Live-in cook/caretaker for a senior citizen

[mizducky]

About two months ago, an opportunity presented itself for me to try out a new part-time career: that of live-in cook/caretaker for a senior. The senior in question was already a friend of mine, who I knew from church. He'd been suffering from some mild dementia-type mental issues and other health problems ever since I'd known him (about a year). These mainly manifested as short-term memory problems, confusion especially in complex and unexpected situations, and physical shakiness of hands and footing, but his personality (not to mention wit and charm) were largely intact.

Around Thanksgiving time last year this man (let's call him "E") went into a health tailspin. To this day the doctors are not quite certain what caused it--the ostensible culprit was a new medication that knocked him off-kilter. But it turns out that, for at least a year previous to the crisis, he had been chronically forgetting to take his (many and complex) prescription medications, to feed himself adequately, and to drink enough fluids. So I for one am convinced that it was the cumulative effects of malnourishment, dehydration, and randomization of medication that eventually wound up putting him in the hospital.

For a few months in there we thought we were going to lose him, if not physically at least mentally. He gradually pulled out of the fog, and was moved first to a skilled-care facility, and then an assisted-living facility--in all, about six months away from his beloved home of many years. He eventually became too "well" to need even the level of care of the assisted living facility, but his medical team, understandably concerned that he might put himself in the same bad way again, said he couldn't move back home unless someone stayed there with him. That's where I entered the picture.

So what does all this have to do with food and cooking? Volumes. As I said above, while the doctors are still arguing about what the hell happened to poor "E", even they are willing to concede that a major part of it had to do with him not eating right and not drinking enough fluids. Plus my own experiences make me a super-strong believer in the healing power of healthy eating. So I figured I would be an excellent person to make sure E gets the nutrition he needs to stay healthy, in as enjoyable a form as possible.

At the same time, hey, I know this guy, and I know he is a person of strong opinion and picky tastes--in everything from classical music, to the style, content, and delivery of our minister's last sermon, to the food he is served. I also know, from numerous after-church lunches we had shared, that he is a notoriously non-adventurous eater. He's an old New Englander from a classic WASP family; the further food strays from the simple meat-and-potatoes fare he grew up with, the less happy he is--even if he agrees the strange food tastes delicious, its strangeness interferes with his full enjoyment. So I knew I had my work cut out for me.

Some concessions were obvious and I just went with them. He has strong allegiance to specific all-American brands, even if (IMO) those brands are overpriced and under-quality. Predictably, he hates real mayonnaise and prefers Miracle Whip; he also has this thing for Roman Meal bread--and it has to be the thin-sliced loaf. Only Mother's oatmeal cookies will do--just the plain ones, not the frosted. Only Cabot brand aged white cheddar--he's persuaded the orange color of even gourmet cheddars is due to artificial coloring, and appeared dubious when I patiently explained the annatto-seed coloring was natural and traditional. There are other foibles, some more subtle than others. He dislikes any seasoning other than salt, and likes rather too much of that--even black pepper is too strong for him. He likes his food as simple as possible--any deviation risks a reaction not unlike the character in Amadeus who complained to Mozart that his music used "too many notes." And you should have seen the look on his face when I suggested that there were other types of tuna than the stuff that comes in the cans.

On the other hand, he continually surprises me with the stuff he does like to eat. He adores beets, including the beet greens--won't let me put the beets in a vinaigrette, that's already too fancified for his tastes, but does love them simply roasted and the skins slipped off. He actually likes organ meats! He lit up like Christmas the night I made sauteed liver and onions--especially since I know enough not to cook the stuff into shoe leather. He actually volunteered a couple different times that he would enjoy my preparing kidneys or heart sometime. And I have come to learn that, even if he does complain a bit when I cook something a little outside his familiarity range, the fact that it tastes good does still get through his defences, such that maybe several days later I'll hear him admit that the strange new stuff was suprisingly good after all.

So what do I actually wind up cooking for this guy? Next post, I'll list as many as I can remember of the meals I've cooked him so far, with notes as to how well they went over. And here's where I can definitely use some help from eGulleteers. I have been avidly following Calipoutine's topic on catering community dinners for 50 senior citizens at a time, and have gotten a number of meal ideas. And my Joy of Cooking is proving its usefulness all over again, as the 1970s edition is like a roll-call of all-American hometown cooking classics. But I can always use more suggestions!

