help with just about everything, but for as long as possible let them do what they can do. We had elderly neighbors once, two sisters, who cut their own grass well into their 70s. One of them even painted her back steps at that age. My first impulse was, “Oh, we should go over and help them with that!” But one of them in particular liked being able to take care of herself. I just watched a Waltons episode when the grandmother came home after having a stroke, and every time she tried to do something, someone jumped up to do it and told her to relax. They meant well, but they made her feel helpless and useless. Even as their abilities diminish, let them do what they can safely do.

6. Don’t squelch talking about the past. As this post points out, they don’t have that much future left, and it may not look all that bright and cheery. This is a great time to ask them about their growing-up years – and a good time to write some of these things down for posterity. One of the things I regret with my mother-in-law is that I didn’t ask her more about these things and didn’t write down what she did say.

7. Help them find usefulness and purpose. This overlaps a bit with the above two points, but an older person can get pretty discouraged when they lose some of their abilities and even lose their home. Once when we had my mother-in-law here for dinner, a funny story from her past came up that we all enjoyed and laughed over: she did as well. Then she said, “Well, at least I’m good for a laugh.” It didn’t hit me until then that she might not have felt she was “good for” much of anything else. You can encourage a parent that as long as God has them alive, He has a purpose for them. Psalm 92:14 says, “They shall still bring forth fruit in old age; they shall be fat and flourishing.” Perhaps you can help them organize their photos into albums (something else I wish I had done) and hear the stories behind them. Remind them often that you’re glad they are here.

8. Always honor and respect them as your parents. I cringe a little at the phrase “parenting your parents” or the idea of “switching roles” with them. In one assisted living place, when we came to pick up Jim’s mom for something, one of the aides said, “It’s almost like you’re the parent now, isn’t it?” and then turned to his mom and said, “Your daddy is here.” Umm…no. Even as she has lost more of her abilities and we’ve taken on more of her care, we don’t think of her like that. As she has experienced a bit of dementia, Jim has had to remind her about some things from time to time (like using her fork rather than her fingers at meals or insisting her hands be washed), and sometimes that might have involved a sharper tone if she persists, but we don’t treat her as a child. I know family dynamics can be tricky and some parents can get more child-like, but as much as possible we still need to show them honor and respect.

9. Forgetfulness and dementia. My mother-in-law does not have Alzheimer’s, so I can’t really speak to that (and again, I’d welcome any perspectives you’d like to share in the comments). She has had a degree of dementia. It’s usually worse when under stress or when anything different is happening, and it has increased over the years.

As a general rule it doesn’t help to say, “Don’t you remember?” (Lisa suggests here to give them the answers rather than questioning them). Sometimes it does help to gently remind them of things: for instance, when Jim brought his mother here from ID, the folks at her church had all given her cards and told her good-bye, and all her kids and several grandkids had come to a combination 80th birthday/farewell party. Yet on the plane, she told Jim, “I think I’ll just stay for a few days and then head back home.” He wisely didn’t try to “set her straight” then and there, but later on he said, “Remember when all the folks at church gave you cards? Do you remember what those were for?” At some point she said, “Oh, that’s right. I’m moving to South Carolina.”

A nurse in the nursing home once told a member of a group from our church who were visiting that it is best not to alter their reality. Sometimes when they get “stuck” on something, distraction is the best tool. When Jim traveled with her, she’d say things like “I sure hope you know where we’re going” and get a little rattled by it all. Even though he is a seasoned traveler, instead of just telling her, “Don’t worry about it, I’ve got it covered,” he told her what gate he was looking for at the airport and asked her to help him look for it. That gave her something to occupy her thoughts. Recently she was “stuck” on needing to go to her daughter’s house. Jim wasn’t home when this started, and at first I tried to remind her that she lived in TN now and that her daughter was back in ID. But that wasn’t sinking in. It was one of our worst weather days this winter, and when Jim got home, he told her, “It’s snowing out now and the roads are icy, so we’re just going to stay here for the night.” He had to go over that a few more times, but after a while her thoughts turned a different direction.

Even in visiting in the “memory care” unit of assisted living, residents would stop us and ask us if we could help them get somewhere. At some level they knew they weren’t home, and some of them were constantly trying to figure out ways to get there. One lady stopped Jim once to say that something was wrong with her car and she needed to get to it. It was close to dinner time, and he said, “I tell you what, why don’t you stay and eat dinner, and we’ll see about your car later.” She felt so honored to be asked. 🙂 (On a side note, when visiting a nursing home or a memory care or Alzheimer’s unit in an assisted living facility, sometimes it is best to avoid engaging the residents in much conversation. When we visited my m-i-l in regular assisted living, we talked with the other residents quite frequently. But we quickly found that in the “memory care” unit, they often wanted you to help them with something, and when you couldn’t, they would get agitated, sometimes angry, and even start yelling and cussing, which not only disturbed themselves and others but made it hard on the aides to get everyone settled back down. We learned to just cheerfully say hello in passing without stopping to talk, and if we did get stopped and asked for something, we’d point out one of the aides and say, “Maybe she can help you.” )

10. Helping them deal with government agencies. Even if you have power of attorney, there are many situations where an agency will want your parent there. Once when my husband was trying to deal with one particular issue (I forget what it was), the man he was talking to wanted to talk to my mother-in-law on the phone. My husband tried to tell him she was very hard of hearing and especially had trouble hearing on the phone, but the man insisted. So my husband went to her room at the assisted living facility, called the man, put the phone on speaker, and they tried to have a conversation. When she couldn’t hear and Jim was trying to convey to her what the man had said, the man shouted, “Don’t you dare tell her what to say!” Understand that they are trying to protect the elderly from being taken advantage of by unscrupulous relatives (unfortunately that does happen), but sometimes they do make it unnecessarily hard on those of us who are trying to help get necessary things done.

