Monday, August 23, 2010

I'll Go Graciously...

It's been two weeks since my mom and I started calling my grandmother each morning and evening to remind her to take her medicine, and she hasn't missed a single dose.  She seems to be enjoying the daily phone calls from each of us, so she has not complained about the reminder - so far.  However, she has complained that she lacks energy - and she did cut back to walking every other morning in the brutal summer heat we have been experiencing.  Even though she walks around her block at 6:00 a.m., the humidity level has been high enough to pester her breathing.  So pacing herself and taking a break every other day is a good idea.

During a conversation with my mom, she noted that she feels Mam-ma's transition to an assisted living facility - of not a nursing home - is inevitable.  I've fought tooth and nail to keep her in her own home as long as possible, but after the incident a few weeks ago where the gas was on under a stove burner with no flame, and the numerous missed doses of medication, I realize that this run at home may be ending.  So I called a local assisted living facility and inquired about accommodations, pricing, and possible financial assistance.

I am still vague on some of the details, but apparently there are two options - a one-room "suite" that has living area and bedroom together with a separate bath for $2600 per month, or a two-room "apartment" that has a living/dining area with "kitchenette" (refrigerator, sink, and room for microwave and coffee pot), plus a separate bedroom and bath ... for $3000 per month.  There are four tiers for Medicaid assistance ... the higher the tier, the more Medicaid will pay.  This is based on an evaluation by authorized nurses and personnel who decide how much help the client needs and assign him/her a tier level accordingly.  So it's possible that Mam-ma could afford this facility, even though her monthly Social Security income is about one-fourth of the "suite" rate.  I thanked the person who gave me the info, made some notes, and set them aside.

That same evening when I talked to Mam-ma, she said she and her friend, Ruby, had been to this facility to visit two of their friends who live there.  Both of them have suites, and Mam-ma said, "Oh, they are NICE ... and real spacious."  I asked, "Do you ever feel like you might to live there?"  She replied, "Well, I just might."  I know that one of her friends who lives there has encouraged a move ... and the friend's daughter-in-law has talked to Mam-ma several times about moving there. 

Mam-ma said that there was an area where she could do her sewing - that in fact, her friend was working on a painting there the day she and Ruby visited.  She said, "Well, it would just be nice to have people to visit with and be around."  But she also added that she didn't think she could afford the facility fees.  I told her I'd done some checking, and I thought maybe she could.  But I assured her it was her decision, and one that didn't have to be made now.  Should she decide she was interested, I'd do more investigating and get the ball rolling for her to be evaluated.

On one hand, I can see how this would be great for my grandmother.  She loves people and having lots of folks around.  Her meals would be prepared, she would have her meds dispensed, and she would be far safer, hopefully, than she is in her own home.  There would be a level, safe place to walk outside around the facilities and plenty of activities to occupy her time ... with her own room to which she could retreat for privacy.  On the other hand, she would not have flowers or a garden to water and tend - at least not as many - or her own cooking to enjoy. 

She could not take all of her "stuff" with her, and while she doesn't have all that much ... she would want to take much of it along.  My mom thinks she would expect to keep her home, much like she did 22 years ago when she "traded" houses with my husband and me.  Her thinking at that time was that she would get "a little apartment" in town and still use her farm house like a giant closet for all of her things.  That didn't happen.  I think she understands that she lives in a home my mother provides, and that the move to assisted living is complete and not a temporary thing.

Anyway, nothing else was said about the assisted living facility.  Mam-ma's cousins from Oklahoma came for a weekend visit, and she was on Cloud Nine, planning and preparing for their arrival ... cooking a meatloaf and other dishes, even though the women assured her they would go out to eat... and getting her hair done.  She had scheduled a much needed perm for last Friday, but when she learned the cousins were coming that afternoon, she called me and wanted to cancel.  I told her that she needed to get it done, and she said, "Well, I really don't feel like it."  I asked, "So you don't feel like the girls coming to visit?"  "Oh, yes!  I feel plenty well enough for them to come." 

Sounding very much like my mother when I was a teenager, I said, "Well, if you are well enough for the girls to come, I think you're well enough for a perm.  It will even make you feel better... you need it!"  It was shades of a parent telling a child, "If you are well enough to play outside, you are well enough to go to school!"  So she relented, although she wanted to go early.  I told her that we didn't know if her hairdresser could take her early, and Mam-ma said, "I don't know why not ... she's always just sitting around when we get there."  That is not true, and I pointed out that the hairdresser takes her lunch break shortly before Mam-ma's 2:00 p.m. appointment.  And I felt quite sure she had arranged for a babysitter to watch her 4-year-old grandson while she stayed late to do this hair perm. 
So I told Mam-ma I would not take her early unless she called the hairdresser and confirmed that it was okay.  She did ... we went at 1:30 p.m.  The hairdresser had forgotten she scheduled an extra blow-dry client at 1:30, and she squeezed in someone else while Mam-ma's perm processed, and we still didn't get done until 4:00 p.m. (which would have been the original time to finish).  This was fine with me, but I could tell Mam-ma was anxious to hurry home.  The cousins didn't arrive until 5:00 p.m., so we had plenty of time to spare.

