20130226-2 – Independent and Assisted Living

This will be the first of three posts regarding living and lifestyle choices we all need to consider as we age. Caution: it may sound a little formal, rather than a casual conversation like I would prefer …
As part of this caution you’ll notice that I’ve slipped into “strategic planner” mode for this series, that’s my instinctive MO (modus operandi or method of operation for you non-Latin speakers), in other words, my natural way of doing things. What that means is that I list and analyze options and I take into account things such as the likelihood that something may happen. However, I tend to over-think and over-plan things and not spend enough time actually executing my plan; so as you read this try to keep in mind the philosophy, “Do as I say, not as I do”. You might avoid the over-planning trap that way!
I subscribe to the Boy Scout motto, “Be Prepared”, so when there’s a significant possibility that something might happen I try to take that into account. Yes, I try to plan for it! What a novel concept! This series is all about planning starting with what triggered the need, considering the desired outcomes, and figuring out where you’re starting from. These posts are about those pieces of a planning process for retirement or senior living, starting with “what triggered all this intensive thought?”
Being in “the sandwich” and having ongoing conversations with aging parents about where they want to live and the lifestyle they want to have opened up our eyes to a lot of options that we need to investigate as we plan our own retirement. My wife’s Mom and Dad decided to spend their winters in Florida and summers in Michigan near their grandchildren. During the winter they desperately missed their family, but not enough to stay in the “cold country”.
As they entered their eighties they talked more frequently about living in a place like Freedom Village in Holland Michigan, where they could be independent but have access to assistance as the need developed. The advantage of independent living facilities is that you quite often end up at the top of the waiting list for associated assisted living facilities when the need arises. Otherwise you find yourself on a much longer waiting list for assisted living. Another huge advantage is the opportunity to begin building new relationships with residents and staff that will carry you through the more difficult transitions to come.
Mom and Dad talked, but never took the leap, opting to stick with their condos and continue putting off the decision despite the fact that their health suggested assistance with living was very likely going to be a necessity. They delayed the decision so long that they reached the point where they could no longer treat it rationally. In fact, we retrieved them from Florida at the end of the 2008-09 winter season because Dad couldn’t be trusted to safely make the long drive back home. They had already pushed their living arrangement beyond the limit, but we couldn’t convince them otherwise.
With both Dad and Mom we were extremely fortunate that assisted living openings were available when they were needed during this last year, just not in what we thought would be their preferred facility. When Dad moved in, the staff could not believe that Mom had continued to care for him to that point given her own condition. Their assessment was that he should have been in assisted living for a year or more before we actually moved him in. And Mom, having spent every day since last Christmas in the hospital, rehab, and now assisted living finally realized that she should have moved much sooner as well.
The emotional attachment to “home” can carry people much farther than they really should go, and motivate them to continue taking care of themselves when they would be much safer with outside help. Sometimes that’s a good thing, sometimes not. Emotions often drive the putting off of decisions about living arrangements when rational thinking should prevail. But how can you tell your parents that the time has come to choose and insist that the choice be made, and tell them they are not being wise to persist in putting things off? There were several occasions when we were told we were being pushy, and were being asked why we were being so nasty about this; we definitely hit their hot buttons.
We really needed to have faith that we were doing the right thing, and to keep reminding ourselves that we were being rational and caring, and that concern for their own safety and well-being was paramount. We wish we had found a way to help them see that the time they were first discussing independent and assisted living options was the right time to make and execute the decision. The best idea is to be sure we don’t make the same mistake, and risk not having affordable accommodations when we need them.
So now it’s time to start thinking about our own lifestyle choices …

