How Do You Manage Your Senior's Finances...and a Few Other Questions and Insights

Several months ago, I was contacted by a writer for NerdWallet.com.  She gave me a lengthy list of questions and asked if I would be willing to provide insights to help her readers who were caring for seniors.  I agreed and spent a couple of days compiling thoughtful answers to her questions.  She didn't use any of them in her story.  

Since I put so much time and energy into the information, I thought I would post it here, so that you, dear readers, can avail yourself of any insights you might glean.  So here goes...

1) Please tell me a little bit about yourself. Is your grandmother your mother? Did she raise you?

I have been married 42 years, and we have no children of our own. My father died in October 1999.  He was an only child, and his mother - my then 87-year-old grandmother - was still living alone in her own home, driving, and doing pretty well for someone nearly 90.

My mother helped my grandmother with many things - as did my sister and I...but Mother remarried in February 2002. Mother traveled a lot in her motorhome...in fact, she and her husband left after their wedding for a 6-week trip along the East Coast. That summer, my grandmother fell and required 3 months of therapy in a skilled nursing facility.  My mother was traveling with her new husband, and the care of my grandmother became my responsibility.

Mother was planning to spend the FOLLOWING summer (2003) traveling, and just as she was leaving, my grandmother again became ill and required a stay for rehab at the nursing home.  Mother handed me my grandmother's checkbook and said, "You're going to need Power of Attorney." So for the next 10 years, *I* was my grandmother's guardian.

My sister, brother (who is deceased) and I were fortunate to grow up in the same community as ALL four of our grandparents, and we were very close...we saw them on almost a daily basis.  My grandmother did not rear me...but we were very close, and she was very much a mother figure to me in the last 10 years...especially given how intertwined our lives were - and the fact that I was somewhat her sole caregiver.

In 2009, my sister's daughter had her first child.  My niece was a single mother attending college, and my husband and I kept the baby while she went to classes.  This morphed into us keeping our great-nephew for longer periods of time. By 2012, my niece had given birth to two more babies and gotten married, and my husband and I were heavily involved in assisting the whole family. So my "sandwich" was my great-nephews and great-niece - and my grandmother. 

My grandmother died in 2013...and the "sandwich" shifted from caring for her and the babies to caring for my mother-in-law (who is now 90) and these three children. This situation is not quite as "involved" as it was...the children are now 4, 5, and 7 - and all in school - and my husband is primarily responsible for his mother, so my responsibilities there are negligible.  But there are times when we have all three children and "Grandma E" together at the same time...and the dynamics of a "Sandwich Generation" situation are definitely there.

Our SUV has three car seats and a handicapped sticker.  When my grandmother was still alive, I used to joke that our car often contained a walker and car seats...and diapers and Depends!  For a "childless" couple, we are well versed in all things NickJr., baby - AND Medicare and geriatric!

My mother was diagnosed late in September 2015 with stage 3C Ovarian cancer, and she began chemotherapy immediately.  Two treatments in, the oncologist said the drugs were not working and the tumors were growing rapidly. She was hospitalized New Year's Day and placed in Hospice Care three days later. She died on January 12, 2016.  Prior to her diagnosis, my mother was an active 76-year-old great-grandmother who drove her own 40+-foot motorhome (with tow car) from coast to coast.  If she fit the "sandwich" mold, it was only the context of my caring for her needs those last few days - and attending to the children and fielding their questions when they would visit her.


2) What made you want to start your blog? 

 I first wrote about my grandmother on a personal blog after several frustrating encounters with insurance companies over the Medicare Part D Prescription Drug coverage, beginning in 2005.  I have never experienced anything more exasperating in my life...and at the end of the day, I had a Medicare rep from Dallas, Texas, on speed dial. This woman would become one of my most trusted contacts over the next few years until she retired...and I always had to reach out to her for clarification each fall as I selected my grandmother's prescription coverage plan.

In 2008, when my grandmother had to go to the nursing home for a third time in five years for "rehab," I decided that my experiences might be helpful to someone else - and I needed a place to vent. So I started "The Deli" blog. At that time, I was not in a "sandwich" per se...but I had friends who were, and I hoped that by sharing my experiences about MY grandmother, I could encourage others to open a dialog about THEIR situations.


What type of support have you found in the blogging community?