11. Smooth awkward moments. You don’t need to call attention to every mistake or fumble: if they’re aware of it, they probably feed bad enough already. Just help take care of spills or messes or whatever without making an issue of it. When they start needing help with personal issues, just handle it as matter-of-factly as possible – I took that cue from when I’ve had surgeries and illnesses and needed help with things I’d much rather have done on my own. Usually the nurses just came in and we got it done, and some of them were even cheerful about it. When my mother-in-law started needing help going to the bathroom, she’d say apologetically, “I bet you never thought when you got married that one day you’d have to help your mother-in-law go to the bathroom.” Well, no, I hadn’t. 🙂 And helping someone that way or changing dirty Depends later on is not really anyone’s favorite thing to do, but it helps to just look at it as meeting her needs and to handle it with as much grace as possible. My husband is great at easing awkward issues with humor.

12. Don’t neglect spiritual needs. Linda had a great post on this. When they can’t read the Bible for themselves any more, take time to read it to them. Some can handle CDs to hear the Bible read. Jim’s mom liked to attend church Sunday mornings until perhaps the last year or so when she just got too feeble and had little energy. When she was in the nursing home, a group from a church we were familiar with had a church service there Sunday afternoons, and Jim went over and accompanied her to it.

13. Have patience. There can be a multitude of frustrations as a parent gets older, even when we understand that they can’t help what they are doing and saying. This is probably the area that I most often prayed for while my mother-in-law was in assisted living, and often while driving there I often prayed and quoted to myself Colossians 1:11: “Strengthened with all might, according to his glorious power, unto all patience and longsuffering with joyfulness.”

The ultimate principle is to “do unto others as you would have them do unto you” (Luke 6:31). Put yourself in their place and treat them with as much love and grace as you would want others to show to you in the same situation.

Grandmother’s Beatitudes

Blessed are those who understand
My faltering step and palsied hand.

Blessed are those who know that my ears today
Must strain to catch the things they say.

Blessed are those who seem to know
That my eyes are dim and my wits are slow.

Blessed are those who looked away
When coffee spilled at table today.

Blessed are those with a cheery smile
Who stop to chat for a little while.

Blessed are those who never say,
“You’ve told that story twice today.”

Blessed are those who know the ways
To bring back memories of yesterdays.

Blessed are those who make it known
That I’m loved, respected, and not alone.

Blessed are those who know I’m at a loss
To find the strength to carry the Cross.

Blessed are those who ease the days
On my journey Home in loving ways.

– Esther Mary Walker

Adventures in Elder Care: Caring For a Parent at Home

Posted on April 2, 2014 by Barbara Harper

Some years ago I heard that one of the most delightful older ladies in a church we used to attend in another state had developed Alzheimer’s and that her son and daughter-in-law were caring for her in their home. One time when we had occasion to go back and visit, I asked her daughter-in-law how caring for her mother-in-law was going or what it was like. She smiled beatifically and said, “It’s our privilege!” I could only think, “Wow…she must be a better Christian than I am, because I think that would be hard.” It’s not that I wanted the nitty-gritty details, but I did want to know how God had given her grace for this ministry in case I ever had to do the same.

Our only experience with having a parent in our home for an extended time was when my dad came years before and got sick and ended up in ICU. I believe he was with us for about six weeks. He was not a Christian then (though he became one during that time), and he had lived alone so long that he had forgotten the give and take that there has to be with a number of people under one roof. I don’t mean to dishonor him by saying so, but he was quite cantankerous, especially when Jim was not home. The tension was so great that Jim said afterward we would never have a parent live in our home.

In my post on making decisions for elderly parents’ care, I mentioned that there are some relationships that thrive better when there is some distance. I share the experience with my dad mainly to say that I do understand it can be stormy to have a parent in the home, especially when age and dementia remove some the natural inhibitions. Some elderly parents can be abusive, and we heard enough even in assisted living places to know that bringing some parents home would be quite stressful. I wouldn’t even begin to know how to advise someone in such a case, especially when there don’t seem to be any other options, except to pray for a lot of grace.

In my mother-in-law’s case, we had been talking ever since we moved to TN about moving her home, because now we had a house with no stairs, and we had a room that would work well for her care (some of you may remember my talking about Jim finishing off a room from our L-shaped garage. My son and daughter-in-law lived there for a while when they first moved here, and ever since we had used it for Jim’s office and as a guest room). There was a small drop-off from the house to the garage for which we’d need to build a ramp, and we’d need to figure out shower issues. I was intimidated at first, partly because of my own health issues and partly because of the level of her needs: at the nursing home she had medical help right there. She is what the therapists call a “total assist”: she can’t walk, feed herself, go to the bathroom on her own, turn herself in bed, etc. At home it would be more complicated, and it would have a major impact on our lives. But as she seemed to sink lower and lower, we really felt the best alternative was to bring her home. So we got the room ready, the social worker at the nursing home set us up with renting a hospital bed, air mattress, and a Hoyer lift for transferring her. She also arranged for physical therapists, an occupational therapist, and a once-a-week RN visit, plus they had a couple of home health agencies they could recommend. Medicare wouldn’t spring for a Broda chair, but my husband found one on Craig’s list in a town 3 hours away for a good price.

So we brought her home at the end of July. Jim told me later he really thought we were bringing her home to die, because she had been at such a low place in the nursing home. But she has been thriving under one-on-one care. She had gotten down to 90 lbs. in the nursing home but now is well over 100 lbs. We have a home health aide here most of the day from M-F, and from 8-2 on weekends. The one who is here through the week is great: she has a lot of initiative and does a lot with her, makes sure to turn her every two hours to avoid bed sores, and they seem to get along great. She and I work together to give her a shower twice a week (actually she does the showering part, and now that we have done it several times, I’m more able to help with getting here ready for it and helping afterwards).

The physical and occupational therapists and nurse’s visits only lasted a number of weeks (about six, I believe.) The therapists told us that because she had been left contracted for so long in the nursing home, we would likely never get her straightened back out again, but doing some exercises with her would help stave off further contracting so we could dress, bathe, and move her.

The advantages of bringing her home have been:

• She’s thriving under one-on-one care. She gets more attention, time with meals to make sure she is eating adequately, stimulation of conversation and interaction with others.
• Since she has the same caregivers, they get to know her and her “quirks” as opposed to a high turnover in other facilities and having different people cycle through.
• We don’t have the long drive to see her (it had been about 20 minutes one way).
• We can see her more often through the day.