20130312 – Parenting, Finances and Circumstances

I’ve been pondering a few things lately as you’ll notice from the title of today’s post. We’ll see where the pondering takes us…
How do you end up in the sandwich? Is parenting a contributing factor, finances, health or just plain circumstances? I’m going to chalk it up to circumstances, keeping in mind that where you are today is the sum of all the decisions you made over the course of your life combined with some coincidences or, as I prefer to think of them, God-incidences, that directed those decisions, and maybe, just maybe, some decisions your parents made on your behalf. OK, parenting has just become the subject.
I must admit that I approached parenting with serious fear and trepidation. I must also admit that I was the softy thus forcing my wife into the role of chief disciplinarian, an unfair position that she never particularly relished, but one that I felt she was much better at than me. It’s always been a regret of mine that I didn’t learn enough and talk with her enough about our parenting style to ensure we were consistent and of one accord during those years; mea culpa and deepest apologies Sweetie.
Anyway, life goes on. And that leads me to the conclusion that parenting can be a factor in later participation in the sandwich generation. There are some really important things about parenting that differentiate between becoming a teacher, mentor, coach, and friend to your children, and becoming an enabler in the negative sense.
What is it the Bible says? From NIV Proverbs 22:6,” Start children off on the way they should go, and even when they are old they will not turn from it. And from Clarke’s Commentary on the Bible:
“Train up a child in the way he should go – The Hebrew of this clause is curious: חנךלנערעלפידרכו chanoch lannaar al pi darco, “Initiate the child at the opening (the mouth) of his path.” When he comes to the opening of the way of life, being able to walk alone, and to choose; stop at this entrance, and begin a series of instructions, how he is to conduct himself in every step he takes. Show him the duties, the dangers, and the blessings of the path; give him directions how to perform the duties, how to escape the dangers, and how to secure the blessings, which all lie before him. Fix these on his mind by daily inculcation, till their impression is become indelible; then lead him to practice by slow and almost imperceptible degrees, till each indelible impression becomes a strongly radicated habit. Beg incessantly the blessing of God on all this teaching and discipline; and then you have obeyed the injunction of the wisest of men. Nor is there any likelihood that such impressions shall ever be effaced, or that such habits shall ever be destroyed.”
 
I think those words apply to everyday teaching as well as religious teaching and include things like responsibility and accountability. Our children are both strong Christians and study the Bible and its context. They have good hearts and pray hard and often. They spend time discerning God’s plan for themselves and their families, and their spouses do the same. They have firm convictions about money, financial responsibility and social responsibility, and hold themselves accountable for their decisions and actions.
 
So maybe we did OK, maybe we swerved into the right stuff, but we did study a lot of references about infant care and raising strong-willed children, the classic Dr. Benjamin Spock guides to parenting and health and Dr. James Dobson on strong-willed kids. What we could have done better is to be more intentional in these times of our children’s lives, maybe have a better plan for the process rather than just swerving into it. Our daughter has been very studious in her role as a parent and her husband very supportive of her learning and application to their family. She’s been very intentional about parenting and has earned our deepest respect for her approach and mothering style. It really seems to be working. She could teach this stuff!
 
We wish Dave Ramsey and his books Financial Peace and The Total Money Makeover had found their way into our household a little earlier than just the past few years because we would have used them to talk about the financial side of growing up and growing financially responsible starting at the pre-teen point in our kids’ lives. Their financial lives have been no cake-walk but neither has ours. Hmmm … I think we just shifted to finances in this discussion of factors contributing to life in the sandwich.
 
Just to be clear, we have a definite position on finances and the sandwich:
Philosophically, we like multi-generational living, but we firmly believe in financially independent family units, whether we live apart or together. We don’t want to encourage inter-generational financial obligations, but we’re prepared to provide a financial assist when a family member needs it. We’ve done it for both of our kids and their families, and our parents have done it for us. We expect all family members to take responsibility and accept accountability for their lives and their choices.  In particular, we never want to be a burden on our children or our parents, financially or otherwise, but as a family we’ll give and accept support whenever the need exists.
 
Our kids understand the financial realities of life, the need to work, and the responsibility to take care of their families. For one of our kids career decisions, circumstances and personal health issues have interfered in carrying out those responsibilities, the sum of which has resulted in multi-generational living in our household, and left my wife and me in the sandwich.
 
So, one kid is living apart from us with a family of her own. The other kid and his family are living with us. Some people would consider us to be enablers and suggest we should have just kicked the kids out of the house at age 18 or 22 and told them never come back. I would agree if this living arrangement was permitting our kids to shirk their responsibilities, but I don’t think it is. They’re working hard to become independent, to get their careers on track, and to support themselves. They’re making progress, and they’ve never backed off from that commitment, nor from their commitment to pay back the loans we’ve made, which by the way are documented and incur interest, thank you Mr. Ramsey.
 
