When things work right: housing and supportive services

My mother died April 1. She was 86, in increasingly poor health, and had long been ready to go.

We encountered some troubling problems with the medical care system at the end. But I'm going to leave those behind and talk about what went right.

When Mom started having more trouble managing in the independent apartment in Oshkosh, Carmel Residence, where she'd lived since 2000, we moved her into the community's assisted living facility, Gabriel's Villa. There was an interlude of illness, skilled nursing, and rehab in between, but that's not really germane to this part of the story.

The apartment was lovely, and Mom quickly made friends with the residents and the aides. The food was superb, and she actually started eating three squares a day. She began walking around her apartment using only her cane, and generally was managing better than she'd been for the past two years.

But things got worse again. She developed pneumonia and digoxin toxicity, the congestive heart failure worsened, the implanted defibrillator started going off frequently despite an increase in potent drugs for arrhythmia. Her mental state became altered.

Gabriel's Villa operates under a residential care apartment complex (RCAC) license. As a result, the staff were able to be very flexible, providing more care as needed for an additional fee. They began administering her medications and checking her every two hours, later every hour.

After we decided to turn off Mom's defibrillator and let nature take its course, her plan all along, Gabriel's Villa agreed to let us bring home hospice into the apartment. No one wanted her to move her again.

Mom died a few hours after we'd returned there, before hospice care could begin. I stayed with her, with much loving attention and help from the aides who were with us, getting her ready for bed, when her big heart went into ventricular fibrillation. A few minutes later, she died, held by my sister and me.

It was as she wanted it-- a good death, I think. For that, we owe much to the dry sounding notion of "elder housing with supportive services."

When the reality of aging loved ones hits home

Labyrinth of Hope from Johns Hopkins University Interfaith Council

Almost daily for the past month or so, I’ve gotten an “aging alert” article about using the holidays to check on one’s aging parents. It’s the perfect time, the authors say, to evaluate how well older adults are doing in their current living situations.

This year, the message became more than academic for me. My sister called the day before Christmas Eve to say that Mom, who lives in independent senior apartments, wasn’t doing well. Pain from arthritis in her spine was making it hard for her to walk, and her anxiety was soaring. With those triggers, she was becoming confused.

I drove up a day earlier than planned and stayed a day longer, feeling grateful that my kids were old enough to have their Christmas usurped without feeling resentment.

Trying to get information and make arrangements over the holidays is a nightmare. But because Mom lives in a retirement community with multiple levels of care, we were able to get an assessment for assisted living today. If all goes well, she will move to a place that’s familiar to her and where she’ll feel safer and get the help she needs on Monday.

We are all feeling a little stunned, apprehensive, and relieved right now. The pieces seem to be sliding into place as well as possible.

Some random thoughts:

• We who live in Milwaukee are so fortunate to have sources of information and assistance that aren’t available in smaller communities.
• I’m so grateful to the social workers and home care managers who return calls even on Christmas day. Your service in allaying anxiety and helping people think through next steps is incredibly valuable.
• While many of us hope to see more “catered” home care delivered in people’s homes and independent apartments, the model of senior apartments-assisted living-skilled nursing on one campus still has a tremendous amount to offer.

To all of you who take care of our older adults, creating safe home for them wherever they are, deepest thanks. It truly takes a community to support us throughout our lives.