There are, of course, disadvantages, and I don’t share these to complain but rather just to be honest with anyone else reading:

• You can’t go anywhere without working around having someone else here with her.
• Caregivers cost $17 an hour with the agency we work with (more on that in a moment), so we can’t use them much more than we already use them. Consequently we rarely get to go out as a family to eat or to an activity.
• Caregivers are a big help, but the downside is having a stranger in your home (especially for an introvert like myself). Though none of the caregivers we have are strangers any more, it still feels awkward sometimes. I don’t want them to feel like they are servants who have to stay in that one area of the house: they do come into the house to do her laundry (I felt awkward about that at first, too, thinking I’d rather do it, but there is not that much for them to do since she sleeps a lot, so I relented), bring her lunch tray back, get water, go to the bathroom, etc., and everything except the bathroom involves coming through the areas where I usually am. Our regular weekday caregiver is very much a gregarious extrovert who I am sure has a hard time being in a room all day with someone who doesn’t say much, so she comes over just to chat sometimes. It’s funny – if I am up and around doing something, she doesn’t usually say much, but if I am at the computer, I guess it looks like I am “not doing anything,” so she is more inclined to come over and talk then, when that’s the time I would least like to be interrupted because I’m often trying to think through a blog post or writing a newsletter. But I’m supposed to be hospitable, so I try to be, and usually I don’t actually mind, but it’s just hard mentally to get some things done. There is one kind of freedom of having someone here and knowing her needs are being looked after; there is another kind when the caregivers are gone for the day and I feel like I can relax.
• When I am alone with my mother-in-law, there is often a certain amount of tension or pressure just in wondering if I should be over there with her if she looks like she’s awake (we have a video baby monitor). If I go in to feed or change her, I usually stay in there with her until she goes back to sleep, but often I still feel like I should be in there all day when it is really not necessary since she does sleep quite a bit.
• Changing her every two hours to avoid bedsores includes the nighttime hours, which Jim has taken on.
• If one of the regular caregivers can’t be here for some reason (going out of town, illness, etc.), there is not always a ready replacement, or we might not choose to use one because we’d spend so much time showing the new person what to do that it wouldn’t be a help to us.

I mentioned working with a home health care agency. The agencies who provide medical care (nurses, therapists) are different from the ones who provide regular day to day care like feeding, changing, etc. If we hired someone individually outside of an agency, we could probably pay them less while they would get more (I think of the $17 an hour we pay, they only get 10 or so). But we decided to use an agency for several reasons: if there is a problem with a caregiver, we can call the office instead of having to deal with it; if we don’t like how someone works, we can ask not to have that person again (which has only happened with one person); if the regular person can’t come we do have the option of having the agency send someone else out (there is one lady who is good as a fill-in); the agency checks out their background and skills before sending them out.

I haven’t mentioned finances: I can’t say much knowledgeably about them because my husband has dealt with that aspect. But I do know that neither Medicare nor insurance pays for home caregivers or assisted living: they did pay for the first 100 days in a nursing home (after a 3 day hospital stay) as long as there was some kind of skilled nursing going on (physical, occupational, or speech therapy). Once the therapies stopped, Medicare stopped paying. They did pay for the therapists who came to the house. They do pay for some of the equipment, such as the hospital bed. Actually they pay for the rental of it, and if we use it for I think 12 or 13 months, then we own it. They paid for a regular wheelchair but not the Broda chair (which she needs since she can’t sit up straight). They would not pay for the air mattress unless she currently had a bedsore (even though she’s had one before and we wanted one to help prevent another.) If her savings and monthly income were to drop to a certain level, then she’d have access to Medicaid. She receives Social Security, a small pension, and a VA benefit, which have not been enough to cover assisted living or nursing home or home health care costs, so we have had to dip into the savings from the sale of her house.

In fact, her savings has gotten down to a level that we feel we need to cut the weekday caregiver’s hours back. The weekend lady is here from breakfast til 2 p.m. since Jim is home on weekends, but the weekday lady we’ve had here til 5 p.m. To try to manage my mother-in-law’s funds better, we’re going to cut the weekday lady back to 1:30 p.m. We’re hoping that doesn’t mean she won’t be getting enough hours and will have to look for another situation: that’s one reason we haven’t cut back before now.

I’ll have to admit that even though I agree that we need to take this step, and though I can handle caring for her in the afternoon now, I don’t feel as beatific as my friend I mentioned at the beginning of this post. People act as if we’re doing something noble by caring for her at home, but it doesn’t feel so noble to spoon pureed food into someone’s mouth and clean up the other end, and there are some days (just like when a new baby is in the house) where it feels like that’s all you’re doing, even though you know it’s not. As I mentioned in talking about the “empty nest” recently, when your kids are grown and gone, you miss them, yet there is a side of you thinking, “maybe I can write that book now, or learn to quilt, or travel” (for some people – I am not a traveler myself). When a parent is in the home, some of those aspirations have to go back on the back burner.
But if this is God’s will, this is my ministry for now. In fact, the very night we decided that we would need to cut back on the caregiver’s hours, thereby increasing my own, God was so good to have these verses in my evening reading for Daily Light on the Daily Path:

Distributing to the necessity of saints. Rom. 12:13

David said, Is there yet any that is left … of the house of Saul, that I may shew him kindness for Jonathan’s sake? II Sam. 9:1

Come, ye blessed of my Father, inherit the kingdom prepared for you from the foundation of the world: for I was an hungred, and ye gave me meat: I was thirsty, and ye gave me drink: I was a stranger, and ye took me in naked, and ye clothed me: I was sick, and ye visited me: I was in prison, and ye came unto me. Inasmuch as ye have done it unto one of the least of these my brethren, ye have done it unto me. Matt. 25:34-36, 40

Whosoever shall give to drink unto one of these little ones a cup of cold water only in the name of a disciple, verily I say unto you, he shall in no wise lose his reward. Matt. 10:42

To do good and to communicate forget not: for with such sacrifices God is well pleased. Heb. 13:16

God is not unrighteous to forget your work and labour of love, which ye have shewed toward his name, in that ye have ministered to the saints, and do minister. Heb. 6:10

Another verse that often comes to mind with my mother-in-law is I Thessalonians 5:14b: “comfort the feebleminded, support the weak, be patient toward all men.” And I Corinthians 13 about love applies, too, as well as the verses I mentioned in my first post about our obligation to care for our parents.

