Preparing for Anything...

Today is a "rest day" for me... much needed after the past week.  Timothy stayed with us the first part of last week, and then for a few hours in the afternoons on Wednesday, Thursday, and Friday, until his GaGa finished with her CNA classes.  Friday, I visited with Mam-ma and did things at home that I had neglected.  Saturday, I learned that my cousin's aunt... the one who just turned 90 and missed her birthday because she had to be hospitalized with a UTI... had passed away.  I factored a visit with my cousins into my afternoon, along with a shopping trip for our own groceries... and shopping for my 85-year-old mother-in-law, who is having knee problems.  My husband had asked her to please stay off her feet - and on her couch... and we offered to bring her some prepared meals and a few other groceries she needed.

By the time I finished all of my "rounds," I was too tired to cook dinner, so Pizza Hut was a welcome reprieve.  Two carry-out pizzas and some R and R on the couch, and I was feeling much better.  However, Sunday I "worshipped at St. Mattress," as my friend Mitch so aptly described it recently, and I caught up on some much-needed sleep and rest. I did a few loads of laundry, ran the vacuum, and did a workout.  Then I picked up Timothy around 4:00 p.m. at his grandmother's (my sister's).

 

Timmy swimming at the Community
Center pool with his great Granny (my mom).

Timmy was wearing a "fever patch" on his forehead, and my sister said he had been feverish and had a runny nose all day.  I brought him home, gave him Tylenol and some children's Zyrtec, and let him soak in a bubble bath.  He seemed better after that, and we played until bedtime.  He slept somewhat fitfully... but he did sleep.  The next morning he was fever free, so I took him to daycare, so that my husband and I could attend the funeral of my cousin's aunt in the afternoon.

Following the funeral, we returned to my cousin's house to visit with the family members we rarely see.  My little cousins, Owen and Olivia were there, and their mother said, "Oh, I wish you had brought Timmy."  So I went and picked him up at daycare and brought him over to play.  On the way to the house, I told Timmy we were going to play with Owen and Olivia.  He was so excited, and he said, "I hug 'em!"  Then he added, "I kiss 'em, too!" 
Then Timmy said, "DebDeb... I so happy!  Are Oooo happy?"  I smiled and told him yes, I was very happy whenever he is happy.  He said, "I happy, you happy, me happy!  Yea!"  So sweet!  And he truly is a happy child... and he enjoyed playing with Owen and Olivia.

Meanwhile, my mother offered to check on Mam-ma for me... and Sunday afternoon, she took her on a long drive.  We are having gorgeous fall weather, and Mom took Mam-ma "all over the countryside," as Mam-ma put it!  She even took her to Sonic for an ice cream cone.  Mam-ma loved every minute of it, and Mom has promised to do this again.  She said, "I don't know why I didn't think of this earlier."  Mom has been a big help with Mam-ma lately... visiting her when I am tied up with Timothy or other things and calling her more often.

Timmy did not sleep well Monday night... more fitful tossing and turning.  Tuesday, he would not nap, and he ran fever off and on all day.  The daycare did not have a vacancy for him, so we just played at home.  Tuesday night, he was so tired that he went to bed at 8:00, but he was awake with nightmares or something at 8:30 and 10:30, and at 1:30 a.m., he awoke drenched in sweat, soaking wet diaper, and asking for milk.  I changed him, stripped off his clothes (amidst a major, ear-piercing, hysterical fit), and settled him back in his bed.  I thought, "He's settled for the night now!"  NOT!  At 4:00 a.m., he awoke, crawled into our bed, and said, "Milk!  Jack!"  I got more milk, changed him again, and turned on "Jack's Big Music Show."

Timmy has been having diaper leakage again, so I've been limiting his night-time liquids and double-diapering at bedtime.  It has worked fairly well the last 2 weeks.  Wednesday morning, we watched 2+ hours of Jack and "Wonder Pets," and we both drifted off to sleep again shortly before 7:00 and slept until 9:30.  When Timmy woke up, he was feverish again and somewhat clingy.

By 10:30, I thought Timmy was ready for an early nap, and he actually said, "Couch!"  We got on the couch and settled in together.  But he asked for more milk, and when I got up to get some for him, he followed me to the kitchen.  He whimpered and I picked him up and carried him back to the couch, where he promptly threw up... a LOT... all over himself, me, the couch, and rug.  I scooped him up and started across the floor toward the kitchen, and he threw up again. This was the first time Timmy has thrown up since he was about 6 months old.  It really scared him.

