Geriatric gloom

Post #400,622 by rcareaga 4/1/15 12:57:20 PM Reply	Geriatric gloom Sigh. The Aged Parent, who was actually looking pretty good at ninety in 2011, is steadily declining. We persuaded him a couple of years ago, after he began to exhibit alarming balance and mobility issues, to move from his little mobile home to a “senior” apartment, an arrangement which, once past some obligatory grumbling, he rather liked. About a year in, he fell and broke his hip on a hospital visit, and has been wheelchair-bound since. He formerly insisted that he would walk again (Us: “Have you done your physical therapy?” Him: “No, I don’t need it”), but I think he now understands that this is not in prospect. We then moved him into a so-called “assisted living facility,” that looked head-and-shoulders above the other outfits we visited, but which after over a year has signally failed to deliver the level of assistance (or even of monitoring—they contrived not to notice suppurating sores on his heels that looked goddamn close to gangrenous by the time my sister examined them) that we felt ourselves led to expect. So at the moment he’s being treated (not well, according to his doctor) at a quasi-hospital. The VA (he’s a USMC veteran of the late unpleasantness in the South Pacific seven decades ago, and his present mobility issues devolve at least in part from a serious injury inflicted from a Japanese pillbox during his attempt to get into their nightclub on Guam without the bouncer’s consent) says that “assisted living” won’t cut it any longer, and recommends a “skilled nursing facility.” This will provide, presumably, the level of monitoring and care to keep him alive (and the VA will apparently underwrite most or all of the expense, which will gratify him on a practical level, since he resents the steep monthly expenditure for his “assisted living” digs, whether or not it causes a philosophical conflict with his Tea Party Republicanism—but he’s always been a deft hand at cognitive dissonance), but in what circumstances? One or more roommates, a communal television, the clatter of bedpans: just kill me now. I should mention that despite his physical decrepitude, the old gentleman still has his wits about him. His four children know not what to do. I just know that if I ever live to within spitting distance of his condition, I want to be in Oregon or Amsterdam. glumly,
Post #400,626 by Another Scott 4/1/15 2:04:35 PM Reply	:-( It's hard. So much of it is luck ("why was that coffee table there?!?"), and so much of it is finding that one person who can make a difference in their care. Too many places are understaffed, have people in over their heads, have nurses that don't understand that all pills can't be crushed, etc., etc. Some nursing homes can be Ok. See if you can find one that also has patients who are there for temporary rehab - they're a lot less depressing than those where everyone is in a bed, some are screaming, there are noxious smells that don't go away, etc., etc. :-( Hang in there. Best of luck. Cheers, Scott.
Post #400,630 by a6l6e6x 4/1/15 5:06:58 PM Reply	One of the "greatest generation"! What I've found with folks that have been in the military too long is that they often don't ask the question "Why?" Why is this happening? Why am I doing this? Why am I here? And so on. It's unnatural and mentally too painful to address the question. The objectives and attitudes need to be provided by some one they accept. For example, Fox News. My brother is one of these. They have no problem with the What, Where and How. Good luck in the tough days ahead! Alex "There is a cult of ignorance in the United States, and there has always been. The strain of anti-intellectualism has been a constant thread winding its way through our political and cultural life, nurtured by the false notion that democracy means that "my ignorance is just as good as your knowledge." -- Isaac Asimov
Post #400,632 by rcareaga 4/1/15 5:39:17 PM Reply	Greatness is as greatness was The Aged P was a Merchant Marine cadet when war was declared, and transferred to the USMC days before this was interdicted. He was with “Edson’s Raiders” early on, and served in Guadalcanal and the Solomons up until he was shot in the course of the Guam landings in July 1944. His injuries were severe: he spent the next year in a military hospital. and never recovered entire mobility. He almost never talked about his wartime experiences while I was growing up. Beginning in about 1985 he took it up as a topic of conversation and hasn’t let it go since. And hell: my early twenties weren’t played for anything like those stakes. True, upon attaining draft age I could have fought the wicked NVA, but this was not, ah, widely regarded as an existential struggle by 1970. Hell, even der Alte, a lifelong firebreathing Republican, told me in advance of that year’s draft lottery that he was prepared to pay my bus fare to Vancouver: “I’ve done enough fighting for this family.” He’ll be gone this year or next. I’m hoping sooner and not later, because as far as I can tell he’s not enjoying a single damned day. cordially,
