The Choice Is Yours, You Make The Choice

Some words and phrases have lives of their own.

"It's a choice. You make (have ) the choice." 

Two sentences. Very few words. 

A single word, "choice", that changes dramatically when the words "you make" or "you have" precede it.

Simple word "choice" and no real negativity implied .... until you're placed in a life situation where the "circumstances" surrounding and possibly implementing this word can hurt, harm or even destroy life as you know it.

Unbelievably powerful statement especially when "choice" is not between "which choice to make" but "if", "what" and "when" a "choice" is made.

There can be deep and life affecting interpretation based on who you are, where you live, how you live and what you interpret these statements to mean.  

In this case, the words keep resounding in my mind as I move through life and am faced with decisions, many of them until very recently, considered to be not capable of considering let alone having to decide between or among.

Life has changed. The resounding and ringing in my ears applies to today and often interupts my forward movement as it conjers up the harsh and destructive spoken and written words by some for the "choices" we were making and made.

A heavy burden I try to lay down, try to set aside and sometimes succeed. It remains, however, and is taken on sometimes unknowingly and sometimes undesired through words and actions about "choices" then and now.

The person making the statement has known a life of privilege from birth through adulthood.They deserve what they have and work hard to get and keep it.

The person, me, this was said to, also was privileged for several years, but tried to teach the lesson of walking in another's shoes before determining how they should walk. 

I knew personal sacrifice; making decisions when the "choices" were not what was wanted. I had good training. I know I passed that along to my youngest as we walked the path together and made the sacrifices together through the choices we made.

We grow accustomed to privilege. 

We grow accustomed to any move beyond where we've been. 

It's the coming down, let alone the crashing, that few understand.

It's the not seeing that for some, life doesn't  provide opportunities, possibilities and the doors opening without challenges and consequences.

Or, that life interupts, interferes or just simply doesn't move past where we think we want to be, want to go or want to do.

Does this person have major life challenges? Quite a few.

What they've not had is everything or almost everything removed, taken away or needed to provide for those they love and not able to replace or even substitute. 

Major life interruptions; major life changes remove the "choice" from the "change".

Moving up and down the scale of "privilege" isn't always a choice. Sometimes the ascent or descent is more of a spinning than a climb and sometimes the inability to fully control movement isn't within your scope of ability or action.

Sometimes it's life's way of providing situations to learn and then to teach; to experience and to remember and reflect clearer than we could have without that first hand personal involvement.

For the two of us, we move forward ever learning from the past and the present.

The medical challenges, the harm done by others who found fault and the losses daily and cumulative, continue to be turning points in lives we live daily and have turned adversity into positive focuses.

Your life is and will be beyond the boundaries of the daily challenges and inability to see an end or even remember fully where the beginning actually was.

From your unique experiences you will find ways to beneift yourself and others.

You retain what others can not understand -- personal life changing experiences from a vantage point that cannot be bought or sold, cannot be moved into and out of just by getting up, moving away and on with your life. 

All I ask now is what I asked then....do not see my life or other's from your point of view. You have choices with few limitations or at least you have choices.

 I and others who have walked this path know life isn't about choices, it's about how you look at, how you handle life and what you do, as always, for others and for yourself that are the true Privileges & Choices in life.

Stepping Aside, Standing Up or Playing The Waiting Game

Another life's journey walking this time with a friend down the path leading to.......

When should we "let go" and "just let it happen" even if we believe the journey should never had started, was a "push into" and is done with steps not of love but of getting tired of having to do?

DHSS WHERE ARE YOU?  So secretive. So sensitive. Hidden behind closed doors my friend labors through a fight she has no control over; she's given meds, heavy doses of antipsychotic drugs, all with claims "they're needed" and all with the "blessing" and "formal acceptable procedure" of a Dr writing the script allowing daily doses of multiple types. And the DHSS?  One female representative told us "If the Dr prescribed it, it's needed." REALLY?  Wonder how often she's resided in LTC?

WHERE ARE YOU, DEAR READER?  Why isn't there an outcry among the population? Do we really believe Dr's are "perfect" and "can do no harm"?

