Who among us regardless of how many resources we have, wish to spend their final days in a nursing home or a hospital? How many of us would make alternative plans if given a choice? And how many of us have been taught that decisions about long-term care must be made by medical professionals? It is time for people to start questioning for themselves: "What is best for me?"
With the State of Vermont's push to allow more people to remain in the community as they age yet require some assistance, the most important thing to consider is that if you begin to plan early enough all choices may be yours to determine. However, when you are in a crisis there is not much help we can give you.
The Council on Aging for Southeastern Vermont receives countless calls on our Senior HelpLine when families are already in crisis. Someone took a fall, broke a hip, or else the family home has become a burden that cannot be handled. Often when an elder contacts us for help with long-term care options it is far too late for many good choices. Housing options, caregivers available in one's community, perhaps an adult day program could have or would have been able to be arranged with more time.
We all want to determine how we live our lives. What is defined as quality by one person may be different for another. Agency staff are willing and able to help elders and their families begin the process of looking at long-term care options and asking the key questions before there is a crisis.
If you are aware of someone who has not made any long range plans, is becoming more frail and could benefit from a fruitful discussion about options, please let them know there is help. Planning ahead could mean the difference between being in total control of your life and being put in the position of having medical professionals and others make those decisions for you.
For more information, please call the Senior HelpLine : 1-800-642-5119.
Joyce A. Lemire, Executive Director
Council on Aging for Southeastern Vermont, Inc.
Aged in Vermont - Articles for those who know someone who is aging...
Wednesday, October 5, 2011
Friday, May 13, 2011
A Care Giver and End of Life Experience
In the last six months of 2010 my husband began a decline in his health and ability to help himself. He was using a cane and walker most of the time but had frequent falls and needed help to get up. I began to depend on family, neighbors, and Westminster Fire and Rescue to help. On several occasions I called on the expertise of the Westminster Cares nurse to help with scrapes and bruises and to tell if we needed to see the doctor. Somehow he never broke a
bone.
His decline was slow but progressive over the next six months, and I put to use many of the services I had learned about as a member of the Council on Aging Advisory Council. I wanted to continue working part time but felt that my husband shouldn’t be home alone. We started out with Life Line but he didn’t use it because it was difficult for him to understand and he was rarely alone for more an hour or two. I decided to hire someone to stay with him while I was at work so that I could then have some time to run errands as well.
The Life Line and caregiver were the first paid expenses. It worked well for both of us and we had a delightful caregiver. I could still help him get in and out of the car and take him to appointments, the store or for a ride. When that became more difficult we bought the kind of walker that had handlebars and a seat so that he could sit down when his knees were giving out. That type of walker was great to use at the table and for getting around in the house as well
as walking on the street.
However, it wasn’t too long before walking was painful and my husband needed a wheelchair. We needed to see the doctor in Brattleboro every week and it became very difficult to transfer him from the car to the wheelchair. My husband was also having difficulty swallowing because of an atrophied epiglottis. The doctor decided it was time to ask a nurse from the Visiting Nurse
Association (VNA) to come to the house and check my husband’s vital signs and take blood checks, saving us the trip to town each week.
This was a big change because we couldn’t go out any longer. The VNA nurse came to the house to do assessments and set up a schedule with the occupational, physical and speech therapists. The VNA speech therapist would come to the home and teach my husband specific exercises. The nurses were caring and professional in every way. Medicare covered eighty percent of the VNA expense. The deductibles in our supplemental insurance had not been met
at this point.
I learned how to prepare special foods. A home health aide came every day to help with showering. We found someone to build a ramp to our front door. Before long we were using a wheel chair all of the time.
I had information about The Gathering Place Adult Day Center in Brattleboro and after visiting there, decided to sign up my husband to attend twice a week. The Connecticut River Transit picked him up at our house and brought him home. This was a wonderful service to have for about four months. He enjoyed his time there and was painting and participating in group activities. That gave me time to shop, work in the yard or just be alone. I knew my husband was trying his best to help himself and I know he knew that I was tired and he wanted to give me some time alone.
