Discussion Topics

Let’s Talk Scenarios supplied to date.
Note: D=was discussed

Several people have asked me (Jim Eastep, GV119, the resident sponsor of Let’s Talk) where these scenarios come from.  There are several answers to that question.  All of them have been reported as actual occurrences at Riderwood. Some were observed and reported by me, some were reported to the manager of social workers for Riderwood and then given to me for this group, and some were reported by other Let’s Talk participants.

All were typed up by me as accurately as I was able, given the way they were provided to me. If you submitted a scenario and feel that details need to be corrected, please let me know, and I will make necessary changes. As with all other details of this group, strict confidentiality is observed and no names are mentioned.

Let’s Talk participants are encouraged to provide scenarios that they have observed (or been involved in) from Riderwood. We have one-page forms for submitting this information. It is helpful, but not required, that submitters provide their own contact information to me, so that I can ask questions if any of the details are unclear to me, but this information is not shared with anyone else.

Please note that all scenarios are described in the “first person” as if the reader was the person describing the scenario while talking. No identity is suggested by that method. It is just an easy way to standardize these descriptions.

1. Getting help to monitor the progression of diseases of aging.

I have been living at Riderwood for over 6 months, and as I suspect is true of most of us, I’m here for a good reason. I was diagnosed with Alzheimer’s disease several years ago, and though I have had to leave my job, get divorced, and struggle through many challenges, I am basically happy here at Riderwood.  However, since I do not have family to keep track of me, I need someone to check in on me and the condition of my apartment every so often. I think about every 6 months would be appropriate at this time.  Who do I contact and how do I make sure I get help when my disease has progressed so that I need it?  Is this the job of the center social worker?  Will she put me on a schedule for home visits for this purpose?  How have others handled this issue?


2. Required DMV drivers test

I was in an accident recently that resulted in a pedestrian injury. The state contacted my doctor, and he suggested a special drivers competency test would be appropriate.  I have taken the test and did not pass. I’m despondent and angry that my mobility has been taken away from me.  What can I do to cope?  How have others dealt with this issue?


D3. Considerations when we get close to each other.

I have been spending a lot of time with a man that I like. Last night we were watching TV, and holding hands.  I felt very close to him, and asked him to spend the night with me.  He said he had to leave, and I got very angry that he did not seem responsive to me, and I really chewed him out.  I’m still fuming about this and I don’t want to see him anymore. What happened here?


Both men and women acknowledged that more open discussion and sharing was needed here. One woman suggested that she should have explained why she wanted him to stay (she felt close to him).  Did she expect him to have sex?  This is sometimes a sensitive issue for older men who may have difficulty “performing” in bed, because of age, or perhaps medications which suppress libido and erections. One man suggested that he may have been happy to stay with her if he could just cuddle and stay close.  We will never know for sure the reasons he left because warmth, caring, and sharing did not occur.


4. Urinary incontinence/urinary tract infection

I had a female friend over to my apartment to watch a movie on TV.  There was a possibility that we could have gotten intimate that night, but she had an incident of urinary incontinence on my sofa, and it was really stinky.  I don’t know how to deal with this.  How does she feel? How have others handled this issue?


5. Intimacy between Riderwood residents…What’s prudent?

My girlfriend and I are getting closer to each other and I think we may be intimate soon. I know that sexually transmitted diseases are very prevalent in the DC area, even more than other parts of the country, and that some of these diseases such as HIV and cancer from human papilloma virus can kill.  How can we plan for responsible and caring intimacy?  I’ve heard that blood tests can help us prepare. What do we ask for and where can this be done?  Is our own health clinic ready to provide good information?

6. Social implications of hearing problems

I am a new resident at Riderwood trying to make friends.  My friends tell me that I am a likable guy, and I enjoy the company of others, but I have a fairly severe hearing problem that makes it almost impossible for me to understand normal conversations at the dinner table in the restaurants.  How do others view this situation?  How have they dealt with it?  I’m single, having lost my wife to cancer several years ago.  Will my hearing problem prevent me from finding another female companion?  Will it prevent me from developing close friendships with the guys?


7. Fecal incontinence

I have a problem with diarrhea due to my medication which increases the speed that food passes through my system. Almost every morning after breakfast I have almost explosive diarrhea that requires me to be close to a bathroom until this is over.  Have others had this problem?  This medication is for memory problems.  How have they dealt with it?  Am I alone with this problem?


8. Getting things done in our apartment

    a. I need help moving some furniture in my apartment. Is there a way that I can get help from Riderwood to do this?
    b. I’m having trouble with my television and I need to contact Comcast to resolve the problem, but I can’t really describe the problem and I have difficulty navigating their automated telephone system. How can I get help with this?


