Smart & Happy Elders’ Lounge

A unique venture to put smiles on the face of senior citizens of the city has been opened at 68, Royapettah High Road near Swagath Hotel. The Ground Floor lounge boasts of air conditioned comfort, colourful ambience, respectful assistants and connectivity to the four corners of the metropolis. Once inside, the seniors can relax and rejoice with board games, TV, music, magazines and books. There are six tables to play cards, carom, chess etc. Wow, there is even an enclave to slouch or sleep. The promoters plan to have physio,  weekly lectures and planned outings to places of religious/tourist interest. Most of all the facility enables self cooking which will be cost effective, cater to individual taste or promote cooperative cooking!!

On being queried as to what sparked the setting up facility, Mr. Narasimhan mentioned, even in the most comfortable homes the elders feel lonely and long for friendly company with human touch, real voice and plenty of laughter. How long can the serial on the TV hold interest?  For how long can they be caged birds? Narasimhan mentioned the President of the Humour Club is with SHEL. Dr Balambal who has traveled the world with Indian Board Games is with the lounge. Eminent personalities of the city such as Nalli, Dr.Hande, Justice Jagdeesan are actively associated. The location abounds with eateries, medical shops, nursing homes hospital, police station, ambulance etc; for any eventuality. To top it all  it is on the ground floor and no stairs to climb..

NRI children can enroll their parents and feel the satisfied smile of their parents time zones away. Even the local sons / daughters could leave their parents in the morning and collect them in the evening. The boys at SHEL would escort the elderly for doctor / labs, if need be  and the ward can feel reassured. Narasimhan said “Such Lounges will absorb many a shock of the modern nucleus family”  If sons and daughters enroll their parents they are helping themselves. Their parents will return home in the evening, motivated and cheerful.

On the International Senior Citizen Day 01 Oct  Governor of Tamil Nadu dedicated this facility to the senior citizens of the city. He was happy to note that this facility is Not For Profit facility and there is No Entrance Fee as in many other city clubs. There is flexible membership fee structure ( Rs 200 a day, Rs 1200 a week and Rs 2500 a month) to suit every pocket and circumstance.  He noted the second childhood of seniors would be better served lessening family frictions, disappointments and anger.

Top 5 constraints voiced by NRIs with ageing parents after a health setback

NRIs with ageing parents

There are many constraints commonly voiced by NRIs when they are discussing ways to take care of their ageing parents back in India, especially after some medical event has made their parents less independent than before. Many of these constraints do not take into consideration ground realities and what is best for their parents.  This article lists some of these contraints raised in order to highlight the fact that it is important for the NRIs to understand that the situation has changed and they and their parents need to adapt to the new circumstances.

1.  My parents don’t want to leave the house/area they are currently living in.

This is one of the commonest requests.  “My parents have always been independent and capable of looking after themselves.  However, since my father had his operation/ has become bedridden, things have become very difficult for them to manage on their own.  However, they don’t want to move out of their house“.

If one or both of your ageing parents are living in an independent house or even an apartment and are no longer capable of managing their daily living activities, and there is no one else to help them, then you should have all options on the table, including the possibility of moving into a care centre (if available).

2.  We don’t want a full-time live-in person as it will impact their privacy. Is it not enough for someone to come only for the morning/night?

Having someone around 24 x 7 is absolutely essential if your parents’ capacity to look after themselves is diminished.  If you have someone during the day and no one at night, what happens if your mother needs to go to the bathroom in the middle of the night?  Or has breathing difficulties?  Or requires water to drink? Or has some other medical emergency?

If you have someone at night but not during the day, who will help them bathe, eat, and perform other daily living activities.

3.  We don’t mind having 2 shifts one coming in the morning and one coming in at night, but they should bring their own food and not use our bathrooms.

If you have two people working round the clock, then you are talking about two 12-hour shifts.  So let us say, one comes in and stays from 8 AM to 8 PM, and the other comes in at 8 PM to 8 AM next morning. It is going to be extremely difficult for them not to have at least one meal and some coffee/tea during their 12-hour period. Or use the rest room for that matter.  Would you work under such conditions?  And even if somebody is willing to, do you think they will be able to give the kind of care you expect for your parents?

4.  Not understanding recovery periods.

My mother broke her hip and has had her operation.  I am here to look after her.  I am sure she will be back on her feet in a month and I can go back.  Nothing needs to change“.

