Supporting Aging Parents from Across the Country or in the Next Town with Dr. Cheryl Greenberg

[00:00:02] what you want, when you want it, where you want it. This is The MESH. This episode of The Caregiver Community is brought to you by Pace at Home in Newton, North Carolina. I used to think healthcare was all the same until I discovered Pace at Home. Now I can come to a place to stay active, see the doctor, or just enjoy a meal with my friends. Plus, having a team of people that help me make sense of my options

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[00:00:58] of caring for our aging parents and loved ones, as well as caring for ourselves. I am Frances Paul, founder and executive director of ACAP, Adult Children of Aging Parents. In this podcast, we're talking about providing support for aging parents or loved ones, whether we are in the next town, across the country, across the globe, wherever we are. I am delighted to be joined by my friend, Dr. Cheryl Greenberg,

[00:01:27] a life coach for seniors and their families at The Age Coach in Greensboro, North Carolina. With her guidance and support, clients who are dealing with health issues, including dementia, learn about physical and cognitive changes, effective caregiving, and ways to navigate the feelings that arise with these illnesses. Cheryl's doctrine focused on adult development and memory improvement for older adults. Full transparency.

[00:01:55] Cheryl is one of the chapter coordinators for ACAP Gilbert County in North Carolina. Hey, Cheryl. Thanks for being here. Thank you for having me. I'm delighted. It's always a joy. Okay, so let's kind of get into this because there is a whole lot to talk about. It seems that when adult children do not live with their parents,

[00:02:19] whether they live literally across town, across the country, you know, wherever they live, there may be gaps in what they really understand is happening for mom and dad or a loved one. I'm going to use mom and dad, but we really are talking about any older adult woman. Sure. So in your experience, how does distance impact the adult child and the parent?

[00:02:46] That is the starting point, right? Because we, first of all, we have four very nice reasons, a positive outlook on how older adults are doing.

[00:03:03] If you, if the National Institute of Health reported a study that said that 44% of people who are 65 to 74 say their health is very good or excellent. And people 75 and older, about a third of them say, I am doing just great. I am really healthy. That's wonderful.

[00:03:31] But on the other hand, we know that in fact, 20% of people have five or more illnesses. That older adults are very likely, something like 85% of older adults are likely to have one or more chronic illnesses. So we have a little bit of conflict in the data here, right? Or at least in the impression people have.

[00:04:01] And now let's look at the kids, these adult kids, the adult children or whoever's providing care. And they, by and large, see the adult, the older adult, their parents typically, as doing very well. Yep, they're doing fine. Actually, that data surprised me. I figured everybody would say, oh, wow, we're in deep trouble. But in fact, that's not what they say. They say, mom and dad are doing great.

[00:04:30] Why do they say that? Well, because they still have an image in their head of mom and dad, that person who took care of everything. Who was wise. Who was loving. Or who was maybe not, but still the power, the strength in the family. The authority in the family. Another reason is they simply don't see. They're not there to see what's actually going on when they visit. Mom and dad may put on the best possible show.

[00:04:59] Maybe not trying to act, but in fact, they're just strutting the best stuff. And then there's one other piece. And that is that when you are the adult child, you probably have other responsibilities. And so you're not so focused as you might be. So we have a rosier picture than I expected before I dug into the data. The fact of the matter is that people do have needs. They do change over time.

[00:05:27] We just might not be seeing it well. And I know from my own mother's experience that because I saw her so much, I was more aware. But I also could see her. And I called it kind of like a light switch. That when she was with anybody else, oh, she presented just teaching. Sure.

[00:05:52] And she may have actually been doing the things she did best with those folks. It wasn't the day-to-day stuff. Right. Right. Absolutely. Right. Yeah. Yeah. So parents and adult children may see the real difference or the adult child may see the difference in mom and dad. They may not see the difference. Absolutely. Yeah. Yeah. Yeah.

