Learning to Read the Signs

Nobody can make you feel inferior without your permission. ~Eleanor Roosevelt~

I post this comment, because there are people who believe that I am uncaring or unfeeling toward my grandmother... that I don't do enough for her, or that I do not treat her well.  They base these assumptions on casual observations and claims of such from my grandmother.  I assure you, there is no basis for any of this.

See, I know my grandmother.  I have observed her behavior and her reactions for over 52 years now, and I am a pretty good judge of how she is really doing.  Last week, a dear friend of hers passed away.  This man was known to everyone as "Sis."  Don't ask why - I have no clue.  His brother - "Deb" - was my grandmother's constant companion for seven years after my grandfather passed.  Deb became a second grandfather to us, and we loved him dearly until the day he died in May 2000, of bladder cancer.  My grandmother was very fond of Deb's brother, Sis, and they visited often by phone, and sometimes in person.  So, when he died, my grandmother was naturally upset.  One of Deb's sons came for the visitation and took Mam-ma.  She saw lots of people, and when I went to her house a couple of days later, that was what she talked about.

During this same time, Mam-ma's blood pressure began to spike.  It worried a nurse's aide enough to call a nurse from Home Health.  The nurse supposedly told Mam-ma if she had pain in her neck and shoulder, to call an ambulance.  That was early in the week.  Friday when we went to the beauty shop, Mam-ma seemed fine, except she kept telling me she "just hadn't felt good for a couple of days."  Now, I recognized the tone and demeanor as a manipulative ploy.  If I would ask what was wrong, the flood gates of symptoms and ailments would open.  But I could see from her actions and the list of things she had been doing around the house that she was basically fine.

In addition to the loss of her friend, my mom and her husband left Friday for six weeks in Arizona. Mam-ma almost always has a medical crisis before Mom can get up the mountain and out of our little valley town.  So I was not surprised when we came home from the high school basketball games Friday night, and there was a phone message from my grandmother... "It's Mam-ma."  It was also 9:30 p.m., and I did not call her back, figuring she was in bed.  After all, she knows how to call my cell phone if she really needs me, and she had not done so.

Saturday morning, my husband, mother-in-law, and I set out to attend an auction.  On the way, I phoned Mam-ma and told her I'd seen her phone message.  Yes, she had called... "What am I going to do about this blood pressure?"  I asked if it was high, and she said yes, it was something like 189/85.  I asked if she had taken her morning medicine.  Yes, she had.  I suggested she take it easy and give the medicine time to work and we would see how she progressed through the day.  I told her we were on the way to an auction, and very quickly, she said (sarcastically), "Well, y'all go on and don't worry about me."  I reminded her I had a cell phone, and to call if she needed anything.  I did not hear from her again that day.

Sunday afternoon around 3:30, the phone rang - Mam-ma.  "What are we gonna do about my blood pressure?"  I asked if it was still high, and she read me some BP readings... 162/82 and similar readings.  I told her it sounded like it was coming down.  "Well something has got to be done!" she said.  I asked if she thought she was having a stroke.  She didn't know.  We bantered back and forth, and I told her our only option was the ER, and when she goes there, they always get her in a mess... screw up her medicine or worse.  Finally, I asked, "Are you wanting to go to the ER?"  She said no, but something had to be done.  I reminded her that a trip to the ER might likely result in a trip to the nursing home.  She said, "Well, I called Shirley (an LPN friend of the family), and she said I could take half a Lasix."  I did a quick search on the Internet of all of Mam-ma's medications and told her I didn't think she should take that until I found someone medical to consult.

So I called Shirley, and she said, "I did NOT tell her to take a Lasix.  In fact, I told her NOT to take ANYTHING until she talked with her doctor on Monday."  Shirley said Mam-ma heard what she wanted and would probably do what she pleased... and one pill would not kill her.  But Shirley asked, did I think this was about Sis.  I agreed that this had crossed my mind, and Shirley said, "I've been expecting a call from your grandmother ever since he died... she was so crazy about him."  We agreed the BP rise was from that and the absence of my mom. Shirley also said my grandmother's voice was strong on the phone and she didn't sound like she felt that bad... just "pouty."

So I called my grandmother back. When she answered, her voice was strong and solid.  Once she heard my voice, hers changed to a very faint whine.  This happens often, and she used to do the same thing to my dad.  It was all I could do not to laugh out loud.  I told her NOT to take anything extra - that Shirley said "No!" and that when her aide came Monday morning, if she felt the BP was high, she would call the nurse, and we could go from there.  She asked, "Well what am I gonna do about this headache?"  For the record, my grandmother has had "the headache" all of my life.  The last week or so, our weather has been totally unseasonable and erratic, and most of the people I know have had a headache at some point from the continual changes in air pressure, etc.  So I tried to explain this to Mam-ma... she still thought it was her blood pressure.  I just let it drop.

By 10:00 a.m. today, I had not heard anything from my grandmother, so I called.  She sounded extremely strong and well.  I asked what her aide had said, and she said, "Nothing.  She was in such a hurry, she didn't say anything."  I asked, "Did she take your blood pressure?"  Yes... it was 148/70.  Now that is a very good reading for my grandmother... and of course, she sounded disappointed.  I told her it sounded like she was on the mend, and she said, "Well, I guess."    We talked a few minutes and hung up, and later in the morning she called me to verify a phone number... she was already on to the next project.  It seems the "crisis" has passed for the moment... and hopefully we will have a smooth week.

