Fragile

We have a team of caregivers who are assigned to Martha's care. Each takes between one and three 24-hour shifts per week, depending upon one of us having something else going on. I am one of five women who care for her.

This past week, one of the team fell ill. It seems she will be out of the picture, either mostly, or completely. Enter a new caregiver.

Exit Martha's comfort.

Bubble and Squeak

Otherwise known as fried potatoes and cabbage!


This is a properly combined meal, for those seniors who have digestion issues. Protein will be served at another time, in that case. 

• 1 lb russet baking potatoes
• 1/2 cup coconut oil
• 1 large onion, diced
• 1 lb green or Savoy cabbage, cored and thinly sliced
• 3/4 teaspoon sea salt
• 1/2 teaspoon freshly ground black pepper

Peel potatoes and cut into 1" chunks.


Place potatoes in Dutch oven, cover with cold water, and bring to a boil. Boil, uncovered, until tender (about 15 minutes). Drain.


Heat coconut oil in heavy skillet over medium-high heat. Saute onion until sightly browned and carmelized, about 10 minutes. Add cabbage with salt and pepper and saute until tender, about 5-10 more minutes. Feel free to add more coconut oil if vegetables stick or get too brown. 


Add potatoes, mashing and stirring into cabbage (leave some of the potatoes lumpy). Press with a large spoon or spatula to form a cake.


Cook without turning until the underside is golden and crusty, about 10 minutes. Serve at once with additional coconut oil, salt, and pepper. 


This would go well with a tossed salad or crusty bread. You may also serve with additional vegetables. 

"You'll Think I'm a Nut"

She was crying, out of the blue, during the late morning on Thursday. I put my hand on her shoulder. "Is something specific wrong, or is this just a sadness wave?"

"It's a sadness wave."

"Ok, then. I'm sorry... and, it will pass."

Later it was time for Martha's shower, and that's always our time to talk deeply. I don't know why. David thinks the analogy of being "exposed and vulnerable" leads to her willingness to open up and talk.

An hour before her shower, I warm up a couple of tablespoons of coconut oil and massage it into Martha's scalp. At the start of her shower, I scrub her back with a hot, soapy washcloth, and wash her hair with medicated shampoo. Then she takes care of the rest of her shower, seated securely on a shower seat. I return to dry her off and help her out of the shower to get dressed. I blow dry her hair into her signature bob after applying lavender oil or herbal balm to the scaly patches on her head.

As she calls "Okayyyy", signalling her shower is done, I gather hot towels from the dryer. I put a hand towel on her head, a bath towel around her shoulders, and one wrapped around her front. All are hot and fluffy from the dryer. Then I massage her arthritic shoulders through the hot towel, and go about the drying process.

Thursday, after I put the hot hand towel on her hair, she sighed and said "Ohhh that's so good. When I recover enough to tell you why I was crying, you'll think I'm a nut."

"Too late" I said, rubbing her shoulders.

"Should I tell my mom she has asked the same question ten times?"

What if your 3-year-old stayed 3 forever? That's a little bit like handling some adults with Dementia or Alzheimer's. Occasional (or frequent) loss of bladder or bowel control. Arguing. Endless questions. Repetition. Anxiety and fear over things imagined. 


Telling your mom she has asked the same question numerous times is hurtful. Your mom has Dementia. She does not remember asking that question, or your answer, or she would not ask again. She's not stupid. I play games in my mind when dealing with the Dementia repetitiveness. I think about the movie 'Ground Hog Day' and that song coming on the clock radio again, and again. 


Try pretending you are an actor, rehearsing. You're just going through your lines again. Make them as real and believable this time as the last fifteen times. "Yes, Mom, it really is cold outside. I'm afraid the little birds may need ice skates soon. See? The bird bath is frozen over." The nice thing is you can get lots of mileage from that one joke. 


Here is a tip for taking to someone with Dementia who is repeating something and seems to feel anxious about it. Get in their face. I mean this is the kindest way. Lean in, so close, and place your hand on their hand. Smile. Tell them the answer as you look them right in the eyes. I use this often, and it works like a charm. No matter what is being asked, I can answer this way, with lower, gentle voice, firm touch on the hand or hands, and a smile. 


You might talk with a 3-year-old in much the same way, to calm them and get their attention. Here's what you won't do, though, for mom. 