[00:06:23] So there can be lots of changes in what's happening for mom and dad. So broadly speaking, what are the categories or types of changes and needs that adult children might want to think about or might want to be aware of? Let's make a little list, okay? Number one, I think we think of most frequently are just health issues. There's acute issues.

[00:06:51] They can be acute issues, acute illnesses. You know, as we get older, our immune system doesn't work as well. So we're more vulnerable to flu and COVID and COVID and we may suffer longer and have more impact down the road. Excuse me. But there's chronic things. But there are diseases that are diseases.

[00:07:18] We're more vulnerable to the next one. And so we're going to look at the next step. So number one is that we probably notice or respond to our health issues. Of course, nowadays, number two following close behind are cognitive issues. What's happening in the brain? How well is the brain functioning? And by that, I mean things like memory and problem solving and even communicating, being

[00:07:47] able to use language well, pay attention. Those are cognitive issues. And because we have so much fear around dementia, I do think that's a close second, if not the first thing that people are concerned about. Also, one that we leave alone perhaps more than we ought to are changes in mood, mental

[00:08:13] health, behaviors that reflect some kind of a person not having a sense of well-being, depressions, for example. We can talk more about that. And then there are a few that we don't usually, if we're not thinking about this deeply, then we might miss them. And one is called activities of daily living. That just means, can you take care of the day-to-day stuff?

[00:08:44] And included in that, ma'am, those are... Well, yeah. I mean, we're talking about things like eating, preparing food and eating, toileting, moving around, ambulating, getting from a chair to a bed or wherever. And I'm leaving one out and I'll come back to it later when we talk about this in more detail. But yeah, it's those things. Oh, grooming.

[00:09:14] Of course, grooming. You know, is the person clean? Is their home clean? Are they showering? Can they shower? Activities of daily living are about, can you take care of the nitty gritty of life to keep yourself independent? So we've talked... I know this is... I'm going to throw a lot of information here, so I will repeat some of these things. We've talked about health, cognitive changes, mood behaviors, and finally, activities of daily living.

[00:09:44] But there are few others, like there are responsibilities in our life, legal, financial responsibilities that a person has to be able to take care of in order to maintain their independence and be, you know, have all the things that they need. And one that we really need to look at, and it comes into almost all these others, is socialization. Are people engaged with other people?

[00:10:14] So they're the big six or seven categories, I would say. Gotcha. Gotcha. Yeah, and we're hearing more and more about that socialization and how important that is, really, for maintaining everything of life. So let me ask you. So as we're talking about and thinking about those different categories, considering some

[00:10:42] of the most common changes, what are some of the signs that could alert a loved one, an adult child or loved one, that maybe there's a problem or an issue that really ought to be addressed? So I think that if I were going to suggest one word for us all to capture, it would be change. You know, if mom was never a good housekeeper, well, you're not going to, if she's not a good housekeeper today,

[00:11:11] that doesn't indicate something's wrong. It may not be ideal. But that's not a change that I need to alert to. Right? So I'm going to look for change. And I want to say this up front, and I'll say it again, probably. We're looking, there's a difference between sudden change and gradual change. So if I see a sudden change, then I may need to respond to it right away.

[00:11:40] I'm going to suggest, when we look at some of these different categories, some different examples, that lots of them are taking time to observe, playing detective a little, having a conversation with mom and dad about how things are going. That's sort of a gathering information thing. We don't do anything right away. We just want to get the lay of the land. What's happening here?

[00:12:05] And then later, and we can talk about this later, you know, then we'll figure out what we want to do about what we're seeing. If the change isn't sudden, if it's not life-threatening, we can do that gradual thing. But sometimes when I, some of the things we'll talk about mean, oh, I see that mom suddenly can't remember. I need to do something about that right away, as opposed to, oh, her memory's getting worse over time.

