Laudable Linkage

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Here are a few thought-provoking posts discovered recently.

Heart Check: 4 Questions to Gauge the Stage of Your Heart.

My Larry Nassar Testimony Went Viral. But There’s More to the Gospel Than Forgiveness. Interview with Rachel Denhollander.

Most of Life Is Waiting. “I feared my circumstances more than I feared God. I had lost sight of the reality that both trials and triumphs are part of the good story God is writing through me.”

On Threats From a Hostile Culture.

Don’t Hold Loved Ones Back From God.

The Simple Beauty of Wisdom. The ladies at Do Not Depart have been studying through Proverbs in January and end with the last two chapters. I thought the comments about the “virtuous woman” in particular were very practical and encouraging.

What Do We Do With the King James Version?

Enneagram: The Road Back to You, Or to Somewhere Else?, HT to Challies.

How the Mom Internet Became a Spotless, Sponsored Void, HT to Challies. I don’t think it’s totally dead, and I think there is a place for both the “raw” and the “pretty” types of mom blogs, but this makes some insightful observations.

Physician to Parents: You’re Doing It Wrong. The title is a little off-putting, but he has some practical advice here.

Why You Can’t Measure the Value of Homemaking, HT to Challies.

Don’t Stop Coming.

Happy Saturday!

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12 Things You Should Know About Caring For the Elderly

Every now and then I come across articles like “Ten Things Your Plumber Won’t Tell You” or “12 Things Your Doctor Would Like You to Know.” Often they are pretty enlightening.

I’ve written extensively before about our experiences caring for my mother-in-law, almost four years in our home and five years before that in assisting living facilities and a nursing home, and shared some hopefully helpful tips for people in the same situation. But I got to thinking, if I ever had an opportunity to speak to a group or write one article on this topic, what are the top few truths or principles I would share? Probably among them would be these:

1. Preserve as much of their independence for as long as possible. It seems like often family members will see an elderly loved one’s need of assistance before that person does. Sometimes denial causes the elderly to think they can carry on as they always have: I think more often it’s fear of loss of independence. I’ve heard more than one person express dismay or impatience that their loved one won’t just go along with the program and make it easier on everybody and move into a facility already. But have you ever thought about what that involves? Depending on the facility and how much money is available, it means much smaller living space, selling the family home, departing with long-loved objects in order to downsize, communal meals, not being able to control your own medication or, to a certain degree, your schedule.  The first time we moved my mother-in-law into a facility, I thought it was something like a cross between a dorm room and a hospital. I liked the dorms in college: I wouldn’t want to go back to them in my later years. Think about having had your own personal space for 50-odd years and suddenly moving into one room that anyone in the facility can come into at any time. Granted, that accessibility, having the staff control medications, etc., is for one’s safety: but that doesn’t make it any easier or make one look forward to it.

2. If/when you do have to go against their wishes, be as gracious as possible about it. My mother-in-law is very much a “stay with the status quo” type of person, at least since she has been here. She has had hearing aids for as long as I remember, but when she first moved here, she couldn’t hear much at all even with the aids, even if we were sitting next to her and nearly shouting. She’d just smile and say, “You’ll just have to speak up!” Frustrating! My husband took her to an audiologist, and all along the way until she actually got the new hearing aids, she kept saying, “I’m doing all right with what I have: I don’t think we need to get new ones.” Jim just kept quietly insisting that we needed to explore the possibility, and once she got the new ones, she was pleased. She wanted to keep baking soda in her room because she used it as an antacid: Jim didn’t think the extra sodium would be good for her health. Once when I visited she just kept bringing it up and insisting it was fine. I had an “out” in saying Jim didn’t think she should have it, but we kept going over the same points of conversation. He finally compromised in letting her keep a pack of Rolaids in her drawer (which technically we weren’t supposed to do: all medication was supposed to be handed out by the nurse). I don’t think she ever used them, but it must have eased her mind just to have them. It’s hard to know sometimes when to insist and when to let something go. You have to choose your battles. But don’t make it a battle, if possible: don’t be confrontational or argumentative. Thankfully his mom was never combative, but I have friends whose parents are. It’s hard to bathe an 85-year-old adult who doesn’t want a bath and even resists it. You can let it go for a while, but eventually it has to happen. Distraction or diversion works for many things, so perhaps discussing something else while getting set up for the bath will get their minds on another track. (If any of you have tips along this line, feel free to share them!)