9. Passing gas

The other day while I was examining the Riderwood activity board a woman I know was doing the same thing. We started talking and almost immediately she passed a bunch of gas.  She tried to “talk over” it. I didn’t know what to do, but I was very embarrassed for her. I know seniors sometimes have this problem and that it comes out with little warning and some of us have very little control over it, but how can this problem be handled with compassion and diplomacy?


10. How will she respond?

Recently, I discovered that I can no longer get an erection for sexual intercourse.  I’m taking medication for memory and easy agitation.  I understand that some medications for depression and agitation can have this effect.  I don’t know if my problem is age related or just a side effect of my medication, but I’m concerned what my partner would think.  I don’t have a partner right now, but what will she think when the time comes for this level of intimacy?  I know I can please her sexually in other ways but I don’t know how she will feel about me since I can’t have sex the usual/normal way?  I don’t yet know if Viagra is an option for me, but how do women feel about the use of this drug and this problem in general?


Several people offered great sharing from their own personal experience. Several people pointed out that closeness, sharing, and understanding between the man and woman is very important.  One woman shared that she had been in this situation. Her boyfriend was unable to have regular sex, but that they were able to be very intimate in ways that was satisfying for both of them in other ways. Details were not provided, but perhaps the group will be ready for other discussion at another time.  Surely her sharing was very reassuring for men who have experienced this problem.  Perhaps a brief talk from a professional medical person could explain the physiology, causes, and treatment for reduced libido in men at another time.


This issue was initially  presented as an illustration of why it is important that we respect our confidentiality rules whenever a participant chooses to share problems that are embarrassing, and certainly should be private.  There was discussion of this issue in a subsequent Let’s Talk meeting, and that discussion is summarized above.


11. MCI = Mild Cognitive Impairment
I have just been diagnosed with mild cognitive impairment.  I realize that I forget things that people say to me and sometimes my mind gets fuzzy when someone is having a conversation with me.  Should I say something to people or just ignore it, hoping that they won’t notice?


 12. Younger than him
I recently came to Riderwood with my husband.  He is 15 years older than me and is so happy that we now  live here.  He loves the people, the activities, the food, everything.  As for me,  I feel like I am living in an old folks home.  I’m even embarrassed to invite my friends to visit me.  I miss my home so much.  I’m miserable, but I don’t want to ruin things for him.  What do I do?


13. Needy neighbor

I have a new neighbor who keeps knocking on my door, asking me to help her with things, always wanting me to go everywhere with her, and always asking me to have dinner with her.  After my husband died, I came to Riderwood for some peace and quiet, but I feel like I’m a caregiver all over again.  She’s so sweet and I don’t want to be rude to her.  I just want my space!!


D14. Doggy Disturbance
My neighbor has two dogs that bark constantly and do their business on my back lawn.  I don’t want to be mean, but they are ruining my garden and keeping me up at night.  I’m afraid to say something.
There was a little disparity of opinions on this one. Some thought that they would like to notify the resident of the problem before bringing it to management’s attention, and some thought it would be better to discuss the problem with the social worker of that center and see what she can do to resolve the problem. This would avoid a direct conflict between the owner-resident and the one(s) who are disturbed by the dog’s behavior.


D15. Blowing smoke
I’m very sensitive to cigarette smoke.  The neighbor who lives underneath me smokes in her room with the window open and the smoke wafts up and comes right in my bedroom window.  I don’t want to have to close my window all the time as I enjoy the fresh breezes.  This is really making things miserable for me.
Like item #14 above there was some disparity of opinions on the best first step, but there was general agreement that if the bothered resident was not inclined to speak with the smoker themselves, that consulting the social worker would be the appropriate place to get them to help resolve the problem.


D16. Doesn’t click
Near rehab in Montgomery Station the outside door occasionally doesn’t latch.  This means that an intruder could enter here without a key.
Though it took me some time to follow up on this, I checked the door near the rehab area in Montgomery Station and also another door I had previously noticed with problems at the entrance to the Charles Terrace parking lot entrance. Both of them worked fine at that time (4/2/14). If participants have any other doors they are concerned about, please notify Bo Lundh at (301-572-8330) if you have notified your local general services provider and they have not corrected the problem.