The weekend apparently went great.  The ladies played Chicken Foot dominoes both nights.  They ate Mam-ma's meatloaf Friday night.  Saturday night when I called, the cousins were frying okra and cooking fresh peas and other veggies from the farmer's market (purchased early that morning), and another Chicken Foot game was planned for afterward.  Ruby came over and joined them, and they had a ball.  The ladies took Mam-ma to church on Sunday and then to lunch somewhere (maybe leftovers at home?), before leaving about 2:00 p.m.  When I talked to her Sunday night, she said, "I'm not tired at all." But she had not been up to returning for Sunday evening church services, and I'm betting she slept like a rock!

During our conversation, Mam-ma said that Ruby had said to her, "Polly, someone told me you are thinking about moving to the assisted living facility."  I don't know who could have told Ruby that, but Mam-ma thinks it was the daughter-in-law of her friend.  I asked, "Did you tell Gail we had looked into this?"  She said no, but she must have said something.  Anyway, Ruby told her, "You won't like it there without me."  Mam-ma said she told Ruby she had no plans to go.  And then she said... "I don't know if I would like that... those rooms are really tiny."  I questioned her ... a few days earlier she had declared them "very nice" and "spacious."  She said, "Well... they're not!"  She said she would want an "apartment" if she moved there, and I told her that might be possible, although the apartments were $400 per month more than the "suites."  That surprised her.   She said, "I'd need a place to have company."  I'm sure she is thinking the cousins could stay there with her, but I honestly don't believe this would be allowed - nor would they want to.  I'm sure they would gladly come to visit and get a motel room somewhere, but I know this is what is bothering Mam-ma.

I asked if Ruby ever considered moving there, also, and she said not really... but maybe.  I think they would be very happy there together.  But I also reassured Mam-ma that we do not have to talk about this - or even think about it - today... but we do have options.  She said, "Well, I told Ruby, when the time comes - if it does - I'll go graciously."  I laughed and told her I want that in writing!

We will see what happens.  It would be wonderful if both ladies would decide to make this move while they are still relatively healthy and able - and can enjoy the other residents and the amenities.  God will handle this, thankfully ... and I'll do the legwork if and when it is required.

On another front, my mother-in-law went to her family physician last month for a bout with vertigo.  She's had a few episodes of this ailment over the last 12 years.  This time, it had been long enough that the doctor wanted to see her again.  Since she almost never goes to the doctor, he drew blood and did a full lab work-up on her at the same time.  He also discovered her blood pressure is now high enough that she needs medication.  Since she is 84, we feel blessed that she has not required such medication sooner ... and the doctor gave her a sack full of samples.

Last week, someone called from the doctor's office and said that my mother-in-law needed to come back for a follow-up visit.  There was a problem with the lab report.  I went with her, and the kidney function numbers were all seriously out of whack ... to the point that they indicated renal failure.  She had no symptoms, other than high blood pressure.  The doctor promptly said he was scheduling her to see a nephrologist, told her to avoid salt and any anti-inflammatory drugs (including the Aleve she takes when her arthritis flares), and he drew more blood.  That was on a Tuesday. 

On Friday, I called the clinic to inquire about the lab results and schedule a follow-up appointment, and the nurse said, "We've not gotten the lab work back, but we've called the hospital to request it."  Meanwhile, she had scheduled a visit with a nephrologist for sometime in September.  I noted the appointment date and time and did a Google search for this physician, whose clinic is in another city 65 miles away.  No one called back about the lab work all day. 

At 5:30 p.m., the nurse called and said, "We've been looking at these lab results all afternoon, and we can't figure it out, but everything is normal.  All of her kidney functions are normal.  We don't know if there was a mistake the first time, or a mixup at the lab, or what, but everything appears to be normal.  And she didn't have any other signs of renal failure when we saw her on Tuesday."  She said the nephrology appointment had been cancelled, and they would see my mother-in-law for a follow-up visit at the local physician's clinic in mid-September.

