Thursday, April 26, 2007

From Failure to Thrive to Desire to Thrive


Here is the preface to my book:

I am just like you.

I grew up in a typical dysfunctional family, where we rarely communicated about the important things such as feelings, money, sex, and dying.

It's no wonder that I found myself overwhelmed and at a loss for what to do when my parents abruptly fell ill two years ago.

You see, they had been completely independent well into their late 80s. They maintained the house they lived in for more than 40 years; they paid all their bills on time; they did all household repairs; they both drove well-maintained cars; they consumed at leased two meals a day that they prepared; Dad handled the yard work; and they were perfectly groomed. My mom was always well-dressed and well coiffed, wearing the latest styles, matching her colors from head to toe, applying full makeup, and wearing high heels shoes and stylish boots every day. She even line-danced regularly, performing throughout Chicago with other seniors. My dad performed all the physical labor inside and outside of the house, including housekeeping, gardening, and decorating the house inside and out during the holidays.

This all changed when my mom suffered a stroke and fell down a flight of stairs in January 2005.

Fortunately, she suffered no physical injuries from the fall because padded carpeting on the stairway buffeted her. Her emotional and mental health, however, began to diminish. We discovered later she had a stroke which caused the fall. She began to deteriorate dramatically, refusing to eat or drink water; she only slept all day long. She began to hallucinate insisting she had spent time with loved ones who had long passed away, including my dear sister. She even insisted she had spent time with Jack the dog. Importantly, Jack the dog had died when she was a little girl.

She was eventually admitted to the emergency room where she was diagnosed with” failure to thrive”. Those words still haunt me today. I spoke to the Chicago doctor from Miami, asking him, what were the next steps? He revealed there were no next steps--my mom would not leave the hospital. Her days were numbered. My mom was determined to fight this diagnosis/declaration/ directive, and was eventually transferred to a nursing home for skilled nursing home care. I evaluated several Chicago nursing homes and chose one minutes from her hospital and only a 20 minute drive from our house.

It was there in the nursing home that my eyes were opened to the world of long-term care for aging adults. During the first two weeks of my mom's 30 day stay, I drove out to the nursing home daily and spent all day at her bedside. Each day I brought her favorite foods, new easy to wear outfits, and family photos to adorn her hospital room. My mom had many visitors from friends, neighbors, church members, and even the pastor of her Catholic church. Her room was always full of flowers, get well greeting cards, and visitors. One friend even sent a manicurist to make my mom's nails beautiful! Another friend washed and braided mom’s hair in the shower stall. Another dear friend, who came with me each day, took my mom's laundry home and freshened it up herself with lots of love and fragrant fabric softener.

It was there in the nursing home that I learned how to communicate with geriatric doctors, social workers, physical therapists, occupational therapists, nutritionist, and a host of round-the-clock nurses and nurse’s aides. The nurses aides are the biggest heroes because they dutifully trudge the road to helping clients who are society’s forgotten and who are often unaware of the care that is given. I developed deep affection for those who care for my mom and a great appreciation for the complexity of their work.

The results of 30 days of intensive round-the-clock professional care were: my mom gained 20 pounds, walked well with the aid of a walker, and had rich and cogent conversations with friends of all ages.

I am for ever grateful to those nursing home staff who transformed my mom from the state of failure to thrive to desire to thrive.

The next phase of our journey began when I brought my mom home in March 2005. Because she had been diagnosed with early-stage Alzheimer's, I was required to provide round-the-clock care.

Sadly, my dad, her husband of more than 60 years, began to decline, right alongside my mom. He also resisted help and denied Mom was sick. He could not accept that his soul mate may never be restored to her prior feisty, passionate self. He made my role difficult because he attempted to undo much of what I put into place. He even resisted every single care giver, yet, now, he depends on them with enthusiasm.

I was charged with all duties of care management for my parents. Since that time, I have hired round-the-clock staff, consulted many times with hospital and mobile doctors, nurses and social workers, elder care agency managers, pharmacists, insurance company representatives, durable medical equipment representatives, lawyers, accountants, bankers, and a wide range of home repair professionals. I even had to maintain the family car, which broke down quite regularly.

On several occasions, I was told by doctors and nurses that she had less than six months to live. Mom has beaten all the odds! More than two years later, she is chubby, happy, and serene. What do those medical professionals truly know?

I travel to Chicago monthly since January 2005 and spend 15-80 hours per week with managing my parents’ care.

Two years later, I find I possess a wealth of information about how to be an effective long-distance caregiver.

In the beginning, I had absolutely no knowledge of what to do or how to do it.

I am extremely pleased that our family had the wisdom to openly discuss advance directives and for healthcare, and how they wanted their assets to be distributed. We had this discussion several years ago. Fortunately, they had an elder care attorney to draft all legal documents, dictating what kind of medical attention they desired, who the decision-maker would be (I have power of attorney for property and healthcare), and how they wanted their property to be distributed. The house and contents and most of the financial assets will go to me, their only surviving daughter.

During my travels, I talk to many people all over the country about my caregiving episodes. Some of the most common feedback I receive is that people marvel that I am doing it alone without the aid of siblings. I reply I have help from my higher power, our family angels and many friends who love my parents, as I do.

