45 Days...

"Nothing happens before 45 days."  This was the comment I was given more than once on Monday by the DHS caseworker who will sign off on my grandmother's admission to the Assisted Living Facility (ALF).  She added quickly... "It won't be 45 days until 2-16."  Today is 2-16. 

I phoned the caseworker on Monday to make sure that there was nothing else we needed to do on our end to expedite this approval.  She would not give me a chance to ask my question directly, but when I told her that my grandmother has decided that she has done something to create a holdup, the woman said, "NO! That's not it... we're just behind and working as fast as we can."  There were other excuses, but the bottom line is, we are still waiting, and I am sure that there is something "magical" about 45 days.  I guess if you work faster than that timeline, people might come to expect quick service.

Meanwhile, Valentine's Day has come and gone.  I mailed my grandmother a Valentine.  On Valentine's Day, I took her homemade stew, and I refilled her medicine compartments.  She was busy doing laundry and setting out lunch for herself and her friend Ruby.  A neighbor had brought beef stew, and Mam-ma was adding some food from her Meals on Wheels lunch to it and, basically, feeding both of them with "loaves and fishes."  I told Mam-ma that I was on my way to straighten my booth at a local antique store, and I left.

That evening, my sister called, and Mam-ma told her, "You are the only one who has called me today to wish me a Happy Valentine's Day."  I told my sister I had been there, and she said, "Yes... she told me you brought stew and fixed her medicine, but she said that you were too busy trying to get to the antique store to see about your stuff to sit down and visit with her."  Oh, and my mom called on Valentine's Day - and she mailed Mam-ma a Valentine - from California!  I have to admit... most days, I'm a little irritated by such comments, but I forget about them fairly quickly.  But in light of the amount of time and energy I have expended with my grandmother in the last six weeks, this remark really stung.  As many in my boat know, it truly never will be enough with her.

Mam-ma continues to be "down" with me when we talk on the phone... she is growing increasingly impatient about this move.  And when she knows it is time for me to call, I get a very whiny voice as she musters enough breath to say, "Hello?"  However, if I call unexpectedly at another time of day... I get a very strong, energetic voice... or even a "Good Morning," if she thinks the caller is my mom! 

Last night Mam-ma phoned about 9:00 and said, very strongly, "I cannot get my front door to lock."  I tried to talk her through it, but she said the door would not lock.  I suggested she lock her storm door and the extra safety latch on her main door... she had done both, but "I like for my door to be locked."  I agreed, but I told her I felt she would be fine for one night.  She said, "Well, I want Greg to come look at it tomorrow."  I told her I was not sure what my husband had planned, but someone would try to come and see about it.  I am going... she will not be happy - in her mind, I know nothing about "man stuff" and will not be able to rectify this situation. 

Monday, I also took Mam-ma another 6-pack of Cokes, and she said, "Well, what I really need is cookies!"  I told her I would bring some next time I came.  As I left, she said, "And I need bread."  I told her I was not going to the store (probably what prompted her irritation about my supposedly brief visit), and I asked if she was completely out of bread.  She was not.  I added it to her grocery list for beauty shop day.

              ***********************************************************
I did go to see about the door. When I arrived, Mam-ma grinned and said, "Well... what are YOU doing out today?"  I told her, "You said your door won't lock, so I came to see about it."  "Well, that's right," she said, "It won't lock - but do you think YOU can fix it?"  "I'm certainly going to try," I told her.  The door locks fine... you just have to push on it to make it latch properly.  This did NOT go over well.  For one thing, Mam-ma did not believe I could actually fix it, and she was less than pleased to learn it was not broken! 

We also had quite a conversation about a doorbell that kept ringing.  I would get up and look to see who was at the door - no one.  Finally Mam-ma showed me a wireless contraption plugged into an electrical receptacle that made a doorbell noise every time you walked across the floor just so.  Mam-ma had tucked a folded envelope between this device and the wall to steady it in the receptacle.  I told her that this arrangement had to go... that it was a fire hazard.  She screamed at me, "No it's not!"  "Yes, it IS," I replied.  She insisted it was fine, and finally I said, "Okay, Mam-ma...whatever... just leave it then.  It's totally up to you."  A few minutes later, when the bell rang again, she said, "I guess I'll take that paper out."

After several frustrating minutes and conversations that went nowhere, I left, feeling like I had caused more trouble by even stopping by to try and see about the door.  I pulled into the Wal-Mart parking lot, and before going inside, I said a little prayer.  I asked myself, "What advice would you give someone in a similar situation?"  My answer was that this is not me... it's her.  I am doing the best I can, and I just have to hang on and get through this.  I felt better, and once inside, I met an old friend and had a good conversation, and my mood was immediately elevated.  Thank you, God, for continually blessing me!

Late this afternoon, the administrator at Southridge called.  She has the care plan from the Medicaid nurse.  She had already e-mailed the DHS case worker and was submitting a form requesting a move-in date.  She asked, "When would you like for Ms. Polly to move in?"  I replied, "Honey, as soon as possible!"  Then I told her that we could be ready as early as tomorrow.  She said, "Okay, I'll give the case worker a move-in date of somewhere within the next few days.  If she doesn't respond by Friday, I will call her." She said she would phone me when she knew the move-in date for certain.  I hung up, elated, but not ready to tell Mam-ma until we know a date.

A few minutes later, Mam-ma phoned - "We're having company!" she announced.  It seems that cousins from Oklahoma are passing through on Friday and plan to take my grandmother out to dinner.  She said, "So I've made their bed!"  (This is the bed we are taking to Southridge for her. I had entertained the thought of moving it and getting things in place ahead of her physical move.)  "Are you sure they are spending the night?" I asked.  "Well, I've made their bed!"  she answered.  "Yes, but are you sure they are spending the night, or did you do that in anticipation?"  "Well... anticipation, I guess... but they are staying all weekend."  "Really?  All weekend?"  "Well... maybe they are going home Saturday... I really don't know."  Neither do I... and if we get THE CALL to move, they may have her house to themselves! 