To be honest, I have not received as much support as I hoped.  I participated in some forums for caregiving and the Sandwich Generation on the AARP website for a while. And I all but begged some people to share THEIR story with me in a format that I could put on my "Deli" blog.  But at the end of the day, I think people are just too tired and busy with their "sandwiches."  If you are not a writer already - and inclined to document your experiences - it's hard to make time for spilling your guts to someone else. 

Having said this, I have SEVERAL friends who are currently dealing with the care of aging relatives - if not a "sandwich" situation - and I hope to maybe resurrect the blog a bit and get some of them involved in the dialog.  We will see what happens!

3) Were you the only one in the family in charge of your grandmother’s finances?

From July 2003 until her death, I was in charge of my grandmother's finances.  At first, I let her handle her own checking account, but I soon discovered that her idea of "balancing the checkbook" was calling the bank every couple of weeks and asking, "What's my balance?"  She would write that in her register and move forward. The impetus for me taking over her checking account came when she had to go to the nursing home for one of her rehab stints.  She had misunderstood the people at DHS and thought she was allowed to have more than a $2000 balance in her checking account and could still qualify for full Medicare/Medicaid assistance for a nursing home stay.  She had just more than $2100 in her checking account, but that was enough to cause a fee of $150 per day for about 5 days until she "spent down" her assets.  After this costly mix-up, she agreed that maybe I should handle her checking account.

Like many seniors in this country, my grandmother worked very hard all of her life, but she never made a lot of money.  She received a meager Social Security income each month that barely covered her food, utilities and medication co-pays. She lived in a home owned by my parents, so she had no mortgage or rent payment. She owned her very old car outright. I wrote checks for her groceries, her weekly hair appointments, and her church tithes.  Somehow, she always had a few dollars left at the end of each month!

The REAL WORK came in making sure that my grandmother was sufficiently covered for Medicare/Medicaid and Medicare Part D, which took a lot of time and was incredibly confusing.  How seniors who do not have an advocate manage this maze of papers and regulations and rigmarole is beyond me!  And don't even get me started on admitting someone to a nursing facility, Assisted Living facility - or even the hospital or Hospice.  The paperwork is astounding. I kept copies of a "cheat sheet" with vital info in my wallet, because it seemed like every other day, I was needing to supply this data to someone for something!  I would just hand them a copy of this information.

Honestly, I don't see a decent way around this.  Perhaps siblings could split the responsibilities financially...but for the most part, one person needs to be handling all of this, so that nothing falls through the cracks.  I think if my sister OR my mother and I had tried to share the management of my grandmother's finances, it would have been even more time consuming and frustrating.


4) You mentioned on Twitter that you were a signer on your grandmother’s account. And you also advised against sharing a bank account with an elder. What made you choose to become a signer? Had you done your research? How did you get informed?

I had to become a signee in order to write checks on my grandmother's account.  As soon as she went into the nursing home and needed an advocate, we signed a card for me to be able to do this.  


5) As a signer what were your privileges on the account?

My name was never on her account...I was merely a "signee." This meant that I could write checks and balance her bank account.  One caveat...when my grandmother died, she had about $130 in her checking account.  I took a death certificate and a copy of my DPOA (Durable Power of Attorney) to the bank and asked to close the account, and they would not allow it.  I was not the "designee" on the account for closing it out.

This is different, apparently, from being the "signee" on a checking account.  I was not designated as the person to close the account - my dad was.  Since he was already dead, the secondary designee was my mother. SHE had to return to the bank with these papers and close the account.  Lesson learned...if you are handling the finances, make sure you are the "designee"...and that you have the proper signatures in place to access a safe deposit box, etc., as well.


6) What approaches did you take with a banking account that worked for you and your family? For example, did you rely on money management tools or software to help you keep track of everything? Or did you choose specific accounts that perhaps offered lower fees?

I did not use specific software...the account was very simple and did not need something like Quickbooks. I did acquire an online banking account, so that I could login and check on things like the auto-drafts and verify that all charges were legitimate and necessary. I would note that I set the account up with my grandmother's name, and one time I locked myself out of the account.  When I called the bank and identified myself, they would not allow me to access the account, because I gave MY name, not hers.  They had to talk to HER for authorization.  She understood NOTHING about online banking...but bless her heart, she authorized me! After that, any time I called on her behalf, I pretended to be "her" on the phone!