• No childish voice or cutesy language (she's 83, not 3)
• No condescension (she may have Dementia, but she knows sarcasm and insult)
• No irritation (yep, that's a tough one!)

If you grow weary of saying the same thing over and over, try re-directing her to something else. I often have to turn the page of the newspaper because hearing that same headline for the 15th time can really get to me! Especially if I'm trying to do the dishes. It takes her a little while to find it again.

So, in summary - (there will be a quiz later) speak in a gentle manner, with low tones, use touch to cue her in on what you are saying, and get into her direct field of vision with a smile. Even if your words sound like the Charlie Brown adults (mwaa mwa mwa), she'll feel better. 

Do you think she doesn't know she's broken? 

Grieving

Long before Ralph died, and even long before it was very evident he was dying, he began to grieve.  Yes, you read that right; HE began to grieve.

I only wish I had understood that during the time it was happening. Let me give you a little idea of what his caregivers experienced:

• Control freak. Ralph ordered everyone around as if they were on this earth to serve his every whim - no matter how ridiculous. "Turn the plant 1/4 inch to the left. Get me fresh water. Hand me a tissue."    
• Night-time exercise. 3:00am he's up doing arm circles and leg lifts. No, I'm not kidding. Up 2 - 6 times for at least an hour at a time. Expecting the caregiver to be cheerful.

When your loved one doesn't feel like eating

I often encounter the reluctant eater. "I'm just not hungry, honey", they say. Unless a person is in the final stages of life and have begun to shut down, getting good nutrition is very important.

Make small, very attractive mini-meals, and serve them on colorful plates. An elderly person may feel no hunger, until they see and smell a delicious snack. Avoid strong, unpleasant odors if the person has a tendency toward nausea. Sometimes a cooler dish will have less of a strong smell, and be more appealing.

Breathing Exercises

Is your Elder breathing correctly? Here is a three-step process which will relax, alkalize, and help them maximize their oxygen levels.

1. Have the elder lie on their back on a firm bed, or the floor if possible. Bend the knees, placing feet flat, at a comfortable distance from buttocks. Rest their hands on their stomach, just below the ribs.
2. Coach them to breathe in slowly through their nose, filling the lungs. The lower part of their stomach should rise first. If the chest rises first, they are not breathing correctly and are not using their diaphragm. This is shallow, ineffective breathing.
3. Have them exhale slowly through their mouth, emptying their lungs - notice the abdomen flattening. Encourage breathing out for a longer count than they breathed in, completely emptying the lungs.

Lack of oxygen is a common problem with the elderly. This exercise, repeated often, can help. You should do it too!

Nutrition and Digestion

Elderly people may have delicate digestive systems. One day they're constipated; the next they have diarrhea. Many factors come into play. The most obvious is the diet. This, as a caregiver, you can help control. Be sure to get the advice of a licensed health care professional if you have concerns about your elderly relative's digestion. Here are a few tips to help them feel better.

I'm Still Here

Depression in Seniors

As their world closes in on them, they become depressed. Wouldn't you? If you found yourself unable to do what you used to do, shut out of conversations because you can no longer follow what's being said, and being very much alone when you used to be surrounded by family... wouldn't that cause you to be a little bit sad?

Add to that the fog of Dementia. I am convinced that many of those with Dementia and/or Alzheimer's, know that they've "lost it". They know this on one level or another. I cried when I watched the video for the song 'I'm Not Me Anymore'. I cry every single time. This loss of self is very great. If you have an elderly parent or loved one who is walking the lonely path of losing themselves, please accept that they are grieving, and will grieve, and may even take this out on you. Get their vitamin levels checked, make sure they are getting adequate nourishment and hydration, and love them where they are and "when" they are.

If you'd like, you may read about how my day with Rose went, yesterday...

Are you "Ensuring" your elders' health?

What do you offer if your senior just doesn't feel like eating a meal?

We've been brainwashed by commercials about "nutritional support" for seniors. Go to any Assisted Living facility or Group Home for seniors and you'll more than likely see little plastic bottles or little cans of vanilla (flavored), chocolate (flavored), or strawberry (flavored) drinks which are supposed to nutritionally support the clients.

Have you read the labels?

Take a moment and do so. And then seriously think about whether those ingredients support anyone's health.