[00:12:34] And I need to be exploring that. Does that make sense? Yeah. Yeah. It sounds like, it sounds like you're really talking about, is there a sense of urgency that something needs to be done immediately versus kind of take a wait and see approach? Yeah. Yeah. And I don't, we can talk about how long that wait and see is, but I mean, we're not going to run into the house. We haven't seen mom in six months or we haven't seen her in two weeks and we're going to get in there and fix everything.

[00:13:05] Most of the time we don't need to, most of the time we can play detective for a while. And, but if mom is suddenly not remembering where she is, we have an urgent situation that needs a physician right away. It could be a stroke, you see? Right. Right. So most of what I'm talking about is going for that visit across town or across the country, as you said, and observing for a little bit, having a little bit of a conversation.

[00:13:36] Now that wasn't at all what you asked me. So let's go back to your question. Your question was really, so what are those things? Yeah. Yeah. Yeah. Let's talk about, let's talk about what those things might be and then we'll sort of unpack that. Okay. Okay. So let's start maybe, let's start maybe in the order, if I can remember the order I said the things and let's look at health. What are we looking for in terms of health?

[00:14:05] We, the clues, we're looking for the possibility that there is an illness. Right. I mean, by definition, but what are we going to see as detectives? Well, we might see a significant weight loss, a sudden weight loss. I'm not, you know, a weight loss in a few months.

[00:14:29] Um, we might see weight gain, significant weight gain, but usually we're worried about weight loss. Might look at whether mom or dad or uncle Bill can, um, get around. What's their gate look like? You know, their steps. Are they sure on their feet? Are they having trouble with balance? Are they grabbing the wall on the chair every time they try to move? Can they get up and down in a chair? Do they look like they're avoiding certain foods?

[00:14:58] Because maybe that indicates some kind of gastrointestinal problem, right? Oh, that food doesn't agree with me now. Um, difficulties breathing. Um, indications of pain. One of the things you can do to play detective, and I think this is just brilliant and I didn't make it up, is be sure that when you walk into the house, you give them a hug if you're a hugging family.

[00:15:27] Because when you hug somebody, you right away know they feel a little frail or they feel awfully skinny or, and you go, oh, I might pay attention to that. But you're also going to look with your eyes. What are you seeing? And you're going to talk to them if they're willing to talk. How are you feeling these days? You know, how's that pain in your arm going? Also, we're going to look at medications because an awful lot of health problems are actually

[00:15:57] created by medications. Taking too little, too much, a bad interaction. So, I don't think we should snoop. It looked like we're snooping in all the corners of the house, but we are in a sense. I'm going to go into the bathroom or the bedroom, and I'm going to try to notice, are there a lot of medicine bottles around? What are the dates on them? Are they out of date? Are there a ton of new ones? Do they seem to be taking them?

[00:16:27] Like, here's a prescription that's a month old, and there's still a whole jar, a whole bottle of meds. So, I'm going to sort of be checking about how well medication compliance seems to be doing. Of course, we can go on and on, but does that give you a sense of what we look at for health? Yeah. Oh, absolutely. Absolutely.

[00:16:50] Because I know that there are people who might even have their pills just not in a bottle, but in a container. You know, and you look at that, and you go, oh, gee, it looks like, you know, pills are being skipped. You know? Absolutely. Absolutely. I used to go to visit my mother who had Alzheimer's disease when she, before she needed, you know,

[00:17:16] full-time care, and I could see she hadn't taken pills or she'd miss a pill one day and it'd still be in the container. And my clue, of course, was, my clue to how her, she was doing cognitively was she denied that. Here's the box. No, I've taken all my pills. So that, just looking at the pills can tell you a lot about health and cognition and brain health. Yeah. Yeah.