D17. “Bedroom Eyes” (Ptosis)
    When I first arrived at Riderwood several years ago, my husband had just died.  I was trying to adjust to this new living situation and my new life here.  I tried very hard to make new friends, mostly meeting them at dinner. I spoke to both men and women in a friendly cordial way.  I was shocked when one woman accused me of “making eyes” at her husband.  I was just being friendly like I am with everyone.  Several other people remarked about my “bedroom eyes”.  I cried at how my appearance was interpreted by others. I visited my ophthalmologist to ask if he could do surgery on my droopy eyelids to correct this disturbing “defect”.  He said there was nothing wrong with my eyes and he would not do surgery.  This has haunted me for all of the years I’ve been here. Has anyone else suffered like this? What can I do?
Ptosis is the medical term for drooping of the upper eyelid. This condition may affect one or both eyes. It can be a condition of early development, a result of aging, or acquired from trauma, or a muscular or neurologic disease. The group was very sympathetic to those with this condition and the misunderstandings that result. Though uncertain of the best “solution”, participants agreed that education of the public and sharing with others the real nature of this appearance should help others to accept and not misinterpret it.


D18.  Scary notification
   Recently I was admitted to the hospital for a problem.  Though I was brought to the emergency room by the Emergency Medical Technicians, I was completely awake and aware during my transport.  I am upset that the person who notified my next of kin, told them that I was unconscious during my transport to the hospital.  This caused undue concern. I would like to know who, at Riderwood does this notification of next of kin, and make sure that accurate information is transmitted to next of kin from now on.
Mr. Lundh’s Answer:
I would suggest the resident to contact Anthony Fowler, the manager overseeing EMT.  He can address both the process and any transportation/notification concerns. Anthony can be reached on phone number 301-572-1300 ext. 2075 or by visiting his office in King’s Court terrace level (General Services).
Questions posed to Mr. Fowler:
1) Who from Riderwood notifies next of kin when someone is transported to the hospital, whether they are conscious or not.  I think the author of this scenario wants to know a  name, title, and phone number of that person so that they can contact them after our next meeting for further information if it should be still needed.
2) Now that you are aware of this issue, what have you done to be sure it doesn’t happen again?  It appears to me that you are cutting and pasting some text from a policy manual somewhere without considering what the question and this issue really is.
Mr. Fowler’s Answer:
The security officer that was the primary care provider on-scene would most likely have been the officer that would have contacted the resident’s emergency contact or agent.  Please encourage the resident involved in the incident to contact me directly so that I may gather more information and conduct a follow up investigation into the incident.


D19. Cart Quandary
   I have been at Riderwood since the first building was built. Back then we could always find transport carts at the front desk in designated areas.  However, these days they are often missing from their storage areas, and the front desk personnel assume that residents have them in their apartments. Yet when I have insisted that they be looked for, the staff seems to be bringing a bunch of them from some unknown location.  I would like to know if it is the front desk person’s responsibility to be sure that carts are available. Can Riderwood share their job descriptions with the residents on this issue?
Questions for Mr. Lundh:
Is it the responsibility of the front desk personnel to make sure that carts are available for resident check out when they need them?
Mr. Lundh’s Answer:
Riderwood provide carts at the front desk, but it is the person borrowing the cart that is responsible to bring back the cart.  Staff is bringing back carts if they see them left on campus.  If carts are disproportionally returned between neighborhoods we are bringing back cart to the other neighborhoods.
Are they stored somewhere else besides in the designated front desk areas?
Mr. Lundh’s Answer: No!
Could you provide us with a copy of the job description?
Mr. Lundh’s Answer:
Management of carts is not part of the job description for front desk staff.  If there are additional questions around responsibilities, I would be more than happy to address them.


20. Patient in denial
One of my neighbors recently told me that her husband has Alzheimer’s Disease. This helped me to understand why she was ordering his food at dinner. Why must she do this for him?  She said he is in denial of his disease.  How should we friends and residents respond when we are sitting at the table with this couple?  How should we and the spouse handle this situation tactfully?


D21. Reduced appetite (Anorexia)
   I used to dine with a couple, good friends, at least once a week. The wife began to be affected with her Alzheimer condition and started to eat less and less. Her husband would order her food and then pressure her to eat.  He was visibly concerned and upset and would coax her to eat.  This happened repeatedly and made it very uncomfortable for the others at the table.  Is there any way for the husband and us, as friends, to handle this better?  Why does the appetite decline like this in Alzheimer’s Disease?

Several suggestions were suggested by the group:
a. Try smaller portions, might help sense of accomplishment.
b. Sometimes cancer patients have reduced appetite. Has a recent medical examination been done?
c. There are medications that can stimulate appetite: Ask your physician for suggestions.
d. Ginger (ginger ale, ginger altoids, etc. are known home remedies for loss of appetite.
e. Senior supplement drinks (Ensure, etc.) can help provide nutrition when appetite is poor.
f. Exercise, massages, and other activity can stimulate appetite.


