Traveling with Food Memories

By Steven Mattingly

I’ve created a BIG problem for myself in a couple of weeks.  Our community throughout 2012 has participated in something we call the “Passport Dining Series”.  Each month we have created a unique dining experience by visiting different parts of the world.  Among others we have had Breakfast in Paris, dined on the varied cuisine of Italy, and celebrated Bosnian cuisine.  Bet you didn’t see that one coming now did you?

The next place that we will visit doesn’t exist in the real world and that is the problem that I have created for myself.  Many who read this blog know that I am a former chef who realized early in his career that I wasn’t going to be the next Wolfgang Puck or even a mediocre executive chef.  I left the 90 hour work week of food and beverage when I came to my senses and began a career in the world of senior housing.  But the urge to prepare food for the masses never really leaves you.  My family will attest to that as does my expanding waistline.   So every now and then (it’s usually around the holidays) I have the hair brain idea that I will cook a meal for the community and that is what I am doing in two weeks.  The place I want to visit doesn’t exist anymore; it’s mealtime at my mother’s kitchen table located in the house that she and my father built on Rural Route 2, Saint Mary’s Road, Lebanon, KY  40033 more than 50 years ago. 

How can I tell the story of that place in the foods that I prepare?  Do I cook the fried chicken that my wife recalls my Mother lovingly showed her how to make when she was a very new bride more than 30 years ago or do I make the Sunday Dinner Pork Chops that she made just like her mother, my Memmaw.  I could make the Cincinnati style chili that was a cold night favorite or my all-time favorite of beef hash with fried cornpone (who knew she was ahead of her time frying polenta cakes).  I could make the 60’s favorite tuna Noodle Casserole from which I picked out all those little bits of mushrooms or the other 60’s dish of Macaroni and Cheese made with Velveeta.  I remember orange Jell-O cubes served as dessert with real whipped cream as much as I remember the chocolate birthday pies that she made for me each year.  Or the divinity fudge that was a Christmas staple along with the regional black walnut cake made with black berry jam. I could make her most famous disasters, the pickled bologna that eventually sat in the refrigerator until it truly turned green.  So many ways I could get to that special place.  It’s overwhelming to consider it all.

I committed to taking our community to this special place more than a month ago. It’s only a couple of weeks away and I still am trying to decide on the perfect menu that will be transport our community to the place that I called home.  What I have to remember is that just like when we all were growing up, the meal will happen, the warm hands and hearts of our care giving team will make sure that we get where we need to be at just the right time, and I will somehow just like my Mom did each and every day I ate at her table, create a memory for the community albeit a fleeting one for many.

As I get older and my vision of my life as a senior become clearer, I see how those little journeys that we have taken this year really are important to our community.  If even for a brief moment a special smell or taste or atmosphere provokes a memory, it’s a good thing.

Contributing author Steven Mattingly is the Executive Director of Pacifica Senior Living in San Leandro, CA.

Winter Holiday Season Caregiving Tips for Families with Loved Ones with Dementia

'Tis the season to be jolly. Or is it?

While those facing Alzheimer's disease or a related illness in their family might question the sentiment, experts say that it is possible to not only keep the cheer in the holidays, but also to savor them.

Some suggestions you might want to consider from the Alzheimer’s Support Organization:

·  Communicate concerns. In advance of the holidays, be candid with family and friends about your loved one's condition and your concerns, and enlist their support. In cases where resentment brews because one family member assumes the primary caregiving role, use this season of giving as an opportunity to discuss sharing family responsibilities and to strive for family togetherness.

·  Set realistic expectations. Consider both what the individual with dementia is capable of and what you, as a caregiver, can handle given your demanding role. Then, put celebrations into manageable proportions. This can help decrease stress and head off feelings of depression that stem from unrealistic expectations, both for you and your loved one.

·  Select appropriate activities. Be mindful of the individual's current mental condition and do special things that they can still appreciate. Engage your loved one in singing and dancing since these abilities tend to remain intact longer. Involve them in some rituals—whether it is lighting the menorah, decorating the tree or baking cookies. Try to spark memories by bringing out family photographs or heirlooms. But do not demand mental performance by asking them to name people, places or other facts. Rather, help stimulate memories by offering descriptions as you present each object.

·  Pare down traditions. With round-the-clock caregiving, it may not be feasible to juggle all of your religious and ethnic observances. You can still keep traditions alive; just reduce their number to avoid feeling overwhelmed and frustrated. Ask your loved one which traditions to choose; it is another way to involve them. Even though they may not recall later on, making the effort reinforces the fact that you care what is important to them and will make you feel better as a caregiver.

·  Adapt family gatherings. Since crowds, noise and altering routines can aggravate confusion and other behavioral problems, revising your get-togethers may be in order. For example, instead of entertaining the whole clan, limit the number of attendees at a holiday dinner or spread out several smaller gatherings on different days. Mark a calendar with upcoming visits to make your loved one feel special.

·  Stick with familiar settings. Because new environments can increase disorientation and pose safety concerns, discard restaurants or relatives' houses in favor of your own home. Likewise, if Mass is still important to your loved one, consider how they can participate. For example, take your loved one to an earlier, less crowded service; if they are unable to go to church, watch a Mass on TV or ask clergy to make a house call.

·  Head off problems. Avoid alcohol, which may cause depression, increase the risk of falls and add to the loss of brain cells. Try to schedule holiday activities or visits earlier in the day before the potential for sundowing - behavioral problems that typically occur toward dusk among those in the middle stages of dementia. And, in preparing for holiday celebrations, do not re-arrange furniture or create obstacles-both are accidents waiting to happen.

·  Limit holiday decorations. Decorations can still adorn your home, but in moderation. Hang cheerful ones that recall memories and family traditions. Do not overdo the ornaments on a Christmas tree. Remember that hauling out a lifetime of garlands, religious items and wall decorations can clause clutter and over stimulation, which can intensify disorientation and agitation. Ensure, even more than usual, that decorations do not block pathways or pose potential fire hazards.

·  Re-think gift giving. Devise ways to include your loved one, depending on their capabilities. You might take them to a store to buy presents, and offer extra guidance. Or, you can buy the gifts for them and wrap them together since many individuals with dementia like handling paper. In giving presents, pick ones appropriate for someone with the disease. Instead of something material, try things that are simple, personal and sentimental. For example, photographs and heirlooms provide the opportunity to reminisce—a gift in itself.