WHAT CENTURY ARE WE LIVING IN?  Dr's CONTROL medical situations in Long Term Care. They work FOR the facility; they're given the "appointment", they're "selected" by the Facility. So who do you think they please --- the patient, the family? THINK AGAIN.

Outside the walls, the windows and the doors our loved ones wait, watch while they can -- and know......they lose their ability to speak up, or it's made silent.

WHY?  Staffing. It's challenging to hear the calls of someone who NEEDS help. Sleeping or drugged in bed, their bodies lose fluids and solids and you can turn them when you have time and attend to changing them.....when you have time.

OVERWORKED. I hear that a great deal. WE'RE CAUSING CHALLENGES WITH OUR REPORTS.....our caring for and about those they agreed to care for.

COMMODITIES.  Valued for their worth?  If medicated, add that to the billing. Watch to see what's "allowed" and what's "devalued" in level of payment to the facility.

Even Non Profits have to keep their doors open and if this has to be done to one....or more...it is, after all, for the "common good", right?

DOLLARS AND NO SENSE as a measurement of human value 

But these are BUSINESSES.  Not For Profit or For Profit entities.

After all.....there's another "bus" coming along any minute.....Seniors are growing older every day and their numbers.....well, we've seen the Statistics.

It's the biggest opportunity out there and if you can make them another "SILENT MAJORITY".....you have a gold mine that just keeps giving.

HARSH?  UNFAIR?  NOT TRUE?  I wish. You should be doing more than wishing because we're all headed down that road and it's a fearful one.

Think you have enough money to get through it well?  Maybe. There are pitfalls most of us do not see, cannot see and won't see -- and we may not have anyone who really does or cares.

LIFE IS WHAT YOU MAKE IT?  Yes, it is. What will you do today to learn the truth, work for change and protect the most vulnerable of our society -- those in Long Term Care who are past the time of being "profitable" for the Long Term.

HOTLINE: Missouri Elderabuse -- Dropped Off, On Hold, Where Are They?

HOW BAD IS IT ... THE NUMBER OF MISSOURI ELDERS BEING ABUSED?

Judging from my attempts this afternoon to reach and report my friend's treatment in a Missouri Long Term Care Center either they have a very small staff to answer the phone OR their system can only hold so many calls.

I'm sitting on HOLD while music plays but it's taken me 7 attempts to dial, listen to the recording (a shortened form follows) and to be hung up on because apparently the "waiting line" was too long to hold any more calls.

Seven minutes into hold.  Music plays. I wait to be connected. Is this a matter of Life and Death? Of course it is. Is it one that warrants as the message directed to "Call 911" -- no.

Abuse can be severe and constant or it can be slow and steady and almost non noticeable because it's done so "professionally"

WHAT IS GOING ON?  This department is associated with the DHSS. We've heard about other "miscommunications" in this Department.

BACK ON HOLD....MORE BACKGROUND INFO...  so here I sit....10 more minutes go by ...not like I have nothing to do...business could be taken care of...trying to get away to visit Carol as I'm worried about her...

Are there so many calls the lines are all in use?  Are they short staffed?  Twenty minutes have gone by and I'm on a HOTLINE??????

Then the next message with the last statement that really upsets me

All staff are currently busy assisting other callers. We apologize for the inconvenience. Your call is very important to us.  Please call back at a later time so that we may assist you.

Isn't this an EMERGENCY LINE?  Who ever heard of calling back to an Emergency Line?

Maybe they should rename it and change the title from Elderabuse Hotline to Elderabuse Reporting Line.

I finally get through. List my concerns and hope someone will connect with me and follow through.

Time Will Tell.

WARNING! Long Term Care Comes At A High Cost

We spend time searching for information comparing and evaluating everything from recipes, childcare, books, automobiles and every tech product on the market.

WHY DON'T WE FIND A WEBSITE WHERE THE GENERAL PUBLIC IS GIVEN THE OPPORTUNITY TO RATE AND REVIEW LONG TERM CARE FACILITIES?

Like "Social Problems" as I learned in a course last year, it's most probably because it's "not a problem until enough people say it's a problem".

WHO WANTS TO VOLUNTARILY GO INTO A LONG TERM CARE FACILITY?  

I've spoken to hundreds of people and have found not one single person who wants to live in Long Term Care if given the choice.

