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How I was prepared to work with Older Adult Patients

By: James J Messina, Ph.D., NCC, CCMHC, DMHS-T

What the Steps in being a Caretaker for My Older Adult Parents taught me

People have asked me how I was trained to work with Older Adults under Medicare. I did not get graduate level training in my Ph.D. Counseling Psychology program but rather the fact is that I had 14 years of training to prepare me. You see I was the principal caretaker for both my aging Father and Mother in their final years.

Step 1: When my father was becoming more and more fragile and weak, I was visiting he and my mom up in Batavia New York and offered to them to move them down to Florida to live in Bradenton, Florida where my wife and I had bought a Condo from my Aunt Rose and Uncle Charlie. They accepted our offer, and we flew with them both down to Florida after we assisted them to put our family homestead up for sale in Batavia.

Step 2: We arranged in Bradenton for my parents to have their doctors and medical needs met and were amazed how well my father flourished with this move. Once they sold their house in Batavia, they bought their condo from my wife and me which was part of the agreement to convince them they would be independent from strict oversight from us once they moved down to Florida.

Step 3: Dad was very content in his new living arrangement as was my mother. She, being an LPN, got back into providing medical support to the residents of the condo association in which they lived, and this kept them busy. Things went well until my father three years later got pneumonia and was hospitalized and died within days of entering the hospital. Mom was sad over Dad’s death, and she began to withdraw and isolating herself from contact with us given we lived about an hour away in Tampa. Finally, one year later she called us and said: “Please get me out of here I can’t keep them from attacking me.” She had become very paranoid and when my wife and I agreed to move her. Upon arriving at her Condo we were startled by what she had done to the condo. She had taped all the windows and doors and had piled papers and boxed all over the condo. It took us a few days to clean out the condo and we filled 4 large commercial dumpster bins with the trash from inside of her condo.

Step 4: My wife and I had begun to research alternative living arrangements for both my parents prior to their move to Bradenton just in case they could not survive on their own. We did visit and examined three well known comprehensive Seniors Centers in Tampa which included: Independent Living, Assisted Living, Rehabilitation Nursing services, and Memory Units. We had settled on one called John Knox Village which was only 5 minutes from our house in Tampa when Mom had called us to get her “out of there.”

Step 5: We were able to sell my parents’ condo as soon as Mom moved out of her unit. We were able to set up financial procedures which would enable us to monitor Mom’s finances and to guarantee she would be covered financially for the remainder of her last 10 years of life. We then were able to enroll Mom in John Knox Village which at the time required that a resident in independent living could pass their screening to live independently and had the financial ability to purchase their independent living apartment. We purchased furniture for Mom’s apartment and helped her settle in. We were relieved that she had passed the screening for independent living since the initial investment made to purchase her unit would guarantee her coverage at John Knox Village no matter what happened to her health or physical viability.

Step 6: It only took three months for Mom to decline rapidly and then she fell and went to rehab. Upon release from rehab, she was moved to Assisted Living where she was monitored daily and provided all types of personal support and participation in physical rehab to help her regain her mobility. Unfortunately, she was never able to walk independently after rehab and was in a wheelchair for the rest of her life. She was getting 24-7 care and support and we were there all the time to make sure she knew we were there to support and encourage her wellbeing.

Step 7: Mom was in Assisted Living for about a year, but her mental status was waning over that time and eventually John Knox Village asked us to approve Mom to enter their memory unit. This setting was a stable setting for mom in that all of her fellow residents were at the same level of physical and mental functioning and the routine schedule in the setting was calming and supportive. In her final year of the memory unit, she declined even greater to the point of no longer being able to speak or to understand what was being said to her. It was at this point that staff moved Mom to their last option for residents which was their Alzheimer’s-Dementia Unit where Mom remained for the last two years of her life. My wife and I visited one to three times a week over the last six years of my mother’s life at John Knox Village which enabled me to learn an encyclopedia of needs of Aging Seniors which prompted me to take up working in Senior facilities when I retired from Private Practice in 1999 while my mom was still a resident at John Knox Village.

Irony of Irony

In 2009, the last year of my fulltime work with Vericare a Health Care Agency which had contracts with Older Adults Centers asked to take over their contract with John Knox Village in Tampa fulltime. I was excited because I could give back to John Knox Village the gratitude, I felt for their fantastic 10 years of care for my mother. At my initial introductory meeting with the administrative staff at John Knox Village there were lots of tears shed in seeing me again and in finding out I would be the psychologist assigned to work with them in the care of their patients. They and I knew that I had a “familial relationship” with the staff in that they let me know over all those years that my wife and I were the only regular visitors to their patients and that we developed a close relationship with the staff. It was a wonderful year of work for me which ended when I accepted a full-time teaching load at Troy University’s Tampa Campus in Clinical Mental Health Training.

What did I learn about the needs of Older Adults over those 14 years?

I learned that:

1. Older Adults are not typically prepared for the waning years of their lives and have not adequately set up a plan of action to insure their physical and mental health. Their financial well-being would be managed supportively until their eventual death.

2. Older Adults are resistant to moving close to their remaining family members if it means they must move from their permanent home where they retired.

3. Older Adults are distrustful of their family members who step up to assist in providing them the social and emotional support they need given that they realize that there are family members who only care about their eventual inheritance from the parents post death.

4. Older Adults suffer a great deal of grief in facing their aging process, debilitating physical conditions, poor health and fading memory and logical clear thinking. 

5. Older Adults suffer the loss of a spouse severely and need loads of emotional support to deal with their prolonged grief experience.

6. Older Adults have no real role models of how to live out the remaining years of their life since they often have moved a great physical distance from their own nuclear families and were not there for their own parents’ aging process. 

7. Older Adults suffer from feeling of abandonment and isolation when they enter an Older Adults Living setting because their family members just leave them alone once they have moved into these settings. Aging Seniors feel lonely and uncared for in their final years of life due to never seeing their loved ones who avoid coming to visit them in their Aging Senior facilities. 

8.Aging Seniors find it difficult to relate to their fellow residents in their Older Adults Living Centers if they are not encouraged to come and participate with other residents in the community activities which are sponsored by their centers. 

9. Aging Seniors need help if they have never been able to fully grieve the loss of a loved one (spouse, parent(s), siblings, relatives, children, friends and community members).

10. Loneliness is a major contributor to the decline of Older Adults' Mental Health. Older Adults  have a whole community of support personnel who work in their Older Adults Living settings including nurses, aides, therapists, attendants, food services workers, janitorial service workers and other varied staff of these centers all of whom are busy enough giving their all to their residents and who cannot replace the missing impact of the Seniors’ own family members who have resisted in visiting or maintaining daily or weekly contact with them 

11. Older Adults who have never used Mental Health Services over their lifetime are resistant to engaging with mental health providers in their final years because they have a negative opinion about such services and refuse to engage with such providers if they are referred to them.

12. Older Adults have a lack of trust in strangers coming into their lives to offer help when it is not clear what help they are talking about offering them.


In my work with Older Adults since I began working with them professionally in 2000, I have learned that the lessons I learned from my caretaker experience with my Mom and Dad had prepared me to confront a myriad of issues which I never had been formally trained for both in my Mental Health Counseling or Psychological training. I was confronted by issues which I had only my 14 years of experience with my Older Adult parents fully prepared me for the incredible interactions I had with my Older Adults patients.