After the Cottage

After the Cottage tag:afterthecottage.com,2009-01-14://1 2009-08-25T22:47:32Z Stories on aging and eldercare issues Movable Type Commercial 4.24-en Carol Mitchell, Adult Protective Services tag:afterthecottage.com,2009://1.36 2009-08-25T23:47:59Z 2009-08-25T22:47:32Z

Carol Mitchell heads Orange County's Adult Protective Services. Together with UCI's Dr. Laura Mosqueda, she heads a weekly forensic task force meeting that reviews cases of potential elder abuse and neglect.

Frank http://afterthecottage.com/mt/mt-cp.cgi?__mode=view&blog_id=1&id=1

(45:12)

If you think about abuse, child abuse is often quite visible and the public has become educated on domestic violence, but elder abuse often happens behind closed doors, often at the hands of family members.

When allegations of abuse or neglect are made, what's the process of investigation?

Carol Mitchell is the Program Manager of Adult Protective Services in Orange County, California. We met through UC Irvine's Dr. Laura Mosqueda. Carol and Laura meet weekly together with other interested parties from law enforcement, mental health and shelter advocates to review cases of adults in jeopardy. If you suspect abuse call the Adult Protective Services hotline: 1-800-451-5155.
]]> Discharged tag:afterthecottage.com,2009://1.35 2009-08-02T00:47:39Z 2009-08-02T01:05:55Z

Mom survives her heart attack.

Frank http://afterthecottage.com/mt/mt-cp.cgi?__mode=view&blog_id=1&id=1 Mom and grandson David

Mom's discharged after a heart attack.

We're elated, and surprised. She's made quite a recovery over the past 8 days. She's back in assisted living with Dad; she'll be taking it easy for a few weeks.

]]> Going home? tag:afterthecottage.com,2009://1.34 2009-08-01T02:30:21Z 2009-08-01T17:13:41Z

Mom's recovering from her heart attack. They're talking about discharge, "tomorrow".

Frank http://afterthecottage.com/mt/mt-cp.cgi?__mode=view&blog_id=1&id=1 Maybe it's Barbara Walters' Audition that's curing her!

She looks great. She's alert, chatty and sitting in a chair. She can take her blood pressure meds orally, so they removed the IV from her neck tonight.

But her blood sugar is high and she couldn't manage without oxygen; didn't last an hour before they reapplied the nasal oxygen feed. She'll go back to assisted living with an O2 tank, and her new walker which showed up today.

My son David and I visited in the morning, took Dad to lunch in the cafeteria and out for a few minutes of sunshine; he got to see David's tricked-out bike. Then David and I did a big ride, the Sand Hill loop, returning at 3:30. A short while later Maureen and Dad slipped away. When Nancy Dudley of Geriatric Heath Services came by, the four of us told stories till 5 o'clock.

I showed Mom photos on the iPhone: grandchildren at the cottage, favorite getaways in Maine, the Coliseum in Rome and photos of all of us siblings with our kids. Mom showed many to Nancy, adding her own commentary. It was quality time and I think I'll arrange our schedule like that for tomorrow, too.

All day different nurses would pop in and hint at discharge "tomorrow". At lunch I told Dad that when this incident first occurred I didn't think she'd ever be going home. "I didn't either," he agreed.

]]> Recovering from a Heart Attack tag:afterthecottage.com,2009://1.33 2009-07-30T05:41:49Z 2009-07-30T05:47:23Z

Mom's in the hospital after a heart attack. Her emphysema makes recovery difficult.

Frank http://afterthecottage.com/mt/mt-cp.cgi?__mode=view&blog_id=1&id=1

My mother's back in the hospital; is she on a 2 week cycle? This time it's because of a heart attack. Her angioplasty shows some heart damage with no opportunity for a stent. Other complications: her doctor describes her long term breathing problems as emphysema. It sounds like the correct term to me.

My sisters Maureen and Kathleen have been shuttling Dad from Assisted Living to the hospital for daily visits. It's been stressful, lots of tears. Yesterday her doctor was asking questions about the extent of care we want. He said most people who go on a ventilator usually don't come off. If she relapses, what response do we want? It's a difficult conversation.

This morning she's looking much better.
]]> Consoling Communities' Eileen Geller tag:afterthecottage.com,2009://1.32 2009-07-21T03:05:40Z 2009-07-21T02:21:00Z

Trained as a hospice nurse, today Eileen Geller works with companies on the issues of serious illness and death.

Frank http://afterthecottage.com/mt/mt-cp.cgi?__mode=view&blog_id=1&id=1

(46:41)

Do you have a "wisdom tradition" for dealing with end of life issues? What is the Five Wishes Living Will? And what about Do Not Resuscitate directives, if you're taking care of Mom or Dad, when should you consider a DNR?

