Thursday, December 23, 2010

Lessons in Frustration

You would think that Medicare Part D would become easier to navigate after six years... NOT!  I thought we had everything set.  We got the formularies from our 2010 provider - Arkansas Blue Cross/Blue Shield - in the fall... and of course, not all of Mam-ma's medications were going to be covered for 2011.  So I began a search for another provider.  We have changed every single year so far.  The "winner" was Health Spring, headquartered in Nashville, Tennessee.

I have to say, from the time I enrolled with Health Spring, the customer service has been superb.  I have gotten right through to a representative, my questions have been answered quickly and thoroughly, and I have even been wished a Merry Christmas!  I got the new membership card in the mail and tucked it into my wallet to show to the pharmacy staff, so that they could record the new numbers when I picked up Mam-ma's medications last Friday for the month of December.

When I arrived at the pharmacy, the clerk said, "I hope you brought Ms. Polly's new card."  I proudly said, "I surely did!" and she added... "That's good, because we need to try to run it - her other insurance provider has refused payment."  "What?"  It seems that Arkansas Blue Cross/Blue Shield went ahead and stopped providing coverage for my grandmother a month early - even though she was supposed to have coverage with them through December 31, 2010.  "Will Health Spring go ahead and pay?" I asked, adding that their information indicated coverage began on January 1, 2011.  "We don't know - we're going to try," the clerks told me.

I was astounded... and frustrated.  The clerks told me this happens all the time, although it's never happened to us before.  And, since there was no insurance coverage, the refills I had called in to the pharmacy the day before had not been filled, so there would be a time issue.  To further complicate things, one of the prescriptions had expired.   We had just seen the cardiologist a week earlier, and he said, "Tie a knot in this rope and hang on," so I knew he wanted to continue this medication.  Luckily, his name was on speed dial in my phone, so I made a quick call, and almost before I could hang up, the nurse had faxed over a new prescription.

I decided to go ahead and do a few other errands... get Mam-ma to the beauty shop... and return for the medications.  When I got back, the new provider was agreeing to cover all of the drugs... except for a name brand on a thyroid medication.  "It was on the formulary," I told the pharmacist.  "Yes, but the insurance provider wants you to use a generic."  We've never used a generic, and it might be fine... but at 98 with all going well, I would rather not rock this boat. 

So, I called the family physician's nurse to see if the doctor could authorize use of the name brand drug.  She was unavailable and would return my call.  She did... about an hour later as I shopped for Mam-ma's groceries.  I explained the problem, and she said, "Well...why can't she just take the generic?"  I explained further that she is 98 and doing well, and we want to keep things the same.  She said, "You'll have to fill out a form."  I told her no... the pharmacy said all it took was a verbal authorization from the doctor, with a notation in my grandmother's file on HIS end, in case the auditors ever checked.  She said, "I'll have to talk to the doctor about that and call you back." 

Thank heavens for small towns!  It was late on a Friday afternoon, and the nurse did not return my call, so the pharmacist "spotted" me a week of the name brand medication.  He said I could get the rest the next week if the authorization came through... or he would fill the generic at that time and I could pay for the seven pills.

On Monday morning, the nurse did call back, and all was well... the name brand was authorized.  She added... "And we need to see Ms. Polly for a 6-month checkup."  I told her we had not been for a "6-month checkup" in years.  She said, "I know... it's been July of LAST year... and we really need to see her.  We're supposed to see her every six months for insurance purposes."  I explained that I do not like to expose Mam-ma to the potential illnesses in the clinic... she is 98 and frail, and it's not worth it.  She said she understood and offered us a late-January appointment - first thing after lunch with the promise of getting her directly into an exam room and a short wait time.  So I agreed.  At this point, I'm picking and choosing battles.

On the way home from the beauty shop, Mam-ma told me that her teeth were really bothering her.  She said that the new liner the dentist put in when he put them back together was "not right."  She added, "They're too full."  I didn't say much... sometimes she has to wear them a few days before they feel right to her.  She did not mention it to my mother, who was out of town celebrating Christmas with her husband's family.

