Chat @ Caregiving: Downhill Fast, But Not Fast Enough

Some things happen fast. Some too fast. Others not fast enough.

A week ago I made a deposit on an assisted living facility. Today I’m trying to wrap my mind around the idea of palliative care. The changes are coming more quickly than I can grasp, but not fast enough to bring my mom the peace and relief she’s longing for.

After my midnight ramble last Thursday night, my husband and I slept in.  We were enjoying our morning coffee ritual, the one where I make him coffee and we spend about half an hour together trying to focus on the positive aspects of our life. Our brief interlude was interrupted by a couple of phone calls.  Mom had been suffering from nausea for several days and nothing seemed to help it.  One medication would put her to sleep, but it didn’t get rid of the nausea.  A crisis was brewing.   The doctor was coming after one and there were decisions to be made. Coffee time was over.

There’s been a lot of doctors in my life lately.  There’s Dr. Alan Kaye, Mom’s personal physician.  There’s another doctor, at the nursing facility, we call Dr. K, because her last name is unpronounceable.  Then there’s Dr. M.  I’m not trying to be mysterious. It’s just that no one can pronounce her name, either.

Dr. M had been the physician who dropped by during my midnight ramble.  Dr. K was the one I was supposed to meet with.  Dr. Kaye is the one I know and trust.  So I put a call into Dr. Kaye and got myself ready to go to the facility.  The next few hours were awful.  Mom was really sick and thanks to the wonders of modern medicine, no one could do anything.

I wasn’t sure what to do, because I was waiting on a call from Dr. Kaye and waiting for Dr. K to show up.  Mom just wanted someone to knock her out, but it wasn’t quite that easy. The nurses on the floor couldn’t do anything without Dr. K’s say so. Taking her to the hospital might have gotten her a little pain medication, but would have opened up another can of worms.  I didn’t want to open that can without Dr. Kaye’s approval.  For all the advances of modern medicine, I longed for the day when the town doctor just dropped by daily and administered laudanum.

To a certain degree, Mom didn’t care what category her health givers put her in, she just wanted some relief.  She was only sure of one thing, she didn’t want that relief to be called hospice.  In her book, that relief was synonymous with giving up and Ruth Cave doesn’t give up.  I have rarely felt so helpless in all of my life.

Finally, at three, Dr. Kaye’s assistant returned my call, but all she did was get the details to pass on to Dr. Kaye.  Within twenty minutes he called.  One thing he was sure of, Mom should not go to the hospital.  He peppered me with questions and I turned him over to the charge nurse. While he was on the phone with the nurse, Dr. K breezed in.

I’m very respectful of the medical profession – from the aides to the doctors .  I respect the training they’ve gone through and appreciate their desire to be in that line of work.  I know I’m not equipped for it.  I’m also very respectful of the fact that these people have lives and cares of their own.  However, I didn’t have much respect for Dr. K.

Dr. K had requested that I be there to discuss my mom’s situation after one.  It was almost four, when she arrived.  I didn’t think Dr. K was showing me much respect.  And when I said she breezed in, I meant it.  I was at the nurse’s station listening as the head nurse talked to Dr. Kaye.  I saw a woman with long blonde hair, a white gauze Indian shirt with beading and clogs.  She looked like she didn’t have a care in the world and I wondered who in the world she might be. As she flung her long blonde hair over her shoulder, someone told me she was Dr. K. The nurse turned Dr. Kaye over to Dr. K, who disappeared around a corner. The charge nurse returned my phone and I was dismissed down to my mother’s room.  Surely something would happen now.

Something did.  Dr. K came in and decided Dr. M had been wrong to put Mom on an IV for dehydration.  I heard her order the IV stopped and lasix to be dosed intravenously.  Some RN came into do that, but he decided the fluid should continue and added the lasix to the drip.  I gave the LVN with him a significant look and as soon as the RN left the room, she shut off the IV and went for help.  She returned with another pair of RN’s who removed the IV and gave the lasix as the doctor had requested.  Can you imagine how my head was whirling?  All this while, Mother is moaning in misery.