I think that rather than enabling, we’re giving out of abundance and caring for our family the way we should, both biblically and socially. I know; I probably just painted a big target on my back so go ahead, fire away with your comments. After all is said and done, everything I talked about contributed to our arrival here; this Tuesday, in the sandwich …

20130311 – Thinking about Our Current Situation

Yesterday was one of those “routine” days that you’d just never have if you weren’t in the sandwich. After church and a light lunch Sunday we headed over to Mom’s condo to clear out a few more things and grab a portable phone and some clothes she needed. Then we headed over to her room at “the manor” to sit and chat for awhile.
Mom can handle about half an hour of visiting and then she gets tired. Her pain medication was wearing off so she decided it was about time to head down the nurses’ station to get her next dose. As we left her room her new best buddy, Helen, swiveled around with her walker in the hallway and gave Mom the biggest hug I’d ever seen. Mom introduced her “kids” and then we moved along with Helen tailgating and waiting for a chance to pass when the aisle widened out. Not for long though as she cruised up to the next doorway, saw another friend sitting just inside the door and spooked her with another great big hug from behind! Well it was pretty obvious to me that just because Mom thinks she’s not very good at making friends didn’t stop anyone else from making friends with her. I think Helen is a blessing and a speed demon in a four wheeled walker; I doubt she has much use for the brakes on that rig!
Anyway the nurse caught us in the hallway, Mom got her pain meds, and we continued on with Mom explaining that sometimes the aide will even offer her a cup of coffee as she strolls toward the dining room, where we parked briefly to continue our chat. As we got up to leave another aide made our acquaintance and, sure enough, offered Mom a cup of coffee before dinner (of course you can always sell Mom on a coffee but what she secretly yearns for is her cola – they avoid serving carbonated beverages at the manor). Turns out this aide is the daughter of a guy who used to work as an RA in one of Western Michigan University’s residence halls where Mom was an admin assistant years ago. Small world and I love small world stories, but once again Mom had captured another life story in her strolls around the manor. Didn’t I say something about that talent in a recent post on boredom?
We said our goodbyes to Mom, headed back home and started to chill for a bit and get some dinner going, when in popped Scott and Liz after work, promptly dropped all their stuff and started filling us in on everything from chats with the celebrities visiting town (for Laugh Fest 2013, a huge fundraiser for Gilda’s Club) to the latest happenings at the museum. Plus we got to hear about the next producer job opportunities and plans for Tuesday night’s visit with Wayne Brady (yes, that Wayne Brady) plus free tickets to his “improv” program. It’s kind of neat to think our daughter-in-law gets to work with all these entertainers and celebrities in the various producer and photographer jobs she does through her company, Happy Hat LLC. As the evening wound down, the dishes were done, and Deb put the finishing touches on a cake for today’s office potluck, I began to think about our current situation.
I can’t imagine a less boring, more interesting life than what we share in the sandwich with our family. We get all the current stuff, all the details, hot off the presses. If we weren’t in the sandwich everything would be filtered and distilled to the essentials by the time we’d hear it. Do we yearn for some quiet time, or some together time for just us two. Sure, and we occasionally get it. But, if we weren’t living in this situation and had all of the quiet and together time we wanted, would I miss taking care of Mom and sharing our home with the kids? Absolutely! So for now, that’s just another day in the sandwich …

20130308 – DNR

Dear Mom,

Thank you for making clear your end of life wishes as you learned more about your condition. You made your passing a gift to your family by making sure we were not left with those difficult decisions that often tear families apart. Your decision was a blessing in disguise.

I love you,

Terry

I’ve been trained and certified in CPR. My Mom had terminal complications from a less prominent illness than those we all know well such as cancer, diabetes, or heart disease, but she made it clear that she was not to be resuscitated and that no extreme measures were to be used to prolong her life. At the end of her life she remained of sound mind and we were conversing almost to the moment of her passing. When she suddenly began that transition every fiber in my being was screaming at me to do something, but her eyes reassured me that I was doing exactly what I should as I let her go. Then I felt strangely calm as I watched her slip away, and comforted as I whispered “I love you Mom” in her ear one last time.