We may just have a little light at the end of this tunnel.  Time will tell... and I'm still praying!

The Waiting Game...

We are still playing "The Waiting Game," and quite frankly, I think we're all a bit sick of it.  The Medicaid nurse did make it to my grandmother's house to evaluate her on Tuesday, February 9th.  She approved her for admission to the Assisted Living Facility, based on her age, the fact that she mixes up her medications, the three visits she has already had to a nursing home for rehab following falls and the flu, and a few other things, such as the fact that we hire a housekeeper to assist with duties that Home Health staff cannot perform.

This was a huge milestone... and it was no small feat to accomplish - from getting the orders for the nurse to visit to actually meeting her criteria.  Nobody can believe my grandmother is 98 years old by just spending an hour with her.  She walks well, speaks clearly and makes sense, and she even heard clearly this particular day.

So we now wait on DHS to approve this move, based on the nurse's recommendations.  Mam-ma grows more anxious by the day.  Yesterday, she decided maybe she walked too well when the evaluating nurse asked her to walk across the floor.  "I should have had you bring me my walker," she said.  Instead, she got up from her couch and walked to her dining area and retrieved the walker herself, pushing it back toward the nurse.  I assured her that this had no bearing on why we are still waiting.  It's something new every day.

The day after the nurse visited, we had a mega snowstorm... some 9+ inches of snow that is still melting.  So very few people made it in to work on Thursday - or even Friday.  I don't know if the DHS case workers were in the office or not.  That probably cost us some time in getting this move scheduled.

Saturday night, Mam-ma assured me that she was not going to church on Sunday morning.  We agreed that,while her streets were fairly dry, the parking lots might have "black ice" and slick spots.  She said, "I know Geneva (a friend who is nearly Mam-ma's age) will want me to ride with her, but I'm not going."  Sunday morning, my mom called me... "I cannot get your Mam-ma on the phone.  She probably went ahead and went to church, but I thought you should know."  I looked at the clock... 11:20 a.m.  Church would be over around 11:30. 

We had not gone to church, but I hurriedly dressed and began calling in earnest around 11:40, when I thought Mam-ma might be home - if she went to church.  At 11:45, still no answer.  As I started out the door at 11:59, I tried one last time... she answered.  "So, you did go to church?" I asked.  "Yes.. Geneva just insisted I go, and my streets were dry, so I thought I just as well."  I reminded her that the streets were not what worried me - it was the parking lot.  "Well, it was dry!" she retorted.  "Doesn't matter..." I told her, "you're there and back in one piece, so that's what matters.  But you've had people from here to California looking for you!"  (My mom is in California with her husband, tending to his brother, who is on Hospice.)

I told Mam-ma that since she had said she was not going to church, it had worried me a little, even though I figured that was where she went.  We hung up, and about an hour later, she phoned me... "I'm sorry I worried y'all, but Geneva just insisted I go to church with her, and she wouldn't let up, and I didn't know what else to do."  I assured her it was over and done, and everything was okay.  I am not certain that Geneva was so insistent as much as Polly just really wanted to GO... but nonetheless, she was now home safely.

Another thirty minutes went by, and Mam-ma called again... "Do you think it would be okay if I went out for a walk?"  I told her to stay on the main street in front of her house, and she should be fine.  "Don't go on any side streets... those are shady and may still have ice on them.  We still have ice on our back deck."  Okay... she assured me she would not get off her main street.  When I talked to her later in the evening, she told me she had walked over to her neighbor's, and "... you know what?  There was still ice on the street!"  I questioned... had she stayed on the main street?  Well... yes and no.  She had walked across the main street to visit a neighbor, then she came back to her house and took a walk down a side street.  "And it was icy?" I questioned.  "No, no, no!" she replied. "It wasn't icy... it was just wet."  Now, she had already told me the street was icy, but she glossed over that.

My mother e-mailed me later and said she had spoken to Mam-ma briefly,  but she was so put out with her over going to church after she told me she wouldn't that Mom got frustrated and didn't talk long.  Mom said, "She's going to go to Southridge alright - but it may be to the nursing facility instead of the assisted living!"  I told Mom that my husband and I have concluded that we have done all we can do to keep Mam-ma safe... if she hurts herself now before the big move, it's on her.

This morning, I stopped by Mam-ma's to take her some chicken stew I had made... something she really enjoys.  She told me last night she was eating bread, sorghum molasses and butter for supper.  She has chicken pot pies in her freezer, but she didn't want those.  Anyway, when I arrived this morning, her Meals on Wheels delivery had arrived, and the milk, dessert and fruit were on her table... but no meal.  I saw a big container of what appeared to be chili or vegetable soup on her counter.  "You not having your meal today?" I asked as I slid the stew into her refrigerator.  "No..." she answered.  But the meal wasn't in her fridge.  Finally she said something about... "I just set that in the microwave."  I opened her microwave, and there was the hot meal... chicken spaghetti, green peas, and mixed vegetables. 

I told Mam-ma, "You can't leave this in your microwave... it will spoil!"  This explained another time when I happened to open her microwave, and she had left a meal in there overnight.  Somehow she doesn't get the connection that food cannot sit out like that and still be safe to eat!  SCARY!!!  I put the tray in her refrigerator and told her, "When you get ready to eat this, get it out and microwave it!"  She said she would.

So we are taking it one day at a time, and praying that the approval for a move comes soon.  With a week of temperatures in the high 60's, this would be an ideal time for moving.  But we will just have to see what happens.  Prayers for a quick move-in time would be greatly appreciated!

This Belongs To...

We are in a "holding pattern" on the big move to the Assisted Living Facility (ALF), known as Southridge. I have done all I can do on my end... the rest is up to DHS. The life insurance check arrived in the mail yesterday - one more piece of the puzzle is set. My grandmother is getting antsy... she is ready to move, and the longer she sits and stews, the more anxious she becomes.