3. Convey to them that they are still important and useful. When we moved my mother-in-law into an assisted living facility, my husband told her she would never have to cook or clean again, and after having done those things for most of her life, she was glad to hear it! She loved having time to enjoy reading, her favorite activity. One day when she was visiting our home for a family gathering, and an old family story came up concerning something funny she had said years ago, we all laughed, including her. Then she said, “Well, at least I’m still good for something” (meaning, good for a laugh). I was stunned. I hadn’t realized that she hadn’t felt “good for something,” that she had kind of lost her purpose. One of my regrets is that I didn’t do more on visits with her, like ask her about her life and history and write the answers down to share with other loved ones, or go through a box of very old photos and arrange them in an album with her.

4. Treat them with dignity: don’t treat them like children. Very old age does have some things in common with childhood, but it is not the same. In I’m Still Here: A New Philosophy of Alzheimer’s Care, John Zeisel writes, “It’s not right to think of Alzheimer patients as entering their ‘second childhood.’ They have knowledge and life experience children don’t have.” That’s true of any elderly person. Once when my husband came to pick up his mom at her facility, the aide with her said, “It’s almost like you’ve switched places, isn’t it?” and then turned to his mom and said, “Your daddy is here, honey.” No, it is NOT like that. He had to ask her not to say things like that. Yes, the son or daughter will have to make major decisions and handle things the parent used to, and the parent may be incapable of doing many things any more, but that’s not the same thing as reverting to childhood. Especially fingernails-on-the-chalkboard grating is talking baby talk to them.

5. Do NOT put them in a facility without checking on the regularly and frequently. You would assume that everyone who works in assisted living or a nursing home is kind, professional, skilled, and will take the best possible care of each resident. We learned, sadly, that that’s not the case. I could tell you stories…my husband has said often that he’s going to write a book about this some day. Each place had some jewels in their workers, but each place also had some who were neglectful, who handled her roughly, who paid no attention to her posture, who talked over her to their coworkers and didn’t even look her in the eye while handling her in some way, who didn’t clean her face well after a meal so that she got red, rough irritated spots on her face, etc. Once I walked in to a facility, and they had her in her wheelchair in the common room with the other residents, she was bent over the side of her wheelchair at a 90 degree angle, even though there were several aides in the room, even though we bought some small pillows to help keep her upright in the chair. Plus the employees are overworked and underpaid and the facilities understaffed. On top of that, the residents might not be able to verbalize what’s wrong, either due to dementia or possibly even fear. My mother-in-law had a “don’t rock the boat” personality, and the more she declined, the more help she needed, the more her care declined. “The squeaky wheel gets the grease” is as true here as everywhere else. There were some residents who really needed a staff member with them almost 24/7 for various reasons, and that left the quiet ones like my mother-in-law unattended for too long too often.

6. Don’t forget them. Whereas #5 was more concerned about their safety and well-being, here I mean don’t forget them on a personal level. Continue to interact even if they don’t remember who you are. A lady in our church who writes notes once or twice a month to my mother-in-law checks in with me from time to time to see if she still enjoys them or gets anything out of them. I tell her, honestly, I don’t know if she remembers who the writer is, and I don’t know if she remembers anything the note said five minutes after it’s read to her, but for those few minutes, she knows someone thought about her and cared enough to jot a few lines to her. It’s incredibly sad to us when holidays or her birthday go by (and the days in-between as well) and she hears from almost no one.

7. The best thing you can give them is your time and attention. When my mother-in-law was in a facility, we tried to visit her every day. We usually sat and visited, but I’d run out of things to talk about after a while. I felt more “useful” when I could pick up or straighten her room or do something physical, but that tended to embarrass her. Likewise, gift bags, flowers, etc., are nice, but don’t feel you have to bring anything. What’s most valuable is for someone to face them, look them in the eye, talk directly to them and focus on them, or, if you live away from your loved one, a personal note, perhaps an new photo, or Face Time or Skype if possible.