But over the weekend, Mam-ma continued to tell me that she needed to go back to the dentist... and she planned to call Monday morning.  I had a full week of activities and preparations for the Christmas holidays, so Monday morning, I called Mam-ma and asked her if she had contacted her dentist.  She had not, but she wanted to.  I decided to cut to the chase and call the dentist myself.  We secured an appointment for the following afternoon at 2:00.  Later that morning, someone from the dentist's office phoned and said, "I'm confirming your appointment for tomorrow morning at 11:00."  I told her no... it was at 2:00 p.m.  She said, "That's Ms. Polly's appointment... your annual cleaning and checkup is tomorrow morning at 11:00."  I had totally failed to write it on the calendar and had no clue.

The gracious receptionist offered me a 1:00 p.m. appointment... with Mam-ma's appointment to follow at 2:00.  That was great!  So Tuesday, I picked Mam-ma up shortly before 1:00 and we drove to the dentist's clinic.  I got right in, and Mam-ma was put in a room next door soon afterward.  The hygienist and I overheard Mam-ma tell another assistant that she was not ready for Christmas, because "they won't let me cook any more."  Now, for the record, last week Mom called one afternoon to see if Mam-ma took her noontime medication, and her friend Ruby answered the phone.  She said, "I don't think Polly took her medicine - we're making peanut brittle."  Mom was so flabbergasted and upset that she just quickly said "Goodbye" and hung up!

Monday morning when Mom called, Mam-ma said, "I'm in the middle of something."  Mom asked, "Are you getting your bath?"  Mam-ma replied, "No, I'm making sugar cookies.  Mary (the housekeeper) is here."  Mom said she felt sure that Mary was not helping with the cookies!  Every time I go to my grandmother's, there is no evidence of any of this baking.  I've not seen as much as a peanut.  I did see a jar of sugar cookies tucked away on a lower shelf of the telephone table today, and I pretended they weren't there.  Mam-ma took peanut brittle to her hairdresser last week and tried to brag to me about making it.  I would not acknowledge her comments... and I could tell that really made her mad!

Meanwhile, the teeth are still not right.  I asked Mam-ma if she was eating better, and she said, "No, not really.  These teeth are still not right."  Now, in the dentist's chair, she said they were fine.  I asked her why we left the clinic with teeth that don't fit right, and she said, "Well, he was busy."  I told her... "He's been busy every time you are there, and he would prefer you get this right and not have to keep returning."  She said, "Well he said, 'Now, if these give you any trouble, you know what to do.'"  I asked what that meant, and she said, "Well, he means for me to come back!"  She added (as always), "You just don't understand, because you've never had dentures!"  I told her, "I understand you don't leave the clinic until they fit right!"  So now the holiday weekend is upon us, and her teeth are not fitting right, and there is nothing to do except muddle through the next few days.

Honestly, we're not sure there is anything to do.  The dentist has worked and worked on these dentures... and Mam-ma absolutely has no jaw bone left to anchor them.  The dentist says it is eroding faster than he can adjust the liner.  If it gets to the point where nothing can be done, I believe it will take a toll on Mam-ma's overall health and speed along her general decline.  I'm hoping when her mouth heals a little and settles down, the teeth will settle into place again, as has happened before.

Meanwhile, we still have not heard anything about the room at the assisted living facility.  I visited friends who live there last weekend, and I reported to Mam-ma about how nice the facility was and how happy these folks were living there.  She had very little comment.  However, an older cousin told me tonight that he had a long phone conversation with Mam-ma last night, and she is ready to move.  He said, "I honestly believe that if I told her right now there was a room ready, she'd start packing."  He added, "She told me she can't wait to move there."  Of course, that is news to me... so we shall see.

