Harriet & Charles
Story Related By: Lisa Krauss, Founder, Growing Options, Inc.
Growing Options was contacted by a Financial Planner who had been helping a client, Harriet, for many years. She recently noticed that her client had increased issues with memory loss and alcoholism.
She knew that Harriet, who had become a friend, needed help beyond what she could offer.
Harriet and Charles were not married but were long time companions and referred to each other as husband and wife. Harriet had one daughter who lived out of state and Charles had 3 children who lived out of state. They resided in Harriet’s home and finances were separate.
Harriet had several falls and was recently discharged from a skilled nursing home facility and was told that she must accept 24 hour care. Harriet and Charles were angry and they begrudgingly decided they would comply temporarily so they could get Harriet back home and resume their customary routine. As you can imagine, providing needed care was quite challenging for the caregivers. The Home Care Agency had placed many caregivers within the home; however, no caregiver would stay for any length of time. Harriet would drink late in the day and became hostile and belligerent demanding that the caregiver leave.
The Home Care Agency recommended to the Financial Planner that it was time to hire a Geriatric Care Manager. I was introduced, to them, as an expert in aging in place. I empathized with their current situation and reassured them that my role was to work with them to come up with a plan that would allow them to remain as independent as possible, with the proper supports. Their major complaint was that “everybody was telling them what to do and that they did not want intruders and strangers in the house.”
The first goal was to develop a trusting rapport. I made sure they felt heard and conveyed that there were many different options we could explore. While I was building rapport I was evaluating what needed immediate attention. I established short term and long term goals.
They signed releases of information so I could speak with all current physicians and get a thorough understanding of their medical diagnoses.
Harriet’s main diagnosis was alcohol-related dementia, caused by long-term, excessive drinking, resulting in neurological damage and impaired mental processing. She had poor insight and judgment; therefore, reasoning with her was not possible. There were increasing behavioral issues which were not easily resolved and they impacted the quality life for both Charles and Harriet. Family on both sides were becoming more and more concerned.
Charles was dealing with cardiac and gastrointestinal issues. He also had mild dementia which appeared to be progressing.
I spoke with their families and their financial advisor/POA. We discussed options with an understanding of what the financial picture was and the best option regarding a Life Care Plan and honoring their wish to remain together, in their own home, as long as possible. When I first met them they were not against the idea of moving to assisted living; however, as is often the case, they did not feel they were ready for such a move.
It was evident that the ultimate goal would be to facilitate a move to the assisted living. The focus was to determine which facility would be the best fit for their needs. All were in agreement that I would recommend the appropriate facilities and then I would assist in touring Harriet and Charles and then have family visit and decide which facility would be best.
During this time issues escalated. The drinking continued but we were able to dilute the alcohol to decrease the alcohol consumption. There were increased incontinence issues and Harriet’s denial and refusal to address the issues created conflict. Harriet also continued to have falls but no significant injuries.
Driving was a major concern. Harriet refused to stop driving and was quite adamant that she was an excellent driver. Charles medical issues prevented him from driving. Harriet was the designated driver for the two of them so he also fought for her to continue driving. She agreed to be tested through the Easter Seals Program because she was convinced she would pass with flying colors. Harriet did not pass and was devastated but it was clear she was unsafe to drive and was putting herself and others at risk. She would not voluntarily surrender her license but once the Department of Motor Vehicle received the report, her license was revoked. Harriet’s memory was so poor that she did not remember that her license was revoked so it became necessary to remove the car from the home. Harriet would call the police and report that her car was stolen. I was able to find a wonderful caregiver who had her own car and would take Harriet and Charles out. Harriet’s memory issues caused a problem when, at night, or upon waking up, Harriet would accuse the caregiver of being an intruder and call the police. After a while Harriet did become attached to the caregiver so much so that when the caregiver took a few days off she would call 911.
I arranged for a Geriatric Psychiatrist and a Geriatric Physician to evaluate and assist with medication review and changes to address the increased agitation and delusions that often accompany dementia and memory loss. During this time Charles’ medical status was declining with cardiac issues, increased memory loss/dementia and generalized weakness.
With an increase in their care needs, it became necessary to have an additional night time awake shift so that the 24 hour caregiver could get needed rest and both Charles and Harriet could receive the supervision needed in the evening.
As winter approached I saw evidence that their care needs were increasing. The cost of care in their home was increasing and their level of activity decreased significantly. It was difficult for the caregiver to take both out together and neither one could be left unsupervised.
It was time to move them to assisted living. I worked with the family and we selected an appropriate Assisted Living Facility and moved Harriet and Charles. They agreed to do as a “one month vacation.” Charles family wanted him to have his own apartment in the assisted living so he would not feel he needed to assist with Harriet’s care and she needed a secured memory unit. Charles spent the days with Harriet and the evenings in his own apartment. Charles medical conditions worsened and so did his dementia.
After 6 months Charles moved in to the secured unit in a two bedroom shared suite with Harriet and they were both very happy while getting the care they needed.
Three months later Charles became quite ill and passed away. Harriet’s dementia increased significantly but she understood Charles was gone. Fortunately, she was in the appropriate setting with wonderful supports and receiving beautiful care.
We had facilitated a life care plan for both that allowed them to age in place, together, with grace and dignity. Harriet passed away one year later.
Their families were very appreciative and grateful that we could honor their wishes.
The aging process can be extremely stressful for everyone involved. Having a geriatric care manager working with you helps alleviate the stress involved with decision-making. The goal is to always honor the client and their needs, helping them stay as independent as possible. Growing Options care managers are experts who know how to navigate the situation and provide recommendations and guidance. You don’t have to do this alone!