End of Life

The Elephant in the Room – Difficult Talks We All Should Have

Posted in adult children, Age Related Issues, Blog, Care Management, Caregiving, Dementia and Memory Loss, End of Life, home care, Mental Health, Moving an Aging Adult, Relationships on April 19, 2013

Linda Fodrini-Johnson, MA, MFT, CMC, Founder and Executive Director of Eldercare Services discusses and give solutions on effective communication with family members about the issues of aging.

These issues might be:

Who would make medical decisions for you? And, do they know your wishes?
Remarriage
Memory loss — possible dementia
Forgiveness — Needing it and granting it
Moving
Can someone take over your financial affairs?
How do I face not driving?
Who inherits what of my possessions and assets?

Mom is Gone

Posted in adult children, Age Related Issues, Blog, Care Management, Caregiving, Dementia and Memory Loss, End of Life, Relationships on January 31, 2013

Founder and Executive Director Linda Fodrini-Johnson, MA, MFT, CMC

You know the time will come. You have been through many big and small health care dilemmas. You have prepared for her final care and found caring and loving people to be with her. You wish you could have done more but know you did your best with the information and support of professionals and family. Yet, when the time comes, it still hits your heart and soul like having the wind knocked out of you.

“This is the day that the Lord has made, let us rejoice and be glad in it.” Psalm 118:24. I can’t tell you why this scripture rings in me when I feel so much loss. But, it is a glorious sunny January day and though it began with her leaving, I think this Psalm is mom telling me, “I am at peace, dear family. Be glad in your life, rejoice with one another for I will always be part of each of you.” “Smile, joke, be positive and find the bright light in every day.”

We have been gifted by a mother who lit the way and guided each of her four children to be themselves, honor family, honor God and care for others. She has imprinted her hand on the hearts of us all.

So, the Academy Award and the Nobel Peace Medal for “Wonderful Mother” goes to Bernice Bidwell born on April 8, 1922 in San Francisco and died at peace, on January 30, 2013 in Walnut Creek.

Taking Me Home?

Posted in adult children, Age Related Issues, Blog, Caregiving, Dementia and Memory Loss, End of Life, Moving an Aging Adult, Relationships on December 18, 2012

Founder and Executive Director Linda Fodrini-Johnson, MA, MFT, CMC

I moved my mother to a small residential care home that gives great care, at the same time I was scheduled to take a week’s vacation. When I returned six days later, I went to see how she was doing and the first thing she said, “How did you know I was here?” I explained I had picked out the home and she said it was a very good one (nice for me to hear).

She has vascular dementia so her short-term memory is impaired but she was very aware that she had not seen me in six days. We chatted for a few minutes with the other five residents before it was time to eat and then I accompanied her to the dinner table to continue chatting with her and all the residents.

As she finished her meal, she gave the caregiver a kiss and then a hug and thanked her for everything she had done for her and then turned to me and said, “Taking me home now?” Wow, I didn’t expect that. I said, “No, you need to stay here.” And she said, “What about my home?” Well, thinking she was talking about her home of 58 years I explained that her grandson was taking care of that house. She said, “No, the other house” and I responded with the name of the Assisted Living she had resided in for 18 months prior to two months in skilled care and she said, “Yes!”

I had to tell her we gave that up because we can’t pay for two places. She has always understood money and that was ok with her – while again telling me that this new home was a good home. I told her if she gets well, she could return to Assisted Living and she said, “Am I sick?”

Needless to say, I drove home in tears but, once I synthesized her comment, I was thinking how wonderful that she has no idea she is nearing the end of her life and that her sweet, tender heart is failing her.

Gracious, appreciative mom – I am privileged to be your daughter.

Life-giving and Integrity vs. Despair

Posted in adult children, Age Related Issues, Blog, Caregiving, Dementia and Memory Loss, End of Life, Relationships on December 11, 2012

Founder and Executive Director Linda Fodrini-Johnson, MA, MFT, CMC

What is “life-giving?” We are aware that in order to be a living creature, we all need air and substance (food and water) but the third and fourth elements will differ for each of us and, I believe, become more important as we age.

