Aging in Place

By Marilyn Carnell

      “Aging in Place” - what a great concept. Implementing it is not so simple. Al, my husband and I have had our share of age-related health problems. I have had both knees replaced and Al has had a broken hip and recently a broken shoulder. The latter is what led us (and our children) to arrange for more assistance in order to avoid going back to the hospital or long term care.

      I hired a highly recommended firm that was “dedicated to the whole person” in hopes that they could help us with some tasks, run errands, assist in personal care, if needed, and be generally helpful and unobtrusive. The objectives were to keep us engaged in life and avoid nursing homes and hospitals.

      Pippa, the “educator” (read sales person) was enthusiastic and full of promises. I was going to have help that would relieve me of stress and both Al and I would have help that would be compatible and help re-ignite the missing “spark” in our lives. Much time was spent in explaining how it worked and finding the right person(s) to work with us. Her colleague Astrid, a Registered Nurse, assured me that the health care was going to be superb. Life would be great again. Al was coming home after six weeks in the hospital and rehab. The Case Manager Crystal, another R.N. was cheerful and practical. She and I agreed on an initial schedule of 4 hours in the morning and four hours in the evening to ease Al’s transition with assistance in morning and evening tasks. I was to be helped as time permitted. Al would get the same assistance and care he had got at the transitional care unit (TCU) and I would be free to take it easy and rest my wonky heart. It sounded like paradise.

      But stop. Remember the snake part of the story?

      First of all, it is difficult to have a stranger in your home. Try having seven strangers in a row. It is like Groundhog Day. The same introductions, explaining our needs, finding out a little about the caregiver’s background and what needed to be done in the next four hours. None of them had been briefed about our needs and circumstances (as I had been assured would be the case). All immediately rushed over to find our case manuals to read up on our history and medical conditions.

      Aide #1 was a young Somali woman named Farah. Since she wore a hijab, I guessed she was Muslim. That was fine with me, but it was during Ramadan and I felt I needed to inquire if she had any special needs. We barely got past “hello” when our cat, Busted, ambled in. Farah was terrified. I thought she was going to jump on the sofa and I might have to scrape her off the ceiling. I mildly observed that things weren’t working out too well and as this was our first experience with help, perhaps she might like to leave. “No, no! She insisted. She could cope. She had not been warned that we had a cat. If so, she would have declined the job. I explained that my husband was still in the transitional care unit in Shakopee, MN and that we were starting early in order to have things in good order before his expected release. I had many items that had not been adequately cleaned after the devastating flood we had experienced in Missouri six years before and I would appreciate help in getting our basement area in order. Three days before we moved into our home here in MN, Al fell and broke his hip. Needless to say, we were preoccupied during the move and our furniture and belongings were almost literally thrown in the door. This was a great opportunity to address a five year old problem.

      Aide #2 A middle aged woman from Kenya. She sashayed into the house with a cheerful demeanor. Tidy uniform, and a can-do attitude. She was some help, but her claim of owned a café back home in Kenya, was a little off as she cooked my scrambled eggs at a blistering high heat so they were lumpy and watery. She also had a habit (that I came to know as cultural)of washing out every dish or pan before using it. I started feeling like I must be lacking in cleanliness.

      Aide #3 Maria was sunny Latino with a very sweet personality and generally helpful. A good cook, but disappointing in some other task executions. She left a pan of dirty water in the middle of the floor, for example. I thought I could work with her if she had more training and supervision, but at the moment I didn’t want to be thinking for two.

      Aide #4 Al’s first day home. Hamilton, our first male aide arrived twenty minutes late at 5:20 pm. He also was from Kenya. I was feeling like a delegate to the United Nations. The idea was that he would prepare our dinner, work with me and then help Al to bed. Of course, Al was furious at what he perceived as an invasion of privacy and refused to talk with anyone. I went about my little routine of getting acquainted with our needs and a little about his background. He had earned a Masters of Public Health and when he heard that I also had a MPH, immediately asked me for a job reference. I allowed that we had just met and was in no position to evaluate his qualifications.

      I had gone shopping the night before and bought a rotisserie chicken, and ingredients for a simple chicken dish that looked good, a premade salad and strawberry shortcake. The tasks were to bone the chicken, dice some celery and measure and mix the other ingredients. It was frustrating to me as he announced he did not know how to cook American food and could I read the recipe to him. He also washed every dish before using it.

