Post Christmas Letdown

We have survived Christmas Day and are now working down the 12 days. Merry Christmas to all, and best wishes for a 2009 filled with peace and love. The “officials” will tell you that Hawaiians say Mele Kalikimaka and Hauoli Makahiki Hou. Old-time locals are more apt to say, “Happy Nu Eee-ah!” That’s what it sounds like. It’s spelled “Happy New Year”!

So besides care-giving, have I done anything since arriving in Hawaii? Sort of. I’ve discovered a cosmetology school where I can get my hair cut for $10 -- including the shampoo and blow dry. I’ve rediscovered 2 real quilt shops, a dry goods store that has a huge array of fabrics and decorates their walls with finished quilts (good for selling the kits!), and a craft shop that sells patterns and miscellaneous supplies. I’ve connected with several cousins – some who live here, others who have visited. Plus several more who I know only online.

Am quite proud that I’ve registered myself as Hawaiian, the equivalent of tribal registry for other Native Americans. Now, when I go somewhere that I want to be recognized as Hawaiian, I wear the bright red Kau Inoa bracelet. I’ve done too much genealogy work for folks who are unable to register as a part of their hereditary tribe because grandparents or great-grandparents chose not to register. That failure is seen as rejection of Native American heritage, and cannot be undone. I don’t what that to happen to my granddaughters. If you are a Hawaiian living on the mainland and would like to register, you can do it online at the OHA website. Go to www.OHA.org or Google on OHA and see what you find.

We had just finished dinner last night when the lights went out. Oh-oh. When my brother called from his home at the other end of the island asking if we had power, I knew we were in for the long haul. He had discovered that power was out over most of the island, but had not yet heard why. I had to call California to learn that most of the generators on Oahu had shut down following a lightning strike and power surge somewhere on the system. Thank you, Nancy.

With only a limited number of generation stations, one line out means most of the system is out of service. This outage left the tourist centers in temporary chaos. People were stuck in elevators, especially in the high rise hotel, condo and apartment buildings. Tourists couldn’t get dinner and were standing in line at ABC stores all over Waikiki looking for those awful pre-made sandwiches. No traffic signals or street lights. At the airport, security screening had to be done by hand. Hawaiian Electric sent a generator out to the home the Obama family is renting in Kailua. I worked on the computer until the battery ran down to critical mode, then watched a movie on the iTouch before falling asleep. Mother had a glass of Kahlua and went to bed early. By 7:30 this morning power was back on and we began functioning normally once again.

I wonder if the Obamas will have fireworks at their house for New Years? Will he have to get the permit from the State in order to buy fireworks? Wonder what the Secret Service thinks about fire works???

More laundry. Then a hospital visit. Took yesterday off, best get there today.

Look for positives. Give Thanks. Don’t forget to pray …..

Christmas Eve

It's Christmas Eve. I have just listened to a very early broadcast of the Service of Lessons and Carols from Kings College, Cambridge. It's only early for me -- Hawaii is a full half a day behind the UK, timewise. My favorite way to begin Christmas Eve.

Still need to wrap the gifts for my father to give to his roommates at the nursing home today. That Christmas Party starts at 10:00 a.m. Then there are the still-unwrapped gifts for my mother, brother and sister-in-law for this evening's gathering. Wrapping is definitely not my favorite task.

To all of you I send wishes for a blessed Christmas. It is, after all, a religious holiday. Be still for a moment, allow the Love of Christ to fill your heart and mind over the next 48 hours. If you come from another tradition, celebrate the now-lengthening days, the promise from nature for new life, new promises of spring. Light a candle in the darkness. Become a light in the darkness.

Look for the light. Give thanks. Keep praying .....

Catching Up

I have just realized that the dribs and drabs I have written over the past month have not gotten beyond the Word file where they were created, to be shared with the rest of the world.

My father's perspective of the last month is both accurate and skewed. He asked me yesterday if the police had been to the house. It seems that he "was driving someplace" and "got stopped". The other people involved [they were very rich people] "weren't very nice" so he "wasn't very cooperative, either". He "got a ticket and had to sign a paper", but I had to sign a paper, too. Then, somehow, he got taken to an apartment belonging to those "rich people" and was given a bedroom where he was very comfortable and slept for about 12 hours. Now he is "incarcerated".

