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| JANUARY NEWSLETTER
Vol. 2, Issue. 1 January, 2007
9 Lessons on Caring for the Elderly
by Marilyn Barnewall Until I became a banker in 1972, I never really thought of physicians or hospitals as businesses. Instead, I thought of them warmly as that part of society that cared for other people so much that they devoted their lives to helping them live healthily and happily.
 As a banker who managed a private banking area that specialized in handling the needs of physicians and surgeons and hospitals, I learned very quickly that they viewed themselves as businesses, not saviors of society’s sick. They were nice, decent people and I am not suggesting otherwise. All I’m saying is that I carried a very naïve view of medical personnel with me from my childhood into my adult years. I think most of us who received medical services during the 1950s and 60s did. Medicine was a business then too, but the emphasis was on patients, not how quickly someone could earn several million dollars and retire at an early age. In those days, doctors did not walk into the treatment room, look at their watches, and allow you 15 minutes to explain and have diagnosed your complex medical issues.
Since government has become involved in the business of medicine, more and more emphasis has been on the business rather than the patient end of things. HIPPA, for example, is just one example of stupid legislation passed by what can only be called legislators with IQs about two points above plant life.
I want to share a recent experience with you… not because I want to publicly complain about something, but because I hope readers will learn some lessons from my experience. Hopefully, it will save you the trauma through which my family has lived this past year.
My 97-year old mother and my 87-year old stepfather had to be moved from their Denver home in January of this year. We had for several years (aggressively) been trying to get them into assisted care where we live in Colorado (about 250 miles away). My brother and I had discussed what we knew would have to happen: An emergency situation would occur and the move would have to be made under immediate circumstances.
On my stepfather’s birthday last January, he fell down the basement stairs. He has Type II Diabetes. Though my sister and I lectured my Mom about the need to stop fixing things like potato soup for him because of the high carbohydrate content and keep candy out of his reach, her 97-year old mind just didn’t remember from one moment to the next.
My brother happened to be in Denver the day Roy fell. He had made the long drive over two winter mountain passes to help Roy straighten out his bills. The diabetes had impacted Roy’s eye sight and my brother found a huge mess. My stepfather had not been able to drive for several months. They had gratefully accepted the kindness of neighbors who would take Roy to the grocery or drugstore. For awhile during a winter storm, the only food Mom and Roy had available was that brought by thoughtful neighbors. It was during this period of time Roy fell.
LESSON ONE: Good, kind neighbors are wonderful. Thank God for them. Mom and Roy, however, began to view their temporary kindnesses as permanent generosity. The very elderly do not live in the real world. When you or your loved ones face the permanent problems of old age, be sure you seek permanent solutions, not temporary ones.
LESSON TWO: Understand that when you get to a certain age, you are going to want to stay in the home where you’ve lived for forty (or more) years whether it is best for you, or not. You would be crazy if you did not want to do so. Few very elderly people are capable of making the best decision for themselves… like: It’s time we moved into assisted care.
Make plans ahead of time to make sure this kind of burden does not fall onto your children’s shoulders. Did I mind doing it? No… but a little good planning would have avoided the need that it be done. Find the place you want to provide for your assisted care needs.
Even during this crisis environment where it was very clear they could not remain at home alone, I had to say terrible things to both my mother and stepfather. “This is it! You are moving to a location where proper care can be provided.” That's not all that had to be said... and it was horrible!
LESSON THREE: Learn the differences between assisted and nursing home care. If you wait too long, you (or your parents) may not qualify to get into assisted care. They may not accept you. You may be forced to go into nursing home care (which costs about twice as much as assisted care and is far less private).
 In assisted care, you must be able to dress yourself, take care of personal hygiene, walk to the dining room (or have a wheelchair to get there), etc. Assisted care provides cooking, housekeeping, laundry and minimum medical care… they cannot give you a shot, for example. They will bring you your medications and make sure you take them, they will take your diabetic blood tests, but the people who provide these services are not Registered Nurses. If you’re temporarily ill, they will bring your meals to your room on a temporary basis, but not on a permanent one.
The day my stepfather fell down the stairs and my brother returned from the store where he was getting some orange juice to have available should a blood glucose problem arise, he found Roy at the bottom of the stairs and Mother sitting beside him, crying. Had she called 911? No. She hadn’t thought of it. That’s what happens when you wait too long… the elderly who suffer from dementia cannot be said to have good judgment. It is too great of a burden to expect them to have the mental acumen of a 25-year old. The biggest problem is, they think they do have it.
