imageThis weekend my AH went out of town for a men's retreat. I am so glad he is getting some time away with his bro-in-law and other church friends. I decided to take the opportunity to try to have a conversation with Elly because of some of the issues that came up this week.

Last Sunday, Elly filled her pill box for the week. I checked it that night and found the wrong pills in the slots. She doesn't take very many meds, just Lasix, thyroid pill, Plavix and Tramadol for pain. She doubled the Tramadol instead of the Lasix and missed the thyroid! Well, no harm done, I fixed it, like I've done before. During the week, she didn't take her Tuesday and Thursday meds. I asked her Thursday evening why she missed her pills this morning. She picked up the pill box and pointed to Wednesday and said she took them. I then pointed out today was Thursday and she had also missed Tuesday. She was clearly confused about the day and tried to deflect. So, with the mix up with filling the pills and then not taking the pills I felt the need for a new plan and conversation.

I sat down and tried to ask Elly to tell me how she might see herself needing more help in the next year. She couldn't grasp that concept. So I tried to ask if she thought her legs were getting stronger/weaker. She answered as a stoic in that she said she has good days and bad days. I pointed out that she had been blaming the weather for her knee hurting this week but that our weather was clear so that her knee must be hurting because it has no cushion, just bone on bone. I told her that she had been mentioning the pain for over a week. She said it didn't hurt much today, so I pointed out that I had put her pain pills in her box for the morning each day this week, so it must be helping. I asked when does she have the most pain. She shared how painful it was to get in and out of the car and that she couldn't take that kind of pain. In the next breath, she said, the pain is only for a couple of seconds and is bearable. We then talked about the activities she doesn't do anymore - go out to lunch (too noisy), Church (too noisy, too many people) and calling friends on the phone (they don't want calls anymore). I just told her that I understood her reasons.

I continued on to ask if there were things that she hasn't able to do easily, things that I could do for her. She mentioned the thing that I have been doing since we moved in, cleaning the floors. I got specific, how about the laundry, "Can you reach into the washer and dryer to get your laundry done." Yes, she said. I asked about her carrying her laundry out to the garage. She said that she is very careful to carry small loads (all her laundry can be done in one load) down the back steps and into the garage. I pointed out that she has been very wobbly in the last few weeks and that it looks like she needs more than the cane to get around the house. I asked her to please let me carry her laundry out to the garage in the morning before I go to work so she wouldn't have to do it and handle her cane. She refused, said she could still take care of it herself. I chuckled and said to her, "My friends are amazed that you can still bend down and pick up a dime on the floor! But that doesn't mean that I won't find you on the floor one of these days!" She laughed. Then pointedly went on a rant about how people think that "People my age can't do anything and should just sit around." I looked her in the eye and said, "You've never heard that from me! I have been telling you that you need to visit Oasis (daycare) because they need "volunteers" over there. You would be perfect with all the stories and experiences you can share with your peers who are also in their 90's. I went over there this last week and spoke with the staff who are excited to meet you." She just scoffed at me.

I addressed her mobility aids: Lift Chair and Walker/Rollater.

So, on the Lift Chair - I asked her why she doesn't use the lift to get in and out. You need to picture this- she backs up to the chair in it's normal sitting position, then squats slightly, leaning back and throwing her legs up to sit in the chair. I told her that she was flopping into her chair just like her great-grandson does! She seriously told me that she just doesn't have traction with these shoes/slippers. We chuckled together and then I asked her to maneuver the chair properly to allow her to leverage into the chair so that her legs (bad leg) don't have to bend too much. She obliged me in the moment but still flops. Again, I reminded her that she will need to start using that lift feature now, not "wait till later."

The Walker/Rollator. I pointed out to Elly that she continues to help set and clear the table which is fine but to carry two or three dirty dinner plates from the table to the kitchen was clearly a struggle we've watched every night this week. She doesn't use her cane at all in this process and then to return to the table has to hang onto the counter, walls, furniture to unsafely navigate her route! Keep in mind that her hands are always dirty-she doesn't wash them after touching the plates but might wipe them dry on the kitchen towel (eeeewwww). This is another struggle in my lonely health and safety world. She admitted that she should have used the walker. I pointed out that she was not making good judgement calls. She said that was right but that she uses the walker more when we aren't home. I told her straight out that I felt she had a pride issue that was keeping her from using it more and that she was sure to end up on the floor. I told her that I wanted her to use it more than her cane and that we can give her more room to get by us and that would be the new normal for her when we were home. There are certainly furniture issues that I could start a war with but would be better addressed in order to make it easier for her to navigate the dining/kitchen area.