7) Did you at any point consider a power of attorney or was that given to someone else in the family?

I was my grandmother's Durable Power of Attorney (DPOA).  This is different from a medical Power of Attorney, which only gives you authority to speak for the person in medical situations. The DPOA is more encompassing. I downloaded a DPOA form online and we signed it and had it notarized. We had to provide copies of this document many times over the years for several different things - applications for assistance, cashing her life insurance policy, and more. I would consider this a vital document to have on hand if you are managing any business activities for a friend or loved one.


8) Emotionally, how difficult was it to handle your grandmother’s finances? How did you manage to juggle those with your family’s?

I probably spent a couple of days a month managing my grandmother's finances. Since she had very little money, there wasn't much to manage. I can see where for someone with substantial assets, this could be quite a lot of work.  The real time consumer was the vast number of papers and forms related to Medicare, Medicaid and Medicare Part D Prescription Drug coverage.  

I cannot begin to calculate the hours I spent on those things. It can be emotionally draining to manage another person's finances while juggling your own family responsibilities.  But all of this is emotionally draining on many levels.  You learn to cope...and hopefully, you have others who can encourage you.  This is why I created the blog...to encourage others and say to them, "See...you're not crazy...look what happened to me!"  Most of the people I hear from say, "These are exactly the things that are happening to ME!" Senior care is universal in many ways.

 
9) Did you make any financial mistakes along the way that perhaps our readers could learn from? (for example overdrafts or missed payments while you tried to learn how to balance it all)

I do think there was an overdraft once when I paid a bill a day or two before my grandmother's Social Security deposit was made. It seems like the fee was about $30...which I paid out of my personal account. I know that never happened again! I don't think my grandmother ever knew about the overdraft.


10) What advice would you have (emotionally and financially) for anyone who has recently become a member of the Sandwich Generation?

You are not alone.  That may not help, but perhaps knowing that there ARE people who are willing and able to offer support will be comforting. Depending on the age of your senior and the circumstances, I would strongly encourage the investigation of long term care insurance.

I know families who have scraped together funds to pay for the care of a loved one who MUST move to an assisted living or skilled care facility.  The cost can be anywhere from $3000 per month and up...and that is just for the facility. 

If you go through the posts on this blog you will see that I have outlined the "extra expenses" that might be incurred...and they add up in a hurry!  No one wants to be in the position of telling Grandma she can't have her hair and nails done every week - or any other "extras" - because there is no money.  And most people don't want to have to liquidate every asset their loved one has in order to pay for nursing home care.


11) Do you have a contact that you met in the blogging community or a friend who may have more to say on this subject? I would gladly appreciate an introduction. 

I do not have anyone to recommend; however, my mother wrote a book about HER experience with HER parents and the nursing home…When Heads and Hearts Collide.   I HIGHLY recommend this book to anyone who has been charged with the care of a senior citizen.  It’s only $10 postage paid, and you can order with PayPal directly the sidebar on this blog.
 
Because of the things I experienced through all of this, I also wrote a book...What to Say and Do...When You Don't Know What to Say and Do. This book can also be purchased via the sidebar on this blog.

If YOU have questions...or a particular issue...that you would like to see addressed on this blog, please contact me.  We are all in this together, and as time permits, I will gladly address any and all inquiries and comments.  Hang in there!

Constructive Conversations - How to Talk With Your Senior

Over and again, I hear people say, "I just don't know how to talk to my mom/dad/grandparent/elderly loved one anymore."  Popular conversations with seniors center on their health concerns and physical ailments - and/or the ills of others in their circle.  Other common topics include the weather...death and dying...money and/or inheritance...feeling alone and neglected...and bowel movements. I get it!  If you rehash these same topics every week with your loved one, you may be reaching the end of your rope!

So what can we do?  One solution is to re-set the conversation pattern...to divert attention and distract with other topics that are more pleasant/interesting.  This can be done without insulting your loved one, and yes...you will have to listen to a fair amount of talk about a sore hip or how Aunt Susie can't hear a word that is said.  But you can often make some subtle shifts in the conversation topics that make the difference between a pleasant phone call/visit and one that leaves you needing a stiff drink!

