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A Bad Fall

Dementia Creeps Up on the Best of Us

By James R. Hood

In hindsight, the late October call from the Florida hospital shouldn't have been such a surprise. A hospital social worker was calling to say that my 95-year-old Uncle Charles was hospitalized after taking a fall.

Now it's hardly surprising that a 95-year-old should take a spill now and then. But what was unexpected was that Charles had fallen in the parking lot of a motel just a few blocks from his retirement community condo. The police told the hospital staff that he had been living in the motel off and on for the last month or two but that he had also been living out of his car for much of the time.

"Why would he be doing that? His home is just down the street," I asked. The social worker didn't know but said that Uncle Charles had told her he had been driving to Chicago but had somehow wound up back in Florida.

Years ago my wife (who is an attorney) and I had helped Charles draw up his will. He made me his medical surrogate and granted me his power of attorney. Thus, with Charles now apparently befogged by dementia and confusion, it was up to me to make crucial decisions about his care and figure out how to pay for it.

It's always difficult for those who were once children to suddenly take charge of their older relatives and, although the process of elimination has made me Charles' closest living relative, the truth is I barely know the man and was a little reluctant to confine him against his will, though I was told it was a necessity.

I told the social worker I would be there as soon as possible and arranged through an intricate series of phone calls to get him admitted, at least temporarily, to the dementia unit at one of the better assisted living facilities in the area.

Unfortunately, it would be several days before I got there. My mother, 89, is undergoing chemotherapy and on chemo days I drive her to and from the clinic and otherwise look after her. One of those days was approaching and would have to come first.

My wife's mother, also 80 something, was in her second week of hospitalization on Long Island with complications from a triple bypass and my spouse was in New York helping with preparations for her mother's return home. Our daughter is self-reliant but at 13 isn't old enough to be left alone so I was unable to get away for the next few days.

Welcome to the "sandwich generation."

I surfed over to Orbitz.com and reserved a $400 round-trip from Washington Dulles to Tampa for a few days hence, rented a car through Priceline for $35 per day and called the motel where my uncle had collapsed to make a reservation.

"Oh, we're so worried about Charles," the inn manager said as soon as I gave her my name. "He is such a dear man and we have been so concerned about him."

Charles was more than a familiar face at the inn. He had practically lived there since his wife died a decade ago, usually eating three meals a day in the inn's restaurant. Misfortune struck last year when Walgreen's bought the restaurant building and tore it down to build a new drug store, leaving Charles with no place to eat.

On my last visit to Charles' condo, the refrigerator had been empty and the freezer filled with empty water bottles. Charles explained that this conserved electricity. The microwave oven had never been used. It would be easier to sell the condo after his death if the microwave was in good condition, he explained.

Obviously, cooking and Charles never met.

Add to this the abysmal state of the culinary offerings in Charles' retirement heaven (Wendy's is about as good as it gets) and you have a recipe for malnutrition. Add to that Charles' increasing isolation as a widower and his reluctant decision to give up golf at 93 and you have an elderly gentleman who spent too many hours spinning webs, not enough hours eating, moving around and talking with others.

My mother had reported with exasperation a few months earlier that Charles, brother of her late husband, had said that he was thinking of selling his condo and moving back to the Illinois town where he had been a strapping lad some 85 or so years ago. Preoccupied with my own concerns, I thought little of this but called Charles and chatted him up about it.

"You thinking of moving back to Illinois?" I asked.

"Yeah, I thought I might sell this place and get me a little shack in town there, next to some of my old pals. And of course Marie is buried there, so they wouldn't have to do more than drag me a few blocks to the cemetery when the time comes," he said.

The Hood men are tale spinners and given to an odd intermixture of understatement and hyperbole, which leads to their seldom being taken seriously, at least intramurally. I considered this to be typical old-Hood-boy web-spinning and played along with it in a "yeah, someday" mode.

Mistake. Alzheimer's and other dementias creep up on us, patient and family alike. Some form of dementia had sneaked up on Charles and had stolen large parts of him, unbeknownst to him and, stupidly, me. Although I have spent years working in the public affairs and communications end of aging services and caregiving, I didn't pick up on the signs. Neither did most of Charles' Florida friends who saw him at church and on his occasional outings.

One of the drawbacks to being a reserved, somewhat droll individual is that faintly outrageous statements are taken as just another tongue-in-cheek witticism, masking one's loss of touch from those who might otherwise detect it.

And so, without telling anyone, Charles sold his condo and somehow disposed of his furniture and golf cart; whether he sold it, gave it away or buried it somewhere remains unknown.

He then "packed," got into his 1989 Buick and headed north, stopping at the inn for an evening or two before he hit I-75. Strange thing is, he kept reappearing at the inn every few nights, like a comet with a very constricted orbit. He would mumble about traffic, then set out again. Where he spent the other days and nights is unknown.

Eventually, Charles collapsed in the inn's parking lot and wound up in the hospital, where I belatedly came into the picture.

I arrived in retirement heaven late Tuesday night. At the local attorney's office the next morning, we reviewed the power of attorney, medical surrogate form, will and Charles' collection of bank, bond, stock and mutual fund statements, some current, others ancient. All of these had come out of Charles' car, which I was told was parked at the inn, though I had looked for it and hadn't seen it.

