Lessons on proper elder care after my mother’s death

We buried my Mom last month. 

In the summer of last year, I first drove her to her new memory care facility. My heart was breaking. She was so scared and vulnerable but was trying so hard to be brave. My brother said it was like taking your kid to pre-school for the first time. And never going back to pick her up. 

But we had to do it. She was far too confused for our 97-year-old Dad to take care of her. She didn’t recognize him. She would lock herself in her room, afraid of the “strange man” in their apartment. She wasn’t eating well, and with COVID restrictions we couldn’t get into her independent living facility to monitor her diet or her health. Worst of all, she would wander. Unable to recognize “home” and unable to convince anybody to come get her, she would set off by herself. Dad would realize she was missing and frantically try to find her. Fortunately for us, she always attempted her escapes when the night security guard was at his desk. But we were terrified that some evening she would get out while he was away, and she would roam out into the winter night. 

We knew that, without round the clock support, we couldn’t keep her safe in any of our homes either. So, we concluded that she needed to be placed in a secure memory care facility. I think it was one of the hardest decisions my family has ever faced. We researched. We consulted experts. We hired a placement agency. We came close to placing her in one home, then chickened out because we felt like the owner was pressuring us.  

Finally, we landed on what looked like the best facility for our needs. They specialized in memory care, and we were assured that the staff had been trained to care for people with dementia. They took notes about her diet, health, likes and dislikes. Most important, it was a secured facility. They knew that Mom wandered, and their secured doors and round the clock caregiver oversight seemed like the best way to keep her safe. It was the most expensive facility we had seen. But we figured her safety and well-being were worth it. 

On Jan. 12, Mom was found in that facility’s back yard. Frozen to death.  

She had let herself out through an unsecured exterior door, unnoticed and unimpeded, on a cold winter evening. No one realized she was missing until the next morning.  A health department investigator told me that she had been out there at least 12 hours. Which means caregivers over three shifts failed to recognize her absence. I’m told she was wearing thin pants, a short-sleeved shirt and socks. The overnight low was 20 degrees. 

We are devastated. Beyond devastated. Frankly, I don’t know that it has completely sunk in yet. I think the brain only lets in a little horror at a time. I re-read what I just wrote, and think “Wow, that would be a really horrible thing to happen to a loved one.” 

I debated what my first column after Mom’s death would look like. I have felt compelled, in social media, to celebrate the person my Mom was and the way she lived. To keep the memory alive of the truly amazing person she was. But I think I did it mostly to distract my mind from the horror of how she died. 

But I am feeling more compelled, in this moment, to tell the story of how she died. Because I think it needs to be told. Because others are struggling with the agonizing decision to place a parent in memory care. Because when we were doing our research, we would have wanted to know that these kind of things happen. 

I am not naming the facility here. It will be public knowledge when the Colorado Department of Health and Environment report is completed. From what I am told, they are horrified at what happened and are working very hard to make sure it never happens again.

My point here is much bigger. I am discovering the enormous problems we face in senior care, particularly in the era of COVID. I was told by someone in the industry that, since the facilities are locked down and families can’t get in to check on their loved ones, standards are slipping in many places. With no oversight, caregivers and managers are getting lazy. I was in regular communication with Mom’s house manager, and I raised flags every time I suspected a problem. But you can only ascertain so much in phone conversations with a dementia patient. 

Now, since her death, we have discovered that her nightly 2 a.m. bed check — a state mandated protocol — had only been done once in the ten days before her death. She could have disappeared on any of those nights, and no one would have realized it. 

I have wracked my brain, to figure out what we could have done differently. The facility had no previous infractions. Their reputation was stellar. Their people seemed very caring. Their web site would make you want to move in yourself. 

Knowing what I know now, I would have asked some very specific questions. How are the doors secured? Are they alarmed? Is the back yard accessible at night? Are bed checks actually done every night? Who checks the logs to confirm? 

I would check for infractions at the CDPHE web site. Then I would find out who owns the facility, and do some online stalking. Is this a person with a history of caring for the elderly, or just someone who has jumped into the very trendy, very profitable business of elder care? I am very concerned that, for many, this “business model” is built on maximizing profits by minimizing compensation for front line workers — the people actually caring for our loved ones. 

Dad is living with me now. We are not inclined to trust any facilities with his care. Watching him grieve has been heartbreaking. If you talk to him, do me a favor and don’t mention how she died. It’s hard enough to say good-bye to his wife of nearly 60 years, without having to grapple with this, too. 

I am, frankly, still in disbelief. I don’t know exactly where I am going from here. But I do know one thing. I want my Mom’s death to spur a closer look at the way we care for our vulnerable elderly. 