I do need to look at it as my friend did, that it is my privilege to care for her. She does make it easy: she is sweet, rarely complains (except when someone’s hands are cold 🙂 ), and smiles and appreciates any little thing that is done for her.

Practical helps

I probably should make this part into a separate post as this is getting long, but I think I prefer to keep it all together.

I feel more confident about being able to care for her myself now after having observed and helped the aides with showering, changing, and moving her. I had been afraid of lifting her since my balance isn’t always stable, but with the Hoyer lift there is really no lifting involved. The aides started out using a draw sheet to move her from side to side or up in bed, but now we pretty much just use a large waterproof pad that is always underneath her.

Since she’s been home we’ve discovered a plethora of information available online (including videos on everything from feeding to using the Hoyer lift to repositioning) as well as resources. Just Googling ‘hospital gowns” and “waterproof pads” has led us to sites with those and other supplies. When she was having trouble staying in position in her shower chair, we tried using a gait belt, but that was a little too firm. I Googled “shower seat belt” and found just what we needed.

With other needs, Jim’s skills have been wonderful. I mentioned the shower situation. The therapist had recommended a sliding seat where the patient sits on one end and then is slid into the bath/shower area, but Jim’s mom wasn’t stable enough to do that. We have a step-in shower in one bathroom, so Jim built a platform in the bottom, so it was level with the step, and then a ramp leading up to it. We put her in her shower chair in her room, put a towel over her, and roll her backwards into the shower, then roll her back to her room afterward.

We do put a towel under the ramp to absorb sprays and drips from the shower.

Transportation was another problem. Right after she moved home she needed to be established with a doctor since she was no longer under the care of the ones in the nursing home. Therapists, nurses, etc., make house calls, but not doctors. 🙂 There is a transport system here that can take patients in wheelchairs to appointments, but they don’t accommodate the Broda chair. So for that visit we had to prop her up in her wheelchair, be ready an hour before the time we needed them to pick her up, and be ready to wait an hour after being done with the appointment for them to come back and get her. Jim and the caregiver accompanied her, but it was a very long day, and there was no way to reposition her like we’re supposed to do every two hours to avoid pressure sores. So Jim found a ramp that would attach to the back side of our van, took out the back seats, and found that if he lowered her chair into almost a full reclining position, he could get her into the van, then raise her up into a sitting position. Then he had clamps to secure her chair into the place where the seat that he had removed usually plugged in, and he was able to secure the seat belt over her into the next seat. It’s hard to explain without photos and videos, but it worked very nicely and gives us more leeway in being able to take her places.

My man job since she has been home has been figuring out how to prepare a balanced diet that can be pureed. An immersion or hand blender works better than the big regular-sized blender (the big one works well but it leaves you with a bunch of bulky parts to wash). You can actually probably puree most anything if you add enough liquid, but some things work better than others (we even tried a tuna fish sandwich once. It did puree, but she didn’t care for it. :)). Almost any casserole purees well. Most vegetables we’ve tried work well, too (except corn and broccoli. They do well in casseroles but not so well by themselves, although creamed corn does fine). Canned vegetables and fruits work well. Mandarin oranges just turn into juice. Meats are probably the hardest. Soft meats like Salisbury steak do well. We keep a jar of prepared gravy on hand for that kind of thing. We add something called Thick-It if a food ends up too liquid. Usually we just puree whatever we’re having, but when we’re having things that would not puree well (like pizza and salad), we keep a few frozen and canned items on hand for her. Of course, things like pudding and ice cream that are already soft work great. We do supplement her diet with Ensure. It is probably not as necessary now that she has put on some weight, but we felt it was vital when she first came home and her weight was so low.

I hope some of this has been helpful. Let me know if you have any questions. As I’ve said before, I am certainly not an expert, but if I can share something I have learned along the way that will be helpful to anyone else, I’d be glad to.

Of course, the bulk of our experience has been with a parent who is pretty much bedridden. I’ve had friends who have brought parents home who are able-bodied but with Alzheimer’s or who are in good condition both physically and mentally but for various reasons can’t live alone any more. That would be a different set of adjustments, but it would include the need to incorporate a new person as an everyday family member rather than a guest and to make yourself available to that person. If you’ve had experience along those lines, please feel free to share in the comments.

In my next and probably last post in this series, I’ll discuss some ways to help parents as they age.

Adventures in Elder Care: Assisted Living and Nursing Homes

Posted on March 26, 2014 by Barbara Harper

As I said in my first post in this series, when we were making decisions for my mother-in-law’s care, it helped me to read of other people’s experiences, so perhaps this will be of help to others. I hasten to say, though, that these are our experiences alone: they may or may not be typical and they are not meant as professional or authoritative advice.

If you foresee that you will probably need assisted living services for yourself or a loved one, the best recommendations will likely come from people you know who have also used them. Then either through the Yellow Pages or an online search, research what it available in your area. Most will have a web site for further perusal, and most are happy to set up an appointment for you to talk with the director and tour the facilities. Some good questions to ask them are listed in Seven Questions to Ask When Searching for Assisted Living and Assisted Living Community Evaluation Checklist.

There are a wide variety of assisted living facilities. My grandmother’s was basically an apartment complex for the elderly. She had her own kitchen and did her own cooking, but there was a nurse on site all the time who regularly checked blood pressure and such. Most facilities have common meals together in a dining room and provide housekeeping. Some have different levels of care, including hospice and an Alzheimer’s unit. Most provide activities for the residents; some even have “field trips” to area attractions.

Those in need of assisted living vary widely as well. Some are able bodied and sound in mind but no longer have the energy to keep up with a home. Most are in some state of decline, either physically or mentally or both, and others are confined to wheelchairs or have full-blown Alzheimer’s.

The key, then, is to find the best fit for your loved one, hopefully at a reasonable cost and not too far away. Realize that no situation is going to be perfect, whether your loved one stays with you or in a facility, but hopefully you can find a workable situation for all involved.