Today, I am going to my Mam-ma's house to start labeling her clothing and the things she plans to take. In true "Mam-ma style," she started without me. She told me last night she had been labeling her underwear. I questioned... did she use a "Sharpie" marker? No... she didn't know what she used. Now, I know she owns a Sharpie... we use it to write the name of her "nerve pill" on the cap of the medicine bottle so she can distinguish it from the others. I told her, "I hope you used something waterproof, or all of your hard work will come out in the wash." She said, "I hope so, too!" Finally, I was able to determine that she did indeed use the "Sharpie" marker she keeps for her medicine. I asked her not to label anything else... I said, "I'll be happy to do that for you."

I also told her that I will clear a closet today, so that she can start hanging clothing there that she knows she wants to take with her. It will give her something to do. Nearly every day, she is telling my mom on the phone that this is "too much for Debbie." Mom has assured her that it is not... that a lot of the "after" work will be done when she returns in March. And as far as Mam-ma needs to know, that's the truth.

The other interesting dynamic has been the input from others. Almost daily, Mam-ma's Home Health aides are telling her this or that about "how it will be at Southridge." Much of their information has been innacurate. One aide told her that Home Health could still come and care for her in the ALF. If you are a "private pay" resident, you could probably pay Home Health to sent out aides. But Mam-ma is not a "private pay" resident, and her care is included - and provided by Southridge. Another aide told Mam-ma that she did not need to take linens... bath towels, etc. - that these would be provided. So Mam-ma was not happy that I spent her money on new towels. I assured her that our "Resident's Manual" clearly states that bed linens, towels, toiletries, etc., are the responsibility of the resident and not provided by Southridge.

Mam-ma's friends are asking her continually, "Polly, when are you moving?" Polly doesn't know, and this is getting on her last nerve, understandably. I know people mean well... and these people all love my grandmother dearly... but they don't realize that she is already a bundle of nerves, and more care needs to be given to what is said to her about the move at this point.

Hopefully a Medicaid nurse will come soon to evaluate Mam-ma. Hopefully she will deem Mam-ma a suitable candidate for Medicaid coverage for this move. Hopefully the DHS case worker will complete her paper work quickly once the nurse's report is filed. And hopefully, Moving Day will come very, very soon!

Meanwhile, we'll keep labeling...

Paper Pushing...

They say a picture is worth a thousand words, so take a look at this one of the papers I have accumulated for my grandmother. I had misplaced a piece of information, so I sat down in the floor to sort everything and see if it could be located. This was the result of my "sort and purge" - and only a couple of papers were designated for the shredder!

It's been an interesting month. We got the ball rolling for my grandmother to move to an assisted living facility (ALF) the first week of January. My husband and I took her to preview an available "apartment" at the facility – called Southridge. She declared it "beautiful." We paid the non-refundable deposit on December 31st, and I began the process of completing all the papers that filled a large envelope.

There were papers for Southridge... a request for Medicaid assistance for an ALF, a physical evaluation and "orders" to be completed by my grandmother's family physician, and more. I set up appointments for a physical exam on January 10th. The papers were turned in at the Department of Human Services (DHS), and I was given an "interview" appointment for 10:15 a.m. on January 11th. It looked like I could get this ball rolling in just a few days.

On Friday, January 7th, a cousin phoned from a nearby city to tell me that her sister had died... my grandmother's niece. This woman was the daughter of Mam-ma's oldest sister, Minnie. The visitation was scheduled for Sunday evening from 6:00 - 8:00, with the funeral set for Monday afternoon at 2:00. We knew we would be unable to attend the funeral, since Mam-ma had her physical exam scheduled for that same time period. To add to the "fun," a major snowstorm was forecast for Sunday - with snow predicted to begin around 5:00 p.m. in our area.

I told my grandmother there was no way we could go to the funeral, and I really didn't see how we could get to the visitation some 30 miles from home - I was not going to drive in the dark in a snowstorm! Sunday after church, I checked the forecast - snow was still headed right for us. I phoned my grandmother, and she said, "Well, I want to go to the visitation." I told her this was not an option. She had also mentioned she would like to go to my cousin's home and visit with family members. I offered to take her early in the afternoon to visit with family members, but we could not make the visitation work. She started to cry and said, "But I want to see EVERYBODY!" (This included all extended cousins and nieces and nephews she assumed would be at the visitaiton.)

We ended in something of a tense discussion with Mam-ma saying, "Just forget it... we won't go at all." I called my cousin and found out where the family had gathered, and I pretty much insisted we drive down for a visit. Mam-ma's comment was, "No, let's not." I asked why she didn't want to go, and she started to cry again, "Because I can't button my pants." Now I laughed. "Do you not have other pants you can wear?" "Well, yes!" This whole situation revealed itself to me when we returned from the visit and Mam-ma said, "I've got to come out of some of these clothes." She had put on thermal underwear, and the bulk prohibited her from being able to fasten the button on her pants! She found something else to wear, we drove to my cousins' home and visited for a couple of hours, and we barely got back to our own homes before the first flakes of what would be about a 4-inch snow began to fall.

Even with the snowfall, I was able to get Mam-ma to the doctor's office on Monday afternoon. He filled out his papers while we waited - an answered prayer - and I marked that off my list. Next would be DHS on Tuesday morning. The case worker began going through my papers and saying, "You'll need this... and that... and something else..." and each time, I'd say, "Got it! Here it is! Yes, that's attached." I have done this three times already over the last 7 years to admit my grandmother to the nursing home for rehab, so I know the drill... or so I thought.

I had gone to the bank and gotten an official print-out of the most current bank statement - for which the bank charged $2 - and I had all of the papers. Because my grandmother is "full Medicaid" - the case worker informed me that she cannot have any assets that exceed $2000. This includes cash, savings, checking accounts, insurance policies, and more. In the past, when Mam-ma went to the nursing home for Medicare rehab, I was told that a small life insurance policy she has did not count. In fact, I was advised to "leave it alone" because cashing it would give her excessive assets and disqualify her for assistance.

