Wednesday, December 14, 2011

Drop me at McDonald's

                I have told my kids that if I ever get to where I don’t recognize them, they should just drop me off in a nice facility, don’t worry about visiting and don’t feel guilty.  When I told this to my sister, she said she wants to get dropped off at McDonalds. 
                The truth is, most of the time, decisions about our aging parents are not so straight-forward.  Caring for a parent with dementia is a dance with guilt set to a refrain of repeated questioning of our decisions.  For instance, how do you know when it is time to take your parents’ driving privileges away?   One day, they may be sharp and on top of things, but the next few days, they don’t remember what day it is.  Taking one’s driving privileges is equivalent to taking one’s independence.
 Through my job and caring for my MIL, I’ve noticed some signs that one should be concerned.  If the car is racking up unreasonable mileage for your parent’s normal travels, they may be getting lost.  I have seen elders who kept driving until they ran out of gas and called a relative to get them hours away from home.  When she was 70 years old, my MIL moved from New Jersey—a state that outlaws pumping your own gas—so she never learned to pump her own.  Since we had to pump her gas for her, we began to notice she used more and more gas but was unable to explain why.  Some of her friends told us they were concerned about her driving, and some wouldn’t ride with her if she was driving.  Boy, did that burn her up!  What an insult! 

                For years, we just observed her and had no reason to legally or logically take her license away.  I worried, because while she might not mind dying behind the wheel, I didn’t want her to take anyone else with her.  Our neighbors told us stories about her driving through four-way-stops and making a fist at the other cars at the intersection—stay out of her way, by golly! 
At the ripe old age of 93, she received a special letter from her insurer, Allstate, for being  a customer for 75 years without ever having a claim.  75 YEARS!  Imagine that.  The very next day, she had a fender-bender.  That was my signal. I reported her to the state regulatory authority.  When the State Trooper visited her to see if she could drive safely, she showed him her letter of congratulations from Allstate.  It took a while, but , she finally relinquished her driver’s license.  That brought both relief and new obligations.  .  For more signs that it might be time to relinquish a driver’s license, check out this resource from the Alzheimer’s Association.

I have never regretted reporting the MIL as an unsafe driver.   Suddenly, we realized how many things the MIL forgot or had trouble doing.  She is smart, and she learned to compensate for what she could not do.  No left turns across busy streets—turn right into the grocery store parking lot, circle through there, a simple left out of the parking lot, cross the highway at a light, turn right and get home without ever turning left on a major road.  Forgot what she went to the store for?  No problem.  Just go back.  I suspect she sometimes made two or three trips a day.  Suddenly, she could blame all her memory problems on being unable to drive.
In my work, I have seen families struggling with these issues.  I encourage you to plan ahead.  Don’t be afraid to take a stand and hold firm.  Read the advice from the Alzheimer’s Association here about planning ahead, having the difficult conversations and coping with the loss of independence.  Because these decisions are never clear and easy, and because our elders will generally fight tooth and nail to keep their independence (read keep their driver’s license), we will likely feel  guilt and insecurity about our decisions.  Dad was sharp today, maybe he’s right.  Who am I to say he shouldn’t have his independence?
The answer is to trust your gut.  Get on the HIPAA forms with their primary care physician and stay in touch with them.  Stay involved with your parent’s day-to-day life.  Take note of new dents in the car.   And finally, don’t be afraid to take a stand.  If you wouldn’t want your child or grandchild to ride in the car with your parent, then there is a good chance they shouldn’t be driving and putting others at risk.   Don’t be afraid to do what you know deep down is the right thing.  Just be prepared to do more driving,  because you might have to make some extra trips to McDonald’s. 

Tuesday, December 6, 2011

Wedding wine

We often don't realize how compromised our loved one's reasoning has become.  They are masters at masking their deficiencies.  The ability of the human brain to compensate and conceal is amazing.

After attending the wedding of her Sunday School Teacher's son, the MIL (mother-in-law) came home with the usual trinkets associated with modern weddings.  An announcement, a tube of bubbles (why is rice taboo now?) and a sweet to eat.  The next evening, while helping with something in her apartment, the  MIL said, "I didn't like the wine they gave at that wedding."  My daughter and I looked at each other, and then at the MIL.  I asked, "What wine didn't you like?"  The MIL gestured to the now-empty tube of bubbles, "That wine--it didn't taste good at all."

These same Sunday School classmates, for the most part, don't realize how poor her reasoning had become.  As her memories of days long gone-by strengthen, her memories of last year and yesterday are lost.  What are the signs?  When do we need to become concerned?  Once we know, how do we convince our loved ones to hand over control so we can help them remain independent?  How do we deal with jobs, kids, grandkids, and our parents, who have now become as children--for whom every day is a new day?  Heck, sometimes every ten minutes is a new day. 

I will add resources, and add photos as I master this art of blogging.  Today, our inaugural day, it is about wedding wine vs. bubbles, dignity vs. shame, patience of a saint vs. loving-human-being-doing-the-best-they-can-but-God-help-me-I-don't-know-how-much-more-I-can-take. Welcome to Cracked Pots--where the vessels are still valuable but don't function the way they used to.