Dear Going On With Her


Dear M,

I am thoroughly confused about my father’s Medicare and his long term care insurance. I  always thought that when the time came that he would need some kind of help, that between his Medicare and his LTCI he would be all set. Why would I think any different? Now I am finding out that this is not the case and that he will have to be able to come up with his own money to pay for some of his care. Would you be willing to explain what is what?

Dear Thoroughly Confused,

You have done a really fine job of explaining what you have seen changing in your grandmother. If you were living nearby you might have noticed more, but sometimes we find that family living at a distance are in a unique position to identify changes during periodic visits from afar. While you were picking up something different in your conversations with your grandmother, your grandfather may or may not have picked up on the subtle interactions. What you are expressing is not uncommon for those of us who are aging specialists of one kind or another, but for you it would be so peculiar.

As you have described the family situation, I would have many questions to ask before I could be sure to say what is going on with her but, just from what you have said, I will share my thoughts. First, you have mentioned some major life changes and/or stressors, even if considered good ones that often bring happiness. Life changes can be for a positive reason but sometimes we are not prepared for the ramifications. Second, when there are more than one or two changes in a relatively short amount of time, we can be stymied when trying to get a handle on our own behavior or that of someone near and dear. 

Let’s start with your grandparents living life in a pretty structured and ritualistic fashion. They each had their respective jobs throughout the years, they may have lived in the same community and possibly in the same home. She went to work each day and so did he. They would return home and spend most evenings in the company of the other, with some changes to that ritual. They had raised your Mom. Maybe they had other children. They most likely had friends and activities. Some may have been related to their work and/or faith. Maybe. Maybe not. Then these major life changes started to occur. Your grandfather retired. That in of itself would have had notable changes for each of them. Maybe your grandfather had many interests to pursue in the vast number of hours in a week that he was accustomed to being engaged at work. Your grandmother was not used to the idea that he would be based at home while she continued to go to work each day. There was a lot to get used to for each of them. Then she retired. The same goes for her. From having spent countless years in one of her life’s passions, she is now based at home. She may or may not have planned for how she was going to use her time. For many people facing retirement, there is a real difference between those who go into it just saying that they will figure it out and those who recognize that they may need to determine what they will do to be sure they do not find themselves feeling lost and possibly feeling less purposeful.

You mentioned that your grandparents made a major move from their home to an Assisted Living Facility. No matter how much they determined that this would be a wise move, often there is ambivalence. “A good move for whom? What will it feel like? Will we be able to have privacy? I don’t know if I want to have to go to the dining room. I don’t like elevators, etc.” Nonetheless, they made the move to, most likely, simplify - to be safe and sound for the future.

But then your grandmother seemed to be acting differently. It would make sense to assume that it was just all the changes that brought on her apparent change in mood. It would be a fair assumption to think that retiring and leaving her home could cause her spirit to change up a bit for a transitional period of time. It sounded like you were worried that she was saying things that were different from “normal.” Here is where I am going to take a leap as a clinician and suggest that depending upon the change in mood and her actions, there could be particular neurological and/or behavioral health issues. The very best advice would be for her to be seen by specialists to complete a comprehensive workup. This could include a neurologist, a psychiatrist, a neuropsychologist, a clinical social worker. There would be lab work done and possible scans to rule out or in a diagnosis that would clarify why you and your family are concerned about your grandmother. It is possible that she could be experiencing a mood change, such as depression. It is also possible that she could be experiencing some behavioral changes based on a neurological change to her brain function. There are many conditions that can be treated in various ways.

As Gram’s grandson, the greatest gift you could bring to her is the possibility of determining sooner, rather than later, the etiology of the noted changes and a potential treatment plan. Kudos to you caring grandson!

Yours truly,

Elder Care Industry Pioneer. Aging Expert. Founder & Managing Director of Elder Care Consultants of Choice. Mom & Daughter. Silver-Haired Queen of Purple.

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