·  Welcome youngsters. While it is important to include children, it is just as vital to consider their feelings. Address the fear factor by helping them have special moments with their relatives. If their loved one uses inappropriate language or easily becomes angry during the visit, explain that this behavior is not personal or intentional; it is part of the disease. Youngsters' excitement about the holidays can be contagious. Singing songs together can strike a chord for someone with dementia. Or having an elder teach dominoes to children is a good way to foster interaction and make your loved one feel they have something to offer.

·  Join a support group. A forum to express feelings and socialize can help overcome sadness for both caregivers and individuals in the early stages of dementia. Unfortunately, the incidence of depression ranks high during and after the holidays. Consult with a healthcare professional if you detect warning signs of depression: tearfullness, poor eating habits, withdrawal, inability to sleep, and physical complaints.

·  Enjoy yourself. The greatest giftat the holidays: time. Ask a family member, friend or healthcare professional to keep your loved one company so you can relish some respite—time for some holiday shopping, a walk in the park, checkers with an old friend or whatever present you want to give yourself.

Contributing author Steven Mattingly is the Executive Director of Pacifica Senior Living in San Leandro, CA.

Mother Most Often Knows Best

By Steven Mattingly

Our community hosted an event this week titled “Don’t Be Afraid of the H Word; Hospice 101”.  An element that made the event very personal was a touching video tribute put together by Annemarie Lorenzini and her sister in honor of their late grandmother.  Annemarie has for the past couple of weeks asked me to review the tribute because she felt it had a message that was important to the subject of the program that night.  I repeatedly avoided doing so which frustrated my co-worker.  It’s time for me to come clean to Annemarie and myself as to why I put off watching her tribute for so long.

It’s been over twenty years since my father died and over five since my mother died.  My father was diagnosed with lung cancer fifteen years after successfully beating cancer of the larynx.  He and my mother were told that he had between eighteen months to two years to live as the cancer was not treatable.  My father died in less than three months.  At that time I lived more than a 10 hour drive from my family home.  My wise mother kept me informed of my father’s rapid decline but she also knew me much better than I thought.  In the southern community where I grew up there is a long standing custom of the gathering of the family whenever there is an imminent death.  I recall when each of my grandparents died there were between thirty and forty people present at the hospital waiting for death.  My mother remembered how much I struggled as a small child and even as a teenager with this custom.  She did not allow my older sister to call me until she knew that I could not get there in time due to the travel time needed.  Once I got the call, I immediately headed to the airport to get a flight to the airport nearest to my family’s home.  When I arrived, my younger sister and her husband met me and I knew by the look on their faces my father had died while I was in transit.  It was a somber and mostly silent ninety minute drive to what was now my mother’s home.

My mother was unable or perhaps once again was a wise woman as she allowed her four children to make the funeral arrangements.  We were somewhat surprised that knowing the cancer was fatal that my parents had not made any plans.  While we have often been discordant as adults we were able to discuss the things that we felt would be important to honor my father’s wishes as well as provide the quiet dignity that we knew would be comforting to my mother.  Simple little details became extremely important all of a sudden.  The casket had to be a certain kind, the flowers had to look a certain way, and we all knew that my father would be buried with his favorite putter.  All of this was accomplished without a raised voice or even a harsh word between the four of us.  While each of us had a very different relationship with my father we realized that this was a time to put aside all the jealousy and individual anger that usually swirled around my father and put the family first.

As is often said about southern funerals, it was a lovely service.  Perhaps the most painful thing about the entire sequence of events occurred after the funeral service.   My very emotionally strong and dignified mother came back to her home, retired to what had been my parent’s bedroom and for almost an hour we listened to her cry.  We assume she then fell asleep.  After a couple of hours we heard the bedroom door open, my mother appeared and immediately asked if we had eaten and she went about putting a meal together from all the food that had been brought to the house.  She never again slept in what had been my parent’s bedroom just as she never again mentioned my father’s death.

My mother spent the next fifteen years doing all the things that she felt my father would want done such as refurbishing the interior of their home for what she labeled the last time, buying a smaller and dependable car, and after many years of unpleasantness with his family that was directed to her, became friends with most of my father’s surviving siblings.  She sewed, made great dresses for her granddaughters, cross stitched quilt tops for each of her children, and made Raggedy Ann and Andy dolls for an increasing number of great nieces and nephews, and all the while, consistently losing at cards.

In her last summer my mother undertook painting the second story deck on her home.  While painting she fell off the ladder and ended up in the hospital.  She went into sepsis shock from what we later learned was an undiagnosed bleeding ulcer and died three days after her fall. 

This time the harmony my siblings and I found when my father passed away was nowhere to be seen.  This instance it seemed even the smallest things caused tension.  We were indeed grateful to find out that my mother once again in her wisdom had left little to be done insofar as her funeral arrangements were concerned.  The casket, the flowers, the music at church, even the outfit in which she was buried was all outlined and to protect the fragile family unit we followed it without exception.  We even took the daring and controversial step to honor her request for a closed casket, something that was just not done in the small town that we all had called home. 

Over the next few months the estate was settled, the house was sold, and our family unit slowly came unglued.  From my somewhat distance outpost, the telephone calls stopped, the updating on our children’s successes and failures were not shared, and we all mourned our loss.  As the family member that everyone referred to as the cruise director I still don’t know what to do to find a connection with my siblings.  My older sister and I stay in touch sporadically (I do wish it were more often).  I haven’t heard much from my younger sister or brother other than what I see about them or their children on Facebook or what my older sister tells me.

I find some reassurance in knowing that for both of my parents their siblings drifted away when the last parent died but in each family there was a coming together again once the various cousins were out of the house and on their own.  Perhaps it is the normal ebb and flow for any child to have a certain period of adjustment to being the head of their own families.  It’s tough to find the right balance.  I hope that my siblings and I find a point in time where we once again can converge as a family and provide that support we found when my father died.

So Annemarie - I knew that your video would be a reminder of a lot of things, many of which still make me uncomfortable.  I was right.  When I saw your short family tribute I didn’t see your Nona, I instead was picturing my parents who were contemporaries of your Nona.  The grainy pictures, snazzy bathing suit poses, and other funny looking clothing were all too familiar reminders for me of similar things for my own parents.  I think that the message of grace and acknowledging a life well lived for your Nona and her loving family is absolutely the right tone to set before a discussion of hospice. Had I had the benefit of hospice for either of my parent’s death I believe I would not feel as strongly something wasn’t whole following their deaths.

