Cities Are Not Empty Pages

“Cities are not empty pages,” writes German sociologist Rolf Lindner. He continues, “There are cities which are like a penny dreadful, a dime novel, stained and well-thumbed and with a garish, torn cover, while others are more like an expensive edition of a classic author, leather bound, with thread-stitching and a bookmark. “– Rolf Lindner, “The Cultural Texture of the City,” Linköping University Electronic Press, 2006.

Growing Old in East Harlem: a video about the East Harlem Aging Improvement District from The New York Academy of Medicine on Vimeo.

Dear Readers,

For me, urban life is more memory than presence. Since 1977, I’ve migrated from big-city Chicago to small-town Henniker, NH, to suburban Boston. I visit cities mostly for refreshment, these days, instead of daily needs.

Yet a film set in East Harlem, New York City, has brought me back to the jam-packed, extravagant, messy, compelling pages of the urban life I knew as a teenager and young adult in Chicago. Watch “Growing Old in East Harlem.” You’ll see the pages fill up with stories.

Thanks for being here,

Mary Ann

PS: Below is a description of the film from the New York Academy of Medicine. You can read more about East Harlem’s status as an Age-Friendly City at the Silberman School of Social Work.

“On August 31, 2010, NYAM previewed a new film, “Growing Old in East Harlem” in which seniors were interviewed about the joys and challenges of aging in this diverse, dynamic neighborhood in New York. Growing Old in East Harlem was filmed and directed by Dorian Block, policy associate at NYAM. It was produced and edited by Jonathan Mena and Jessie Daniels, both of Hunter College.

“More than 200 older adults, community leaders, and business representatives from East Harlem gathered at NYAM to view the film and to discuss the findings of a recent study of older adults in East Harlem who expressed concerns and improvements they would like to see in their community. The assessment and resulting event are part of Age-Friendly NYC, a collaboration between NYAM, the Mayor’s Office, and the New York City Council.” — NYAM, 2010

Demystifying Home Care

Editor’s Note: The following essay began as a guest post for OpenPlacement, a company that links seniors and their families with providers of senior housing and home care services. In writing this piece, I’ve relied on my experiences as a professional caregiver, but the views expressed are my own, not those of my employer, and I did not receive any compensation for the essay. The client in the story, Mrs. Josie Delancey, is not a real person, but the issues underlying her fictional character are drawn from real life. — MAB

Woman Sitting by the Window (detail) by Tivadar Kosztka Csontváry

Woman Sitting by the Window (detail) by Tivadar Kosztka Csontváry, via Wikimedia Commons.

Every few months, I find myself standing on the doorstep of a new client, ringing the doorbell.

Who will she be? I wonder, this new member of the community of elders whom I meet in my work as a certified nursing assistant and companion to elders.

What family photographs will I see on her walls, what medicines on the table by her bed?

Will I have the skills she needs? Will she accept help from me, a person she’s never met?

Looking back on these moments of mystery on the doorstep, I’m struck by how high the stakes are when we try to help frail and vulnerable people as they grow older. When a family calls my agency to ask about home care, chances are this is just one step in a long journey. Perhaps their mom is struggling to cope at home with illness or injury. Perhaps their World-War-II-veteran husband has escalating memory problems that trigger agitation or even rage. Even in more fortunate circumstances, asking an elderly person to consider home care is a big step.

My hope in this essay is to demystify home-care by telling you something about it from my point of view as a practitioner with eight years of experience in the field. This work is by its very nature private, yet as the baby-boomer generation ages, there will be more and more elders who need the assistance of direct-care workers in order to live safely at home. That’s why I write about my experiences — taking care, of course, to preserve client confidentiality by changing any identifying details about my clients and their families.

Client Story: Mrs. Josie Delancey

Suppose you are an adult daughter named Alicia, and I’m here to help your mother, Mrs. Josie Delancey. You and your mother have met with my agency’s staff to discuss her situation. At age 85, Mrs. Delancey has been living alone in your family home since your dad died five years ago. But lately you and your three siblings have seen a big decline in her health. She was hospitalized twice in the past year, once with pneumonia and more recently with a fractured wrist. Her arthritis makes it difficult for her to stand up from a seated position. She’s no longer able to drive, and has become increasingly sad and listless. Her once-immaculate house fills up each week with discarded newspapers and used cat-food cans. She’s been losing weight and needs help with using the toilet as well as cooking, cleaning, medication reminders, and rides to the grocery store.

As you can see in this scenario, you and your mother have already given us lots of information that will help me do a good job. My supervisor has worked with you to set up a care plan that specifies what tasks your mother does independently, where she needs a little help, and where she needs substantial assistance.

Home Care Map

Indeed, since my agency uses secure email and web-based documentation tools, the information flows quickly and easily between the family and the client, agency supervisors, and caregivers like me in the field. Today, as I meet your mother and set about making her breakfast, I have a mental Home Care Map in my head that will grow and change with each visit.

Home Care Map for Mrs. Josie Delancey

Client Home Care Map

Tools of Support

Included in my mental Home Care Map is a list of intangible Tools of Support. It’s been my experience that the emotional support a caregiver can offer is just as important as the assistance we provide our elderly clients in the activities of daily living. As caregivers, we need both strong arms and kind smiles. When clients or family members resist care, or when something about our presence triggers some negative response from a client, we need to be able to work with the situation as tactfully as possible.