Lasix aside, what were we going to do about Mom’s nausea?  Dr. K returned.  I don’t remember her exact words, but she certainly didn’t approve of Dr. Kaye’s opinion of things. She gave me a list of things that she thought could be excuses for overriding Dr. Kaye.  I’ll spare you, but I reminded her that Dr. Kaye had been Mom’s personal physician for decades and that Mom had just been in the hospital.  They said there was nothing else modern medicine could do for my mother and all we were looking for was some relief from the nausea.  Dr. K told me she had other patients she had to see about on another wing.  She stopped at the door and turned to me.  I do remember what she said there, “Hospital or hospice – you’ve got a tough choice.”

She was gone before I could say, “We already made that choice.”  I looked at the clock and it was five.  Five on a Friday afternoon.  Friday on Rosh Hashanah and Dr. Kaye is Jewish.  I sat down to talk to mother.  I laid it all out for her and she said, “I’d put up with anything to get some relief.”  I said,”Then I’m going to call hospice.”  Her only reply was white noise.

The next two hours were excruciating.  Thankfully, I’d followed Dr. Kaye’s request and signed up for hospice without indicating a start date during the week before.  Within minutes, Mom was on hospice, but it was five thirty on Friday and we were waiting for Bernard.  Though I’d been doing everything I could for Mom since I got there at eleven, she was still miserable.  I can’t blame her for her anger and accusations as we waited for Bernard, but that didn’t take the sting out of them.

When he arrived, he got the smile and sweet words I’d wished for all day.  After taking a few vitals he got on the phone and started the ball rolling.  When he left, Mom still hadn’t gotten anything for the nausea, but she felt like something was finally happening.  A continuous care nurse showed up.  I wasn’t sure what that meant, but I was glad for her.  I finally gave up and went home.  Mom wasn’t talking to me anyway.

The next few days were a blur.  Exhausted, I was operating on pure adrenalin.  Were I put on the witness stand right this moment, I could not provide a time line.  I could relay a number of vignettes, but they don’t make any sense.  I know I was there Saturday for a while, but there were no sweet moments for me to cling to.  I know that Saturday night  they called me.  Mom’s temperature was at 95 and her feet were mottling.  We thought this was the end.

I went through all of the motions I’ve been told to go through.  I told her what a good job she’d done in all of her roles.  I told her I loved her.  I told her everything was in order, just as she’d requested.  I told her it was OK for her to let go.  She’d done her job well and she deserved her reward.  But she wasn’t ready to go yet.

I stayed with her through the night.  For a while, I held her hand, hummed her favorite hymns to her and continued the one way dialog about the excellence of her life.  Finally, exhaustion took over and they brought me a recliner.  I went to sleep holding her hand.  I’d done the same with both my father and my aunt during their ordeals.  This felt familiar.

But Ruth wasn’t through.  Her temperature went back up, her feet were no longer mottled and another day began.  For lunch she wanted me to go to Wendy’s to get her a hamburger and a frosty. I fulfilled her request and she had a bite or two.  How many times was Ruth going to go to the brink without letting go?  I took a few hours away from the hospital, but then I packed up a bag and went back for the long haul.  When I returned, they said she’d been asking for me, but now she had nothing to say to me.

Monday morning I handled a few pieces of business and picked out a room on the third floor.  I’d been frequently reminded that Mom was still on the recovery floor and they weren’t really staffed for hospice.  Monday evening the continuous care ended and I was left alone with Mom.  Sure there were nurses out there, but they didn’t seem any better equipped to deal with the situation than I was.  Meanwhile, Mom floated along in a drugged state, rousing occasionally to go through the farce of a meal.  We’d get her up, put on her bib and give her a few bites that she’d chew on but rarely swallow.

Tuesday, around lunch time, they moved her.  I’d been told they would move her on Saturday and so I’d packed everything up.  We’d already lived out of suitcases for three days and by ten thirty I was tired of it.  I got ugly, but I got her moved.  On the nursing floor, I expressed my concern over the way they’d been medicating her. I feared they were over-medicating and she was in there somewhere cursing me.

So they backed off the drugs a little, but if she had been in there, she wasn’t anymore.  She was desperate to leave – telling me her girls would be home from school.  She remembered me as someone she knew, but she sure wasn’t certain who that someone was.  Before the night was over, we were back on morphine.  Less this time, they’d been giving her too large a dose, but it was still her only friend.

In the morning, I met with hospice and put her on palliative care.  I still don’t know if anything I did was right, but God knows, I’m doing my best.  I slept in my own bed with my husband last night.  I must balance the checkbook before I go check on her.  This has all happened too fast, but the rest is not happening fast enough.