So another Christmas is upon us. Mam-ma has made new baby quilts for my great-nephew, Timothy, and his sibling who will arrive next May.  She asked me to buy her white glue last week at the store, and Tuesday, she sent home two large white shopping bags that contained the quilts.  She had glued Christmas cards to the sacks for decoration... a clever idea... and a much safer use of her time and energy than baking or making candy!  My mom and her husband will pick up Mam-ma and bring her to our house for the day.  She will be exhausted when she returns home... and she won't hear half of what is said while she is here.  She told me today that she plans to wear her long underwear under her clothing so she won't be cold.  There is no way we could keep our house warm enough for her and stay in it ourselves!

Our family opted not to exchange Christmas gifts this year... for a variety of reasons.  Santa Claus has left filled stockings for everyone, and we will enjoy sorting through those goodies.  But our day will be about eating a good meal and enjoying each other's company - and watching Timothy play with his gifts. 

If anyone asked me what I want for Christmas this year, it would be for us to enjoy a good day together with no crises or catastrophes... and for a room to become available at the assisted living facility for my grandmother.  Whether she takes it is still up to her... but I'm praying that the timing will be right and everything will come together for her to find some semblance of happiness there.  At least I will know that she really is taking her medications when she says she is, and she is relatively safe and her basic needs are met each day. 

I'm realizing that I whine and complain a lot about things that I cannot change, and I'm earnestly seeking a deeper faith and trust in God to handle what I already know I cannot.  I'm trying to learn to let many things go in one ear and out the other... and to fully understand that we are now at a point where Mam-ma may not even be able to remember she isn't supposed to do certain things, like bake cookies.  This is a transitional stage, and for the most part, my grandmother is still functioning better than many who are a decade younger.  Still, she grows a little more tired and frail with each week.

I plan to treasure the time we share this Christmas... to collect as many memories, take as many pictures, and enjoy as many laughs as possible.  I hope that your holidays are filled with the same.

Thursday, December 16, 2010

Catching Up...

I know it has been a LONG time since my last post, and I do apologize. I could use the holidays as an "excuse," but honestly, I can't explain why I have not found time to share a few things with you. Perhaps I am like many people - I just need a break.  But life has marched forward, so here goes.

We celebrated Thanksgiving at my mother's home.  We had a good meal and enjoyed being together - I think.  Timothy was the star of the show, and he entertained us well.  I would have to say that much of the day, Mam-ma was very bored.  She didn't seem all that alert... and of course, she doesn't hear well... and she refused to bring her walker into the house.  So every time she stood, we held our breath as she reached for unfamiliar furniture and surroundings to "hold onto" as she toddled from one spot to the next.  My husband said he didn't know whether he was more nervous about Timothy getting into something he shouldn't, or Mam-ma falling!  I really think Mam-ma was the bigger liability!

Mom took Mam-ma to Wal-Mart to get more fabric for yet another baby quilt - this time for Timothy's new sibling, who will arrive late next spring.  Mam-ma has begun to tell a few people she is on the list to move to the assisted living facility. I have talked with the administrator, and she says a few things have changed, and there MAY be a vacancy ... but she has not returned my call to say we are on "Go!"  And if she does, I can't guarantee that Mam-ma will agree to move.

Last week was one for the books.  Mam-ma had told me the week before that her teeth were bothering her.  She mentioned it to Mom on Sunday over lunch, and Mom said, "Make an appointment to see the dentist, and I'll take you."  On Monday, Mam-ma said the same thing, and Mom told her again to make an appointment.  Mam-ma replied, "Well, they are a little better... if they start to bother me again, I'll call the dentist."  Less than an hour later, Mam-ma phoned Mom to tell her she had an appointment - for TUESDAY!  Mom was busy on Tuesday and didn't want to bother me with this, so she told Mam-ma to reschedule.  We had been keeping Timothy for a couple of days, and Mom knew I had a full week ahead with other appointments and obligations for Mam-ma and myself.

Mam-ma wanted to get a dental appointment on Wednesday, but Mom knew that we already had an appointment at our local hospital to get Mam-ma's pacemaker checked that afternoon.  So she told her the dental visit needed to happen on Thursday.  Now here's where it gets hairy.  Mam-ma had moved her beauty shop appointment to Thursday afternoon, so that we could do the rescheduled cardiologist appointment on Friday.  So... this meant that on Thursday, Mam-ma went to the dentist in the morning, then Mom whisked her to the beauty shop in the afternoon, where I picked her up afterward and took her home.