I'll discuss some alternatives later this week. Meanwhile - consider offering organic vegetable juice and/or fruit juice (whole food juicing, not bottled liquid taken from the fruit or vegetable), rather than a plastic bottle of heat-processed, oil-filled, sweetened food substitute! Trust me - they'll feel much better!

I raise my glass to you!

I Hear Music

All through the day my client with Dementia heard music yesterday. How do you handle it when you are with a family member or client who sees or hears things that aren't there?

"Do you hear that?" she would say.

"I don't, but this is Christmas time - so it's probably a neighbor playing Christmas music. I drive my neighbors crazy with mine!"

"Do you hear that?" (five minutes later)
"Sometimes the dryer sounds like music!"
"Oh, that's probably it."

"Do you hear that?" (ten minutes later)
"Not sure what you hear - but I do hear a power tool outside - sort of sounds like a man's voice singing."

"Do you hear that?" (well, you get the idea)

It's Possible

Ralph served as a Colonel in the US Air Force. He was a proud man, right up until the end of his 90 years on earth. He was also very fond of jokes; both good and "questionable". We shared one, which I would like to share with you.

One morning little Johnny was getting ready to go to town with Mother.
"Johnny, did you wash up?" asked Mother. "Yes, Mother. I washed up as far as possible, and down as far as possible."

Bathing and Toileting Elderly With Dignity

How do you get your elderly relative or client to allow you to assist them in the bathroom? This can be tricky. Here are a few tips:

• Approach it as naturally as you approach making them a meal. Your relaxed and matter-of-fact approach will make it part of the routine.
• Assume they will accept your help. I swear this works wonders. If you assume they will fight you; they will. If you assume they will let you help them, they somehow sense this is the right thing to do.
• Look into their eyes while assisting them. Make every effort not to openly stare toward private areas. This takes a little practice!

On the Lighter Side

Elderly care has many funny moments. Some aren't necessarily meant to be... but those of you who care for elderly parents or other relatives already know that! The fact that the person who has Dementia may or may not be aware of their own age and capabilities can be dangerous, or hilarious. Yesterday was hilarious.I had gotten Rose up, surprisingly easily. More on that at another time. She finished her breakfast and we sat together at the kitchen table watching the birds flocking to her bird feeder. She realized it was her bird feeder. That may sound funny unless you've been with a person who has Dementia or Alzheimer's.

A beautiful Northern Flicker came to visit. We were discussing how much larger she was than the other birds, her distinct markings, etc. I said "You know, you can buy meal worms to feed those birds. Some people put out little dishes of worms, or stick them into holes in a little log for the Flickers and other woodpeckers to find." She looked at me in surprise.

Recipe: Cod with Dill Sauce

Cod with Dill Sauce

• 2 leeks, white and tender green parts, thinly sliced and soaked in water to remove sand.
• 6 tablespoons olive oil, divided
• 2 garlic cloves, minced
• 1/2 teaspoon dried savory
• 1 1/2 cups vegetable broth
• 1/2 cup dry white wine
• 1 tablespoon butter or Earth Balance
• 4-8 oz cod fillets
• Salt and freshly ground pepper
• Unbleached flour for dredging
• 2 tablespoons minced fresh dill, plus more for garnish

In a large skillet over medium heat, saute the leeks in 2 tablespoons of the oil until soft, about 3-4 minutes. Add the garlic, savory, broth and wine. Raise the heat to high, and cook until the liquid has been reduced by half, about 12-15 minutes. Put the mixture in a food processor or blender, add the butter, and puree. Pour into a small bowl, set aside, and cover to keep warm.
Sprinkle the cod with salt and pepper, and lightly dredge in flour. Heat the remaining 4 tablespoons olive oil over high heat in the same skillet. Add the cod fillets and saute, turning once, until golden - about 2-3 minutes per side. Be careful not to overcook.

Arrange fish on a serving platter. Stir the dill into the sauce and season to taste with salt and pepper Pour the sauce over the fish. Garnish with additional dill if desired.

Serve with fresh, steamed vegetable or salad

"I just want to expire" she said

Her daughter and granddaughter came for a visit. As usual, anticipating the visit consumed her mind. I was glad they were coming; she has been very sad since her beloved cat, named "kitty", died. I wondered if they knew that this visit was the only thing of importance in Rose's world.