We could still communicate about the day-to-day activities. But we didn’t get much sleep because we got up several times in the night. Finally, we hired help to come for one overnight each week. We paid for these services out of our pocket. (This might not be the case for everyone who wants to attend adult day.) Our daughter, son and son-in-law were also helping in many ways.
Although the services were very helpful and necessary there now were people in and out of our house all the time. Sometimes we would have four or five visits and many phone calls during the day. We were trying to complete the exercises that had been suggested by the speech and physical therapist. Furniture had to be moved so the wheel chair could fit through the house.
Special food needed to be prepared to help prevent choking. We were both anxious when he choked. We knew that if he ingested food into his lungs he would get pneumonia. This was all becoming overwhelming, and everyone was getting more and more tired. I had to do a lot of lifting. It was difficult. We absolutely needed all the help we could get. The nurses were always helpful and kept telling me I was doing a good job. It was our family’s wish to make my
husband’s life as normal and pleasant as possible.
We frequently had visits from our clergy and friends for which we were thankful. Our daughter and her husband came over in the evenings to help out and visit. It became apparent that no one person could give this much care, particularly if that person was an elderly spouse or had health issues of their own.
On one visit the nurse called 911 because my husband had become very weak and she suspected that he was dehydrated. This was the case and he was in the hospital for a week with pneumonia.
When it was time to bring him home from the hospital, he needed a hospital bed, a Hoyer lift for transferring in and out of bed and oxygen. How all of these items fit into the bedroom was a puzzle. We had to keep a sense of humor through all of this. Thankfully, my husband was always pleasant and thanked everyone for all they did for him.
The hospital discharge planner and the doctor at the hospital talked to us about going on to Hospice Care. This was a very difficult decision because it was admitting that we were heading toward the end of life.
To make the best of it we decorated the room for Christmas and had soft lights and music in the bedroom. It was a very pleasant atmosphere despite the wheelchair, lift, and oxygen tank and hospital bed. The hospice nurses came every day, the hospice doctor talked to us at length about the pain medications that we would be using. Hospice was on call 24/7. I did call several times and the nurse was calming and helpful. A hospice counselor came to talk with the family about end of life wishes and concerns. They were caring and compassionate. On two occasions a hospice volunteer sat with my husband but I was nervous to leave him. I thought he might be frightened to be alone with a stranger with no family around in case of an emergency.
Between myself, our caregiver, daughter, son, and son-in-law we shared the round-the-clock care giving. It was a difficult six months mainly because things just kept changing so quickly, but hospice gave us lots of information so we could help my husband and also know what to expect as his body shut down. We made his end of life the best we could. Hospice came right away when we called. They stayed with us and were there to pronounce his passing. Hospice
also sent a counselor to visit with us the next day.
I am thankful that he could be at home and would wish that for most people. However it is all consuming, tiring and takes many helping hands. This would be impossible for many families. It would also have depleted most of our savings without Medicare.
To give you an idea of the cost of all of this I broke it down into the following approximant
numbers:
Private care and Adult Day Care $17,000 Private pay
Medicare for VNA/Hospice 20,297
Medicare – Hospital 8,942
Medicare – Ambulance 1,000
Medicare - Doctor and Lab work 2,822
Equipment 1,700 Private pay
Total $51,751
bone.
His decline was slow but progressive over the next six months, and I put to use many of the services I had learned about as a member of the Council on Aging Advisory Council. I wanted to continue working part time but felt that my husband shouldn’t be home alone. We started out with Life Line but he didn’t use it because it was difficult for him to understand and he was rarely alone for more an hour or two. I decided to hire someone to stay with him while I was at work so that I could then have some time to run errands as well.
The Life Line and caregiver were the first paid expenses. It worked well for both of us and we had a delightful caregiver. I could still help him get in and out of the car and take him to appointments, the store or for a ride. When that became more difficult we bought the kind of walker that had handlebars and a seat so that he could sit down when his knees were giving out. That type of walker was great to use at the table and for getting around in the house as well
as walking on the street.
