Elder Care and In Home Care

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Sandy, Power of Attorney for Mary, contacted Ivory House Care Management in February 2007.  Mary, at age 88 years, had sustained a very large stroke and was hospitalized at an acute rehabilitation center for the brain injured.  She was paralyzed on her left side, had difficulty swallowing and was incontinent.  Her diabetes and hypertension also presented complications.  Mary’s long term prognosis was poor.  Her physician had told Sandy that she would be lucky to live six months.

Since she had never married, Mary had no close family to care for her.  Other than her nephew in Virginia, she had two close friends, Sandy and Clara, who shared responsibilities as Power of Attorney. Also there was Wilbur, a handy man who lived on her property.  None of her friends had senior care experience.  When the rehabilitation center notified Sandy and Clara that Mary was ready to be discharged, they contacted Ivory House about assisted living care.  Mary wanted in home care to be with her cats and friends.

Prior to Mary’s discharge, a geriatric care manager from Ivory House went to visit and reviewed her medical history and progress at the center.  She met with the social worker and arrangements were made to have medical equipment and a hospital bed delivered to Mary’s in home care even before she left the center.  The geriatric care manager also met with Sandy to review the assisted living care for Mary and discuss several elder care services.  Round-the-clock in home health care services were provided.

Pam was the aide from Ivory House who cared for Mary from 7 A.M. to 3 P.M.  She and Mary developed a close relationship.  Every day Pam would make Mary’s favorite breakfast which included eggs, bacon and fried tomatoes.  After breakfast she would bathe and dress Mary and get her up in her chair to watch the “Price is Right” or Animal Planet.  Pam also monitored Mary’s blood sugars, blood pressure, level of awareness and general well being.  If there were changes, she would immediately call the care manager at Ivory House and have her assess the situation.

Because Mary was incontinent and wore diapers, skin care was especially important.  Mary’s senior care manager would visit every 1-2 weeks to assess her skin and general condition.  She would then discuss with Pam the best approach to maintaining Mary’s skin.  This helped prevent skin breakdown and ulcers from occurring.

After several weeks at home, Mary’s physical condition continued to improve.  With exercise and good nutrition Mary was able to go visit the hairdresser and antique business located on her property.  By summertime she was strong enough to take short excursions with Pam to the grocery store, farmer’s market and fruit farm in Pennsylvania.  Eventually Mary became a “fixture” again at the antique shop and made flower arrangements with Pam during the Christmas holidays.

In September 2008, Mary had her 90^th birthday.  Sandy and Clara helped Mary arrange a reception at the L’Hirondelle Club which included Mary’s favorite foods, drinks and a dance band.  Pam took Mary shopping at Nordstrom’s for a new silk suit and “strappy” sandals.  Although she was wheelchair bound, Mary wanted to look her best for this event.

January 2009 Mary suffered a second massive stroke.  After 3 days in the hospital she came home on hospice care.  Over the next week family and friends came to visit and say goodbye.  Mary died quietly in her sleep and all agreed that she had lived the last two years, as a gift, with quality.

Elder Care Clients Receive Exemplary In Home Care and Quality of Life

Sandy, Power of Attorney for Mary, contacted Ivory House Care Management in February 2007. Mary, at age 88 years, had sustained a very large stroke and was hospitalized at an acute rehabilitation center for the brain injured. She was paralyzed on her left side, had difficulty swallowing and was incontinent. Her diabetes and hypertension also presented complications. Mary’s long term prognosis was poor. Her physician had told Sandy that she would be lucky to live six months.

Since she had never married, Mary had no close family to care for her. Other than her nephew in Virginia, she had two close friends, Sandy and Clara, who shared responsibilities as Power of Attorney. Also there was Wilbur, a handy man who lived on her property. None of her friends had senior care experience. When the rehabilitation center notified Sandy and Clara that Mary was ready to be discharged, they contacted Ivory House about assisted living care. Mary wanted in home care to be with her cats and friends.

Prior to Mary’s discharge, a geriatric care manager from Ivory House went to visit and reviewed her medical history and progress at the center. She met with the social worker and arrangements were made to have medical equipment and a hospital bed delivered to Mary’s in home care even before she left the center. The geriatric care manager also met with Sandy to review the assisted living care for Mary and discuss several elder care services. Round-the-clock in home health care services were provided.

Pam was the aide from Ivory House who cared for Mary from 7 A.M. to 3 P.M. She and Mary developed a close relationship. Every day Pam would make Mary’s favorite breakfast which included eggs, bacon and fried tomatoes. After breakfast she would bathe and dress Mary and get her up in her chair to watch the “Price is Right” or Animal Planet. Pam also monitored Mary’s blood sugars, blood pressure, level of awareness and general well being. If there were changes, she would immediately call the care manager at Ivory House and have her assess the situation.

Because Mary was incontinent and wore diapers, skin care was especially important. Mary’s senior care manager would visit every 1-2 weeks to assess her skin and general condition. She would then discuss with Pam the best approach to maintaining Mary’s skin. This helped prevent skin breakdown and ulcers from occurring.

