Stories in the Springfield Business Journal and State Journal-Register have described staff cuts at Memorial Hospital, and that the Valet Parking Program is closed. Memorial’s decision is wrong. There are three ways to make money; one is to bring income; another is to plug the leaks in the operation which drain income. Read this and you will arrive at the third way to make money. Think of a hospital like a swimming pool; adding water only works if it stays in the pool. Cutting Valet Parking is the equivalent of cutting 8 holes in the pool’s lining!
The Valet Parking Program produced material benefits which shield, the income-producing, aspects of the hospital’s operation. The State Journal- Register’s article included interviews with users of the valets who mentioned some of the issues described here. The following observations are the accumulation of my 17 years as a Medical Visit Companion through Senior Sidekicks. My work repeatedly took me through both Springfield hospitals. When valet parking was established, its founders may not have realized all the ways it would add value to Memorial. Now we will learn of these benefits by their absence.
Drain One: Traffic cop needed. Many people converging on a small area can cause traffic jams and delays. Add infirm patients to the mix, and safety concerns rise. This situation reminds me of navigating O’Hare airport. O’Hare has officers; Memorial didn’t need them because the valets coordinated ramp traffic. The hospital will need to hire off-duty officers: an added cost.
Drain Two: Missing point of contact. Valets performed that function for the entry area. They answered questions and gave directions: freeing other staff to do their jobs. Now, no one coordinates. The hospital will be forced to re-hire part of the former valets to monitor the area, another added cost. The valets knew who to call if a patient appeared to be in distress, a mishap, or a traffic accident. Who is in charge now? It’s another rehire cost.
Drain Three: Rising liability costs. Injury prevention became one of the defacto tasks of the valets. They made sure the brakes are actually set on the wheelchair before the patient is transferred. Valets watched for trailing clothing which could get caught in the wheelchair wheels. Simple things like these prevented tip-outs and injuries. Now we will see how many incidents were previously prevented! Valets also assisted when a driver appeared to be untutored or infirm. (Now, who will help a 6 ft, 250 lb, post-op, man that is being assisted into a car; by a 5 ft, senior woman?) I predict that Memorial will see a rise in the rate of additional injuries to patients and their families. More incidents push the liability insurance through the roof; another unnecessary, cost.
Drain Four: Loss of society causes loss of manageability. When the valets retrieved the cars, the family stayed with the patient. Patients can react to their procedures. I have observed some patients that seemed disoriented, looked exhausted, and sometimes shivered, even when the weather is warm. Occasionally, patients become agitated. Family knows the patient and how best to respond. Thus, a small situation didn’t become a big scene. Now these situations will drag other staff away to respond. The loss of valets forces the family away from the patient to hunt for the car.
Drain Five: Delays and congestion in the reception area. Valets reserved a certain area of the lot for their cars which cut the response time. No valets=need for a designated area. Thus, a family must trek through the lot for the car. Since everyone must trek, moving patients through the transport area will slow down. This will lead to delays in getting patients out and crowding in the patient waiting area. How does Memorial plan to keep patients at a safe distance from each other to prevent a rise in infection rates? How does a rise in infection rate affect to the Memorial’s licensure? Not all costs come in money form.
Drain Six - Part 1: Traffic jams due to delays. The family must leave their cars in the ramp to retrieve patients. A family might leave the car running, possibly with an open door. Families may not have set the parking brake even though there are two hills at either end of the ramp.
Drain Six - Part 2; Preventable Issues; A. An unset parking brake leads to a rolling, unmanned car. B. A passing car clips an open door. C. An item left on the seat (cell phone) goes missing. D. Cars with two open doors (second one opened for the patient) take more space; crowding and already crowded drive. Do any of these scenarios remind you of O’Hare? No valets = more traffic jams and more accidents. Hired officers will be needed because the valets, who prevented them, are gone.
Drain Seven: Accidents caused by family rying to avoid the parking ramp; Eventually, crowding and congestion will give rise the use of ramps or stairs by post-op patients; leading to incidents. Memorial’s front was never designed for frail patients to negotiate. The valets ensured that patients would leave the hospital quickly, and in cars. Now, some families might try to walk the (patient) to the parking lot! Another rise in liabilities=another rise in costs.