Back to the quote.  There are those who would think I am horrible for not rushing my grandmother to the ER with such high blood pressure.  At one point yesterday, she yelled at me, "Well if I die tonight or in the morning, it don't make any difference!"  I've heard those sorts of threats before... and to some that would sound cruel, but I know her!  The last time we took her to the ER for high blood pressure was a couple of Easter Sundays ago, and we sat in the ER for probably 6 hours - some of that without the monitor even connected because they took her for an X-ray and forgot to reconnect her upon returning.  They finally gave her a blood pressure medication that her cardiologist said she is NEVER to have again, and after not eating or having any of her regular meds all day, she bottomed out, nearly passed out, and threw up!  We were several weeks getting her totally regulated after that little episode, so I am less than eager to go dashing to the ER when my instincts and assessments tell me we are not in a crisis... and certainly not an emergency situation.

But I have seen the looks from others.  I've heard the "I hope you know your grandmother is really sick!" (as if I was not checking on her and had no clue) comments, and I've felt the daggers from those who believe Mam-ma when she tells them, "Debbie is too busy to fool with me."  And Eleanor Roosevelt is right... only I can let those things make me feel inferior or inadequate... or guilty!  I have made a conscious decision not to "go there."  I'm pedaling as fast as I can, and I'm doing my best to keep my grandmother safe and well cared for... and to love her as much and as often as possible!

Meanwhile, our nephew Timmy is coming to spend a few nights with us... his regular two, plus an extra because his grandpaw is sick. So we are going from one end of the spectrum to the other - from high blood pressure to teething and crawling!  Life is certainly anything but dull and boring... and most days, this "sandwich" is pretty darn good!

A Lesson in Patience

We have had record-breaking bitter cold this week, along with some small accumulations of snow and ice.  Friday, the high was forecast to be in the lower twenties, with a morning low in the single digits - and wind gusts of 25 mph and upward.  I called Mam-ma - did she want to brave going to the beauty shop in the cold?  She said, "Well, I look like Phyllis Diller.  I'm not going to church or anywhere, but I sure need to get this hair done."  I told her it was her decision... that I was coming to her house either way to bring her medicine and re-dispense it.  I knew that my mom had taken her shopping last Saturday, and that Mom got her milk and groceries again on Wednesday in preparation for a winter storm.  In fact, Mom said she was at the check-out line with half of our county when Mam-ma called and said, "I forgot to put buttermilk on my list."  Mom said she had bought buttermilk for herself, and rather than get out of line and travel to the back of the store for more, she just put her jug in Mam-ma's pile of groceries and made do without on her own account.  But I did ask... "I guess you don't need any groceries?"  Yes, she needed dishwasher detergent and dishwashing liquid soap.

When I left home around noon, the temperature was about 18 degrees and there was a sharp wind.  I stopped at the pharmacy and got Mam-ma's medications.  When I arrived at her house, my plan was to fill the medicine compartments before we went to the beauty shop.  She had also complained that she was losing a thumbnail after mashing her thumb some time back, and I had brought some acrylic glue-on nails.  I planned to attach one to her thumbnail in hopes it would grow on out without coming off and snagging on something or being uncomfortable.

When I got inside Mam-ma's house, she had a grocery list on the kitchen table... dishwasher detergent, dishwashing liquid soap, buttermilk, and "ointment."  Atop the list was a prescription tube of some sort of ointment that was about three-quarters empty.  I looked at the tube and said, "Mam-ma, I've just come from the pharmacy."  "Oh, you have?" she said meekly.  "Yes... and I don't think I'm going back today."  Her shoulders slumped, and she frowned and said sternly, "But I NEED that ointment!"  I asked what the ointment was for, and she said, "That's for them blood vessels on my legs that have come to the surface, and they itch.  I didn't know you was goin' to the drugstore."  I reminded her that I had told her that morning I was going to pick up her medicine and fix it for her... and I had asked, "Is there anything else you need?"  She didn't remember that conversation, but she continued to pitch a fit that "I've GOT to have that medicine!"  Fine, I said... I would call and order some.

I called the pharmacy, and that prescription was so old that 1) there was no longer a pharmacy label attached to the tube, and 2) the pharmacy could not refill it.  The clerk said, "You'll have to call her doctor." When I told Mam-ma that, she said, "Just forget it!" (her favorite phrase when she is disgusted and wanting to lay on the guilts)... and I asked, had she tried some hydro-cortisone cream?  No, she had not.  I suggested I get a tube of that at the store, and I added it to the list.  She got up and walked into her bathroom.  I sat down at the kitchen table to fill her medicine compartments.  She returned and threw a tube of hydro-cortisone cream onto the table in my direction.  "I've got some of that... you don't need to buy any more."  I told her that was fine... and I suggested she try using it and see what happens.  For the life of me, I don't recall ever hearing of this blood vessel in the leg ailment... and neither do my mom or my sister!  There is no telling how old this tube of ointment really is... or when it was prescribed.

I filled the medicine boxes, and then I applied the acrylic fingernail to her thumb.  She immediately began fiddling with it, and I am not sure how long it will last, but hopefully it will protect the nail bed until her dead thumbnail can grow off.  She got her coat, and I helped her get out the door... where was her scarf for her head?  She had forgotten it.  Where were the new ear muffs I got her for Christmas?  On her spare bed.  I went back and got the scarf and ear muffs.