I quickly stripped both of us and carried him to a makeshift pallet in the living room floor.  Thank goodness we have hardwoods, because we left a trail you would not believe.  My husband came in and wrapped Timmy in a blanket while I ran around in my underwear and tried to sop up the mess and regroup.  Timmy was burning hot with fever, so I gave him 7-up and Tylenol, and he laid limp on the pallet for about 45 minutes.  Then as quickly as he got sick, he popped up and seemed much better!

The rest of the day we tried to remain quiet and keep the fever at bay; however, I could not get Timmy to nap.  We ditched plans for a haircut and a visit to Mam-ma's... apparently this is a "bug" that is circulating in our town, and I can't risk exposing her and the others at the ALF.  My sister picked Timmy up at 5:30 when she completed her last CNA class- she is official now (YEA!).  She said Timmy was asleep before they arrived at home... and he slept until 8:30 a.m. today!

After the baby left, I stripped beds, did laundry, and regrouped... then headed for the couch!  With a good night of sleep, I am better rested, but still tired.  I realize that younger moms do this every single day... but for me, it's a lot... especially with the other factors and people for whom I feel responsible.  I talked with Mam-ma today and explained why I have not been to see her this week.  I feel like I am neglecting her, but I am confident she is safe and comfortable and well-cared for at the ALF... and she knows why I am not coming very often and seems okay with it.

My house is not nearly as clean as I would like, but I am learning to let things slide a bit in favor of being rested and doing what absolutely HAS to be done... and anticipating "the next big thing."  I'm learning to roll with the punches... that comforting a frightened, sick little toddler beats dusted furniture and a haircut any day of the week... and that hearing "I so happy" from my little guy is possibly the BEST phrase in the whole world.

One other thought... Sandwich Generations are nothing new.  At the funeral of my cousin's Aunt Louise, there was a lot of talk about the service this dear lady gave to her family.  She never married... spent 90 years taking care of others.  When her sister suddenly became a widow with three small children and another on the way, Louise took them all in, and they lived with her and Louise's parents... forever.  Louise retired early to care for her ailing elderly mother, then she helped with the care of her sister, who developed Alzheimer's.

Along the way, Louise taught 3 and 4-year-olds in Sunday School for 25 years, helped with the rearing of her sister's four children - school functions, weddings, births of their children and helping to babysit, family gatherings, and much more. Louise's life was very much serving as the "filling" in a sandwich that included elderly parents and her sister on one side... and the younger generations on the other. And nobody could recall ever hearing her complain.

As we reminisced about Louise and noted how well she had loved and care for so many throughout her life, I realized that she is a tremendous inspiration. If I can make my "sandwich" half as rich as hers, I will have truly accomplished something in this world. I don't know how she kept such a positive attitude, but she has motivated me to work on the grumbling, too. Wish me luck!

* * * * * * * * * * * * * * * * * * * *

BTW... the formularies for Medicare Part D Prescription Drug Coverage have arrived... it's time to start picking our new plan for 2012! So sharpen your pencils and start calculating!

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.

Fun With Bureaucracy...

My grandmother has a history of telling one person one thing, and another something else. So I was not surprised when my mom told me that Mam-ma was telling my cousins, "Debbie is taking me to look at a room at Southridge (the assisted living facility) next week." She had told me that she wanted to think about it, and that the room "was too small" and too dark. So I called her and asked, "Are you wanting to go look at Southridge?" She replied, "Well, I don't want to, but I think I better. I may not be happy there, but I'm not happy here, either." This was the first time she has flatly admitted to not being happy.

I told Mam-ma I would call and talk to the administrator and set up a time for us to take a tour. I called right away, and the administrator told me that there are now no fully-funded Medicaid rooms available. In the time since I first visited with her, she has "given them all out." I asked about a waiting list, and she said there was no one on the list at this point, but she didn't foresee any rooms coming available anytime soon. I asked to be placed on the list.

I explained to Mam-ma that we may have to move very quickly if a room comes open. There won't be time for her to waver back and forth... she will have to take a look and either say "Yes" or "No." The administrator did tell me that we could get one of the mid-sized rooms (which has 355 square feet vs. 248 sf for the fully funded room). This room currently costs the family an additional $500 per month, regardless of what Medicaid pays. That is in addition to any "incidental" expenses Mam-ma will have, which I am tallying at about $300 per month for such things as her medicine co-pay, getting her hair done, personal toiletries (toothpaste, mouthwash, soap, body lotion, etc.), toilet paper, candy, cookies and soft drinks, her telephone bill, and more. We have no guarantee that the $500 per month currently being charged might not rise at some point. Once we make the move and Mam-ma empties her house, where would she go if we deemed this to be too expensive?