LONG TERM CARE is almost always not a choice but a necessity.

"The average stay in a nursing home is 835 days, according to the National Care Planning Council. (For residents who have been discharged, which includes many who have received short-term rehab care, the average stay in a nursing home is 270 days.)Jun 28, 2018"

https://www.agingoptions.com/.../how-many-seniors-really-end-up-in-nursing-homes/

LTC is supposed to be for the most advanced cases of medical supervision. 

HOWEVER, it's not always that way. 

Due to lack of financial capability men and women enter Long Term Care because our Federal System of Medicare does not provide for "accomodations" in its coverage for those medically challenged. 

A majority of our aging do not have the financial means to "plan ahead" or Long Term Care Insurance that will actually pay for quality Long Term Care -- and there is a BIG difference in the type of care provided in LTC's.

"Although Medicare covers long-term hospital care, you could face significant charges if you receive long-term care beyond three months. In 2018 under Medicare Part A, you only have $0 coinsurance for the first 60 days of each benefit period. For days 61-90 you pay $335 per day of each benefit period. For days 91 and beyond you pay $670 coinsurance per each “lifetime reserve day” after day 90 for each benefit period and you only have up to 60 days over your lifetime. Beyond the lifetime reserve days you pay all costs until a new benefit period begins. " medicare.com/coverage/medicare-cover-long-term-care/

When will Long Term Care be a Social Problem?

A Social Problem is defined as being an affect on the general population that is recognized by a significant enough number of people to continue to draw attention to it from many sources and resources.

IN ACTUALITY: Long Term Care will continue to be a problem because Society sees the "inability" of individuals to provide for "quality healthcare" as they age -- including these amazing and luxurious residences springing up that now include Independent Living, Assisted Living and Long Term Care -- as NOT SOCIAL PROBLEMS, BUT INDIVIDUAL POOR PLANNING FOR THE FUTURE.

Did my mother want to go into Long Term Care?  NO!  She was convinced by an individual it would be in her best interest but then that individual walked away with cash and visitation rights to see Mom and control her including, in my belief, advancing her symptoms through feeding her delusions. 

Long Term Care even in the nicest facilities is still in the dark ages. 

Until we understand quality of life including personalized care plans reviewed by the family and provided on a weekly basis,mandated to be shared with at least one person, are the only way to keep the light turned on bringing it into LONG TERM CARE FACILITY RESPONSIBILITY AND ACCOUNTABILITY we will continue the endless circle of Long Term Care at a High Personal Price -- the lives of men and women who receive not the best but the least society chooses be provided.

Half A Century: Cause For Celebration: Happy Anniversary!

Looking back is easier when knowledge of what could have been done, should have been done, is the subject of a discussion long past the time of the occurrence.

Old adage:  hindsight is 20/20; foresight is often blind.

It's past. Turned the corner. Moving evermore forward.

Challenges come into my life's path; it's my decision how to handle, what to do and how to make this time effective.

Some words are so interesting --- the simple change of one letter changes the entire subject -- like the word "come" and "came".

Challenges happening and continuing are constant and immediate.  

Challenges handled and survived that are overcome become "past". 

If we learn well, even when they come again, in what shape or form, we have the lessons we learned, the knowledge gained, to apply, even if the challenges are greater, more severe and longer.

I miss you. I'd never thought I'd be where I am and where you are today, at this time in life, in this way.

The other "anniversaries" will still come and go; those of celebrations and those of unanticipated and unwelcome life events.

For now, this time, the celebration is in having had the opportunity to share life with another, create a life and our lives together and to spend what time we had, were given, simply put.....together....even when we were apart.

How do you express "happiness" when the anniversary or the event isn't like it was  for so  long .... together.... occasion for celebration of years added one by one.....?

You walk the path of rememberance. 

You take joy in what life was together. 

You realize and recognize --- 

          it could have been less, it could have been more....

You Give Thanks ..... 

       for what you had and what you have....

           memories & experiences of being together!

WHY ME?

I try to step away. My feet are turned back. 

I try to look away. My eyes are drawn to see.

WHY ME?

I don't feel what I've done has been enough.

I'm hurt. I'm angry. 