I questioned the buttermilk on her grocery list... didn't Mom get her a carton?  Had she already used it?  I checked her refrigerator, and there was a full quart... that was the problem... "Well, your momma only got me a quart!"  (I usually get a half gallon.)  I explained WHY my mother only got a quart - that it really was HER buttermilk, and she was being nice...  but Mam-ma still wanted another quart of buttermilk.

Then she asked, "Did I offend your sister?"  I didn't know what she was talking about, and she said, "Well, I called her to come get some food from my freezer, and she has acted funny - and she still hasn't been over to get the food."  I was really at my wits' end by this time, and I said, "Mam-ma... she is busy.  She has the grand-baby and a sick husband and a job and a daughter... and she has not been able to get out of her driveway in several days because of ice and snow.  No, she is not offended or upset.  And... she has not eaten the two big sacks of food you gave her a couple of weeks ago." 

To my grandmother's way of thinking, when she calls and says, "Come when you can," that means "come NOW!"  She has done this all of my life.  When we were children, Mam-ma would call my parents and ask, "Can you come help pick the peas (or beans, or whatever needed picking in the garden)?"  By the time my parents got off work, gathered three children, and drove the five miles of dirt road to get to my grandparents' house, the peas or beans or whatever were already picked and shelled, and supper was most likely on the table, with an admonition, "Well, I decided y'all weren't coming."

Additionally, Mam-ma has always said, "Now we need to eat up what's in the cellar and deep freeze to make room for the things we put up this next summer."  At 97, as my mother puts it, Mam-ma is no longer needing to feed the world.  She has a "deep freeze" so full of food that she can barely cram another package of chicken thighs in it, and yet she still is purchasing and "putting up" vegetables from generous church members.  And she is fussing that "we need to eat what's in that freezer!"  The other day, Mom asked, "What exactly is in that freezer?" and Mam-ma replied, "You'd be surprised."  Then she said, "Well, you know, Debbie brought me all them peas..."  If you have been following this blog, you know that two summers ago, my grandmother asked me to purchase her a half bushel of shelled purple hull peas... and before I could get them from the farmer's market to her house, she had accepted another half bushel from a church member!  We're talking a 118-lb. single widow who eats like a bird!  So, now she has made it her mission to feed my sister and her family - and the rest of us - from her freezer.

Mom took Mam-ma to buy some meat, and she said she saw some really nice looking pork ribs and roasts in the meat case, and she thought, "Oh, those are the ones I would select."  Mam-ma picked out the fattest packages she could see... they would be more tender.  Then she told Mom she didn't have room to put them in her refrigerator or freezer.  So Friday, she asked, "Would you like to have a pork roast?"  We don't eat pork or beef much, and I said no at first... but then I realized that was not a good answer. She sighed and said, "Well, I have so much food and I don't know what I'm going to do with it all."  So I brought the pork roast home, and it's simmering in the oven.   I'll remove as much fat as I can and we'll make sandwiches from it.

So we got the hair done, the dish detergents and buttermilk purchased, and the roast came home with me.  Saturday, Mam-ma called my mom and wasn't sure she could go to church because of the cold... she didn't have a good heavy coat.  Mom asked what was wrong with the heavy black wool coat I had given her?  She said it would barely button.  I find this amazing, as it was plenty big on her, but she also phoned me and asked me whether I thought she should go to church.  I asked, why was Sunday any different from being out for a hair appointment on Friday, especially since Sunday was forecasted to be warmer?  She didn't know, except she wore an old red down-filled coat she bought at a garage sale, and she didn't think that was nice enough to wear to church (it's not, especially since she has a wool dress coat!).  She also told me she had been to Fred's on Saturday with her friend Ruby to walk in the store for exercise.  So how was it okay to go to Fred's on Saturday but not to church on Sunday?  Reluctantly, she said, "Okay, I guess I'll get up in the morning and get dressed and see how I do."  Mom e-mailed me Sunday afternoon - her message said simply, "black coat."  I wrote back... "buttoned?"

After the events of Friday with my grandmother, our great-nephew Timothy came that evening to spend the night.  What a joy!  Teething, fussiness, and even a restless night were a welcome contrast to the stress and strain of arguing over ointment and buttermilk!  My grandmother is slipping.  She isn't remembering things for more than a few hours... if that.  Several times last week, she said, "I thought your sister would come by," and when I told her that the roads were iced over and no one was going anywhere, she would say, "Oh, is it bad out?  I didn't know."  We all told her how bad the weather was - and the roads - and still she would say, "I didn't have any idea it was bad out!"  Still, when I look at the challenges others are facing with their seniors, I count my blessings.

And as always, Timothy provides balance... and a breath of fresh air.  He is sitting up well now, and his Uncle Greg taught him to stand up and hold onto the side of his playpen.  He has new Michael Jordan leather basketball shoes - fifty cents at the thrift store (I haven't completely lost my mind yet!) - and he has learned a few new noises.  All of these milestones bring us great joy, and we realize how quickly they grow and change.  Maybe the challenges and tests of my patience that come with assisting my grandmother are good training for managing the challenges of an 8-month-old.  One thing is for sure... their temper tantrums are not all that different!  If only the solutions were more similar... and could all be solved with a bottle or a bounce on the knee.

Have a great week... keep your balance and your sense of humor... your gonna need 'em!