One is a belief in a higher power or a resolve in whatever one believes is the circle of life. This is inline with Erickson’s stages of life when he says, the last stage of development for us is to resolve the integrity vs. despair step. In simpler words, making peace with the whole of your life vs. longing for something that wasn’t or could never be for a myriad of reasons.

As I look at my mother’s life though, on Hospice, I see it was a simple life but she did accomplish that last Erickson task – and there is great integrity to the life she lived. I believe this is why she does not complain and is appreciative of every interaction – with “thanks” being expressed frequently.

The fourth element, which differs in each of us, is the environment we need to thrive. I mean both relational as well as the physical environments. I need times of complete quiet in my day. Days that are overfilled with “to-do’s” stress me and leave me anxious and actually interfere with sleep. However, I also long for the intimacy of spending quality time with my spouse, family and friends.

In my physical environment, I need nature but more specifically trees. And out of every window in my office and my home you can see trees. Why trees? I have no idea other than the fact that they are actually oxygen producing and stand tall during any weather. I also know that trees need to bend in order to be strong and over supporting them makes their trunk weak – just like people!

You each will need differing elements to be life-giving and, as you age, it will be important for you to keep that which gives your life meaning and importance in your everyday life.

Also when making decisions for others, remember to keep these four elements in the forefront and base your actions on what has been life-giving to this individual, not you – often they can be the same but, not necessarily.

Hospice for Mom?

Posted in adult children, Age Related Issues, Blog, Care Management, Caregiving, Dementia and Memory Loss, End of Life, Relationships on February 13, 2012

Founder and Executive Director Linda Fodrini-Johnson, MA, MFT, CMC

My heart and the mind are in conflict – a challenging choice.

Today the doctor suggests Hospice; a wonderful supportive process of ushering one from this life to the next, with dignity and comfort. My experience says this is a good plan as I have appreciated the wonderful care my clients have received from all the terrific hospice professionals over my 30 years in Geriatric Care Management.

But, for my mom, it can’t be that time – because I don’t want it to be that time. I want her in my life. So do my brothers and all the grandchildren and great grandchildren. It is so hard to envision holidays and family milestones without her.

I have stepped up my advocacy for mom these past two years. I know it was that advocacy combined with her never giving up that gave her the last year in Assisted Living in a lifestyle she enjoyed. If she had stayed in her home I think we would have had to say our goodbyes long ago. One thing that has contributed to her 90 years is her ability to let go of stress and worry. With
every hospital stay she has never fretted or been anxious – is this a lesson for all of us?

I will need to embrace the circle of life because there is no alternative, despite my skills or incredible love for a good mother.

I will talk with the hospice team and with my mom about our choices but I will not give up on hope or the possibility of her bouncing back like she has done so many times before. For where there is love there is hope.

Mom is part of me and all my family so when she does pass from this physical life to heaven’s doors, she will live through each of us in so many little and big ways – we will never truly lose her.

Love is doing what we need, not what we want. Hard choices face us on this journey we share - life!

Mom in the “ER”

Posted in Blog, Care Management, Dementia and Memory Loss, End of Life, Relationships on February 13, 2012

Founder and Executive Director Linda Fodrini-Johnson, MA, MFT, CMC

I sit listening to my mother snore – wondering, is this the trip she doesn’t return from? This is the 8th hospital visit in 13 months and she is almost 90 years old. I need to be realistic; this is my field of expertise and I know what the consequences are of her many diagnoses. Yet I can’t get that picture out of my mind of her walking into my office yesterday with one of my staff who had just taken her to a medical appointment for me since I couldn’t attend because I had a speaking engagement.

She was so happy to see me and the other staff. She always gets a certain grin that tells me she is proud of my achievements – it is a grin like no others. Who can give you that unconditional approval like a mother? Is this what I will miss – it feels self-centered to even think this because I know I will miss her for her always helpful advice and her deep faith in a loving God. Not to mention her love for all of her family.

She is a fighter and will not give in so I will stand beside her and help her understand her options and advocate for her at every step on this slippery journey.