So what is reality? People in uniform -- fire dept. and EMS -- picked him up off the floor and ultimately helped him to the car. He was combative and uncomfortable in the Emergency Room, so staff was very assertive with him. He probably saw that as mean. He signed at least one consent for treatment form in the hospital, and I am sure that I signed something on his behalf. Once admitted to the hospital, he was placed in a private room on the neuro/psych floor and placed in restraints "to remind him that he needs to have someone close by when he gets out bed", as he is a significant risk for falling. The food at Queen's was good, quite unlike any hosptial food I have encountered anywhere else, with the entree actually served on a china plate. He spent two weeks there, and was moved 10 days ago to a skilled nursing facility.

So he's gone from a private room in a 500+ bed hospital to a 4-bed ward in an 82-bed facility where he is one of perhaps 6 caucasians among patients and staff combined. Initially, he was extremely uncomfortable. Then he discovered that whatever he asks for (except his freedom!) he gets. This pleases him. He enjoys the physical therapy, and is discovering how much strength he has lost. He wants to know when he is coming home. It is unlikely that he will recover enough to ever come home again, especially with the incontinence and instability. He would have to be "reminded" at home that he cannot get out of bed without help -- thus, back to the restraints which make my mother very uncomfortable. I've not seen him in a walker, just a wheelchair. This house cannot accommodate a wheelchair. He is not free to come and go at will, or even get out of bed by himself. I can understand how he feels incarcerated.

So as Christmas approaches we give thanks that he is well cared for and reasonably happy. We continue to look for those silver linings. We keep praying ....

Turning Points

I'm still running on adrenalin. After all, it's just after 5 p.m. and I've had less than 2 hours sleep in 36 hours. Why, you ask? Fall victims, especially those not seriously hurt, even those with dementia, do not have a high priority in emergency rooms.

My dad fell again last night. It must have been about 7:30 p.m.; I remember looking at the clock at 8:00, and the fire department first responders had already arrived. This time he hit the back of his head on the edge of a bookcase, and scraped the skin off two spots on either side of his elbow. It took three brawny fire fighters to get him from his bedroom to the car -- probably 40' total distance. Another team of helpful young men at the ER/Ambulance loading dock got him out of the car and into a wheelchair. I don't know who got him from the wheelchair into the ER gurney. Took Mother home just after 10 (it was going to be 2 hours before the CT scans would be read), and was back in the ER by 11:30. The ER doc (who looked like a teen-ager) called his own doctor at midnight, who asked that a Hospitaler (a doctor who treats primarily inpatients) admit him. It was 4 a.m. before we climbed to the top of the Hospitaler's priority list. He saw no clearly defined problems, although there was enough of a suggestion of pending pneumonia to justify admitting him. That and the fact that it was all two strong nurses could do to keep him standing upright long enough to take a blood pressure read. No way was I going to get him back home by myself. There was no evidence of major stroke, no concussion, no skull fracture. Just the goose-egg where his head hit the edge of the bookcase.

The admitting doctor ordered another chest x-ray later in the day, a physical therapist to work on mobility and check his ability to swallow, and evaluation by a geriatrician. We'd been unable to get an appointment with a geriatrician before April 2009, so this order was an welcome relief. We agreed that he should be kept comfortalble, but that no heroic measures should be taken to prolong his life. I left at 4:30; Daddy did not get to his room until about 6 a.m.

I learned about something called 'sundowning'. After dark, especially in unfamiliar settings, dementia patients tend to get more agitated than usual. The IV lines and monitors, all with associated cords and cables, often trigger agitation and aggressive behavior. So I became the bad guy, because I was the one who agreed to his admission as an in-patient.

Ian did the hospital visit thing today, arriving on the heels of the geriatrician. Did Daddy remember what happened? Of course. He was thrown out of his airplane seat. Did he remember being in the ER? ER, he wasn't in the ER. He was on an airplane, and didn't get home until 6 a.m. Who was that man standing over there (pointing to my brother)? I don't know, but he's been around for awhile. What year is it? 1986. Do you know where you are? Blank stare.