End of the Year Housekeeping

Happy New Year! Our year ended with two words... stomach flu! My sister phoned me three days before Christmas and wanted to know if I could come and get my great-nephew. She had succumbed to stomach flu (he was still recovering), and neither she nor her husband could manage the illness AND a baby. Timmy's mother was working long shifts as a nurse's aide at a local nursing home, so my husband and I were next on the list for baby care. We picked up the baby and brought him home, and we began to help him recover from his bout with this "bug" in time for our family holiday on Christmas Eve. We made it through our Christmas lunch, and then my husband began to feel sick. My mom and her husband and my grandmother decided they were already exposed, so they stayed until early evening.

The next morning around 3:30, I awoke so nauseous I could not move. I looked at the baby sleeping in his crib and thought, "I can't even get up to check on him." We managed until mid-morning, when the baby's dad arrived to get him. It was a long Christmas Day, and my husband began to gradually feel better, assuring me that within 24 hours, I would be better, too. And I was... but by December 26th, my mom's husband was down, and my grandmother was saying she was sick. She recovered the fastest of any of us, so we aren't sure if she really had the "bug" or if she ate too much rich holiday food. Either way, we were thankful she bounced back so quickly.

Meanwhile, there has been so much end of the year work to be done. I got Mam-ma re-enrolled in Medicare Part D coverage - a new provider, of course. I've begun getting the papers to apply for her supplemental assistance. I filled out several pages of information for one service, including a lengthy bank statement showing her auto-draft for utilities for the past three months. The application was returned, noting that I needed "proof" of her utility payments. Apparently highlighting her auto-drafts on a bank statement is not sufficient evidence. We determined that this supplemental assistance, which nets some $14/month, is not worth the time and trouble it takes to apply for it, so we are forfeiting. I realize that this is what the agency may hope will happen, and if my grandmother truly depended on this service, we would keep it. But we are in "divide and conquer" mode, and frankly, I just did not have the time and energy to collect - and copy - all of her utility bills, proof of her pharmacy purchases, burial insurance and more for $168. I'm something of a slow learner, I guess, since I've done exactly this for several years now. But I finally decided to cry "Uncle" on this one - and thankfully, Mam-ma agreed to it.

Meanwhile, I am very grateful that my 97-year-old grandmother is doing so well. Sure, she gives me a run for my money many days, but all in all, we're doing great. My sister-in-law lost her 90-year-old father on December 21st to a massive brain bleed. Her 91-year-old mother suffers from macular degeneration and other physical ailments. The family laughed that "together, this couple made a whole person." She couldn't see - he couldn't hear. Now decisions have to be made about how this mother will function alone - and IF she can manage in her own home with help. Mam-ma still sees well enough to embroider pillowcases, read the newspaper daily, and do routine household and personal chores. She still hears relatively well and can manage quite ably in her own home with the assistance of Home Health aides and family and friends. I realize this is a delicate, and precarious situation that could quickly change. And she does show signs of becoming more confused and forgetful. But for the moment, we are hanging on and making it all work.

I look at my little nephew and how dependent he is on us for virtually everything in his life, and then I look at my grandmother and the assistance she requires, and I realize that the two are different, yet somewhat similar. Timmy's needs are more physical - food, clothing, clean diapers - while Mam-ma's are more of the paper variety - forms to complete, errands to run, medicine to dispense, bills to pay, and more... at least for the moment. At some point, the needs may begin to look more and more alike. My sister-in-law said her prayer was always that her parents would be able to live alone in their own home until one of them fell over dead, and that is virtually how it happened. This is my prayer, too - that for as long as humanly possible, Mam-ma will be able to function in her own home, on her own terms. I'm doing all I can to make this happen... and for now, we're doing okay.

December In a Sandwich Family

The holidays are upon us, and all indications are that my grandmother has her peanut brittle factory in full swing (an offer of candy for my husband yesterday and a comment that she still needs to make a batch for a cousin!). I have given up worrying about it or trying to prevent it and turned to praying that she makes it safely from stove to cookie sheet with hot molten candy lava.

Timmy is seven months old now and mesmerized by the Christmas lights and decorations. Most years, I have my Christmas shopping done by October, the cards mailed by the first week of December, presents wrapped and under the tree the 2nd week, and baked goods to share with family and friends. This year I have most gifts purchased, cards e-mailed - but a box for mailing on the desk, nothing wrapped, and no baked goods. Hopefully I will have a couple of days in a row where I can knock out a few things on my list!

Medicare Part D enrollment is complete for 2010 - somewhat less painful this year than in those past. Everyone is healthy for the moment. We really are blessed and have little to complain about... although we do seem to find something... but I'm working on that, too!

Cousins came from Oklahoma to visit my grandmother Thanksgiving weekend. They brought her twenty-five gifts... wrapped and numbered. She was instructed to open one gift per day, in the order listed, until Christmas! She is having a ball with this. The first day it was a wreath. Day 2 brought a pretty pin for her coat lapel. Day three it was a box of Christmas cards - AND stamps! Day 4 she got a Christmas coffee mug. And so it goes. This was a genius idea - and took a lot of work and thought. But you might have a senior on YOUR list whose holidays would be brightened by this gift extravaganza!

When I did my grandmother's errands this week, she seemed more confused than usual. I spent extra time at her house helping her with some Christmas cards and things... and just reassuring her that she was tired (probably from making peanut brittle the day before) and this would pass. But I do see a steady decline in her. And while I know she can spin on a dime, for the moment, she seems to have mellowed a bit and is very kind and appreciative - and cooperative. Maybe she is just too tired to argue! At any rate, her little house is cozy and decorated for Christmas, thanks to her housekeeper and friends who have brought in fresh greenery and such. Her gifts are purchased and ready to deliver. She is looking forward to spending time with her family on Christmas Eve - especially her great-great grandson Timothy. And the daily packages have given her a reason to get up each morning.