I don't understand so many who fail to see.

I wonder if what I've done will benefit those in need?

So little done. So much to do.

WHY ME?

Looking back I see the road set out before us and especially the path I've taken.

We walked each step without realizing where it was going, how it would twist and turn and when we would encounter the many dips, plummets, swerves and curves. 

We simply continued the journey believing we were making choices and they were right for the times, the places, the people, their wants and needs.

We had blinders on. Some we placed upon ourselves while others were custom built by others who believed it better not to know everything, not to know the possibilities and for some to want to experiment with something they believed would happen.

Counseling. Not a reality. Confronting. Not the choice.

Decisions made and challenges met forecast the future we did not see so focused on the present were we all the days we shared.

Problems only exist when enough people recognize them and draw significant attention to them. Or so I learned in a class I took several months ago. Social problems, that is. Life problems, I also add, from my own experiences.

NOT TRUE. 
Problems exist with or without "recognition" and with or without individual or group involvement in trying to resolve them. 

Problems that are "social problems" are INDIVIDUAL PROBLEMS -- those that affect us, one by one, in families, groups and as members and part of an organization.  

We are not alone. We are part of everything around us. We determine singularly and as a part of the whole what happens, when it happens and how it happens.

LOOK and SEE.  LISTEN and HEAR. 

WAIT TO ACT AND YOU WILL BECOME A PART OF THE PROBLEM.  

TAKE PART and BE A PART OF THE CHANGE THROUGH SEEING, LISTENING AND ACTIVELY MOVING CHANGE FORWARD.

SIMPLY PUT:   IF IT'S TO BE, IT'S UP TO EACH OF US -- ME INCLUDED.

I've set aside my action to enlighten and encourage others and it's time to take back the reins of what I see -- a run away system that only provides for us when we look, observe and constructively make change when the direction becomes offest, out of line and going the wrong way.

Look for more. I'm looking, I'm listening and I will continue to take action and make positive change.

What will you do to make a difference?

Wounds and Sores No Regulations Federal or States

Mom suffered many wounds and sores in her facility from abrasions to openings large enough to require stitches. 

They were overlooked, mismanaged and caused many additional medical costs, pain and suffering.  

Mom had inadequate monitoring of medications -- A MAJOR PROBLEM IN LONG TERM CARE FACILITIES WHERE DOCTORS ARE "ON STAFF".

Computer programs are often old versions that do not  provide anything more than basic "accounting" of medications administered.

These "recordings" are often done by staff who move from one to another and then "enter" the distribution after administering to several patients -- often questionable as to time administered, dosage, etc. 

Recordings of services provided are often not entered until the "provider" can find the time between being called to one and then another and another and only being the single staff person available or perhaps one of two to serve as many as 20 individuals needing assistance and all in varying stages of capability and need for personal assistance.

Doctors are admitted to practicing at the facility and as such are "employed" by the facility and subject to release by the facility. 

While many will tell you is difficult to find Doctors willing to go into a facility, I believe if an accurate invesitigation was done of the number of "patients" seen by a Doctor during one visit to a facility of one hour was recorded we would find less than 5 minutes was spent with each one

I've observed Doctors moving from person to person, in an open environment of a general gathering place like the hall, or an area where food was served or patients were "parked" for hours on end. No gloves, no change of gloves, no washing or sanitizing of hands.

Not only does this violate a person's right to HIPPA privacy it also violates their right to dignity, self determination and privacy as I've witnessed Dr's using stethascopes under garments they lift or lower and other examination procedures in full view of residents, staff and visitors.

AND WE WONDER WHY DISEASES SPREAD SO RAPIDLY WITHIN LONG TERM CARE FACILITIES?

QUESTION:  If this is done in sight of a "visitor"? What might be done when one is not present?

Today, reading more Rules and Regulations for the State of Missouri and reviewing sites giving advice on preparing for the “annual” visit by the Department of Health and Senior Services reviewing Long Term Care Facilities,I was shocked to read the following:

“Neither state nor federal regulations require a facility to keep/provide a report” on pressure sores/wounds.