I always thought of grieving as a lonely experience, until I met Eileen Geller of Consoling Communities in Seattle. She shares her experiences as a hospice nurse, "amazingly, it's about living".

Download her free Guide to Care and Support During Serious Illness.
]]> Elder Abuse, UCI's Dr Laura Mosqueda tag:afterthecottage.com,2009://1.30 2009-06-17T01:07:21Z 2009-06-17T00:26:33Z

UC Irvine's Dr. Laura Mosqueda speaks about her work to raise awareness of elder abuse.

Frank http://afterthecottage.com/mt/mt-cp.cgi?__mode=view&blog_id=1&id=1

(28:42)

What's the fastest growing segment of the population? According to Dr. Laura Mosqueda, Director of Geriatrics at the UC Irvine Center of Excellence on Elder Abuse and Neglect, it's 85 year-olds. Since this same demographic is so prone to dementia, you have all the components for elder abuse.

Maybe you're thinking of institutions like nursing homes, but "the vast majority of elder abuse occurs in private homes and the perpetrators typically are spouses or adult children". Surprised?

She and her colleagues have made hundreds of house calls with Orange County Adult Protective Services to look for signs of elder abuse. But that begs the question: is that a bruise because the elderly bruise easily, or is it abuse?
]]> Getting Settled into Assisted Living tag:afterthecottage.com,2009://1.31 2009-06-07T18:52:33Z 2009-06-07T19:47:59Z

After much argument, Mom and Dad settle into assisted living .

Frank http://afterthecottage.com/mt/mt-cp.cgi?__mode=view&blog_id=1&id=1

Assisted living doesn't look so bad. Here they are settled into their own place, making new friends and all of us siblings assured they're getting their meds correctly. Whew! What an ordeal it's been!

They've been visiting for 12 weeks, since Valentines Day. They came for a visit that had some business issues to deal with, like a new Last Will and Testament, a Living Will and a Power of Attorney. Everyone agreed those issues needed resolution, but then it's been one health calamity after another. An accident and pneumonia for Mom, a hernia then a heart stent followed by an infection for Dad. Doesn't sound like much as I write this list of ailments, but combined with their increasing dementia it's made for a difficult time for the siblings.

No matter how many times I answered their questions, "'I'm homesick; why can't we go home?" by the next day they just couldn't recall what I'd said, so round 2 would begin, each iteration a little bit more argumentative, followed by growing resentment and obstinate behavior. They were no fun to live with, nor to visit.

Then a crisis hit. Dad complaining of chest pains meant a trip to the emergency room. After more than a couple of exciting moments, he was out, but moving back in with my sister's family wasn't a suitable next step. He'd need more supervision and care; it turned out to be the deciding factor in favor of assisted living.

My mother moved in while Dad was still in the hospital. We knew he'd go wherever she went. She loved it as we thought she would. The social activities lead to making new friends and from there, life works as you'd expect; she was happy. An anti-anxiety prescription helped to calm her nerves; some of us regretted we hadn't focused on this earlier.

Last week as they settled in, it was time to revisit their doctor and get the results of their cognitive tests. We knew Dad had suffered mini strokes before, at least one, so that was no surprise; likewise his age related brain atrophy. But Mom's brain scan showed several mini strokes; that was news. The doctor adding that "things will only get worse". Mom found that upsetting.
]]> Uncharitable, Dan Pallotta tag:afterthecottage.com,2009://1.26 2009-05-27T00:46:09Z 2009-05-27T00:14:04Z

Uncharitable author Dan Pallotta describes the problems we as a society create for our non-profits.

Frank http://afterthecottage.com/mt/mt-cp.cgi?__mode=view&blog_id=1&id=1

(38:39)

Just read this: if you sit on a nonprofit board don't think you're going anywhere soon, not until after you listen to Dan Pallotta describe Uncharitable, his riveting indictment of how we hobble nonprofits. It's a myth-busting, paradigm-shifting re-examination of what's going on in Charity, in my case, right under my nose.

I'd noticed the review in the New York Times awhile ago, so I picked up a copy then it sat in a pile. But since I sit on 4 nonprofit boards, the sub-title nagged: "How Restraints on Nonprofits Undermine Their Potential"; I took it on 2 long distance trips, a week each in Atlanta then Madrid. What a great companion this manifesto turned out to be.

Like many of my angel investor peers, in addition to sitting on for-profit boards of private companies, many of us end up on nonprofits, too.

