My aunt had the same doctor for a number of years.  She was happy with him and felt he did a good job for her.  I had made sure when I called for an appointment to talk with his nurse and let them know ahead of time all that had happen.  So when we got to see the doctor I asked my aunt in front of him if I had her permission to explain to him how I found her this morning and that things were a bit off.  His reactions was that I was stepping on his authority.  He responded with a cool get down to business let’s move on approach.  As if we had come just for shots.  Nothing seemed out of the ordinary to him.  All her vital signs were good and she was talking and following the conversation.  Weight was down a bit, but nothing to be concern about.  That was it.  I again explained to him what had happen the last week and asked if it could be a UTI (urinary tract infection).  He seemed imposed but had his nurse draw some fluids for a test.  That was that.  Even my aunt was amazed.

On our return ride to her apartment we stopped off to have lunch.  I was still astonished over the doctors reaction when I noticed that my aunt was woofing down her meal.  I gave her some of my food and she ate it all.  I asked her again if she had breakfast – yes she did.  It was interesting.  So we stopped to get groceries and this time I picked up some fruit and bottle water.  We agreed she would drink a bottle a least each day.  We arrived at her apartment and I started to put the groceries away when I notice…the food from the Monday before was in the same place.  I quickly looked at the counter where the cookies had been and saw that they were almost gone.  Ah ha!!! She was just eating cookies!

Equipped with this new knowledge I sat down and started to talk to my aunt about what she liked about this place and what she did not.  It was a senior housing, but without food services or nursing.  She said she would love to have someone else to do the cooking for her and reminded me she told me that before (She had about six months ago before my mom’s stroke but it was just part of a chatty conversation.  I did not take it seriously). I asked her if I could find a couple of places, and would she go with me to check them out.  She agreed.  I would call the next day and see what we could view for the next week.  She also agreed to let my mom or myself to call for reminders to eat and drink water. I told her I would set her up with meals on wheels.  She reluctantly agreed.  When I got home I called my mom and explained all that happen.  I suggested she ask more questions about my aunt’s food to see if she really ate anything, not just did you eat.  My mom said she had a friend living there who would check in on her and have her come to supper.  Feeling good about the plan, I started to work on possible housing with services.

As I was setting up meals and tours the next day, my aunt called.  She said she started to think more about it and did not want to leave her place.  She understood she was not eating right and she would promise to eat better.  That was it.  Maybe meals on wheels in the future, but not now.  She hung up before I could say anything.  Then my mother called and begged me not to push my aunt on moving.  My mom promised that she would have her friends check auntie and just to give her some time to think.  Of course I could not force my aunt to move.  I thought we had a good plan.  With all these promises I agreed and would give the weekend to see how it would go.  My mom begged me not to call my aunt for the weekend…she would.  I agreed.  Big mistake.

The weekend went really fast.  I talked with my brother and he had talked to my mom and all seemed to be well. I called my mom, and all seemed to be well.  Monday morning came and I was at work.  My mom called.  Something is wrong.  Auntie Vi is not picking up her phone.  Calming my mom down, I told her maybe she is down getting her mail or, and before I could say anything more she yelled…”all weekend she has not answered her phone.”  ALL WEEKEND!!!  I responded.  “And you are just now telling me???”  “I thought she was down stairs getting her mail.” my  mom said.  Taking in a deep breath, I reassure my mom that I would take care of this and would call her back.  I then called my aunt’s housing director and asked if she would immediately go and check on my aunt.  She did.  They found her wrapped up in her sheets on the floor of her bedroom.  She was aware of the housing director but not much more.  911 was on their way and I left to meet them at the hospital.

Evidently my aunt had open her bedroom window to let air in as she always does (because the bad furnace smoke could kill you…even though this is the 21 Century and she has electric heat).  But with the weather in early April it changes fast and it got colder and started to rain.  She woke up and decide to close the window but got her feet tangled in the sheets and fell.  She was unable to untangle herself and ended up getting more tangled.  From laying on the floor for two days and three nights she was dehydrated.

When the ER doctor met me, he was ready to tear my head off.  Explaining that so many families just do not care for their elders and leave them to fend for themselves without understanding that they need help.  I understood his frustration – but this was not the situation.  I quickly explained about the last week.  As I was doing so, my aunt moved her head up and down in agreement with me.  I took the doctor aside and asked if he thought she should be in an assisted living or at least housing with services (knowing full well she did).  He agreed.  I asked him to tell my aunt that and even write it down!  Because my aunt will listen to him before me.  He did.  At that point the nurse interrupted and told him that my aunt had a UTI.  We both looked at each other with that knowing look.  They would keep my aunt in for a few days to give time for the medication to take affect and that would give me some time to find a place for her.