8. All eating problems do not mean the end is in sight. Whenever I have mentioned eating problems with my mother-in-law to almost any health care professional, they’ll say, “Well, you know, when they get near the end, they’re just not as interested in food.” That may be true, but that doesn’t mean other factors might not be involved. When we moved my mother-in-law to our home from the nursing home, she was around 90 lbs., and we thought we were bringing her home to die. That was four years ago. I think a combination of food prepared and seasoned well, warm and not cold from sitting on a cart while food is distributed, and, most important, someone to feed her who takes time with her, all contributed to her eating well again and gaining weight. We learned that eating tires her out, so sometimes you have to give her a few bites, give her a drink, wait a bit, then try a few more bites. Even now she’ll have certain meals, or even certain days, where she’s just not interesting in eating. Since she doesn’t speak much any more, we don’t know if the food is too hot, too cold, doesn’t taste good, or if she’s just tired or doesn’t feel well. Sometimes I think she’s just not going to open her mouth because eating is the one thing she can control in her life. But that usually lasts just a day or so, sometimes a few days, and then she’s back to eating normally.

9. It is probably going to get worse. My mother-in-law has been on a something of a plateau for a couple of years now, but for a long while, if anyone asked us how she was doing, the response would be that she wasn’t doing very well. Sometimes people were taken aback that we didn’t have a positive cheery answer, like when people say, “How are you?” and expect no other answer except, “Fine, how are you?” in return, and they’re jarred a bit at any other answer, especially a negative one. Once we said, “Well, she’s declining,” and the person responded, “Well, we’re all declining.” (Sigh.) I’ve wondered what people expect when they ask that question in the waning years of a person’s life. The person may have many wonderful days, but in the long run, they are either losing abilities (in my mother-in-law’s case) or multiplying health issues, and things are steadily going downhill.

10. The caregiver needs care. Even if the loved one is in a facility rather than the home, often one of the adult children is primarily in charge of seeing to her care and needs. And of course, if she is being cared for at home, obviously that person or family is taking on the bulk of her care. The caregivers need to know they’re not alone, that everyone else cares. They may need advice, emotional support, financial support, respite. I’ve known some cases where one is the primary caregiver, but the other siblings take the parent home for a weekend or a few days. Distance or the parent’s condition may prevent that, but it’s nice if it can happen. Thankfully we’ve had friends both in church and online who have cared for parents in their home, and they’ve been highly valuable and helpful to confer with, even just to have that fellowship of someone understanding exactly what’s involved.

11. I’m not a saint, except in the Biblical concept that everyone who believes on the  Lord Jesus Christ as Savior is called a saint. Some people put caregivers on a pedestal or overly praise them, but we’re just ordinary people struggling through what we’re called to do. Appreciation or encouragement are more welcome than unvarnished praise, but it’s hard to know where the dividing lines are sometimes.

12. It’s hard. It’s hard to see one’s loved ones decline and to see their circumstances and quality of life reduced. It’s hard to feel the weight of their care. It’s hard to feel guilty about feeling that their care is weighty or about occasional resentment. My husband feels guilty that he doesn’t spend more time with his mom, but she sleeps about 20 hours a day, and it doesn’t do either of them any good for him to sit in her room while she’s sleeping. It’s hard to feel limited. It’s expensive to hire outside help – the agency we use charges $17 an hour, and we already have them here forty+ hours a week just so we’re free to run errands, make appointments, or just have a break. But we can’t just pick up and go out to eat, go on vacation, go to our son’s house, etc., without making arrangements and incurring more expenses. One friend who lived alone with her mom had people who could come over for a few hours or even a couple of days, but, still, that’s a lot to ask of someone, so the caregiver doesn’t feel the freedom to ask that often. In our case, my mother-in-law’s situation and the care needed is such that just having someone come and sit with her would not be sufficient. We’re limited even in ministry: we can’t go to everything that happens at church. My husband was a deacon when we first brought his mom home and submitted his resignation to the pastor because he just couldn’t be away for long meetings, etc., at that time. It’s hard to feel like even mentioning these things sounds like complaining.

I’ve written about this before, but what helps most is just accepting that this is our ministry for now, just like having a new baby in the house is a mother’s primary ministry. As Elisabeth Elliott has said, our limitations just define our ministry: “For it is with the equipment that I have been given that I am to glorify God. It is this job, not that one, that He gave me.” Each ministry carries its own responsibilities, weights, and cares, but “God is able to make all grace abound to you, so that having all sufficiency in all things at all times, you may abound in every good work” (2 Corinthians 9:8).