[00:17:45] Interesting how all that can be connected. I want to go back. You were talking about health a second ago and talking about foods that they avoided because of potential digestive issues. I want to also point out that there can be dental or oral issues. Oh, right. Right. Make a huge difference in being able to eat something and potentially eat at all, which

[00:18:12] becomes a nutritional issue, which then becomes a weight loss issue and a frail issue and a balance issue and, you know, just all of this kind of a, kind of a mushrooming kind of situation. Oh, that's such a good point. And all the senses count. All of our senses count. Any changes in the senses? I'm glad you brought that up. For example, somebody told me recently that they had just found out that hearing, good hearing,

[00:18:41] was essential to good brain health. That's not new. So we want to check hearing, not just because it's more comfortable to be able to hear, but because if we don't hear well, we are at greater risk for dementia. And as you say, it's all a mushroom. It's all rolling down the hill. Yeah. Thank you for bringing that up. Yeah. I didn't want to get you sidetracked because you're getting such good information.

[00:19:09] But I want to be sure that we address that also or bring that in. Yeah. Yeah. Sure. So are there other things, other issues? Yeah. Yeah. Let's go. I'm sorry. So let's move on. And for folks who are listening to this podcast, a piece of paper won't hurt.

[00:19:36] But if you ever need a list of this, I'll send it to Francis and Francis can send it to you if that works. Because it's a lot of information. Generally, I'm just talking about being observant. I'm giving some examples of being observant. Right? So let's talk about number two, which was dementia. Concerns about memory. Again, we're looking at change.

[00:20:01] If mom never had a good memory, then I'm not terribly concerned if she still doesn't have a great memory. What I'm worried about is change. So it becomes more and more difficult for mom to remember things and things that are pretty essential. You know, forgetting a birthday is not a big deal. But a birthday you always knew is a flag.

[00:20:27] How to cook that meal or unlock that shed door, which you did without thinking in the past. Now there's a problem doing it. Then there's potentially a problem with how the brain's functioning. And it's not just memory. It's problem solving and making decisions, making good judgments.

[00:20:54] So one of my clients said, oh, well, you know, mom has a checkbook and she writes a check to every charity who calls her or sends her an envelope. Well, she might have always been like that. And I hope she had a lot of ability to pay those contributions. But seriously, this could be an indication that she's not making good judgments.

[00:21:21] She's not even the front of her brain has some problems where we make decisions like that. So being able to do those things that you always could do well or being approached by somebody and making an untoward decision, you know, being scammed, for example, or defrauded. These are things that indicate the brain's not working well. But we're going to see other things, too.

[00:21:50] We're going to see changes. You said everything's connected. We see changes in mood because of brain health changes. We see people becoming confused about time and place. Oh, this is I've never been to this house before. And it's your house. And mom has been there. So those changes in language, you know, forgetting words.

[00:22:19] We all do that a little. But when it becomes really more and more difficult to have a conversation, then we're looking at something that may indicate concerns about how well the brain is functioning. So what we can do to actually is just have conversations so we can see how well mom or dad or Uncle Bill is thinking and remembering and speaking.

[00:22:48] And some of those changes. Again, with my mother, I was very, I guess, confused because some of the changes seemed plausible. You know, that they were changes, but it seemed plausible. But then it got to the point that what she was saying was pretty far-fetched.

[00:23:18] And that was the beginning of a clue that maybe things are not quite as sound or connected as I thought they would be. And I guess what I'm saying is, go ahead. No, go ahead, Francesca. Well, what I'm thinking is that sometimes I think that we look for these big major changes.

[00:23:48] And I certainly understand that there are big major changes. But I think one of the things that you are really suggesting is when you really see any change, just notice that. And just be aware and just kind of watch that. Don't need to do anything immediately, but be aware of it. Yeah. Let me jump to that idea of, so what do you do next?

[00:24:17] And then we'll come back to these changes. When we see a change, we want to log it. We want to remember it. And we want to follow up on it. So if you are seeing changes in, the question is how quickly, right? So if mom's having a pain in her stomach that's, you know, been going on for a little while, I may not have to rush to the emergency room that day or I may have to.