The pacemaker check went fine... we really were not gone very long at all.  The only real problem was that we have had very cold weather for early December, with lots of wind, and Mam-ma does NOT like wind!  But we persevered, and on the way to the hospital, Mam-ma told me that Ruby had fallen that morning in her front yard.  "Was she hurt?"  Yes, Mam-ma said her arm was hurt, but her doctor was not in his office on Wednesday afternoons, so she was going to tough it out until the next day.

The bottom line... Ruby's ankle gave way as she crossed her yard, and she fell and broke her wrist.  She has now seen her family doctor, an orthopedist, and has a cast on her arm.  She was trying to retrieve a box that had blown into the yard.  I would venture to say it was well below 32 degrees that morning.  By God's grace, a neighbor happened to be out and saw Ruby fall and helped her get back up and on her feet.

So Mam-ma told me that she had been taking her daily "walks" inside her garage.  I questioned her - wouldn't it be better (and warmer) to walk inside her house?  Well, there was more room.  And I surmised... "Oh... easier to maneuver your walker in the garage?"  "No...I don't use my walker in the garage."  This did NOT make me happy, and I tried to hold it together as I explained to Mam-ma that a fall in the garage could result in her lying on cold concrete for hours before anyone discovered her... and she could freeze to death!  "Well, that's right!" she replied.  But I have no doubt it went in one ear and out the other.

Thursday, Mom took Mam-ma to the dentist, where her dentures got yet another "liner."  The dentist explained to me that Mam-ma's jaw bones are disintegrating, due to age and the pressure of years of chewing, and there is really nothing for her dentures to fit around.  So he puts in a liner that makes them fit a little more snugly - for a few weeks/months.  If the dentures are loose, they rub very painful blisters on her gums.  We've probably had better than a half dozen new liners in the last couple of years.  The dentist is WONDERFUL with Mam-ma.  Since she is a former chairside dental assistant who has made a gazillion sets of dentures, they have a lot to talk about.

Mam-ma and the dentist she worked for made their own dentures, long before the advent of our dental labs of today.  The dentist would select the teeth from his tall cabinet of tray-like drawers... canines in one, molars in another, incisors in yet another... and he and Mam-ma would "set" the teeth in the soft "gum" form.  Then Mam-ma would take the teeth home and "cook" them in a big special pot on her stove (while supper simmered on the other burners), and this would "set" the teeth in the gums, and they would harden and become dentures.  I know there's more to it, but that's basically how it happens.

I spent many hours in this dental office as a child, and I was intrigued with the trays of teeth and thought nothing of that vat of dentures cooking on the stove at my grandparents' house.  So the dentist of today is fascinated by my grandmother - and her tales of earlier times - and he treats her like a queen.  I will be forever grateful to him for his kindness and love for her.

Since I had my own appointment Thursday mid-day, Mom took Mam-ma to the beauty shop at 2:00, and I picked her up there at 3:00, groceries in tow.  She'd made me a list the day before.  Of course, after her appointment on Wednesday, and TWO appointments on Thursday, she admitted she was really tired.  And it showed.  Her speech was getting loose and slurred... the thoughts didn't come very fast, and she was moving at the speed of a snail.  I dropped her at home and told her to REST!  She said she would.

Friday morning, my husband and I were there to get her at just after 10:00 a.m. to make a 30-mile drive to visit the cardiologist.  When I called Mam-ma the night before to make sure she took her medicine, she said, "I dread that trip."  She LOVES this cardiologist and always enjoys the trip to see him, so this was my first clue that she truly is realizing at least some of her limitations.  She continued, "I wish he came to our hospital, and I could see him there."  I told her one of his associates came to our hospital, and I was sure we could switch to him.  But I was afraid to do this, because I know how much she likes this other doctor.  However, she said, "I think it may be time to do this."  I asked if she wanted me to pursue it, and she said, "No... let's see how tomorrow goes."