Our father is in an alarmed bed to warn the nurses when he tries to get up. When seated in a chair, he is connected to the chair with a mesh vest-like device to "remind" him that he cannot leave the chair. Today he had to be spoon fed before he would/could eat. When alone in the room he wears large mittens that look like boxing gloves to keep him from pulling out lines and monitors. He got pretty good at that trick in the ER.

The expectation is that he will remain at Queens until at least Monday. I think Mother is relieved. We meet with the social worker on Friday morning to discuss options.

Give thanks for the geriatrician. Look for those silver linings. Keep praying. ...

Emerging from a Bad Spell

Going it alone. Not going well. Some of you manage life alone very successfully. You thrive. I wish I could. I recently read a letter written to my mother by her aunt mentioning my grandmother’s loneliness as a widow. Neither of them really understood. One of their mutual friends, a widow, had said, “I just need something alive in the house.” I find it is more than that. A pet qualifies as something alive; a pet you enjoy does make a difference. The radio and TV provide another human voice. I need something alive that can carry on an intelligent conversation, share things we both enjoy. I would appreciate someone who can walk all the way to the back of Home Depot without wearing out. I’m looking for someone who would enjoy a day in Yosemite or at Cherry Lake or exploring Hawaii Volcanoes National Park. Maybe even visit New Zealand and Scotland. Someone who can share the driving.

Maybe this most recent slump (which I am finally beginning to climb out of) has to do with the futility of care giving in my parents’ home. Very few people who have lived independently into their 90’s are willing to take direction from a child who has been only an occasional visitor in their home for 45 years. We haven’t “grown up” together. We haven’t shared an adult life or adult interests. They don’t know my interests, skills and competencies. I am just learning about their weaknesses. Our tastes are different. When did my parents start enjoying beets or split pea soup? When did they stop eating thick-crusted, hearty breads, or rocky road ice cream?

Then there’s the dignity issue. My father came to the lunch table today in obviously wet clothes. After lunch I stripped and re-made his bed and emptied his hamper, laid out a clean change of clothes for him, and told him I needed everything on his body for the washing machine before I could do the wash. He was insulted.
On what do you base your judgment?
Observation.
Maybe I should just move.
Where will you go?
Silence.

He called Mother into his bedroom where they could talk privately. I heard her say, “You are wearing them and you are still wet?” Then realization struck. He was wearing Depends. He does not understand that they only absorb a finite amount of fluid before leaking. He does not understand that it is not wasteful to change them several times a day. He did not want to hear that if he wears wet clothing all the time, his skin will break down and he will get sores – diaper rash with a vengeance.

Before he could even get them on his body, the fresh clothes were wet.

It’s hard to tell whether my dad’s willfulness is anger and vengeance, or if his dementia is cycling in again. Yesterday Mother told him his car is no longer insured and he cannot renew his driver’s license. Yesterday he was angry because both Mother and I told him to wipe up the bathroom floor after he peed on it. Today I think I am seeing dementia at work. Which means we are heading into another downhill slide.

Give thanks for the good times. Keep praying …

Getting Even

The question is, who needs care? What kind of care? Who decides what care to give?

Mark, the caregiver from Options for Elders, was supposed to come on Wednesday last week. Through a series of crossed wires – and the absence of an answering machine on my parents’ telephone – we didn’t get the message that he had a Wednesday conflict and would not be here until Friday. That set a sour tone for my mother. On Friday Mark arrived exactly on time – and right on the heels of Glenn, who mows the lawns. It’s a good thing Glenn works unsupervised!

Afterward Mother commented, “I agreed to this because I thought he was going to help me. Apparently he thinks he is supposed to help your father. Seems to me your father can get along just fine. He can get outside, sit on the lanai, look at the yard. He doesn’t need someone to take him out. I need help with things like heavy cleaning. I asked him to clean the counters in the kitchen. He wiped them down, but there are stained spots that need to be scrubbed and the stains are still there.” But he also scrubbed down the woodwork and diagnosed the problem with the overhead kitchen light.