So we are waiting for the fully funded room, and Mam-ma is managing. The lady in her Sunday School class who my mom felt would become a new "designated driver" did indeed drive Mam-ma to church last Sunday, since Mom was out of town. She also drove her to the Senior Center for lunch one day this week. And Mam-ma has not complained too loudly about being lonely or "looking at the four walls," although she does tell me often how much she misses going places with Ruby.

Last week Mam-ma told my mother that she had not seen anyone all day... except her deacon, the Meals on Wheels delivery person, and her Home Health aide! She is also continuing to forget to take her medication - or mixing it up some. She tells us she took it, but it's still in the compartments when I check on Fridays. Her response is always, "Well, I'm sorry." I've told her, "Don't apologize... just go take it!" This week, she said "I didn't take my noon medicine, because the box was empty. I may have taken more than one dose at a time." I told her to go to the Friday box and take the medicine in it, and I would fix it on Friday. She said, "There are three half tablets in Friday's box." I have pretty well decided she has dropped the container a couple of times and tried to replace the medicine herself... with mixed results.

Last week, Mam-ma called to tell me that her semi-annual pacemaker check had been set for Wednesday, December 8, at 1:15 at our local hospital. I made a note on the calendar. She said she got a letter about it. Then she called on Friday and said there was a telephone message and, "My pacemaker check has been changed to Friday, December 10, at 11:30 a.m. - in Searcy." (30 miles away) I called the number for the pacemaker technician, and she said that she could not explain the phone message about December 10th, but the appointment was for Wednesday, the 8th, at 1:15 - and it was at our local hospital.

Mam-ma was to have her semi-annual checkup with the cardiologist this past Wednesday at noon - in Searcy. As my husband and I dressed and got ready to make the trip, I decided that I should call and confirm the appointment. Now, I had done this two weeks ago when we went for an echo cardiogram. But nonetheless, I made a call. The receptionist said, "No, that appointment has been rescheduled." I said, "You have got to be kidding." She said... "Well... let me check. I'll connect you to the scheduler." She put me through to a voice mail machine for another cardiologist. I called again. She apologized and tried a 2nd time... this time reaching the voice mail for yet another cardiologist. I called a 3rd time. I explained that we were about to walk out the door, and we really needed to know about this.

The receptionist said, "Well, I know your appointment is not today, because the doctor is out this week!" She said she would check on things, and the next person I spoke with told me that Mam-ma's appointment was now scheduled for Friday, December 10th, at 11:30 a.m. It was all coming together. She said, "We spoke with you on November 15th." I assured her no one had spoken with me. She said, "And we sent you a letter." I told her if Mam-ma got a letter about the appointment change, she had not mentioned it.

I also told the girl that we already had appointments for that Friday, and she cut me off and said, "I don't mean to interrupt you, but we are booked solid through March. That is the only appointment we have available until then." I wanted to scream, "My grandmother could be DEAD by March - she is 98 years old!" But instead, I told her "Fine... we'll take it and I'll reschedule her other appointments." She said, "Now if that won't work, we could talk to the nurse and maybe work her in some other day." I know what that means... sitting for hours on end in the waiting area for a spare minute. Mam-ma is not up to that. Just going to the beauty shop tires her these days. So I assured the scheduler we would be there on the 10th.

As I had done with the pacemaker tech, I asked this person to make me the point of contact for phone messages and letters about appointments. She reviewed my address and phone number and said, "That's where we send everything already." I told her no... I had never gotten any of the messages... they all go to my grandmother. She said she would make the changes on Mam-ma's records... we will see.

With an unplanned day suddenly available, I decided to tackle enrolling Mam-ma in a new Medicare Part D Prescription Drug plan for 2011. You would think that after 5 years, I would have this down pat... NOT! I still had to call the Medicare office in Dallas to make sure I was understanding the information correctly... would someone with extra help be required to pay premiums and deductibles? The answer was no... and ultimately, my choice came down to finding the plan that covered all but one of Mam-ma's meds (an anti-anxiety medication that has never been covered) and had the lowest co-pay.