Yeah! Right!
As people get older,  recovery takes longer.  And even after they recover, they are unlikely to get back to their old independent self. At least not in the majority of the cases.  Face the facts. Things have changed.  You have to deal with it.

5. My parents only eat what they have cooked.

Well, if they are no longer able to cook, then they have no other option but to hire a cook or order food from outside. Can you think of any other option?

Well, we aren’t here to dismiss your constraints and worries.  You are far away from your parents and neither party can move in with the other.  These are ground realities.  Everyone knows you as an NRI would find it extremely difficult if not impossible to uproot yourself from home, family and career to come back to India to look after your parents.  Just don’t let that guilt stop you from making other hard decisions.  Put your foot down where you need to, and make the changes that you have to. If it costs you more, well, just figure out a way of taking care of it.  The well-being of your ageing parents is still your responsibility.

The NRI and their ageing parents

The NRI and their ageing parentsEvery week we get calls from around the world asking us the same question. “Can you recommend someone who would look after our ageing parents back in India?”.

Unfortunately, in most cases the short answer is “no”.

While India may be the head quarters of outsourced services for the software and back-office industries, we are as yet unable to find high-quality service providers for looking after ageing parents.

This is not just because there are so few such home health care agencies ready to take on such a role, but is also because of the myriad constraints that the NRIs and their parents put on the potential service providers.

Ideally what you are looking for is a continuing care facility or a multi-level care facility such as those found in the west which provide all the services necessary to an ageing resident, whatever be their physical and mental condition, now and in the future.

Such establishments are rare in India, at this point in time, though a few are coming up in various parts of the country.

Realistically though, for now your best option is to find an immediate family member or a close relative to look after your parents and arrange for a home healthcare service provider to assist the family member/relative in the care giving process.

Options

If an immediate family member or close relative is not available, look out further for a relative, who because of financial reasons, would be willing to stay with your parents and look after them for a monthly salary. This would be a win-win situation for both parties as it gives you a dependable and trustworthy resource to be your representative at home while providing this relative with boarding, lodging and a certain amount of financial independence. Of course, it may not be fair to have them look after all aspects of caregiving (depending on the condition and needs of your parents). So, you can arrange for professional home care service provider to assist this person in the routine aspects of caregiving.

In the next article we will see what are the common constraints people face and how some of those could be tackled.

Long toenails and associated issues

Long toenails and associated issues

Recently I visited an elderly gentleman in his home. After talking to him for a few minutes, I was just taking my leave when I noticed his toenails. They were long and uncut.

I pointed them out to him and requested him to cut them down to size. Apparently he had been wanting to do that for a long time, but because he was unable to bend, he had not gotten around to doing them for a while. He also seemed very reluctant to ask family members for help. I asked him to bring his nail clipper, thinking I would do his toenails. He brought a pair that turned out to be useless against his thick and long toenails.

I am sending across a toenail clipper to him today. Additionally, I am looking for a salon/spa that provides pedicure and grooming services at home for elders. Believe me, it seems to be easier finding grooming services for pets than for the elders. Such is the state of affairs here!

Anyway, coming back to the topic, here are some of the reasons why you should ensure that the elders in your house have their toenails trimmed regularly.

  1. Long toenails can curl up and cut unto the skin.
    2. Thickened toenails can become hard and difficult to cut.
    3. Toenails harbour a lot of bacteria and other harmful germs. If one were to scratch oneself with their toenails, chances of infection are high. These infections can lead to complications and in some cases even septicemia and death.
    4. Long toenails can cause people to trip or stub their toes more often.
    5. They are unsightly.

As they say, a stitch in time saves nine. So arrange a pedicure today.

The importance of (not) sitting

The importance of (not) sittingI read an article recently where it states that sitting for long periods is the new smoking.

Till recently, say till about 2 generations ago, people were more actively involved in manual work involving standing, walking and running. However, with more work moving to the desk, we are finding most people spending at least 9 hours a day sitting at their desk.

These prolonged periods of inactivity, according to health experts, can lead to obesity, heart diseases, muscular issues including back problems, as well as dementia. The WHO has identified lack of physical activity as one of the biggest killers on this planet.

While most of these articles and TED talks are focused on the young, this is true for the ageing population as well. Especially because many elders spend even longer hours sitting. So, if you notice that you are sitting for long periods of time, please change your life style as soon as possible. Go for short walks more often, join an elder yoga class, stand around for longer periods or join a gym. This should help keep at least some of the problems at bay.