Edited July 25, 2007 by mizducky (log)

[mizducky]

So here's some entrees, sides, and etc. I've made for E so far, in no particular order:

--steak (he loved this)

--liver and onions (he loved this)

--baked chicken

--pot roast, with potatoes, tomatoes, and carrots (he loved this)

--chicken stew with giblets

--broiled salmon (he loved this--but then it was wild-caught Alaskan salmon!)

--Salisbury steak (he loved this)

--meat loaf (he loved this)

--oven-"barbequed" beef ribs

--oven-"barbequed" country-style pork ribs (he found these too greasy)

--borscht (I put in too much black pepper for his tastes)

--omelettes (he loves these)

--melted cheese sandwiches (he loves these)

--tuna salad sandwiches

--coleslaw (with Miracle Whip, so he loves it)

--chicken/rice skillet dish (his suggestion--he loved it)

--lamb chops (he liked the idea of lamb, but alas he found these too tough and greasy)

--fried rice (outside his comfort zone, but he surprised us both by liking it)

Interestingly, E and I just had a conversation earlier tonight about how he's liking my cooking so far. He admitted that it's not as if he finds the food I make unpleasant, far from it. In fact, he admits that it's all quite tasty. It's just that a lot of it doesn't really "do it" for him. Part of his issue is his New England country background, which conditioned him to like really plain and simple food. And part of it is the fact that he really hasn't been all that interested in food, period, for some years now. He totally understands that bad nutrition is part of what got him in a fix before, and realizes that he can't get away with the diet of peanut butter, crackers, and oatmeal cookies that put him in that situation. And it's not like he never eats of his own volition--in fact, he often wakes up in the middle of the night and makes with the peanut butter, crackers, and cookies.

Now as far as I'm concerned, there's nothing wrong with grazing--in fact, I do believe that several little meals is in some ways better for the body than two or three large meals with no snacks in between. The challenge is to expand his grazing repertoire to include stuff from other parts of the food pyramid. Hmmm.

P.S. I know some of you will ask why I haven't made him any pasta dishes. It's because he tells me that he hates pasta. Apparently the assisted care facility he was in served tons of pasta and macaroni (hey, it's cheap and filling), and he doesn't want to have anything to do with anything that reminds him of that place. Can't say that I blame him for that sentiment.

[dockhl]

Ahhh, ducky. You are a good person.

I hope I get to meet you someday.

[petite tête de chou]

What about...

corn pudding

sweet bell peppers stuffed with a simple chicken and rice filling

sausages with cabbage and apple rings

green beans and bacon

swiss steak

roasted butternut or acorn squash

chicken and dumplings?

[Milagai]

Mizducky: You are one fabulous person.

May your shadow never grow less (in a metaphorical

sense, of course).

I absolutely understand where your friend is coming from.

Once the food-emotion connection is strongly established

with a particular style of cooking, that's what you tend to

revert to when the body is stressed. You can enjoy other things,

but they can be psychologically unsatisfying after a point, though

actually delicious......

[nibor]

I was going to suggest that you just ask E what he likes. But you would probably get the same answer I get from my 40-ish husband - "Oh, I don't know..."

So, what I do with my husband is sit down and go through a cookbook with him. When he sees something he likes, he knows it. You could try that with the Joy of Cooking. Or a Betty Crocker, or something more New-Englandish, which I would not know about.

[jackal10]

Blessings on you

Its back to school meals:

Sausages

Hamburgers

Hot Dogs

Pizza?

Baked beans (with aforementioned sausages or bacon) (aka cassoulet)

Breakfast foods for dinner: egg bacon hash browns

Gammon/ham

Stews (aka Daube Carbonade etc)

Steamed puddings - steak and kidney

What about sweets, like brownies, or sponge pudding or fruit with custard,,,

[Margo]

You are an angel, Miz Ducky.

When my grandmother wasn't using Joy, she used the Fannie Farmer cookbook. A New England favorite.

Will he eat other fish--pan-fried cod, haddock, etc.?

[hjshorter]

So, what I do with my husband is sit down and go through a cookbook with him. When he sees something he likes, he knows it. You could try that with the Joy of Cooking. Or a Betty Crocker, or something more New-Englandish, which I would not know about.

←

As Margo just said - get your hands on a copy of the Fannie Farmer cookbook (AKA Boston Cooking School). Every New Englander is issued a copy at birth.

Boston Baked beans?

[rooftop1000]

Ellen

You be carefull all that rich food is no good for You

tracey

[Kouign Aman]

-even if he agrees the strange food tastes delicious, its strangeness interferes with his full enjoyment.