Drain Eight - Part 1: Missing wheelchairs and accidents; The scarier scenario would be the patient, in a hospital wheelchair, piloted on their maiden voyage by family! Who will stop that untrained family, or prevent them from taking hospital wheelchairs? How would some of the patients make it all the way to the car without a wheelchair?
Drain Eight - Part 2; How many times have you seen grocery store carts left beside the disability parking places? The whole Memorial lot becomes a defacto disability parking place. Like a grocery store, Memorial must hire staff to collect wheelchairs from the parking lot. Have you ever seen a homeless person who “adopted” a grocery cart? Does Memorial believe no one will “adopt” a lonely wheelchair from a parking lot? Add missing equipment to the other, above-listed costs incurred by removing the valets.
Keeping the valets would have been cheaper for Memorial. Now operations will cost more because the valets are gone. There are actually three ways to make money, bring income, plug income holes and avoid making short-sighted decisions. Memorial has made a short-sighted decision by removing the valets. Valets don’t cost as much as they pay.
What worries you about these cuts? Do you know someone who will have trouble getting care because they can’t access it? Do you have any ideas to solve this problem?
We want to hear from you. Contact Senior Sidekicks, on the following form. We’ll gather your responses. Your feedback will guide our next steps.
In "Companies need to do more for adult caregivers. Here’s why," by Darya Moldavskaya, the author touches on several points that have frustrated my clients who are, or were, caregiving adult children. Elder caregivers constantly juggle their work-family-household-AND-Mom lives. Introducing the topic through a Lunch-and-Learn format is great because the company already has the employees there. Now that Zoom is ubiquitous, employees who work split weeks can still attend those L-and-L's.
Senior Sidekicks' Parenting Preparedness course is formatted to fit into a luncheon series: Preparing to Parent You Parent.
I recommend that companies bring adult caregivers, as well as Caregivers Emeritae (those whose elders have passed away) into the process to develop an Elder Caregiver Support Benefit Package.
Senior health studies show that social isolation is as important health as flattening the Corona-19 virus infection curve in seniors.
OPINION: It’s Time to Flatten the Loneliness Curve for Older Americans, by Marc Freedman and John Gomperts, was published in Next Avenue, April 20, 2020. The article discusses the impact of social isolation on elder health. This factor was an issue before Covid-19. However, the quarantine has made their social isolation even worse. The article references other countries’ methods of recognizing and responding to social isolation and encouraging elder social engagement. It offers several possible methods to facilitate the development of programs in the USA as engines to promote a better quality of life for seniors and for society in general.
Did you know that grants were made last year to develop a Social Isolation Task Force and create a public education program? These grants were offered to all the state agencies that operate under the mandate of The Older Americans Act.
I was on one of those task forces in my state. The assumption was the public wasn’t aware of the magnitude of social isolation amongst elders. Another assumption was the public wasn’t aware of the effects of social isolation on senior health and cost of care.
Covid-19 changed all that. We‘ve all had a crash course in the experience of social isolation: the Stay-at-Home orders. We’ve seen people reacting, sometimes threatening violence, in a push-back against such measures. Children have suffered socially, emotionally and in their education as a result of being isolated from friends and school. To combat Covid-19, social isolation was one of the few measures we could employ. While we intended to combat the virus with isolation, we didn’t intend to isolate elders before Covid-19. Our society’s systems just didn’t address elder social isolation.
Our society did not face social isolation before because of three factors; our original population, our history, and our lack of a collective memory experience.
Our population was largely imported, usually young adults and their children. Later, they might send for the elders in the old country, or not. A sea voyage could be quite stressful on an older person. Thus, young people settled here. Later, another generation of young people left for the next new frontier. Our history shows that elders were left behind; again, and again. As a result, our focus was a succession of new frontiers. The USA never developed a role or task for elders. Today, our old frontier is closed. It’s time to bring society into the new social frontier: one in which we recognize we are a multi-generational country. There are gifts from each generation. We need to develop a role, and a function that recognizes the value of elders: a living history, perspective and experience.