Having said that, there is at least one time when sitting is of paramount importance. And that is when you are trying to put on your underwear and trousers. Most of us, especially the men, do this while standing. As your flexibility decreases, the chances of your foot getting caught inside and making you trip increases quite rapidly. So, always, always sit down before your wear your clothes.

Now, if you are in the habit of wearing your clothes in the bathroom, the situation is even more dangerous. Yes, I know, you have been doing it for several years, practically since you started dressing yourself. Nevertheless, times have changed and you have become older.

Get a shower bench or shower chair for your bathroom. After you wipe yourself, quickly wipe the showerchair as well and then sit on it to wear your clothes safely.

Remember, a fall can lead to a lot of complications and additional dependency on others.

Sometimes, sitting is good.

Are we any close to a cure for Parkinson’s?

There is an article in Wired about 23AndMe’s quest for Parkinson’s.  23AndMe, as you know is a company that is decoding the human genome in search for patterns to help us understand diseases.

Parkinson'sParkinson’s is an incurable neurodegenerative disease that affects 1 million Americans. The biggest risk factor is age, but certain genetic mutations can increase risk too. 23andMe reports two of them to its customers, which each increase the chance of developing Parkinson’s between about 30 and 75 percent. (Sergey Brin, the Google cofounder and ex-husband of 23andMe founder and CEO Anne Wojcicki, carries one of those mutations, called LRRK2.)

But scientists don’t know how the disease works or even how much genetics play a role in its development and progression. Unlike Huntington’s or hemophilia, there’s no single genetic signal for Parkinson’s. 23andMe is betting that through brute-force pattern matching, it can map the constellation of genetic causes—and potentially inform new treatments.

To read the entire article go here.( https://www.wired.com/story/23andme-is-digging-through-your-data-for-a-parkinsons-cure/)

This is what happened to me when my parents moved in

This is what happened to me when my parents moved inJoy, frustration, irritation, adjustment, finally happiness! Getting your parents to move in with you is a tough proposition. When they finally agree to move in, it requires a change in the mindset of everyone. The initial euphoria on both sides slowly moves through difficult periods of adjustment leading both sides to question the decision. But if you persevere and remain true to the reason as to why you want them to be with you, it is very rewarding in the end.  It is far more difficult for our parents to adjust since it means giving up ostensibly their independence.  Giving the limited space in our homes, it also means giving up prized possessions so as to accommodate everyone. It also meant making the home more secure, safer and comfortable for seniors.

Many conflicts arise during the initial phase – things to keep and throw away, finance, medical, the list goes on. When there are kids involved, the demands that are placed on us as parents often lead to what we perceive as interference from our parents. To them, we are still their kids who need to be spared physical and emotional demands. This often makes them intervene directly in delicate situations which make the grandchildren resent them and us. They miss their independence and their life and substitute that with trying to be a part of what happens at home. They constantly tell us when to be home, what to cook, how to buy our groceries and how to save. The conflict arises in how we raise our kids because of very different schools of thought about food, schooling and discipline.

Three generations of mood swings happen at the same time – old age, menopause and teenage. And you have to deal with the aftershocks. You navigate your way through treacherous waters filled with obstacles.

After you successfully navigate your way through these treacherous waters and lead your family successfully, it is richly rewarding to see your parents by your side through the joys and sorrows of everyday life. At the end, I am happy they are with me.

What are the criteria for finding good in-home care services?

criteria for finding good in-home care servicesWhat is home health care?

Home health care is the process of providing health care to people in their homes. This could include post-trauma care, post-operative care and elder care, and may range from supporting daily living activities to complete at-home ICU setup.  In this article we will restrict ourselves to home healthcare for elders.

The need for home health care

Of late, India has woken up to the need for home health care.

Firstly, a burgeoning population is putting a lot of pressure on hospitals to treat and discharge patients as soon as possible.  This is extending the post-hospitalization and recovery period where people who have come back home continue to require a fair amount of health care in order to fully recover.

Secondly, the elder population in India is growing steadily and small families are finding it hard to look after the elders at home without professional help.  India today is home to over 120 Million people above the age of 60 and a good 10% require some health care and support at home.

These two together are creating a new market for professional home healthcare services.