[00:24:44] But I certainly want to mention at the next doctor's appointment or move a doctor's appointment to the next week. I'm not saying you sit on it forever. That we want to make a judgment about how quickly we have to move. If somebody is having some memory changes, I want to mention that. I want to actually say it and make sure the doctor hears that and ask for some feedback about what might do we need an evaluation.

[00:25:10] I'm just suggesting in the moment we walk into the house, we don't panic right away. We gather information first. And then we decide how quickly we need to move. Right. Yeah. You want to use some other things to look for? Yes, absolutely. Yes. So one of the things I talked about was sort of mental health and affect, you know, how people are behaving.

[00:25:37] Is it normal for them how they're behaving or what their moods are? So if you see somebody who is so down in the dumps, that's a sign. If they are not interested in the usual stuff for them, they have no interest now in their hobbies or they're still working and they have really no interest in a job they used to like. If they're not socializing, they're avoiding people. They're not returning phone calls.

[00:26:06] These might indicate that something's going on that we need to pay attention to. On the flip side, if somebody is or flip side in terms of kinds of emotions, if somebody is very agitated, if they are having outbursts, they're saying stuff they never would have said before. Or, you know, they're cursing at people. They're up and down with their moods. That's what we call mood swings, right? It's commonly.

[00:26:38] Or if they have changes in their sleep patterns or their eating patterns, then we might be looking at something we need to pay attention to. Where's this coming from? What's going on? Is there a need to talk to a physician, for example, to check out whether there's something organic going on, a disease process? Or it's a mental health problem.

[00:27:05] It's just social isolate, not just, but it's social isolation. But those mood changes are not insignificant. Just because mom's a little crabby doesn't mean we ignore it. We might want to have our 10 up and say, well, she hasn't, that's not usual for her. That's a change. What's causing that crabbiness or that passivity? Doing nothing. Doing nothing. Right. So we talked about health.

[00:27:32] We talked about brain, body, sort of everything but the brain health. And then brain health. And also mood, affect, behaviors. You want to talk a little bit about those activities of daily living that we started to talk about? Yeah, let's do it. Because probably most people are fairly aware of those. But just to make sure that everybody knows what we're talking about when we say that.

[00:28:00] So activities of daily living at the most superficial level are those basic things we have to do in order to survive. If we can't do them on our own and we need assistance for them, then we have concerns about how a person can continue to be healthy enough and to continue to live on their own.

[00:28:24] So as I said before, it's grooming, like bathing, brushing your teeth, washing your hands. And by the way, having clean clothes on and living in a clean environment. Clean enough environment. Then there's toileting. The end of being able to control your toileting but also do it on your own, on one's own. Dressing.

[00:28:53] Not just selecting clothing but getting it on and off in the right order. I mean, and that's really seriously a sign of dementia is Uncle Bill puts his shirt on backwards and can't figure out where the buttons are. It's not funny. It's actually a sign that something very basic to how he's lived his life is not working anymore. And then there's, I talked about moving around, what they call ambulating.

[00:29:22] Being able to walk on your own. And to also to transfer, to get up out of a chair, into bed, out of bed. These are, if you can't do those things, we don't think about it much, but that really affects whether you can be independent or not. Sure, sure. And then eating and drinking. And that often involves making sure the food is there or you've prepared the food.

[00:29:50] But there's actually the very basic, can a person eat on their own? Can they pour a glass of water and drink it on their own without assistance or cuing of any kind? So that's activities of daily living, what we call ADLs. But at the basic level, there's also sort of higher level, which we call instrumental. You don't really need to know. Everybody doesn't need to remember the word.

[00:30:16] But it's instrumental activities of daily living, meaning you can shop for the food. You can make an appointment to go to the doctor. You can take care of your pet. You know, that's sort of another level of living independence would be involved.

[00:30:36] And that's really more of sort of bringing together more mental capacity for what we're talking about in terms of making appointments and purchasing food. But that's just a higher level. And if we start seeing that those are areas of some difficulty, then again, to be aware of that. Yeah. Now, how are you going to know?