Here’s our personal list of a few wounds and sores that we believe warrant specific reports generated with or without attention by a Doctor or by an outside Medical Facility:

Mom fell, she suffered a “wound”, a cut; facility looked at it and determined no problem; we took her to the ER and the Dr on duty assessed a need for 5 staples. There was no entry in her record about this “wound” from the fall.

Mom was subjected to having a rough towel used to remove hardened fecal material on her anal area with a rough, scrubbing procedure. This caused bleeding of the Hemhorroids and sores on the exterior part of her anal area. Her screams could be heard all across the floor; I know, I was there.

We noticed small sores on her legs caused by flaking of skin and rubbing of her legs against something. We were told there were no “sores”. Taking Mom to a wound specialist who’d seen her before she was given specific medication for infection and specific instructions for wound care – which was not followed by the facility.

Mom had pressure sores from sitting in a wheelchair for long periods of time; she had pressure sores from not being moved and staying in one position for long periods of time.

Time has passed. Mom passed in 2014. Procedures have not changed. When are we going to speak up about this abuse of our least capable population of human beings? 

Our mothers and fathers, sisters and brothers, relatives, friends and even people we've never met are being treated as though they were less than human and even lower than some animals we keep in captivity or in shelters.

Look Before You Leap: Visit, Shop Around Long Term Care

Even if you have no intention of "going into" a Long Term Care Facility.....SHOP AROUND AS THOUGH YOU NEEDED IT NOW.... or someone you care about is already in imminent need.

Why?  Simple.  We shop for everything else in life but almost all of us don't think we "need" to shop for something we "don't need at the moment". 

How many college visits did you make with your kids? How many people did you date before deciding this was "the one"? Belong to an organization, a club or even making a choice where to eat or meet -- most of us put more into those choices than we do "a place to live" when living means more extensive medical care and supervision.

You need to visit more than once and walk the facility, all areas, check out the on line information from the DHSS including Annual Reports. 

Know where you/your loved one wants to go if it's the choice that needs to be made. IF YOU DON'T, you'll settle for someone telling you where to go and what's available and won't have any ability to choose, you'll just have to "go" where you're told "has space".

Google/Search the web for comments from people who have loved ones there and you won't always find it where you think it will be.  Look for Blogs about families with loved ones in LTC, Assisted Living or Independent Living. 

Visit every facility within a twenty five mile radius of where you want to reside or place a loved one.

Why that distance? Easier to get to for you in times of need and just to visit more frequently because it's closer.

Do not eliminate any facility because it appears to be high priced or very inexpensive. 

You'll get ideas and see the possibilities to look for at those that are in your budget or category of care range.

Just as you'd shop for a home or apartment -- make a list of what inclusions and features you want to have.

Is there an outside area that residents can use BY THEMSELVES and without having to be "admitted". 

Even if they have mental challenges or wander, an enclosed patio with sturdy chairs, of adequate height and with arms for pushing the body up and easing down, are important.

Put yourself in "their" place. 

Have them use their cane or walker and walk with you from point to point to see their abilities and challenges.

Remember! Their movement will usually become less and less and they will probably advance to other forms of self movement that are more limiting as time passes.

Get into a wheelchair and see from their perspective how far it actually is to get to the dining room, the main area where family and friends visit and even from one room to another on a floor to visit a new "friend". 

Attend a meeting of the Resident Council and the Family Council. They are two separate organizations.

These should be open to the general public although membership is generally exclusive to residents in the one and to family members/friends of residents, in the other.

Talk with residents about what they did today, yesterday and even a few days ago.  

What does the facility do to transport residents to outside activities and for excursions (shopping, etc)?  
Who goes? How are they selected? What's the cost?

Walk with your nose leading the way. 
If there's a smell of urine or other waste products, human or food or whatever, it's not "natural" and "to be expected. 

It's a housekeeping necessity and if this isn't taken care of, what else that might cause infections and other medical problems could there be?

What do you need to ensure you're given immediate access to records (if you have Power of Attorney; and if you don't, someone definitely needs this and Medical Power of Attorney).

Most people spend as little time as possible seeing these as the last place they ever want to live. I understand. Mom always told me that. If  you've read our story, you know Mom was manipulated and controlled by someone using Undue Influence at a time when her Lewy Body Dementia was starting to become more and more extensive and she was "mallable". 