For myself, I'd learned quite a bit from fellow angels, especially Tech Coast Angels' Dave Berkus, and I'd enjoyed putting some new concepts on the table and into play for 2 nonprofit boards in the past year. I was enjoying the process: making an organizational change and seeing a pretty immediate positive result, then I did it again for the local school of the arts advisory board I sit on and again, an almost immediate positive change; this was fun, tweeking nonprofit boards was not only possible, but the feedback cycle could be immediate. Like learning to drive, I thought, maybe I can accelerate the cycle. So that makes me and maybe you, too, the perfect audience for Uncharitable author, Dan Pallotta. I need to create a new sub-category on this blog, "myth buster", then Dan could be cross referenced with the likes of Fools Gold author Scott Shane and Early Exits author Basil Peters.

On the 10 hour flight home from Madrid last month I lent my copy to Angel Capital Association Chairman, John Huston. Half way over the Atlantic he hands it back, "this makes my head hurt; I'm getting my own copy!". When I tell Dan, like the interviewer I'm supposed to be, he asks, "what do you think he meant by that?". I was pretty sure I knew and you'll be able to guess once you listen to Dan Pallotta.
]]> Calamity Central tag:afterthecottage.com,2009://1.29 2009-05-26T16:39:26Z 2009-05-28T00:09:08Z

My dad spends the long weekend in the hospital while my sisters minister to my mom. Before the weekend is over my sister Mary will be in the Emergency Room herself.

Frank http://afterthecottage.com/mt/mt-cp.cgi?__mode=view&blog_id=1&id=1
Later Friday afternoon dad suffered a setback that turned into quite a panic. I think it was more serious than the doctor says, his vitals dropped sending every nurse and doctor on the floor into his room, shuffling my mom and sister Kathleen out into the hallway. Whatever color of Code Blue or Red included summoning the Chaplain and I got a teary phone call from Kathleen when they didn't know just how serious this incident was. It was up to me to contact the siblings.

In this day and age how can you reach out to 3 people and not get any response?
]]>
Meanwhile Maureen was arranging to fly up from San Diego. She'd already heard the news and was arranging for Andy to care for the kids. Then Mary called, from Las Vegas. "I couldn't hear my phone in the casino and when I looked and saw all the messages I knew something was up." She was about to fly home to Maine the next day, but I encouraged her to fly the other way instead. Kathleen said they were both a huge help, especially dealing with mom.

Time for a little background... my parents have been 'visiting' since Valentines Day. Visiting is my term, they call it kidnapping. They want to return to the cottage in New Hampshire, it's the season to be there, but they've had one calamity after another since arriving in California. First it was my mother; on day 2 she split open her leg requiring 17 stitches then the day she flew from Newport Beach to Palo Alto she was diagnosed with pneumonia. This cascade of maladies kept setting back any thoughts of flights home. But there was more; my mom's dementia was noticeably advanced since last summer. And the crying, she'd sit in a chair at my house overlooking the ocean which I thought would bring her some peace, but instead the tears were constant. Although she was better with her week long visit to Eric's, she was working her tear ducts at Kathleen's. I raised the issue again, "she's depressed, let's get her anti-depressants and end this funk". Kathleen brought them to her doctor, but apparently this doctor saw more than just a little case of the blues, so he ordered a series of tests for both mom and dad. Cat scans, blood work and cognitive tests filled the next few days and although we're still waiting for some of the results, the cognitive tests offered immediate feedback. My mom failed the simple tests, see Kathleen's report. So they've been in limbo while they wait the results and they're not taking it well. Each day they grouse about assisted living and wanting to live on their own. "I should be able to live where I want even if it means starving to death," dad ranted during the Hearst Castle weekend wrap up at Carmel Valley. However patient anyone of us is to answer their concerns about lifestyle, they struggle to make new memories so tomorrow it's another day of questions and resentments all over again.

Dad's heart problems may clear up quickly as many stent wearers know, but meanwhile he's increasingly delusional, "sundowner" syndrome Kathleen called it. He's lucid much of the day, but looses his grasp as they day winds down. He had to have a full time nurse in his room because he was removing the wires and tubes used to monitor him. We saw similar behavior in Boston while he recovered from his new valve. Now he's on anti-psychotics, vomiting and complaining of stomach pain. A gallbladder infection gets added to the list. Sure, let's ship him back to NH. Kathleen announces that he can't come home to her house, they'll have to move into assisted living. It's taken a crisis, but it's the right decision for all concerned.