[00:31:04] We've been talking about having conversations with mom or to find out if she can remember or we give her a hug to see if she feels awfully skinny, thin, brittle, you know, fragile. In this case, I would say you use your senses, all your senses. You walk into the space and you say, hmm, there seem to be piles of paper everywhere. Or the house is really dirty.

[00:31:34] Or there's an odor in the house, like something is spoiled. Or I walk into the refrigerator. I look inside the refrigerator and I see there's really old food. Or there are multiples of the same thing. There are six cartons of cottage cheese. There are five loaves of bread. That's not normal behavior for mom.

[00:31:59] Then we're going to say, hmm, I don't like what I see is jogging me, is making me think about this. Are there, is there plumbing dripping? Can I hear drips? Can I hear grinding in the heater fan? Things of that sort. So, you know, you're walking into the space and noticing, but using all your senses to notice what's going on.

[00:32:30] And then once we see or are aware of those kinds of things, then what are next steps? What do we do when we observe those kinds of things?

[00:32:51] Well, first of all, and I don't mean to sound like I'm too laid back, but the first thing I want to do is I want to see things and I want to evaluate them. I want to say to myself, is this a change and is this a concern? So, I mean, I really want to spend a moment taking a deep breath and saying, so what's going on here?

[00:33:16] The next thing I want to do is, again, if there's time, if it's not an emergency, if it's not urgent, I want to talk to other people who have spent time with Uncle Bill because they're more objective. Remember, we said all those things that kids don't see, that adult children may not see because this is their mom, their dad, their uncle. So, I want somebody else to notice with me.

[00:33:46] I'm going to have a private conversation with them and say, you know, I'm a little concerned. I noticed that mom's house was uncharacteristically messy for her, that there were piles of laundry on the floor and dust, you know, a lot of dust on the tables. Or she seems not to be thinking as clearly. Is this my imagination? What do you see?

[00:34:15] So, having somebody who is perhaps a step more removed than you can often help you figure out what's going on. It can help you be more sure of the things. I want to put a plug in. I want to sort of underscore what you are saying. It is so important for us, particularly when we are living some distance from mom and dad, and we don't get to see them on a daily basis or even a weekly basis.

[00:34:44] It is so important to have somebody in their village, somebody who sees them regularly and knows them well enough to really see, yes, there are changes or, no, it's really fine. You just caught her on an off day, you know, kind of thing. Yeah, I just want to underscore. And that's not always the case. And when you say village, you're taking the Susan Pinker idea.

[00:35:14] And if anybody on the podcast hasn't heard of Susan Pinker, I recommend you listen to her. She talks about needing a village of people you're close with and also, you know, on the outside of the village, just casual acquaintances. But these people will, particularly the ones who are close in the tight part of the village, these friends and family members can, as you say, notice things that are changing.

[00:35:45] But we do know that a lot of older adults, enormous percentage of older adults live by themselves. And if they are not socializing, if they're not going to activities outside the home, or they're not speaking regularly with their friends, it may be hard to find that partner to give you some feedback. Absolutely. Absolutely.

[00:36:11] But if there is someone like that, a neighbor, somebody who sees them on a regular basis, I remember very honestly that my mother got really irritated with me when I collected phone numbers from her address book. But it was, I knew that there would be those times that that would be really important to have that.

[00:36:34] And I am not advocating overstepping, but I am advocating if there is somebody or there are some people, be able to contact them. Yeah, we call that actually building a team. And I would encourage people along with you to be really specific about building a team as best you can, to know who can be helpful, when they can be helpful, what they're willing to do, and how to get in touch with them.

[00:37:05] I want to also say, so that's all part of having people you can talk to, to sort of process what you're seeing, to get some feedback about whether you're too concerned or not concerned enough. But I do want to caution you also, everybody also, that you won't always be in agreement.

