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.
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.
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.
This is pretty much all that is left of a family dinner that my grandmother prepared last night. She phoned me early afternoon and said she was preparing dinner for my mom and her husband, Lee - did Greg and I want to come? I told her I would check with Greg, and she said, "I don't know what you and your momma will eat (mom is diabetic - I have a corn allergy). I'm fixin' green beans, corn, sweet potatoes and a lemon pie." I asked her if I could bring some chicken, and she said, "Well your momma is bringing ribs. I told her I would just go out and get some ribs, and she said she already had ribs cooked." (How did Mam-ma think she would "go out" and get ribs? Mom says she never mentioned getting them to her... Mom offered to bring ribs, and Mam-ma accepted.)
I called Mam-ma back to tell her we would come for dinner and that I would bring some roasted chicken breasts, and I had checked with my mom, and she said she would take Mam-ma some potatoes to cook (Mam-ma's comment was... "I only have 2 Irish potatoes.") We hung up, and Mam-ma called back ... "You can't eat cornbread, can you?" "No, but that is okay," I assured her, and she said, "Well, now... I'm gonna make a pan of rolls, too." Now, for those of you who make homemade rolls, you know what a process this is! Granted, the more you do it, the faster you become, and Mam-ma has done it for 90 years, probably, but it's the stirring of that stiff dough that gives us trouble... and for someone nearly 97 with limited arm strength, it's a definite challenge - or should be. But as you can see, the results were light, fluffy, melt-in-your-mouth delicious... and she sent the leftovers home with us! Yippee!!!
Call #4 was to ask if my sister and her husband were babysitting grandson Timmy. I told her I didn't think so, and I asked, "Can you not reach them on the phone?" She replied, "Well, no, but I haven't tried... I wondered if they would want to come to supper, too." I told her to call and ask them, but... "do you have enough food?" She said, "Well... I don't know... but if we don't, at least we'll all be together." When we arrived, not only were my sister and her husband there, but my niece Jasmine and baby Timmy were there, too... and we had more than enough!
Such a seemingly simple thing as a family supper... such a day-long chore for the woman who prepared it. Mother and I cleaned the kitchen as Mam-ma tottered in and around us, finding containers for a "dab" of this and a "dab" of that to save as leftovers. I showed her the leftover roasted chicken breasts and broth I had brought and suggested she combine all of the vegetables with the meat and create a stew... a dish she seems to be enjoying of late because she can chew everything in it. The dentist says her jawbones are eroding after years of grinding food with her dentures, and her "teeth" now slip and slide and create blisters on her gums frequently. So she likes soft foods that are easily chewed, and the stew is hearty and nutritious for her. Mam-ma put everything into the refrigerator individually, but hopefully she will make a stew today.
One day I think that my grandmother is declining... and she is... and then I look at all she still does for "96 and a half," and I am amazed and bewildered... and extremely grateful. As she sat and held Timmy in her arms last night - all 15+ pounds of him - and never faltered, I thought, "Her arm strength may still surpass mine!" I was reminded that hard work is good for the body - and the soul - and we must never quit! I probably need to make more rolls... but then, that perpetuates the need for even more "work!"
So it was a good evening. We gathered, we ate, we played with the baby. We were together, and truly, it was enough.
Thursday was a fairly uneventful “errand day.” Mam-ma was dragging… she didn’t have any energy, and she didn’t look well when I got there. Usually she doesn’t even look like she needs to have her hair done, but this week, she had slicked it down and it looked BAD. She was complaining of being tired and “feeling bad all over.” I quizzed her – did her head hurt? did she have a stomach ache? was her throat sore? No, no, and no… none of the above… but she “felt bad all over” nonetheless. Finally when we got back home, I suggested maybe it was the heat. She insisted that her thermostat was fine on 78 degrees and did NOT need to be lowered! Then she said she had not slept well and had even gotten back up to take Tylenol and an Ativan. She said once she went to sleep afterward, she slept GREAT! I suggested maybe she had a “hangover” from the medication, and she said, “Well maybe that’s it!” I told her she should take a good nap and rest and see if the next day wasn’t better.
Friday, she called and sounded 1000% stronger and more energetic. She mentioned that she needed a new telephone book. Ever since we moved her telephone to the nursing home when she was there in 2003, the phone company has listed her address in the directory as the nursing home’s street address. She has mentioned it once before, or I would never have realized, and I debated whether to call the phone company or not. Mam-ma got someone else's extra phone book, so that solved her telephone directory dilemma. And the last time we changed something with the phone company, they disconnected her phone for several days. It’s sorta like calling the “black hole” to call the phone company about your account, so I hesitate to do it.So today, I took her an extra phone book that I had. I had been out EARLY to some garage sales and stopped by her house at 7:30 a.m. She was up and had just eaten her breakfast, but her house was all dark yet, with curtains drawn and every door shut and locked. She said she was going to walk later in the morning. We are in the middle of a heat wave, and even at 7:30 a.m., the air in the shade was stifling! I told her, “If you are going to walk, do it now before it gets any hotter, while you can still get your breath.” She agreed and began getting ready to walk.I asked if her teeth were feeling better since our trip to the dentist for new denture liners, and she said, “NO! I’ve got to go back! He [our beloved Dr. Eades] said I might have to, and they are too long… they are rubbing my gums.” I told her to let me know what day she could see him, but not to schedule anything for Thursday because “my calendar is full already.” She asked, “Oh… are you not gonna be able to take me to the beauty shop?” “Yes,” I replied… “YOU are part of that calendar!” She laughed, and said, “Well I guess it will be Tuesday.” I asked why she thought that, and she said, “Well I called yesterday, and they weren’t there.” (HELLO! We went through this LAST Friday!) I reminded her, “No… remember… they don’t work on Fridays!” “Well, that’s right!” she exclaimed. She added, “I can’t call them again until Monday.” “So you are assuming you might get an appointment on Tuesday?” I asked. She said yes… and added, “I’ve worked on them already… I cut a whole piece off, and they are better.” This is not the first time she has worked on her own dentures! I would attribute this to her work as a chairside assistant for another local dentist for 18 years - she literally "cooked teeth" on her stove at home in the evenings - helping the dentist make his patients' dentures. But knowing Mam-ma, she would whittle on them even IF she didn't know how to make a set of dentures from scratch!
I suggested that maybe her work would do the trick and the dentures would settle down over the weekend, and she said, “Well… maybe… but I don’t think so!” I told her to just let me know what she determined on Monday! I knew there was a reason I didn’t read that last magazine when we were there Wednesday!
As I left to go to more sales and Mam-ma to walk around the block, she said, “Wait just a minute… let me get a jacket.” It was already nearing 90 degrees outside. I said, “Mam-ma… the last thing you will need is a jacket!” She said, “Well I don’t walk very fast.” I told her… “You will break a sweat standing still today!” When we got on her driveway, she agreed that she didn’t need a jacket. As I pulled out of her driveway and started down the street, I watched her in my rear-view mirror. She was pushing her walker in the opposite direction. Her neighbors were having a garage sale… that may be as far as she got!
