Archive for the ‘Joan’s Pearls Of Wisdom’ Category

Wrenching Choices At The End Of Life

Posted on June 18th, 2013 by karen

"Give me a good glass of wine, play me some Mozart..."

by Joan Blumenfeld, MS, LPC

If I’ve told my children once, I’ve told them a thousand times. “When I’m near the end of my life, give me a good glass of wine, play me some Mozart, and LEAVE ME ALONE!”

I’m being only partly facetious. The wine and the Mozart are easy. Leaving me alone without trying to fix me is the wrenching part. Believe me, I know. I muddled through this process with three family members whom I loved deeply, and I’ve watched families of my frail, elderly clients go through the same experience.

Even when advance directives and living wills are as specific as they can be regarding Do Not Resuscitate orders, feeding tubes and ventilators, families still struggle with the decisions. There are conflicting views within the family, as well as conflicting medical advice, not to mention the uncertainty and fear in their own hearts and minds.

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Managing The Move

Posted on March 7th, 2013 by karen

Moving boxes

by Joan Blumenfeld, MS, LPC

Moving from your home is rightfully included on the list of life’s most stressful events. It’s stressful even when you’re young, but overwhelmingly so when you’re older. Leaving the “ancestral home” where you may have lived for 30 or 40 years, where your children grew up, is tremendously difficult, fraught with anxiety and a combination of dread and grief. For some, it may be exciting to locate and create a new home but for many elders, the attendant changes in residence, social network, recreation patterns and sense of community can cause a deep feeling of disconnection.

Just the thought of cleaning out years of accumulated stuff is burdensome: outgrown toys, old clothes and other childhood artifacts, broken tools, boxes of tax returns and other out-of-date papers, old bicycles and chairs that someone meant to repair but didn’t, skis, ice skates, tennis racquets, sports equipment that hasn’t been touched in decades, odds and ends of the family’s history and overflowing collections of just plain old household junk, all piled high in attics and basements.

The seemingly endless list of decisions to be made can be paralyzing: what to take, what to leave, what to give away, what to throw away, what to sell . . .  And sometimes there is troubling internecine warfare over which children get to take what family treasures and heirlooms.

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Aging In Place

Posted on February 12th, 2013 by karen

by Joan Blumenfeld, MS, LPC

Hurricane Sandy gave me something to think about regarding my frail elderly clients, some of whom were stranded without power or heat for a week or more. My clients universally want to “age in place,” as most elderly people do. They want to stay in their beloved homes, surrounded by their treasured belongings, living in their familiar communities until their lives are over. However, aging in place requires adaptation and change to make it a viable option for a safe and comfortable quality of life. But not everyone is ready to adapt, and few are ready to change.

Indeed, I am struck by the stark differences among my clients regarding their willingness, or lack thereof, to make the necessary adaptations to their circumstances.

For example, after the hurricane, one elderly couple I know, who could well afford a top-of-the-line generator, refused to get one. They did not want to spend the money, nor would they leave their home for a shelter of any sort. They said they would be fine by just adding another blanket or sweater and could survive an extended power outage, even though they knew that long periods without heat can be dangerous, even life-threatening, to older adults.

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Combating Isolation

Posted on January 29th, 2013 by karen

by Joan Blumenfeld, MS, LPC

Isolation is what we do to punish prisoners. Isolation is what we do to punish psychiatric patients who act out. Isolation — “You need a time out!” — is what we sometimes do to discipline small children. And isolation is a cruel reality of old age.

Our society is growing older by leaps and bounds. By the time people are in their 80s, their social structures have faded away. Children and longtime friends have moved or died. Concerned family members are often geographically unavailable. Spouses may have died as well, leaving the elder in the community alone and lonely.

Frail elderly people are less able to get out and about because of limiting medical factors. Driving becomes problematic. And even for those older adults lucky enough to age with adequate help in the home, isolation becomes a serious matter. The finest of aides can only do so much: feeding, clothing, bathing the elder, managing the household. But they can’t be all things to their patient.

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Saying Goodbye

Posted on January 15th, 2013 by karen

by Joan Blumenfeld, MS, LPC

My mother died in 1998. She was close to 95 years old. I was . . . well, mostly prepared for it. She had struggled with Alzheimer’s for nearly 10 years and had been in the final stages of that devastating disease for many months. She was curled up like a fetus in her bed at the nursing home, unable to speak, unable to swallow, barely able to move. So it was not really a surprise when the nursing home called to say Mother was “actively dying” (a medical term for the process whereby bodily functions visibly shut down) and that they did not expect her to live for more than another week.

I immediately flew into high gear, rearranging my schedule to be available for those final days and hours of my dear mother’s life. I canceled an impending trip to England (luckily, it was well insured!), canceled all professional appointments and social engagements, and spent part of each day at Mother’s bedside.

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Hoarding: An Intractable Problem

Posted on December 4th, 2012 by karen

by Joan Blumenfeld, MS, LPC

My 85-year-old client, Mike, was a charmer. Even though he was becoming increasingly confused and forgetful, he had a way about him. He was articulate, gracious and a good conversationalist. He had many interesting stories to tell about his family history and his many years curating a world-class museum of Islamic Art.