Post #400,633 by a6l6e6x 4/1/15 5:43:02 PM Reply	He probably agrees with your conclusion. Alex "There is a cult of ignorance in the United States, and there has always been. The strain of anti-intellectualism has been a constant thread winding its way through our political and cultural life, nurtured by the false notion that democracy means that "my ignorance is just as good as your knowledge." -- Isaac Asimov
Post #400,634 by rcareaga 4/1/15 5:59:18 PM Reply	Interesting hypotheticalfactoid James V. McNulty, who as an OBGYN subsequently ushered me into this world in 1952, was a USN physician on a hospital ship off Guam in July 1944. There's no proof that he ever treated der Alte, but it coulda happened. cordially,
Post #400,779 by gcareaga 4/8/15 6:55:40 PM Reply	Re: Greatness is as greatness was Dad rediscovered his enthusiasm for military culture in 1979. By 1985, he was lobbying for Purple Heart veterans in Sacramento and DC. Ahead of one DC trip, he casually mentioned that he planned to drop in to the Pentagon and visit with the Commandant of the Marine Corps. I snorted derisively (silently, to myself). Sure enough, a month later I got a letter and photo from Dad and there he was with General P. X. Kelly in what looked like an office a Commandant would occupy. I asked him how he managed it. He said the General's aide was initially dismissive. Dad told him:"tell the Commandant that a Marine Corps Raider wants to pay his respects." Dad said that he got an hour with the General on the spot. I am inclined to believe that he wasn't exaggerating. Our old man was one of nature's alpha males in his day. It makes his current state all the harder for his four children to grok.
Post #400,791 by rcareaga 4/8/15 11:23:04 PM Reply	Re: Greatness is as greatness was A former IWT member—an apparent suicide, alas, last year—was in the USMC at that time, and related the story of P.X. Kelly receiving a WWII Marine Raider veteran unannounced, told to the troops as an example of the Commandant's "open door" policy. I have no doubt that this was der Alte. Upon looking up PXK's Wikipedia entry, I find that he went on record during the Cheney Shogunate against "enhanced interrogation." Good, very good on the man.
Post #400,803 by a6l6e6x 4/9/15 3:28:31 PM Reply	Re: against "enhanced interrogation." Yep, folks that served at the point of the spear understand the implications. Arm chair chicken hawks have no clue. Alex "There is a cult of ignorance in the United States, and there has always been. The strain of anti-intellectualism has been a constant thread winding its way through our political and cultural life, nurtured by the false notion that democracy means that "my ignorance is just as good as your knowledge." -- Isaac Asimov
Post #400,794 by pwhysall 4/9/15 3:24:43 AM Reply	Re: Greatness is as greatness was My paternal grandfather, were he alive, would be your father's contemporary. He fought with the Royal Navy, principally in the far East and the English Channel. After the war, he spent 20 years working as a miner before finishing his career as a foreman at a power station. When I was a boy, "what did you do in the war, Grandad?" would generally only elicit the tales of him and his friend Frank who got into trouble for drinking, carousing and fighting whilst on shore leave. He would much rather hold forth on the state of the nation (he was a resolute republican, active in local politics and community-enriching things like scouting and the Royal British Legion) or mining, or the ins and outs of electricity generation. He was an engaging and charismatic speaker, as comfortable speaking to a crowd as to an individual. But once he hit 75ish, all that fell away. His world contracted sharply, and the only topics of conversation on which I could engage him were the war and his health. This became worse when my grandmother died just a few weeks after my father - a tornado of grief (my father and grandfather were close, and my father died unexpectedly) from which he never recovered. His last few years were spent dominating and victimising my mother, and rambling about what minor ailments he'd acquired this week. There was no joy in his company for us, and I doubt there was much for him. I wasn't pleased when he died, but there was relief. Not least because my mother, a woman who loves life, could actually start to live hers.
Post #400,640 by crazy 4/1/15 7:56:15 PM Reply	go find a geriatric nurse you can trust Preferably an LPN, not an rn. Then get a recommendation from her (assuming her, such as my wife). That is the only way you have a chance of a good placement. Hang out at the possible nursing home of choice, be there for a late shift change, and talk to the smokers. Then follow them to the bar (the vast majority of them need a wind down drink or two or twenty). Tough job. Then hang for a bit, buy them a few drinks, and then pump them for info. They will tell you the horror places and the ones that are better. My wife's patients all die sooner or later. And they love her. It is her job to see them through to the other side.