Now, it counts. We went back and forth, and I was not successful at explaining that my grandmother’s pre-paid funeral encompasses the burial insurance and it has no cash value. So I left the office with a January 21st deadline to return with proof that my grandmother's insurance policies had either been irrevocably designated toward her funeral or cashed and spent down below $2000 - and I had to have receipts to show how I spent the money.

I understand how some of this works. You can't just cash out your checking account balance and put it in your wallet. You can't write a check to someone and make a "gift." You have to "spend down" the money on things that can be shown... does your loved one need a new mattress or chair? a new coat? We bought things Mam-ma will need at Southridge... Ensure, Depends, new towels and linens, etc.

I left DHS and drove straight to the funeral home and got a letter that stated that there is NO cash value to the burial policies - they are irrevocably tied into the pre-paid funeral plan. Within 30 minutes, I was back at DHS handing this information to the case worker. I wanted her to know I am serious. She had told me that we would see if we could get this done so that Mam-ma can enter the facility on February 1st. If not, she said, "we'll work from February 1" - which means that Mam-ma would get another Social Security check which would have to be "spent down" - and basically, we would start over on the finances.

The other piece of the puzzle is an actual physical evaluation that must be performed in-home by a nurse who represents Medicaid. She has to say that my grandmother qualifies for Medicaid assistance in an ALF in order for us to get any Medicaid assistance... which basically means she determines whether Mam-ma actually can go to Southridge. I asked the DHS worker if she would go ahead and send out a nurse for this evaluation, and she said she would.

I determined that I needed to cash the life insurance policy. Since I knew that this would not happen overnight, I asked the DHS worker if I could drain my grandmother's checking account (showing a paper trail, of course) and prove that when the life insurance check comes, we will not have more than $2000 in assets. She said yes, this would definitely work.

So my goal for the rest of the week was to get the life insurance issue settled and "spend down" the checking account. I called the life insurance company to determine how to proceed, and I was told that they were not authorized to talk to me. "We have to have power of attorney papers on file... and we don't accept any power of attorney that is more than five years old." Mine was issued in 2004. I asked how I was supposed to work with them. The rep said, "I really don't know - maybe get a new power of attorney?" I told her I did not have time to do this before February 1st, and my papers were good enough for DHS and Medicare, so I wasn't sure why they weren't good enough for her company.

I told the rep, "I do not mean to offend you, but I am on a tight time line... is there someone else I could speak with who might know how I could do this?" She put me on "hold" and was gone a while, then returned and said, "We need authorization from your grandmother. I can mail her an affidavit to sign about the power of attorney." I explained we don't have this kind of time. While I was on "hold," I recalled talking once with another case worker at another agency who would not discuss my grandmother's case with me by phone, and we ended up putting Mam-ma on the line via my cell phone, and she authorized the discussion. I asked this rep... "What if you could hear from my grandmother that this is okay?" She said that would work. So I picked up my cell phone and dialed Mam-ma.

I told Mam-ma what was happening and that she needed to tell this lady on the other phone that she could talk to me. I held the phones together, and Mam-ma said, "You tell her anything you need to and ask her anything you need to." The rep said, "All I got was buzzing from the cell phone." However, she offered to conduct 3-way calling with Mam-ma if I could get Mam-ma to hang up, and she would phone her directly. We did this, and the rep asked Mam-ma (who had been napping), "What are the last 4 digits of your Social Security number." "Just a minute," Mam-ma said, setting down the phone and going to find her purse. She could not locate the Social Security card, and she did not know her number.

So the rep asked, "What is your mailing address?" Mam-ma could not remember. I finally prompted with the first digit, and she was able to give the rest. Then the lady asked Mam-ma her birthdate, and Mam-ma said, “November 5, 1912. “ The rep said, "No, that's not right." "Yes, it is," I interjected. "No, that's not what we have." I opened the original policy from 1970 and looked at the information. "I am looking right at the original policy, and the birth date is November 5, 1912." The lady insisted she could not help us because that was NOT what her records showed. Mam-ma became upset. "Well, I know my birthday IS November 5, 1912." I laughed and said under my breath to the rep, "Bet you don't get very many 98-year-olds on the phone, do you?!"

Finally the rep said, "Okay, Mrs. Chandler, is it okay if I talk with Debbie about your policy?" Mam-ma replied, loudly, "Sugar, you talk with her about anything you need to. It's just fine." The lady thanked her... I told her we would talk later, and Mam-ma hung up. I was able to ask two questions... what is the cash value of the policy, and how do I surrender it? The rep wanted me to FAX some info. I told her I do not have a FAX machine at home, but if I had to drive somewhere and find one, I could. She then said she would mail some papers to me for surrendering the policy. I explained again about our timeline, and I asked if she could FAX the papers to me? She said she could, but it would take a couple of days for her to request the proper forms to send by FAX. I told her that I would call two days later and give her the FAX number, and she promised to FAX the papers immediately.

This all came together on Thursday, January 13th. I took Mam-ma to the beauty shop to get a permanent, and I went to my old office to pick up a FAX I'd received there and mail the original insurance policy back to the company, via expedited mail. We also had to go BACK to the doctor's office to have Mam-ma's blood drawn - the lab tech was not in the office on Monday because of the snow. Thursday was a raw, bitterly cold and windy day, and by the time I got Mam-ma home, she was exhausted.

Oh, I forgot to mention... on Wednesday morning, my sister had called to say that their household had stomach flu. Timothy was recovering from it, but they didn't want him exposed again... could we keep him a few days? So Thursday, I left Timmy and my husband at home together for four hours while I ran errands with my grandmother. Timmy stayed with us from Wednesday morning to late Friday afternoon... and we loved every minute of his visit! I am blessed to have such a wonderful husband who steps in and does whatever is needed... and who loves Timmy as much as I do! And thanks be to God, neither of us ever caught the stomach bug!