So it's time for my sister Mary to return home:

"I got motion sickness, got nauseous + when trying to get to bathroom I passed out on the plane last night + dislocated + fractured my right ankle in two places. the crew on plane were great. Tons of pain. On morphine. I'll tell you whole story when I see you. I've been in emerg since landing in Maine at noon. I have surgery tom afternoon + will have to stay off my foot completely for about 2 weeks and crutches afterward for up to 10 weeks. But will know more after surgery - my 1st one). No phone in emerg room and cell isn't working in here. I can call u when I get to my room, or can call in AM. What a nightmare. Let's see how surg goes and we'll come up w a plan. I can work at home while recuperating. Does dad need gallbladder out? Feel so bad for m+d, but let's take it a day at a time this week before making flights. Pls let all K + sibs know. It I had just stayed in my seat I wouldn't have fallen but I was so sick..."

What a weekend!
]]> Seattle Times: Choosing When to Die tag:afterthecottage.com,2009://1.28 2009-05-23T20:55:40Z 2009-05-23T21:01:47Z

The Seattle Times reports the first authorized assisted suicide in Washington State.

Frank http://afterthecottage.com/mt/mt-cp.cgi?__mode=view&blog_id=1&id=1 Sandi Doughton reports for the Seattle Times. Read the article.]]> NYT: Playing Bridge into your 90s tag:afterthecottage.com,2009://1.27 2009-05-23T20:28:20Z 2009-05-23T20:53:30Z

The NYT reports on a group of dementia-free bridge players in Laguna Woods, CA.

Frank http://afterthecottage.com/mt/mt-cp.cgi?__mode=view&blog_id=1&id=1 New York Times reported on a group of cutthroat card players in a Laguna Woods, CA retirement community that are putting their sharp minds to work. The best of them exhibiting no dementia loss. Is there a correlation between competitive bridge and mental acuity? Read the article.
]]> Dad's in the ER tag:afterthecottage.com,2009://1.25 2009-05-22T19:07:05Z 2009-05-23T21:04:59Z

Dad's in the emergency room, getting an angiogram; he's at risk of a heart attack.

Frank http://afterthecottage.com/mt/mt-cp.cgi?__mode=view&blog_id=1&id=1

Dad's been complaining of chest pains, so Kathleen called 911 last night. He told me of discomfort while we were on the Hearst Castle trip last week, but he told me at 4 o'clock of pain he'd had that morning. And he was combining his laments with his hernia discomforts; he'd been fitted with a truss just before we departed, so I ignored him. At Stanford Medical Center they say he's in grave danger of a heart attack, that one of his arteries is almost completely blocked. They're doing an angiogram this afternoon. He'll probably be getting a stent.

Makes me glad that we did the Living Will back in February. Although he's conscious and still making his own decisions, the doctors are complaining about his dementia. It may be the stress. They're having difficulty communicating, "tell me why you're here today?".

Update: he's proudly wearing a new stent! One of his arteries was completely blocked, now it's flowing like the Merrimac River he claims he wants to see again.

]]> Assisted Dying tag:afterthecottage.com,2009://1.24 2009-05-11T22:16:15Z 2009-05-11T22:21:42Z

Two recent stories on assisted dying get my attention and won't let go... Philosophy Bites does a podcast and the LA Times writes a story; together they make me want to be in control of my own ending.

Frank http://afterthecottage.com/mt/mt-cp.cgi?__mode=view&blog_id=1&id=1
Sometime recently didn't the subject of assisted suicide come up? Or was I telling you of the recent LA Times story, see below. Anyway, put that new iPhone to good use and check out Philosophy Bites, podcasts of top philosophers interviewed on bite-sized topics. They did a beautiful 13min show on assisted dying; I can't stop thinking about it.

Then last week, the LA Times did a piece on assisted suicide in Washington State. Written from the perspective of the grown children caring for their father in his final days, they describe rural doctors that are unwilling to write prescriptions for those suffering terminal illnesses, even though it's legal to do so. These doctors are concerned about acting "against their conscience". Meanwhile Stephen Wallace, a pancreatic cancer sufferer, dies in agony. ]]> Hearst Castle is in Canada? tag:afterthecottage.com,2009://1.23 2009-05-09T00:30:45Z 2009-05-26T17:31:43Z

Kathleen http://afterthecottage.com/mt/mt-cp.cgi?__mode=view&blog_id=1&id=5
Then she had to draw the face of a clock inside a big circle on paper. She was told not to draw the hands, which she preceded to do, then couldn't understand what "draw" a clock meant. We told her several times to just write the numbers of the clock inside the circle. She was very confused by the directions and started at 1 at the top, and got to 5, which she wrote where the 3 is on a clock, then stopped writing the numbers. The nurse asked her to put in the hands at 10 past 11. She couldn't do that either. She asked for help but the nurse told her to just do it the way she thinks it should look. I took a look at the finished product and it looked like she put in more than 2 hands and they were no where near the correct positions. Nurse then asked her to repeat those 3 words, and she only remembered apple pie ;(

I was asked to step outside during the depression evaluation. When I went back in the room mom said she told the nurse she was very happy. So I'm not sure how that went. While we waited for the doc to come in mom said she had wanted Dr A. in NH to do these tests, but I told her we couldn't wait, that we had to take care of her medical needs now and it wasn't good to wait.