Let me say here that I would not recommend putting a loved one in a facility where there are no other family members nearby, especially if they have any kind of dementia. Even if they are near close friends or an active church family, those people will not have the same position of authority if any problems arise. Wherever you place them, you need to visit them often, not only to encourage them and show them love, but also to see that they’re being cared for well. Do not put them into a facility and assume they are being well taken care of and forget about them for months at a time.

I mentioned in my first post in this series about decisions that we had come to the conclusion that my mother-in-law needed to be in a facility. As we discussed the situation with other siblings, it became clear that moving her to live near us was the best option. Jim’s sister would be moving away from their town in ID, so placing his mom in a facility there would not be an option because there would be no one there to check on her regularly. She rarely complains, but to a fault: many times in the past we wouldn’t know there was some problem going on until we came to visit. When we asked why she didn’t let us know, she’d say, “I didn’t want you to worry.” So we felt if she was in a facility away from everyone, we’d never know how she was really doing. Other family members had careers and commitments, I was the only stay-at-home member at the time, our family could be involved in her life, the facilities in SC were much less expensive than in CA where Jim’s brother lived, so, all told, moving her East appeared to be the best solution.

The rest of the family lives out West, so they all gathered for Mom’s 80th birthday for a kind of farewell get-together. Jim flew back to help her get ready and to fly with her back East. Thankfully they did not have to close up the house at that time. His sister took care of that later when we got ready to sell it.

She handled the whole transition with a lot of grace. I can’t imagine leaving a home and church family of 35 years for such a major move. She did get understandably teary at saying good-bye, and one of the hardest parts was leaving her dog behind. She also got teary when her house was sold. But otherwise she has done quite well.

There was an assisted living place just a few minutes from us, and it worked out well for her to be there. It was divided into four smaller homier buildings, as opposed to a bigger, more institutional facility a little farther away. One of us visited her nearly every day, we brought her to the house often for meals and Scrabble and even to my youngest son’s basketball games, took her out to dinner a few times, brought her to church, etc. Being in a facility actually gave her a measure of independence that she enjoyed and faces to see besides ours. She was not inclined to participate in many of the activities: she usually preferred to stay in her room and read. But sometimes they’d talk her into going, especially if there was a church group singing. This facility had a bookmobile that visited at regular intervals and would even bring books to her room so she didn’t have to go rummage around for them. She was evaluated by a physical therapist and provided with a much-needed walker.

She was in that place for a year, until we had to move to TN because of my husband’s job. He valiantly staved off moving as long as he could, but finally we had to. She was in one facility here for a year, until her care needs reached a level they did not feel they could manage, and then in the “Memory Care” unit (not so much because of her memory but because she needed a higher level of care) of another facility for about a year and a half until she went to the hospital and then to a nursing home.

Each assisted living facility that we had experience with had different levels of care. Level 1 was usually minimal assistance needed: the resident could walk to and from meals, take care of their own bathroom needs, etc. Level 2 and 3 provided more assistance as needed, and of course, the higher the level of care, the more expense. We concluded that assisted living places were fine as long as you didn’t need much assistance: as Jim’s mom’s abilities declined, and the level of care she needed increased, the quality dropped off.

There were things we liked about assisted living:

• Access to physical therapy
• Regular checking of blood pressure, weight, etc.
• Camaraderie with others in the same situation. An older person can get a little depressed initially about the need to use a walker, etc., but when they see many other managing with one, it helps. They also see people in much worse conditions than themselves, which helps to put their own situation in perspective.
• Building friendships. My mother-in-law did not benefit from this as much because she preferred to stay in her room and read, but even with just going to meals, there were people who greeted her, were glad to see her, etc. It did enlarge her world a little bit.
• Family dinners. Two of the three facilities had regular dinners or events where family members were invited. It helped to get to know families of some of the other residents.
• We could decorate the rooms however we wanted (short of painting them), hang pictures on the walls, etc. to make it more homey.
• There were a few CNAs who were real pleasures, who were dedicated and kind and attentive.

But there were things we didn’t like as well. Most of these facilities were understaffed and the workers overworked and underpaid. We knew not to expect everything to go 100% like we’d like: no place is going to be perfect. But we didn’t expect to regularly have these kinds of problems:

• The only time we were away for an extended time was for my son’s wedding in another state. The day before we left, I found a broken picture frame on the floor – Mom was still using a walker then and must have accidentally knocked the picture off from where it was sitting. I picked up the big pieces of broken glass, went to the office, explained what happened, and asked if someone could vacuum up the smaller slivers. When we came back a week later, they were still there. Even without someone coming to clean that particular mess up, you’d think someone would have vacuumed the room in a week’s time.
• Food left on her face, from actual bits sticking to her face to a whole chin smeared with sauce, often enough to make red places on her face.
• The hearing aid was often left out, or put in without a battery, or the battery was put in backwards, causing her ability to hear and communicate to be almost nil.
• Food or poop (sorry for TMI, but it happens) would be left under her fingernails.
• When she began to lose the ability to sit up straight, we would come in to find her bent completely forward or bent to the side at a 45 degree angle. We purchased a shoulder harness that helped her to sit upright, but they said they weren’t allowed to use it because it was classified as a restraint. We could understand that, but we felt they could have straightened her up from a bent position and tucked pillows on either side, etc. Just looking at her should have alerted someone that she was extremely uncomfortable.
• One aide would give us grief every time we told her Mom needed to go to the bathroom. Then for a while, every time we would come in, she’d rush over and tell us that she had just taken her to the bathroom, and she’d had “a good poop.” Funny how no matter what time of day we came, she had just taken her. 🙂 The deal was, she wanted to take all the residents to the bathroom on her timetable. But of course they can’t all schedule their need to go to wait until she came. If, while we were visiting, Mom said she had to go to the bathroom, we’d call for an aide, and this one would question Mom about whether she really had to go, or make little remarks loud enough for us to hear when she took her in (“You don’t need to go? Well, we’d better try.”)
• Regular taking of supplies by the aides from one resident’s room to use for another. Granted, sometimes a resident would run out of Depends or wipes, and their family member couldn’t get there that day with more (often they didn’t let us know she needed some until she was completely out, even if it was 10 p.m.) But instead of “borrowing” from other residents, we felt the office should have kept a supply on hand that they could use in emergencies, and either incorporate it into the costs or charge the account of the person needing them. This was particularly rampant in one facility. Not only did wipes disappear at a fast rate, but Mom’s plastic cups, gait belts (used to help her stand up and to transfer her from wheelchair to other chair or toilet, etc.), and even her shower chair were used for other people, even though her name was on all of her things with black Sharpie markers. Clothes disappeared to who knows where.
• Some aides would not be gentle in moving her. For a long while, she could move and help them in their movement of her, but she’s stiff and arthritic, and it would take time. Some would jerk on her arm in ways that hurt her instead of taking their time and going about it slowly and gently.
• Some aides kept running conversations going with each other and did not interact with her at all while they transferred her or took care of her needs.