However, it wasn’t too long before walking was painful and my husband needed a wheelchair. We needed to see the doctor in Brattleboro every week and it became very difficult to transfer him from the car to the wheelchair. My husband was also having difficulty swallowing because of an atrophied epiglottis. The doctor decided it was time to ask a nurse from the Visiting Nurse
Association (VNA) to come to the house and check my husband’s vital signs and take blood checks, saving us the trip to town each week.
This was a big change because we couldn’t go out any longer. The VNA nurse came to the house to do assessments and set up a schedule with the occupational, physical and speech therapists. The VNA speech therapist would come to the home and teach my husband specific exercises. The nurses were caring and professional in every way. Medicare covered eighty percent of the VNA expense. The deductibles in our supplemental insurance had not been met
at this point.
I learned how to prepare special foods. A home health aide came every day to help with showering. We found someone to build a ramp to our front door. Before long we were using a wheel chair all of the time.
I had information about The Gathering Place Adult Day Center in Brattleboro and after visiting there, decided to sign up my husband to attend twice a week. The Connecticut River Transit picked him up at our house and brought him home. This was a wonderful service to have for about four months. He enjoyed his time there and was painting and participating in group activities. That gave me time to shop, work in the yard or just be alone. I knew my husband was trying his best to help himself and I know he knew that I was tired and he wanted to give me some time alone.
We could still communicate about the day-to-day activities. But we didn’t get much sleep because we got up several times in the night. Finally, we hired help to come for one overnight each week. We paid for these services out of our pocket. (This might not be the case for everyone who wants to attend adult day.) Our daughter, son and son-in-law were also helping in many ways.
Although the services were very helpful and necessary there now were people in and out of our house all the time. Sometimes we would have four or five visits and many phone calls during the day. We were trying to complete the exercises that had been suggested by the speech and physical therapist. Furniture had to be moved so the wheel chair could fit through the house.
Special food needed to be prepared to help prevent choking. We were both anxious when he choked. We knew that if he ingested food into his lungs he would get pneumonia. This was all becoming overwhelming, and everyone was getting more and more tired. I had to do a lot of lifting. It was difficult. We absolutely needed all the help we could get. The nurses were always helpful and kept telling me I was doing a good job. It was our family’s wish to make my
husband’s life as normal and pleasant as possible.
We frequently had visits from our clergy and friends for which we were thankful. Our daughter and her husband came over in the evenings to help out and visit. It became apparent that no one person could give this much care, particularly if that person was an elderly spouse or had health issues of their own.
On one visit the nurse called 911 because my husband had become very weak and she suspected that he was dehydrated. This was the case and he was in the hospital for a week with pneumonia.
When it was time to bring him home from the hospital, he needed a hospital bed, a Hoyer lift for transferring in and out of bed and oxygen. How all of these items fit into the bedroom was a puzzle. We had to keep a sense of humor through all of this. Thankfully, my husband was always pleasant and thanked everyone for all they did for him.
The hospital discharge planner and the doctor at the hospital talked to us about going on to Hospice Care. This was a very difficult decision because it was admitting that we were heading toward the end of life.
To make the best of it we decorated the room for Christmas and had soft lights and music in the bedroom. It was a very pleasant atmosphere despite the wheelchair, lift, and oxygen tank and hospital bed. The hospice nurses came every day, the hospice doctor talked to us at length about the pain medications that we would be using. Hospice was on call 24/7. I did call several times and the nurse was calming and helpful. A hospice counselor came to talk with the family about end of life wishes and concerns. They were caring and compassionate. On two occasions a hospice volunteer sat with my husband but I was nervous to leave him. I thought he might be frightened to be alone with a stranger with no family around in case of an emergency.