Visiting Elderly Relatives During the Holiday Season

This is the time of year many distant family members travel to see Mom or Dad, or a Grandparent. Maybe you haven't seen them for a while. You don't know the condition of their mind, and you are a bit nervous about what to say to them. Let me help you. She's still your mom. She's just different. She may have Dementia, and may not appear to recognize you. He's still your dad, but he is so unfamiliar to you. How did he become so frail, so small, and so shaky?


When you are getting ready to visit an elderly loved one, it is a good idea to jot down a few conversation topics so you don't end up with "dead air". I will be posting a story, tomorrow, about a botched visit which left my client feeling very depressed.


Make a list. If your elderly family member has Dementia or Alzheimer's, you will want to avoid asking them questions other than "how are you feeling?" or other at-the-moment questions. Here's a list to get you started:

• Your recent activities, as well as those of any children you have. Think about any activities which might stir up good memories of their past.
• Books you are reading. If appropriate, bring one along to discuss with them.
• The day's newspaper. Read headlines and discuss the news. Stick with good news, if possible! It's amazing to me how distraught some clients with Dementia get over stories about things like child abuse.
• Things you enjoyed as a child growing up. I have found that discussions which evoke memories of smells and feelings are very stimulating. For instance; a client of mine was very excited to reminisce about the sheets hung on the clothesline in the back yard.  I could see her relax as she thought about the touch and smell of those clean sheets.
• Things you appreciate about your loved one. This can be a tender moment.. You never know what memories will be sparked by this discussion.

Sit close to the elderly person. Look them directly in the eyes. Hold their hand if you can, at least for part of the time.  Speak clearly, and slowly.


Here is a list of what you should not say:

• "Remember"? It's so tempting to say that - but do your best not to. Just eliminate that from your vocabulary. If they've got Dementia or Alzheimer's, they don't remember. Instead of saying "Remember, Mom? I was here last Thursday." Say "Mom, you had on a pretty pink blouse when I saw you on Thursday. I like this yellow one, too."
• "What did you have for lunch"? (dinner, breakfast, etc.) this can be so distressing. I know you mean well, but... they may have NO idea that they even ate lunch.I've had clients forget within minutes of leaving the table. Instead, you might say "I hear they served one of your favorites, meatloaf, last night. I still think you make the best meatloaf."  
• Any questions which require that they remember anything. Don't ask if they saw the doctor, or your sister or the pastor. Make comments, but don't ask. I watch an elderly person with Dementia appear to search the walls for an answer when asked a question. it scares them that they can't remember.

The last gentle suggestion I have is this: Please talk with your elderly relative, and not in front of them. As tempting as it is to "leave" them and talk to the other person in the room - please don't. Not while you are there visiting them. Be present with them. Talk with them. Look at them. Encourage the oth
er visitor to do the same. The two of you can go get coffee and de-brief later. For now, it's all about this precious person. If you don't really think this matters, be sure to read tomorrow's post. All too soon, you'll be talking about them because they will be gone.

Caring For Lucille

I chased an elderly woman around all day! Dementia has stolen her mind, but her body is surprisingly strong. This can actually be dangerous. Imagine someone with 90 years' experience and a limited comprehension of consequences moving at a high rate around appliances and stairs.

Cooking For The Elderly - Protein

Caring for Elderly and Disabled people is rewarding and challenging. My favorite part, besides pampering them, is cooking for them. To have someone say "Oh, honey, I'm really not hungry" and then consume every last bite on their plate is such a rush for me! This is not a recipe, but a few ideas that I hope you can use. Recipes to follow!Protein:

Training For Caregivers

I have attended a remarkably helpful training, and want to share the resource with you. Teepa Snow is a unique woman, who teaches the basics on caring for and living with those who have Dementia and/or Alzheimers. If you can't go to a training, watch her videos! You will be glad you did.

Welcome to Your Life - Dementia

Dementia is Scary.

What if you woke up one day, and discovered you were in a place you'd never seen before? What if a friendly, but unknown-to-you person cheerfully entered the room in which you had been sleeping, and announced that it was time to take your medication; handing you a little glass filled with pills you had never seen and could not identify? What if that person urged you to get up, even though you could not remember having slept at all, and proceeded to take you to the toilet, expecting you to allow them to remove your underclothes?

When Music Hurts

Ralph isn't feeling well today. Asked how he felt on a scale of one to ten, he replied "A three". Modern medicine is keeping him alive, but not making him healthy. This hurts my heart. So we wait it out. There are more hugs now.