Chat @ Caregiving: SSUURRRRE You’ll Be Back

You know it’s the small stuff that makes you crazy and I’m beginning to think making you crazy is the primary purpose of health care facilities.  Why else would hospital employees wake a patient numerous times throughout the night to draw blood, weigh, take vitals, etc. etc. etc.?  Now that Mom’s moved over to skilled nursing, there’s a little less of that going on, but they haven’t abandoned the most frustrating phrase in all of medicine, “I’ll be back.”

The medical world introduces you to various forms of this promise long before you find yourself in a nursing facility.  Like when you’re sitting in that paper gown on the end of an examining table. “The doctor will be right with you.” Yeah, after I have frostbite.  At least when you’re at the doctor’s office they do eventually appear.  They like to clear out the office before they go home.

In May, this medical odyssey began with a broken arm.   The arm had to be belted to Mom’s waist, rendering her virtually helpless.  Helpless and Ruth don’t belong in the same room.  Theoretically, she was supposed to call someone every time she got out of bed, but once she figured out that she could maneuver the wheel chair with her feet, she was through with that.  However, the task of dressing herself was a little more than she could manage.

Each day, whether by phone or in person, our first conversation of the day included a frustrated rant about people who promised to be right back, but weren’t.  They’d wake her up to give her meds and then promise to help her dress, but they’d never return.  She spent the whole day scheming about how she’d trick them into helping her dress on the following day, but those pesky aides would find yet another way to avoid her.  I began to think it was a part of the rehab program:  frustrate the patient enough and they’ll figure out how to do it on their own.

She did go home after a few weeks, at which time the rehab case manager informed me Mom was a little stubborn.  Oh really?  What was your first clue?

Then there was the first bout with congestive heart failure.  At the rehab facility, some anonymous person would come in and tell her something. Then my job would be to find out who it was and make them do whatever it was they said they were going to do.  The most elusive was a female doctor in a hijab.  In all the weeks Mom was at this particular facility, I never saw a hijab, but every time the woman came to see Mom, she’d leave some question hanging.  Mom put a marker in her brain and would wait impatiently for her return. Had the nurses not confirmed there was indeed a doctor in a hijab caring for my mom, I could have been convinced Ruth was hallucinating.

We’ve been in and out of the hospital a few times since the hijab, but folks are still falsely promising to return.  Mom’s current venue is not ideal.  I bet the “I’ll be back” thing works with a lot of the patients.  I’ve hung out with them.  I’m not trying to be cruel, but the fact of the matter is, some of them don’t know who they are, much less where they are. As soon as they hear “I’ll be back,” they forget it. But that’s not Ruth.

Yesterday was shower day.  Mom hates dressing for breakfast and then undressing for her shower, so she requested breakfast in her room.  When the aide delivered the tray, she asked, “Do you want your shower now or later?”  DUH!!  Who wants to get a shower while their breakfast is chilling in the next room?  So, the aide said she would be back.  Someone else came to pick up the tray and Mom was back in “be back” hell.

Since we seem to be able to regulate everything else when it comes to healthcare, I propose that we regulate, “I’ll be back.”  It should never be an open ended statement.  It should be, “I’ll be back in ten minutes,” or “I’ll be back at seven thirty” or something measurable – and then they should be back.  Heck, the world is so electronic, why don’t the have a channel on the TV that shows where the patient is in line.  Imagine how many calls to the desk that would eliminate.

I can hear all the healthcare personnel defending themselves and I’m not unsympathetic to your plight.  With who knows how many patients, all demanding your attention, I don’t know how you get anything done, but that little “I’ll be back” is part of the problem.  I was only there for a short while, but Mom talked to at least five people about her pending shower.  I have no idea how long ago the shower had been promised, but it was almost ten and breakfast is served between 7 AM and 8:30.  She’d been waiting more than ten minutes.

Someone might argue, “What’s the big deal?  It’s not like she’s going anywhere.” Right – with that attitude you probably have a great future in the geriatric healthcare industry.

OK – I’ll get down off my hobby horse.  “I’ll be back,” isn’t the only phrase that should be erased from human communication.  “No problem,” “Have a nice day,” “How are you,” and “I’m fine” are all pretty useless, too.  Every time a waiter tells me what I want is “no problem,” I know they’re cussing me all the way to the kitchen.  And there’s a new one, “My pleasure.”  Sure and I’ll be back.