All of us need advocates for, without them, our history might not be conveyed in ways that assist the medical team to treat appropriately. We also need advocates to see we can be gently ushered unto our next life, based on our values.

Being the guide when the ultimate outcome is loss and grief isn’t for the faint of heart but this is the role I play in mom’s life now, and it is an honor. I am fortunate she was, and is, my mother.

Thank you, kind and considerate medical providers who work in the ER!

How to Know When Your Loved One Has Reached Their “End of Life”

Posted in Blog, End of Life, Relationships on January 6, 2012

: Professional Geriatric Care Manager, Eldercare Services, Jean Tokarek, MPA, CMC

Realizing that your loved one’s end of life is upon you is not an easy event to face or admit. Telltale signs can include refusing to eat or take medications, taking to their bed, sleeping all day and having more difficulty with ambulation.

When this occurs, their primary care doctor should be contacted who may order some lab tests to rule out any vitamin deficiencies, dehydration, assess for depression or other things medical going on with the body. If the doctor clearly feels that Mom or Dad is at the end of their life, hospice services can be ordered and brought into the home to make their last months most comfortable and a reflective time to be had with family members and friends.

The hospice team can be a godsend when Mom or Dad’s household and health are in a state of flux. The RN case manager will assess the patient for pain and symptoms, recommend comfort medication and order medical equipment such as a hospital bed to relieve pain and suffering, and educate family members and other caregivers on what to expect when your loved one declines in function. The social worker will help out with any practical financial issues like Powers of Attorney, burial plans and hiring additional in home care if needed. A home health aide will come to the house 2 to 3 times a week to give patient a bath or shower and change the bed linens.

Volunteers are available to be with the patient and give family members a break for a few hours a week. The chaplain will make home visits to attend to Mom or Dad’s spiritual care and a bereavement counselor will work with patient and family members with any anticipatory grief concerns. The hospice team will work very closely with the family and or care manager with any medical or psychosocial concerns of the patient.

One of the hardest things for both family members and caregivers to watch is when your loved one stops eating. When this happens, they can lose weight very quickly and rarely relieve their bowel or bladder. It is best to encourage Mom or Dad to eat but not force feed. At this point, the patient knows when they have had enough and gradually their body will begin to shut down.

When the eating process slows down, it is not painful to them but important to know that the patient needs to be kept comfortable. An extra blanket, some soft music that they enjoy, ice chips for thirst, a cold cloth on the forehead and a gentle touch of the arm can mean so much. It is also during this time that meaningful conversations can be conducted with family members and friends to reminisce about happy, earlier times and to let your loved one know how much he/she means to you.

Hospice RN’s are also available to the patient and family 24-hours per day. If there is a drastic change in medical condition with your loved one, it will provide comfort to the family to know that an RN on the other end of the line and his/her expertise is only a phone call away.

End of life situations can be a very difficult thing to plan for and discuss with family members. Knowing that there are resources available and having the discussion on how to proceed sooner rather than later will make the last chapter of a loved one’s life less chaotic and will be spent comfortably and surrounded by people who are very important to them every step of the way.

Zen Hospice – Volunteer Hospice Program with a Twist

Posted in Blog, End of Life, Future Trends on September 23, 2011

Founder and Executive Director Linda Fodrini-Johnson, MA, MFT, CMC

Most of us are aware that individuals close to the end of their journey on this earth can have the care and attention of a Hospice service. Generally this is provided for those with a diagnosis of 6 months or less of life. If one is covered by Medicare, the services of the medical providers, comfort medications and some durable medical equipment are covered, given the individual doesn’t want to be taken to a hospital and are in agreement to be given general “comfort measures” only. The Hospice movement has gained ground in the past 30 years after getting its start in England.

I had the privilege to visit the Zen Hospice in San Francisco recently. This is a licensed residential care home and not a “Medicare Hospice”. Families pay a daily rate but the care, philosophy and attention to detail provided to those approaching the end of their lives is filled with dignity, comfort and overseen by a professional staff of nurses, volunteers and under the direction of Dr. BJ Miller, a palliative care specialist at UCSF Medical Center.

