Monica had not visited her parents in eight months. The 13-hour drive from Boston to Wilkesboro passed quickly because she was so happy to be going “home” for the holidays. As she pulled into the driveway, she scanned the well-lit front porch where her mother usually would be waiting, but the porch was empty.
When Monica stepped in the front door, she was surprised by the unusual smell lingering in the air. She expected the usual scents of mulled cider and pumpkin pies. It took a few minutes to identify, but the odor of dirty diapers was unmistakable. That was odd: she could not think of anyone in the family who had a new baby. Her mother swooped into the room and wrapped her in hugs. As they separated and Monica got a clear view of her mother’s face, she was startled by how tired her mother looked and by how much she had aged.
Looking in to the den, she could see that her dad was in his recliner watching TV, his back to the doorway. She stepped over quickly to face him and received another jolt: he looked terrible. He had lost a lot of weight, there were dark circles under his eyes, his shirt was spotted with food stains, and he seemed to be looking through her rather than at her. Her close proximity informed her that he was the source of the dirty diaper odor. Coming to her side, her mother immediately noticed the smell and walked her dad down the hall to the bedroom, speaking to him as she would one of the grandchildren. Monica stood in shock at the realization that her father was not only incontinent but was losing his awareness and adult capabilities.
In the days that followed, Monica’s mother described the drastic decline in her dad’s mental health after he fell off a ladder and injured his head in the spring. The incontinence issues were only the tip of the iceberg, as her father’s sharp mind began to enter the foggy confusion of dementia and his caregiving spouse began to reach the end of her rope physically, mentally, and emotionally. Monica realized the situation had reached critical mass in a very short time and if she did not act quickly, her mother’s health could be at risk. This was one holiday surprise Monica wished she could have avoided!
Over the holidays, many people traveled to visit older family members for the holidays and had a surprising experience similar to Monica’s. They observed drastic changes in abilities, attitudes, and behaviors both in the person whose health had declined and in the person who was providing care. Without a reliable point of reference, they may make incorrect conclusions about the situation and about the alternatives for solutions. In Monica’s case, she could help her parents by having conversations about their goals and expectations for the future, helping with the choices that need to made, and making sure that the proper documents are completed and in place to guide the decisions that lie ahead of the family.
Navigating the options for care and support of aging adults is like entering a maze, where false turns mean lost time and setbacks in opportunities for sustaining health and well-being. So often, our aging loved ones have not prepared in advance for aging milestones that for most of them, are inevitable. This leaves their children in the unfortunate situation of trying to figure out what to do when crisis arrives. When emotions are raw and the circumstances are urgent, it is not the best time to try to make critical decisions!
However, the best scenario is when each person takes responsibility and action for their future, ahead of time, and spells out for their families how they want their choices to be honored. This process of arranging for future health care decisions is called Advanced Care Planning and the documents needed are called Advance Directives. These documents do not take the place of a will that assigns beneficiaries and asset disposition, but instead, serve to address specific choices that are made ahead of time concerning health care actions.
In North Carolina, there are several recognized Advance Directive documents, including the Health Care Power of Attorney, the Living Will, the Do Not Resuscitate order, the Medical Orders for Scope of Treatment, and the Five Wishes. Each of these documents has a specific authority and purpose. They come into play at different stages of the aging process and decline in health. What is most important is for people to implement these documents while they are mentally competent to do it. Currently, one in nine people age 65 and older has Alzheimer’s disease, and it is on the rise: Alzheimer’s is the sixth leading cause of death, more than breast and prostate cancer combined. In North Carolina, Alzheimer’s is projected to grow 31% over the next eight years, from 160,000 cases in 2016 to 210,000 cases by 2025.
Fortunately for Monica and her parents, it was not too late for her father to implement a health care power of attorney – his doctor determined that he was competent to assign the person he wanted to serve as his health care decision-maker and make other choices for his care options. He was very clear on matters surrounding end-of-life care. Monica could not believe how relieved she felt once the painful conversations were over and she understood how her father felt about his future health care choices. It was a load off the family and they had a plan for following his wishes once he was no longer able to express his decisions.
To learn about Advance Care Planning, attend an Advance Directives Clinic hosted at Parkwood Place Assisted Living in Elkin, 601 Johnson Ridge Road, the second Wednesday of each month, at 10:30 a.m. Mountain Valley Hospice & Palliative Care is facilitating the clinics, which are offered free of charge. For more information, contact the Elkin office of Mountain Valley Hospice at 336-526-2650. Visit www.mtnvalleyhospice.org for information about advance directives and clinics hosted in the area.
Allison T. Brown is employed with Mountain Valley Hospice & Palliative Care.