My frustration came not from the process itself... and certainly not from the extremely helpful Medicare rep, Anna. The problem resided in the Medicare.gov website. More times than I can count, the site "timed out" on me, and I had to go back and re-enter my "code" to access my drug list and start the process again. I was taking time to compare plans... or talk with Anna on the phone... or look over the details of a particular plan. I would sometimes get a screen that "you are about to be timed out," but more often, when I tried to return to my list of plans, I had to start almost completely over. So even though I feel like I understand this process about as well as anyone, it still took more than two hours.

But we have Mam-ma enrolled, and I think we have her appointments straightened out... although I will be calling a few days in advance this time. What if we had taken off from jobs to drive her to Searcy? I have to believe that the staff knew 2 weeks ago when were in the doctor's office that he would be "out of the office" this week. Maybe not... but it's highly suspicious to me.

All of this makes me wonder... what do people do who have no one to help them? Mam-ma gets things so confused these days, and were she still able to drive, I seriously doubt she would think to confirm an appointment before driving 30 miles for it.

In fact, we've done this ourselves... early on in our caregiving. We drove to Searcy one day for the echo cardiogram, and no one had called to tell us that the "tech" no longer performed these on that particular day of the week. After Mam-ma threw a little fit and told them we had driven 30 miles, they were able to locate a "tech" who happened to be shopping in town, and she drove over and did the 15-minute test. I learned then to always call and confirm... and usually I call the day before an appointment. But having just been there 15 days earlier and confirmed, I let it get by me. And I realize now that Mam-ma confused the pacemaker check info with the rescheduling info, so in some ways, it was as much our fault as theirs in this instance.

So what does this all mean at this point? We are just taking things one day at a time. Mam-ma seems to have made a better adjustment to not using her stove for cooking than I would have ever anticipated. She has not fared so well with the fact that Ruby can no longer drive her around. Someone asked me last week how she was doing with this, and I said, "Not well. I have seen a noticeable decline in Mam-ma since the wreck." I believe this is mostly mental... a mindset... but it's there nonetheless. She seems defeated, tired, and much older in recent weeks. My hope is that she will remain healthy enough until a room does come vacant for her at the assisted living facility. My goal is still to avoid the nursing home.

This is all pretty much out of my hands at this point, and I've come to terms with this fact. We will all be gathering for Thanksgiving next week at my mom's, and I am looking forward to spending time with my family and enjoying this day with my grandmother and Timothy... watching the generations interact, and making memories in the process.

Each day is a gift at this point... and for the moment, Mam-ma seems to have mellowed a bit in her temperament. Last night when I told her to be watching for her new prescription drug coverage info in the mail, she started to cry and said, "I don't know how I'll ever pay you for all you do for me." I told her, "Your my grandmother... you don't have to." She persisted, and I said, "Look, if you had to pay me, you couldn't afford me, so just be glad you're my grandmother!" We both laughed, and she moved on to another topic.

I am grateful that I am in a position to help her... and I do often wonder how on earth other people manage. My husband says half the clients on his Meals on Wheels route are nowhere near as well off and able as my grandmother... and many don't have anyone to see about them, save maybe a Home Health aide a few mornings a week. Some don't even have that.

Our culture has not kept up with the issues that face aging Americans. And as a gerontologist pointed out to me last summer, much of this is because Americans now live far longer than they once did. People like to talk about how "We used to keep Mom and Dad at home and take care of them until they died." Well, Mom and Dad only lived to their mid-fifties. We honestly are not equipped, in many circumstances, to care for parents and grandparents who live well into their eighties and nineties. I know there are people who are working to bridge the gap and improve things, but some days, the process seems pretty darn slow. And when you factor in the bureaucracy and the bumbled schedules and websites that are not user friendly, it's hard to see progress.

In the words of Scarlett O'Hara... "Tomorrow is another day..." and for me, it's "beauty shop/errand day"... wish me luck!

Ten Steps to Easier Care of Your Senior Adult

Knowledge is power... and I've harnessed many of my personal experiences into a list of ten steps that can help you better manage the care of your senior adult.  They are not rocket science, but I bet some of them will be new to you - or offered in a manner you had not previously considered.

The leaflet is only $3 and is available in PDF format... e-mailed directly to you.  You can order online using the info on the left-hand sidebar of this blog... PayPal and credit card payments are accepted. 

More informational data sheets may be offered at a later date.  If you have suggestions for topics that might be helpful, please contact me.  I welcome your feedback!

Taking Care of Business

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Here We Go Again With Medicare!

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

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

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

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

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

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

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


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

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

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