We also lack a collective memory of the elder’s journey. We all remember things from our childhood; many of us may not “remember” things from our elder hood; unless we have made that journey ourselves. Society hadn’t experienced certain aspects of aging, like social isolation, until now. We should view stay-at-home orders as our chance to learn what life is like for seniors who are forced to stay-at-home.
What puts elders in that position? Their health may not permit frequent trips outside the home. Other elders are trapped at home because they can no longer drive. Public transportation may be too infrequent, too strenuous, or non-existent. Some elders find that vision or hearing problems interfere with socializing. We have few forums in which all generations come together. Religious institutions fill some of that gap but they can’t cover all the bases. Our neighborhoods are often age-segregated. Schools group children into smaller age cohorts: this is not the era of the all-ages, one-room school house. We build age-segregated housing only for elders. How is anyone to learn about the elder journey if our opportunity for observation and interaction are taken away?
Covid-19 has given us a gift in disguise; we all shared some of the elders’ social isolation predicament. We reacted vehemently to these restrictions on ourselves. Now we know what they feel. The recommendations made in this article should be implemented. Let’s learn from this. As the old song says; ”Someday, some d-a-a-y, we’ll be together. Yes we will, yes we will...”
“‘This will be catastrophic’: Maine families face elder boom, worker shortage in preview of nation’s future,” from The Washington Post, could be a description of a dystopian movie: it’s not. This is the state of State of Maine, which is the harbinger of things to come for the rest of these 50 United States. We need to listen to this alarm.
We’re facing a demographic dilemma: not enough young people to fill all jobs, even those outside of elder care. We need them now! Where do we get them? We can’t hire them because they were never born! Thus, current workers remain on the job long after it’s safe or appropriate. Results include accumulated injuries to workers who keep doing injurious jobs. Even the field of healthcare can’t find enough workers or volunteers.
The State of Maine has learned that there is no one available to fill home care jobs. There is no one to fill care facility jobs either. Professional fields have the same problem; many of the number of nurses and doctors are now older and there are not enough of them it is and there’s no one to replace them.
Medicaid pays far less than other employers, drawing the few workers away from elder care. However, simply raising wages won’t help if there are not enough people to hire!
Maine is already experiencing the results, some facilities closed altogether. Others closed admissions for months due to too few staff. No vacancies in care facilities means families must place their loved ones wherever they can. A loved one far away means a l-o-n-g commute to visit. Younger, disabled people also get caught in this care-crunch. If no one is available, some adult children try to fill the gap. Those care gaps further pressure the few remaining working adult children.
Keep this number in mind:
*By 2030, 1 in 5 Americans will be over 60.
*The number of seniors will DOUBLE between 2015 and 2050.
*The senior population over 85 will TRIPLE in that same period.
**We will need 7.8 MILLION new people to fill these jobs. Since we didn’t give birth to them; where do we get them?
This isn’t as riveting as a news story as a fire, or a shooting, that’s the problem. The numbers of affected families are there, but they aren’t collected (aggregated). This problem is spread everywhere.
We’re in a presidential campaign yet no candidate is talking about this national problem. Why? This demographic dilemma is happening one family at a time: Your family is next.
When families gathered on Thanksgiving day, some realized that their senior was not the same as last year. Families often respond by doing internet research. The internet is a good first step. However, some sites make outlandish claims. I saw one that offered a treatment that “cured Alzheimer’s”. There is no cure and some of these sites can offer dangerous suggestions.
Here are a few reputable sites that offer reliable information:
Alzheimer's Association. This site also has a page devoted to explaining the different types of dementia. It also lists other physical conditions or environmental conditions that can look like dementia.
American Society on Aging. It can feel encyclopedic in size. The society has done decades of research and offers reliable information. It’s a good second step.
AARP offers many programs and information for families as well as seniors. Each state has a chapter with offices in each area. Look up your state to find help in your area.