Missing were Charles' wallet and his checkbooks. Oddly present was a rather elaborate mahogany box, which the attorney, through an abundance of caution, had not yet opened. We pried it open, finding the mythic family silver. This gold-plated setting for 8 was said to date back to about the time of the Norman Invasion and had been at the center of numerous family feuds, including a few I dimly remember from childhood.

Pathetic is perhaps the word that best describes this supposedly priceless heirloom, now found stuffed in a box with old mutual fund statements and keys to safe deposit boxes in banks that have not existed since 1930. The last person holding the family silver wins? Not so sure about that.

I filled the rest of the morning with visits to two local banks where many of Charles' assets were held. With the power of attorney, I arranged for statements to be sent to me and set up the mechanism to transfer funds into a checking account as needed to pay for his care.

The one bright spot in Charles' predicament was that he was, by normal standards, loaded. He had more than enough savings to pay for the best private-pay care. Very few Americans are this fortunate and the entire scenario would have been much grimmer without Charles' nest egg.

After the banking chores, I beat it over to the assisted living facility, performed the formalities and niceties with the staff there, then swallowed hard and went to see Charles. He was in bed at 2 p.m., wearing a hospital gown, largely because he had no clothes beyond those he had been wearing when he was taken into the hospital. I asked how he was doing.

"Well, fine, except I'm locked up with a bunch of crazy people and they took my pants away," he said, the corner of his mouth turning up slightly, which passes for a grin in our family.

"Uncle Charley, we need to get your clothes. Do you have any idea where they are?" I asked.

"Why, they're in the car. I'm all packed for my trip to Illinois," he said.

"What color is your car?" I asked. "I know it's a Buick but I can't remember the color."

"It's burgundy," he said. "The paint's a little faded because it sat out in the sun so much. My suit's in there. I want to wear my gray suit when I go to Illinois."

Charles was always a car guy and took very good care of his cars, which were usually top-of-the-line Detroit iron. I had already looked through the inn lot, where the police said his car had been left, but couldn't find it.

Determined to find the car and its contents, I drove back across town, all of a three-minute trip, and cased the lot again. Nothing. Well, there was a burgundy Buick there but it couldn't possibly be Charles' car. Surely this car belonged to a migrant farm worker who had stopped at the inn for some reason. Its top was rusted, the right side badly scraped, a headlight lens broken and, most significantly, it was piled to the ceiling with trash.

I turned the key we had found in Charles' one pair of pants and popped the trunk. Inside was everything but the golf cart – a mad jumble of dirty socks, small appliances, old pictures, golfing trophies, a 1924 basketball trophy, silk neckties, golfing caps, shirts, suits and plastic bags containing just about anything.

The back seat was even worse. There were two huge Samsonite suitcases, completely empty. There were fast food containers, underwear, a flashlight, two canes, lamps, telephones, a radio, more bank statements, two more canes and any number of one-of-a-kind shoes – all mixed together in one big jumble.

This is the way somebody's car would look if they had Alzheimer's, I thought.

Until that moment, I had been deluding myself that Charles was dehydrated, malnourished and confused from injuries suffered in the fall. A physically powerful but restrained and unfailingly polite gentleman, Charles had been an amateur boxer, prison guard and U.S. Border Patrol officer before he and my father teamed up to poison the Midwestern sky by helping to manage a zinc refinery in the sylvan village of East St. Louis, Illinois.

Charles had been known to settle disputes decisively and had during his middle years wound up in the occasional tight spot for so doing. This did wonders for his standing in the eyes of a certain nephew of similar temperament though less ability.

I went sadly back to the dementia ward and began trudging in with assorted loot. I dug around in the junk to extract family photos, trophies and other mementos and tried to find clothes that didn't smell too bad. Three or four trips was all I could manage. I remembered to bring the gray suit for Charles' trip to Illinois.

I realized that in my earlier visit I had merely skirted touchy topics, hoping to delay the moment of truth. This time, I put a toe in the water.

"Charley, do you know where your wallet is?"

"Yeah, it's with my checkbook. It's in that black box that they have at that place that's not a bank but they can send it to any bank you want them to so you can get it when you need it. I can't think of the name of it," he said.

"You know I went to both of your banks this morning – Bank of America and Wachovia – and got all of your accounts in order there so you won't have to worry about paying the bills while you stay here," I said.

"Wachovia's not really a bank. There used to be a bank there, Barnett's Bank, but now this Wachovia bought it. Wachovia's not a bank. It's a company but they run it like a bank. It's a rec center too," he said.

We meandered on like this for a few more minutes before the 3 p.m. sing-along got under way in the "Living Room." Uncle Charles, by now nattily attired, made his way eagerly down the hall, thinking it might be time to eat. I retreated to Charles' room and sat there, staring out the window and rebuffing the staff's attempts to lure me to the sing-along, explaining I really didn't feel up to it.

The next day, I had lunch with Charles and three ladies from his floor who were entranced by the well-traveled, snappily-dressed raconteur who had appeared among them.

As I prepared to leave, I hugged my Uncle Charley, the last living genetic link to my sorely missed father, and said I would be back to see him in December.

"Hell, I'll be in Illinois by December," he said.

---

Postscript: Uncle Charles spent just a few happy months in the assisted living facility before he died suddenly of a stoke Feb. 2. Though it's easy to say it's "for the best," the fact is he could have spent four or five years in a comfortable, protective, socially-engaging setting if his only nephew had paid a little more attention. Moral: The only way to be sure elderly relatives are OK is to visit them -- in person and frequently.

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