I’ve written from our experiences and that of friends, but, of course, every experience is different. People have widely varying capacities as they age: we know a 90-year-old who still lives at home, drives, is active at church and with her hobbies, an 80-year-old who still travels internationally and even recently remarried. I had one friend whose mother-in-law had Alzheimer’s but was physically fine, and she was able to take her mother-in-law with her wherever she went, at least in the earlier stages of the disease. And there is much, much more that could be said. But I hope you’ve been able to find some degree of common ground here and something helpful.

(Sharing with Inspire me MondayLiterary Musing Monday, Testimony Tuesday, Wise Woman, and Woman to Woman Word-filled Wednesday)

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Adventures in Elder Care: Ministering to the Elderly and Their Caregivers

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I didn’t feel I could conclude this series without a post about ministering to the elderly. Some of what I wrote about how to help parents as they age would apply generally, but I wanted specifically to address ways to minister to an elderly person who is not your parent.

Neighbors. If you live near an elderly person who is still in his or her own home, just being a good neighbor is a great first step. Greeting them, talking over the back fence or the mailbox, sharing from your garden, taking them treats (after asking about dietary restrictions), etc., are all ways to keep in touch. Most would welcome a visit, but don’t assume that because they’re older and at home most of the time that they don’t mind if you drop in any time. Some wouldn’t, but some would: as you get to know your neighbor, you’ll be able to discern whether she likes to have company or not, or when might be a good time. You want to be alert for ways that they might need help, but you don’t want to run roughshod into their lives or make them feel useless and helpless. Some might love to have you cut their grass, for instance, but some might take pride that they’re still able to do it and might like the exercise. You might especially be alert to checking on them if you haven’t seen them out for a while.

Visiting facilities. If someone you know is in an assisted living facility or a nursing home, visiting them is probably the number one way to minister to them. Even if they have family that visits often, there are still a number of hours in the day when they don’t have visitors (and it helps the family to know that they are not the only ones who care about the loved one). Some will be more involved in the activities of their facilities than others: you might check with them (depending on their mental abilities) or their family members or even one of the staff members to ask when would be the best time.

Some churches have a regular visitation program for their senior members, which is nice. Just don’t do what one lady did: we happened to be visiting my in-laws at their home when a couple of ladies from their church came to visit my husband’s mom. I believe they brought her a flower, and after she exclaimed about it and expressed thanks for their visit (probably more than once), one of them said, “Well, you were on our list.” If you’re doing something for someone just because they’re on a list of some kind — there is no need to say that! It would be much better to ask the Lord before visiting to help you be a blessing and to have wisdom to know how to best minister to and encourage that person.

What might you do when you visit? Ask about the person, how they’re doing, what their day was like. I read a post about visiting the sick where the writer concentrated only on spiritual issues, like praying with them or reading the Bible or encouraging them with the Word, but left out anything personal. Yes, do those spiritual things: an elderly person might not to be able to or remember to read the Bible on their own, and even if they do, the fellowship of doing it with other believers is a great benefit. But don’t make them feel like they’re a project, like the ladies in the above paragraph. Show a personal interest in them. When you do read the Bible to them, remember some might be hard of hearing. It helps to sit right in front of them so they can see your lips moving and to read in a firm, clear, loud but not yelling voice. One friend used to read aloud and discuss something from the large print Readers Digest with my mother-in-law. Going through a photo album and talking about her loved ones was one of her favorite activities as well.