DO NOT RESUSCITATE or “DNR” can be a scary topic, but it is an absolutely critical piece of an “advance directive” or a Durable Power of Attorney for Health Care necessary for others to make decisions about your care when you are no longer able. After my father-in-law’s passing last year and prior to my heart catheterization and stent insertion last fall my wife and I visited our family attorney to arrange for these essential documents for each other. We knew from my experience with my mother and ours with my father-in-law that we couldn’t leave each other without instructions about our own care should our health take a sudden turn.

End of life decisions can be difficult for anyone, but I’d rather make my own decisions regarding my life than pass that responsibility to someone else who might have no idea what I had been thinking. I’m 63 but I think even my 28 year old daughter and 32 year old son should be thinking about these things and discussing them with their spouses. It’s never too early do something about Powers of Attorney, Medical Decisions, wills and trusts; life is too unpredictable and they can always be changed later if circumstances change.

I remember the Terri Shiavo case a few years ago where the courts ended up deciding whether or not to pull her feeding tube because there were no clear instructions from her, just some ambiguous conversations between her and various family members, and different opinions between her parents and her estranged husband. I remember thinking if that was me my brain would be screaming “Hey, don’t starve me, I’m still in here!” If my heart failed or I stroked out, that might be a different story.

When I was thinking about my own situation I could see why people just don’t want to deal with it. These are tough questions for me to answer for myself; I imagine for lots of people it’s not any easier. Maybe for some it is but I can be indecisive in certain situations. I’m young enough that I could have a good quality of life if someone performed CPR on me and I pulled through. On the other hand, if I suffered a stroke or serious head trauma, I don’t think I’d want to stick around in a persistent vegetative state for years with only a miniscule chance of recovering, maybe give me a few weeks and if I don’t come around, pull the plug. Fortunately our attorney helped us think through these issues and come up with answers we could live with, sorry about the pun.

Having this conversation with aging parents can be difficult; we were fortunate our parents all made and documented their decisions well ahead of time while still of sound mind. We’re following their example and reminding those of you in the sandwich (and everyone else for that matter) to do the same. The sandwich will be a little more palatable for all concerned; even the old PB&J can be pretty tasty with just the right amount of jelly and the perfect little swirl of peanut butter! Make those “end of life” decisions for yourself now and don’t force them upon your loved ones.

Make life easier on those who care most about you and care for you, and you’ll be giving yourself some peace of mind as well …

Comments Allowed!

Hi Folks,
For any of you who have tried to comment on this blog, please accept my apologies and try again! I accidentally left comments restricted, that has now been corrected. Your comments are welcome and encouraged!
-Terry

20130307 – Frustration and Boredom

I’m frustrated. Sometimes I just don’t know what to do for my mother-in-law. She’s bored. There are daily events inside and outside her residence and she doesn’t participate. She’s bored. She has knitting and puzzles and a phone to talk to family and friends but she’s bored. She has cable TV with five dozen channels but she’s bored. Other residents get together for dominoes, a game she really enjoys but she doesn’t join in and she’s bored.

Mom has always said she doesn’t make friends very easily and yet if you put her in a new place she often knows half the life story of the person sitting next to her when you come back ten minutes later. I’ve seen her do that in the mall, in a restaurant, on a dolphin-watching excursion in the bay, you name the place! But she’s bored in her new residence and there are loads of people she doesn’t know yet.

How can you tell if someone is giving up on life? Is this one of the signs? I know Mom’s been through a lot this past two years with the loss of her older sister, her husband, and her ability to manage a household on her own. She’s always been one to bounce back; forty year cancer survivor, multiple heart attacks, all sorts of other health problems and yet here she is, 88 years old and determined enough to hate using the walker beside her chair, but she’s bored. And she’s tired, and she’s in pain, and she doesn’t want to be a burden, and she insists she just doesn’t have the strength to go out for breakfast, or to church.

Is she giving up? Is there a way I can help her engage in life again? We don’t want to lose her any earlier than necessary but we don’t want to force her to do things she doesn’t want to do. Is it the pain talking and keeping her from doing things she usually enjoys? Is it just too tiring even with the pain medication she takes?