When my husband's family gathers at his mother's house, the conversation runs along some pretty predictable lines.  We go through all of the grandchildren and what is happening with their schools and extracurricular activities.  We talk about any "news" from relatives who live out of state. And then, the discussion generally turns to stories about people most of us don't know, as one relative or another relates things that are happening in their own lives with their circle of friends and acquaintances.

While this conversation might be mildly interesting to my 90-year-old mother-in-law for a little bit, it doesn't hold her attention very long.  And frankly, it's not all that fair to her.  When we visit, SHE should be the center of attention.  So my husband tries to get his mother to talk about her childhood...her parents, grandparents and siblings...life on the farm in Iowa...living in a boarding house in Iowa City while attending high school...his dad's stint in the Navy...and pets they owned as kids, to name a few topics.

My mother-in-law's memory for things that happened a long time ago is fantastic.  She can recall dates and details...and it's like she is transported back in time - and takes us with her!  This is good for her...and good for us and the grandchildren and great-grands!

When my grandmother was still living and able to talk, I would call her a couple of times a week or more.  I also spent most of the day on Fridays with her going to the beauty shop, grocery shopping, and running any other errands that arose.  So there were chances for conversation by phone, in the car as we traveled, and sitting in waiting rooms at doctor's offices more. 

Generally, I would try to tell her all of the cute things that the children had said and done.  As we would travel out of town to doctor visits, Greg would ask her questions about the area, and she would point out locations that triggered a recollection, such as "I picked many a strawberry in that field," or "That's where old Uncle Matt and his family lived," or "We lived there when I was about 12, and we would walk several miles to school and "singings" at church."  She enjoyed the trip down "Memory Lane," and we learned a lot about my grandmother's childhood. Once my grandmother lost most of her ability to speak, "conversing" with her was truly a challenge. So I would try to think of "news" to share with her when we visited.  Again, cute stories about the little ones were always a hit.  I avoided talk of people she knew who might be doing fun/exciting things -like "I saw Ruby at the swimming pool last week"...and word of the ailments and infirmities of others.  On the phone, I always tried to steer clear of questions like "What's new?" or "How are you today?"  She would tell me anyway, but if I could keep the conversation going in another direction, there was less chance of the tone taking an unpleasant turn.  I tried to think of a few things to tell her - or ask - before I ever picked phone.

The thing that always seemed to be a big hit with my grandmother was my sewing.  My Mam-ma was an amazing seamstress and quilter.  So I would take the little garments I made for my nephews, nieces and cousins and show them to Mam-ma. She would finger the stitches and ruffles and smile brightly.  Her eyes would grow wide with joy and pride...and she would gesture that she remembered when SHE used to do this sort of thing.  In fact, I would say, "I don't know how you managed to make those tiny Barbie dresses for my sister and me."  And she would beam with pride.

We also talked about birds that gathered at her feeder outside the window - and birds that I had seen at our house...dishes that I had made - especially with her recipes...and Greg's latest projects.  My grandmother was always interested in what the men were doing...and this line of talk opened the door to remember my grandfather and dad and the work that they did.

My grandparents are all gone now...as are my parents. I think about the conversations we shared, and talks I have now with my mother-in-law and other elderly loved ones.  And I've come up with some thoughts and suggestions that might be helpful...

• You don't have to call EVERY DAY.  My pastor told me once that "'No!' is a complete sentence!"  He was absolutely right.  For all of my grandmother's talk that "I haven't seen a soul in days," there was a virtual "revolving door" of visitors at her house/apartment on any given day.  I saw her on Fridays - and often through the week.  There was no need to call her EVERY DAY...until the time came when we had to call each day to make sure she took her medicine.  And then, the conversation was brief and generally directed toward said question.
• Think of a few things to discuss/ask BEFORE you call or visit.  If possible, take a photo or memento to discuss when you visit.  I recently spent some time with an elderly cousin and took some pictures of my great-grandmother and her contemporaries, in hopes that she could identify those in the photographs.  This sparked a really fun conversation about "old times" and gave us something to discuss.  I also took her cookies from the recipes of my grandmother and the woman's next-door neighbor.  This was another starting point for a good conversation about recipes and cooking.
• Be prepared to listen to your loved one's litany of ailments and complaints...but set a mental time limit.  Use your pre-planned questions/activities as a way to steer the conversation in a different direction.
• Don't be afraid to simply sit in silence.  Some of my best "conversations" with my Mam-ma Polly were times we sat in silence on the front porch at her Assisted Living Facility and rocked in the sunshine.  We watched people come and go...we looked at the clouds and felt the warm breeze...and we were together...and that was all she needed.
• Don't be afraid to call and say, "I just have a minute, but I was thinking of you and wanted you to know."  Every conversation doesn't have to be lengthy...and probably shouldn't be!
• Shift your attitude.  I remember how much I dreaded the phone calls.  I knew that I would get an earful.  But once I developed a "game plan," and mentally prepared myself NOT to get frustrated or upset, everything went much better.  Yes, there were days when I hung up the phone, shook my head and laughed at some of the things that were said.  But that was better than wringing my hands and gritting my teeth! (And yes, there were still days when this happened, regardless of what I said/did.)