Death is inevitable for everyone, it’s how we and the loved ones who surround us near or far, face it that can make turn it into a positive setting for the one who is dying and their loved ones.  Bravo for a job well done last night and thank you for not noticing or at least pretending not to notice how emotional I became. 

Contributing author Steven Mattingly is the Executive Director for Pacifica Senior Living in San Leandro.

Music For The Ages

By Steven Mattingly

In our community, we regularly have a gentleman who sings the standards of the heyday of most of our residents accompanied by a karaoke machine.  My office is in a space adjoining our main floor living room and whenever he performs I have to close my door as his performance grates on my ears.  For the most part I am not able to carry a tune but with guidance from my wife who sings in two choral groups I have learned what a well-trained voice can do.  This particular performer sings up to the notes most often but I have to say his performances are always well attended and he just exudes charm.  He’s a big hit with the ladies; he uses his vocal stylings to shamelessly flirt in the innocent way of the 1950’s.

There has been an array of articles in recent weeks about the benefits of music for seniors and in particular those with more advanced dementia. I’ve seen firsthand the benefits that music therapy can provide to individuals with more advanced dementia.  It goes beyond the calming effect that everyone assumes will happen, in the right setting with the right music choice and the right encouragement.  I’ve seen even the most withdrawn residents exhibit what I can only describe as the greatest of human emotion - a simple smile.  Increasingly the many experts in dementia research are telling us that even though we are unable to discern a visible or verbal response, studies of brain waves before during and after musical programming clearly indicate the resident is processing the information.  They have compared that response against voices of loved ones, normal sounds of daily life, and even sounds from a favorite pet and the studies consistently show that the greatest response is to music.  An interesting facet is that it's music overall, not to a specific genre.  Does that translate to suggesting that you play Led Zeppelin when you visit mom or grandmom?  That I think is more of a personal choice but hearing some old fashion rock and roll or some twangy country music would be interesting and perhaps more appropriate for some of our residents.  Not everyone loves Glenn Miller or Tommy James.  My mother was a big Elvis fan. 

In our community when I come in first thing in the morning I put on my favorite classical station to get us off to what I see as a gentle and easy start in the morning.  About mid-morning we change to a Singers and Swing station that plays songs that many of our residents listened to when they were growing up or dating that is more up tempo.  Can you imagine in a few years when assisted living communities program the songs that the next generation grew up listening to or when they were dating.  Are we ready for “Let’s Get Physical” by Olivia Newton-John, or “Bohemian Rhapsody” by Queen?  Can you picture a spandex clad, baggy sweatshirt and leg warmer wearing  70+ year old demanding more Disco music at 7:00 a.m.  Or does the image of an 80 year old tattoo covered deadhead make you sit upright?

What do you listen to on a regular basis?  Can you imagine the faces of your children when you are in your 80’s and they chide you for still listening to Phil Collins or even worse Donny and Marie?

Contributing Blog Author Steven Mattingly is the Executive Director of Pacifica Senior Living in San Leandro, CA.

The Art of Finesse

By Steven Mattingly

At our daily meeting recently our team was reviewing our staff’s concerns about a particular resident’s behavior.  We discussed various strategies and different approaches that we might use to help this somewhat new resident more easily adjust to the daily rhythm of our community.  Our Culinary Service Director chose an unexpected and interesting word to describe his suggestion. That word was finesse.

I was amazed to observe how quickly our discussion took on a totally different tone.  Prior to this brilliant word use, the focus had been on preventative and outcome driven strategies.  By thinking how we might finesse our interactions with this individual, a much more caring attitude was immediately apparent.  The team began to examine how our approach and actions would affect the resident’s response.  Instead of taking actions that we thought would give the desired result quickly; we began to think in terms of building a multi-step process with individual small results.  The small successes would allow us to build toward the bigger goal that we hoped to achieve.  When we thought about it even more we realized that this approach would offer continual positive reinforcement to the resident.  As we all have heard more than once, success breeds success.

I recently downloaded a dangerous new “app” for my smart phone that may take over my life as it once did when I was in college, Bridge.  Why could that happen?  Both my mother’s and my father’s families whenever they gathered for any family event, inevitably a card game of some type would break out.  Eucher (sp), Hearts, Canasta, Spades, Tripoli, numerous Poker variations, or Buckpitch were just a few of the games I learned to play.  It seemed perfectly normal at both of my parent’s funerals to have extended family members playing various card games in the side rooms of the funeral home.  I think it may be a Southern thing. 

When I arrived at college I was introduced to Bridge and for a good portion of my freshman year I along with other card playing friends from my college days, ate dinner early and retired to Parrish Parlors for an hour or two or three of competitive bridge.  We used rotating dummies so you learned to play various styles of bridge quickly.  I found that my card playing days with my family pre-college served me well.  If you are a regular reader, at this point you are asking yourself “where is he going with this?”.

Back to the art of finesse.  When our Culinary Director used finesse to describe a resident care strategy it just seemed so obvious.  Card games like Bridge use finesse to overcome missing trump or face cards in order to win the required number tricks to meet the bid amount.  It was the classic “aha” moment.  Using a bit of finesse when working with residents allowed us as well as the resident to overcome missing trump cards and make the bid.

This meeting also produced a flood of memories for me that included the places and the faces of my past bridge playing time so many years ago.  It is after that meeting that I searched out the Bridge app that now seems to have taken over my spare time.  Each and every time I celebrate a Bridge finesse I am reminded of how one simple but out of context word produced a significant change in thought for our team.

There are obvious challenges for those of us who care for seniors face on a routine basis.  I can see now how using a little finesse every now and then can produce great results.

Contributing author Steven Mattingly is the Executive Director of Pacifica Senior Living in San Leandro CA.