Between myself, our caregiver, daughter, son, and son-in-law we shared the round-the-clock care giving. It was a difficult six months mainly because things just kept changing so quickly, but hospice gave us lots of information so we could help my husband and also know what to expect as his body shut down. We made his end of life the best we could. Hospice came right away when we called. They stayed with us and were there to pronounce his passing. Hospice
also sent a counselor to visit with us the next day.
I am thankful that he could be at home and would wish that for most people. However it is all consuming, tiring and takes many helping hands. This would be impossible for many families. It would also have depleted most of our savings without Medicare.
To give you an idea of the cost of all of this I broke it down into the following approximant
numbers:
Private care and Adult Day Care $17,000 Private pay
Medicare for VNA/Hospice 20,297
Medicare – Hospital 8,942
Medicare – Ambulance 1,000
Medicare - Doctor and Lab work 2,822
Equipment 1,700 Private pay
Total $51,751
Thursday, April 7, 2011
How to Best Prepare for an Emergency
It is always helpful to try to plan for emergencies in advance. The Advisory Council of the Council on Aging for Southeastern Vermont, Inc. has been meeting for quite some time to plan and implement a simple means to prepare for emergencies.
The Emergency Readiness for Older Adults and Caregivers Checklist, developed by the Administration on Aging, helps individuals to think about the risks they might face; a list of items they would need to survive in their homes until help arrives and a personal plan..
These checklists are available through the Council on Aging.
In addition, the Advisory Council has created an Emergency Preparedness Self Register. This one page document outlines whether the individual requires oxygen or other equipment using power, has a vehicle or not, and other information that would be helpful for the local Emergency Preparedness Coordinator in each community to have. In case of emergencies, the coordinator
would know which residents might be in need of special help. If someone completes personal information for this register, the only person to have access to this would be the Town's Emergency Preparedness Coordinator. Each town has assigned a person to be the coordinator.
The goal of the Council on Aging is to assist any individual who would like to plan ahead for some type of disaster or emergency. The information collected would not be accessible to staff at the agency but would be turned over to the particular town's Emergency Preparedness Coordinator.
The Advisory Council is made up of representatives from each town in Windham and Windsor county. Some towns recommend the checklist, and others do not. To find out if your town does recommend the checklist, call the Senior Help Line at 1-800-642-5119.
To receive a copy of the Checklist or the name of the Emergency Preparedness coordinator in your town please call the Senior Help Line at 1-800-642-5119.
Joyce Lemire, Council on Aging
for Southeastern Vermont, Inc.
The Emergency Readiness for Older Adults and Caregivers Checklist, developed by the Administration on Aging, helps individuals to think about the risks they might face; a list of items they would need to survive in their homes until help arrives and a personal plan..
These checklists are available through the Council on Aging.
In addition, the Advisory Council has created an Emergency Preparedness Self Register. This one page document outlines whether the individual requires oxygen or other equipment using power, has a vehicle or not, and other information that would be helpful for the local Emergency Preparedness Coordinator in each community to have. In case of emergencies, the coordinator
would know which residents might be in need of special help. If someone completes personal information for this register, the only person to have access to this would be the Town's Emergency Preparedness Coordinator. Each town has assigned a person to be the coordinator.
The goal of the Council on Aging is to assist any individual who would like to plan ahead for some type of disaster or emergency. The information collected would not be accessible to staff at the agency but would be turned over to the particular town's Emergency Preparedness Coordinator.
The Advisory Council is made up of representatives from each town in Windham and Windsor county. Some towns recommend the checklist, and others do not. To find out if your town does recommend the checklist, call the Senior Help Line at 1-800-642-5119.
To receive a copy of the Checklist or the name of the Emergency Preparedness coordinator in your town please call the Senior Help Line at 1-800-642-5119.
Joyce Lemire, Council on Aging
for Southeastern Vermont, Inc.
Peaceable Living
We had moved our mother into a new assisted living complex in early 2000. It was such a wonderful place. It gave my mother independence, yet we knew she was being watched over in the event of an emergency. My four sisters and two brothers helped with the move; as stressful as it was, it clearly took a toll on our mother as well. This wasn’t what she wanted, yet she knew deep down that this was the best for her welfare. She couldn’t live alone, so far from friends and
family, and this was her new home.