And Senior Sidekicks offers a course; Preparing to Parent Your Parent, to prepare families for the practical issues they will face as they become caregivers. Contact us about teaching this course in your church or at your job. Call (217) 787-5866 or email us for more information.
How do you know when this old house is the wrong house now? Seniors who are reluctant to move may refuse to leave.
One senior refused to leave her old neighborhood even though the neighborhood had changed. As she left for church one morning, she was shot in the heart by a stray bullet. Waiting to move until there’s a crisis means the senior loses control of the move. The senior who was shot was moved by others. They didn’t know what she had wanted to take with her; she lost some things which made her very sad.
Taking your senior on a decision-making journey helps them to see for themselves that things have changed. A senior realized a move was necessary when she needed more medical care. The house by the lake was too far away. She spent anxious moments waiting for first responders to arrive when she was in need.
A house is not a home, even though some seniors think they’re the same. One senior wanted to keep e-v-e-r-y-t-h-i-n-g, including the china hutch. She measured her new apartment to show it would fit. However, the movers couldn’t get it through the front door. Perhaps it doesn’t fit after all. What else won’t “fit”? We move into a house and we make it a home.
What’s really important to your senior? It’s probably not the kitchen sink or the screen door. Important things, like photos and mementos, can go anywhere. These can go to the next housing phase. Senior won’t lose the important things: their history.
One family referred to the next phase of housing as a new “home”. Their senior dug in her heels and refused to do anything! The family called for my help. I asked the senior to define the word “home”. She described an early 20th century county old age home! I explained that the last of those had been torn down years ago. I offered her a different option; her own apartment with indoor mail box and a grounds crew to mow and shovel. She was willing to learn more.
How has your senior’s old neighborhood changed? Sometimes they need to see it for themselves. I took my Grandfather out to his front porch. Together we remembered the old neighborhood. He talked about the people who once lived there, the streetcar track, and the horses stabled at the end of the street. Each time I asked him, “Where are they now?” At the end he was silent for a moment. Then he said;”They’re all gone”. I offered that if all the people and horses had left, maybe it was OK for him to move on as well. “I like my front porch!” my Grandfather said emphatically. “You’re right; your next place MUST have a front porch!” I said just as emphatically. Then my grandfather pointed to the two trees in the front yard. “I planted those to shade the house”, he said. “They do a great job”, I told him. “100 years from now, they’ll stand as a testament to your efforts”.
Referring to changes as; the next phase of life, works better than to call it; giving up your home. One of my clients was forced to move when she was robbed at home, twice! Even so, she was very upset about leaving. I took her for lunch and a tour of a senior apartment building. She gazed in awe at the beautiful chandelier in the lobby. She did a double-take when a uniformed waiter asked for our luncheon order. After lunch, we toured several apartments. As we drove back to her house I asked her what she thought. “It looks so nice”, she said, “When can I move?”
Another senior had been a great gardener. He was unhappy about leaving his garden. I contacted a newly-constructed facility and asked about gardening plots. On our tour, they pointed out future space for residents’ gardens. The senior explained that the area had too much shade and offered another part of the yard. Since the plots were not yet set, the staff agreed to consider his idea. He would be their gardening consultant! He moved.
Seniors may see a change of housing as a loss of who they used to be; show them how they keep their interests, their memories and mementos.
If you would like our Free Has Your Senior Outgrown The House? Checklist please check mark your request below, and submit.
One of my patients recently complained. I asked her what her doctor said. She told me she had forgotten to tell her doctor. She told me that she had become used to the problem and “accepted” it. Many senior-related articles advise writing down symptoms and questions before visiting the doctor. Good advice; as far as it goes. It’s the stuff that falls off the radar that could be the most important. The doctor needs information from the patient or the patient’s advocate. That information is the basis to decide which questions/tests to pursue.
What kind of information doesn’t get to the doctor?
Imagine you’re sitting quietly in a meeting or religious services; suddenly your heart starts pounding. You feel like your blood is coursing through the veins in your arms and legs. It’s bewildering and scary: Why?! There is nothing about this setting that calls for such a reaction. Yet, you have this reaction. It is important that caregivers understand what leads to this reaction and what they can do about it.