After several weeks at home, Mary’s physical condition continued to improve. With exercise and good nutrition Mary was able to go visit the hairdresser and antique business located on her property. By summertime she was strong enough to take short excursions with Pam to the grocery store, farmer’s market and fruit farm in Pennsylvania. Eventually Mary became a “fixture” again at the antique shop and made flower arrangements with Pam during the Christmas holidays.

In September 2008, Mary had her 90^th birthday. Sandy and Clara helped Mary arrange a reception at the L’Hirondelle Club which included Mary’s favorite foods, drinks and a dance band. Pam took Mary shopping at Nordstrom’s for a new silk suit and “strappy” sandals. Although she was wheelchair bound, Mary wanted to look her best for this event.

January 2009 Mary suffered a second massive stroke. After 3 days in the hospital she came home on hospice care. Over the next week family and friends came to visit and say goodbye. Mary died quietly in her sleep and all agreed that she had lived the last two years, as a gift, with quality.

When Do You Need Elder Care for Aging Parents?

Barbara and Emma’s Story

In April of 2006, Barbara’s children contacted Ivory House regarding elder care for aging parents and assisted living care, because they were concerned for their mother Barbara and their aunt.  Both women were in their eighties.  Barbara had experienced a small stroke that affected her sight and was placed on a blood thinner that the doctor was having trouble regulating.  In addition, Emma had begun to have lapses in her memory and was diagnosed with early dementia.  The family thought that both women would benefit from the services of a geriatric care manager.

Barbara and her sister Emma had been close, only 18 months separated them in age, until Barbara married and moved away from Prince Georges County.  Emma stayed at home giving up her hopes of a theatrical career and worked for the State Department in Washington D.C.  Barbara moved to Ruxton and with her husband and raised two children. After Barbara’s husband died, Emma came to live with her sister in an apartment in Ruxton.  Barbara was known as a gardener and both she and her sister loved to cook and bake items for others.

After a thorough assessment which included physical findings, social data, mental health status, and medical record review the geriatric care manager from Ivory House compiled a list of assisted living care recommendations based upon the findings and wishes of all parties.

Elder Care Services Role in Assisted Living

Since the sisters’ goal was in home care and neither of them was able to drive a car, transportation was arranged for an aide to be present for four hours on Wednesdays and County Ride applications were completed for transportation to appointments that were scheduled for other days of the week.

On Wednesdays Barbara and Emma were able to go to their favorite places which included Trader Joe’s and the Library, as well as run any other necessary errands.  As much as possible, doctors’ appointments were scheduled for Wednesday.

The Ivory House geriatric care manager also made recommendations for medical care which included, at the client’s request, a physician who specialized in Senior Care and a clinic which was able to get Barbara’s blood thinning medication into control within a few weeks.  An elder care wellness plan was developed for both sisters, and the care manager accompanied them to their physician visits.

Over the next two and a half years, the Ivory House geriatric care manager visited the sisters at least every two weeks to monitor their health and quality of life.  Minor illnesses, such as shingles, colds and urinary tract infections were recognized early and treated without the need for emergency room visits or hospitalization.

Geriatric Care Managers Remain Involved

Both Barbara and Emma remained active and content, living in their apartment.  They enjoyed gardening in the spring and summer months.  When Barbara’s daughter visited from California in June, they would travel to a local orchard to pick cherries and blueberries.  During the summer these fruits would be turned into pies and jams for neighbors and loved ones.  In 2007 Barbara celebrated her 90^th birthday with family and friends.

During the fall of 2008, Barbara began to experience unexplained falls.  Her geriatric care manager from Ivory House arranged for increased aide services to assist with ambulation, laundry, cooking, and light housekeeping.  On an early January morning in 2009, Emma found Barbara lying on her bedroom floor, unresponsive.  She called her neighbor from the apartment across the hall, who in turn called 911 and the sister’s care manager from Ivory House.  The care manager met Barbara, Emma and their neighbor at the emergency room.  She was able to provide the emergency room staff with important health information, medications, and advance directives.

While waiting for the emergency room physician to complete his evaluation, the Ivory House care manager contacted both of Barbara’s children to tell them what had happened.  As they were frantically making arrangements to fly in from California and Puerto Rico, the emergency room physician talked with Emma and the care manager regarding Barbara’s condition.  She had sustained a large stroke that was incompatible with life.

After a discussion with the family, life support measures were discontinued.  Since Emma was emotionally not able to do so, Barbara’s care manger stayed with her until she passed away peacefully.  Barbara’s daughter arrived from California later that evening and her son arrived from Puerto Rico the next morning.  Both were grateful, knowing that their mother had received the best of care and had not been alone during her death.

Emma continues to live in the apartment that she shared with her sister.  Her Ivory House care manager visits weekly and she has an aide who assists her on Mondays, Wednesdays, and Thursdays.  Next month Emma will be ninety and a party is in the planning stage.  Her niece and nephew continue to frequently visit.  Friends often have Emma over for dinner and her neighbor checks in with her on weekends.  Last week she and her aide planted Pansies to welcome Spring.