The bottom line is that this, too, shall pass.  And you will long for your loved one's voice - even if it is to chastise you that "you don't do enough for me," or "I haven't been to the bathroom in three days."  We never want to disrespect our elders or make them feel like their thoughts and feelings are not important.  Sometimes, we have to simply listen to them talk.  But that doesn't mean we can't at least have a plan to steer things in another direction.  The end result might just be that the phone calls and visits become more pleasant.

If you have questions or comments, I would LOVE to hear from you. Please weigh in, and let's start a conversation!

I Can Still See "Them Eyes!"

He's here... our newest great-nephew, Nathan Daniel, arrived Friday morning.  All 6 pounds 13 ounces of his 18-inch body are perfect!  He will be a wonderful little brother for Timothy and Zola... and all three children will surely be a challenge for their young mother!  I can't wait to meet him and have some snuggle time - hopefully by the end of this month!

Friday afternoon, I visited Mam-ma Polly at the ALF.  I had not been to see her since the previous Sunday, although I knew that my mom had been there mid-week for a visit, and all reports were that she was doing remarkably well.  Mam-ma was sound asleep when I arrived, so I tip-toed around a while... and honestly, I considered not even waking her.  But I had brought her a picture of Nathan that I printed out all nice and big, and it HAD been a while since my last visit.  So I did a few things in her room until she woke up.  She was THRILLED with the picture and said, "Sit me up."  I did, and then she wanted to GET up and sit in her wheelchair.  The aides, Debbie and Kay, came and helped her, and they oohed and ahhed at the picture.  Dr. Smith was there making rounds, and Mam-ma said he had seen her that morning... and had very little to say.

Dr. Smith passed Mam-ma's apartment doorway and saw us, and he ventured in and told me everything was good, and he didn't change a thing.  He thinks "we are doing very well" and "hanging on..."  He commented about the picture, and I thought everything was great... until I got up to leave. 

I hugged Mam-ma and started to leave her apartment, and she grabbed my arm and began to frown. Then she heaved a big sigh and started to breathe heavily, and she said, "Well, I forgot to tell you..." and she couldn't get it out, and I waited and waited... and finally she said, "Well, them big eyes..."  I said, "Yeah?"  She said, "Oh... them eyes... they just haunt me."  I asked, "Whose eyes?"  She said, "That man!  I woke up and all I could see was them big eyes."  I asked, "You woke up and saw a man's eyes?"  "Yes!"  "When did this happen?"  "A few nights ago."  "Who was it?"  She tried and tried to think of the man's name, but she couldn't.  I asked was it someone she knew?  Yes.  Was it her deacon?  NO!  Was it someone who lived at Southridge?  Yes. 

By this time she was crying - and she even had a few tears in her eyes.  She said, "I was so scared."  I told her, "If that ever happens again, press your button.  Is that what you did the other night?"  She said, "No!"  I asked her what she did, and she said, "Well... I screamed!"  She said an aide came in and sat with her "a right smart while" (one of her favorite sayings).

I assured her that it was okay... and that I would ask around - that no one had mentioned it to me.  I told her "Good-bye," and went to find the aides.  They were unaware of this incident.  The nurse was also unaware.  The administrator had not heard about this and said none of her male residents roam or go into other people's rooms... that they are all "with it" more than that.  We both agreed it could be something Mam-ma cooked up because I was leaving - everything had been fine up to that point.