That's Amore

By Rebecca Weitzel

Pacifica Belleair was entertained and delighted by the Fun Time Singers who came to perform for us a couple of weeks ago.  Singing many songs including Patsy Cline’s “Crazy” and Elvis’ “Love Me Tender”, our residents and care givers alike were  clapping and tapping along with the music.  The highlight for me was when one of our residents opened up and belted out the refrain to “That’s Amore”.   Perhaps this isn’t so exciting, but when you consider that this lady hardly speaks anymore, it was quite a surprise to hear her lovely voice belting out “When the moon hits your eye like a big pizza pie, that’s amore”!  Her face was beaming, her hands were waving in expression to the words and when I asked her if she liked the music, she lit up into a big smile and said, “Yes, I was remembering!”  It made me think of how hearing a certain song can sweep us all back in time. Pat Benatar whisks me back to my freshman year in college, The Eagles, well that’s high school and of course there is that special song that takes me back to my minivan, loaded with my school age kids, all of us singing at the top of our lungs to Billy Ray Cyrus’, “Achy Breaky Heart”!  Even today, when that song comes on, each of us will start singing (yes, at the top of our lungs!), inharmoniously, but loudly and enthusiastically nonetheless.  Now, thanks to the Fun Time Singers and a lovely lady, another memory has been cemented; from now on, when I hear “That’s Amore”, I will be reminded of the sweet woman who lives at Pacifica and wonder what memory she relives as she’s transported back in time and hears “When the moon hits your eye like a big pizza pie….that’s amore”!

Contributing author Rebecca Weitzel is the Community Relations Coordinator for Pacifica Senior Living Belleair in Clearwater, Florida. 

Age In Place....Really?

by Rebecca Weitzel

When introducing families to our community, I explain that our residents enjoy "Aging in Place".  This is a popular buzz phrase that’s currently misused, misunderstood and incorrectly offered by many assisted living providers.  Saying that mom can “Age in Place”….sounds nice, but what exactly does it take to make (and keep) this promise? 

Regrettably it is important to understand and anticipate that a person suffering from dementia declines over time.  As conditions worsen, care levels increase, frequently to the point of becoming acute.

Most Tampa Bay AL’s operate with a Standard License and provide routine personal care services to their residents.  Florida guidelines specifically define these services, which are quite limited in scope, as they do not permit delivery of the higher care needs required of more progressed residents.

Pacifica Senior Living Belleair has earned and been awarded a Specialty License called an Extended Congregate Care License (ECC License).  This permits us to legally give and manage higher acuity care needs than can other communities.  Having this designation allows residents to live here without the threat of one day having to move into a skilled nursing home.  Therefore when speaking to families, I legitimately offer “aging in place, here in our cottages, because we are licensed to provide for the increasing healthcare needs of our residents. 

We are one of few dementia care communities in Pinellas County to hold an ECC license.  Having been awarded this specialty license by the State of Florida, Pacifica Senior Living Belleair offers "Aging in Place" ....really!  From the earliest stage of memory care need through the entire journey, our residents remain here, at home, with us. This is one more promise we make (and keep) that makes Pacifica “just the right place” for many Bay Area families.

Contributing author Rebecca Weitzel is the Community Relations Coordinator at Pacifica Senior Living Belleair in Clearwater, Florida.

The Value of Saying Thank you!

By Steven Mattingly 

This past week, September 9-15 was a special one in the world of Assisted Living Communities. It was National Assisted Living Week.  Our community used a large poster to say thank you to our staff and encouraged staff members, residents, and family members to personalize it with notes and encouraging words.  It was great to see as the week went along the growing and glowing tributes that appeared.  We also used this week to honor two members of our staff for their “above the call of duty” care giving skills.  They were honored at a Happy Hour event in which all members of the community participated.   I felt that we had hit a home run in the thank you game for the week.

It was with a concerned ear this past week that I listened to one of our healthcare vendors tell our concierge how glad they were to see our poster since in their visits to most assisted living clients they serve, they saw nothing in observance of National Assisted Living Week.  I made a point of seeking out that vendor during their visit and ask them if that remark was really accurate.  Sadly they said yes.  We commiserated about what the caregivers in locations where there was no observance might feel.  The buzz words of under-appreciated, un-feeling, and we need to do more were tossed about and we both felt better afterwards or was it perhaps our smugness showing.

This incident in so many ways forced me to reflect on how I as a manager perceived my staff.  Were they worthy of some special acknowledgement during National Assisted Living Week; absolutely.  But are they also worth my time and energy to say thank you each and every day; again the answer should be absolutely.  Do I say thank you each and every day?  I have to admit to my shortcomings and say no I don’t.  I mean to, I really do!  But then that report comes due, I get a call from my boss, a family member needs answers, a resident walks into my office with concerns, etc.  I think you get the picture.  Like everyone else I have constant distractions from my good intentions.  To quote my now infamous mother “the road to hell is paved with good intentions”. 

Lots of business schools graduates and experts have spent lots of time coming to the conclusion that the one thing managers can do that motivates employees the most is show real and genuine appreciation.  Public appreciation like the poster we used, the recognition in front of the community for some, and happy hour for all certainly were signals and signs of appreciation.  But those same experts have told us that quiet moments and simple words of appreciation have an even greater effect.  In my upbringing we were reminded regularly to say our please and thanks yous.  I can remember all too well my parents at the dinner table not serving us food until we used the “magic” word please and we often heard the phrase did you forget something when we didn’t say thank you.  Now I understand and appreciate those gentle and even not so gentle urgings of my parents all the more when I think about saying thank you and asking staff members in an appropriate way to work harder and do more.  The phrase “how much more our parents know as we get older” keeps coming to mind.

There has been a general (do I dare used the in-the-news-word) bounce in good feelings around and about the community following last week.  I hope our tracking polls show it as more than a bounce and something that we can continue to build.  I hope that my good intentions don’t send me to hell but I do have a plan to say thank you more to our care giving team in some way every day I am in the community.  Little did I know that my parents were as smart as or perhaps even smarter than the business school crowd when they taught us good manners?

Contributing author Steven Mattingly is the Executive Director of Pacifica Senior Living in San Leandro, CA.

Our Aging Parents Continue to Change

By Steven Mattingly

One of the most difficult tasks you face as an Executive Director of an Assisted Living Community is talking with family members about changes you and your staff see in their loved ones.   It’s never easy for family members to see the changes or as is more often the case, to process how the changes are affecting their loved ones daily life.