Because I don’t want what happened to my Mom to happen to another vulnerable elderly person again. Ever. 

COMING UP: Sin, suicide and the perfect mercy of God

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I love my hair stylist. 

She’s a devoted Christian. So, when I see her, we tend to have much deeper discussions than the usual gossipy hair stylist sessions. And, because it’s a small shop, the discussions often branch out to the other people within earshot, waiting for their appointments or waiting for their color to process. Because she tends to attract a smart and faithful clientele, the discussion is always interesting. 

Yesterday, at my bimonthly appointment, we somehow got onto the topic of suicide — specifically, the insidious way that it spreads among teenagers. One suicide often leads to another, which leads to another. I made the comment “It is demonic.” 

At that point, a woman in the waiting area chimed in. “I disagree. I’m Catholic. It used to be a mortal sin, but they changed it. It’s not any more. It’s mental illness.” 

If a nice Catholic lady at my hair salon could be confused about this, I figured perhaps some of you out there may be as well. Which made me think perhaps it’s time for a little review on the nature of sin — both in general, and specifically as it applies to suicide. 

First, sin in general. The fundamental point here is that the Catholic Church has no power to decide what is a sin and what isn’t. It’s not like there’s a committee that meets periodically to review the list of sins, and decide if any need to be promoted from venial to mortal, or demoted from mortal to venial, or dropped from the list entirely. 

Sins are sins because they are outside of God’s will. And they are outside of God’s will because they have the potential to do tremendous damage to people created in His image and likeness, whom He loves. We know they are sins because it was revealed to us in Scripture, or it has been handed down from the time of Christ in sacred tradition. Sometimes the Church must apply these timeless, God-given principles to new situations, to determine the morality of technologies undreamt of in ancient times. 

The Church has the authority to do that because she received it from Christ, her bridegroom. And once she does declare on a subject, we believe it is done through the inspiration of the Holy Spirit, who is the same yesterday, today and tomorrow. So the Church isn’t going to change her mind. Something can’t be a sin, and then suddenly NOT be a sin. 

“But,” you ask. “What about eating meat on Friday? That was a sin, and now it isn’t.” This is an example of a discipline of the Church. Eating meat has never, in itself, been an objectively sinful behavior — on Fridays or any other day. But the Church was calling us, as Jesus calls us, to do penance. And the Church selected that penance as something we could all, as a Church, do together. The sin was never in the ingestion of the meat. It was in disobeying the Church in this matter. This particular discipline has been dropped. But it doesn’t change our obligation to in some way do penance for our sins and the sins of the world. 

Now, on to suicide. It is obvious that something must have changed in the teachings of the Church. Because, in the olden days, a person who committed suicide couldn’t be buried with a Catholic funeral Mass. And now they can. So what gives? 

Here’s the situation. Taking innocent human life is always a grave evil. (I add the “innocent” qualifier to distinguish this discussion from one about self defense, or about the death penalty — which in a sense is self defense. But those are separate discussions.) God is the author of life, and it is He who decides when our lives will end. To usurp that power always has been, and always will be, a grave moral evil. 

But there is an important distinction we must understand. There is the objective gravity of the sin — the nature of it, and the great damage done by it. Then there is the question of the individual’s moral culpability of that sin. In other words: a great evil was done. But is the person who did it liable to judgment for it? Or were there extenuating circumstances that mean that, while the evil was indeed done, the person who did it was somehow functioning in a diminished capacity that reduces or eliminates their moral responsibility? 

For a person to be culpable for a mortal sin, three conditions must be met. First, the objective act must be gravely sinful. Second and third, the person committing the sin must do so with full knowledge of the sinfulness of the act, and full consent of the will. In the question of suicide, we have learned to much about the psychological condition of a person driven to such a horrible deed. The instinct to self preservation is strong. In order to overcome it, the mental and/or physical suffering is frequently very intense. There may even be, as my friend at the salon mentioned, mental illness involved. All of this can drastically reduce a person’s mental and intellectual capacity to make rational decisions. 

And so, while an objectively horrifying act has occurred, God may very well have tremendous mercy on that person’s soul, given the extreme states of agitation and pain that led up to the act. 

Know that I write all of this as someone who has lost one beloved relative and several friends to suicide. And I am tremendously optimistic in my hope that they are with God. Not because they didn’t do something terrible, or that what they did was somehow justified. But because the God who loves them sees their hearts, and knows that pain and suffering can drive people to acts they wouldn’t possibly consider while in their “right” minds. 

And this is why the Church offers the Rite of Christian Burial to those who die by suicide. Because they need the prayers. And their families need the comfort. And because the Church, too, believes in that the God who embodies perfect justice also embodies perfect mercy. 

And we live in great hope that they are with Him.