So we are grateful that these results are good... and hoping they are correct!  Since my mother-in-law's bout with vertigo, she has seen an ENT to have her ears cleaned, she is scheduled to see a surgeon for a colonoscopy, and she was scheduled to see a nephrologist.  She said a friend told her, "Those doctors will find something wrong with you and make you sick!"  We are determined this will not happen. 

We are not being cavalier with her health, but we've decided not to fuss when she salts her food at the table.  She is swimming every other day at our new Community Center pool, and if she wants to take an Aleve when her "bad knee" aches at night, we are thinking she should do just that.  This woman is the picture of health - you would look at her and think she was in her early seventies at best ... not 84.  Prior to taking medication for high blood pressure, she took an occasional Aleve, a somewhat daily B-vitamin, and two drops daily of an eye medication for glaucoma.  Contrast that with my grandmother who takes SEVEN medications daily in varying dosages, as well as a frequent anti-anxiety pill, Tylenol, and probably a few OTC things I don't know about!  In my husband's words, "I'm not going to let the doctors make Mom sick."

I've seen both sides of this equation.  My maternal grandmother had a pill for everything, and her favorite pastime was seeing the doctor for some ailment - real or imagined.  She ended up with Parkinson's disease, and I feel that it was at least partly due to the way she mixed and matched her medications.  Once when my mom was helping straighten up my grandparents' house, she found one of Grandmother's pills in the closet - atop a pair of shoes!  My Mam-ma will tell me of her family physician, "He needs to see me ... he's my doctor!" 

My dad had a "routine" arteriogram at age 61 that resulted in instant "cholesterol showering," which we found is more common with this procedure than most realize.  Within a month, he was in complete renal failure, and he spent the next 22 months or so on daily dialysis before suffering a heart attack and stroke that claimed his life at age 63.  This helps to explain why I recently went almost a month with a respiratory ailment that had probably turned into bronchitis at best ... or even pneumonia ... before I broke down and took an antibiotic, which helped me get well in a few days.  I have a healthy respect for physicians ... but also a healthy fear of creating problems where none exist.

So for now, we are in a holding pattern ... holding steady with my grandmother in her own home and taking measures to keep her safe there ... holding steady that my mother-in-law is healthy as a horse for her age and doesn't need a barrage of tests and specialists to tell her differently.  We know that things can change drastically in a heartbeat with older adults, and we are prepared for inevitable challenges down the road.  But for now, were taking it one day time.  I have total confidence that there will be many changes ahead, but I know of at least one who probably will not "go graciously" as promised.

Wednesday, August 11, 2010

So Far .... So Good!

The daily phone calls to remind my grandmother to take her medicine are going well ... so far.  She seems to be enjoying the attention and is quite chatty ... and she is remembering to take her daily doses!

Last night, I tried to talk to Mam-ma about getting Meals on Wheels.  She argued with me that the meals are not the same as what is served to those who physically go to the Senior Citizens' Center for their lunch.  I assured her the meals were exactly the same ... and Greg confirmed this. He delivers on Mondays, and I've helped him a time or two, and I've seen how they serve the food - and it all comes out of the same pots! 

Anyway, I told Mam-ma I am concerned about her use of the stove and not realizing that the gas is on under a burner, but there is no flame.  She said, "I knew that gas was on.  Ruby had been here, and she told me that there was gas on at the stove, but I didn't get up and see about it."  I asked her why she didn't do that, and she said, "Well ... I forgot!"  I stressed to her that she must remember those things - and she must be very careful about the stove. She said she fries an egg each morning for her breakfast.  I guess now when Mom calls, she can ask, "Did you take your medicine?" AND "Did you turn off your stove?"!

Here's a link to a great story about a caregiving angel.  They do walk among us!

Sunday, August 8, 2010

One Step at a Time...

It's been an interesting two weeks with my family.  Last week, we were keeping Timothy, and he was fussy.  We think it was a combination of teething and some booster shots he had gotten.  But he ran a low-grade fever and slept restlessly, then he would be happy for a few minutes before napping again - mostly in our laps.  I left him with Greg to go and do my grandmother's errands on Friday afternoon.

Before I even opened her back door, I smelled gas. When I went in her kitchen, one of her burners was turned on, but not lit. She said, "Oh, I'm sorry." I told her not to apologize, but we have to be careful about those burners! I ran the exhaust fan some and turned on all four burners to try to burn any excess gas that might be floating around the stove... don't know it that's the right thing to do, but it seemed right.