I remember visiting a friend of mine who was under hospice care, years ago, before I embarked on my career as a caregiver. I noticed that the hospice caregiver would help my friend get situated on the toilet and then wait outside the bathroom, with the door barely ajar. It was a small detail, but my sense was that in respecting my friend’s privacy at this vulnerable moment, the caregiver was supporting her independence and autonomy.

Appreciating Family Caregivers

Finally, I would like to express my appreciation for the family caregivers with whom I have worked over the years. A couple of years ago, I worked with a family caring for their 82-year-old father. He loved baseball, so for Father’s Day his son bought him a tablet device with a link on the home page to the Baseball Hall of Fame website. He especially loved the online exhibit, Picturing America’s Pastime. Looking at the pictures and telling stories about games he remembered gave this elderly man hours of enjoyment. I’ll always remember the thoughtfulness of the son’s gift and the joy it gave his father.

About the Author

Mary Ann Barton is a certified nursing assistant, elder companion and blogger who writes about health, healing, and caregiving for elders, their family members, and their paid and volunteer care partners. She finds joy in singing and is writing a book about finding rest and renewal as we care for others. See more by clicking here.

Stove Reminder™: A Home Safety Tool for Your Kitchen by Alan Majer

Editor’s note: Today’s post gives us a glimpse into the world of inventors who develop products to help individuals maintain their independence at home. I invited Canadian entrepreneur Alan Majer to share his experience with Joyous Paradox readers because I’m fascinated by the stories behind innovative products and services for elders and their families. I don’t have any financial interest in Majer’s company, Good Robot, so this isn’t a product review or endorsement. Your comments are welcome. Have you had trouble with charred pots on the stove? — MAB

Did I Leave the Stove on? A Meme.“Do you have anything that could help out with the stove?” It was a question I’d been asked quite a few times after discussing some of the aging-in-place gadgets that Good Robot makes.

Now this was a bit of a surprise to me. After all, when we first surveyed caregivers, a lot of them said that having a home monitoring system that could collect data about their loved one’s stove usage was pretty low on their list. (This chart shows it as second-to-last in importance.)

My lesson on this one? Sometimes the stats don’t tell the whole story.

So I asked a few of my colleagues if they’d seen any similar reactions. Indeed, everyone else had, too. It was enough to convince us that we ought to investigate whether we could help.

We learned that stove safety is a huge concern. Cooking is the most common cause of residential fires, and leaving a stove unattended is the biggest culprit. We also learned that adults 85+ are at the highest risk of a fire death (4.5 times the norm). And while most of us know we shouldn’t leave a stove unattended, it’s easy to get distracted, even by answering the door or taking a phone call.

Stove ReminderIt’s no surprise why stoves are such a problem. If you look at all the things we own, they’re getting smarter – smart cars, smart phones. Yet most stoves are pretty dumb. On a typical stove, if you set the burner on high, it will keep on heating your food to the point of fire. An unwatched pot could burn your house down if you don’t take action to stop it. That’s really the opposite of safe.

So we tried to tackle the root of the problem: forgetting to turn off the stove.

The result is Stove Reminder™, a $99 gadget available at StoveReminder.com. This little unit raises a stove’s IQ. It automatically senses when the stove is in use, and chimes a periodic reminder to ensure you don’t forget and leave the stove on by mistake. Bringing people’s attention to the stove when they’re cooking can make a big difference. People become more aware of their stove usage too. One user said our unit helped them realize that they sometimes forget and leave the stove on minimum temperature at night.

Just as important is the link between cooking and independence. Think Grandma’s cookies, or the social aspects of cooking and sharing a meal. Dr. Sharon Cohen is a neurologist and director of the Toronto Memory Program, one of Canada’s largest facilities for the diagnosis and prevention of Alzheimer’s disease and related disorders. Cohen highlights the important of maintaining individual autonomy and self-esteem as we age.  “Stove Reminder is a vast improvement over traditional safety approaches which preclude stove use and prevent seniors from cooking for themselves,“ she says.

Last, in addition to Stove Reminder, here are some other kitchen safety tips that can help avoid kitchen fires:

  • Stay in the kitchen when cooking.
  • Keep flammable items away from the stove.
  • Turn pot handles inward where they won’t get bumped by accident.
  • Avoid loose sleeves or clothing.
  • Use the back burners whenever possible.
  • Keep your stove clean; grease or food residue may catch fire.
  • Avoid alcohol consumption; remain alert when cooking.

— Alan Majer, CEO, Good Robot

For more on home safety, see Infographic on Alzheimer’s Disease and Home Safety.

For Alan Majer’s essay on caregiving in Leo Tolstoy’s classic novel Anna Karenina, see The Courage of a Caregiver.

Image credits (from top): Portrait of an Old Woman, oil on canvas, 1611-1612. By Guido Reni [Public domain], via Wikimedia Commons. Caption added at memestache.com. Stove Reminder graphic from Good Robot, 2013.