In some ways, 7-month-old babies are not all that different from 97-year-old great-great grandmothers. They both need lots of love and attention. For the moment, God is giving me plenty of stamina to meet these needs... and I have no doubt He will continue.

Have a blessed, happy 3rd week of December!

Taking Care of Business

On November 5th, my grandmother celebrated her 97th birthday. We actually celebrated the day before with a lunch at our local hospital cafeteria. Everyone was there, and many local residents stopped by to wish my Mam-ma well, too, so she had a great day. I think her phone rang almost non-stop on her birthday, and her mailbox was filled with cards. She also had a few visitors drop by to say "Happy Birthday." My mother picked Mam-ma up and brought her to the lunch, then took her home. We were probably at the cafeteria for two hours or better, and when Mom pulled into the driveway, Mam-ma said, "Can't you come in and visit for a while?" No... Mom had things to do. Mam-ma also told her, "You hardly ever come to see me any more." Mom admitted she doesn't go often, but she HAD just spent two hours with my grandmother!

On Friday, November 6th, I picked Mam-ma up for her beauty shop appointment, and the house smelled like a bakery. I knew from posts on Facebook that the children of a cousin who lives in Little Rock had called and wished Mam-ma a "Happy Birthday," and one of them mentioned he liked her sugar cookies. She replied, "Well I'll bake you some, but you'll have to come see me." When I smelled the cookies, I knew she had taken his request quite literally. She began telling me that "the kids are coming," and I cautioned her that "soon" to them probably didn't mean right away. She didn't buy it. So when I got home, I posted a comment on Facebook and let them know that Mam-ma had already made the cookies for their son. They came on Sunday, so they avoided the dog house!

As we left for the beauty shop, Mam-ma said, "My walker needs new tips on the legs." Now I think I posted here a few months ago about the ordeal of getting new legs for her walker when "all I wanted was two tennis balls." So I said, "We've been through this." Well, this was ANOTHER walker, and the tips were shot. I said, "Let's take the walker I had fixed for you a few months ago, and you use this walker outside where the tips don't matter." She said, "Okay, but THIS walker has wobbly wheels." I couldn't see it, but she reluctantly took the newer walker, and I told her that the next Friday, I would factor in time to take it by the medical supply store for a look/see.

Over the weekend, my sister and I were talking, and she said, "I'm worried about Mam-ma... she said she hadn't done well for two days." I asked if Mam-ma told her about the cards, phone calls, visits, cookie baking, laundry she had folded, etc., and she said, "Noooooooooo." That explained her exhaustion!

My husband and I keep our great-nephew on Tuesday and Thursday afternoons while his mother attends college classes. Sometimes we keep him overnight and on weekends, too. Tuesday afternoon, I barely got Timothy in his crib for a nap when the phone rang. I was unable to reach it in time, but caller ID showed me it was Mam-ma. I returned her call and told her I was just putting the baby down for a nap and couldn't get to her phone call. She said, "Oh, you've got the baby?" "Yes, we have him every Tuesday and Thursday afternoon." (She knows this!) "Oh, you do? Every Tuesday and Thursday... well that's nice." She wanted to ask me what color to embroider some pillowcases I had purchased for her - just for something to do. I told her it did not matter to me... but she wanted me to pick a color!

When I picked up Mam-ma the day after her birthday, there were several pieces of mail for me... the new Aetna formularies for Medicare Part D prescription drug coverage, and two letters from the Arkansas Department of Finance telling me that Mam-ma's handicapped parking sticker is expiring. I read through everything - as expected, Aetna will not cover one of Mam-ma's most expensive medications in 2010, so for the FOURTH year in a row, I am choosing a new provider and making the switch!

One morning I sat down to review the providers and see if I could figure out which insurance company might fit Mam-ma's needs. I went to http://www.medicare.gov/ and began the comparison process. First you have to enter your Medicare ID number, your birth date, the date Medicare coverage began, and a few other things. If for any reason after you advance to the next page you hit the backspace key, you lose every bit of that info and have to retype. I know... I've learned the hard way. Now once I get to the actual page for comparing providers, I have "saved" my grandmother's prescriptions for reference, and I can edit dosages and even add or subtract prescriptions if needed. However, to do this initially, I had to enter each drug individually, along with the dosage and the number of pills she takes per month. It wasn't hard for me, but then, I am not quite a "senior" yet and consider myself fairly computer savvy.

I adjusted Mam-ma's meds and added a new one and removed the old one and SAVED my info again. But before I did this, I realized that the website now offers a "My Medicare" option, where you can create a login and password, and you will be able to retrieve all of your information about Medicare coverage, including what you have spent, what is still available and allowable, and more. So I thought, "Great! If I get a login and password, maybe I won't keep losing my info each time and having to retype things." Here's what happened. I created a login - and there were specific instructions about how to make it something you will remember, but not something others might readily know. Then I gave my e-mail address and I was told that a temporary password would be sent to my e-mail account - and mailed to Mam-ma! (Won't she be tickled?!)