Your life is busy. You don't need one more thing to do. I get it. 

It's your life. It's your choice.....or it should be.

Learning From My Cat's Dementia

Caregivers can learn a lot from their aging pets as they move towards their end of days. 

This entry was started in late 2013, Mom and our cat were both approaching their "end of days". We saw obvious signs in our cat's behaviours and her obvious changes; with Mom, we saw changes and felt her time with us was growing less and less.

OBSERVATIONS:  Cat has lost a great deal of weight and has gone from being "choosy" regarding what she eats to also including where she eats what she chooses to eat.

For humans, one of the "signs" of "end of life" in the elderly is their "choosing" to eat less and less and then refusing food.

Various studies have concluded that medications can change the way we humans smell and taste; medications that affect the body and the brain. 

Perhaps we're not seeing the correlation between the brain that's being affected by disease and the medications elderly people are often given for a myriad of reasons -- including "mood" improvement, especially in Long Term Care Facilities.

Cat is not on any meds but notice she tries to smell more what she eats and may turn away even when given various choices: canned food, fresh food, it doesn't matter.

Our senses are important from birth onward. The newborn "roots" and uses the sense of smell to locate food and to recognize caregivers.

Watching our cat and Mom, I see these "basic instincts" becoming more important as the brain seems not to process everyday common activities as it once did.

Cat's ability to chew also seems to be affected and she's been surviving on the "gravy" we've found in some canned food and the "liquids" we produce from cooking fish or chicken along with a very small amount of the actual solid materials.

Taste for one type of food may produce eating and then again it might cause her to turn away. Is it the sense of smell or taste or both?

In Long Term Care facilities, Dental Hygiene is often non existent or at such a low level as to cause complications never experienced before by the individual while living with family members or on their own.

THRUSH -- take a look at this report by government resources

WONDERING.  Why facilities don't have more food choices they offer and keep track of what items seem to be more "accepted" by residents on an individual basis? 

Why aren't LTC's trying like I am for my cat and did for my children and my Mom when she lived with us, to watch closely their Nutrition and ensure they received the necessary amount of nourishment to promote health and well being?

Reality Check:  Staff that's hired from a service, constant turnover, two few staff for number of residents -- problems are rampant but it takes highly observant family members to eliminate this chronic problem.

INTERESTING COMMENT:  I was once told Mom lived as long as she did because she was a "determined person". Guess what we provided for almost forty years for her mental and physical well being including healthcare that intervened when necessary and didn't wait until the complications (like so many of her Urinary Track Infections at the facilities causing severe challenges) didn't have any positive effect?

And, it was our constant vigilance and action while she lived in the Long Term Care Facilities that added to her life despite the lack of facility oversight and care.

In the facility Mom was in for the last two years, the access to recording information concerning residents appeared to be limited to wall mounted units in the hallways and those appeared to be used by Aides to record what they did. 

The Aide, who moved from one to another to another, had to make/take the time to record after performing a service and she/he could often be seen making notes on more than one resident at a time. THAT'S DANGEROUS.

The Nurses (LPN's) used laptop computers at the "main desk" or at "medication stands located near the main desk" where they pulled up information on individual residents OR they wrote on pieces of paper that then had to be filed and, of course, couldn't really be accessed and referred to easily AND each person's hand writing or printing might be very difficult to interpret. 

ANOTHER OBSERVATION:  Cat eats in different areas and what she refuses in one, she may accept in another. Facilities, at least Mom's did, often move residents from a "main dining area" where they've eaten for a long time to a "special dining area" but there is often one person to feed three people at one time or two will sit waiting for as long as it takes to feed the one before "getting their turn". BY THAT TIME, MANY REFUSE, HAVE FALLEN ASLEEP OR ARE DISINTERESTED.  

Cat likes to be near me and will accept some foods when they're placed near my chair as I work on the computer or even "in bed" in a box she's chosen to lay in near the back door where the Sun warms her very lightweight body. In Mom's facility, residents "share" tables but there's no "moderator", no "promoter" sharing time and place with them who has been trained to lead conversation, share current affairs or involve residents in "the real world" and keep their minds active and involved.