So... I felt I had all of the T's crossed and I's dotted... I paid almost of my grandmother's last utility bills. I bought the Ensure and Depends and other items she will need. We saw the doctor and I surrendered the life insurance policy. I was within inches of getting all bills paid, receipts printed, and papers returned to DHS. The only “fly in this ointment” seemed to be the telephone bill, which is auto-drafted. In December, the draft was on December 17th, but by January 18th, there had still been no draft. I needed to know the amount of this bill to complete my spending.

I decided to get an online account and look at the billing. In order to do this, I had to submit Mam-ma's telephone number, and someone would call her within 15-30 minutes with a "code" that was needed to complete the login and password. I decided it was worth a shot, so I completed the process and called Mam-ma. "Someone from the phone company will call you in the next few minutes and give you a code. Have a pen and paper handy and write it down... then call me." "Okay," she said. More than an hour went by, and Mam-ma did not call me. I knew that my husband had been at her house to deliver her Meals on Wheels and change a light bulb. I thought maybe she got distracted. So I phoned. "Mam-ma - did anyone call from the phone company?" "No!" she answered. "Oh... wait! Yes, someone called, but she didn't speak English, and I couldn't understand her... then a man came on, and I thought it was a sales pitch, so I hung up." I told her that was okay, and I dismissed it. A few minutes later, Mam-ma phoned me... "I think I messed up." "No, Mam-ma, it's okay... don't worry about it."

Later in the day, I decided I really did need that phone bill info, so I thought I would try again. I called Mam-ma and said, "Okay, we're going to try this again. This time, if you can't understand the person who calls, just say so and someone else will come on the line. Write down the information they give you and call me." "Okay," she said. A few minutes later, Mam-ma phoned me... "That man said if you will call 1-800, you can get what you need." "One-eight hundred what?" I asked. "Just 1-800," she answered. "OKAAAAAYYYY!" I said! I decided to move ahead and pray the bill was drafted in a day or two. Soon Mam-ma phoned AGAIN... "Did you ever get what you need?" "Yes, Mam-ma, I have everything taken care of... thank you!" On January 19th, the phone bill draft appeared on the online banking account. Thank you, Lord!

Now I had all I needed. I wrote a letter to the DHS case worker, outlining all of the payments I had made. I printed out a current bank statement and attached copies of checks and receipts to prove that I had spent the balance. I showed proof of receipt for the insurance policy I had surrendered to the company headquarters in Kansas City. I still wanted to show the current cash value of the life insurance policy, and I also wanted to verify that the company DID receive it and all was well. So I phoned the life insurance company again… and again I was told they could not talk with me.

Cut to the chase… get Mam-ma on the line… have her tell the rep I can talk with her. AGAIN, the worker argues that the birthdate is not correct. She says her records show neither November or a five. I told her it sounds to me like someone entered the data wrong on their end, because I am looking at a copy of the original policy – which they now have – and it clearly says November 5, 1912. She said maybe the agent entered the date wrong. I pointed out that this policy was created in 1970 – on what appeared to have been a MANUAL TYPEWRITER! The bottom line was that I had to FAX my grandmother’s ID to the insurance company with proof of her birthdate. I was able to verify yesterday that this FAX was received, and hopefully a check is forthcoming.

Meanwhile, I phoned DHS and asked to speak with my case worker. I also got in the car and drove to DHS and left my letter and receipts. The very helpful receptionist date stamped everything and said she had discovered the case worker was not in the office that day, but she should be back in the office on Thursday, and my papers were atop the case worker’s desk for her review.

It took three days and several phone calls, but I was finally able to speak to my case worker, who told me she had not had time to look at my papers. I explained what I had done with the money. I assured her that there is no money left - I've spent it down and left receipts to prove it!

The case worker had told me on January 11th that she would go ahead and send a nurse to evaluate my grandmother. To date, no nurse has come. I asked if she could please send the nurse. She said that the nurses were doing double duty with another agency, and she just didn't know when the nurse could get there. I asked about the February 1st deadline, and I pointed out that we were in the midst of a second major snow event, and I am on pins and needles that my grandmother will try to get to her mailbox and fall and break a hip before I can get her admitted to Southridge. The case worker said she understood, but she said that she is the only Medicaid case worker available presently - the other worker has been ill and is on sick leave. She said there were several people ahead of us who have been waiting more than a month already.

I asked, "So your comment about getting this done by February 1... is that not still possible?" She was not sure. And she could not tell me if the nurse would be able to evaluate Mam-ma before the end of this month... "If I told you a date, I'd be lying," she said... "because I just don't know." So I do not know WHEN we will be able to move. I told the case worker, "I'm going to hang up and say a prayer." She laughed, but I hung up and did just that.

At this point, I have done all I can do. But I do not underestimate the power of prayer. I have not told Mam-ma that we might not actually move on February 1st. I'm believing that God will work in this situation and fill in the gaps now where I am powerless. If you want to agree with me in prayer, that would be great! Meanwhile, I'm washing new towels, labeling everything with Mam-ma's name, and preparing for the big move in 10 days. I'll let you know how it goes!

Making a Big Move

It's official... my grandmother is moving to an assisted living facility.  I put down the non-refundable deposit yesterday.  For over a month now, my grandmother has been telling other people that she was going to move into the assisted living facility.  But there were two obstacles:  1) there was no room available for which she qualified financially, and 2) every time I mentioned it, she would say, "I'm not a goin'!"  She also reminded me lately that... "your momma said I had a home to live in as long as I wanted."

My husband and I tread lightly as others began to tell us that my grandmother was reporting to them that she was moving to the assisted living facility... "as soon as they have a room for me."  And on Christmas Eve, she sat down on our hearth beside a cousin who lives in a condo on the same campus... collectively known as Southridge Village... and told him, "I'm ready.  I'm just waiting on a room."