I checked my e-mail account, and here's the good part... to create my temporary password, I had to take the first letter of my grandmother's first name, then add the last four digits of her Social Security number, followed by the first letter of her LAST name, followed by a code that Medicare gave me in the e-mail message. Once I was logged in with this password, I could change it to anything I wanted, as long as it included at least 8 characters, a letter AND a digit, and any number of characters such as *,&, !, and others that are generally not allowable in all things Internet or computer! Now I had to laugh... what genius came up with this procedure for SENIOR CITIZENS?! It truly boggles the mind.

I now have a call pending with the Medicare office in Dallas, as I do each year, to clarify questions for which I cannot find answers on http://www.medicare.gov/. I think I know the answer, but I have to be certain!

So Friday, I picked up my grandmother for her hair appointment, and she practically met me at the door, pillowcases and embroidery thread in hand... what did I think about lavender? I told her it was fine by me. Then I started to dispense her medications into her daily pill boxes. She had not taken her night-time medicine four out of seven nights. She had missed two morning doses, and her Friday noon medication was still there - and it was almost 2:00. I discussed this with her, and she had no clue why she had not taken all of her medicine - and honestly, she didn't realize she HADN'T taken it! She had, however, worried herself silly over a "shoebox" for the church for a project for Franklin Graham's Samaritan's Purse Organization, called "Operation Shoebox." She and her friend Ruby had both stuffed shoeboxes full of toys, candy, toiletries, small workbooks and more, and Ruby had wrapped the boxes in padding and then covered them in colorful Christmas fabric. A couple of 5-9-year-old boys in a foreign country will get a real treat this Christmas!

Mam-ma took her noon-time medicine, and we started to the beauty shop. She showed me the old walker and said, "I just took those tips off... they were shot." I told her that I planned to get her newer walker looked at while she was having her hair done. I took her to the hairdresser's, then drove to the medical supply place. A very nice man and woman looked at the walker and declared that "Someone has put the miles on this!" The wheels were worn flat and hard... and the walker itself was completely out of alignment. They could put new wheels on it, but there was nothing to be done about the alignment. The woman said, "Since Medicare has provided her with a new walker in the last five years, they will not pay for a new one, which is $120. But I have a used one that is refurbished and perfectly good that I can sell you for $50." I told her I would take it. So I got a new walker for Mam-ma to use at church and when she goes places with Ruby, and we agreed she could use the old wobbly one with new wheels outside and in the yard. When I got home, I wrote OUTSIDE in black magic marker across the handle rails of the old one, and I put her name on the new one.

But before we could get home from the errands/beauty shop, we had to stop at the Department of Motor Vehicles and get a photo ID and new handicapped parking sticker. Mam-ma somehow qualifies for two of those hangers to place on the rear view mirror, and she wanted BOTH of them. Just as it was our turn to be served, the computers went down, so we had to wait about 20 minutes. But we got the photo ID and two hanging permits.

Back at home, I started putting away my grandmother's groceries, and she said, "I don't know why I'm so out of it." and I reminded her it was due largely to not taking her medication. She didn't answer me. I insisted she has to try harder to remember to take it and not get so busy. I finished putting away the groceries and dispensing her medicine, then I took probably 10 pieces of clothing off her clothesline - she had hung each one on a hanger and pinned it to the clothesline with TWO clothespins! That line is high - I have no idea how she did that and balanced on a walker! AND... there was a THIRD walker at her back door that I had never seen before! Counting her "good" one inside, she had FOUR walkers! I folded up the one with no tips on the legs and put it in my car... and I told her it was going away!

Here's the kicker... my husband and I went to the local high school football game later that evening, and Mam-ma's Home Health Aide, whom I've known for over a decade, asked, "Did you help Mam-ma get her peanut brittle made?" "What? Peanut brittle?" I had not heard this one. The aide went on to say that when she helped Mam-ma that morning with her bath, she said, "I wish you could stay all day and help me." "With what?" the aide asked. "Making peanut brittle!" my grandmother replied. This makes the second year she has made peanut brittle "on the sly" and tried not to let me know about it, because she thinks I will fuss at her. And I might - she handles scalding molten candy in a HEAVY saucepan, and one winter she required physical therapy on her shoulder after a Christmas season of making peanut brittle. Hers is the best around, and she will probably make close to 50 lbs. of it this year. Last year she made nearly that much and never once asked me to buy as much as a peanut, much less sugar and corn syrup. She had friends and church members keep her in supplies and help with deliveries.

Knowing all of this, it's no wonder Mam-ma isn't remembering her medications... she has too much else on her mind, from embroidery to parties to peanut brittle! The aide also told me that Mam-ma nearly killed herself making THREE BATCHES of sugar cookies for the cousins who came. But she truly did enjoy them, so I guess it was worth it.

When I left my grandmother's house, I still had to return to Wal-Mart for OUR groceries. Also on my list was another box of diapers for the baby, plus formula and baby food, and a child car safety seat. I had to laugh... as I loaded my groceries into the car, I opened a door to set the car seat inside, and there was the walker. Now if I'm not covering both ends of the spectrum, nobody is! And we get to do it all over again this week!

Here We Go Again With Medicare!

On November 5, 2009, my grandmother celebrated her 97th birthday. She is in excellent health and still lives alone in her own home. She is able to do this because of the vast assistance from her family and various agencies, including our county's Home Health department, assistance with utility bills twice a year, Medicare, Medicaid, and her monthly Social Security pension of $759. I serve as her Durable Power of Attorney and handle all of her business transactions for her.