Cat has always been small; she was the littlest in the litter we were told; but she was active and quick and very agile before her Dementia really took effect -- a lot like Mom's abilities to move, be active and accomplish tasks.

Cat reminds me, as Mom did, of a regression physically backwards in time to being a small kitten/child. Animals, however, are born being more capable of moving and fending for themselves while humans go through many stages of being totally dependent to developing skillsets and abilities.

Overheard a woman visiting her husband saying to the receptionist how THEY'RE going to have to give him something because he's just so unpredictable and she can't stand to visit him when he's one way one minute and another the next.

HOW SELF CENTERED WE BECOME, THOSE OF US WHO CAN WALK AWAY AND WHO CAN MEASURE "OUR" TIME AND OUR LIVES as needing not to be "disturbed" by another's needs and wants expressed in a way we do not feel is "acceptable" to us. 

I can only wonder what kind of relationship, what type of marriage these two had. Maybe she's "making up for" the poor ways she was treated; maybe she was always the one who did't listen, wouldn't listen.

LONG TERM CARE needs to focus on all three words, ephasising the CARE. Too few provide real compassion and concern. Too many walk away or simply find other things to do rather than watch, listen and provide caregiving.

Choice Is A Privilege

Older. Wiser? Weaker? Stronger!

When the year began it was as though I'd turned a corner and found myself walking along a different street, on a different path.

I knew this year would come, was coming. I felt I would see it, feel it, touch it and even smell all the fragrances of life -- sweet, sour, mellow, bright. 

Like light and shadow; movement and stillness. Life and the living. Death and the dying.

Each month that passes the time grows closer. What will it really be like? Hitting that mark. Being at that exact point in time? Will I weep? Will I laugh? How will I meet this inevitable part of my journey?

Before January 2011 I would have sang a song of happiness and anticipation. Thinking back and looking forward. Dreaming dreams and making plans. 

Life had been good, for the most part. 
     Tomorrow would be better.

Decay and germination. Related opposites.

One feeds the other, one rises from another.

It's May. Almost through the month. Mother's Day wasn't as challenging as it has been although Mom was in my thoughts. 

We went to her old facility, visited a woman we've befriended and so many others who sit, wait and are in line for their final journey. 

Each had gone their own way and now come together. 
         One by one they come; one by one they go.

Sometimes I wonder where the time HAS gone. January 2011. Seven years. SEVEN YEARS. How can that be?

Looking forward we couldn't see seven days and now it's been seven years -- moving towards eight.

Four years. 

        Years within years. 

                  Tears not forthcoming then flowing nonstop.

Weight carried in our hearts, in our minds and occupying every fiber of our being.

Admittedly the load has shifted.     It's compressed a little. 

The distribution is a little easier to carry  and we make the load lighter for one another as we carry it together moving forward, day by day.

In May so many years ago there was such great anticipation. I was graduating from College. We were engaged since March. We were going to be married in October.

I would leave the only "home" I knew, the one with my mother, my amazing and always, always there for me, mother.

Plans for "the wedding" helped to set aside my angst. After all, that's WHAT WE DID.  We "left our parent(s)" and made our way in the world with someone else beside us.

And so we did. For three years. Then we became reunited.                                       We added our first child. 
            We added my mother to our family.

Raised in love you give with an open heart. There are no questions about "what if", there is understanding you will go through and beyond whatever. 

And so we did. Almost four decades together.

Today we ridicule and taunt many who chose multigenerational living. 

Sitcoms thrive on these  "dysfunctional relationships"

Sadly they do not see the truth because to see would be to miss, to be without, to not have and to have given up.

We grow older. 
      We hope to grow wiser.

We sometimes become weaker.
      We learn how to grow stronger.

Paper Trails A Must In Long Term Care Facilities

Paper trails are a must as your loved one progresses to need more care, more time and "costs" the facility more money. 

Without your tracking the challenges you've seen first hand or become aware of through a visit, your concerns and complaints become a lost cause to try to remedy when the State comes calling, as they do, for either a regular visit or for a special investigation.

Aides are the lifeline and the heartbeat of Long Term Care Facilities. 

They are the 24 hour people responding to the call, the buzzer, the needs and wants of the residents. And, they see, hear and touch residents having the most frequent contact and the most active physical, emotional and psychological contact.