It’s a “fight or flight response gone wrong. It developed when we had to run away from Saber Tooth Tigers. Our ancestors were successful, that’s why we’re here. Those ancestors passed down to us their methods of coping with their world. Our modern world doesn’t have the same kinds of stressors, especially for caregivers. Our stressors are less clearly defined And they last longer. Our stressors change shape; one minute we’re dealing with the house-the spouse-the kids-and-the job. Then there’s a crisis and we’re caregivers for Mom! From that point forward, our caregiving increases but with no way to know when the need will become greater or how long caregiving will last.
Our bodies respond as our ancestors’ once did; we produce Cortisol to rise to this crisis. The process goes like this: Stress causes the Hypothalamus to secrete. That triggers the Pituitary Gland to secrete. The Adrenal gland secretes Cortisol. This process has several names: HPA Axis, HPA Cascade or Syndrome X, or AKA Insulin Resistive Syndrome. (Wouldn’t it be helpful if we could all agree on one name?) It’s not the crisis that’s the problem. It’s the crisis that doesn’t end that creates bad effects on caregivers.
The effects show up in different ways. Cortisol encourages promotes fat deposits in the outer layer of the body, especially the waist. Some caregivers gain weight. We can measure this effect by doing a BMI (Body Mass Index). Other caregivers have different conditions; heart disease, Type-2 Diabetes and Stroke. We can measure Cholesterol levels through a C-Reactive Protein lab test. We can also do a cheek swab to check Cortisol level. However, how many doctors don’t even ask patients if they are caregivers. The tests are there but they are not used to evaluate identified caregivers at this time on a general basis. You need to ask for them.
When our bodies rise to meet a crisis: they must also let down. Even Saber Tooth Tigers would give chase and then give up. The caregiver’s duties do not end the same way. In fact, they do not “end” unless we place some “ending points” into the caregiver’s life. That is the role of self care, to provide end points such as respite and small moments. That’s why it’s necessary to spread the caregiving load so it doesn’t fall on one person. That is why we need to enlist family to give caregivers this kind of support. Otherwise, the caregiver can be sitting quietly in religious services and the Cortisol response “alarms” for no exterior reason. We need to advocate for caregivers to be recognized in the medical arena. Learn more by taking our course; Preparing to Parent Your Parent.
When someone advises you to, “take care of yourself”; that doesn’t explain how. Elder caregiving is so new that some methods are still under development. However, we know some things that work and some to avoid. Self care does not mean a day at the spa. For many caregivers such a day would be out of reach financially or out of time to devote to a spa. Therefore, plan to care for yourself in moments, not hours. Think about your life like your heart; it beats all the time. Actually your heart takes a tiny rest between each beat that allows it keep going. When you care for yourself in moments, you pause and continue.
Try these ideas. Put up a sign saying, I NEED A MOMENT, to remind yourself to pause. Put up other signs family can see to remind them that you might need a moment before you can respond to their requests. Is the person in need bleeding or on fire? If the answer is no, then it’s OK for you to take a moment. It’s OK to train your family to allow you to do so. It’s OK for you to ignore repeated pleas for your attention (for a moment). Training takes time but you’re worth it.
What do you do in that moment? Be sure you are safe. If you’re up on a ladder, get down first. Focus on something blank, like a wall or the ceiling. Breathe, deeply, through your nose, hold and count to 3 or 4. Let your breath out through your mouth but slowly; 1-2-3-4. Now, if you can afford the time, try looking at something peaceful; out a window, at a picture, or at some memento that is meaningful to you. Breathe again the same way.
Many caregivers respond with; “I don’t have time to …” You’re right, time is at a premium. Most caregivers find themselves in that role at the same point they also have the house-the spouse-the kids-the job-the pets and MOM! You have a lot on your plate. Sometimes caregivers believe they can wait until they have time. By waiting until later, the damage from lack of self care will have done its worst. Undoing damage is much harder. The best intervention is prevention. Prevention comes in bits of time you claim now.