D22. Heavy Doors
   Parking next to the chapel, the exit door is extremely heavy. I have tried to bring this to the appropriate person, and have been told that they will “Look into this”, but the problem is never resolved.  There has also been a door exiting the Charles Terrace building to the parking lot which has no device to pull the door closed whenever it is opened. This problem has existed for weeks. When there is a problem with exit doors, what can we do to be sure this is brought to the attention of Riderwood management in a way that will assure that these issues are attended to promptly?
We agreed that we should notify Mr. Lundh and get his opinion. I apologize that I have not done that yet.  I will get on this.


D23. Feeling isolated when spouse has Alzheimer’s Disease
   My wife has had Alzheimer’s Disease for quite some time. She had trouble eating and we decided to eat in our apartment. This means that we don’t get to socialize with everyone like we used to, every day at dinner. Since then, I have felt isolated from everyone. We now have several home health aides come to help my wife with the things she can’t do on her own. I find that now she seems to show more affection to them than she does to me. I’m very sad.  It’s like I’m no longer living with the woman I once was, and we no longer have the intimacy of husband and wife. What can I do?  I’m very depressed.
This scenario prompted an excellent discussion for nearly the entire next session. Many thanks to the scenario provider for this very important topic. Suggestions of participants were that we recognize that it is sometimes difficult to show affection and tenderness with our spouse when the day-to-day stresses are peaking, but several members felt that touching, hugging, stroking her leg, holding hands, sitting close…and many more ideas I forgot to include would help rekindle affection between spouses.
There is no question that this is one of the most worrisome problems we struggle with during our lives in a continuing care retirement community. If other members think of good suggestions that I missed, please remind me to add them.


D24.  Unresponsive clinicians?
On several occasions when I have sought medical attention from several specialists associated with the Riderwood Medical Center, I have found them to be unresponsive and unhelpful.  This was certainly not what I would have expected in a facility for those with cognitive and physical problems.  My experience was very frustrating and has led me to think that in some cases Riderwood could do better for purposes of providing quality medical specialist services.  Would it be possible for Riderwood to allow periodic resident evaluations of each of the medical providers we have here and that results not only be shared with residents but also that these evaluations have some bearing on the provider’s continued service to Riderwood residents?
There was agreement from several group participants that several specialty services were not as supportive or helpful as we should expect, and support for the suggestion that periodic resident evaluation of our clinicians be done, and the results posted for review by residents.  Left unresolved was exactly how to present this issue to Riderwood Administration for consideration.


D25. Don’t residents have the right to choose?

A friend and fellow resident here at Riderwood who was having a variety of health  issues asked me to accompany him to a meeting he tried to schedule with his social worker.  Although my friend told her that he wanted me to attend the meeting with him, the social worker insisted that HIPAA (Health Insurance Portability and Accountability Act) requirements precluded her talking about his case issues with me present.  A similar situation arose soon after regarding a meeting with his doctor.  In neither case do I feel that HIPAA requirements were being applied correctly or that my friend’s interests and desires were well served.  What are HIPAA’s requirements and how do Riderwood’s various service providers interpret and apply them to residents?
There was a spirited discussion of this scenario and general agreement that HIPAA requirements are indeed complicated, not very well understood, and possibly too often applied more restrictively than appropriate out of a fear of law suits.  It was suggested that the Riderwood Administration offer a briefing/Q&A opportunity for residents wherein appropriate persons could explain in as simple terms as possible the HIPAA requirements and how Riderwood’s service providers interpret them.  Given the late stage in life that all Riderwood residents are in, there would likely be a great deal of interest in such an event.
As for how this issue could be put forward, one avenue might be through the RAC; another might be for someone to raise this suggestion in the context of one of the regularly scheduled public meetings with Administration.


26. Coping with the death of friends.
At Riderwood it is not difficult to establish both close and casual relationships with many other residents.  The meal structure and many activities can foster a strong sense of community, even a significant level of caring for one another.  In some cases I expect these bonds might be stronger than those we had with neighbors in the neighborhoods we left.  Another fact of life at Riderwood is that a very large percentage of the people with whom we have built relationships are quite old and can quite suddenly and unexpectedly disappear forever from our lives.  How do folks deal with such losses without getting depressed or backing off from establishing close relationships?


27. What to do about Complainers?
What do you do when someone complains about everything tht pertains to Riderwood?  Nothing is good.  I have been tempted to tell this person to move.


28. Please keep the scenario sheets coming!!!


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