The next day I would then explained to my aunt that she would need to find a better place that would take care of her.  I did a lot of thinking over that.  How would I convince her to move.  I really did not get any sleep.  Prepared for the worst I went into her room the next day to present my argument as if I was facing the Supreme Court.  I brought her flowers which right away she started to cough “Take those out of her…I hate the smell of dying flowers!”  I explained that they were brand new.  “Get them out of here!”  We were not off to a good start.  After I brought the flowers down the hall (as far away from her room as nose possible), I sat down next to her bed.  She started to tell me that she was upset with that apartment building for letting her lay on the floor for so long.  After all the money she gives them.  At first I almost started to explain that it was not their fault…but then I took the opportunity to present a different version.

“You are right Auntie Vi.  That is not the place for you.  Paying that much money you should have…a hotel!  Where they prepare meals for you and clean your room, fix your hair and nails,  and have parties and….would that not be so grand?  And then mom would be envious of you.”  She looked up and thought about it for a few moments.  “Yes!  That is what I want.”  And that was that.

The moral of the story:

• Holidays are a perfect time to do a bit of a check.  Are there any differences that you notice?  Are your out of town relatives annoying you that something does not seem right with Uncle Bill?  Don’t hush them.  Ask them why.  Let them tell you from their eyes what they see.  It may be nothing…it may be something.  Make a note of it.  Write it down.  It may not amount to much…this time.  But you will have a note to help you remember next time.  Changes in people can be small and unnoticed to those who see them daily/weekly.
• Dehydration is a major issue in elderly. Drinking coffee with caffeine is not hydration.  Thirst is not a reminder.  We need to encourage water.  Add a lemon or lime to make the water “special.”  Also, electrolytes are affected by dehydration and they need to be replace.  Ask their doctor for suggestions.  Think sports…there are good hydration drinks out there but they are not to be used every day.  They are not a substitute for proper water and food consumption.
• If you are multi-tasking in the caregiving area, have someone else take some of those duties off you.  If there is no one, check with local senior programs for services like adult day programs.  They are a daily support that will give you ease of mind.
• Eating proper meals, not frozen TV dinners which are high in salt.  There is no drink substitute for a good meal.  So unless it is doctor orders – real food.  If the preparation is too much, meals on wheels.  If it because they are lonely and need companionship (people do eat better when others are around), senior centers that server a hot meal or find a friend to eat with.
• Check those refrigerators.  Look to see if things have been open or if they are past their expiration date.
• Start developing good relations with the doctor’s office.  Yes, your parent may be threaten by this, but if done in small steps at least the doctor office will know you.  Tell them ahead of time your concerns/issues etc.  Read your notes to them.  If they seem to dismiss your concerns (real concerns about their health)…maybe time for a change.
• Use your doctors influence to help the elder to accept new ideas.  Remember, they are still the geration who think Doctors walk on water (now the baby boomers may be another story).
• There are a number of options for senior housing.  Do not look at it as a one move to end all problems.  There will be another move…or two.  So make your decisions based on the what if’s of life.
• Above all, go with your instincts.  If something looks wrong…something may very well be wrong.

Looking back all these years I wonder if my aunt had chosen a better complex to live in would her quality of life been better.  That six months while my mom was healing were six months that my aunt lost support that we were not aware of.  We had no idea because my mom was covering up for her if she realized it or not.  She was my aunts fail safe; my mom phone calls gave her reminders and kept her alert.  While my mom was gone – no one was there for those daily tasks.  Our once every few days phone calls, which seem appropriate at the time,  did not replace my mother’s hidden duties.  We see this a lot in couples.  Covering up for the others lack…is normal.  We even make jokes about it.  Think President Reagan with Nancy whispering in his ear the name of a person approaching them.  It is part of being a couple that they soon do not realize (or do not want to tell) and it becomes just a way of life.  That is until one is sick or hospitalized or worst.  Then families are taken aback just how much the other needs help.

My Aunt loved her new place and enjoyed all the convinces, as if she was living in an expensive hotel.  My mom and aunt still continued with their phone calls to each other.  My aunt found a whole new audience to teach about those dreadful candles.  When she passed away, I found what seemed like a ton of those little newsprint cutouts explaining the dangers!  And all these years later, I still forget the jello.  I just know she is up there elbowing my mother saying…”I knew it!”

 

My Auntie Vi was my mom’s older sister.  They did not get along very well, but as they grew older they bonded together as if holding on to each other would keep what was to come away.  They would have moments of great disagreements and then they would do the kindest thing for each other.  It kept us on our toes.

Auntie Vi had very strong opinions.  she had this habit of cutting out articles from the newspaper (and making copies) to hand to you whenever she saw you.  Mostly to point out where she got her information from and prove she was right. If that didn’t work she had other ways.  Such as the time she felt we were all going to die if we burned candles, not because of the fire but the fumes.  If we were sitting at a table that had candles lit she would softly remind everyone of the dangers.  When no one would acknowledge this, she would start clearing her throat louder and longer.  She would do this until someone blew out the candles.  Or we could all sit there continue to eat our meal and ignoring the elephant in the room, trying not to give eye contact and keep conversing.