[00:37:28] And so, oh, I see this so often with siblings, where one says there's nothing wrong, you're being alarmist. And the other one says, oh, no, we need to act right now. Something is, so it's not an easy path to get those other people into the conversation.

[00:37:50] But when people can work together with goodwill and objectivity, it can be helpful to get another set of eyes. Now, that set of eyes might not be a family member or a neighbor. It might be somebody at the faith community. It might be the physician. It may be that there are some people who come into the home to provide some support. What are they seeing?

[00:38:19] Like, you know, as a home health care worker or somebody who's doing light housekeeping, they may see things that you need to know. So I'm going to take us back to where we were. First step was to play detective in a kind, respectful way. Not gangbusters, not sit here, I'll go look at your whole house. But just observe.

[00:38:47] The second is check with others to get some feedback about what they see. And then this is really important. Really important to me is that you then say, OK, there are a few things I need to do here. And I'm going to do some work figuring out what resources are available for me. Who's a good doctor? If I think mom is going to need some help in the house she doesn't have right now, who are those folks?

[00:39:17] How can I find them? How do I hire them? What do they cost? What are their fees? If maybe mom would do well to have community activities, I'm going to try to check out what's available. In other words, I'm going to collect resources before I ever talk to mom. Again, only if it's not urgent. And now I'm ready to think about the conversation with mom.

[00:39:49] Now I'm going to plan who, what, where, when, why. Why do I want to talk to her? What do I need to tell her? Who would be the best person to talk to? Am I the person she'll listen to? Who would, you know, cousin Sue be somebody she'd be more comfortable with? When should we have the conversation?

[00:40:16] We're not going to have the conversation during Easter dinner, which is not. That's not a good time. We're not going to have it when the house is full of company. So what's a nice, relaxing, private time that we can have a conversation? And most importantly, what are you going to say? How are you going to approach? How are you going to approach talking to mom?

[00:40:44] So who, what, where, when, how, why. Now I'm ready. And now I'm going to sit down or the cousin's going to sit down with mom and say, you know, I just wanted to talk to you. I'm wondering if you've noticed that you seem not to be eating as well as you were before. He said, what do you think?

[00:41:11] In other words, you're going to try to open a conversation without going in and saying, you're not eating well. This isn't good. Here's how we're going to fix it. We're going to try to involve mom in the conversation. You know, mom, you've lost a lot of weight. I wonder why that might be. And I've been thinking it would be a good thing to go over to see Dr. Brown and bring this up and see if maybe you need some nutrients or you, maybe something's going on that we,

[00:41:40] you know, that he needs to help you with. So it took us a long time in terms of steps to get to talking to mom. It might not take a long time in terms of actual time. If something is fairly urgent, we might be moving really fast. Or we might have some space to do this gradually.

[00:42:05] You have to make that assessment based on what the problem is that you see. But I love your way of engaging and involving the parent or the loved one. Because it really is their life. And they really are an adult. They're not a child.

[00:42:29] And they really have the right to be involved and to help make decisions so far as they possibly can. And I love your, what was coming to my mind when you were describing how to open that conversation, was just sort of a sense of curiosity and a curiosity with the loved one. You know, what do you think?

[00:42:57] You know, what about, what would you think about? You know, yeah, that's really lovely. Because so often we swoop in and we think that we know. And we just, you know, kind of come in with almost the bull in the china shop kind of approach. We know what needs to happen. And so here we go. We got it. We know.

[00:43:26] And actually, what's going to happen when we do that? The average person, many people, the older adult, many of the older adults are going to go, wait, wait. And actually, I'm not having that conversation. Or you don't know what you're talking about. Or how dare you?

[00:43:49] So a gentle approach is respectful of them and also gives them time to take a breath and say, hmm, maybe I need to think about this a little bit. I don't want to suggest for a minute that you always have time to work gradually. And I also don't want to suggest for a minute that Uncle Bill or Mom is ultimately going to agree with you. They might not.