Chat @ Caregiving: A Place for Mom

It’s been a long week. For most of it, I’ve been with Mom over at Presbyterian Hospital.  Chest Pains, ambulance, emergency room and admitted for observance – the usual.  Or at least it’s becoming the usual.

One of the first things her cardiologist suggested was assisted living, but he got the same reaction I’ve been getting over the last few weeks when I made similar noises.  Then everyone who walked into her room had the same suggestion.  The universe was definitely sending her a message.  By happy hour, Mom had gotten it.

I didn’t know what the immediate future held, but I did know I’m traveling in mid-September.  If she’s moving, I had to get on the stick.  After the early morning scare and the day at the hospital, I was pretty ragged, but I couldn’t put off the urgent need to start considering assisted living facilities.  When I got home, I sat down at the computer and googled “assisted living dalllas.” The first result was A Place for Mom.

I’d heard of them.  A lady faced with just what I was facing decided the available resources weren’t resourceful enough.  She started a nationwide referral service for elder living solutions.  I’d found the place where Mom currently lives on my own, so I knew I could do this, but I didn’t want to.  I  filled in a few blanks and clicked “Start Your Search”.  I had the “what can it hurt” attitude.  If there was a way to make this easier, without adding to the cost of it, then I was all for it.  I thought I’d get a list, but what they did was promise to call.

Here’s what surprised me.  It was past usual office hours, but before I could make another click my phone rang.  It was them.  They were ready to help.  As I answered all their questions, I was looking for my “Been Here, Done This” t-shirt.  How many times over the last few years have I explained my Mom’s situation to a caregiver of some sort?  I really wish I had a recording I could play for them.  Problem is, the details change almost daily, but I get so tired of this phase of the process.

Then I got Frankie Radabaugh.  If you contact A Place for Mom, you may get someone else, but Frankie is my new best friend.  Frankie and I went through a list of facilities.  She knew some I didn’t.  I knew some she didn’t.  We hung up and I had dinner.  When I came back to the computer, Frankie had emailed me my appointment list.  I was so relieved I wanted to cry.

Back in my do-it-myself days, I’d worn myself out playing phone tag and then I played the “tell me something about your Mom” game until I was blue in the face.  It literally took DAYS to make a handful of appointments.  Then when I arrived at the appointment, we spent more time playing “tell me something about your Mom.”  In the A Place for Mom world, I showed up for the appointments and was in-and-out in thirty minutes, generally. How do you spell relief?

In the days since, I checked on a couple of places that weren’t on Frankie’s list, but she streamlined the job more than I can explain and the one’s that weren’t on her list probably aren’t going to be my answer anyway.  Mom has a couple of more days in the hospital and then she’ll be in rehab.  No one can make this decision for us, but without Frankie and A Place for Mom, I’d still be trying to set up appointments.

In case you’re wondering, A Place for Mom also handles dads, aunts, grandmas or whoever else you may need to find help for.  It’s just called A Place for Mom, because the lady who started the company was looking for her mom.  Maybe you’ll never be faced with a task like this, but if you are, start with A Place for Mom.

Chat @ Care-giving: Medical Mis-steps

It should have been simple. At Dad’s annual physical, he discussed the upcoming cataract surgery with his internist.  A few weeks later, we met with the cataract specialist who needed a medical release from the internist.  Since I needed to be in Temple in a few days for the first meeting with Aunt Edie’s hospice nurse, I stopped by the internist’s office immediately after the specialist’s appointment to drop off the needed form.  I wanted to be sure Dad was well-taken-care-of before I headed out-of-town.

The internist was in Canada for a funeral, but I was assured he’d return in a matter of days and the cataract surgery was still a few weeks away, so I felt like everything was taken care of.  I left a copy of the release form with the receptionist and she took copious notes during our conversation.  She took my phone number and promised I would hear from her.  I didn’t.

Since I was with Aunt Edie after the internist returned, Mom called his office to check on the status of the release form.  Of course, she couldn’t talk to any one and had to leave a message.  I know my mom’s messages.  She writes down everything she wants to say before she calls and leaves very carefully worded details.  She told them when Dad had last seen the doctor, when the form was delivered to the internist office, when the form needed to be at the specialist’s office  and requested to be called to confirm the form had been faxed.