I’ll give you an example from personal experience.  All other members of my family are located near our ancestral home in Kentucky.  I moved to California more than 15 years ago and as a result I didn’t see my mother regularly the last 12 years she was alive.  Unlike my siblings I didn’t get to enjoy her Sunday fried chicken, watch her consistently lose at cards, or for the umpteenth time ask “which hand are we on” in Shanghai (a rummy type card game).  The image I instead saw during my semi-annual visits was how much my mother was changing as she aged.  When I tried to talk to my siblings about the things that I saw they were always either surprised or defensive.  I was the person who informed my younger sister that our 80 year old mother could no longer safely provide free childcare for her two children after school.  You can imagine how well that was received.  I added a different and at times not welcomed perspective to the family dynamics, not unlike what I often do with family members of residents of our community.

Perhaps the most important role of an Executive Director and his/her team is to be the objective viewpoint in the family dynamics that envelope every single resident in a community.  I often tell family members that we are the people who now live with their loved one 24/7/365.  We are better suited to know a resident needs because we see and experience the difficulties their loved one encounters each day.  Family members sometimes tell me that their loved one saves all their complaints and sad stories to share when they visit; I think that is not the case in most instances.  What our team most often observes is the “gearing up” for the visit phenomenon.  Residents, even those with advanced dementia, go into a different functionality when loved ones visit.  They are more engaged, more alert, participate in the conversation more, and exhibit their “best” behavior when families visit.   What happens when the visit is over I describe as the “crash”.  Even residents who normally have great coping skills when dealing with their daily challenges experience, albeit small in some instances, some diminishing of their coping skills.  That’s when my staff sometimes tells me “I wish their son/daughter/friend could be here now”.  The implication is the family needs to see and hear what they are experiencing after a visit.

A few years ago I worked with a family who adamantly maintained that their mother was not incontinent and how could we charge them for that level of care and the accompanying undergarments.  After many rounds of discussion I finally in a moment of great exasperation told the family fine, take Mother to live with you for a week and if you don’t come back with an understanding that she is incontinent, I’ll not charge you rent for a month.  It took less than 24 hours and mother was back in the community.  As much as I wanted to feel a sense of triumph I couldn’t.  What I had done was remove one more element of the dignity that Mother had in the eyes of her children.  It was needed to make sure their mother got the care she needed and we were correctly paid for providing that care, but it was hardly something that I saw as a victory in any sense.

Many of you by now have realized that I often use my own family to illustrate situations or problems.  I find it is often easier to talk with a family about a problem or concern if you use a third party to illustrate the point.  But I also think I use my own family stories so that our resident’s families can know my empathy is real.  I too have had to face a world with aging parents.

Contributing author Steven Mattingly is the Executive Director of Pacifica Senior Living Assisted Living in San Leandro, CA.

Senior Fraud Hits Home

By Steven Mattingly

We all hear about and read about fraud committed against seniors and it’s exactly that, something that we hear and read about.  Most of us pay little heed to the discussion most of the time. Even though I work with seniors each and every day like most of us I tuned out the various commercials and internet pop ups thinking them little more that auditory and visual pollution.

I have changed my nonchalant attitude rather quickly in the past couple of weeks when our community was called upon to assist one of our own residents fight an ongoing case of identity theft and financial fraud.   A former business acquaintance of the resident had gathered enough information ranging from bank statements that were altered to included additional names, copies of a state issued ID, and other personal information.  This individual was using the information to represent herself as the caretaker of the resident and was attempting to lease an expensive home in the bay area in the resident’s name. 

The good news is that an alert property manager for the potential rental property sensed something out of the ordinary and reached out to our community for help.  Because of privacy laws we do not respond to questions asking if a resident or staff member is part of the community.  Our standard response is that we cannot confirm or deny that information.  Fortunately in this situation the property manager was persistent and a manager on staff made the appropriate decision to cooperate once she learned a bit more about the nature of the inquiry. 

With cooperation from our community, the resident affected, and the property manager, the police with jurisdiction over the case set up a “sting” operation to apprehend the individual.  It was somewhat surreal.  It was like being involved in a scene from “Law and Order”.  The good news is that the sting worked, the individual attempting the fraud was apprehended and will be prosecuted.  The bad news is that our resident has to do the leg work to restore her good credit status with the various with the credit bureaus, no small feat, but she is determined to put things right.

There are numerous sources where you can get information about how to prevent senior financial fraud.  Most of it is simply good common sense.   Here are some suggestions you might want to consider:

·        Identity thieves love aging parents because they think they are so vulnerable. Social isolation, loss of a spouse, early dementia, general memory loss or confusion set up our elders and aging parents an easy mark. Add to that, seniors tend to be friendly and trusting, and you have a combination that can make your aging parent a sitting duck.

·        How can we help them protect themselves?    We need to educate our aging parents that trusting strangers on the phone is very dangerous. We need to warn our aging parents that even their own children can rip them off if they are desperate. Drug and alcohol abuse, serious financial trouble and mental illness can lead an adult child to steal account numbers when visiting and later raid his own parents' bank account and steal from the ones most likely to trust him or her.    Can we thwart the attempts at stealing our aging parents' identities? We can at least take protective measures. Some of the simplest protections are the best.

·        First, buy a cross-cut shredder. Shred or have your aging parents shred sensitive mail, credit card solicitations, and outdated personal documents such as bank statements, rather than throwing them in the trash. Thieves go through the trash looking for anything they can use to steal.

·        Guard credit cards. Watch sales people, staff in restaurants, and anyone who asks for your credit card. Thieves use tiny scanning devices called skimmers to steal the numbers and then use the cards. Get rid of any rarely used or unused cards. The fewer your parent has, the better.

·        Mail letters at a mail box or the post office, rather than leaving outgoing mail in the mail box in front of the home. Thieves steal checks and payments slips, taking the information and using it to attempt to steal the entire identity. They take out new credit cards in the victim's name and rob them of everything they can.

·        One should never, ever give out personal information or financial account information over the telephone. Telephone solicitors offer prizes and rewards to trick the person into telling the solicitor his bank account number, social security number, and mother's maiden name. With that, the thief can wipe out a bank account in minutes.

·        Don't let anyone copy your aging parents' driver's license. Anyone doing this can get access to bank accounts, personal data, and anything else you would want to protect. Getting the license number to verify a check is one thing. Letting someone take the entire license and have the other information on it is rarely necessary.

