Thursday, 14 February 2013

08:51 – Barbara had to leave work yesterday afternoon and head over to her parents’ apartment because her mom was very upset. Frances got over there in time to relieve Barbara so that Barbara could go to dinner with her friends as planned, albeit a little late. Barbara then headed back over to her parents’ apartment. She and Frances eventually got their mom calmed down enough for Barbara to come back home to spend the night. They have a sitter coming in to cover today and then Barbara has duty tonight and all day tomorrow.

Sankie’s main doctor tells them that it’s essential that Barbara’s mom and dad remain together rather than separating them and putting Sankie in a mental facility. I’m sure he’s right that that’s best for Sankie, but I’m afraid the stress on Barbara, Frances, and Dutch is going to be more than they can handle. From what Barbara has said of her mother’s behavior–confusion, sun-downing, paranoia, repeating things over and over and over, forgetting recent events while remembering those from years or decades ago, and so on–it’s pretty clear than Sankie is suffering from moderate senile dementia. That’s particularly bad because it means Sankie may not understand what Barbara and Frances are telling her, and even if she does she may well forget about it.

Barbara and Frances told their parents last night that they (Barbara and Frances) are both near the breaking point, that they (Barbara and Frances) can’t continue to do this day after day and night after night, and that it’s essential that their parents co-operate if they want to remain together at their apartment. They have hired a company’s services to put someone in the apartment with their parents during the day, but their parents are going to have to get along by themselves at night. If that works out, great. If it doesn’t, they’re going to have to move their mother to a mental care facility.

Barbara said she’d stay with her parents tonight and tomorrow night, with Frances on duty Saturday night and then Barbara again for Sunday night. After that, their parents would be on their own nights. If something happens at night, they have pull chains to summon someone from the facility to help them. They also have fell-and-can’t-get-up pendants that call 911 directly. I suggested to Barbara that she talk to Frances about making tonight the last night, and leaving their parents on their own from Friday night on. That way, if an early crisis is going to occur, it’d probably be over the weekend, when it’s easier for Barbara and Frances to deal with it.

11 thoughts on “Thursday, 14 February 2013”

  1. They have hired a company’s services to put someone in the apartment with their parents during the day, but their parents are going to have to get along by themselves at night. If that works out, great. If it doesn’t, they’re going to have to move their mother to a mental care facility.

    I think keeping Dutch and Sankie together would be good if Barbara and Frances can figure out a way to do it. If hiring some to sit with their mother works during the day, could it also work at night? Or could they both be together at a skilled nursing facility? As I understand it, Medicare will pay for that in the short term for patients who have had a hospital stay of three days or more in the last month.

  2. The short term is, sadly, probably going to be a risky tightrope to walk and once they are no longer together, one or both are likely to deteriorate rapidly. I wasn’t going to say this and hope I’m totally wrong, but we saw this with our own parents. Once my dad was finally gone, our mom rocketed down that slope real fast. Yet, she still walks and talks, albeit not in anything like her right mind, fifteen years on.

    Best wishes, esp. for Barbara and Frances, who have done heroic service.

  3. Best wishes, esp. for Barbara and Frances, who have done heroic service.

    For once I completely agree with the other Dave from Nova Anglia. I’ve been having a hard time dealing with one aging parent whose issues are mild compared to the ones Barbara and Frances are dealing with.

  4. Yeah, dealing with either physical *or* mental issues with *one* parent is tough enough; dealing with physical *and* mental issues with *both* parents is pure hell.

    When I called Barbara earlier to see how she was doing, she was sitting at her desk crying. She said she was leaving at 2:00 to go over to her parents’ place and try to get things back on course. She said she couldn’t get any work done anyway. Her mom had pretty much forgotten everything they’d discussed last night and was acting delusional. Her dad was saying if Sankie was going to continue behaving this way, he wanted her moved to a mental care facility and wanted to move to a single-bedroom apartment to live on his own.

    Then Barbara called a while ago and said she was still at work. Frances’ supervisor had told her to leave and go take care of her mom, so Barbara doesn’t have to go over early. Then Barbara got another call she had to take, so I’m still waiting for her to call me back and tell me what’s going on. Geez.

  5. That’s exactly what I was talking about earlier; a caregiver need not be on the front lines yet still gets a nice dose of stress anyway.

    Get a night in there somewhere, Bob, and take both Barbara and Frances out for a nice dinner and see that they have that night off, however it can be done. Do it real soon.

  6. Hope that it is not too late for Chuck to see this about MP3 apps.

    I still use MP3Tag as the very best. Then I follow up with MP3Gain to normalize all the songs in a playlist. I have tried a number of normalizer apps, but MP3Gain is the only one that will not destroy, or modify the tags.

  7. I really, really feel for the situation Barbara and Frances are going through.

    What we have with my aunt and uncle is working for now. Both are in the same nursing facility that does both dementia/Alzheimer’s care and standard nursing care. My uncle sleeps in his own room on the nursing side, and then travels via wheelchair to my aunt’s room in the locked down Alzheimer’s unit during the daytime. They spend the day together and eat together. Both are happy with this arrangement (well, my aunt really wants to be back in her own home, but that is not ever going to happen). Both need help dressing and undressing at this point, and that help is not available in the assisted living. Nor are wheelchair-bound people allowed in the assisted living. For that reason, it is not clear whether they can actually return there. Also factoring in, is the lack of help for my aunt, who keeps trying to leave their apartment at the assisted living place. She cannot get out at the nursing facility, as the dementia unit is locked. The entrance I come and go through, is a double-door, painted with a very lifelike bookshelf on the Alzheimer’s side. It is so real looking, that I have to tell myself I am not Alice in Wonderland.