Judgement Issues lead into the next area- Pill Taking! Oh my! I presented the plan to have her daily pills present on her placement in the morning before breakfast so there could be no confusion about the day or what pills needed to be taken. She couldn't let go of the concept of having all her pills out in the weekly box. She implored me to just leave it the way we have it and she would be able to handle it. I pointed out then that she had mixed up the pills when she filled the box and then didn't take her pills every day. She tried to justify her actions by saying that she "wanted to see if the pills really worked." The next reason was "sometimes I just want to skip a day." I had to remind her that she could choose not to take her pills but she would need to realize that she could end up having a stroke and sores on her legs. She asked several times in a looping sort of way about maybe not having to take so many pills. I answered with the same words, "The doctor said you take very few pills for someone your age and they are are critical for you to take and be healthy." She would then say, "Well, I need to ask the doctor if I really have to take all these pills." I told her, "We can make another appointment so you can see the doctor more often to ask her that question if you'd like." That always stops her, she doesn't like going to the doctor but she'll go back to that question quickly! I told her that in the pill taking area, she was beginning to lose good judgement.

I tried to talk about her judgement abilities. She understood that I saw her judgement was lacking with her pills. She insists on keeping up with her checkbook - I just check online to see how she is doing. She has had trouble balancing the last month or two but got to a point where she was satisfied. She has duplicate checks but she doesn't write hard enough for it to transfer so she writes in the carbon check amount most of the time. I am leaving that one alone for now. I gave her the victory by mentioning that her son talked to her two years ago about having me assist her in writing her bills and handling her checkbook. She got a kick out of that memory and how she won that battle. I smiled. So, then I asked about her memory, how does she feel about it. She began by saying there were memory problems in the family, her father had really bad problems- she never used the word dementia so I didn't bring it up. She says her memory is sharp! I asked her: "Are you the kind of person who would like to know, maybe take a test to know if your memory was really sharp or having problems?" She couldn't answer that. So I tried, "Are you the kind of person who doesn't want to know if their memory is having problems, just let me be happy?" She still couldn't answer. So I said, "I am the kind of person who would like to have a test done to see if I have some early Alzheimer symptoms so that maybe I could deal with it more and not struggle as much." She seemed unwilling to answer. Hmm, so I said very tenderly, "Grandma, I have noticed that you ask the same question several times in the same hour. I am not sure if you haven't heard me properly, but you have answered me back. Every time you ask the same question, I try to give you the same answer." So then, she wanted an example. I gave her the most recent example, she asks me and tells other people, "I can't figure out why there is a ring of grass around the walnut tree. There are no pipes out there and I've checked, the water isn't on." The answer is: We have a drip line on top of the ground that waters the walnut tree twice a week. I she really had walked out there, she would have seen it clearly! This is what she agreed we should do.  She couldn't come up with a good reason for why she can't remember that, other than saying, "Well, everyone has trouble remembering some things." So, I said, I think you will have more memory problems as you get older and so will I!

I really wanted to have some kind of communication of how she is or is not accepting her growing limitations and that we are living here to help her through the transitions continuing to live in her own house. I feel that talking it out brings it out into the "real" world where she KNOWS that I KNOW and I have told her that I KNOW. I feel also that I can now ask her to use the Walker/Rollator because we've had the "knee conversation" - she's admitted to that weakness. Today, I saw her use it more than yesterday.

We don't talk about her death or her dying. That does bother me. I do wish we could be open about that. I would like her permission to begin to get ready for that - some grandparents are good about letting go of trinkets and decluttering the less meaningful things in their home. We certainly have several months worth of decluttering to attend to when the time comes. With that decluttering comes the conversations about what is really valued, friendships, family, memories and letting go . . . but if she feels she isn't at the end of her life (that's the closest she could come to saying something about death) well, why declutter! We are really in for a ride, in our 6th year now.

Thanks for listening. This is just where I am with the caregiving journey. I long for living in my own home with my AH with our own schedule of napping, relaxing, working like crazy and creating. It's good that I have that longing, it means that I am still in there!

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What a wonderful granddaughter you are. Elly is so fortunate to have you and AH in her life. All the previous comments_mysql are so valuable, but I just want to comment on how you write with such LOVE when you talk about her.


EGD, I'm so impressed by the way you handled this conversation. You were calm, but persistent. When Elly veered off topic or came up with \"explanations\" (excuses) you gently but firmly brought her back to the issue at hand. I love that you gave her options (going to the doctor more frequently) and reminded Elly that you too expect to face some of these issues down the road (e.g., memory loss). Well done this round! :) (As Denise, say's it's a process.) I look forward to hearing about your next conversation.


I love that you took advantage of the right moment to have the conversation. I think of these conversations as a process--it's not one and done but one and ready for the next one. \n\nWhen you mention giving her treasures as gifts now so she can enjoy the recipient's gratitude, how does she respond?


It was medication issues that eventually made it clear my folks needed to be in assisted living. Dad was forgetting to take any of his and Mom was taking a month's worth of benzo's in two weeks and going through withdrawals. We tried the compliance packaging - where the drugs are packaged together for a single dose, ie: all the morning meds for today in one small plastic packet that is labeled with date and time to be taken. \n\nMaybe giving her options would help? I like the pretty pill glass idea. I used to tell my folks that these ways of adapting all help to keep them at home longer. \n\nI am glad she wants to be independent and is trying to do things for herself. Making up excuses for what they can't do or can't remember is pretty common. My mom's a master. Dad, on the other hand, just grins and says, \"oops\", when he forgets something.