Meanwhile, my grandmother's friend Ruby has not improved as much, and a subsequent trip to visit her family physician revealed that she cracked two or three ribs. The doctor increased her pain medication and told her it could take as much as six weeks or more for the ribs to heal. She is, understandably, very upset and discouraged.
Once my voice returned a little, I made the visit to our local assisted living campus to determine what our options were and what might be possible for my grandmother. The administrator told me almost immediately that the facility had enacted a new policy the previous week, and now all Medicaid-subsidized rooms cost an additional $500 per month, paid by the client or his/her family. I was dumbfounded and told her I felt there was no way this could work for us. I had been told that the facility would accept whatever Medicaid would pay, based on my grandmother's "Tier assignment" - plus the difference up to $2600 for a suite or $3000 for an apartment. I was thinking we could make this work for the "suite" with her monthly Social Security income. I have to admit, I was pretty devastated. I explained to the administrator that I was concerned for my grandmother's safety and well-being in her home, but she was not yet ready for the nursing home.
After talking a little more, I learned there are other options. First the administrator asked me some questions about my grandmother:
- could she feed herself (yes)
- could she transfer herself from bed to chair (yes - we're talking a woman who still walks around the block in her neighborhood most days)
- could she handle her own medications (only with help - I dispense them and we prompt her by phone twice daily to take them)
- could she bathe herself (no - she has Home Health aides who assist with this)
- could she remember where she was from one day to the next (yes)
I explained again that my grandmother had no extra money to pay the $500 per month, and while we could pay that for her ... what did people do who couldn't? It didn't make sense to think Medicaid would pay for her to move in across the street at the skilled nursing center (nursing home) and be fully covered for services she really doesn't need ... yet she could not get the same coverage at the assisted living facility.
- the hairdresser
- cokes, cookies, candy, etc.
- medications not covered by Medicare Part D - her anti-anxiety medicine, Tylenol, vitamin B-12 injections, cough syrup, skin creams, etc.
- toiletries, makeup, etc.
- "spending money"
- her tithe to the church
- magazine subscriptions, bird seed, and more
So we decided to sign my grandmother up for Meals on Wheels and do what we could to curtail her cooking. We asked my mom to speak to people from church and ask them not to bring garden vegetables, peanuts and corn syrup for peanut brittle, and other things for Mam-ma to cook. We asked her neighbor, Merrellyn, to call us if Mam-ma came along and asked her to provide any assistance that seemed a little questionable - like a ride to the store or to Ruby's. We figure that now that Ruby is unable to drive, Mam-ma will start searching for other "drivers" to take her places ... and we know she is not above asking!
We also agreed to check on her more often - to keep a little closer tabs on her activities and try to head off some of her antics. So I called the Senior Citizens Center and signed Mam-ma up for Meals on Wheels. The director will have to make a home visit and "interview" her, which is a formality, because she already knows Mam-ma well. The meals should begin sometime this week, and Mam-ma will get a hot meal each weekday, plus two frozen meals on Friday that she can pop in the microwave over the weekend. All of this is accomplished for a "donation" of $2 per day ... a BARGAIN!
On Friday, I went to get Mam-ma for her beauty shop appointment, and I went early to talk with her about the meals. Meanwhile, my mom was phoning the church members, and all of them were 100% on board with what we are doing and in total agreement the time has come for some changes.
Mam-ma told me almost instantly that her digestion was upset, and she was not eating right. I said, "That's something I want to talk about with you." I explained that I had signed her up for Meals on Wheels, and they would be starting soon. She grumbled, and I told her, "You just got through telling me that you are not eating right. This will be a hot, balanced meal every day - and even a couple for the weekend that you can pop into the microwave." I continued to explain that several incidents lately had caused us to really become concerned ... the two times I know of she left her stove burners turned on with no flame ... my mother-in-law's sudden failing health ... Ruby's fall and subsequent decline ... and I didn't even mention the episodes of confusion and forgetfulness and her barging into someone else's home.
I told Mam-ma that I would rather she not use her stove as much. She glared at me. "But I love to cook," she said. "I know you do," I replied, "but I am concerned about you hurting yourself or burning down the kitchen." We went back and forth, and I told her, "I am not saying that you can never use your stove. Maybe on Tuesdays when your housekeeper is here, you could bake a cake or a pan of cornbread. Or if you feel you just have to cook something, call me, and if I can make time to come over, I will."
I knew what was coming next... "What am I going to do with all that food in my 'deep freeze'?" I told her I had already considered that, and I planned to start having some "family dinners" at our house, and I could use that food in preparing some of the meals. Then she mentioned cake mixes in the cabinet and other food, and I said, "You can come to my house early and bake a cake for the family dinner. Don't worry about the extra food - we'll figure it out."
Then I brooched the biggie ... I told her I did not want her to make any more peanut brittle. I explained that I knew she had done it for years and could make the candy in her sleep, but she was just too shaky, even with supervision, to handle that molten candy safely any longer. She sat and stared a hole in me ... completely silent for almost a minute. Then she began to cry. "You just don't understand."
I told her I did understand that this is hard, and she said, "NO! You DON'T! I've always cooked and took care of myself. I've always done what I pleased when I pleased." And I pointed out ... "and you've had a good run of it for 98 years. But we are trying to keep you in your own home and out of the nursing home or assisted living." She replied, "Well, I've thought several times that maybe I should just go to the assisted living."
So I explained what the options were there - a room about the size of her living room, with very little space for her "stuff." I pointed out all of the good things, and I told her, "Whenever you are ready, just say the word. The administrator called me back after I visited, and she says they can have a room for you next week." But then I went on to tell her that we don't feel that she is ready for such a major change... and if she will cooperate and get the Meals on Wheels and stop using her stove unattended, we feel she can continue to live at home on her own for now.