    Unfortunately, what you are describing in terms of Sankie’s behavior, is exactly what my mom and now my aunt have gone through, and was diagnosed as Alzheimer’s. Unless her short-term forgetfulness is caused by the recent drugs she has taken, I doubt she will return to ‘normal’. They can slow the on-set with drugs, but cannot reverse it. My aunt periodically does not recognize her own son.

    A couple weeks before she passed on, my mom told me that I must stop calling her “Mom”, because—she maintained—she “obviously” had not yet had any children. She thought of herself as a young girl, and maintained her parents—dead for decades—were still alive. I took her out for her birthday just weeks before she passed on, and she told me to drop her off at her parents, but not to come in, as they would not approve. We were headed to Tiny House, which she thought of as her parents’ place, and not the house she and my dad had lived in for more than a decade after retirement, and where I was staying with her.

    And this is the stage my aunt is approaching. She maintained the other day that her sister (my dead mother) was coming to visit her that evening. What is even more odd, is that, while my mom did not recognize me, her own son, she did recognize my cousin for who he was. Likewise, my aunt, while not recognizing my cousin as her son, does recognize me for who I am. Very odd.

    All I can say at this point, is that Barbara and Frances’ sanity and peace of mind, should be placed above peace and calm for their parents. Life goes on, and those approaching that change we all will go through, are not aware of the pressure they are putting on loved ones. This was the same for me when Jeri was nearing the end. I quit working during the last 2 weeks, because Jeri could no longer be alone. She should have been institutionalized with professional care when she could no longer get around on her own. I was doing everything for her, 24/7, and were it not that Jeri’s mother and brother arrived for her last several days and spelled me, I might not have survived. I was sick in bed with chills and fever while her mother and brother took over for me while I recovered (doctor daughter in-law said I caught things from being close to Jeri, while her immune system shutting down and allowing things she had to be passed to me). After prodding from the whole family, Jeri finally agreed to go to the hospital to be cared for, because we just could not do it any longer, and cruelly, I had to get back to work or lose my job. Jeri passed on that night in the hospital.

    Not only is it unfair to the loved ones to be forced to provide care, but it is really very unkind to the patient. None of us were trained to care for someone who was dying. Professionals ARE trained to bring comfort and a sense of self-respect when the person can no longer control bodily functions and needs attention every couple of hours. These decisions just cannot be left to the patients, who cannot judge their own condition and needs. It must be in the hands of persons who can still reason—while they still can reason and before they are worn down and lose a sense of sharpness to their judgment.

    Personally, I do not mind being waited on hand and foot (nor does my uncle), so I cannot imagine insisting that I remain at home, when I can no longer do things for myself. My kids have been instructed what to do if I lose it. But it is not cruel to put someone needing care in the hands of professionals trained to deliver it, rather than making family crazy, knowing they cannot interrupt their lives to be forced to give lesser care than the professionals.

    And again, if my aunt and uncle are any indication, in spite of the doctor’s orders, it just might be better for Dutch to be relieved of responsibility for Sankie—at least through he night. The doctors correctly saw that my uncle was utterly exhausted at 90 years of age, from having to deal with my aunt 24/7 with no other help from anyone. Things are much better for him, now that he can get a full night’s sleep without my aunt waking up, dressing, and leaving the premises.

  8. @ Chuck: MP3Gain is the only normalizer that I have tried that does NOT modify tags.

  9. Okay, this may be good news or bad. MP3Gain is actually an implementation of ReplayGain. Now in ReplayGain, there are 2 methods of achieving the ‘volume leveling’ adjustment. One is examining the audio in the file and writing an adjustment figure in the file header—which also contains the ID tag info—that the player looks to and obeys during playback of the file. The other method is to examine the file and make changes by altering the audio portion of the file itself, without touching the header and tag info. MP3Gain uses the latter, which is why it does not touch the tag info.

    Each frame of the MP3 audio has an 8-bit unsigned integer attached which represents the volume of the frame. Values are 0 to 255, although in practice, there are seldom values over 230. MP3Gain uses the ReplayGain analysis to determine how much the overall volume should be altered, then goes in and changes all those frame integers by the same amount, raising or lowering the overall volume. In this method, each 1 unit change in the integer is 1.5db. Multiples of 1.5db are the only changes possible using MP3Gain (or any implementation which modifies the gain integer of the frames).

    Now there are 2 cons to this method. Let’s say the analysis says gain should be reduced by lowering all integers by -6. That means a frame that stood at 4 will be reduced to 0 and no further. Okay, let’s say for some reason you want to recover the original file. You can ‘undo’ the reduction, which is saved only as the total reduction applied to all frames. So that frame of 4, which was reduced to 0 by the -6 reduction, will now be raised to 6 by the undo, and not back to its original 4. There are very few frames that would be affected thusly in most files, but still, it is a consideration.

    The second con is that there are data frames placed by some encoders (not LAME) that carry 0 as their volume integer. If those frames are given the +6—or any other raise—by the undo command, then they are raised to the level of noise interference, and are subsequently audible as blips, clicks, or squeaks.

    So you picks your poison. Most audiophiles consider any of the gain compensation methods to be ‘destructive’, but it looks like MP3Gain is more destructive by changing the frame volume integers of the actual audio, whereas the ones that put volume compensating info into the header/tag info do not actually touch the audio frames themselves.

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