A better definition of comfort food there never was. It so nice to see it said clearly. What a lucky E!

ideas:

Lamb stew - similar to the beef stew but opening the possibility of different seasons on reprise

Rice pilaf / biryani

Potroast sandwiches (w gravy)

I had a beef heart soup in Spain that was delicious, tho I couldnt tell you how to make it.

Chicken 'n dumplings (aka chicken stew)

HotPot (or whatever that dutch infinitely variable dish of smooshed spuds and veggies is called)

Bubble&Squeak (cabbage and spuds, cooked separately then smooshed and panfried) (non-stick pans can crisp this with remarkably little added fat.)

Clam/fish chowder

You already have 10 "he loved it" listed there. I think he might appreciate repeat meals more often than you might. If so, having 21 dinners, to rotate among every two weeks, would be a solid basis. It might get dull for you but it would have the benefit of being "mindless" (thats not the right word, but habit is easier than doing something new all the time.). And if there is a basic repetoire of 'old favorites' for most nights, you might have room to take the menu further afield in search of adventure, one night a week.

[Kerry Beal]

I used to cook meals for my old friend Hughie before he died. I'd make them up in bulk and freeze them and he'd nuke them.

I seem to recall shepherd's pie was always a hit.

[MomOfLittleFoodies]

E sounds kind of like my grandmother. My parents moved in to take care of her when she couldn't really manage by herself anymore, and egads was she picky. She'd complain when Mom served rice or pasta more than once a month.

[Carrot Top]

Vegetable Soup

Corn Chowder

Senate Bean Soup

Popovers

Well-Chopped Chef's Salad

Waldorf Salad

Baked Glazed Ham

Succotash

New England Boiled Dinner (pronounce that "dinnah", please )

Codfish Cakes

[EllenC]

What about other fish dishes? Seems to me that being from New England those should come into play. Poached, steamed with herbs, pan fried, fish stews, etc?

[Carrot Top]

I seem to have a built-in file of old-guy New England recipes in my head.

Welsh Rabbit

Stuffed Peppers

Pot Roast with Mashed Potatoes and Gravy (made with Lipton's Onion Soup and Cambells' Cream of Mushroom Soup spread on the roast as it cooks )

Sauerbraten with Red Cabbage and Potato Dumplings

Spaetzle

Fruit Cobblers

Apple Crisp

BLT

Egg Salad Sandwich (you might be able to add a touch of curry here, Ellen )

Country Captain

Cold Poached Salmon with Mustard Mayo - plain cucumber and tomato slices to garnish

Shrimp Cocktail

Shrimp Salad Stuffed Tomatoes

Potato Soup

Shrimp in Lobster Sauce

[Toliver]

Ellen,

This is a great topic and I wish you continued success with your new position.

Do you cook with the aim of providing certian nutrients? Or is it just a matter of making sure he just eats something? For instance, my mom religiously eats a banana a day for the potassium. She suffers from nighttime leg cramps which the potassium alleviates. But potassium has also been shown to benefit the brain so she's getting good coverage out of just one banana.

Oh, and if you can put the Salisbury Steak recipe in eGullet, I'd be quite grateful!

[Carrot Top]

So, what I do with my husband is sit down and go through a cookbook with him. When he sees something he likes, he knows it. You could try that with the Joy of Cooking. Or a Betty Crocker, or something more New-Englandish, which I would not know about.

←

As Margo just said - get your hands on a copy of the Fannie Farmer cookbook (AKA Boston Cooking School). Every New Englander is issued a copy at birth.

←

Or James Beard's "American Food" which I don't have a copy of anymore but which is stock-full of this type of recipe.

..................................

I may have to borrow your guy, Ellen. My file keeps churning out more ideas.

Strange.

I hope this is the end of it.

Creamed Mushrooms on Toast

Grilled Bologna Sandwiches

Sole or Flounder Stuffed with Crabmeat

Chicken Noodle Soup

(Maybe) Spinach Salad (small portion) Wilted, with Bacon and HB Egg. Served with

Cornbread

Potato Pancakes with Applesauce and Sour Cream

Chicken Chausseur

Meatloaf

Peas in any way

Carrots in any way

Peas and Carrots together in any way

Devilled Ham Sandwich

Coddled Eggs with Toast (some fresh snipped herbs and cream on top perhaps?)

Phew. Wierd. I have no ideas where these ideas are coming from. Maybe all these years I have been an old (New England) guy myself just masquerading as me.