She says it’s time to start clearing out the condo, and she doesn’t want to visit there; she’d rather have us take care of it and just ask about certain things like her collections and china. We agree, but from the perspective that simplifying life can be liberating. She could enjoy life more without all the trappings accumulated over the years. We see it as a new beginning; she sees it as another end-of-life task.

So today I’m frustrated, and she’s bored … any ideas … anyone?

20130305-2 – What are those infernal numbers?

YYYYMMDD – These blog posts come from a journal I keep, actually several journals, one for each blog. That eight digit number is the date that I first drafted the entry, first the year, then the month, then the day. I add a dash and a number for days when I draft two or more entries on the same day. It’s an old habit that has to do with sorting and sequencing chronological records in a database, and absolutely nothing to do with anything you care about I’m sure. Just one of those quirky little things I do that my dear wife has learned to live with …

20130305 – Contemplating Caregiving

Sitting here at McD’s nibbling my Egg McMuffin® and sipping my diet soda while Ernesto and the Tuesday crew work hard behind the counter I began thinking back over the last four years and started to appreciate how easy life in the sandwich has been compared to other caregivers like my Dad and our family friend Mr. D who each cared for their spouses 24 hours a day. Assisted living, nursing home, and hospice care can be expensive propositions and most people don’t like the idea of living in Medicaid-induced poverty, assuming they can qualify for assistance at all. So these two men, retired and aging themselves, cared for their spouses at home during their last days.

Ms. D suffered from dementia and the related failure of bodily functions that made her care particularly difficult and the commitment to provide such care something that comes only from unconditional love through 50+ years of marriage. My wife and I have been fortunate not to be the 24 hour caregivers that he needed to be. I stand in awe of Mr. D’s work in seeing his wife through to her passing, and I’m grateful for all of the information he shared with me about what to expect with my Father-in-law as his dementia progressed. What he shared helped us immensely in understanding what my Mother-in-law was experiencing in caring for Dad. The best thing he shared with us is a book called A Dignified Life: The Best Friends Approach to Alzheimer’s Care, A Guide for Family Caregivers; I heartily recommend this book to anyone caring for a dementia sufferer.

My Mom suffered from the loss of heart and lung function, a gradual decline that left her mind and will generally unaffected but in some ways made her care more difficult for my Dad. Her decline was more generalized and affected her mobility but left her capable in many areas. What she needed most was continuous communication and to see activity continuing around her. She could be very demanding and impatient because she couldn’t do the things she normally did around the house, and expected Dad to pick up all of the slack under her direction. Dad is a quiet and gentle guy who would do anything for anyone; it was a challenge to meet her expectations while being subject to her scrutiny regarding his own health. In my Dad’s situation I was able to take a little time from my job one day each week to go back home (about an hour away) and spell him while he took a little time for himself. Dad also gave of himself unconditionally although I’m not sure Mom really appreciated the sacrifice, but I saw; I knew. And I stand in awe of him as well.

It has been a challenge for me and my wife to help in the care of her parents over the last four years while living in the sandwich as we also helped our son and his wife through some difficult times for them. But as I look back I begin to see how much greater the sacrifice could be than the one we’ve made, and I think that more than anything this look back leaves me grateful for the chance to help our family to the extent I have these last few years.

I’ve been fortunate to have the kind of work that leaves my schedule up to me, and keeps me available to help my family. My wife and I have paid a financial price for it, but when I trade that cost for my presence when I was needed, it’s a small price to pay. I have no regrets. What I have is faith that we’ll be taken care of when we really need the support.  What’s the saying? “Pay it forward!”

