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CRAIG T. KOJIMA / CKOJIMA@STARBULLETIN.COM
Corina Lee, left, believes in caring for "the whole patient." Ninety-two year old Christel Guessefeldt receives 24-hour care from Lee's elder care agency, Health Care Solutions.
Helping older people leave
this world with dignity is as
wonderful as assisting a birth» What to do after someone's death » Awareness of elder abuse urged
Corina Lee enjoys bringing people into the world and helping them to leave. For more than six years, she worked as a nurse in a hospital labor and delivery room and in an elderly care home.
"I was privileged to be a part of each experience -- both birth and death," she said. "I was nurturing and bringing one into the world and maintaining an older person's quality of life until they were ready to take their last breath.
"It correlated so nicely. ... It was a real nice circle."
Originally, Lee studied nursing to become a labor and delivery nurse. Helping bring life into the world "is all I ever wanted to do," she said.
But she also needed to find a part-time job while in nursing school, and began working as a nursing aide to the elderly, where she found her second calling. After several years she left nursery work for a full-time position at a home health agency.
"I really got to see the administrative side of insurance bureaucracy with Medicare and Medicaid, and how hard it was to get services to people who couldn't really afford them. I was really frustrated," she said. "We get so caught up in the cost of health care. If an elderly person needs open heart surgery, they should be afforded the same opportunity as a young person. They paid their medical premiums like everybody else."
So, Lee started her own agency, Health Care Solutions, to provide home care, disease management and consultation services, nursing services, transportation, patient advocacy and more. Some patient requests are simple, requiring help with cooking and light housekeeping only.
COURTESY OF CHRISTEL GUESSEFELDT
Christel Guessefeldt was just a baby in the early 1900s when her family moved to the isles. She received lots of loving care from a nanny, above.
"The company took on a life of its own," said Lee, now responsible for 60 certified nursing aides on duty.
The family-owned company also respects clients' spiritual needs.
"Many old people stop going to church or temple because they can't get around," said Lee. "We have priests and ministers visit a person's bedside if they are confined to the home.
"As a nurse, it is my responsibility to train and nurture new nurses so that the profession continues to stay strong," she said, fulfilling her obligation by conducting a CNA (certified nurse's aide) course at Health Care Solutions and teaching at the University of Hawaii.
Her aides are taught to care for "the whole patient." Christel Guessefeldt, 92, is proof of that. She has 24-hour care, but it includes more than just feeding, grooming and health care.
Health Care Solutions certified nurse's aide Joylynn Tagupa regularly takes Guessefeldt on outings.
"We went to see the ships before they left for war," she said.
They also attended the recent Pet Expo and watched the cat parade together. Guessefeldt has also taken in Honolulu Symphony performances and made trips to visit the animals at the Hawaiian Humane Society.
Learning an individual's life story is part of the caregiver's responsibility, said Lee.
"They tend to forget, and that way the caregiver can reminisce with the patient about the old times."
And Guessefeldt certainly has a lifetime of stories to share. Her parents were German immigrants who brought her back to Germany when she was a young girl, where she remembered seeing Adolf Hitler greeting a crowd.
"He was a crazy man," she said.
After the war, the family returned to Hawaii where Guessefeldt was able to attend Queen Liliuokalani's funeral. She described the huge kahili that were displayed as if the event had taken place yesterday.
Guessefeldt attended Punahou School and remembers being in one of the cars that drove across Pali Highway the day it opened.
Her eyes lit up as she talked about her travels. She went on more than 24 cruises -- her favorites being to New Zealand and Alaska.
Many elderly people just want to have companionship and the chance to share their life events, Lee said, and her staff members agree that they are privileged to work with the elderly.
"I love the elderly. They are walking, talking encyclopedias," said Ida Fogarty, another nurse's aide who also cares for Guessefeldt. "These are the people of the Depression, and once they die, the history goes with them," she said. "We can learn so much by listening to their stories."
Lee spends most of the time "talking story" with her elderly patients. She was a nurse's aide when she met Guessefeldt. The year they met, Lee brought Guessefeldt home for Christmas, exposing her to poi and laulau. Guessefeldt told Lee at that time, "You are going to help me die one day. That was the whole purpose of us meeting more than 10 years ago."
"When a patient can go comfortably with dignity and family all around, it's an awesome feeling," Lee said. "We always thank the family for allowing us to be a part of that experience."
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Someone you know
has died: Now what?
"Before & After: What to Do When Someone Dies," by Judith Lee(JEL Publishing, 216 pages, paperback, $20)
Lee will sign her book 12:30 to 1:30 p.m. Thursday at Bestsellers in Bishop Square.
Death is a part of life, yet people avoid talk of it, even though it surrounds us.
Most people do not even know what to do when it happens. Discussion can be frightening and overwhelming.
Judith Lee, who was raised in Honolulu and on the mainland, has produced a "how-to" guide that covers an array of topics, from dealing with a dying person to handling final arrangements.
Lee was working in the nursing home industry when she earned a master's degree in psychology, with an emphasis on death and dying. She was struck by the fact that when a patient died, survivors had no idea what to do, even though death was expected.
The facility made it a practice to discuss options with families months prior to the death, she explained. Still, arrangements were not being made.
"The book evolved from that experience," she said.