Introduction to professional home healthcare services in India

“Home healthcare services” is still a nascent industry in India.  It is also a very challenging space because the requirements and conditions in India are very different from those in developed nations. Which means that we do not have a successful model to emulate or follow.

Currently, there is no regulatory body or umbrella organization for the home healthcare sector that could regulate and set up the rules of engagement.  So, we are pretty much bordering on what can be called an unorganized, unregulated sector.

Also, most home healthcare services organizations are independent organizations not affiliated to any hospital.  This means that, more often than not, the hospital is not aware of what specific services the home healthcare agency is providing for their discharged patient and whether it is in line with what they – the hospital –  has recommended. In fact, most often, the home healthcare services are provided without any supervision or monitoring by a doctor.  This means all the due diligence in the selection process and the supervision of their work with the patient rest solely on the shoulders of family members of the patient.

This is why it is essential to learn how to select the right service partner for you.

  1. Collect the list of service providers operating in your area.  These could be individuals (freelancers), general manpower agencies, local hospitals’ outreach business arm, or dedicated home healthcare providers.
  2. Select a service partner who meets your current requirements and be prepared to switch to a different partner if the needs become more complicated (or less complicated) as the case may be.  This will give you some flexibility in managing costs.
  3. If you are selecting a freelancer or individual, there are both advantages and disadvantages. The advantages and disadvantages are
  4. (A) The cost will be low.
  5. (A) If you have the space, you can find someone who is a live-in service agent.  This will prevent sudden “no-shows” and unexpected disappearances.
  6. (D) You will have to do all the due diligence starting from the security aspect onwards.  Is this person reliable?  Where do they live?  Do we need to get them to get a police clearance?  Should I get copies of their important documents?   These are all some of the questions you will need to grapple with.
  7. You will be responsible for their personal needs in terms of food, security and shelter (in the case of a live-in).
  8. When they leave for whatever reason, either permanently or for a short/long leave of absence, finding a replacement can be challenging.
  9. If you are selecting a general manpower agency, it should be only for a companion or a nursing assistant (untrained helper).   You should not rely on a general manpower agency for professionally qualified personnel such as nurses, physiotherapists, occupational therapists or doctors.  The advantages of going to a manpower agency over an individual is that you can expect the manpower agency to do some of the due diligence (though we would strongly recommend that you do your own due diligence).  Additionally, finding a replacement for a truant caretaker may be easier.  On the down side, expect “no-shows” and everyone involved, from the agency to the actual personnel, to be “unreachable” at such times.
  10. If your local hospital provides home healthcare services also, that is ideal.  Since all the services are provided by the same organization, one can hope that they all work in unison and provide you with the right level of support whatever your needs are.
  11. Finally, there are a number of independent professional home healthcare agencies that have come up in India recently.  They are expensive, but they provide a wide range of services from house calls by doctors to 24×7 intensive care.

Bottom Line

The bottom line in all this is that the quality of service received is, at the end of the day, dependent on the quality of the individual deputed to provide that service.  As a fledgling industry, training of personnel for home health care is still not very advanced and you can expect a lot of rough edges.  Be prepared to spend time on training the deputed personnel on matters such as hygiene, empathy, kindness, caring and pleasant bedside manners.  You will also have a tough time taking them away from their phones!

All the best!

 

 

How to handle a parent who has become, bitter, rude and even more stubborn as they have aged?

DementiaThough this may sound pithy, it is true that old people are like children. And sometimes, the older they get, the more child-like and/or childish they become. While this can be endearing at times, it can also be very frustrating and annoying. Not to mention, difficult to manage.

If you feel that your elder loved one is behaving badly, ask yourself this question.
Is this completely new, surprising behaviour or is this their usual inherent traits getting magnified a bit (or a lot)?

If you feel that there is a sudden and drastic change in the personality of the person, then this could be a symptom of dementia. Seek professional help. Take the loved one to a neurologist and have a proper assessment done.

Dementia is a generic term for decline in mental ability of a person. It is not a specific disease. Alzheimer’s is one of the common forms of dementia among elders. Dementia results in a loss of ability to perform even routine tasks properly and the person suffering from this may become frustrated and angry at their own inability which can then manifest itself in the form of bad behaviour.

If on the other hand, the traits exhibited have always been inherent in the person, except that it is coming to the fore more often and more forcefully, then it could be due to other factors.

In both cases, a lot of patience, tolerance, love and care are needed. Here are few tips for handling such situations:

1.Try and identify the cause(s) for their frustration.