Often when visiting the person you know in a facility, you’ll have occasion to talk for a bit with other residents. Many in assisted living are fine mentally but can’t live at home for various reasons, and we enjoyed chatting with and getting to know some of them.  I mentioned in an earlier post that things can get a little more complicated when the other residents have a higher degree of dementia. The number one thing we were told was “Don’t alter their reality.” If you try to talk them out of whatever they think is happening, they can get greatly agitated, and that causes more problems not only for the person but also for the staff. When my mother-in-law was in a memory care unit made up primarily of Alzheimer’s patients, residents would often stop visitors to ask for their help in some way. Most of them were constantly trying to figure out a way to get out, not because it was so terrible, but just because they knew on some level that they were not home. When we couldn’t help them in whatever way they wanted, they’d get upset, which again caused more problems for everyone involved. Sometimes you can redirect them: once my husband told a resident who wanted him to help her find her car so she could go home, “Well, they’re just about to serve dinner – why don’t you eat with us and we’ll see about the car later.” She graciously accepted. 🙂 Other times we’d just say, “I’m sorry, I’m just visiting, but maybe that person can help you” and point them to a staff member. Honestly, in that place, sometimes we’d just try to avoid eye contact and go straight to my mother-in-law’s room. I felt bad about that, but that seemed the best way to keep the peace. In the nursing home, when someone said they needed help or wanted to get up or whatever, we’d just pat their hand and tell them someone would be along to help them in a few minutes. If someone seemed in real distress, we’d go find a staff member. I’d caution against giving a person other than your family member any physical help or even going into their room. If someone has fallen, you could do more harm than good and open yourself and the facility up to a lawsuit if something negative happened (or even if the resident accused you of something negative). I wouldn’t even help wheel a resident from one place to another without asking a staff member if it is all right: it may be they are supposed to be where they are rather than back in their room at that point in time.

Gifts. Sometimes people like to bring things when they visit. Most of the time it’s not necessary: just the time with you is the best gift. But there are things that make for good gifts and things that don’t. A lot depends on the individual person. Before bringing any food item, check on food allergies or dietary restrictions. Unless you know the person to be in sound mind, I’d check with someone other than them. Again, depending on a person’s abilities, a fruit basket may not be best. It’s healthy, but some might not be able to peel fruit or might not have knives in their room to cut them up, and it might spoil before they can finish it. I’d generally avoid decorative items unless you know the person could use them. Most have had to downsize their possessions to be able to live in one or two rooms and only have limited space on their walls or end tables. An exception would be anything that children have drawn or colored – most love that and can tape the items on a door or somewhere.

Some items that have made good gift baskets for my mother-in-law in the past:

All-occasion greeting cards (back when she was still sending cards)
Stationery and stamps (when she was still writing)
Pens and pencils
Lotions (some might have skin sensitivities)
Bath items: nice-smelling shampoo, body wash, powder. Avoid bath oils – too slippery
Large-print books, magazines, crossword or word search puzzle books
Small individually wrapped chewable candies
Small packages of cookies
Small throw blankets
Slip-proof socks
Magnifying glass
Tissues
Flowers or plants (see note below)

In our experience, cut flowers (even from the visitor’s own garden) worked better than plants. The staff in a facility doesn’t have time to care for a plant. I personally do not have a green thumb. Unless the resident is aware enough to care for one or has family members who visit often enough and don’t mind caring for a plant, cut flowers are best to brighten up the room for a few days and then can be discarded.

Most facilities do not allow any medication in resident’s rooms: all medication has to be dispensed by the staff (though we did get away with Tums), so I wouldn’t include medicine in a gift basket to someone in a facility.

Cards and notes. My mother-in-law has also been blessed by friends and family sending cards. That is a highlight of her day when I bring in a note or card someone has sent and read it to her.

Value. Sometimes we might wonder how much good we’re doing when we visit or send cards, especially if the person has dementia and might not even remember who we are or that we visited or wrote. They might not remember, but for those few minutes you’ve brightened their day and brought them joy, so I’d say, yes, it’s worth it. I wrote in an earlier post, when I struggled whether it was worth it to drive for 40 minutes round trip for 10-15 minutes of groggy conversation, “But really, visiting her shouldn’t be about making me ‘feel useful.’ It’s about letting her know she’s loved and not forgotten and ministering to her in whatever way she needs.” Remember to minister “with good will doing service, as to the Lord, and not to men” (Ephesians 6:7).