Lee believes it is the American psyche: "We will conquer death." But because no one has come up with a way to prevent it, we just don't talk about it.
In the United States, 6,000 people die every day. Of the families involved, less than 20 percent knew what to do, said Lee. And, she added, less than 1 percent of adults have given any thought to their final arrangements.
Other cultures don't avoid the topic of death. This turning away seems to be an American phenomenon.
"In the 20th century, death became hidden with people dying in places other than the home. Children are protected and death is hidden from them," said Lee, who incorporates information on funeral practices from a variety of cultures and religions. A section of her book is dedicated to etiquette and proper condolences.
The book vividly describes the stages of death, including the emotions of both the caregiver and the dying person.
The book also doesn't shy away from taboo subjects such as body disposition, organ donation, funeral arrangements and settlement of accounts. Legal and medical terms are defined for those seeking information on living wills, medical directives and authorized agents.
You might not expect it, but humor is used to great effect in the book. One of Lee's favorite examples is a quote included in the "My Condolences" section from a teen who accidentally tips over an urn at a memorial service: "Oh, geez! Oops, sorry ... geez ... uh, I ... oh, geez!"
"The topic of death and dying can be a turn-off to people, so I used interesting, even funny bits for the reader's enjoyment," Lee said.
Learn about death and dying
>> "Near-Death Experience": Topic of the Death and Dying Discussion Group, 7 p.m. Wednesday. The group meets every other week. Call 722-3000.>> "Living Your Dying": The Hawaii documentary explores the universal question of how to best approach one's final journey in life. The hour-long film screens at 7 p.m. Thursday at the University of Hawaii Art Auditorium. The film focuses on the insight of the Rev. Mitsuo Aoki, who after a near-death experience 40 years ago dedicated his life to studying the subject. Aoki views death as a healing process, a key to self-understanding and an opportunity to experience life more fully. Free. For information, visit www.outreach.hawaii.edu and www.livingyourdying.com.
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Public urged to be
more aware of elder abuse
Caring for an elderly person can be stressful, especially if they are suffering from a physical or mental impairment. Caregivers who do not have adequate skills and resources may become frazzled, which can lead to elder abuse and neglect.
Many people don't know how to look for or do not want to acknowledge signs of abuse, said Alicia Maluafiti, associate director of advocacy and communication of AARP. She said the agency is working on an educational campaign to make the public more aware of the problem of elder abuse.
Right now, she said, parents can visit a child-care center any time to view licenses and standard practices. The same rights, she said, should be available at elder care homes.
"If we do not set standards, it says we value our children more than our frail and elderly."
Safety officials need to make unannounced visits, added Corina Lee, owner and administrator of Health Care Solutions.
"Violations against the elderly need tougher penalties. They cannot defend themselves. They are totally at the mercy of someone else."
Currently, certified nurse's aides can open and operate a facility after only one year of experience working with the elderly. It only takes eight weeks to complete the certified nurse's aides course, added Maluafiti.
Tragedies involving elder-care homes have made local headlines recently. In 2000 an 81-year-old man died after he was assaulted in a Kalihi care home. In August 1999, Chiyeko Tanouye, 79, died of blood poisoning in a Pearl City care home. The care-home operator was convicted of manslaughter in the case. And a Big Island man suffered a broken hip, pneumonia and decubitus ulcers, and died at 86 in his care facility.
Many incidents of death due to negligence go unreported because the death of an elder is generally not unexpected, according to Maluafiti, who contends that death in elder care homes representa hidden epidemic.
"One death due to neglect and abuse is too many," she added.
Private-duty nursing with 24-hour care can run between $12,000 and $15,000 a month. In a care home, costs start at $4,000 a month, which means elderly patients should be receiving top-notch care. Yet, no one is holding care-home operators accountable for annual doctor visits and nursing assessments, said Lee, who continues to be appalled by incidents she has seen, heard and read about.
"When I started my business, I randomly visited care homes, and many people were getting bare minimum care. People are not getting oral care, they are sitting in diapers all day, with obvious body fractures, in rooms that smell of urine," she said. "Some patients were all curled up in bed in a fetal position, rocking and moaning.
"Pressure sores are totally unacceptable because they are 100 percent preventable. We use that as a gauge for neglect. They were in one position way too long. More accountability needs to be placed on care-home operators. They are operating a business and should have standards."
The first step toward correcting the situation, she said, is raising awareness.
"People need to begin to assert and speak up for themselves," she said.
Unfortunately, dementia and forgetfulness make it easy for someone to take advantage of elder patients. In some circumstances, a patient's family doesn't know what is going on until it's too late, when the caregiver is listed on the house deed and the car and bank accounts are under his or her name.
"It's just a nightmare," Lee said. "They ask them to sign documents, and the elderly person is trusting. They lose their sense of judgment early on. They still may be able to have wonderful conversations, and they seem competent.
"One of my clients had a houseboy who was taking advantage of her. The elderly woman had signed all of the checks in her checkbook. In 30 days the houseboy had made out checks to himself adding up to $10,000."
For now, those looking for a care home must trust their instincts. Examine the care home premises, and spend a day studying how caregivers treat their current patients.
To be fair, most homes are good -- they love their residents and want the best for them, said Lee.
"It only takes one of two bad ones that kill somebody or allow them to die to make it difficult for those who truly care."
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