What I'd like to say to you is that if I can do it, you can too!

There are multitudes of resources and references on how to effectively care for your aging loved ones.

I am not an expert. I am merely someone who has actively cared for my parents from a long distance for more than two years.

I hope you will find reading about my journey, helpful in your journey!

Best Regards,


Karla Scott, Long-Distance Caregiver

Thursday, April 19, 2007

A Week in the Life of a Long Distance Caregiver

A Week in the Life of a Long Distance Caregiver

My name is Karla Scott and I have served as care manager and guardian, making all major decisions, for my invalid, nonagenarian (in their 90's) parents for two years. Importantly, they live in their Chicago house they purchased in 1958 and I am the only surviving daughter and live in Miami, alone. I travel monthly from Miami to the South Side of Chicago to manage their care, oversee home caregivers, and spend quality time with Mom and Dad. I draw upon my personal experience to share advice on how I successfully manage their care.

Week of April 12 through April 18, 2007


In the midst of the Imus racist/sexist radio scandal and the horrors of the Virginia Tech massacre, I managed to care of my two nonagenarian parents from long-distance. I have performed all duties of long distance geriatric care manager for more than two years now.

Here it is a typical week:

It began with Charlotte, the daytime caregiver, calling me to notify me of the latest gas and electric bills. I paid them both online.

Subsequently, she read me a letter from Medco that my moms Alzheimer’s medication, Aricept, had been authorized for another year. It amazes me we must renew it annually, even though Alzheimer’s is a progressive illness.

I contacted my moms endodentist to authorize a root canal. The dentist, her Dad, performed phase 1 of the procedure last week, and I spoke to my mom's doctor to assess whether she has the capacity to recover from such an invasive procedure that will require pain medication and healing in her mouth.

I met with a financial planner for the first time to discuss how to best manage my parents' estate, given that their monthly pension and Social Security income does not cover their care.

Next, I spoke with the weekend caregiver who informed me my mom is suffering from hemorrhoids. She has given her hemorrhoid medication for two days in a row. My mom's incontinence has gotten worse. My dad is losing control over his bladder as well. She feels my mom needs to wear larger diapers that provide greater coverage, and that we should consider putting diapers on my dad. That would certainly change the nature of the caregiver's jobs; currently, they are only taking care of my mom's incontinence. I know how painful it would be for my dad to have women cleaning him down there. It is all heart-wrenching! The weekend caregiver says the anti-itch medication appears to be working again. Mom has such a violent rash that she scratches aggressively until she bleeds all over her body. She has a habit of scratching upon awakening, and during the evening. It is very difficult to watch her breaking her skin, scratching until she bleeds.

I recall when I was there two weeks ago, one morning, my mom woke up wondering where she was, insisting that was not her house, and questioning why her skin was torn and bruised. She had no recollection of her incessant scratching.

I confirmed that both daytime caregivers will be able to take my mom for her root canal appointment. They both work for a state agency; So I don't have to worry about liability and they will be paid hourly for their time. I am so grateful to have those women, and I'm grateful that my parents’ private insurance covers most of the cost of the procedure. I am also grateful that for a change, the weather is not freezing or snowing in Chicago. It is safe for my Mom to go outdoors. It has been the longest winter in a while and record low temperatures have been set during the month of April.

I went to my mom’s dental insurance company’s website where I reviewed her coverage, printed out temporary ID cards, and downloaded the policy. Last week, I had Aetna mail new ID cards to my Mom and Dad. Thankfully, they both have Aetna dental insurance.

On the day of my Mom's scheduled root canal, the dentists’ assistant contacted me to complete a medical history form. I spent an hour on the telephone with her answering all her questions about my mom’s medical history. She needed to go back 10 years. She verified my mom's insurance information. She faxed in authorization form for me to complete. I had her fax it to a friend and he will e-fax it back to me.

Our nighttime caregiver experienced several personal crises this week. This happens often a lot, because she juggles family, personal illness, and handles out of state deaths in the family. Because she is conscientious, she always finds a replacement. The other caregivers cooperate and fill in for her when she is unable to work. At least her job gets done and that's all that matters. I have made several adjustments to her work and I am willing to accommodate her, because whenever there is a crises, the other caregivers contact her and she runs to their rescue immediately. She is like family, we all love her. She is a good person, and we trust her.

I Googled washer and dryer sets from Sears. Both the washer and dryer, 30 year old machines, need to be replaced. There are units on sale. I can order online and shipping and handling and removal of old equipment are all included in the price. I should probably order new machines.

I went to the IRS website to check on the status of my parents income tax refund. I filed their taxes a month ago. The refund is being processed and will be issued April 20.

I called my mom's best friend, Juanita, to discuss her visit with my parents on their 63rd wedding anniversary, April 9. She was happy to see my mom. I had asked her to take down the Easter decorations. I always decorate for the holidays, just as my parents did for my sister and me when we were children. I had visited the week prior and brought Juanita by the house to visit my mom for a six hour stay.

I began writing my book, Doing What’s Best for Your Parents, on Sunday, April 15.