My husband would talk to the office about some of the problems, in a kind way – he’s not an angry ranter and raver. They were always very sympathetic and promised to make changes, but either that didn’t filter down to the aides, or they didn’t heed it, or things would improve for a while and then go back downhill. We did understand that if we came just after a meal, they might not have gotten to her yet to clean her up. Most of the time we would just take care of the issue and not say anything about it.

I mentioned the different levels of care. In the second facility she was in, as her abilities declined, a couple of aides began to complain about the extra work she required. We learned then that they had a rule that each resident had to be able to get out of the building on their own within 13 minutes during a fire drill. We hadn’t heard of that before. When Mom failed to do so, we were notified that she needed to move right away. No warnings, not 30 days, not even a week’s notice. We talked to the county ombudsman but found that assisted living facilities are not very regulated.

At the next place, we asked if we were going to run into the same problem when Mom declined to a new level, and they said no, she should be able to finish out her time there, and they could even arrange hospice care when it became necessary. She was there about a year and a half when she developed a serious UTI. She was prone to them, and her urine had a certain odor when she had one. When we suspected she had one, we asked the nurse at her facility if they could get a urine sample and then get her started on antibiotics (which they could do at this facility: they had a nurse practitioner who worked with them). For various reasons (among them their being out of toilet “hats” which they used to collect samples), they did not test her for a UTI until a week after we first mentioned it. They started antibiotics, but by that time the infection was rampant, and she was very sick and was taken to the hospital. While she was there we were told that they would not be able to accept her back. So we had about a week’s notice to find and arrange for her to be transferred to a nursing home.

We had talked to a couple of nursing homes before her last move and were told that she could be put on a waiting list, but it was rare that anyone was admitted through the waiting list: they usually were admitted after a hospital stay. Medicare’s regulation was that they would pay for 100 days of skilled nursing in a nursing home after at least a 3 day hospital stay. Mom was in the hospital for about a week, so that requirement was met. Physical therapists, occupational therapists, and speech therapists were all working with her, so she met the skilled nursing requirement.

When she went into the hospital, she had to be out on pureed foods, and she has not outgrown that. We never did figure out why. We thought maybe the depth of her illness as she battled infection caused her to be weaker, and then moving and adjusting to a new place and people was traumatic. But she has not regained the ability to eat regular foods without choking. All we can figure is that as she has gradually been losing muscular abilities (walking, going to the bathroom, feeding herself, etc.), this was a further loss of muscular strength.

The nursing home was the one facility we had been most afraid of, having grown up seeing people in them staring vacantly from wheelchairs or beds. But in many ways she received the best care there at first. They were very gentle in their handling of her. We didn’t have to bring up posture issues: they were on top of that. We learned there was such a thing as a Broda chair, which reclines and has little side pillows built in, so she could now sit in a wheelchair without being stuffed and strapped in. We had always thought it was sad, before, to see people in wheelchairs in the hallway, but now we understood that being out in the busier areas does get them out of their rooms for a bit, and it seemed stimulating to Mom to people-watch. Plus some people would speak to her as they passed by, giving her a bit more interaction than she would have had in her room.

One down side to the nursing home was that her living space was extremely tiny, and everything looked really run down. But a couple of the best aides were there, and one nurse, though seemingly gruff at first, ended up being one of our favorites.

But each facility is only as good as its weakest worker. Jim walked in a couple of times to see an aide feeding her, but watching TV while doing so and only interacting with Mom by shoveling food in. We asked them if they would turn off the TV while feeding her, make sure her hearing aid was in and working, and talk with her a bit while they fed her: we felt those measures would improve her eating. Some of them did. Then, after just a little while she would put up her hand to say she’d had enough. When Jim fed her and she did that, he would give her a drink, let her rest a bit, and then offer her more, and she would eat more. But the aides had the next person to get to, so at the first sign she was done, they’d move on to the next person. Even with regularly getting Ensures and high-calorie shakes, she got down to 90 lbs.

Then she developed a bedsore and couldn’t get into her wheelchair because of where it was, so she had to stay in bed for weeks while it healed. They had stopped physical therapy when she “plateaued,” but were still supposed to be putting soft splints on her arms and legs to keep her from curling up into a fetal position. But somewhere along the way that dropped off. So those weeks while she was in bed, she ended up curled up into a ball, and seemed lower than ever. When we would go to see her, she would often be sleepy or groggy, so we had no idea if she knew we had come, and she must have felt like she was spending endless days alone. People in the facility only saw her to change her Depends and feed her.

We had discussed often over the previous months whether we should try to bring her to our home. At this point we concluded that if we didn’t, she was going to waste away to nothing. In fact, when we first brought her home, Jim assumed that she didn’t have much time left, and he wanted to bring her home to pass away rather than having it happen while alone in her room there.

In my next post in this series I’ll discuss the ins and outs of having an elderly parent at home.

Adventures in Elder Care: Decisions

Posted on March 20, 2014 by Barbara Harper

A few years ago I happened upon a couple of blogs dealing with being a caregiver for elderly parents, and they were a help to me even before we got to that point. Those blogs are no longer active, and for some time now I have been thinking of writing some of the experiences and things we learned along the way with my mother-in-law in the hopes that they may be a help to someone else. I had hoped to contain everything I wanted to say in one post, but it got to be way too long even before I finished, so I thought I’d better divide it up into sections.