It had now been two months since that move, and this was my first visit to her new place. Imagine my shock when we walked into what looked like a complete stranger’s home. All her belongings were gone, replaced with new furnishings. A few familiar pictures adorned the walls, reminders of her life well-lived. The only other remaining items that truly meant something quite powerful to my mom were our old couch and a chime clock.
The chime clock hung neatly in the dining room, as it always had but now no longer chimed (I fixed the clock later). The couch had been the centerpiece in our home for many years; lots of holiday gatherings, laughter by the fire, curled up watching Sunday football. But because a few of my family members who live nearest to my Mom didn’t care for the couch (it’s old and falling apart), it was placed on the screened-in porch at the new complex. Want to guess where my
mother was spending nearly all of her time?
My sisters had taken the lead in this effort because we were moving my Mom close by to their homes. However, my sisters did what they would have wanted for their aging years. They set up a Laura Ashley-like home, picture perfect in every way - except that it wasn’t perfect for our mother.
If I had to do it all over again, I would have spoken to my mother in more detail before the move. I would have spoken to my sisters before they did what they thought was the right thing. Their hearts were in the right place but they never thought about how simply our Mother liked to live. I didn’t want to chastise my sisters for turning my mother’s new place into a showroom, because they did a great job. However, I did ask: “Where did her memories end up?” It wasn’t a pleasant discussion.
As our parents age, let’s remember that there’s a balance between allowing them to live their lives in the way in which they have already lived their many years and how we’d like to see them live out their remaining years. TALK TO THEM NOW! Talk to your siblings. Have a plan. Reacting to circumstances is not a plan but a trap that will cause more anger, arguments and frustration at a time when you need to be compassionate, understanding and consoling.
Yes, health, memory issues and mental capacity play into all of these decisions and can certainly change decisions made previously. But starting a dialogue sooner allows everyone to better understand what to expect further down the road.
Don Dawson, Westminster
Cares Board Member
family, and this was her new home.
It had now been two months since that move, and this was my first visit to her new place. Imagine my shock when we walked into what looked like a complete stranger’s home. All her belongings were gone, replaced with new furnishings. A few familiar pictures adorned the walls, reminders of her life well-lived. The only other remaining items that truly meant something quite powerful to my mom were our old couch and a chime clock.
The chime clock hung neatly in the dining room, as it always had but now no longer chimed (I fixed the clock later). The couch had been the centerpiece in our home for many years; lots of holiday gatherings, laughter by the fire, curled up watching Sunday football. But because a few of my family members who live nearest to my Mom didn’t care for the couch (it’s old and falling apart), it was placed on the screened-in porch at the new complex. Want to guess where my
mother was spending nearly all of her time?
My sisters had taken the lead in this effort because we were moving my Mom close by to their homes. However, my sisters did what they would have wanted for their aging years. They set up a Laura Ashley-like home, picture perfect in every way - except that it wasn’t perfect for our mother.
If I had to do it all over again, I would have spoken to my mother in more detail before the move. I would have spoken to my sisters before they did what they thought was the right thing. Their hearts were in the right place but they never thought about how simply our Mother liked to live. I didn’t want to chastise my sisters for turning my mother’s new place into a showroom, because they did a great job. However, I did ask: “Where did her memories end up?” It wasn’t a pleasant discussion.
As our parents age, let’s remember that there’s a balance between allowing them to live their lives in the way in which they have already lived their many years and how we’d like to see them live out their remaining years. TALK TO THEM NOW! Talk to your siblings. Have a plan. Reacting to circumstances is not a plan but a trap that will cause more anger, arguments and frustration at a time when you need to be compassionate, understanding and consoling.
Yes, health, memory issues and mental capacity play into all of these decisions and can certainly change decisions made previously. But starting a dialogue sooner allows everyone to better understand what to expect further down the road.
Don Dawson, Westminster
Cares Board Member
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