From The End of the End

CLOSENESS,  AND OBSERVATION

As far as subjects  like “closeness”, I believe that it’s nice to give them a back rub or a back scratching while you’re walking with them. They get a big kick out of it and it develops a nice intimate routine where you’re keeping a close proximity to your mom or dad and actually helping their muscles relax while taking them for a walk with their Walker.  Don’t be too rough on them, but don’t be afraid to give them a good scratching and rub down through their clothes while walking.

Eldercare is like baseball. It’s a game of inches.  Closeness is something to aspire to, from the beginning if possible.  I came a little  late to achieving more closeness with my folks. But I always gave them a hug hello and a hug goodbye every day.  I have a recliner that I placed in my parents room upon arrival at The British Home and we all sat around and watched TV and snacked together (and I used the internet and my laptop to do my location scouting and managing work). Once my dad died, and I moved my Mom to Pasadena Highlands, I moved my recliner, too, and now I sit close to her while we watch TV. When she gets a cold or a bout of pneumonia, I sit in a different armchair directly next to her and offer the occasional pat on the back or let her hold my hand.  It’s quality time, better spent closer, and it promotes her healing.

See, she really has no reason to “try” to enjoy her life except for because of my willingness to encourage her and offer her companionship, so I’ve gotten used to the “mission” of just “being there” as much as possible.  When my dad was bed-bound in his last month, I spent several 30 minute sessions sitting next to him and holding his hand.  He would squeeze it as hard as he could to express his appreciation for the odyssey we shared of leaving Florida and setting up life in California together.  The closeness we nurtured allowed us to really re-connect before dying.

In Marilou’s bedroom, in the morning when I wake her, I give her a morning hug – (and we have a goodnight hug every evening). I got into the habit of hugging my Dad, Mort a lot, too, especially in his last two years of life.  I learned from my cousin, who told me, that when My Uncle was told he was dying, he made up for lost hugs by hugging and smothering her with kisses. They had never really hugged much during her whole life, she said, and it stuck with me that his instinct was for making sure his love for her was expressed in a fury of hugs and kisses.  I think all elderly parents yearn for the hugs of their kids at this phase of life.

As for privacy issues, when I’m in my Mom’s room,  I will avert my eyes when she goes to use the commode, but I don’t run out of the room like I used to. She’s a little too unstable, so in case she starts to tip over, I can keep an eye on her.  After watching her, if I spot some carelessness in her “technique,” I  “coach” her now and then – reminding her on how to use the hand rail net to the toilet for safety while still able to crouch and clean herself up – and where to position the handi-wipes package, and maybe even “anchor” it to the sink with tape so she can pull a handi-wipe out with one hand.

You never really “check off the boxes” once and for all on the checklist of eldercare — it’s a process of setting up healthy routines and then basting them in reminders of how the routines work for their comfort and safety, and why they work.  Their memories are pretty iffy at this phase, so just build it into YOUR routine –  that you are going to be repeating yourself – your “speeches” about how to stay safe, etc.  This process of observation and adjustment is transferable for all manner of tasks of daily living -for example:  I positioned a chair close to a small bookshelf inside the closet with clothes hanging above it.  Marilou can sit and reach most items on the shelf (underwear, pajamas, socks etc. – and a package of handiwipes taped to the shelf).  From this “dressing chair,” she can then stand up carefully and pull a shirt off a hanger, and then sit back down to put it on.  She cal also access all of her underwear, pajamas, shoes and socks and stand up and sit down using the arms on the chair, with her walker opposite her, locked.  This setup grew out of observation and “rehearsal” of the safest way of using the space in her room and her abilities.

“Don’t Fall Down,” is my parting shout before blowing her a kiss every time I leave my Mom’s room for any significant length of time.  It’s our little joke, but it’s based in my philosophy of observation, coaching, repetition, adjustments and the fact that almost all of the deaths of folks over 90 result from falls or pneumonia.  Strokes hit them younger, cancer kills them even younger.  If they make it to 90, they’ll live until they fall and break a hip or catch a bad pneumonia.  That’s the impression I get.

According to the U.S. Centers for Disease Control and Prevention:

• One in four Americans aged 65+ falls each year.
• Every 11 seconds, an older adult is treated in the emergency room for a fall; every 19 minutes, an older adult dies from a fall.
• Falls are the leading cause of fatal injury and the most common cause of nonfatal trauma-related hospital admissions among older adults.
• Falls result in more than 2.8 million injuries treated in emergency departments annually, including over 800,000 hospitalizations and more than 27,000 deaths.
• In 2015, the total cost of fall injuries was $50 billion. Medicare and Medicaid shouldered 75% of these costs.
• The financial toll for older adult falls is expected to increase as the population ages and may reach $67.7 billion by 2020.

It does a lot of good knowing that she’ll use the commode privately in the middle of the night more safely because I closely observed and made adjustments in its position.  And  I can keep score on her abilities more accurately, and I can see if there is any decline in those abilities by choosing to be close much of the time.

So for example,  if I want to fold a load of laundry. I could do it away from her, but I do it right there on her bed while she’s in it, so that when she wakes up, I can watch how she gets up, and take notes on how she moves when she’s still half asleep. These little moments of instability will creep up on you, and they won’t have a chance to call out – they’ll just fall down.

At this age Marilou is like a potato chip on edge: I can’t let her fall down. And I can’t let her get too wet because she’ll crumble – meaning she can’t fall and break a hip. She’s too crispy. And, she can’t get any more bad chest colds or pneumonia, because she will expire from the struggle against pulmonary Edema .