Post #400,924 by rcareaga 4/15/15 6:29:37 PM 4/15/15 9:06:37 PM Reply	The Aged P Goes down and down. There's nothing identifiably wrong with him: he's just wearing out. He could expire tonight, or a month from now, or six months hence. Nothing is certain except for the health care industry's determination to extract his entire life savings (and matched public subsidies) before he's permitted to do the Nunc Dimittis bit. He could go in a week; he could linger for half a year. In his place, at his level of confusion and discomfort, I hope that thirty years from now it will be permitted for some merciful relative to smother me with a pillow. wearily, Edit: fixed, with thanks to A_S. Edited by rcareaga April 15, 2015, 09:06:37 PM EDT Expand All History
Post #400,926 by Another Scott 4/15/15 8:24:43 PM Reply	:-( There's not much I can say except I'm sorry. Your link goes to an interesting place, but was it intentional? ;-) Nunc Dimittis is an interesting link. Hang in there. Cheers, Scott.
Post #400,932 by rcareaga 4/15/15 11:32:34 PM Reply	Fixed Thanks. Linky should now go to intended tune.
Post #400,934 by Another Scott 4/16/15 12:29:00 AM Reply	:-) Thanks.
Post #400,928 by a6l6e6x 4/15/15 9:06:07 PM Reply	Hang in there friend, it will pass. Alex "There is a cult of ignorance in the United States, and there has always been. The strain of anti-intellectualism has been a constant thread winding its way through our political and cultural life, nurtured by the false notion that democracy means that "my ignorance is just as good as your knowledge." -- Isaac Asimov
Post #400,933 by rcareaga 4/15/15 11:34:57 PM Reply	To be sure. It will pass. The grief will be dealt with when the occasion summons it forth. I'm not disposed to front-load anguish. cordially,
Post #400,939 by rcareaga 4/16/15 2:43:22 PM Reply	the nursing home He can't stay where he is. He can't go back to where he was. He needs more round-the-clock care than any of his children are remotely capable of providing. There are some primo (as these things go) convalescent homes in the region. They all have waiting lists. Der Alte will be on the wrong side of the lawn long before his number is called. We are accordingly reduced to choosing among the second- and third-tier. One has been found with a vacant bed. The online reviews stop short of calling it a hellhole, but the level of care appears to hover around "mediocre" (keeping in mind that the reviewers are anguished children of the senescent). On the plus side, it's about a twenty-minute drive from my home. The wife's experience five years ago with her own father's (mercifully briefer) decline suggests that squeaky wheels get much more grease in these establishments, provided that the squeaks are emitted from an upright position rather than from a bed. The starship Gerentoprise will now explore strange new worlds where so many men and women have gone before. cordially, PS: He recently amended the relevant medical POA form to indicate that he doesn't want a feeding tube. He always had this incredibly bold signature for as long as I can remember: even two years ago it looked the way it did in 1962. As of two days ago, it's a palsied scrawl, shaky and barely legible. God, I want to die of something—anything but this extended crucifixion of everything simply wearing out in parallel.
Post #400,942 by rcareaga 4/16/15 3:10:44 PM Reply	He now wants hospice care Reboot. cordially,
Post #400,962 by mmoffitt 4/17/15 8:51:36 AM Reply	You have my empathy. I had to place my mother in a hospice facility last week. Last night I received the news that she had passed away. I knew it was imminent, but it was difficult nonetheless. I take some comfort in knowing that for the first time in her life she was made as comfortable as possible.
Post #400,966 by malraux 4/17/15 10:01:39 AM Reply	Sorry to hear that Mike. I have not yet had to go through that and I'm not looking forward to it. Regards, -scott Welcome to Rivendell, Mr. Anderson.
Post #400,967 by Another Scott 4/17/15 11:24:36 AM Reply	Condolences to you and yours. :-(
Post #400,969 by mmoffitt 4/17/15 1:25:45 PM Reply	Thanks all.