[00:44:18] And under some circumstances, as the adult child, you may be in a position where you have to make a decision that Mom doesn't want you to make. It may be that their safety, their well-being is so at risk that you're going to try to get them on board, but you're going to help them make a change even if they don't agree. And that's tough. That's a tough place to be.

[00:44:47] Yes, it is. Yes, it is. I remember that I used to say we don't compromise on safety, but that's sort of the bottom line. We just can't. Right. Right. Right. I'm working with a couple now, with a family now, where Mom doesn't understand she can't be alone, but she's not stable on her feet and not taking her medications and her dementia is diagnosed.

[00:45:15] You know, she's gone that route already. And they, at some point, are going to have to decide whether they have to make a decision to move to another level of care for her or not. That's a tough one. That's for sure. We have talked about so much in this. And, Cheryl, this is such good information and so clear. But let me end with one more question.

[00:45:43] And that is, is there an overriding concern, like some concern that really ought to be considered, particularly when caring for someone from a distance or being involved with their well-being from a distance? Is it kind of a final word on this? Yeah. Let me give you two final words, if I may. Okay.

[00:46:12] One, we did not talk about safety. And I want you to, I hope that everybody will pay attention to safety issues. So, without going into detail, we want to know that Mom is safe driving, that Dad is not, is safe in the kitchen, that they know how to prepare for weather events and things of that sort. So, I just want to throw that into the pot of things we're going to look at when we look at them.

[00:46:42] The answer to your actual question is like, what's my overriding concern? It really is about the dignity and need for independence of older adults. That we are going to do our very best to be sure our loved one is healthy and able to function on as well as possible.

[00:47:10] We're going to be driven to helping them aggressively. But as you said, that's not the best route. Partly because they may resist and they say no and then you're stuck. And partly because they are and always have been their own person. And we don't take that away from them. We don't disrespect them.

[00:47:37] And we notice that any time they have to make a change that they don't want to make, it's an attack on their independence. It's an attack on their identity. This isn't who I am. I don't live this way. And so, I want to be sure that while we're vigilant and caring and thoughtful about what we see,

[00:48:05] that as much as possible, we preserve the dignity and the independence of our loved one. Thank you. What a perfect ending note. We would not want our dignity. We would not want our dignity stripped. We would not want for us to be disrespected. And so, it really is a bit of trying to remember how we would want to be treated.

[00:48:34] As much as we can. Still knowing that at some point we may have to make a decision that's going to be difficult for everybody. Absolutely. There are those times. Sadly, there are those times. Yes. Yeah. Cheryl, thank you. Thank you. Thank you. For just great information. And I'm hearing dignity and respect, but be aware of changes. Perfect. Bottom line with all of that.

[00:49:04] Thank you to you, our listeners. We hope that this insight, that this information will be helpful to you as you journey with your loved ones. And we certainly want to thank Pace at Home in Newton, North Carolina, for sponsoring all of our caregiver community podcasts. This podcast is part of the mesh network of online shows and podcasts.

[00:49:27] We record one new ACAP podcast each month, addressing a wide range of topics related to caregiving and advocating for an older adult. You'll find our podcast on any platform where you listen to podcasts, including our own website, which is www.acapcommunity.org.

[00:49:49] So while you are on our site, if you go to our site to look for the podcast, we hope that you will also take a look at our chapters and our other programs, podcasts and videos and all kinds of things going on. We want you to learn more about ACAP as well as these incredible podcasts. And if there are other topics that you might be interested in, please do let us know.

[00:50:18] As I say every month, we record a new podcast. Thank you. Thank you, Cheryl, for being with us. Thank you to our listeners. Thank you to Pace at Home. Stay well, everyone. Bye for now.

[00:50:45] You've been listening to The Mesh, an online media network of shows and programs ranging from business to arts, sports to entertainment, music to community. All programs are available on the website as well as through iTunes and YouTube. Check us out online at themesh.tv. Discover other network shows and give us feedback on what you just heard.