Mike was attractive, though a little down at the heels in his attire. He carried a bunch of keys on dirty strings around his neck. Some were to the door of his apartment and his mailbox, some for his car, and some which no longer held any recognizable purpose. Mike’s old friends had either passed on or moved away, and his family lived at a great distance. Mike had consequently become seriously isolated.

And worse yet, Mike was a hoarder. He didn’t collect things that had any intrinsic value, like coins or antiques or stamps. Instead, he hoarded old newspapers: The New York Times, The Wall Street Journal, the local town paper. He saved outdated calendars with photos of sports heroes and mountain landscapes and sailing craft.

He collected dozens upon dozens of greeting cards that he thought he might want to send to friends, but somehow never did. There were solicitations from every wildlife organization on the planet; from every Indian reservation in the USA; from local and national charities of every description; not to mention bank statements from years back and, most threatening of all, unpaid bills and import renewal notices of all sorts. In fact, papers were stacked several feet high on every available surface in Mike’s apartment, except for the kitchen and the bathroom.

Mike could not bear to part with one single scrap of paper. He felt an urgent need to keep everything . . . just in case. He thought that one day he might want to read an interesting article he’d overlooked or donate to a charity he’d forgotten about. The very thought of cleaning out his apartment was completely overwhelming, even paralyzing.

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Save Your Pennies!

Posted on November 15th, 2012 by karen

by Joan Blumenfeld, MS, LPC

In Connecticut, if a person can pay for nursing home care out-of-pocket for several months, or in some cases show enough assets to pay privately for a year, they can select the facility they want and reduce waiting time. If they have spent down their assets and are subsequently accepted by Medicaid, then Medicaid will select the facility, depending on wherever there is a long-term bed available. Thus, setting aside money to privately pay for nursing-home care allows people to make crucial choices they cannot otherwise make.

My 72-year-old client, Sylvia, was outliving her money. And her worst nightmare was inexorably unfolding.

Sylvia was recovering from a stroke and was about to be discharged from rehab when I was hired by the court-appointed conservator to manage her care. Sylvia desperately wanted to return to her nine-room home in one of Connecticut’s lovely shoreline suburbs, but she was ill-equipped to do so.

As a result of the stroke, her walking was impaired, though she could ambulate unsteadily with a walker. One arm and hand were weakened. Sylvia had already been experiencing some dementia, which was exacerbated by her stroke, leaving her judgment and ability to manage her money, her meals, her medications — her life in general — severely diminished. She also struggled with an unrelated life-long mental illness that resulted in hallucinations and delusions, which impaired her relationships with others and required careful medicating.

From a Geriatric Care Manager’s point of view, Sylvia was a challenge!

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A Field Trip For Mary

Posted on October 30th, 2012 by karen

 

by Joan Blumenfeld, MS, LPC

Eighty-nine-year-old Mary had every reason to be sullen and depressed.

She’d had a stroke that left her unable to walk, swallow properly or take care of her personal needs. She was fed a nutritious solution through a tube permanently inserted into her stomach.

Mary was widowed from a husband whom she had treasured dearly. She had no children, and her relatives were few and lived far away. She’d been a biologist in her earlier years and was still quite sharp mentally, but spoke rarely because she was self-conscious about the swallowing problem which caused her to drool. Mary had been an avid reader but now had poor vision, and this prevented her from reading anything but very large print, and even that was dauntingly difficult.

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Stranded In Connecticut

Posted on October 16th, 2012 by karen

by Joan Blumenfeld, MS, LPC

Sally was a wonderful daughter. When her father, a former mover and shaker, began to decline mentally and her mother became increasingly frantic and depressed, Sally stepped right up to the plate. She offered to build an addition onto her beautiful antique home in Connecticut and move her parents in with her so that she could help take care of her father.

Sally built a stunning new wing onto her house. It had a large, sunny living room, a sweet dining area, a spacious bedroom with full bath, a small kitchen, and a front porch with twin rocking chairs. She built a separate entrance for the new wing so her parents could come and go as they pleased.

Her parents made the move with a mix of excitement, anticipation and trepidation. It was a huge change for them. They sold their 12-room Victorian mansion in Tennessee. They terminated their membership in the country club where they had been at the top of the social ladder for years. They left their church and the community where their children had grown up and where Sally’s father had owned a business that employed half the town.

But now Dad was retired and needed care. He was well into mid-stage Alzheimer’s disease. He would wander and get lost, he was forgetful and confused, and his decision-making judgment was no longer sound.

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A Good Death At Home

Posted on October 2nd, 2012 by karen

by Joan Blumenfeld, MS, LPC

Eli wanted to die, and he wanted to die at home.

He had no children and no siblings. His wife of more than 60 years, who meant everything to him, had died a few years before. He had some distant cousins scattered around the world, but he had not been in contact with them for more than half a century.

Eli had congestive heart failure and refused his medication. He refused to eat or drink. He had a bed sore the size of a saucer and as deep as a cup. Eli, who had been a smart, cultured, feisty, interesting and handsome man, was now frail in the extreme and approaching the end of his life.

He had lost the will to live.

I was called in by his lawyer, a good friend who held Eli’s medical power of attorney. Eli was to be discharged from the hospital the very next day. He had been there for a week being treated for the bed sore and dehydration. Not surprisingly, the lawyer was at his wits’ end. He had no idea what kind of help Eli needed or where to find it. That’s why he called me — this specialized knowledge is the purview of a Geriatric Care Manager, not a lawyer.

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