Meanwhile, Daddy still needs to feel useful, even if he really is creating more work for someone else in the process. He is entitled to some quality of life. If I think about it, I can appreciate the thought process going on. He’s spent most of the last 70 years – probably most of the last 94 year – considering only his pleasures, not the consequences of his decisions. While he’s been enjoying life, she has been hurting. Are we playing “get evensies”?

We are seeing obvious signs that Mother is slipping, too. There was the charge on her credit card – the one for which she remembered writing the order, but not putting it in the mail. At dinner last night she asked about her “meat pounder” – one of those hammer-looking devices used to tenderize meat. Said she looked everywhere for it, but it was not to be found. I found it right where it was supposed to be. Yes, it was buried under a spatula, but still in the box. Took the box out to show her. She was chagrinned. He quietly said, “Thank you.”

What about me? I am getting restless. I think I need to find a friend or two, someone to have coffee or lunch with occasionally, someone who is interested in craft fairs or special exhibitions or just exploring, or someone who would enjoy an occasion afternoon movie. Now what?

Owning vs. Renting

We have spent the last week looking at Senior Communities.

We went back to Pohai Nani, where my dad passed the "assisted living" test. He can live in the regular apartments with help -- as much or as little as he needs, with the appropriate associated fees. Pohai Nani is operated by a unit of the Lutheran Church specializing in services to seniors, both in transitional care and independent living settings. Decisions on services are made by local management based on what corporate experience suggests is popular or desirable for resident care. For example, they are transitioning all their tub/shower units to step-in showers (i.e., small curb to contain water). Roll-in showers represent a higher level of care and are available in both the small group cottages and skilled nursing facilities. Pohai Nani is in a suburban community on the windward side of Oahu; all apartments have lanai and magnificent views of the mountains.

One Kalakaua is much newer than Pohai Nani, and has a very urban apartment complex feel. Units there are privately owned, and compactly designed. Each has a full kitchen and washer/dryer. The master bedrooms are spacious; where there is a second bedroom, it is tiny. All the common rooms are on two floors -- there are no common areas on the residential floors. With your apartment comes covered, secure parking for one car. There is no community bus; the City bus and taxis are readily available. Your monthly service fee includes only 1 meal in the dining room daily, and the lunch and dinner menus are identical. Many residents do not use even their 30-day allotment of dining room meals preferring to eat in their apartments or in another restaurant in town. Everyone wears an emergency call bracelet or necklace, and there is 24-hour coverage at the front desk. You cannot sneak out the front door without being seen! Someone set on escaping might be able to get out through the garage, but there's a lot of walking involved in that exercise. An interesting concept is that the hallway door to each apartment is alarmed nightly from the outside by the facility security staff. If the door is not opened to break the alarm circuit in the morning, someone will call and ask you to open your front door. If they do not get an answer by telephone, they will come into the apartment to check on your status. The down side is that since the units are privately owned, all decisions for services (except on the medical floor) are made by the Homeowner's Association members -- i.e. the residents. If the majority of those interested in the decision-making process are from the young-and-active crowd (anyone can live there as long as the primary resident is at least 55), policy will reflect their preferences. They do have active residents in their 90's, and are proud of them. There are more off-premises activities here, reflecting both the more active status of the average resident and the location right in town.

So here's the Question of the Day -- at 95, is one better off to (1) stretch really hard, purchase a unit, pay a smaller monthly service fee, and have a piece of real, inheritable property or (2) make no initial investment, rent for a much larger monthly fee -- which is affordable now, but may be more difficult for my mother alone -- and have no investment at the other end. Your perspectives are appreciated.

Today's trivia: Barach Obama spent most of his growing up years living with his grandparents only a block away from One Kalakaua in another apartment building where his grandmother still lives.

I learned a new Hawaiian word this week: mokulele. Moku is a boat. Lele is jump, or jumping. Mokulele is airport. Thus an airplane is literally a jumping boat! Interesting concept. I wonder if other cultures describe them similarly?