BUT... when I got back down the hallway, Mam-ma was out at nurse's office, and she was trying to tell Peggy, the nurse, this story.  Kay came along, and sweetly she said, "Oh, you know, lots of the little ladies see men in their rooms.  One lady has a man who comes all the way from Mississippi."  We again assured Mam-ma that no one was coming her room - that the aides and Peggy would keep their eyes open... it would be fine.  She was NOT convinced. 

I  once again said "Good-bye" and left.  I got out in the parking lot and remembered that Mom had told me the other day that the aides thought Mam-ma was confused... and the week-day nurse had ordered a urinalysis, just in case.  So I went back and told Peggy about the UA and the aides thinking Mam-ma was really confused, and maybe that was it... maybe this happened when she took her nap. 

We were talking in the doorway, and I heard Mam-ma's very clear and strong voice from down the hallway... "Debbie!"  I turned around, and she was right at her apartment doorway, and she raised her hand and pointed her finger and said, "Plank*!  His name is Plank!"  Peggy and Debbie said, "Oh... Mr. Plank!  We know him... he wouldn't go in her room."  Mam-ma insisted that he did. 
Then Debbie remembered that when she put Mam-ma down for her nap, she said, "Ms. Polly, you need to get some sleep," and Mam-ma said, "I don't know if I can... I keep seein' them eyes."  Debbie didn't know what she was talking about.  Peggy tried to explain to Mam-ma that dreams could be vivid... she had waked from a dream and thought it was real more than once.  Mam-ma was adamant - and agitated - that this was NOT a dream... Mr. Plank was in her room leaning over her bed - and now it was "night before last." 

So I assured her again that nobody was coming in her room - the aides and Peggy would be watching.  I finally went in her room and coaxed her back inside to drink a Coke.  I put a straw in a can  of Coke and handed it to her and said, "Drink this and look at the picture of the baby, and that will perk you up."  She took a big swig and said, "Well, now I have to go to the bathroom."  I made sure her call button was punched, and I told her "Good-bye" yet again... and left.

So I just don't know... Peggy was insistent that Mr. Plank would never do this... but how would Mam-ma know this man's name?  And yet, I know she was not confused earlier... and why would this happen just as I left?  It's all so convoluted...and disturbing.  I had to think about her so adamantly accusing one of her favorite aides a few weeks ago of bruising her arms. Is this a new "thing" with Mam-ma now... to imagine that people are doing things?  I am so sorry I woke her!

I called my sister and warned her... and I told her I wonder if I need to pursue this more... or if I should let it ride for now.  She said to let it ride... so that's what I will do.  I just felt she needed to know what had transpired before she went in for her night shift as an aide at the ALF.  Hopefully it's over with and Mam-ma will not mention it.  Time will tell.  I really thought Mam-ma was doing so well when I first arrived... but maybe not.  Suzanne did not even seem to know who Mr. Plank is.  It did throw me when I found out he really exists... but as my husband and Peggy both suggested, she probably had a nightmare... and he was in it!

My mother tried to console me by telling me that my maternal grandmother imagined things... she insisted that the nursing home staff where she resided were dressing rats and seating them in the dining room for meals. She was sure of it - she had seen them!  But what threw me the most was how quickly my grandmother spun from being really well and mentally clear to being totally upset and confused.  I seriously wonder if she was having a TIA... and we will never know for sure.  My mom encouraged me to put it out of my mind.  I am trying.

Hopefully it is all forgotten and Mam-ma will not mention it again.  Time will tell. I have seriously dreaded my last few visits.  It seems to always be something... ranging from mildly irritating to downright bizarre.  One thing is for sure... I can't say the visits are ever dull and uneventful... and that is not necessarily a good thing. I am hoping for a calm and peaceful week.  I will print out a couple more pictures of Nathan for Mam-ma to enjoy.  Maybe that will get her mind on something more pleasant - at least for a little while.

*Name has been changed.

You Messed With The Wrong Bulldog!

Every six months, my grandmother visits her cardiologist.  Every three months, her pacemaker is checked by nurses who visit our local hospital.  In between THOSE visits, her pacemaker is checked by telephone, using a device she keeps at her apartment. The "heart clinic" has always sent letters to remind us of appointments... and they were sent to my address.  This worked great, because I could make notes in my calendar - and on Mam-ma's. They also called the day before to remind us of the appointments.  The only "fly in this ointment" was when the tech mistakenly called my house a few times for the telephone check, and I had to explain that he was to call my grandmother at her apartment instead.