Upon his arrival at the hospital, Roy’s blood glucose was 600 (very close to coma and death). They found the fall had caused a minor heart attack. He had double pneumonia and he had a kidney infection and fever.
When you live away from your elderly parents, it is difficult to really know their health status because they spend so much time in bed. Too, if your parents get into their upper 80s and 90s, you’re in your late 60s to mid 70s and have some difficult health problems of your own. My brother had five by-passes after a heart attack six months before Roy fell. His wife of many years died three months later… then Roy fell six weeks after that.
I had to drive over two mountain passes in the middle of a blizzard (Eisenhower Tunnel had been closed at midnight the night before my trip). Since I have been disabled with arthritis, thyroid disease and asthma since 1993, and since I have an eye disease, I had no business driving to Denver in a snow storm. I ended up in the hospital with pneumonia a month later.
If you wait too long to make the decision to go into assisted care, you and your children will pay the price for it. The stress knocked my immune system down to zero and I, who am rarely sick (I have health problems, but I'm almost never ill) have been in the hospital a second time since the crisis. It would take a book to explain the difficulties we went through getting these two elderly people moved from one side of the mountains to the other. Their insurance company, Secure Horizons, advertises itself as a national company… even provided me with a list of physicians locally who accepted their insurance. Not one physician accepted Secure Horizons. I called them all... a horrid waste of my time when I had a hundred things to get done for my parents. Secure Horizons had no presence here so the insurance carrier had to be changed.
New Medigap insurance could not be gotten until Mom and Roy were here to sign insurance forms at the new company (which, since both are legally blind and have no photo ID to present a Notary, is a job in itself). A new physician had to be found immediately because Roy needed access to insulin shots. An assisted care facility had to be found. Their furniture and personal possessions had to be moved… and it had to be done within two weeks.
My brother and I got them established in their new residence and the facility into which they went is a good one. The food is good, the people running it are kind and thoughtful.
Then, a month ago mother became ill. My stepfather, without telling my brother or I, turned off the ringer on the telephone because he didn’t want mother’s rest to be disturbed. We would call (we couldn’t just drop in because both of them were always in bed asleep when we stopped by) and the phone would just ring.
I finally called the facility to talk with a nurse who explained to me that Roy had just come to her to demand she call an ambulance to take my mother to the hospital. They took her vitals and aside from difficulty breathing (she had “a chest cold”), she was fine. They scheduled a doctor’s appointment for the next day. Within 12 hours, Mom saw her primary care physician.
She was diagnosed with bronchitis and the doctor prescribed Levaquin. She got better. Then it sounded to me as if she were getting worse again and I called Roy and told him to get mother dressed, that I would be there in twenty minutes and we were taking her to the hospital emergency room.
Now here are some real lessons.
Upon arriving at the ER, someone had to provide insurance information and medical knowledge to get her checked into ER. I did it as quickly as possible and was then ready to go to the treatment room to provide medical information to the doctor. Oooops… I could not go into the room because my stepfather was there.
HIPPA – Health Insurance Privacy Protection Act – says that only one person plus the patient can be in the room providing information to the physician. Thus, the ER physician was getting his information about a woman who was dying from two people who suffer dementia. That’s a reliable source, right?
Had I not insisted to the nurse that she tell the doctor I needed to speak with him, I doubt my mother would have been admitted to the hospital. When I gave him the facts, he was aghast that they had not told him these things... medication allergies included.
Emergency Rooms at hospitals need to be more sensitized to the fact that “second childhood” generally means living in an unreal world. The elderly live in unreal worlds because it is preferable to living in the real world where their lives have become equated to waiting for the day they die. Fantasy worlds are not the best source of factual medical information.
LESSON FOUR: If you take elderly parents to the emergency room for treatment, be sure you are the one who goes with the patient into the cubicle to provide information.
When I called my mother’s doctor (before making the decision to take her to the ER), I found he takes three-day weekends. Okay. People need time off, I know. I was directed to call another physician who was taking her PCP’s calls. I did so.
LESSON FIVE: I don’t care who you are or how old you are, if your physician is in independent practice with no partners, you will not get the best medical care available in an emergency. Why? Because no one has access to your medical records. I learned that it is very important to have a physician with partners who cover when the primary care provider is away. They are reachable and they have access to medical records.