Yet they are the most under-trained and seldom given first hand, from the best source (especially any from outside a facility), direct experience training.

Aides usually get "retrained" after an "incident" that has involved a resident and caused some form of need to acknowledge a problem. 

Think you're protected? A Federal program. The Ombudsmen (actually men and women).

In our area this Federally Mandated service is now called "VOYCE" so check closely to find your "version" of "Ombudsmen".

Then look closely. You'll probably find variations on a theme. The theme? Must be invited in. Aren't there to really meet with, work with. Usually only able to spend a few hours in the whole facility. Let's see -- a few hundred people -- how many do you think they really "get in  contact with"?

In many, they're not the advocates they're supposed to be. They're "mediators" only activated and coming into the facility when a phone call or email activates a "need to respond" and even then, it may be only a phone call to "check it out" and not a "real personal visit".

CNA's have the ability to see actions on the part of the resident that could lead to more serious challenges, that is if they are encouraged to spend time with the resident and observed and their input is valued and not dismissed or told "that's the LPN or RN's job".

EVERY PERSON IN THE LIFE  OF AN OLDER AMERICAN WHO LIVES WITH, PROVIDES FOR OR COMES IN CONTACT WITH is an important link in the chain of ensuring Seniors have quality of life.

Most facilities are understaffed with CNA's, sometimes as in Mom's old facility with one CNA for a whole half floor, numbering between 15 and twenty people, and one LPN per wing/half floor -- or in some cases for the entire floor.

State Regulations should be based on the needs of the patients and also on the concept one person (Aide) cannot be in two places at the same time; it's like two kids who want something at the same time or who NEED something at the same time and a parent can't be in two places at once.

Taking this concept a step further: think of it this way -- one parent, one child versus one parent five children. Now, have them all be "sick" at the same time although the levels of "need" from providing medication to changing bedclothing or clothes varies. Could you predict when the one parent will begin to "lose it" and or not give the right service at the right time?

That's exactly how our LTC's shouldn't operate but they do. Faced with mounting bills and reduced compensation, they struggle to keep staff and usually face cuts all around -- staffing, services, food, etc.

Ever notice when you visit how early the residents "go to bed"?  

Do you really think it's their choice? 

Ever notice how "sound asleep" they are?  

Did you know they're probably "knocked out" for the night? 

Doctors associated with Long Term Care Facilities are "selected" by the facility, are "allowed in" by the facility. So who do you think they work for? The patient? 

Did you know, at least in the State of Missouri, as I discovered yesterday in my readings of State Rules and Regs that the Facility Doctor in charge can actually "override" and "add" to the PNR's given to patients and among these, of course, can be meds to allow "rest" for the patients who seem to be causing "disturbance's" with their ability to roam, call out or in other ways "disturb" other residents and staff. 

IS THIS WHAT YOU WANT FOR YOUR LOVED ONES?  

HOW ABOUT FOR YOURSELF IF YOU BECOME ONE OF THE MANY FACING BEING "INSTITUTIONALIZED"?

Keep a "Visitation Diary" noting the date, the time arrived and specific notes.

OBSERVE  and check out drawers, closet, medicine cabinet, bathroom, bed.

Where is the call button when you arrive? Within reach? Or pulled out of the connection?

Take off your shoes and walk across the floor. Is it dusty, dirty or slick? 

Any visible black and blue marks? Ask to see the record and when it/they were noticed and what was cited as "the cause".

Check out medical records if you have the Medical Power of Attorney. What meds are give regularly and MORE IMPORTANTLY, ask for a list of all "as needed" drugs still on the record.

WANT TO REALLY ENSURE YOUR LOVED ONE'S SAFETY AND WELL BEING?  

Ensure someone has a Medical Power of Attorney and hopefully you have a family unit that works together so that all members observe, notate and share with other "care givers" what they've observed and heard.

Ask yourself.....as a parent did you use a "nanny cam"? Did you question the children about their "sitter"? Did you interview others who used the caregiving services?

Why do we "turn over" complete care to people who are paid based on the amount of services rendered?

Why do we "assume" our loved one is well taken care of and the facility only has their "best interests" in mind?

Many do. Many don't.