When the Medicare Part D Prescription Drug Plan was enacted in the fall of 2006, I selected what I felt was the best plan for my grandmother. Shortly after January 1, 2007, I discovered that Medicare had "switched" my grandmother to another plan without my knowledge - a plan that did not cover her prescription medications. It took some work and the assistance of a very helpful Medicare official in Dallas, but I was able to get my grandmother switched back to CignatureRx. This was not the end of the story... there were continual struggles with CignatureRx, because drugs they said were covered in 2006 seemed to mysteriously be "no longer covered" as the year progressed.

In 2007, I learned that CignatureRx was no longer a good fit for my grandmother, due to lack of coverage and the addition of premiums and deductibles. So I repeated the process to search for a new provider, and I chose Humana. I have to say, the folks at Humana were wonderful and very customer-friendly. They tried to tell me that two of my grandmother's most expensive medications were not going to be covered, but after hearing from her physician, they gave her a "lifetime waiver" on those drugs - she could receive these drugs for the initially-agreed-upon co-pay. I thought I was set! I learned in November 2008 that "lifetime waiver" was only good for one year - that in the insurance company's terminology, a "lifetime" equals one year.

Medicare employees confirmed to me in November 2008 that most seniors will have to re-apply for coverage EVERY SINGLE YEAR, due to changes in formularies, premiums, deductibles, and more. So once again, I am searching for an insurance provider that will adequately cover my grandmother's seven daily prescription drugs.
I know this is lengthy, but believe me, I have condensed it greatly. If you were to read my blog posts of February 2006 and November 2008, you would see some of the ordeal that has transpired:

• http://firecrackerbaby57.blogspot.com/2006/02/medicarerx-drug-plan-is-fiasco.html
• http://firecrackerbaby57.blogspot.com/2006/02/keep-your-fingers-crossed_10.html
• http://firecrackerbaby57.blogspot.com/2006/02/its-over-hopefully.html
• http://delisandwich.blogspot.com/2008/11/if-its-november-it-must-be-time-for-new.html

Aside from the obvious concerns over how this is handled... here are my issues with this plan. I am a 52-year-old former elementary school teacher with a MS in Education. My husband and I founded a magazine and publishing business. I know how to navigate "red tape" and make appropriate contacts, yet I still struggled with this one. If getting prescription drug coverage is this difficult for me, imagine what it would be like for seniors trying to do it themselves. They get through two pushes of the menu buttons (and there are dozens!) and they give up and go away. I figure this is the hope of many of these bureaucracies. As concisely as I can make it:

• Medicare Part D is another example of how convoluted our health care system is.* The average senior cannot figure this out on his/her own, and I seriously doubt most have advocates to do this for them. Even four years into this, I still have to call my Medicare connection in Dallas for clarification and confirmation. I got this contact because initially I complained loudly to everyone from then Governor Mike Huckabee to Congressman Marion Berry, both of my senators, and others. Most seniors won't have the resources - or patience - to do this. (See my first blog post link for info on the responses - or lack thereof - I received!)
  
• I try not to let my grandmother know how much is involved in getting this coverage each year; however, sometimes she is required to verify information on the phone for representatives, etc., so she does know there is work involved. One day she said, "I'll just not take those medicines." I quickly told her this was not an option! But I fear that this is indeed what many seniors are doing... rather than fight the phone menus, comparing plans, and more, they give up and forego needed medications. This system is designed to shoot them down quickly and frustrate the seniors into quick defeat.
  
• The Medicare Part D Prescription Drug system is not equitable. So far, because of her meager "income," my grandmother has qualified for a waiver on premiums and deductibles on certain plans. Many others do not, and those premiums and deductibles add up quickly for older Americans on a fixed income. And what happens when the plans get so out of whack that my grandmother and others like her no longer qualify for waivers on these fees, as well?


• The "donut hole" is ridiculous. The mother of my mom's neighbor had to have an extremely potent antibiotic last January. The doctor could have given her injections, which would have been covered somehow by the insurance provider as a "medical procedure" perhaps. Instead, he prescribed oral medication - to the tune of about $3000 per month. This meant that this lady was thrown into the "donut hole" in February! I have a sick feeling this is in no way an isolated instance. Yes, it was a mistake made by the physician, but it shouldn't be possible. Physicians need to be treating patients, not keeping up with which forms of certain drugs are covered by insurance companies - and how!

Thankfully, I am now semi-retired and have more time to devote to keeping my grandmother in the necessary assistance to sustain her in her own home. We've done three stints in nursing homes for rehab following injuries and illness, and that is not where she needs - or wants - to be. And frankly, keeping her at home is far more economical for the federal government, in terms of capital outlay for her care.

The bottom line for me is that this system is not working for our seniors, and it's almost as if - as a nation - we don't care! As I understand it, presently the government cannot regulate premiums, deductibles, and formularies for the pharmaceutical companies. I believe it is time to revisit this situation... and maybe this is where the public option could help... something that seniors could choose that would cover their medications without imposing these fees and restrictions. I wholeheartedly support the President's health plan, and I believe that, sadly, this fiasco with Part D coverage is only one small part of a much bigger problem. But it is one that desperately needs to be addressed.

"Generational Rivalry?"

Last week when I picked my grandmother up for her beauty shop appointment, she hobbled to the door and said, "I've lost my coat." I questioned her about which coat, and she said a lightweight tan coat that she and my mom bought at Wal-Mart. She said, "I've looked EVERYWEHRE for it... and it's not in any of my closets." I assured her we would look for it when we returned. As we got into the car, she said, "I'm going to get a permanent today, if Pat has time. I told her I might last week." Now, a permanent takes 2 hours or better. I was hoping to hurry back home, fix a quick supper, and get to our high school homecoming game that night. This would delay me by at least an hour... and I wasn't sure the hairdresser was prepared to stay longer.