One year I made a wonderful Crown Pork Roast.  She convinced my mother they would die when she saw the meat was pink.   They were so upset I had to take their meat and nuke it until it was almost leather.   To their credit when they were younger it would have been a health risk to eat pork that was pink – after explaining this they would yell “you’ll get worms!”  Because of all the fuss I had forgotten the jello salad until after everyone left the table fo which my aunt exclaimed:  “I knew it!”  And every year after, she would remind me not to forget (and every year it seemed she was right).

My mom and aunt talked on the phone, not once but many times during the day.  It kept them grounded.  It kept them alert.  It gave them a purpose.  At times they would drive the rest of us crazy with the relentless phone calls…but it was good for them.  It kept the sisters together.

It was Easter time and I was to pick up my aunt.  She lived across town and it was an easy trip.  This year we would be going to Stillwater to have dinner by the boat docks.  My brother thought it would be nice for my aunt and mother since they grew up in Boston and always talked about the water. The past few months our attentions were on my mom’s health.  She had had a small stroke.  She was now back in her apartment and doing well.  My aunt had been worried for my mother and missed their daily talks.  So now that my mom had returned home she was very happy to have the calls again.  All was going well for the outing.  We were starting to breathe again from my mom’s stroke.  Things were getting back to normal.

That Easter morning I got a call from my mother.  My aunt was very mad at me.  I was not there to pick her up and…there were more words regarding how bad I was.  I looked at the clock and it was two hours before I had to pick up my aunt.  I explained that to my mom, reasoning that why would I pick her up two hours early to just drive around?  My mom was upset and still was not the best in her reasoning skills from her stroke.  I hung up and called my aunt.  She would hardly talk to me.  She asked “how could I do this to her!” and hung up.  My brother soon called and told me because I forgot to pick her up he would.  He heard the story from mom and he understood.  But to keep all happy I would pick my mom up instead.  We hung up and I stood there numb.  What just happen??

My mom and I arrived before everyone else.  When my aunt got out of the car something hit me.  Something was not right.  My aunt was presentable enough but her hair which is always perfect was not.  Her clothes and shoes did not match and that was a big no-no for her.  I was helping my mother to the table and asked if she noticed.  My mom was more concerned about making any disruptions and begged me not to say a word.  So we sat together and started in the polite conversations, keeping everything positive.  Out of the corner of my eye I did noticed that Auntie Vi would be talking off in the distance about the water and it didn’t make sense.  It was as if she was pointing to someone or asking for someone.  In the rush of ordering and getting our food her comments lost to others kept waking my “work” senses.  Something was wrong.  She was not eating much.  She was off.  Not completely, but enough to make me wonder.  I encourage water and food and soon realize my instincts were right.  I pointed out to my brother what was wrong and told him I would take her home.  But this time she was calmer around me and the glass of water started to make a difference.  She was more alert and seem to be able to track our conversations to the point my mom thought I had over reacted.  I started to second guess myself and came to the conclusion that maybe I had.  But I still wanted to take her home to see for myself if anything was out of the ordinary.

Walking into my aunt’s apartment I saw nothing out of place.  I did a sweep as we talked.  I checked her kitchen cabinets as well as the refrigerator.  All seem well.  She had food that was up to date and even some cookies on the counter with only one or two gone.  So in my check list it seems that maybe it was dehydration and she was doing well now.  I made sure she had some more water before I left.  But something kept me from leaving.  How could it go down so fast?  She was so upset with me in the morning.  I checked her wall calendar and there it was…the time for me to pick her up was right.  I then check her clock to see if that was wrong…it was not.  So at that moment I made a decision.  I  stepped out of the niece persona and went into my working persona.  I went back to where my aunt was sitting and asked her about what she remembers about the day.  In the conversation she was not aware that she had been mad.  I asked her about her hair and if she did it and why not the salon. She could not remember and thought maybe she did not make an appointment (she has a standing appointment).  We talked a bit more and then I explained to her that I have been noticing her forgetfulness.  We talked about these changes and I suggested that maybe I should make an appointment with her doctor and I would come with her – since I could remember better.  She accepted that.  She was doing fine now and I knew she was in a safe place.  I left with a new list – to write down these changes/issues and call the doctor in the morning.

I could not get her in until Thursday.  I had alerted the senior housing staff and was assured they would look in on her.  I called her every day to be sure she was doing well with reminders of when I would pick her up.  That Thursday morning I called to remind her what to wear and time for pick up.  She agreed and would be ready.  I got to her place and when she open the door – there she stood – fully naked and looking a bit panic.  She could not figure out what to wear, or what purse to take.  She was not aware that she was naked. I quickly got her back inside and closed the door.  The niece persona was shocked.  The working persona took over.  As I was helping her get dress I realize that even picking out a slip or shoes was hard for her.  Calming her down and reassuring her I asked if she had eaten breakfast and she said she had.  I gave her a glass of water then I combed her hair and off we went.  I was glad I had made this appointment and ready to get help for her from the doctor.  What I was not ready for was his reaction.

to be continued….