She got a call, but it was from the appointment clerk.  Mom explained the situation to the clerk.  “Ma’am, I just set the appointments.  Lucky told me your husband needs to do some testing and then come in for the results.”  “Then I need to speak to Lucky.”  “He’s at lunch.  I’ll set the appointments for the tests and the office visit in case you do need them.  I’ll tell Lucky to call.”

Ah, Lucky!  Lucky is the internist’s nurse.  For years, it was Rhonda.  Rhonda was smart, efficient and polite.  Lucky is not.  Rhonda still works for the internist, but has been promoted to position where she no longer has direct contact with the patients.  Now the patients have Lucky.  Lucky didn’t call me when he got the release form in his in box.  (I saw the receptionist put it in there with her explanatory notes.)  Lucky didn’t return my mother’s call about the form.  He also didn’t call after Mom talked to the appointment clerk.  His name may be “Lucky”, but the internist’s patients certainly are not.

So, with fear and trepidation Mom set the appointment.  Why fear and trepidation?  Because experience has taught her Murphy’s Law delivers the worst case scenario more often than not.  I assumed the internist needed another test to reassure himself Dad was OK for surgery.  Mom assumed the internist set the appointment to explain to Dad why he wouldn’t be able to have the surgery.  Then, we’d lose the deposit we put down for the surgery and my dad’s eyesight would be hampered for the rest of his life.  She was also worried that the battery of tests were too close to the ones Dad had just had and we’d end up paying for them.  We were both wrong.

Caring for aging parent’s is a tightrope performance, especially when the parents are hovering on that cusp between semi-independence and the need for full-time assistance.  I always want to be there for them when they need me, but I also want them to feel “normal” for as long as they can.  Dad’s appointment was on a Thursday afternoon and that’s the day I usually spend with them, so I assumed I’d be going to the internist with them.

On that Thursday, I got to their house very early, because Mom had an early appointment with her internist for her six month check-up.  Her blood pressure was somewhat elevated and I explained her concern over Dad’s surgery to the doctor and updated him on my aunt’s situation.  Since Mom has some significant dental surgery on the horizon, her doctor decided she needed a stress test, which he would schedule.  After the check-up we picked up the dry cleaning, got her glasses adjusted, went to Wal-Mart and Kroger, picked up barbecue from Dickey’s for lunch and did several chores around the house.  Then Mom sent me home.  “You got here at the crack of dawn and have already spent most of the day with us.   You’ve gotten more done than I could have hoped for and you’ll be here for two days next week.  Go home!  The doctor is around the corner and I promise to valet park the car.”

Normally, I might have insisted on going, but I wasn’t feeling too good.  Sensing my hesitation, my mom turned up the heat.  “You have a life.  You spent the last week with Edith and will lose several days next week with Dad.  Take care of some of your own business.  Send out some query letters.”  Ouch!  I was behind on my self-imposed quota of query letters.  Then she pulled out the big guns.  “I don’t want Bill to get disgusted with how much time you have to spend with us old folks.”  I hugged my parents and headed home.

By the time I got home I knew something more than exhaustion was bothering me.  I immediately went to bed and slept for several hours.  Then the phone rang.  “Honey, I’m sorry if I’m interrupting you, but you’re not going to believe what happened.”  Dad was going to be able to have his surgery, but thanks to Lucky, Dad did take a completely unnecessary battery of test.  I put on my best soothing voice.  “I’m so sorry Mom, but all we’ve lost is a little time and money.  Be thankful we can afford it.”

Mom wasn’t through.  “We were in the waiting room for a long time.  Then Lucky took Dad back and told him to undress.  It was so late in the day that I thought they’d forgotten us and you know how cold George gets.”  When the  doctor walked in, he said, ‘We did all this just a few weeks ago,” as if my geriatric parents had somehow forgotten that Dad had only recently had a physical.  I would have enjoyed being a fly on that wall as Mom set the record straight.

Dad had the eye surgery last week and is recuperating well at home, but I’m infuriated with his internist’s office.  I know there are wonderful health care professionals out there like Rhonda, who devote their lives to caring for others and make patients feel well-cared for, but there seem to be more Luckys everyday.  Who are the Rhondas you depend on as you help your seniors?

Chat @ Care-giving: H is Also for Horrible

A few months ago I blogged about how relieved I was that hospice had been recommended for my Aunt Edie. I’d felt so alone and unprepared to deal with her worsening health situation. I’d watched others slip out of this world and into the next with the help of hospice personnel and assumed that what I’d seen before was what my family would experience.