Senior identity theft and fraud are crimes perpetrated by individuals who see seniors as easy prey.  It is estimated that 1 in 7 seniors at some point is a victim of fraud.  You’ve been warned!

As a footnote to this recent incident, the resident involved has just gotten her fourth “check” from the Nigerian Lottery, all she needs to do to cash the check is call a listed number.  Our wise and cautious resident has given this information to the police. 

Contributing author Steven Mattingly is the Executive Director of Pacifica Senior Living in San Leandro, CA.

Exercise for Seniors

There is a fountain of youth: Millions have discovered it - the secret to feeling better and living longer. It's called staying active. Finding a program that works for you and sticking with it can pay big dividends. Regular exercise can prevent or delay diabetes and heart trouble. It can also reduce arthritis pain, anxiety and depression. It can help older people stay independent.

There are four main types of exercise and seniors need some of each:

• Endurance activities - like walking, swimming, or riding a bike - which build "staying power" and improve the health of the heart and circulatory system 
• Strengthening exercises which build muscle tissue and reduce age-related muscle loss 
• Stretching exercises to keep the body limber and flexible 
• Balance exercises to reduce the chances of a fall

It is safe for most adults older than 65 years of age to exercise. Even patients who have chronic illnesses such as heart disease, high blood pressure, diabetes and arthritis can exercise safely. Many of these conditions are improved with exercise. If you are not sure if exercise is safe for you or if you are currently inactive, ask your doctor.

It is important to wear loose, comfortable clothing and well-fitting, sturdy shoes. Your shoes should have a good arch support, and an elevated and cushioned heel to absorb shock.

If you are not already active, begin slowly. Start with exercises that you are already comfortable doing. Starting slowly makes it less likely that you will injure yourself. Starting slowly also helps prevent soreness. The saying "no pain, no gain" is not true for older or elderly adults. You do not have to exercise at a high intensity to get most health benefits.For example, walking is an excellent activity to start with. As you become used to exercising, or if you are already active, you can slowly increase the intensity of your exercise program.

If your muscles or joints are sore the day after exercising, you may have done too much. Next time, exercise at a lower intensity. If the pain or discomfort persists, you should talk to your doctor. You should also talk to your doctor if you have any of the following symptoms while exercising:

• Chest pain or pressure
• Trouble breathing or excessive shortness of breath
• Light-headedness or dizziness
• Difficulty with balance
• Nausea

Sources: NIH: National Institute on Aging, FamilyDoctor.org

Musings On Wine and Getting Old

This past weekend I went to a 40^th anniversary party for Cakebread Cellars, one of my favorite wineries in the Napa Valley.  It was a wonderful event with great wines (the 2001 Chardonnay Reserve was my favorite wine) and great food (the crab salad on top of a fried green tomato slice was my favorite food). 

As is the nature of this type of event, my dinner companions and I made polite small talk and talked about the type of work that we do.  The mix consisted of a CPA who did personal accounting, a CPA who worked for a large accounting firm, a professional banker, a school teacher, an Information Technology Officer for a startup healthcare provider, a contract management officer for the University of California San Francisco, and me, an Executive Director for Assisted Living, (insert punch line here).  I was a little surprised when the work that I did for a living became the focal point for the evening’s dinner conversation.  But perhaps I shouldn’t have been surprised since everyone at the table was of the sandwich or “tweener” generation.  Sandwich or “tweener” families are providing support for their own children, but as we see more and more often, are also providing support for aging parents.  The support is certainly emotional but for many “tweeners” it is also financial. 

We talked at length about how many from our parent’s generation even as their resources are dwindling, are obsessed with making sure they leave something behind, a final bequest to either their children or their grandchildren.  Whereas the tweener generation at the table indicated they felt no obligation to leave something behind for anyone.  One person said they would spend every last dime and that seemed to be the sentiment for most.  This sentiment signals a clear change in attitude from one generation to the next.  Perhaps equally surprising is that it has happened in such a short time span, a single generation.  A generation is usually thought to represent roughly a twenty year period.  Sociologist and psychologist who study such things are scratching their heads in wonder at this rapid change.  While the experts pontificate various explanations,  I think the “me” generation had spoken, perhaps prodded along that evening by the various wines that were being sampled. 

Trying to appear as innocent as possible, I pushed the conversation to what those at the table had done to prepare for their aging process.  After the usual I’m not going to get old comments and twitters of laughter got out of the way, I sensed a very real underlying fear among my dinner companions.  I didn’t see it as simply fear of aging but more likely a combination of many fears.  The fears of changes we expect as we get older are there for everyone to see but there are other fears that we as “tweeners” feel.  The term “tweeners” certainly indicates the position my generation has socially but it also references the push and pull we get from the generations before and after us.  The fear of not having the resources to support our children and also to support our parents can’t be hidden behind puffed out chests and driving the brightest and newest car(s).  Isn’t the question really if I meet those obligations how will I be in a position to provide for my own later years?  What I see is a disconnect promoted perhaps unknowingly by “me” generation.  We haven’t instilled the same sense of respect, responsibility, and even obligation from one generation to the next that our parents did with us.  Somewhere in the back of our minds is the fear that we’ve done something wrong that is going to suddenly come to light.

Perhaps using the illustration of the inheritance obligation felt by our parent’s generation and the lack of that same sense of obligation for our generation sidesteps a lot of the issues that surround the future of senior care.  But I do think it albeit for a brief fleeting thought represents one of the fears we as “tweeners” have about getting older.

There has been a sort of running joke in my family about making sure that one of my children became that pinnacle of the American success story, a doctor.  The undercurrent of that joke was that child or children would be the financial reserve that I could tap as I got older.  I’ve not been silent about expressing that thought out loud somewhat jokingly.  Alas, none of my children as of yet are doctors nor look to be on track to being the next Bill Gates.  Like many others of the next generation they are struggling with their own types of pressures made all the more complicated by a society that doesn’t at present offer the wide array of opportunities that faced me in my twenties and thirties.  Midlife I’ve had to change gears and re-examine my retirement plan.  I’m not sure that my children will feel the same sense of obligation but I’ve also come to increasingly having to face they most likely will not have the resources to help even if they wanted to help.  I would be willing to bet that I’m not alone in having that discussion with myself.  Like the majority of “tweeners” I approach getting older with many fears.