Doc asked, How would you like things to be in 12 months? She said she wanted to go home to Massachusetts, then said NH, then said a place they go where there are lots of people who live near them and they help each other. She couldn't remember FL or Treelakes and was frustrated by that. Doc recommended I get them involved at a local senior center; he wants them out meeting people and making friends.

He told mom that they should continue their plan to go east "to tidy things up" but that they need to come back here. Mom said she wanted to go back to FL and live independently. He told her that was "unrealistic" and "you are fooling yourself" to think that. There was no moving back to FL. He was very gentle and kind with her, she did cry though. She asked why at 80 years old she couldn't decide where she was going to live, and he told her that she was very lucky to have her children helping her, and that she needed to listen to us because we loved her and had her best interests in mind, and that he hoped he would be lucky enough to have his daughter guiding him when he was 80.

He talked about how he moved to CA and it took a year to like it, and now he loves it. He told her she needed to start a new chapter in her life, that different generations shouldn't live together, it wasn't good for any of us, and that they could have more independence and feel productive if living in Assisted Living. Her EKG last month was abnormal. He needs results of prior tests to make a comparison. This is on his list of concerns but not high right now. She gained 4 pounds - 128 now. He may consider some new meds for her but wants to get blood work and brain CT scan done first.

Dad: we found him wandering in the hall - he left his exam room instead of waiting for us/doctor like he was told. He told the doctor that he was confused because he didn't remember that he had a doctor appt today (!), of course I had told him and he had already been with the nurse doing the cognitive test and his vitals. BTW- I got a peek at his clock, and he had done it correctly!! He put in the 12, 3, 6 and 9 and drew the hands at 10 past 11! Not sure how he did on the 3 words but he couldn't remember any of them in the car on way home - mom remembered apple.

Dad has a hernia, very common, (no sign of stone on the scan) which means that part of the intestine is pushing through the muscle wall in the lower right pelvic area, can slide in and out. Options are surgery, which is effective but risky, or wearing a hernia truss (compression belt) during the daytime, a partial solution. Doc wants to try truss first and see how that goes. Dad's blood work was ok & stable. Doc ordered brain CT scans for both of them, and a fasting blood test for mom - a full panel. He didn't address dad's driving, or his managing the sale of the cottage, which I had brought up with him & mom. I asked about Assisted Living in front of dad, he told doc he was against that. The doctor told them both that they are in transition right now and that they need to open their mind to the possibility of Assisted Living.

They go back in a month for a follow up, which keeps them here until about mid-June. We're going to Mothers day tea on Saturday at the Assisted living. Also - Mom can't grasp that Hearst Castle is south of me. I've corrected her many times, and even showed her on a map. She keeps saying north, then last week started saying it was in Canada (?) ;( Both were very subdued the rest of the day - I think mom was surprised at how poorly she did on the tests.]]> Alzheimer's Dr. Maria Carrillo tag:afterthecottage.com,2009://1.8 2009-05-06T23:18:13Z 2009-05-23T23:24:44Z

Dr Maria Carrillo is the director of Medical & Scientific Relations for the Alzheimer's Association's National Office in Chicago.

Frank http://afterthecottage.com/mt/mt-cp.cgi?__mode=view&blog_id=1&id=1

(40:56)

Has it touched your life, affected one of your loved ones?

"Alzheimer's is the public health threat of the 21st century," says Maria Carrillo, Director of Medical and Scientific Relations at the Alzheimer's Association in Chicago. Although it's the 6th leading cause of death in the US, and working its way up, "there's so many different avenues of research that are being pursued right now that give us a lot of hope". Like drugs in Phase 3 trials, for example.

Where are they at? They're doing a lot of basic science research. Maria describes how the research is working back in time; they know the end result and they believe the disease begins 20 years prior. Do the math, that means the disease is beginning for many of us right now!

"Probably 95% of our donations come from individuals." So they have quite a marketing challenge and have to keep getting the word out, like: "there are 5.3 million Americans living with this disease today". Last year they donated $26M to fund research, a new high; a lot of it going to new investigators.

]]>