Suppose you actually have a whole hour to yourself. It’s a gift! Ask yourself, “What refreshes me?” Notice I didn’t say what can I eat nor where can I sit down? Some caregivers eat to cope with stress. We need nourishment but not that way. Rhythmic movement, like walking, can help us feel less worn and is surprisingly refreshing. If you can’t go far; walk around the house or around the block. If you live in an apartment building, walk in the hall. “Go get the mail”, that errand will buy you a few minutes. Try to set a self care routine just as you have set other routines with child care or at work. Routines help us get things done without doing us in.
Some things to avoid include sugar and alcohol. The stress hormone, Cortisol, takes sugar and converts it into weight around your middle. Sugar may not be sweet; baked goods convert to sugar. As part of a balanced meal they’re fine; as a snack, not so much. Large amounts of food can have a numbing effect; like a Thanksgiving dinner. When we feel numb, our minds seem to turn off. When you see you have time and turn to the refrigerator; ask yourself why are you eating? In a similar way, alcohol can create a numb feeling. We believe we’re relaxed but a caregiver’s immune system is more vulnerable and needs extra protection that alcohol doesn’t provide. Alcohol is also a depressant, which won’t help caregivers.
So how does one “turn off” the constant “list-making” that goes on in the caregiver’s mind? Try other things. Try relaxing teas like Passion Flower, Elder Flower or Chamomile. Try playing some relaxing music that’s meaningful to you. Try a rhythmic movement “dance” (try it with your partner). Try a hot shower or better, a hot bath. Try placing essential oil of lavender in your bedroom. All of these set the stage for relaxation. Develop your own mediation or routine to think about at bed time instead of a to-do list. There are also tapes available. So self care comes in moments you claim as your own. To learn more ways to cope, take our course: Preparing to Parent Your Parent.
This is the first of a three part series about the often-heard advice to caregivers to “take care of yourself”.
What does that mean? Since elder caregiving is relatively new, many caregivers aren’t sure. Let’s begin with the word self care; it means considering yourself as part of the caregiving plan. Your health and mental well-being are a vital part of providing care. Think of your contribution in other ways: wouldn’t you take care of equipment used to care for the elder? Wouldn’t you make sure to have enough supplies on hand? Wouldn’t it be hard to provide care without equipment and supplies? Think how much harder would it be if you weren’t able to provide care? You’re the most important part.
Caregivers may believe that they should put their needs aside: no! That’s like pouring yourself out without putting anything back. Such a belief leads to caregiver burnout. Some caregivers burnout emotionally, others develop health problems, and still others find their families are disrupted. All are symptoms of burnout. Many symptoms go unrecognized. Now that you are aware, you can be alert to the influence of caregiving on your life.
Some caregivers believe that the entire task is theirs alone; not necessarily. Part of self care is letting go of that assumption. We ask for help in other parts of our lives; accountants, plumbers, physical therapists, or lawn crews. No one believes these helpers take away our responsibility; they contribute to our successful process.
What do you do in a typical day? How many of those tasks require direct interaction with the elder? Who else could do them? For example; laundry must be done. Why does it have to be you? Does it matter to the elder who does it? Letting others into the care process is part of letting go. Letting others in is part of self care.
Self care can mean admitting to yourself that you feel certain things in response to caregiving. Some of those feelings are not too “nice”. Frustration, anger, despair and sadness are all parts of the caregiving journey. If a friend came to you admitting to these feelings would you send them away? Perhaps you would listen to them and sit with them. Sadly, I meet caregivers who whisper their negative feelings if they say anything at all! Part of self care is becoming your own “best friend”. You and that self need to talk to each other. Admitting to those not-nice feelings doesn’t make bad things happen. In fact, it allows you to let out some of the pressure behind those emotions. Self care begins with recognition of one’s value, affirmation and support for the caregiver.
To learn more, take our course: Preparing to Parent Your Parent or call (217) 787-5866
"A Senior Moment" is written by Ms. Sara Lieber, owner of Senior Sidekicks. Ms. Lieber has over 30 years of experience in senior care.