Contributing author Steven Mattingly is the Executive Director of Pacifica Senior Living in San Leandro, CA.

Compound in Red Wine Could Improve Mobility in Seniors

by George DaSilva

A new finding presented to about 14,000 scientists at the 244^th National Meeting & Exposition of the Chemical Society (the world’s largest scientific society), concluded that the compound Resveratrol,  (an antioxidant found in red wine and dark-skinned fruits), could be beneficial in improving mobility in seniors.  Resveratrol has been touted in the past as the “miracle molecule” by many scientists for its vast health benefits.

According to the research team leader, Jane E. Cavanaugh, Ph.D., the study based on lab mice suggests that consumption of Resveratrol through either dietary supplementation or diet itself could actually decrease motor deficiencies seen in older people - decreasing their injury risk due to slips and falls and therefore improving their quality of life. According to the American Geriatrics Society, one in three older Americans has difficulty with balance or walking.

Previous studies have shown that Resveratrol might help reduce inflammation, lower cholesterol and slash the risk of heart disease and certain cancers and perhaps have some anti-aging effects in the body. Resveratrol is available as a dietary supplement and is abundant in foods such as red grapes, blueberries and nuts.

Source: Medical News Today

A Poem

By Steven Mattingly 

The daughter of a new resident of our community sent me the following poem written by her mother’s second husband. She also shared that having her mother at Pacifica “. . . makes my life so much easier and I'm happy to be with her again". It is pure joy to see her at peace and happy at Pacifica. She knows she is safe and well cared for! 

The poem is about a community where her mother and her mother’s second husband lived for several years before he died. The daughter wished that he was still around to write one for her mother’s new community. 

This is a realistic and poignant look into the world of assisted living from the viewpoint of a resident. He seems to be expressing his appreciation for those whom he encounters each and every day and the idea that while he knows life will come to an end, he is a better person for knowing those whom he names in his poem. May we all be able to make this kind of a difference in the lives of those entrusted to our care. 

There’s place for those who seek a rest - 

It’s found right here in the Golden West.

You’ll spot it as soon as you arrive 

At Eight-O-One on Island Drive.

If your pace has slowed and you’ve ceased to roam,

It’s just the place you might call “home”.

A gracious lady runs this place

And it all reflects her charm and grace.

A greeting by Cindy; then a chance to explore? 

She’ll usher you in to see David next door.

Have a quick look around; and we’ll see you later. 

Please try not to hurry our nice elevator!

There’s a typical room! It’s nice and it’s neat!

Now let’s go and see where you’re going to eat.

Three things you will find that are no surprise:

You sleep and you eat and you exercise!

And now, you’re to meet a special wee lass - 

It’s Rosemarie and her exercise class!

She keeps us all limber and balanced and strong.

Without her I’m sure we’d not last very long.

Not to worry my friend; and please don’t be afraid,

Meet the rest of the team who are here for your aid.

Aseleph hands out the pills here each day 

As she tries to keep doctors and nurses away.

And there’s Barbara and Amber and then Saba too,

All here just to do their best for you.

And then to make life just a bit more worthwhile

Martha greets all with her bright morning smile. 

The grounds are great and the place is neat, 

And we get far more than we can eat.

Now, let’s take a look at these folks of yore

Who make up the tenants - 100 or more! 

As you get to know all these people so well,

You find that each one has a story to tell. 

Lives spent in brave service for country and God.

From office or factory or paratroop sod.

On the land, in the air or on the blue sea,

They have stood in our places to keep us all free.

There’s Cliff and there’s Art and there’s Thomas and Bill 

And Charlie and Sheldon and Herbert and Gil.

While walking and talking are harder these days,

Their lives still shine through in hundreds of ways.

Few are the places these folks have not trod,

And now they’ve come home from a long life abroad.

There’s Tony and Margaret who’ve lived far away

They are golfers deluxe, and may show you some day.

Lillian’s a hiker - very much on the go. 

While Helga still touches her toes like a pro.

There’s music here too, and in flat or in sharp,

There’s Jean with her so welcome Vibra-Harp!

We all love to hear those old songs of our choice, 

And Cecilia brings with her that bright, happy voice!

Do we all have problems - did I hear you say?

I can’t even remember the time of the day.

A cane is a must, or we’d sure take a roller,

But most of us here sport a very fine stroller.

There’s a sadness here too, for we’re all getting older

And a pat feels so good on a tired old shoulder.

Try as we will to reverse this dread trend,

We know in our hearts that it all has to end. 

~Gil Dunkin

Tax Deduction of Assisted Living Costs

by Patricia Conlon

Over one million seniors live in Assisted Living communities across the United States and many of them pay their monthly fees with their own financial resources. Some or all of their costs may be tax deductible.

These are the basic rules concerning the tax deductibility of assisted living expenses:

According to the 1996 Health Insurance Portability and Accountability Act (HIPAA), “long-term care services” may be tax deductible as an unreimbursed medical expense on Schedule A.

Qualified long-term care services have been defined as including the type of daily “personal care services” provided to Assisted Living residents, such as help with bathing, dressing, continence care, eating and transferring, as well as “maintenance services”, such as meal preparation and household cleaning.

Assisted Living residents seeking tax deductions for their services must qualify as “chronically ill”. This definition refers to seniors who are unable to perform two or more “Activities of Daily Living” (eating, transferring, bathing, dressing and continence) without assistance, or who need constant supervision because of a “severe cognitive impairment” such as Alzheimer’s disease or related dementias. The Assisted Living resident must have been certified within the previous 12 months as “chronically ill” by a licensed health care

In order to qualify for a deduction, personal care services must be provided pursuant to a plan of care prescribed by a licensed health care practitioner. Many Assisted Living communities have on staff a licensed nurse or social worker who prepares a plan of care, sometimes called a “Wellness Care Plan,” in conjunction with the resident’s physician which outlines the specific daily services the resident will receive in the community.

In order to take advantage of deductions, a taxpayer must be entitled to itemize his or her deductions. Additionally, long-term care services and other unreimbursed medical expenses must exceed 7.5% of the taxpayer’s adjusted gross income. (Generally, a taxpayer can deduct the medical care expenses of his or her parent if the taxpayer provides more than 50% of the parent’s support costs.)

For some Assisted Living residents, the entire monthly rental fee might be deductible, while for others, just the specific personal care services would qualify for a deduction.