The drives to the cardiologist are always interesting.  Mam-ma tells us all sorts of things about her childhood... and this trip was no exception.  The stories come S-L-O-W-L-Y, but she told of her dad working as a blacksmith... and a coffin maker.  She related how he would have her and her sister, Babe, hold the fabric and lace that lined the coffin while he tacked it into place.  She told of her school days and going to live with an older sister, Minnie, and her husband Ray, for about 6 months to attend school in another community.  I made notes, but I do plan to get to her house and get some of this documented better and in a more chronological order.

Once we were in the cardiologist's exam room, I asked Mam-ma, "What do you think... do you want to see about moving to another doctor?"  She replied with a sigh... "Well, I just believe we'd better."  So I asked the doctor, who was gracious and agreed that it was time for this change.  He gently reassured Mam-ma she was doing the right thing.  I told him she was on the list to go to assisted living, and he also agreed - and reassured her - about this decision.

We had lunch at Dixie Cafe before returning Mam-ma to her house, where three cousins from Oklahoma were just arriving to spend the weekend with her.  These "girls"... as Mam-ma calls them... are so good to Mam-ma, and they come to visit several times a year.  But Mam-ma always overdoes it when they are here, and she is exhausted when they leave... although she will not admit it!

The cousins stayed all weekend, going home Sunday sometime.  Monday, I checked on Mam-ma, and she seemed fine... of course, she said, "I'm really not tired at all."  Not thirty minutes later, she called me again and said, "You or Greg needs to come get my teeth.  They just broke in two when I tried to eat my dinner."  I called my husband, who was out delivering Meals on Wheels, and he went to Mam-ma's, got her teeth, and took them to the dentist.
Monday night, Mam-ma still didn't have her teeth.  We surmised the dentist had sent them out to a dental lab for repair, as Mam-ma said they snapped into two pieces.  I asked her if she had any canned cream soups she could fix for supper.  She said, "Yeah, I've got soup, but I have to thaw it."  I said, "No, I meant a can of cream soup - like cream of tomato, cream of chicken... don't you have something like that?"  She replied, "Yeah, but the soup in the freezer is vegetable."  Vegetable soup is one of her favorite meals.  I just quietly asked, "Well, Polly... how do you plan to chew vegetable soup with no teeth?"  She started to laugh... "I don't know," she giggled.  In the end, she had cream of chicken soup, crackers, and applesauce.

The dentist repaired the teeth himself, apparently, and late the next day, they were ready.  Mom took Mam-ma to get them, and an assistant put them in for Mam-ma and sent her on her way.  Mam-ma told Mom she had had a terrible headache all day from not having her teeth, and we surmise it was from not having much to eat (and probably the effect of little food and her medications on a somewhat empty stomach).

Tuesday night, Mam-ma was much better when we spoke, although her speech was very slurred and halting...probably from being tired.  But she said she had eaten, and her headache was gone.  She added... "I tell you what, I don't think I have EVER gone three days without my teeth!"  I said, "But Mam-ma, you weren't without your teeth for three days."  "Oh, yes, I was!"  "No... Greg picked them up yesterday at noon, and you got them back this afternoon - that's scarcely more than a day."  "Well... WHATEVER!"  I laughed and told her I was sure it seemed like three days, and she said, "It sure did!"

However, this made me realize that Mam-ma, who is prone to exaggeration, really convinced herself that she had been without her teeth for three days... and that tells me how confused she is becoming.  And there's more... she has taken almost a week to tell both my mother and me that her Home Health nurses have been talking to her about a new program called "Personal Care."

Mam-ma called me Monday night to tell me that a nurse had visited her and "evaluated" her for "Personal Care," a Medicaid program that provides additional in-home care for those who need it, particularly the elderly.  Supposedly, this aide will come three days a week and do laundry, housekeeping, and other things for Mam-ma.  She said, "I'll be the laziest thing in town - I won't have anything I have to do."  She also said, "You'll probably get a call... that nurse said she was going back to the office and get the ball rolling to get this for me."  She told my mother, "I didn't sign up for anything - I wanted to talk to Debbie first."  So I have not gotten a call and really don't know what is going on with this.