I debated whether to phone the administrator and check on the availability of a room.  She had told me in late October that she would see what could be done and get back to me, and I had not heard anything.  But with the end of the year approaching, my husband and I decided a casual phone inquiry to ask if things had changed might be in order.  I didn't want to be the "spark" that lit this fire, but at the same time, I didn't want us to get deeply into the cold, dreary winter months and miss an opportunity for Mam-ma to spend those days in the company of others whom she would enjoy.

I phoned the administrator, and she said that nothing had changed... however, some things were about to change for 2011, and she just happened to be headed to a staff meeting to discuss the new adjustments.  She would see what could be done and call me.  The next morning, she phoned to say that a room was available.  I told her I would bring my grandmother to look it over the next day.

This process is not quick or simple.  There is a large amount of paper work to complete... physical evaluations to administer by a nurse and my grandmother's family physician, and more. In total, all of this will take four to six weeks to complete.  There was also a non-refundable deposit to the ALF ($500 at this particular facility, depending upon the resident's circumstances and level of admission).   And there will be additional monthly expenses... toiletries, personal items such as stamps, stationery, telephone service, candy and cookies, the hairdresser, and other "extras" are not included.

We never dreamed that an ALF would be an option for my grandmother... it seemed too far out of reach financially.  So we have done all we could to keep her safe and happy in her own home.  But the day has come when she is needing more attention and services - and she is lonely.  Home Health nurses, friends and family members can come through her door all day long, but she needs the continual companionship of people her own age, and this is where we think the ALF experience will shine.

We toured the room and the facility, and Mam-ma liked it.  I've completed all of the forms, and I've set up appointments for her exams and reviews.  We will begin to look at her clothing and personal items and determine what she should take with her... and what needs to be left behind.  I've assured her that all she has to do on moving day is get her purse and coat and go... my husband and I will handle the rest - along with my mom. 

Already, I've seen a marked difference in my grandmother.  I think this decision has weighed on her for months.  Once she made up her mind to go, she has been like a new person. (I'm knocking on wood here!) When I picked her up for her beauty shop appointment, she had no complaints. She was forgetful... but pleasant and accommodating.  She asked me to purchase a new quilt top for her at Wal-Mart, so that she could make a baby quilt for her church's youth leader... a decision she would never have allowed someone else to make for her in the past. I was concerned that what I chose would not suit her... she declared it "just fine."  She told me "I didn't know what to put on the grocery list... I don't know what I want."  I reminded her that soon, she won't have to worry about that, and she agreed.

At Southridge, there will be three meals a day, with a "daily special" plus options from a menu.  Snacks and coffee/tea, etc., are offered throughout the day.  This will be more food than my little grandmother can ever hope to eat.  And she has a mini-fridge in her room, so she can keep Ensure and Cokes (and her Three Musketeers and Chips Ahoy cookies) for midnight cravings and extra sustenance.  She can take her bird feeder... the maintenance person will keep it filled if she provides the seed.  She can take her sewing machine and place it in the activities/crafts room.  She can take her gardening tools and help in the spring/summer with a common garden.  Newspapers are provided - both the daily state paper and the semi-weekly local editions.  Each room comes with Directv... more channels than she presently gets at home with her extended cable package.  She has her own heat/AC unit, which thrills her... the room can be as hot or cold as she desires!

Beyond that, for my peace of mind, she will have medical and CNA attention... as much as needed.  There will be help with bathing, daily administration of her medications, and an alert button she carries with her at all times.  There are safety measures in place should there be a power failure or other emergency.  No more worrying that she is out in a rain storm trying to tell the neighbors her power is out... or dashing to her storm cellar.  No more concern about her slipping on an icy driveway as she walks to her mailbox - or that she will be trying to shovel snow and ice from said driveway "so people can get to me."  No more concern over her falling or having a heat stroke while watering her summer flowers and garden - the maintenance staff will water them for her!

There will be no more concern about Mam-ma's cooking.  And once these papers are completed, there will be fewer forms to complete over the year.  For the first time in years, I will be able to enjoy my grandmother rather than manage her care.

On Christmas Eve, my grandmother seemed so frail and confused... restless and miserable.  I looked at her and thought... "we may not have her with us next year."  After we toured Southridge, I asked my husband how much longer he supposed we will have Mam-ma.  He replied, "I'd give her about another eight years."  And truly, if she does as well as we think she will at Southridge, she very well might make it to 106!  But even if she only lives another few weeks or months, I know this is the right decision... and I think she does, too.

As we begin a new year, change is on the horizon.  Mam-ma told the administrator, "This is the biggest change I've ever made in my life."  I thought about her changes... losing her home of nearly 30 years to a fire, becoming a widow, losing her only grandson, son, and a long-term companion within the course of 2 years just a little over a decade ago, moving from her farm to a house in town, and more... all big changes.  But she knows that this change is probably more significant.  She realizes that admitting you can no longer live alone in your own home is a big step... and one that has a myriad of ramifications.

I have no doubt that this will not go as smoothly as I would like... there will be dark days and hard times as we near the move-in day.  But everyone who knows my Mam-ma will tell you, she is one tough bird... and she will rise to the occasion.  I'll let you know how it goes!

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... ArlineChandler.com.

Hard Choices

If I've learned anything in the last two weeks, I've learned that a lot can happen in a short period of time, and everything is fluid.  My mother-in-law has continued to show improvement, for which we are grateful.  My grandmother's cough is much better, and after eight days with absolutely no voice, mine has returned enough that I can communicate verbally again.  Hopefully a full recovery is imminent!