Scripturally and morally we’re obligated to care for our parents when they can no longer care for themselves. In Matthew 15:3-6, Jesus says to the Pharisees, “Why do you yourselves transgress the commandment of God for the sake of your tradition? For God said, ‘Honor your father and mother,’ and, ‘He who speaks evil of father or mother is to be put to death.’ But you say, ‘Whoever says to his father or mother, ‘Whatever I have that would help you has been given to God,’ he is not to honor his father or his mother.’ And by this you invalidated the word of God for the sake of your tradition.” (This is from the NASB, which I think gives the clearest meaning to this passage.) God did not honor their gifts supposedly to Him at the expense of neglect of their parents. In instructing the church concerning the care of elderly widows, Paul writes in I Timothy 5:4: “But if any widow has children or grandchildren, they must first learn to practice piety in regard to their own family and to make some return to their parents; for this is acceptable in the sight of God,” again from the NASB. Both it and the ESV say “children or grandchildren”; the KJV says “children or nephews.” But the idea is that our first responsibility and ministry is to our family. The “sandwich generation” is not a new phenomenon: people have always needed to care for their parents and grandparents in some way. Besides the “obligation” of such care, we should be glad to “return the favor” of caring for those who cared for us for so many years.

Most people really don’t think seriously about what to do with a parent who can no longer live alone until they get to that place. Admittedly you can’t really make a decision until the time comes, because it will depend on the family’s life circumstances and just what condition your loved one is in. But it is good to do some research and have some discussions before you have to make a decision in a crisis.

I would say to anyone nearing retirement age that, as much as we don’t want to think about losing our independence, we have to face the fact that that day will come to all of us. It’s good to look ahead, prepare advance directives, talk to your children about your wishes and financial state, etc. We could even start reducing the amount of “stuff” we have squirreled away in attics or sheds before we get to the place where we don’t have the energy to deal with it so our kids won’t be faced with that chore.

It often seems as if other people see that an older person is having trouble living alone before that person realizes it, but I would make every provision for them to remain in their own home as long as possible. Most people wouldn’t relish the change from private home to a dorm or hospital type setting where anyone can come into your room at any time unless they are extremely gregarious, and many would feel burdensome moving in with their adult children. Some folks I’ve known have hired some household help to come in a couple of times a week; I’ve known some who rented out a room to a college student whose responsibilities around the house offset their rent (some degree of housecleaning, taking care of the lawn, perhaps some cooking, etc.)

The main reason for moving a parent out of their own home would be safety issues: the danger of falling, of forgetting to take medicine or taking too much because they’ve forgotten they already took it, etc. Even still, necessary changes need to be discussed and urged upon the parent without running roughshod over their wishes and feelings. It’s usually better to plant the seed that we need to start thinking about the future long before the need actually arises.

In my mother-in-law’s case, she wasn’t taking any medicine that we needed to be concerned about. We were all concerned about her living alone after her husband passed away. She lived 2,000 miles away from us but had a daughter and grandkids nearby. When my husband visited a couple of times, he noticed the housekeeping was declining and the dog had the run of the place (probably for companionship. They’d always had dogs, but they had never been allowed on furniture or to have free reign in the house, but now every piece of furniture was covered in thick dog hair.) He flew up to ID to accompany her to our home in SC and back for a visit to our house since we didn’t think she could travel alone, and while there he took her on a tour of an assisted living facility “just to see what it’s like.” She said it was nice, but she wasn’t ready for anything like that yet. Just about the time we felt like we needed to gently insist that she needed to consider moving, her daughter became available to move in with her. That gave everyone a reprieve from having to make any changes for a time. I don’t believe her daughter was ready, mentally and emotionally, for her to move to a facility yet, either. They did well together for a time, but then my mother-in-law began having some falls, and one time could not get herself up until her daughter got home from work. Additionally, her daughter began having some back trouble and could no longer help her with things like getting out of the bathtub. They both finally came to the conclusion that the time had come for a major change.

The next step, of course, is trying to figure out what that change should be. My husband and I discussed the possibilities many times as did my husband and his oldest brother long before this day actually arrived.

There are several things to consider when deciding whether to move a parent into your home or an assisted living facility:

1. Housing situation. Not everyone has the space to include a new adult addition, or the house might not be conducive to someone with physical problems.

2. Availability of other family members. It’s easier to bring a parent into your home if you have some kind of support system than it is to do so alone.

3. Finances.

4. Mental ability. If the elderly parent has Alzheimer’s or mental confusion, someone would need to stay with them all the time, and even a family with a stay-at-home member might not be able to manage that between errands, school obligations if there are school-aged children in the house, etc. I know some handle this by hiring someone to stay with the elderly parent a certain amount of time each week.

5. Level of care needed. There might be some situations in which the older person needs physical or medical care that can’t be given at home.

6. Relationships. Some older people will always see their adult child as a child, and won’t follow instructions about medical care (e.g., medicines), food, etc., but they would take such instruction from medical personnel in an assisted living situation.

7. Personalities. We might be loathe to admit this and we might think that every family relationship should amicable, but in real life that is just not the case. Some relationships prosper with a little bit of space for each party.

8. Safety. Particularly Alzheimer’s or some forms of dementia in advanced stages may cause some patients to physically strike their caregivers when frustrated or angry even if the patient would never have done that in earlier years.

9. Socialization. Assisted living could provide the mental stimulation of interacting with others and participating in the activities there, and it might encourage folks to know there are others who are going through the same things she is.

10. Independence. If a person is not capable of being alone, mentally or physically, for short periods of time, it would be hard to bring them into the family home unless someone else in the family can be home all the time, or the elderly person is able physically to go with the family to their activities. It might seem odd to list this as a factor when a person going into assisted living seems to be giving up their independence. But in such a facility they actually do get to make some of their own decisions and schedules to a degree and have their own living space. Some would feel that if they lived with their children they would be an imposition (even if the family is glad to have them), and they are more comfortable being on their own as much as they can be.