Post #400,970 by pwhysall 4/17/15 1:38:26 PM Reply	{manhugs}
Post #400,976 by mvitale 4/17/15 2:23:40 PM Reply	Ugh. :( So sorry to hear. -Mike @MikeVitale42 "They that can give up essential liberty to obtain a little temporary safety deserve neither liberty nor safety." - Benjamin Franklin, 1759 Historical Review of Pennsylvania
Post #400,986 by rcareaga 4/17/15 5:41:40 PM Reply	sorry, mmoffitt Our parents are such...forces of nature as we grow up. I'm not sure that they're ever quite human to us, in the way that people we encounter in the course of our post-childhood lives are. And it's selfishly sobering when they no longer stand protectively between us and the trench. cordially,
Post #401,004 by a6l6e6x 4/18/15 2:13:59 PM Reply	Condolences! Late, but that's what happens when I get out of loop visiting my brother. Those hospice services are amazing. Alex "There is a cult of ignorance in the United States, and there has always been. The strain of anti-intellectualism has been a constant thread winding its way through our political and cultural life, nurtured by the false notion that democracy means that "my ignorance is just as good as your knowledge." -- Isaac Asimov
Post #400,944 by Ashton 4/16/15 3:55:35 PM Reply	Re: the nursing home Seconding that last: Ecstasy was a mental-State quite before Die Stadt decreed that You Can't Go There (or if you repeatedly try to erase-Self: we'll escalate the punishments) ... unto granting your wish: Our way, with Red-State random potions. We can't spend too much on frills. Wish I had uncovered some arabesque around the world's most cynical warehousing-franchise (I expect to have to employ my own pharm-chem, with back-up to augment any mechanical difficulties (as seem the way* of Cosmic humor, don't they?) Trouble Is: people of my (and even your) age-group never ever faced-in-advance all those unanswerable questions as were always elided in our earliest inculcations. Only the outliers did; you'd think that those born in late-50s, sentient during '60s? have realized all along, here in the dis-US: The fucking embedded-Puritanism will fight any choices whatsoever. Messy/noisy extra-vulgar Make-dos are the Murican Way. All the more Reason to disobey.. * There exist now several classes of such, pretty well vetted against any surprise side-effects; unknown how much /kg-body-wt. is sufficient for a splendid departure, accompanied by one's own fav tunes (or not.)
Post #400,946 by boxley 4/16/15 4:42:59 PM Reply	speedballs and smoking opium kills the pain and wears you out fast Any opinions expressed by me are mine alone, posted from my home computer, on my own time as a free American and do not reflect the opinions of any person or company that I have had professional relations with in the past 59 years. meep
Post #400,949 by gcareaga 4/16/15 6:26:37 PM Reply	Geriatric hot potato Last Friday, I went to the post-acute facility where the old gentleman was being treated for pressure sores. I wanted to be there when his VA home health provider paid a visit. When I arrived, he was no longer there. He had been transferred to a local hospital the night before. The facility was at first unwilling to tell me where they had sent him or why since I do not hold his POA. I used my outside voice to good effect until they changed their minds. That is a skill I learned from my father, but one I deploy a couple of orders of magnitude less frequently than he did in his prime. I stayed with him for his second and third days in the hospital. He has become alarmingly frail and was only intermittently lucid. It was difficult to get direct and succinct information from the hospital about what comes next, but it became apparent—and the sibs agreed—that he'd need a higher level of care than an ALF could provide. We investigated options. Alpha sibling flew down to take over logistics on Monday and has done excellent work or organize and inform. Still, as of yesterday we had no communication from the hospital about a discharge date. Today, we did receive such communication. His discharge date is today. Fortunately, this morning Dad was at his most lucid since I arrived last Friday, and communicated his wishes that his next move should be into hospice care rather than long term care in a SNF. I managed to find a VA-underwritten bed that would provide hospice care that would be available on 4/18. Hospital's position has been "tough shit. We want him out today." Alpha sibling has been reconnoitering and found local a hospice bed today. We will move Dad's belongings out of his old place this weekend. This is third time in as many years that we have moved him. This is certainly the last one. I agree with rc. I intend to be somewhere with humane end of life laws before I get too near that stage. Washington state is another (and my preferred) option.
Post #400,952 by Another Scott 4/16/15 8:23:47 PM Reply	... outside voice ... :-) I'm glad that worked. I'm glad your family is working together in your father's care. It doesn't make it easy, but mutual support is very important for all your sakes. Hang in there. I hope his remaining time isn't too painful and stressful. Take care. Cheers, Scott.

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