Case Study 5.6
Jessica Gragert
Lakeview College of Nursing
N309 Nursing of the Gerontological Client
July 10, 2012

Case Study 5.6
In case study 5.6, Lillian Perry is a seventy-four year old widow who is interested in giving up the responsibilities of maintaining her household in order to move into a senior independent living complex. In an independent living facility, the elder is able to live in an environment that allows them to maintain self-care while relieving them of the stresses of household maintenance and/or living alone. An independent living housing situation may be ideal for a patient like Mrs. Perry who is still able to take care of herself but finds the physical upkeep of a home to be increasingly difficult as she ages. The social aspects of such a move could be very positive as well, as she would have the ability to interact with fellow residents in common living areas and have larger areas to accommodate visits with her family. Some independent living facilities may also have the ability to provide services for those patients that for one or another find themselves unable to completely care for themselves and offer the option of assisted living for those who may need it. The assisted living alternative can provide security to those older adults that no longer have the ability to independently care for themselves but do not yet require extensive intervention to maintain a healthy life.  Some facilities may offer housing arrangements for multiple levels of independence which can enable that residents are moved to appropriate levels of care as needed (Mauk, 2010). Both independent and assisted living facilities cater to those who are relatively healthy and retain some or all ability of self-care. The purpose of both housing situations is to allow the aging adult to hold on to their independence for as long as is possible while offering the peace of mind of community living and offering the support and services some elders need or desire (Mauk, 2010). 
Older adults who choose to living in independent living settings must be able to adequately care for themselves by performing the “activities of daily living (ADLs)” which include “bathing, dressing grooming, showering, and toileting activities” (Mauk, 2010, p. 797) and must require little to no assistance or supervision in order to do so. These adults must also  maintain the ability to conduct the “instrumental activities of daily living (IADLs)” that include more complicated requirements of living such as “handling finances, preparing meals, or managing one’s medications” (Mauk, 2010, p. 799) and do so with the same lack of oversight. If Mrs. Perry required regular assistance in maintaining any of these life tasks she would not be a candidate for independent living.  
At seventy-four years of age, Mrs. Perry is a member of “The Silent Generation” which was so named because of the reduced numbers of citizens born during the Depression era and the placement between the more commonly known generations referred to as “The Greatest Generation” and the “Baby Boomers” that came before and after ("Silent Generation Community Options," n.d., para. 2). Lillian Perry is a typical member of this generation as the provided history displays years of hard work a pragmatic tendency. Mrs. Perry’s history also indicates a strong sense of community in her chosen work on behalf of her church as well as a strong sense of family as she continues to provide care for her great-grandchildren (“Silent Generation Community Options,” n.d.). 
While Lillian Perry’s long-term residence may be indicative of her generation’s tendency to remain close to home and community, it is somewhat of a rarity in the general public. The United States Census Bureau describes that according to information obtained in the 2007 American Community Survey, residents of the United States can expect to move an average of 11.7 times throughout the duration of their life “based upon the current age structure and average rates and allowing for no more than one move per single year” ("Migration Expectancy," 2012, para. 3). 
In my own life I have witnessed the dividing of property after a loved one’s death on more than one occasion. After the passing of my maternal grandmother, things were divvied out among remaining relatives but I don’t recall any fighting over them. As grandchild a received a pretty washing basin and pitcher and my siblings and cousins received items of a similar nature. There was no significant monetary value but the nostalgia and sentimental value were meaningful and those items are proudly on display even to this day. I have also witnessed the negativities and conflict that dividing items can bring. On my father’s side, my grandmother passed at a young age while my father was still a toddler. There are some notable dysfunctions present in the dynamics on that side of the family. I found myself at odds with my own father when his mother’s wedding ring set was given to me. When my grandmother passed my grandfather kept her rings and passed them down to the first of their sons to marry. The aunt that received these rings wore them as her own wedding rings for over 30 years, at which time she decided their increasingly delicate condition meant they shouldn’t be subjected to possible damage from day to day wear. While I had no idea even of the existence of these rings, I was the oldest grandchild descended from that marriage and my aunt offered them to me to hold as a family heirloom and instructed me to pass them down to my daughter if I were to have one (which I later did). The rings were given to me while my grandfather was still alive and when my aunt announced to him and I that the rings would be going to me he stoically said “That’s where they should be” and gave me a hug.  Later he passed only 3 months before my father was to be married. At the wake I was asked by my father and future step-mother to give them the rings so that they could be used to make her a new bridal set. After much thought and stress I decided that the rings had been handed to me with the blessing of my grandfather and I would not be handing them over. I truly believe that if my father would have ever approached my grandfather and asked that the rings be taken from me and given to him in order to be reset and restyled into a suitable set for his second wife, my grandfather would’ve told him exactly where he could go. Those modest rings will sit protected in my jewelry box until the day I hand them down to my daughter and tell her the story of Leo and Wanda, which I believe is what they both would have wanted. The story of Mrs. Perry’s phone call from her daughter-in-law reads as ultimately sad because (to me) heirlooms should be given for value of history and sentiment, not requested out of entitlement.
While the site www.edivvyup.com does not appear to be currently operational, financial author Lisa Gerstner described the service provided on the site as one in which the executor of an estate is able to set up and account that allows those loved ones who are invited to participate to be allotted an amount of credits and then using those credits to bid on items of the estate (2012). The usefulness of such a service is that participants can choose the estate item they hope to obtain and place a value on that item. This would presumably allow that items go to participant that personally values each item the most which could reduce the conflict that rises from some estate dividing. It could also be argued though that this approach resembles more of a financial commodity and acquisition situation and some may find such handling of family items to be impersonal (Gerstner, 2012).
Reminiscence Therapy uses the recalled experiences of one’s life to improve their mental health and well-being (Mauk, 2010). This is commonly used in the elderly when there “may be a need to put one’s life in order to come to an acceptance of present circumstances” (Mauk, 2010, p. 341). The premise of this therapy is that the processing of previous experiences, both positive and negative, can potentially offer multiple positive outcomes for the patient. 
Reminiscing can allow the older adult to suffer less depression, and increase “life satisfaction, self-esteem, and psychological well-being” (Mauk, 2010, p. 341). As one nears end of life, looking back on past experiences can allow the patient to find “meaning” of his or her life and to accept “its uniqueness” (Mauk, 2010, p. 771). The ultimate outcome of reminiscence in the aging is to become at peace in their own lives and of “their coming death” (Mauk, 2010, p.771). 

References
Calculating migration expectancy from ACS data. (2012). Retrieved July 11, 2012, from http://www.census.gov/hhes/migration/about/cal-mig-exp.html
Gerstner, L. (2012, January). Eight smart estate planning steps to die the right way. Kiplinger Financial. Retrieved from http://www.kiplinger.com/magazine/archives/8-smart-estate-planning-steps-to-die-the-right-way2.html?kipad_id=4
Mauk, K. L. (2010). Gerontological nursing: competencies for care (2nd ed.). Sudbury, MA: Jones and Bartlett.
The silent generation explores retirement community options. (n.d.). Retrieved from http://www.seniorcitizensguide.com/articles/chicago/silent-generation-retirement-community.htm