They told us that, at first, someone would just be dropping by once a week or when they were called to check on my aunt.  That was OK.  She was an independent sort and her pain was well under control.    Just knowing someone medical would be checking on her made me feel better about leaving her to return home to Dallas, three hours away, where I provide care to my mom and my dad.

I called her daily and some days that would be a pleasant experience.  Other times I would get off the phone wondering whether her hospice care takers were really taking very good care of her.  My cousin and I would email back and forth, speculating on whether we were doing everything we should.

As the situation escalated we were informed that we needed to be at Aunt Edie’s side more often.  We questioned what hospice would be doing.  Well, the nurse would come by more frequently and an aide would come by a few times a week to bathe Aunt Edie.  Anything else we’d have to provide ourselves, either personally or by payment.  No other agencies could apply for funds for someone under this hospice plan.  I began to wonder what hospice plan.

I have no complaint about the caregivers who were provided, but about the sparsity of their visits.  Each person who came to see my aunt was gentle, knowledgeable, capable and compassionate.  They just weren’t there very often.   Other people I’d known on hospice had a hospice representative with them around the clock.  Sometimes it had been an aide and at others it was a nurse, but the families never had to face the situation alone.  When they told me hospice, I’d coveted those bedside companions.

For a while we hired a woman to come sit with her five hours a day and to provide meals.  My very frugal aunt would stare at the woman who was costing us $15 an hour and fret.  The fretting was more damaging than the solitude.  Aunt Edie pointed out she was merely sleeping most of the time anyway.

Finally, it became clear there was no threshold at which hospice would suddenly provide more assistance.  Aunt Edie had no spouse and no children.  In fact, she lived in a town where she had no other relatives.  She had a lot of friends who wished they could help, but most of her friends were near her age and had no business caring for someone as seriously ill as my aunt; or they worked full time; or they had family members of their own who needed their attention.  So my cousins and I divided up the coming weeks.  In the last days it was too much for one person alone.  My cousin Brenda and I spent the last week of Edith’s life standing by, administering pain killers and wondering every moment whether we were doing the right thing or not.

I’m telling you this because I want you to know that not all hospice is created equal.  If someone you love goes under the care of a hospice team, ask more questions than we did.  When they tell you that they’ll be with you every step of the way, ask what that means.  Ask specifically whether there will be someone there to assist the family
AROUND THE CLOCK in the last days.  Not whether someone will be a phone call away, which we were assured we’d have.  Even when we called, we were merely told that we were doing the right things and admonished to call if we needed anything else.  When we said we needed help, we were told we could have twelve hours of respite care.  We didn’t want respite care – we wanted help.  Our aunt was dying.  We didn’t want to go bowling.  We wanted someone who knew more about this than we did to guide us through this.

We didn’t get it.  After Aunt Edie died…I can’t say passed away; there was nothing passive about it…hospice called the funeral home, removed the medical devices and took the sheets off the bed.  They left a folder for us.  It had a workbook for us to use to labor through our grief.  We threw the workbook away.  We’d made it through Aunt Edie’s death virtually on our own.  We doubted the workbook had much to offer.

Chat @ Care-giving: Taking a Tumble

Well, I know Mom didn’t do it on purpose, but she found a way to slow down the retirement center project. I understood that in the last weeks of her sister’s life she wouldn’t want to talk about making such a big step as moving, but I hoped that after the funeral she’d have a renewed interest in her own life.

Though she wasn’t eager to start visiting retirement properties, she was interested in some of the financial recommendations we’d made, so on our regular Thursday I took her to her bank.  I’ve told her about upteen million times that she should wait for me to come around and help her out of the car, but she’s hard to slow down.  When we pulled in front of the bank I was fritzing with the sunshade and putting up the handicapped sign.  She hopped out with her cane in one hand and her purse and an envelope in the other.  I climbed out and started around the car.  About the time I got to the headlight on the passenger’s side, I realized she was in trouble, but before I could reach her, she was down.

No one heard my desperate scream.  When I reached her, I realized there was blood flowing.  I ran into the bank to get something to wipe up the blood and ran back out.  Bank employees followed me.  Mom was sitting up and she was bleeding big time.  In the few seconds since the fall, she had blood all over her face, all over her shirt, all over both of our purses.  Soon it was sprinkled on the ground around her and on my feet.  One of the employees asked if I wanted them to call 911.  Mom was saying no, but I was saying yes.