Edited July 25, 2007 by Carrot Top (log)

[mizducky]

Many thanks for all your kind words! I swear I wasn't fishing for compliments on taking on this situation (though it's very sweet to receive them). In fact, it's a win-win situation for the both of us, as I had just found out that my now-previous roommate was giving up our apartment and moving on, so I was looking at finding new housing as well.

Many excellent suggestions here. I'm making myself a list.

Getting myself a copy of the Fannie Farmer cookbook is a brilliant idea. E has great fondness for his old copy of the McCall's cookbook, and a little notebook full of hand-written and clipped recipes he'd collected over the years. I confess I have trouble reading either--especially the little notebook--without frequent shudders. They're rife with calls for canned cream of mumble soup, instant soup packets, bottled dressings, and other pre-packaged artificial-ingredient-drenched shortcuts. There's even a recipe for Cool Whip Pie.

But these are the things he loves, so I'm adapting. I even made the meatloaf recipe right off the back of the Lipton Soup Mix box last week. (I did use half ground beef and half turkey, at least. ) To me, it tasted like, well, Lipton Soup Mix--and thus too salty, and too assertively artificial-onion-flavored. But he adored it. So I guess there's more soup mix in my future.

I do frequently make a "light" version of whatever we're having for dinner, so that I don't blow my own health regimen out of the water. Or I'll make extra veggies, and give myself a smaller portion of the entree and a bigger portion of the veg.

Several folks have suggested baked beans, Boston or otherwise. E mentioned those fondly just the other night. Though when I responded enthusiastically to the adventure of making them from scratch for the first time, he replied that he was thinking more along the lines of the canned brand Bush's baked beans, which he remembered fondly from his childhood, suggesting that instead of me doing all the work of from-scratch that he'd be perfectly happy with the Bush's and some finely-grated coleslaw as a nice light dinner. Nothing against Bush's--I haven't tried them, but I understand they're a good brand--but I'm still trying to get my brain wrapped around somebody turning down the prospect of made-from-scratch beans in favor of canned.

I'm still not 100% sure if that's all about him preferring the canned, or some mixed feelings on his part of seeing me go to all the trouble of the from-scratch version. Again understandably, he has several layers of issues going on about me "doing" for him: some old WASP misgivings about anyone making a fuss on his behalf; some grief about the age-related deficits that make it necessary that he have help; the long-time bachelor's discomfort with sharing his space and having his routine unsettled by a newcomer who seemingly does everything differently ...

Which touches on another issue. It's not like his kitchen was a disaster area--in fact, it's a very nice kitchen, with decent equipment and--that rarity of rarities in Southern California, an actual gas range (mid-level 1970s-era consumer model, so it's not a big BTU-burner--but it's gas, thank the cooking gods!). The issue with the kitchen is, well ... think of how a kitchen might be arranged by a 75-year-old bachelor New Englander with not much real cooking expertise in the first place, and some growing forgetfulness in recent years. Got it? Stuff randomly and idiosyncratically stored here there and everywhere; stuff either precariously stacked, or even worse not stacked at all so that there was huge wasteage of space; lots of stale stuff that should have been chucked ages ago; and some gear that is just totally inadquate. He has several little knives with steel blades that have been sharpened so often over the years, and mistakenly run through the dishwasher so many times, that the wood handles are like driftwood and the blades crumbling at the edges. But he not only insists on continuing to use them, but looked scandalized when I refused to use them myself--let alone when I suggested that they be removed from the knife block and retired from service.

We also had a little controversy over his insisting on clearing the table, loading the dishwasher and putting stuff down the disposal after dinner. I suspect that he was always way haphazard about these things--I've met too many people who haven't a clue about how to load a dishwasher properly. But there are some definite relatively-recent nuances that I admit concerned me deeply, such as holding dishes at an angle that threatens to spill their contents on the floor, or placing them on the counter such that they're hanging way over the edge just waiting to be knocked onto the floor; or confusedly shuffling items in the dishwasher, seeing that they don't fit but not quite figuring out how to fix it. When he put his hand down the (fortunately stopped!) disposal to clear something he insisted would be okay to put down there but wasn't, I confess I freaked out a little over-fiercely. I wish I had handled that more diplomatically, but, eh, we talked it out and it's done. I assured him that his self-worth or usefulness to the world in no way hinged on his ability to look like he's holding up his end in the kitchen--that's what I'm there for, to free him up from those duties. So now at least I don't have to be a nervous wreck while he clears the table anymore.