We got to the beauty shop, and I went in ahead of Mam-ma and asked the hairdresser, "Do you have time to do a perm? Mam-ma is saying she wants one, but I wasn't sure that would work for you." I know the hairdresser is rearing her grandson, and he goes to a daycare, so she might have to make arrangements for him to stay later when this happens. She insisted it was okay, but she wished she had known and we could have come earlier. I told her, "I just found out as we got in the car. Seriously, if it's not okay, just say so and we will wait." She said it was fine, but we would have to work around other clients, and it would take at least 2½ hours. So, I headed out to grocery shop and run some errands with plenty of time... even took in the Homecoming parade that was blocking my route.

I had just about finished shopping when my cell phone rang... the hairdresser... they finished in 2 hours. So I hurried to load my groceries into the car and make the trip back downtown to the beauty shop. I got Mam-ma into the car and started home with her, and she said, "I bet you were into something else this afternoon." I told her yes and no... that I had to get home to get supper ready so we could go to the ballgame. She offered me beans for supper... I thanked her and said I had already prepared a big pot of potato soup. I also mentioned that the baby was spending Saturday night and part of Sunday with us, because his grandparents were sick with the flu and he couldn't go to their house while his mother worked. She said, "Oh, you'll have the baby?" "Yes."

I was laughing that a friend had asked if we still keep the baby, and I told her we do, and she asked if that was still fun, and I said, "Of course!" Mam-ma said, "Well... it will start to wear on you." I told her keeping Timothy will NEVER get old to me... and she said, "Well you better enjoy it while you can." I laughed and as I got out of the car, I said, "Yes, there may come a day when he doesn't want to come stay with me," and I heard her mumble, "Yes, just like you kids. Someone asked me the other day, 'Polly, why don't your kids ever come to see you?' and I told them, 'They've grown up and they don't care nothing about me any more.'" I have heard this a thousand times, and rather than argue, I told her, "Mam-ma, when people grow up, they have responsibilities and their own lives to live... and they are simply busy."

Inside, we combed every closet for the elusive coat. She described it first as tan, then as khaki, and then as a light stone color, with a navy collar. I couldn't find anything like that. I called my mom and the drycleaners and neither had seen the coat. I told Mam-ma, "You've left it at Ruby's or at a domino party... call your friends and ask around." She said, "Ruby tells me all the time, 'Polly, you are always leaving your coat somewhere.'"

Trying to get home, I started to the door, and Mam-ma wanted me to look at her tomatoes. She has a big vine in her back yard with clusters of green tomatoes on it. A cold front had come through earlier in the morning, and she wanted to cover the tomatoes from potential frost. A blanket already surrounded the heavy wire cage supporting the vine. I said, "Looks like it's covered to me." She exclaimed, "Oh no it's not!" So I told her to get me a sheet and I would cover the tomatoes. "No, you won't!" she replied. "I'm going to do that." "Well I'm going with you!" I added. So she hobbled outside and got on the walker she leaves posted at her back door, and together we covered the tomatoes and pinned the blanket to the cage with clothespins.

Saturday, our phone rang... Mam-ma. "Do you have the baby?" "No, he isn't coming until around 1:00 p.m." "Oh... well... I found my coat!" I asked where it was, and she said, "In my closet. I had just simply overlooked it. I got up at 3:00 this morning determined to find that coat... and there it was." Then she added... "I bet you were cooking lunch." I told her no, I was watching the Razorback game. "So am I!" she said! She told me a few other things and then said, "I'll let you go watch your game." A few hours later, she called again... "Did you get the baby?" "Yes, he's here." "How was the game?" "We lost." "Well, I had company and had to turn it off, so I didn't know. What was the score?" I told her. "Well, I had company, so I didn't know... now I do." Click... she had hung up. And it clicked with me - she is jealous of the time we spend with the baby! Now, that's not all of it, but it's a big part.

At the ballgame, I sat behind my mother and grandmother's pastor... a man a few years older than I whom I have known all my life. He had visited Mam-ma recently. He introduced me to some church staff members sitting next to him, and the woman said, "Oh, I've heard a lot about you!" I asked from whom, and she said... "Your mother." I laughed and said, "Good... then it was probably nice things. If you had said my grandmother, I would have worried." I shared my afternoon experience and my grandmother's comment that we don't care and don't come to visit. My pastor friend shook his head. Then he laughed and said someone had complained lately when he visited her that he didn't come often enough - that he should visit her every week. He said, "I told her, 'You don't want to be sick enough for me to visit every week!'"

My mother got a call Monday from Mam-ma, and a cousin had said, "You ought to take a picture of those tomatoes!" Mam-ma was wanting to know if Mom had a digital camera. Mom offered to take pictures on Wednesday... what was she thinking?! I told her, "Mam-ma will expect that photo to be in the local paper!" True to her word, she went to my grandmother's today and photographed the tomatoes! I'm sure my cousin commented in passing, but Mam-ma internalizes everything!

Friday we go to the cardiologist for our check-up. It's supposed to be storming and flooding... seriously - like 5-7 inches of rain! My husband has graciously offered to drive us (or row us there?). Wish me luck... I'll let you know how we fare!

BTW... our darling Timothy DID spend much of the weekend... we didn't sleep much, but we were so blessed by his smiles.