My Introduction to Elder Care

My grandmother recently ended up in the hospital, and then a nursing home. She is fine, but the incident brought up the question of “how do I help” when I am so far away. The end of this note has some suggested talking points as a starting place.

Background

The first thing to know about my grandmother is that she is feisty and independent. While she has lived in New York City most of her life, she does not fully understand how bureaucracy in America works and does not really care to understand it. The rest of the family has all moved far away, and she lives alone. (We have repeatedly spoken to her about moving in with relatives, but she won’t leave NYC.)

This year, two unlikely things happened to her. First, she was in a bus accident that saw her tossed over a seat and into the stairwell of the bus; she turned down medical assistance. Second, her apartment building caught fire and is now unlivable. She has moved into a place in Connecticut, but it’s in the suburbs and she has to figure out transportation and get used to a new life.

The Incident

I actually still don’t understand what prompted my grandmother going to the hospital. I had just landed in Europe and had trouble calling back to the US, so I only got snippets. Largely, my grandmother was confused about being “held captive” in the hospital and there were a lot of emotions (concern, judgment) that she was “allowed” to live all alone.

My grandmother is insistent that she is independent and doesn’t need help. She asks for help to cross the street in NY, and gets rides from neighbors, but she manages living on her own just fine. I periodically bring up issues about long-term care and cleaning some of the junk out of her apartment, and she always replies that she wants to die in her little sanctuary and doesn’t care about what happens after she is dead.

Dignity is important, so I don’t push any agenda too hard. I want my grandmother to know that she has options besides being alone. But I’m not going to force her to do something that will ultimately break her spirit. (She is currently back in the nursing home for physical therapy, and I see how she struggles to fight the hopelessness that it seems to create.)

Thoughts on Medical Advocacy

How do you even help someone who is remote from you, and who doesn’t want to be helped? Where do you start?

Below is the distilled advice from friends on what to ask the social worker assigned to my grandmother’s case:

• “I want to form a partnership with you (the social worker) to ensure a high standard of care for my grandmother. There is a lot I don’t about healthcare, and I am counting on you to be my and her advocate on the ground there in CT, since our family lives so far away from her. To start, I have some questions…”
  • Who is the current team of people working on her care? (doctors, nurses, others)
  • Who are the support providers available to work with her?
  • Are there facilities or services or departments that we should be talking to? My grandmother supports herself from her social security check, so low-cost options are important for us to learn about.
  • How can we enlist these support providers to help her?
• My grandmother’s goal is rehabilitation and independent living.
  • That might not be completely feasible, but we need to take a scaffolded approach to her care so that she can evaluate the feasibility for herself.
  • Discussions that are too far in the future are generally unsuccessful with her.
  • She has led a life of incredible determination and succeeded beyond all contemporaries that she would consider a yardstick.
• unfortunately, our family lives too far away from her. We need to recruit a support team to help her reach her goals.
  • As a first step, we need to locate a rehabilitation facility for her.
  • Can you make some recommendations?
  • How can we help her to choose between facilities? What points do you think she should consider?
• We also need to talk to her about a medical care directive.
  • Are there other documents that we should explain to her?