Ministering to caregivers. I wanted to mention ministering to caregivers briefly, rather than a separate post, because I don’t have that much to say about it. It has greatly ministered to our hearts when someone have ministered to my mother-in-law in any way. I can’t tell you how much of an encouragement it is when someone goes to see her or writes to her. It’s encouraging when people ask about her, too, but if I can say this without it sounding wrong – ask about her, but ask about other things, too. When my husband was going through months of issues with his eye after a detached retina, he said that all anyone ever talked to him about was his mom and his eye. It’s not that he didn’t appreciate those questions: he did, but it would have been nice to talk about something else sometimes. Often when asked about my mother-in-law, there is really nothing new to say. When people ask me how she’s doing, I generally say, “About the same.” Some seem a little perturbed by that, so sometimes I go on to say, “She sleeps a lot, eats well, talks a lot sometimes but not at all other times.” I figure they don’t really want to know about bowel difficulties or things like that. 🙂 That’s pretty much her life right now. I don’t want people to forget about her and I appreciate their asking, but just understand there is often not much to say. “About the same” is at least a better answer than “She’s declining,” which is what we had to answer for several months before we brought her home. Sometimes people would seem startled by that response, but as a person gets older, that’s what happens.

A few times, especially when we first brought my mother-in-law home, it greatly ministered to me when someone asked, “How are you doing?” and listened with empathy and without judging when I said I was struggling with the idea.

It also helps when people understand that people caring for a parent might not be as available as they once were. A friend’s mother still lives in her own home an hour away and has had so many medical needs and procedures that my friend has had to lay aside some ministries she was involved in to be able to take her mother to various doctors and help her after procedures. In our case, my mother-in-law can’t be left alone, so we can only do things during the morning and early afternoon while we have home health care here, or we have to take turns or just have one of us go to events in the afternoons or evenings. Some times that’s fine, other times I’d rather stay at home than go by myself, and I don’t like to be out too often and leave my husband to spend his evenings or weekends caring for his mom alone after working 50-60 hours a week. Occasionally we’ll pay extra for home health care to be here in the evening, usually when the family is all here so we can go out, but otherwise we just accept that this is going to be a quiet and somewhat limited phase of life. It’s similar to having a new baby in the home: for a period of time, caring for that family member is one’s primary ministry.

Besides showing an interest in my mother-in-law, there is not really much that we need personally. We haven’t needed meals or errands run or that kind of thing. I did come across one article with some ideas along those lines, and Sandy, whose husband received a heart-breaking diagnosis of early-onset Alzheimer’s while in his 40s, has mentioned in passing things that people have done that have blessed her family.

I’d love to hear more ideas from you. If you have an older loved one, what are some things that people have done that have been a help to you?

Other posts in the Adventures in Elder Care series:

Helping Parents As They Age.
Making Decisions for a Parent’s Care.
Our Experiences With Assisted Living and Nursing Homes.
Caring for a Parent at Home.
A Plea to Caregivers.

A public service announcement concerning walkers

No, not the walkers babies use, but the ones the elderly or disabled use.

1. Do not pull or jerk on the walker, even if trying to help the person over a bump. There are several reasons for this:

  • It throws them off balance.
  • The walker is an extension of themselves and it is an invasion of their personal space as much as if you pulled on their arm.
  • It can make them feel helpless and embarrassed.

Sometimes, however, the person may appreciate a little assistance if they are having trouble maneuvering. If you see someone trying to get their walker up a step or over a hump, be patient and observe for a moment and see if they are doing all right or seem frustrated. If you think they might like help, offer first. “Mrs. Jones, can I help you get your walker over this step here?” Don’t just jump in and jerk it. Gently lift it, especially being careful if they are leaning on it for balance: you may need to let them take your arm as well, depending on whether they can balance on their own for a moment or need help with a step.

2. The person with a walker usually understands that he or she is a little slow and you may want to get around them, and that’s fine, but please don’t cut in too closely — the sudden movement and closeness can also cause balance to waver.

3. Some people can’t stand long even with a walker. They would love to talk with you, but may need to sit down first.

4. If you see someone coming with a walker, please move out of their way. Often they feel conspicuous and cumbersome and are embarrassed to ask. Some are not, though, and will just call out a cheery, “Beep, beep!” or something similar — please don’t be offended.

5. Similarly, please don’t be offended if they accidentally bump into you. Sometimes, especially with older people, their depth perception is affected as well. Some might not even be aware that they bumped you, but most would be horrified.

I am writing both from the perspective of having used a walker for several months after TM, but also from my elderly mother-in-law’s perspective now. I think most people mean well, but have just never thought about or experienced some of these things from the point of view of one using a walker. A little patience and thoughtfulness are much appreciated.

Please feel free to share anything I may have forgotten or not thought about, but please keep it positive. I don’t want people to think we’re ranting or griping at them, but rather just informing and educating.