Assisted living residents and their adult children should speak with their own income tax advisors to get clarification about their personal 


Patricia Conlon in the Community Relations Coordinator at Pacifica Senior Living in Palm Beach, FL.

A Lesson Taken From The Movies. . .

by Steven Mattingly

This past weekend I engaged in one of my favorite guilty pleasures, watching an oldie moldy movie.  This Sunday in between watching the 2012 London Olympics, I watched one of my favorite oldie moldy movies, “Now Voyager”, starring Bette Davis, Paul Henreid and Claude Raines.  I remember this movie from my childhood.  As an adolescent I think I spent many Sunday afternoons during winter watching outdated movies on “Sunday Afternoon at the Movies” on the television with my mother.  To this day there are movies that bring flashbacks of the avocado green Naugahyde covered couch, the orange Naugahyde covered chair, and multiple bowls of popcorn watching the black and white television.  I can also reminisce about the oversized ashtrays and the matching antiqued end tables with matching lamps, but I’ll save that for another time.

There are a fair number of familiar Bette Davis quotations:  “If you want a thing well done, get a couple of old broads to do It.”; “Hollywood always wanted me to be pretty, but I fought for realism.”  But my favorite remains: “Old age is no place for sissies.” 

These are great and very true words about the aging process.  Residents of our communities encounter the things that we’ll call bullies each and every day.  Arthritis, stroke recovery, cancer, congestive heart failure, congestive obstructive pulmonary disorder, diminished vision, diminished hearing, family members who don’t have time to listen, family members who don’t want to listen, and a healthcare system that systematically fails to treat them as adults and far too many more to name.   A few of our residents have only one demon to look in the eye each day but for most, a whole gang of bullies sizes them up each day ready to pummel them with as much hurt and force as they can manage. 

With age there sometimes comes a unique grace and certain degree of suave in managing the bullies that are found on life’s path.  I am amazed each and every day at the aplomb and fortitude shown by residents as they stare down, beat back, and conquer their individual bullies.  Every now and then I’ll hear residents comparing their list of bullies and it sounds almost like a game of one-up-man-ship.  There is a strange reverence reserved for those who defeat the biggest number of bullies routinely. It reminds me of the game “King of the Hill”.   Remember that the next time your family member or loved one starts reciting the list of their various ailments.  It not that they are complaining, perhaps they are just getting ready for their next game of “King of the Hill”.

The title of the movie “Now Voyager” is taken from a poem titled “The Untold Want” by Walt Whitman.  In a pivotal scene for the character played by Bette Davis she is handed a piece of paper with the following lines; The Untold Want By Life and Land Ne'er Granted Now, Voyager Sail Thou Forth to Seek and Find Life isn’t the movies and no one gets handed a piece of paper telling them to sail forth and seek and find.  But a good swift punch will beat back the bullies each and every time. Steven Mattingly is the Executive Director of Pacifica Senior Living in San Leandro, CA.

Why Watching the British Open Made Me Cry

Remembering My Father  

By Steven Mattingly

For those of you who are not golf fans, I’ll begin with a bit of recent golf history. A 40 year old recently won the prestigious British Golf Open something that as of late has been left to the younger generation of golfing giants. Being of that certain age myself (50+) it was great to see the old guy make good one more time. But it also reminded me of a time when my father was the “old guy” trying to win one more time. 

My father for the last 20 years of his working life was the golf course superintendent for a small golf course where I grew up in Kentucky. He often referred to himself as a high class dirt farmer. He had grown up the oldest of 11 children on a poor scrap of a farm with a father who was both mean and mean spirited towards his children. The ragtag assemblage of the family and their circumstances can at best be described as dirt poor. I think my father enjoyed a secret laugh each time he made the high class dirt farmer reference since he not only escaped the hard scrabble of being a farmer, he had done it with style. 

My father was also quite the competitive and successful sportsman as a teenage and young man, playing baseball on a couple of semi-pro teams until his knees and back gave out and he couldn’t jump up quickly enough from his catcher’s position. At the ripe age of 34 he took up golf and that in turn in a very roundabout way led to his becoming a golf course superintendent. For anyone who has played golf you know the frustration of the game and also know that practice does indeed make perfect in the game. My father rarely had time to practice between a 16 hour work day in the warm weather and still being a father to four children. So it was somewhat surprising the August that I was 12 that I noticed my father was carving out 15 minutes here and 20 minutes there to hit golf balls and work on his game. He had always been a good golfer by never a great one. Being a youngster I couldn’t figure out the angle until it was the week before Labor Day weekend when I realized my father had with quiet determination set about qualifying to play in a well respected and highly competitive match play golf tournament held over the three day weekend at the golf course where he was the superintendent.

Somewhat surprising to many who knew him, he qualified to play in the championship division. My father over that three day weekend got up at 4am and got me up as well since I was his helper and mowed, raked, trimmed and otherwise manicured the golf course to the pristine order for which it had become known under his tenure. He then came home 6 hours later, cleaned up and went back to the course to play his matches. To his great credit he won matches his first and second day and made it to the elite group of four for the final day. On that final day he again was up at 4am did a day’s work, and went back out to face what he knew as did I his toughest opponent, a strapping and strong 18 year old with a slamming swing that just sent the ball soaring into space. The match was fascinating to the crowd that traditionally watch this part of the tournament and to me who served as my father’s caddy throughout the tournament. 

There was never more than a difference of 1up throughout the match and it ended up even after 18 holes of play going into sudden death right at 12noon. And that’s when it happened, the responsibility of being the golf course superintendent and the desire to prove something clashed. If you know anything about Kentucky weather know that in late August it is ungodly hot and humid, two things that spelled disaster for my father’s carefully manicured greens, often referred to by many as the finest in all of Kentucky. He didn’t want to forfeit so he did what he had to do. He played the first hole of sudden death and at the end of putting pulled out the hoses (no automatic sprinkler here) and hand sprinkled the green for the time it took for his opponent to walk to the next tee, he then sprinted from the previous green to the next tee and continued the match. This continued for four holes of sudden death until my very tired father missed a very makeable four foot putt and lost the match. I thought of my father as I watch the British Open and saw the “old man” win and just cried for I knew he could have made that last putt.

Steven Mattingly is the Executive Director of Pacifica Senior Living in San Leandro, CA.