In our case, the biggest factor was that our home was not conducive to my mother-in-law’s needs. We had a split level at the time, and she could not handle the stairs safely. The other major factor was that we still had kids at home, one of whom was not driving yet, so our lifestyle involved a lot of taking kids to school, practice, and activities as well as errand-running where we couldn’t leave Mom at home alone. A friend who takes care of her mother-in-law with Alzheimer’s takes her with along with her to her granddaughter’s outings and school activities, etc, and she does fine, but my husband’s mother wasn’t physically capable of that and probably would not have been interested in that, either. She was very much a homebody, and even when her own kids were home, she didn’t go to many of their activities. Socialization was a smaller factor: I almost hate to even use that word because I know it is leveled as an unfair charge against home-schoolers has been a lack of socialization, and most of them get plenty of social interaction and don’t really need to be put into a classroom of people the same age to get it. But we knew if my mother-in-law lived with us, we would be her whole world — she wouldn’t feel the need to or have the desire to interact with others besides surface greetings at church. Too, some of my own physical issues made me unsure I could help with hers: in fact, when she visited, I inadvertently hurt her shoulder trying to help her out of the tub.

My husband had been researching the nearby assisted living facilities and found one with more of a homey rather than an institutional feel just a few minutes away from us. In the next post in this series (probably next week) I’ll discuss some of our experiences with assisted living and nursing homes.

Disclaimer: This series is not meant as professional or medical advice. It is merely based on personal experiences and offered as information and encouragement.

Happy Birthday to Jim!

Posted on March 6, 2014 by Barbara Harper

I posted this last year – but I really can’t improve on it, so I am sharing it again. 🙂

Happy Birthday to the man who…

…protects me from critters…

…takes me out to eat at nice places…

…gave me three great sons and heads up a wonderful family…

…concentrates on doing a good job no matter what he’s doing…

….knows how to be silly…

…makes great food…

…takes care of his mom…

…builds stuff for me…

…and so much more.

Thank you for showing your love to me in countless ways every day! I so appreciate your character, your integrity, your work ethic, your kindness and compassion, and everything that makes you the wonderful man you are. I thank God for you and for His grace in our lives.

This past year has been a challenging one in many ways, with surgeries and bringing your mom home, but I’ve appreciated the way you have handled things with grace.

Happy Birthday, Mittu!

Posted on February 20, 2014 by Barbara Harper

Wishing a very very happy birthday to my lovely daughter-in-law!

A long, odd day

Posted on January 30, 2014 by Barbara Harper

We got our share of the Polar Vortex this week. Not only has it gotten down to 1 degree at night, but Tuesday we got about 4 inches of snow. The odd thing was that snow has been forecast several times without our getting any, but this time, there was no snow on the weather app I check in the mornings, but it started coming down around 9:30 or 10 a.m. Grandma’s aide was nervous about driving home, so she left about 11 – and ran into a ditch with boulders in it on her way home. She wasn’t hurt, but the front of her car was smashed in. She called her husband to pick her up and called AAA to get the car, who told them to leave it and go on home, because it would be a while before they could get out to it. So they did, and in the meantime another car ran off into the ditch and crashed into her car from behind. I’m glad she wasn’t in it at the time.

I didn’t know any of this was going on until later. Meanwhile, I was home with Grandma for the longest stretch I had ever been before. I also fed her lunch for the first time ever, and thankfully that went well.

For months now she has not been very verbal: she’ll answer questions, say something here or there, sometimes talk a bit more, but then fall silent again. But Monday night she kept giggling as we got ready for bed (we never did figure out what was so funny) and woke up talking off and on through the night. Tuesday morning she was in rare form, talking up a storm and laughing. By lunchtime she kept asking me if I had seen her daughter lately. Her daughter lives in ID and we’re in TN, so, no, I hadn’t seen her. By midafternoon she was asking if I knew where Jim was and if he could take her home. I tried to explain that she lived here now and had for five months, but we kept having the same conversation over and over. Finally I just started saying that Jim wasn’t home yet. By evening, she was wanting Jim to take her to her daughter’s. Instead of trying to straighten her thinking, he just kept telling her that it was snowing outside, so we were going to sleep here tonight. But again her mind kept running along the same track: when we tried to put her to bed, we couldn’t get to the door before she was calling out for Jim. Finally he positioned her so she could see the TV and turned on The Waltons, hoping to get her mind going in a different direction.

When we changed her Wed. morning, she kept saying, “How did you find me?” Jim teased, “I knew where to look!” and she laughed, but she kept running on that track for a while. Once the night before she asked if I had seen a blue pickup, and I said, “No, who owns a blue pickup?” She said, “My husband!” Jim said the blue pickup was from a long time ago, and then when she started asking about relatives who had passed away a long time ago, he realized that in her mind she had forgotten about moving here and having been in SC before we moved here. She asked at one point how in the world she ended up in TN. He got out a scrapbook a granddaughter had made for her of a get-together they had right before she left ID, and he talked to her about that and how we moved her to SC to live near us and then we all moved to TN. She seemed to understand.

Her aide wasn’t going to come in at all on Wed. both because she thought the roads would be icy plus she needed to take care of the details with her car. I was ~~a little~~ antsy about spending the whole day alone with Grandma in light of the tracks of thought she kept getting stuck in the day before, but Wed. she was back to being mostly silent. She had been awake much more than usual for two days, but Wed. she slept most of the day. Jim and I have been scratching our heads trying to figure out what caused the difference for a day or two and what caused things to revert back again afterward. We have no idea!

I was glad to learn by experience that I could take care of Grandma alone if need be. I don’t think I could have when we first brought her home – I was too intimidated. Though I appreciated her aide anyway, I really appreciated her after she was gone for a day and a half! When I was alone with Grandma, even when was sleeping, there was almost a constant pressure to check on her and make sure she was doing ok, and it’s nice, when the aide is here, to be able let that go mentally.

Thankfully everyone else in the family was safe on the snowy roads: I was concerned about Jesse coming home from school since he’s not used to driving in the snow, but he was fine, although it took him over twice as long to make it and he said he did slide a few times.

It’s supposed to get into the high 40s Friday, which will be very welcome. I’m about ready for winter to be over.