However, I asked Mam-ma... "Did you tell them you are on a waiting list for the assisted living facility?"  She said she did, and the nurse said, "That's okay... if you go, we'll stop it."  Not wanting to tell Mam-ma I've made an inquiry again at the assisted living facility and expect a call soon from the administrator, I asked, "You know, the assisted living facility could call us any day and say a room is available.  So, if they call and have a room ready for you, don't you want to at least go look at it?"  Mam-ma changed the subject somewhat and said, "Well, that aide said, 'Don't you want to stay at home as long as you can?' and I said 'Yes, I DO!'"  So I am having my doubts that Mam-ma will be agreeable to even looking at a room at the assisted living facility... much less agree to move there.

I've done a little Internet research, and while this program looks good, I am not sure it will provide the level of care my grandmother may need and/or desire.  For one thing, these aides cannot handle any medications... the assisted living facility provides nursing care and will monitor all of Mam-ma's meds. The aides can also not provide any transportation, and that's a biggie with Mam-ma - having someone to drive her places now that Ruby is not able to chauffeur her to the store and such.  And... while this is three days a week, Mam-ma needs PEOPLE around her EVERY day.  As we approach winter and she becomes more housebound by the weather, she will become even more restless and lonely.  At the assisted living facility, she would be surrounded by people all of the time.

Still... this is totally my grandmother's decision at this point.  She is mobile.  She went to her Sunday School brunch at a local restaurant this week.  She continues to "show her spunk" at every turn, and for the most part, we've managed to make the adjustments that are keeping her relatively safe in her own home.

I say "for the most part," because... last week, Mom called one afternoon to see if Mam-ma had taken her noon medications, and Ruby answered the phone.  Mom said, "I just called to see if Polly took her medicine."  Ruby responded that she probably did not, "because we're making peanut brittle."  Mom said, "I didn't know what to say to that, so I pretty much just hung up!"  When I went the next day to get Mam-ma for her appointment, there was absolutely NO trace of peanut brittle, save an empty corn syrup bottle tucked in a corner on her counter.  But I could smell the cooked sugar of candy making... I know that aroma all too well!  The candy was never mentioned.

On Thursday, when I picked Mam-ma up at the beauty shop, we were leaving and her hairdresser stopped at her station and said, "Oh, what's this?  I wonder who left this candy?" It was a zip-loc bag filled with peanut brittle.  Mam-ma grinned like a proud school child and said, "I did!"  The hairdresser asked, "Who made it?"  Mam-ma grinned again, "Well, I did!" she said.  Behind her, I mouthed, "She's not supposed to make peanut brittle," and the hairdresser nodded in agreement, pulling me aside a few seconds later and saying, "She told me a couple of months ago that y'all won't let her make peanut brittle any more."  We both just sort of rolled our eyes!

I did not acknowledge any of this to Mam-ma.  We got into the car and started home, and she said, "Ruby said, 'Oh, I'm so glad we got that peanut brittle made before I broke my arm.'"  Again, I did not bite.  This irritated Mam-ma to no end, and she got short and curt with me afterward.  I changed the subject to something else, and I knew she was not happy - she wanted me to fuss at her and cause an argument.  I don't know how I held my tongue, but I did.  To her credit, she did not leave a bag of the candy for me to bring to my husband, or I might not have been so patient.

Clearly, as long as Mam-ma lives at home, she is going to test the waters... from making candy to walking in her garage without a walker to things I don't even want to imagine.  I pray each day that God keeps her safe... and that He gives me the strength to deal with whatever may happen next.  Meanwhile, I just chalk these incidents up as "fodder for the blog!"

On a side note, my mom has just written a new book about the history of the entertainment industry in Branson, Missouri.  Since so many people like to visit Branson, I thought there might be readers here who would find this information of interest.  My mom has now written five books... you can learn more about her work at her website...