2. Help them in tasks they are having difficulty with.

3. Where possible assist them in finding ways by which they can remain independent, rather than taking up those tasks yourself. For example,

– If they are constantly forgetting things, get them a board on which they can write things they need to remember and allow them to use it to supplement their memory.

-If they are forgetting dates and seasons, get them a big calendar that they can refer to regularly.

-Sometimes they are misplacing things, help declutter their living environment and designate places for the things they misplace. For example, a decorative and distinct keyholder can ensure that they hang all the keys there. A spectacle stand kept within ready reach can help them remember to leave their specs in the same place most of the time.

-If they are getting lost, buy them a wearable GPS tracker. This may not help them but will help you ensure that they don’t wander away and get lost.

If they are abusive or physically threatening, then get them to sit down and explain why such behaviour is disturbing to you and ask them how you can make them happier. If that does not work, you can switch to expressing your displeasure at being abused and take certain actions to ensure that they get the message that you will not tolerate bad behaviour. For example, you can move out of the room saying “I am not going to come back till you calm down and behave properly”. If they get physically violent, get support.

If they are suspicious of you, don’t take it personally. Many times, you are the only person they are interacting with and so you become the easiest target to vent out all their frustration, anger and suspicion. If they are worried about monetary issues, keep their bank passbooks and other asset related papers somewhere close to them, so they can go through them whenever they want and reassure themselves.

Each case is unique. The main thing to remember is that you don’t have to face it all alone. Get help. Talk to your friends and family. Enlist their support. Talk to fellow caregivers. Join a self-help group. Approach NGOs that are working with elders.

Above all, tell yourself that their behaviour is not a reflection of their opinion of you. Don’t let your self-esteem suffer. All the best!

Transitioning from the saree to the nightgown

Transitioning from the saree to the nightgownMost elderly ladies, especially in South India, have worn nothing but sarees all their lives.  While the saree is an elegant dress, it is quite a handful to drape, even for a normal person.  But to have to drape it on another person, that too someone who is confined to their bed is not only tedious but also difficult to manage for multiple reasons.  Just imagine having to change the saree every time there is a diaper ‘accident’ and you will understand some of the problems faced in such situations.

One such story involves an 89-year-old lady. This lady had been very active until she fell and fractured her hip a few months ago.  One thing led to another and now she is confined to her bed, and dependent on her daughter for everything.  A feisty lady, the perceived loss of control of the household and having to depend on others made her very difficult to deal with.

One of the things she refused to compromise on, in the beginning, was the saree.  She insisted that she had to be in a saree all the time.  And not just any kind of saree but one of the starched and iron cotton ones that she was used to all her life.  The daughter tried gamely for a few days but was unable to take on the additional burden of changing her mother’s saree two or three times a day.

She then bought nightgowns from us, but her mother refused to even consider them, even after she was given a wide choice of designs to choose from.  Finally, the mother and daughter had a big showdown at which time, the daughter reduced the choices to grey hospital gowns and our special design Cocoon nightgowns.  The mother finally relented and decided to go with the nightgowns, for she abhorred the dowdy hospital gowns, which she felt made her look and feel even sicker than she actually was.  Needless to say, the mood in the house subsequently went downhill.

We came to hear about this story when the daughter, the primary caregiver came to buy some more of our specially designed back-open nightgowns for her mother.

With dark circles around her eyes, hunched shoulders and a resigned look, she appeared to be at the end of her tether.  On gentle probing, she confided that she felt that she had let her mother down as she could not even meet the simplest of her wishes.

Once she narrated her story, we took a leaf out of another customer’ story (similar beginning, but a different ending), and suggested the following:

1. Have specific visiting hours for her mother during which time her friends and relatives can come and visit her.

2. Get the mother dressed in a saree for the those visiting hours, so she can receive her visitors the way that she liked – prim and proper in a starched cotton saree.

A few weeks later, the daughter came back for a few more of our nightgowns.  She seemed to be in a much better mood and was happy to share with us that our suggestion had worked very well and both mother and daughter were very pleased with the arrangement.

“Now that my mother has got used to wearing nightgowns, she finds them very comfortable and elegant.  She has sent me here to get some more, with clear instructions to get pastel shades because that is what complements her complexion”, she said with a throaty laugh.

On our part, we are very happy to have contributed in making the life of another care recipient and that of the care giver just a little bit better.