I tried to talk to Mam-ma about our joining our new Community Center, and she said, "Well, I really need to see it first." I asked - had she and Ruby not been out there to look it over? No, Ruby has... she's already taking classes. I explained to Mam-ma that it's $10 a month, with a 3-month minimum, but she can well afford $30 a month. HOWEVER, those classes Ruby takes are extra... another $10 a month. I told her, "For $10 a month, you can walk on the track and swim in the pool. You could also play racquetball and basketball, but I don't see you doing that." She laughed. She said, "What I think I need is that pool. Ruby says that really helps her."

I don't think I ever made her understand that Ruby is not swimming laps or just floating around... she is taking water aerobics... and there is an extra fee for that, which Mam-ma can afford - but she won't like it. I suggested she go with Ruby to a class and just observe and see what she thought. She said, "Well, I really thought that YOU would take me out there to look it over." I told her I could not do that on that particular day, because I had Timmy at home and after her beauty shop I would have cold groceries. But I told her that if she and Ruby had not gone by the end of the week, I would come early on the next Friday and take her to see the facility.

So as I left, I said, "I bet you and Ruby can get out there sometime this week," and she said, "Well, I doubt it. Ruby goes to exercise class... then she goes to swim... and then she goes to work for her friend Gladys. She's got too many irons in the fire." So I'm thinking... if Ruby goes to exercise, THEN to swim, and then to Gladys' house to work, it's not going to work for Mam-ma to go with her anyway. This may all be a total bust. I know what's coming... Mam-ma is either going to want me to take her to the Center every day to walk, or she is going to finagle someone else to do it - like one of her deacons!

Actually, God humbled me by placing my friend Anna ahead of me in the check-out line at Wal-Mart.  Anna is a little older than my mother, and she has been like a second mother to me - our families have always been close. She and her husband have an adult grandson living with them.  He has a daughter nearly two years old, and for some reason, he only sees her every other weekend.  Supervised visits are required, and Anna and her husband, are the supervisors.  So every other weekend, this 70-something couple (who have a myriad of personal health issues) are hosts/supervisors to their great-grand-daughter, their grandson, and the grandson's mother and her husband!  Here I am, much younger than Anna, and she is caring for a child who is almost two every other weekend. GEEZ... I have no room for a pity party! I told her, "Bless your heart!" and I meant it!

Later in the week, I picked up an application for membership at the Community Center.  I realized that Greg and I were not going to utilize the pool for swimming laps, nor would we drive across town to walk on the indoor track when we have our own treadmill.  And I could not see my grandmother getting to that Center several times a week to walk/swim without a huge ordeal for her and everyone else.  So I called her and asked, "Do you want to go to the Center and look around?"  She said she did not... it was too hot (we've had triple digit heat for about two weeks running), and she had about decided the Center was not for her (thank you, God!).  So we opted to dismiss this project.

This past Friday, I went to get Mam-ma for her hair appointment, and she was confused and whining about how she "can hardly go." When I opened her medicine compartments, she had missed a LOT of medicine last week... Saturday, Monday and Tuesday mornings, and Tuesday, Wednesday, and Thursday nights! I showed her - she argued that she had NOT forgotten - and then she said, "Well, I'm sorry." Again, I told her, "Don't apologize, but when you say you are out of sorts and can't go, this might be why. Your body gets used to having this medicine three times a day." So now my mom is calling her every morning, and I'm calling her every evening to remind her to take her medicine. She won't like it, but it beats her going to the nursing home, which is the next step. I honestly don't think that Mam-ma would last six months in the nursing home... and neither does anyone else in the family.

My grandmother's comment about the medicine was, "Well, I haven't died yet!" I told her no, but she wasn't feeling great, either. This is just typical for someone who is nearly 98, and it could be so much worse.  My mom's aunt is in the nursing home here and dying of bladder cancer. In fact, she was transported to Little Rock for a surgery over the weekend- they cauterized a tumor in her bladder to try and stop some bleeding. It was very traumatic for my aunt - and every procedure is painful and frightening to her.  When my uncle died a few years ago, his son swore he would never be back - not even for his mother's funeral.  He lives on the West Coast.  A daughter who lives in New York has written letters to her mother - but she had not visited since her dad's funeral, either, which was 2005 - until this weekend.  I think the son is now planning to visit later in the month - if his mother is still alive.  Basically, my aunt has had no immediate family to see about her for years now.

I can't imagine this, but I know it happens ... and I know there are often mitigating circumstances, so I am not passing judgment.  I am just praying we can keep my grandmother living safely in her own home as long as possible.  And if/when she has to go to a nursing home, I know our lives will change dramatically as we do what is necessary to keep her happy and comfortable there.  Meanwhile, I am realizing just how fortunate and blessed we are, especially in comparison to many others. I'm leaning on God and praying faithfully ... and taking things one step at a time.  So far ... so good!