My mother was put in the hospital where she stayed for two weeks (she just graduated from the hospital into a nursing home rehabilitation center). While she was hospitalized, we were unable to get ahold of any of the “independent physicians” who covered for her primary care guy. In two weeks, we were never able to get a telephone call returned to learn her status. When we tried to get information from the nurses, HIPPA reared its ugly head, again.
I was her daughter, my brother is her son… unless you have a Medical Durable Power of Attorney that shows your relative wants you to have information about their medical condition, good luck getting it. Fortunately, we did have a Medical Durable POA. We could not get it to the hospital and placed in her file until the next day and so could not get information about her status until then, though. Even her husband with a joint medical insurance card could not get information.
You can thank your Congressmen and Senators for HIPPA, by the way. My mother’s grandchildren were calling the hospital to check on her status… sorry. Friends called… sorry, I couldn’t tell them anything because they would not tell me anything.
LESSON SIX: Have a family Medical Durable Power of Attorney drawn up by a good lawyer.
LESSON SEVEN: Use your common sense regarding your elderly parent’s condition. When I found out my mother had congestive heart failure and pneumonia, I asked which expectorant they were giving her. Having asthma and resultant bouts with pneumonia myself, I know that expectorants are given to help you clear the liquid from your lungs. They were not giving her anything.
LESSON EIGHT: When I found out about the expectorant, I had a long talk with her Registered Nurse for that night. I was direct but fair and as pleasant as I could be. You may not accept it, but those of us over a certain age realize that not as much work goes into treating the conditions of the elderly as goes into the treating the conditions of younger people. I cannot tell you how many elderly people have told me, "We're expendable."
“I understand that my mother is 97,” I said to the nurse. “I understand that it may be her time to go. I have already told her that if she wants to go and meet the Lord, she has nothing to worry about. I will make sure Roy is cared for until he joins her. On the other hand, I do not want anyone else to open the door on Mom’s behalf to help her through to the other side. That is God’s job. I want her to get every medication you would give someone who is 25 and suffering from the same malady. Do we understand each other?”
They started the expectorant. She got better rather quickly. I would not have bet a quarter she was going to make it through that first night in the hospital. She was that weak and that sick.
The other downside to having an independent physician rather than a practice with partners available was apparent when five different doctors saw my mother on five different days. I cannot emphasize to you strongly enough to think over the advantages of getting your medical care from a practice with multiple partners/doctors. Levaquin had not worked for me in February when I had pneumonia and it had obviously not worked on my mother. Which medication did they give her? Levaquin. I tried to tell the nurses she needed Zythromax, but we were unable to get in touch with any of the doctors treating her because we never knew which doctor would show up to see her. When she got to the nursing home and the pneumonia looked like it was coming back, they listened and put her on Zythromax. Her strength started coming back almost immediately.
My brother and I are currently looking for a non-independent medical practice.
THE FINAL LESSON: During this entire year since Roy fell down the stairs and the transfer from their home in an emergency environment had to be made -- getting my parents moved 250 miles from home, getting a new insurance company, getting a new doctor, finding a good assisted care facility -- I have found that every problem that arose was made worse by federal legislation of the health care system.
It sounds pretty good when seniors hear about all the wonderful benefits the government is going to make sure Medicare recipients receive -- like since they came out with Plan D for prescription drug coverage, my medicine costs have doubled.
We all need to be less dependent on government bureaucracies when it comes to our health care. They cannot even run themselves efficiently. People look to AARP which appears to me to be more interested in its insurance power base than member well-being. They have supported all of the “freebies for seniors.”
From now on, whenever AARP says federal legislation of this or that will be good for its members, I will plug my ears.
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Marilyn Barnewall, in 1978, was the first female to be named vice president in charge of a major loan and deposit portfolio at Denver's largest bank. She started the nation's first  private bank, resigned to start her own firm and consulted for banks of all sizes in America and other countries. In June 1992, Forbes dubbed Barnewall "the dean of American private banking."
Author of several banking texts, she has written extensively for the American Banker, Bank Marketing Magazine, and was U.S. consulting editor for Private Banker International (Lafferty Publications, London/Dublin). Copyright 2007 -Christian Business Network. Used by permission of The Christian Business Network and the author. | |
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