(It's worth noting that the situation that first brought E's growing issues to light was a kitchen mishap--a social worker had arrived to do an intake assessment on him just in time to find him accidentally setting fire to a box of Cheerios he had left standing on a burner of the stove. I am massively for encouraging him to be as independant as possible--but that inevitably has to be tempered with realism about the risk of accidents.)

[Ted Fairhead]

Kerry Beal(above) suggested the one thing that I have always loved...Shepherd's Pie.

I guess I qualify as a Ol' Geezer and my version is ground beef sauteed with onions, a few chopped carrots. After beef is cooked and onions and carrots are soft add plenty of Bisto gravy or another package gravy with strong beef flavor, then a good handful of frozen peas added at end of cooking in the pan. Put the whole thing in a pyrex dish and cover with package mix mashed potatoes. Then place under the grill for a few minutes to brown the potatoes. Easy on the washing-up too!

I also love sage and onion stuffed hearts but I haven't seen hearts on sale for years.

How about Toad in the Hole with gravy, using very mild (english if you can get 'em) sausages baked in a Yorkshire pudding batter?

I too will have baked beans on toast for a quick easy to prepare dinner. Our pediatrician, many years ago, assured us that our youngest daughter would come to no harm if that is all she would eat. ( BTW, her "fad" lasted for several months, and numerous cases of Heinz Baked Beans, and she didn't come to any harm)

Edited July 25, 2007 by Ted Fairhead (log)

[mizducky]

Shepherd's pie goes on the list. There's even a box of instant mashed potatoes in the pantry already!

Tonight, by request, I am making beef heart with prunes. The beef heart I'm definitely up for. The prunes ... heh. Y'all have heard me sound off in other topics about my personal distaste for sweet notes in otherwise savory dishes. But E has definitely got a sweet tooth, plus this is a recipe from his beloved McCall's cookbook so it's got nostalgia value for him. I'm telling myself it's just like tzimmes ... which, actually, it kind of is. And this also underlines a point that came up in CaliPoutine's topic on making dinner for seniors: the tastebuds for sweetness persist long after many other tastebuds have bitten the dust. Hmmmm. I see a lot of overly-sweet (to my taste) dishes in my future too! Fortunately, though, I've got my bottles of soy sauces and hot sauces at the ready, so I can magically turn my portion of sweet stuff into something a little more Southeast Asian.

[Carrot Top]

You are both brave and good to do this, Ellen, regardless of whether you were looking for a new living situation or not.

I think that it will be more difficult for you to deal with the issues of his health, particularly the dementia, long-term - than it will be for you to deal with the cooking part (my opinion is based on having been around more than one elderly person who suffered from dementia along with Alheimer's etc.).

The foods that he enjoys, the canned foods and the familiar flavors . . . whether it is not-as-good-tasting or quality as fresh . . . are something that he has to hold on to as a firmament of who he is while some other things are slipping away. It may be that he will try some new things, but there may be times when he simply does not want to.

I hope that you will find a "care-givers" course or group in your area to be with if you want to while you are doing this, as it is not just nothing, this part of it.

.............................

Oh. Yeah. Sorry. Here's more:

Scallops in Bacon

Rice Pudding

Strawberry Shortcake

Blueberry Pie

I wonder if he would like Blintzes?

[SuzySushi]

While you're at shepherd's pie,

Chicken pot pie

Chicken a la king on toast points

And I second (or is it third?) the idea of more fish dishes...

Cod or scrod if you can get it

Fillet of flounder or sole if you can't

[mizducky]

The fish dishes are a definite yes. He likes fish--and he could use the omega-3 fatty acid content. (As could I.)

Speaking of seafood: amusing conversation he and I had just now over dinner--I asked him if he'd trust me, a non-New Englander, to make clam chowder for him. He responded that he'd want to know what color my clam chowder was. I assured him that I detest Manhattan-style clam chowder, and he said well alright then. So--clam chowder on the horizon too.

By the way, the stewed beef heart with prunes--oh, and apples too, that was part of the recipe--came out pretty nice. Not noticeable oversweet at all. I could have stood for it to be a bit more strongly seasoned, but, well, you know ...

[Margo]

Fish chowda, oyster stew...

I haven't had Bush's brand baked beans, but they do seem to be a natal taste for New Englanders. (Of which I am one--but my natal taste is for mom's home-made.)

With the beans, you should have steamed brown bread. James Beard has a recipe in the American Cookery mentioned up-thread, and I would bet so does Fannie Farmer.

And, conveniently, Bush's makes a canned version, too.

Which is funny and appropriate at once, since in the days when coffee came in one-pound cans, those were the preferred steaming vessel.