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)

The bottom line was that Mam-ma would be a "Tier 2" on the 4-tier Medicaid system, meaning she needs help with bathing and medication.  "Tier 3" patients cannot feed themselves or remember where they are from day to day.  Why are Tiers important?  Medicaid determines the amount paid based on these Tiers.  So at this point, we were looking at a room for which Medicaid would garnish my grandmother's monthly Social Security check (less $61 for 'personal items') and supplement this to meet the facility's requirements - plus $500 per month from us personally.

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 administrator said there was another option ... Elder Choices.  This is a program that can be funded via Medicaid and allows clients to continue to live in their own home with live-in assistance.  For more information on Elder Choices, view a brochure at http://www.daas.ar.gov/pdf/ecbrochure0707.pdf.  This sounded great until I did further investigating and learned that the patients must be unable to do two of three things:  toilet, transfer, and/or feed themselves.  Mam-ma can still do all three, so she would not qualify ... at least not at this point.  However, this is good information for the future, should things change and she needs help with these things and we are not ready to commit to moving to the nursing home.

Meanwhile, I continued to tell the administrator that it made no sense that there wasn't some option for people with no assets.  Finally she said, "We do have a limited number of full-coverage Medicaid rooms, but I don't know if we have any rooms available at the moment that would qualify."  I asked if I could at least see one, so that I knew all of my options.  The administrator had given me several brochures, pamphlets, and floor plans of three available "suite" options.  She did have an empty room to show me, so we left her office and walked through the facility to look at the space.

The room was 235 square feet.  The administrator said her uncle had a room this size and he had a queen-sized bed, two recliners, and an entertainment center for his television.  It must be wall-to-wall, because this little room didn't seem big enough for all of that.  There was a clothes closet with bi-fold louvered doors, and an in-wall stacked unit of drawers topped by a mini-fridge.  There was a separate bath that was handicapped accessible and had a medicine cabinet and was fairly spacious for a bathroom.

On the "up" side, the facility is truly lovely - very modern and well-decorated, neat and clean, pleasant, and filled with amenities.  All staff members were friendly and cordial and seemed to be very professional.  For the right person who would get out of their room and take advantage of the opportunities to socialize, this might be a good fit.  The administrator did point out that the room she showed me had big windows with bird feeders outside, and she said my grandmother was welcome to have more feeders.  And Mam-ma does love her birds.  There are also two gardens, and Mam-ma is welcome to bring her shovel and other gardening tools to use there.

The administrator explained the menu in the dining area with options plus a "daily special."  She said frequent outings and activities are planned, like a "day to the races" in Hot Springs and a visit to the Clinton Presidential Center in Little Rock.  I don't know that Mam-ma would enjoy either of those, but at least there are options.

So I put my name on the waiting list, and I told the administrator I would talk all of this over with my husband and my grandmother and get back with her the following week.  I came home and showed all of the information to my husband, and we agreed to mull it all over.  He readily said, "We could pay the $500 a month."  This would get my grandmother into a little bit bigger "suite" - a whopping 350 square feet that includes a "sitting area" near the bedroom space in sort of an "L" fashion.  The third option is a 430-square-foot "apartment" with living area/kitchenette, separate bedroom, and separate bath.  This particular unit rents for $3000 per month.  I got the impression that this option would cost us much more than $500 additionally.
 
 I asked if there was a place where Mam-ma could set up her sewing machine, and the administrator said they would be glad to fix a spot in the activities room.  She asked if my grandmother quilts (she does), and she wanted to know if she would be willing to teach others to quilt (she would).  Several ladies who live in condos on the campus are wanting 
to learn to quilt.  I asked about cooking, and the administrator said the activities room had an oven and hot plates, and yes, Mam-ma could bake cornbread and hot rolls there.


I decided to make a list of all of my grandmother's "incidental" expenses:

• 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

These expenses totalled approximately $300 per month.  Now we were up to $800 per month out-of-pocket, if we opted to select the mid-sized "suite".

We took a couple of days to think about all of this - and to play with Timothy, who came for an overnight visit.  When we were able to sit down and look everything over again, we realized we could not ask my grandmother to go from an 1100-square-foot, 3-bedroom, 1-bath house with nice yard to a 235-square-foot bedroom ... primarily because she is having issues with cooking.  Frankly, the 350-square-foot unit was not that much larger, especially for an additional $500 per month. 

We realized that the three times my grandmother has been admitted to the nursing home for "rehab," she was completely covered by Medicare, so her Social Security income was left untouched.  This is why we had never considered the $300 in incidentals before - she always had money to cover them.  Now we realize that, should she go to either an assisted living facility OR the nursing home, she may very well have expenses that exceed the allotted $61 monthly allowed by Medicaid.  It's a small issue, thankfully ... but one many families need to know about and be prepared to address.  Of course, one option is to expect the resident to "do without" some of those items, but I hope I never have to ask my grandmother - or any family member - to do this.

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.

More silence, and then Mam-ma said, "Well, you just need to come over here and we'll go through that freezer."  I told her I would be glad to do that, and she added ... "and what I can't use, we'll gather up and take back to the grocery stores and get our money back."  I was dumbfounded.  I told her that was not happening ... it didn't work that way.  She said, "Well I know it most certainly does!"  I told her that no, we could not take food back to the grocery store for a refund - they won't do that, and besides, we don't have receipts.  Then she said, "Well, you don't understand... some of it's not fit to eat."  I figure about halfway down in her freezer, things are so old they need to be tossed, so I said, "Yes, and what's gone bad we will toss out." 

Mam-ma shook her head, "No! No! No!  I mean that stuff they bring from the Center is not fit to eat!"  She meant the Meals on Wheels.  I told her that I've not seen a meal come out of the kitchen there that I wouldn't eat, and she retorted, "Y'all don't eat like I do!"  I agreed ... but I added, "There are a lot of things I used to eat that I can't eat now because of my allergies ... and I've learned to adjust.  You're going to have to adjust, too.  I would think if it means being able to continue to stay at home, it would be worth it."