The lovely Victorian home is decorated in décor that is soothing and refreshing. The meals are of gourmet level; one was being prepared during our visit as a volunteer sat in the dining room preparing fresh dried herbs to be used for the meals. In one of the bedrooms was a volunteer playing a harp.

The majority of hospice delivery is provided in the home but at times the home is not workable for a variety of reasons and we are seeing more free standing Hospices designed to bring the highest level of human dignity and grace to the final journey.

The Zen Hospice as many other hospice programs across the country offer grief groups and a variety of classes on end of life. More information can be found regarding this service a www.zenhospice.org.

I want to thank all those who volunteer in hospice programs – you bring comfort, love and grace to those about to leave this life. You are “angels” on earth!

Geriatric Care Managers – Saving Families Money

Posted in adult children, Age Related Issues, Alzheimer's, Blog, Care Management, Caregiving, Dementia and Memory Loss, End of Life, home care, Relationships on January 7, 2011

Founder and Executive Director Linda Fodrini-Johnson, MA, MFT, CMC

Watch the video on YouTube by clicking here.

Families at a distance, families in conflict, families with resistant elders and families at a loss for options for their frail or confused elder often can save hundreds or thousands of dollars using the expertise of a Professional Geriatric Care Manager (one who is certified).

If you are living across the country and have to take time off work and fly on short notice across the country, it could cost you thousands of dollars as opposed to spending a few hundred dollars on a local expert to assess your aging parent and give you direction, counsel, coaching and advice before you fly across the country.

When families are in conflict on what is best for mom or dad it can mean one or many are taking time off of work without pay to care for a parent that might be better served by a local program, an entitlement or skilled caregivers. It can also mean that the energy in arguing with siblings is causing you stress and adding to your own health care costs. The neutral, Geriatric Care Manager, won’t take sides but make recommendations based on the needs of the aging parent.

Not knowing local, State or National benefits costs families thousands of dollars. One client of mine, after a one-hour of consultation, left my office with the knowledge of a benefit that brought $22,800, in one year, to her parents who live across the country. That more than paid for the one hour she paid me.

Get professional help if only for a 2-hour family meeting or a 1-hour consultation. Thinking you can do it alone on the internet can lead you to a good sales pitch but poor information that isn’t client centered and all about what they are selling!

What Gives Your Life Meaning?

Posted in adult children, Age Related Issues, Alzheimer's, Blog, Care Management, Caregiving, Dementia and Memory Loss, End of Life, Relationships on September 21, 2010

Founder and Executive Director Linda Fodrini-Johnson, MA, MFT, CMC

What Gives Your Life Meaning? This is one of the first questions I ask most of my clients in geriatric care management and in counseling. The reason for this question is to know what is important to you as an individual – what gives your life meaning, value and purpose. If I know this before the issue, it always helps me to redirect, coach, and counsel you or your entire family keeping that value in all decisions, options and outcomes.

Taking inventory to that which gives your life meaning is important in drafting legal tools and financial planning goals. I say this not as an attorney or a financial planner, but as an advocate for you to have “life your way” no matter what your unforeseen needs may be.

For example, if “family” (children and grandchildren) is your primary focus for meaning, as well as for a relationship, then you will want to live near them or have arrangements made for frequent visits if at a distance. Likewise, in your legal tools, you might want to leave all of your assets for the education and well being of your grandchildren.

If your passion for your faith and God is a primary place of meaning and value, you might want to indicate in legal tools that you would want to live in a religious run or managed care facility should you ever need assisted care. Likewise you might want to give the majority of your estate to the religious institution you are affiliated with. If you are leaving assets for a religious group you might want to indicate how you want them to spend your donation – such as children’s or music ministry or mission outreach. It can be a general donation, but if you have been on many mission trips and want to ensure missions will continue, you want to be specific in your directions.

An inventory of what gives your life purpose is also important in delegating time and energy during ones life. If animal protection is your passion, you might want to volunteer at a shelter. If adult literacy is a concern of yours, you might want to assist those who didn’t learn to read as a child– what a wonderful gift.

What we do with our lives is up to us – take inventory of your passions and make them part of your life today, as well as your legacy forever.