      Explaining cooking terms, locations of equipment was a trial to me. “It is in the top drawer to your left.” Meal preparation was not easily accomplished. It took him an hour to prep and assemble a mixture that had only five ingredients. Meanwhile, I sliced and sugared the berries and set the table. When our dinner was ready, it became clear that it was 7 pm and he had brought no food with him (as he was supposed to, I later learned). I didn’t know what else to do but invite him to join us in the meal. Al was not happy with a stranger eating with us, but it seemed rude to me to not offer food. In addition, now I was between him and Al’s ire. We ate in near silence and after clean up and some unpacking of boxes, I was happy to see him leave.

      Aide # 5. Michael arrived at 6:50 am. He was from Unganda and ten minutes early for two non-morning clients. He had a bit of an attitude. When I cautiously asked if he were Muslim (I was concerned about dietary laws and wanted to be polite.) His terse reply was “Have you ever met a Muslim named Michael?” I sheepishly said, “No, I guess I haven’t.” Al went to the bedroom to pout, so Michael and I retreated to the basement. I have some knock-down pine shelving units that I have moved all over the U.S. I had assembled some of them when we moved in, but there were two more units that I needed help putting together. It is a simple process (usually) that I once could do alone, but it is easier if two people work together. (One to hold up the supports and the other to insert and snap in the shelves.) I got constant complaints of “I am not a carpenter.”

      The last straw was a lecture on the evils of slavery .“ I can’t understand why there was slavery in the U.S.” v“Nor do I”, I said. "It is evil and wrong, but I and my ancestors had nothing to do with it.” I sent him home early.

      Aide # 6 At the sight of another new person at the door, Al went to the bedroom and slammed the door. I had planned a simple spaghetti dinner: a jar of Prego with added sautéed mushrooms, a salad, garlic butter , ciabatta and the leftover strawberries. I had started prepping dinner as I didn’t want to cope with a million questions about cooking and equipment locations. The water was boiling, the sauce simmering and the bread sliced and buttered. Lucy was a happy surprise. She was a funny chatterbox - a welcome relief. Since Al refused to eat, I invited her to join me. She had brought her own food, but said she would be foolish to turn down strawberry shortcake. I enjoyed her company and after dinner clean up, we went to the basement again to clean and sort.

      Aide #7 Caitlin arrived promptly the next morning. In our now ritual introductions, I learned that she was a refugee of Hurricane Katrina. Well, we had something in common to discuss – a water disaster. After getting downstairs, I explained that I needed to unpack more boxes, clean and sort. “I can’t lift more than 5# she announced flatly. So I ended up bringing in the boxes to go through while she half-heartedly washed some items. She did put the hooks in some curtains and hung them for me. Apparently, she had never done that before. A third curtain was threaded on a rod, but the matching one had to wait as she was unwilling to try to hang it for me.

      Aide #8 Mannu was another guy who would rather talk than work. Middle aged, everything seemed to be a great effort. We struggled along, but I sent him home a half hour early. I couldn’t stand any more.

      “Why keep trying ?” my friends and family said. The only reason I did was because Crystal was bending over backward to make it work. Unfortunately, she would get something fixed and someone else would either not follow through or would change things in a way that was not what I wanted.

      After eight different “helpers” I was getting sick from stress. I called Pippa. She quickly let me know that it was her job to “educate” and after that I should only call Crystal, the Case Manager. In other words, she was no longer a resource. Needless to say, I was pissed. I contacted Crystal and she again bent over backwards to help me get the kind and amount of care we needed. She came on her own time to dress an arm wound Al got when he fell a second time after getting home. We were clearly at high risk for injury and those falls got both of our attentions.

      But enough of troubles. There was a bright spot. We ordered meals from Seattle Sutton (the real name) that were great. All 21 meals for the week for both of us picked up or delivered twice a week. Being Scots-Irish, I opted to save $20/week and pick the fresh food up myself. It was perfect for us – well planned, and healthful with fresh fruits and vegetables along with freshly prepared foods. A five week cycle of menus to avoid boredom.

      As for help. I settled on one aide who was helpful and had initiative. She was available twice a week and that seems to be enough for our needs right now.

      (Names changed for privacy.)