Again, I told Mam-ma to cook when her housekeeper came on Tuesdays.  She said, "I love to put on a pot of brown beans - in fact, I've got a pot on the stove now.  I could cook them in the crock pot, but they don't taste the same."  Now, there are various "camps" on this theory, but I told her to start hers in her old iron pot on the stove when the housekeeper was there, then have the housekeeper transfer them to the crock pot before she left, since beans need to cook all day. 

Then she said, "Well, I'll tell you what, I'm a makin' a pan of cornbread for supper!"  I told her that was fine - make her cornbread.  She had a neighbor coming to visit and eat with her, and I told her, "Make that cornbread while Margueritte is here."  Then she added ... "and I've GOT to make one more batch of peanut brittle for my deacon."  I told her no she didn't, and she said, "Oh, yes, I do - he fixed that kitchen light for me, and I told him that as soon as the weather faired up, I'd make him some peanut brittle."  I explained that her deacon would feel terrible if a batch of peanut brittle in exchange for changing a light bulb put her in the ER or the nursing home. 

So she said, "Well just what are we supposed to do with all those peanuts?"  I explained that they didn't have to be made into peanut brittle and that ... "if nothing else, we'll grind them in the blender and make peanut butter for Timothy!"

We changed the subject ... we had said all we needed to say at that point, and I knew she was very upset.  My stomach was in huge knots, and I felt like a dictator or the Big Bad Wolf!  I called my mom and warned her that she would probably get an earful when she called that evening.  I also refilled the medicine compartments for the past week while I was there and had extra time ... and for some reason, the Monday night medicine was there.  Mam-ma told Mom every single night that she took her medicine, so we don't know what happened, but that is the only dose she has missed in a month.

So Mom said that the evening phone call went well - no mention of our conversation about the Meals on Wheels or the stove.  However, the next morning, when Mom called, Mam-ma was very upset.  She had burned dried peaches in her crock pot.  She said she fell asleep ... and we're thinking she had left them cooking in her crock pot overnight.  At any rate, it was a smelly mess, and she was upset.  That being said, Mom doesn't think she will stop using her stove.  In fact, Friday evening, a man from her church brought her okra!  So there's another church member for Mom to talk with about our plans. 

Mam-ma told Mom yesterday morning that she had decided to get Meals on Wheels, and that I had told her I didn't want her to use her stove any more.  Mom tried to reason with her about how we have to change sometimes, and it's hard, but we have to do it.  She felt she got nowhere.

Yesterday afternoon, I called Mam-ma to check on her and tell her some news, and she never mentioned the peaches.  But after we talked a few minutes, she said, "I've been thinking about it (and she started to cry) ... and whatever y'all want to do with me, I'll go along with it."  I laughed and told her that what we want to do with her is keep her in her own home doing virtually what she has always done ... but with Meals on Wheels and not using her stove unless someone is there with her.  Then she wanted to know about the cost of the meals.  I assured her she could afford them, and I would handle the payment process for her.

I do feel badly for her.  And I know I don't fully understand as well as I think I do.  But I also know that I lost a LOT of sleep this past week over the thought of putting her in a tiny bedroom suite ... the logistics of deciding which of her things to keep ... and getting rid of the rest.  Every time the administrator started talking about the things many of the residents cannot do, Mam-ma could do all of them - and much more.  The bottom line is that she still does pretty darn well for someone about to celebrate a 98th birthday.

I know this could all change tomorrow.  I think the peaches incident scared her a little - at least I hope it did - about her cooking skills and her safety in the kitchen.  My husband and my mom and sister have convinced me I am not evil and did what I had to do to keep Mam-ma safe.  The church members and neighbors have all been very agreeable and cooperative.  And I'm praying Mam-ma gets good delivery people who will brighten her mid-day as they drop off her lunch.  I know that Greg is such a blessing to the people on his route - and he has actually been able to help some who were in distress and needed emergency assistance.  So knowing that someone is dropping in to check on Mam-ma each weekday gives me an added layer of security.

Thursday night, Mam-ma had called me to see if I had my voice back and was coming to drive her to the beauty shop on Friday.  Over and over she said, "I hadn't called you because I didn't think you could talk."  I told her that was right ... I couldn't.  Then she said, "Oh, I have missed you!"  I told her I had missed her, too ... as Mom has been doing all of the calling.  Before we hung up, she told me she loved me. I know she still does, but she surely didn't say such things yesterday!

This is a valuable learning experience for me.  I now know the options for assisted living and for the nursing home ... and I learned about Elder Choices.  I have a clearer understanding of extemporaneous expenses, and I can somewhat prepare for these - for my grandmother or any other loved one who might require residency in one of these facilities. 

I've also started thinking more about my own situation.  I know that tantamount for all of us is a sense of personal control.  And I do know people who have made a conscious decision earlier in life to move into a "retirement village" - or even an assisted living facility - well before the time when that choice might have to be made suddenly or by someone else on their behalf.  Friends of my parents who are in their late 70's/early 80's have recently moved to a patio home in a retirement village, and they are loving it!  The gentleman is a playwright, and he and his wife are producing some of his plays written in the 1940's and 1950's for residents of their own facility and others.  They have lunch in the lodge almost every day, utilize the fitness center, and enjoy the knowledge that more services are available on-site, should they need them some day.

In a couple of weeks, it will be twenty-one years since my grandmother moved into her little house in town ... and it has served her well.  This was a good move for her... although at the time, it was difficult - and honestly, quite devastating.  But it was the right thing to do ... and so is Meals on Wheels, for now.  A few years ago, the only alternative for people like my grandmother was to move into the nursing home.  Thankfully, as our population has aged, programs have been developed that are designed to keep our seniors in their own home longer - and to enable them to afford intermediate steps like an assisted living facility.

One of the purposes of this blog is to provide information and share my experiences, in the hopes that others can learn and gain valuable information and insights for providing the best possible care for their own seniors.  Just as with children, caring for seniors "takes a village," and I for one am glad to know that I'm not alone in this.