I insisted that Mom lay back down.  She wanted to go home and I told her to lay still and let me handle this.  I was putting pressure on the cut with one hand and trying to wipe the blood off her face and neck with the other.  A bank guard showed up with a cold pack and started applying pressure to the wound.  He asked me to stand up and block the sun out of her eyes.  In moments the paramedics were there.

As they worked with her and asked her questions, I looked for the medication list I knew she kept in her purse.  They taped a huge piece of gauze to her head, put a neck brace on and moved her to the stretcher.  It seemed to me they were taking entirely too long to start transporting her, but within about 20 minutes of her fall, we were in the emergency room.

Then the pace came to a screeching halt.  The paramedics had stabilized her condition and triage began to monitor her vitals.  Eventually a doctor came in and checked her over.  He couldn’t find anything broken, but he wanted a CT scan.  Two hours later, office personnel were convinced she didn’t have any complications.  They gave her a tetanus shot, sealed her wound with dermabond and gave her a glass of orange juice.  Then we waited while they satisfied themselves that she was going to be OK.  They behaved as if it were all a storm in a teacup, but it was my mom.

Getting her home, I made lunch for all of us and got everyone settled.  I watched her carefully all afternoon.  Finally, after I’d gotten both she and dad dinner, they insisted I should go home.  I did go, but I came back the next day.  She looked worse, but she had a to do list for me that was a mile long.  By afternoon, she seemed to be percolating along pretty well, so I went home in time to make it to a lecture at the museum.

I called the next morning and things were worse.  Her bruising had worsened and her eye had been swollen shut.  My little sister took over for the weekend, bringing them meals and checking on Mom.  Sunday evening, I went by myself and the whole left side of her face was bruised.  The cut had almost healed, but she looked dreadful.  She was also suffering from vertigo.

We have an appointment with her primary care physician tomorrow, but she’s warned me it’s going to be a while before she’ll be interested in the retirement center project.  Her doctor may not agree with her assessment of the situation.  What do you think?

Chat @ Care-giving: A La Carte Assistance

When I began my search for a retirement center for my parents there was a lot I didn’t know. I had the general idea of it, but I wasn’t familiar with all the lingo.

I knew there was something better than the nursing homes of old, but I didn’t realize how much assistance you could before you had to sign up for assisted living.

One of my mom’s greatest fears was the specter of assisted living, where she’d be assigned a spot in a dining room populated with the near dead and the mentally challenged.  She wanted some help, but didn’t want to pay that price.  By the same token, independent living sounded like an apartment for the elderly, where she’d be just as isolated as she is in her own home, trying to take care of my dad all by herself.

In my shopping around I learned that the abyss between assisted living and independent living is a thing of the past.  Each property has its own level of care – a different number of meals, more or less frequent laundry and housekeeping and different policies concerning transportation are just a few examples.  You’ll really need to go to the properties, take a tour and ask questions to find out exactly what they mean when they designate something as independent living, enhanced independent living or assisted living.  Sometimes the same words are used to describe vastly different levels of service.  However, most properties offer something in-between independent living and assisted living:  on-site home health care.

Our family has utilized home health care – from physical rehabilitation after a fall, to the bathing of an uncle in a wheelchair.  In addition to the scheduling challenges and personality conflicts, there’s the added expense of travel expenses.  Within a short time, the assistance provided in the home caused almost more problems than it alleviated.  But what if home healthcare were just an add-on service which was as easily accessible as the books in a property’s library.  That would make things much more manageable and that’s exactly what is now offered.

One of the challenges my parents face is that my father is seven years older than my mother and requires a lot more help than she does.  How does she live the enhanced independent life-style she wants, while he gets help bathing?  On-site home health care is the answer – and instead of having to handle all the details of locating, hiring and managing your home health care, the property’s management takes care of it all for you.

And things just keep getting better.  When this service was first offered, it came by the hour, much like it does when you have someone come into your private home.  The cost of travel was taken out of the equation, but still you had to need an hour’s worth of help for it to make sense.  Maybe you just needed a little help organizing your medications once a week or maybe all you needed was a shot or the bandaging of a wound.  Forking over an hour’s price for a few minutes of help didn’t make good fiscal sense.  A growing number of properties are now offering assistance in fifteen minute intervals and I believe this will become the norm over time.

This aspect of retirement living is just one of the ones I have learned in this process.  What did you learn as you went through this process?