This "system" worked fairly well... until December 2011.  Mam-ma was scheduled for an appointment with her cardiologist on December 14th - at our local hospital, where he maintains an out-patient clinic.  Since Mam-ma was hospitalized from Dec. 6-12, I telephoned the clinic nurse and told her that I was not going to bring Mam-ma back to the hospital for an exam on the 14th.  In fact, when I talked with the  nurse, I wasn't even sure that Mam-ma would be discharged from the hospital by the 14th, and we agreed that the doctor could walk upstairs and see her, should she still be a patient.

On December 15, a nurse spoke with me by telephone and said, "If we can't get your grandmother to the hospital, let's at least do a telephone check of her pacemaker."  I agreed to this, and I got the nurse at the ALF to help Mam-ma get her device out of the drawer and hook it all up at the appointed time.  The call to check the pacemaker never came.  When I made some calls to inquire, a tech said, "Oh, I saw that on the schedule... and her scheduled appointment on the 14th, and I decided that since she had just seen the doctor, this must be a mistake - so I didn't call."

We rescheduled my grandmother for a visit to the cardiologist in January, and as I described in a previous post, the "heart clinic" notified the ALF instead of me, for some reason, and when I went to get my grandmother for her appointment, she had already been transported to the hospital with another resident - an hour early, so they could ride together.  I arrived at the hospital and thought I got it all straightened out... all correspondence was to come to me... the phone calls for pacemaker checks went to Mam-ma at her apartment.

So a couple of weeks ago, I was looking for something in Mam-ma's apartment that she insisted was "stolen" (a recurring theme with her these days), and I discovered TWO letters notifying Mam-ma of upcoming appointments... one for a telephone check of her pacemaker, and another for an in-person check.  I noted the dates on Mam-ma's calendar, then brought the letters home and made notes on my calendar.  On the day we were to have the phone check (January 26th), I arrived at Mam-ma's apartment 30 minutes early, got her all hooked up to the machine... and the phone call never came.  I made several calls to nurses/techs/the clinic itself, and I could never get anyone in person.  I left many messages... to date, no one has returned my phone calls.

I let the ALF know that we had an upcoming appointment for an in-person pacemaker check, and that I would personally take Mam-ma, because I wanted to try to straighten out this confusion. Yesterday was "the day."  Bless her heart, Mam-ma has been so excited about "seeing the doctor" that she has called me nearly every day for over a week... "Is today the day?  Aren't you coming to get me?  I'm dressed and ready!"  "No, Mam-ma... it's NEXT week.  I'll let you know in plenty of time."  I didn't even address with her that we were not seeing a doctor... this was an "in-and-out" pacemaker check.

I did not get any phone call the day before to remind me of the appointment, and I wondered as I drove to the ALF... "Will we get to the clinic and discover that the appointment was cancelled?"  Mam-ma was dressed and ready - hair combed, lipstick applied - she looked like a million bucks and was clearly excited.  It was a cold, raw, rainy day, but she was not deterred.  So we drove to the hospital for the appointment.

We waited only a few minutes in the waiting area before a very sweet nurse ushered us back to an exam room.  She attached the electrodes to Mam-ma's chest as I explained that we had a mix-up about who to contact.  She looked on her computer and discovered that the ALF was the "point of contact" - both address and phone number. I was listed as an "emergency number."  We were in the middle of changing all of this, when another nurse entered the room.  She heard me say to Nurse #1, "I spoke with someone named XYZ, but she never called me back."  Nurse #2 said, "I'm XYZ... and I did call!  I spoke with someone yesterday."  I asked who she spoke with, and she glanced at the computer screen and said, "It was you... I recognize the name."  "No, you didn't speak with me," I replied, "and my husband would have told me if you had phoned our house."  "I know I talked with you," she replied, her voice getting louder and more agitated... "we'll just look in the computer... I make notes on everything.  But I know I called you... I always return phone calls."

The other nurse completed the pacemaker check and changing the info in the computer.  My little grandmother sat quietly in her chair.  I tried to nicely explain to Nurse #2 that we had had three appointments since the first of December... and all of the notifications had gone to the ALF and caused major confusion... and two of the appointments never materialized.  She was still insisting, "I called you, I know I did."  Then she got her computer screen up, and she said, "HERE... I called you... December 15th... I KNEW I called you."