Faith, it’s what I live on day to day as I share with you our life in the sandwich …

20130226 – Living with the In-laws

My daughter asked her sister-in-law, “How can you live with your in-laws?” The response, “Well, it’s not easy, but we learned how to make it work.” That’s the same response I would have given my daughter – it cuts both ways.
Two generations living together, sharing kitchen and living spaces, is hard. Learning where to draw lines between being parents and children, adult equals, and landlords and tenants is hard. Learning about each other’s habits and quirks and personalities is hard. Heck, marriage is hard and it’s a lot like getting married. They say when you marry; you marry the whole family and not just your spouse. It’s true, and it must have been incredibly hard for our daughter-in-law to not only marry our son, but actually move in with his parents at the same time!
When my wife and I got married I couldn’t have done it, and I’m pretty sure my wife couldn’t have either, even though my Mom was the one who suggested I ask her out!  Interestingly though, we actually did live with my wife’s parents for two months with an infant on board while finding a house after our move from Colorado back home to Michigan; and her parents also lived with her grandparents for more than a year, so we can say that there was at least some family experience with multi-generational living.
So yes, life with the in-laws is hard. What’s the one hard and fast rule? Talk, and don’t quit talking. Be honest, be engaged, and don’t get nasty. Talk about how you talk with each other. Share your hot buttons so we can be careful not to hit them. Tell us if something we said hurt you and why, so we communicate fairly and less painfully. Talk about and establish clear and acceptable expectations of each other. Talk about equitable divisions of labor. And parents especially, learn when not to be parents and instead be counselors and advisors; learn to wait to be asked and to not butt into your married children’s business. But also learn not to be afraid to speak up when their business is affecting the household.
When you get it right, multi-generational living is rewarding and emotionally uplifting. To share joyful announcements and successes with each other, to be surrogate Dad and Mom to your daughter-in-law when her own Dad or Mom can’t be there and give her a hug when things have gone badly or well, to be able to give your son a lift to work, to have a deep conversation between the four of you around the dinner table, to laugh to the point of tears at a great movie you enjoyed together, and just to celebrate life together is a remarkable experience that brings us even closer as a family.
Cherish the opportunity …

20130221

I know; it’s not Tuesday.  But it’s an emotional day that deserves a comment.

My Facebook status today: “After nearly three weeks with Kim and the kiddos including the trip to California to help them settle into their new home I’m back sitting in my office, briefly Elijah’s room, Pack-n-Play neatly folded by the door … it’s heartbreakingly quiet in here … so I go to Kim and Cadence’s room … just emptiness … heartache redefined …”

When you’re in the sandwich things can get a little emotional, yes, for guys too. A big event like part of your family moving from a home only a day’s drive away to one that’s only accessible by a hard and expensive preplanned day of flying and driving, is exciting when you’re in the moment, but heartbreaking when you contemplate the distance that separates you. The thought of being a Dad and not being able to get to your daughter quickly when she needs you is hard to bear, and establishes the importance of trust that her husband is up to the challenge.

Technology can actually help a little; webcams and Skype are wonderful tools that help keep the family a little closer. It’s always so pleasing, but not too satisfying, when my little granddaughter wants to show me everything she’s doing and learning, but has to kiss Pop-pop goodbye by kissing the screen.

Being in the sandwich triggers emotions ranging from joy to frustration, hope to despair, disappointment to happiness. Managing your emotions is essential to keeping some semblance of normalcy in an environment that is not normal for us Americans. Most other cultures in the world accept extended families as commonplace. We don’t. And maybe we should learn to. Because if we can accept the different stereotypes brought on by extended family living we can reduce the emotional peaks and valleys, and the stress on those of us living atypically. It can be OK for male heads of household not to be the primary breadwinner, it can be OK for the woman to have the steady job, it can be OK to take care of your parents while you can instead of dumping them in some home and ignoring them, and it can be looked on as not being soft on your kids if you haven’t kicked them out of the house just because they’re older than 22 and need a little “tough love”.

We tend to be bound by cultural norms that may not be in the best interests of our family members who really need help. Everyone’s situation is different. We’ve looked at ours and decided this is the best way to help each one in our family to the best of our ability. Our challenge is to find the correct balance that gives my wife and me strong family ties, financial security, and peace of mind. And sometimes we have to have faith that we’ll be taken care of when we just don’t see where the money is coming from to tackle that next hurdle.

Let some emotion enter the equation, but don’t let negative emotions rule your situation. You can handle this. Many people do. It’s not as unusual as you think. Your true friends will understand and support you. They’ll encourage you and give you space. And they’ll offer you a shoulder to lean on when you need it. It’s cliché, but just keep putting one foot in front of the other…