I just looked at her, and said, "You very well may have called me on December 15th, but we are talking about YESTERDAY!  We've had three appointments since that date."  "But you agree... I did call you, right?  Because I always return phone calls," she insisted  I just laughed and told her, "We were talking about yesterday - and January 26th, when the tech never phoned for a pacemaker check and no one returned my calls.  Yes, I probably did talk to you on December 15th, but we're talking about who was called yesterday."  Then she looked at Nurse #1 and said rather curtly, "You need to go ahead and complete the exam... we can work this out later...we have other patients waiting!"

Nurse #2 turned to me and said, "I can tell that you are upset... and I am upset that YOU are upset!"  I told her, "I am not upset... I just want to get the notifications, because my grandmother cannot read her mail nor remember to give it to me, and the ALF does not let me know when you call them about appointments - they just handle them, and that's causing confusion."  I felt like I was in a bad dream... or a three-ring circus.  FINALLY, Nurse #1 sweetly said, "I think the problem is that somehow the ALF got on the records as the point of contact.  I've changed that to your information, and deleted the ALF, so we should be all set."  I smiled and thanked her for all of her help.

Nurse #2 was still insisting that she always returns phone calls, and I did not call her.  I opened the call log on my phone for January 26th, and we went through the numbers... both nurses said none of them belonged to Nurse #2.  However, she gave me her number and said, "If this ever happens again, call me, and I will personally do the telephone check."  I entered her number into my phone.

I turned to Nurse #1 and inquired about the pacemaker check, which was why we were there.  She told me all was well, and the battery was good for another 3+ years.  She then said to Mam-ma, "You are lucky to have someone who cares so much about you.  Most people just let the facility handle these things, and we never see a family member."  Mam-ma nodded.  Nurse #1 turned to me and said, "You are sweet to care so much for your grandmother."  "She's worth it," I replied... "and I know you two think I am something of a bulldog, but I have to stay on top of this."  They assured me they didn't feel that way, and Nurse #2 even gave me a hug and said, "I'm sorry for upsetting you."  I told her again that she did NOT upset me... and I was sorry if I had confused her about the phone dates.

The bottom line is that we hopefully have this all straight now... and Nurse #2 must have been having a very bad day.  She burst into the room, got into the middle of a conversation, and went ballistic.  I thought I might need a pacemaker before it was all said and done!  I have a sneaking suspicion that she reacted as she did because this has happened before... and she was clearly defensive.  If there had not been such a pattern of ineptness in the first place, there would have been no need for such a confrontation.

Oh... and the telephone check on January 26th that never happened?  The "notes" showed that the tech DID phone the ALF later that afternoon and "rescheduled" for 2:00 p.m.  When he phoned at 2:00 p.m., the notes say the nurse told him that there was a staff meeting, and nobody was available to help Mam-ma with the test.  All of this was news to me. I didn't mention this to the nurse at the ALF... it wasn't her fault, and I'm sure that they do handle this sort of thing regularly for many of their patients.  The point is... we were there at 11:00 a.m. for an 11:30 telephone appointment that never happened, which is on the "heart clinic" staff, not the ALF nurses!

On the upside, Mam-ma was thrilled and told the aides at the ALF that she had had a good "doctor visit," and that "he just wants to see me ever once in a while!"  I went to her mailbox and retrieved mail that had accumulated there for several days, including several Valentines.  I made a mental note to check her mail more clearly ... and hopefully this won't be an issue again for awhile.

I share all of this to demonstrate, sadly, just how convoluted things can get when it comes to medical care and paperwork...and managing the care of loved ones - especially the elderly.  There is no reason this has to be so complicated... but my grandmother can no longer manage any of this, so someone has to advocate for her... and that "someone" is ME!  As a nurse friend at the hospital told me back in December, "You are her only advocate, and do not apologize... if you don't see about these things, nobody will."  My friend who is the hospital administrator disagrees with this comment, because he says "Hopefully we are doing a good job of advocating for our patients."  But I am here to tell you... things fall through the cracks left and right... it's simply a fact.  And we know your loved ones better than the doctors and nurses.  So it's OUR JOB to stay on top of things.  And it we have to be a bulldog to get the job done, so be it!