Catching Up...

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

The cousins stayed all weekend, going home Sunday sometime.  Monday, I checked on Mam-ma, and she seemed fine... of course, she said, "I'm really not tired at all."  Not thirty minutes later, she called me again and said, "You or Greg needs to come get my teeth.  They just broke in two when I tried to eat my dinner."  I called my husband, who was out delivering Meals on Wheels, and he went to Mam-ma's, got her teeth, and took them to the dentist.

Monday night, Mam-ma still didn't have her teeth.  We surmised the dentist had sent them out to a dental lab for repair, as Mam-ma said they snapped into two pieces.  I asked her if she had any canned cream soups she could fix for supper.  She said, "Yeah, I've got soup, but I have to thaw it."  I said, "No, I meant a can of cream soup - like cream of tomato, cream of chicken... don't you have something like that?"  She replied, "Yeah, but the soup in the freezer is vegetable."  Vegetable soup is one of her favorite meals.  I just quietly asked, "Well, Polly... how do you plan to chew vegetable soup with no teeth?"  She started to laugh... "I don't know," she giggled.  In the end, she had cream of chicken soup, crackers, and applesauce.

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

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

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

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

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

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

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

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

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

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

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

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

Hard Choices

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

Meanwhile, my grandmother's friend Ruby has not improved as much, and a subsequent trip to visit her family physician revealed that she cracked two or three ribs.  The doctor increased her pain medication and told her it could take as much as six weeks or more for the ribs to heal.  She is, understandably, very upset and discouraged.

Once my voice returned a little, I made the visit to our local assisted living campus to determine what our options were and what might be possible for my grandmother.  The administrator told me almost immediately that the facility had enacted a new policy the previous week, and now all Medicaid-subsidized rooms cost an additional $500 per month, paid by the client or his/her family.  I was dumbfounded and told her I felt there was no way this could work for us.  I had been told that the facility would accept whatever Medicaid would pay, based on my grandmother's "Tier assignment" - plus the difference up to $2600 for a suite or $3000 for an apartment.  I was thinking we could make this work for the "suite" with her monthly Social Security income.  I have to admit, I was pretty devastated.  I explained to the administrator that I was concerned for my grandmother's safety and well-being in her home, but she was not yet ready for the nursing home.

After talking a little more, I learned there are other options.  First the administrator asked me some questions about my grandmother:

• could she feed herself (yes)
• could she transfer herself from bed to chair (yes - we're talking a woman who still walks around the block in her neighborhood most days)
• could she handle her own medications (only with help - I dispense them and we prompt her by phone twice daily to take them)
• could she bathe herself (no - she has Home Health aides who assist with this)
• could she remember where she was from one day to the next (yes)

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

I explained again that my grandmother had no extra money to pay the $500 per month, and while we could pay that for her ... what did people do who couldn't?  It didn't make sense to think Medicaid would pay for her to move in across the street at the skilled nursing center (nursing home) and be fully covered for services she really doesn't need ... yet she could not get the same coverage at the assisted living facility.

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

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

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

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

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

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


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

• the hairdresser
• cokes, cookies, candy, etc.
• medications not covered by Medicare Part D - her anti-anxiety medicine, Tylenol, vitamin B-12 injections, cough syrup, skin creams, etc.
• toiletries, makeup, etc.
• "spending money"
• her tithe to the church
• magazine subscriptions, bird seed, and more

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

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

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

So we decided to sign my grandmother up for Meals on Wheels and do what we could to curtail her cooking.  We asked my mom to speak to people from church and ask them not to bring garden vegetables, peanuts and corn syrup for peanut brittle, and other things for Mam-ma to cook.  We asked her neighbor, Merrellyn, to call us if Mam-ma came along and asked her to provide any assistance that seemed a little questionable - like a ride to the store or to Ruby's.  We figure that now that Ruby is unable to drive, Mam-ma will start searching for other "drivers" to take her places ... and we know she is not above asking!

We also agreed to check on her more often - to keep a little closer tabs on her activities and try to head off some of her antics.  So I called the Senior Citizens Center and signed Mam-ma up for Meals on Wheels.  The director will have to make a home visit and "interview" her, which is a formality, because she already knows Mam-ma well.  The meals should begin sometime this week, and Mam-ma will get a hot meal each weekday, plus two frozen meals on Friday that she can pop in the microwave over the weekend.  All of this is accomplished for a "donation" of $2 per day ... a BARGAIN!

On Friday, I went to get Mam-ma for her beauty shop appointment, and I went early to talk with her about the meals.  Meanwhile, my mom was phoning the church members, and all of them were 100% on board with what we are doing and in total agreement the time has come for some changes.

Mam-ma told me almost instantly that her digestion was upset, and she was not eating right.  I said, "That's something I want to talk about with you."  I explained that I had signed her up for Meals on Wheels, and they would be starting soon.  She grumbled, and I told her, "You just got through telling me that you are not eating right.  This will be a hot, balanced meal every day - and even a couple for the weekend that you can pop into the microwave."  I continued to explain that several incidents lately had caused us to really become concerned ... the two times I know of she left her stove burners turned on with no flame ... my mother-in-law's sudden failing health ... Ruby's fall and subsequent decline ... and I didn't even mention the episodes of confusion and forgetfulness and her barging into someone else's home. 

I told Mam-ma that I would rather she not use her stove as much.  She glared at me.  "But I love to cook," she said.  "I know you do," I replied, "but I am concerned about you hurting yourself or burning down the kitchen." We went back and forth, and I told her, "I am not saying that you can never use your stove.  Maybe on Tuesdays when your housekeeper is here, you could bake a cake or a pan of cornbread.  Or if you feel you just have to cook something, call me, and if I can make time to come over, I will." 

I knew what was coming next... "What am I going to do with all that food in my 'deep freeze'?"  I told her I had already considered that, and I planned to start having some "family dinners" at our house, and I could use that food in preparing some of the meals.  Then she mentioned cake mixes in the cabinet and other food, and I said, "You can come to my house early and bake a cake for the family dinner.  Don't worry about the extra food - we'll figure it out."

Then I brooched the biggie ... I told her I did not want her to make any more peanut brittle. I explained that I knew she had done it for years and could make the candy in her sleep, but she was just too shaky, even with supervision, to handle that molten candy safely any longer. She sat and stared a hole in me ... completely silent for almost a minute. Then she began to cry. "You just don't understand."

I told her I did understand that this is hard, and she said, "NO!  You DON'T!  I've always cooked and took care of myself.  I've always done what I pleased when I pleased."  And I pointed out ... "and you've had a good run of it for 98 years.  But we are trying to keep you in your own home and out of the nursing home or assisted living."  She replied, "Well, I've thought several times that maybe I should just go to the assisted living." 

So I explained what the options were there - a room about the size of her living room, with very little space for her "stuff."  I pointed out all of the good things, and I told her, "Whenever you are ready, just say the word.  The administrator called me back after I visited, and she says they can have a room for you next week."  But then I went on to tell her that we don't feel that she is ready for such a major change... and if she will cooperate and get the Meals on Wheels and stop using her stove unattended, we feel she can continue to live at home on her own for now.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Are Home Health Care Agencies the Next Business "Bubble?"

Ads for Home Health Care agencies are all over the Classifieds sections of local newspapers these days. Not only are these businesses wanting you to hire their caregivers to assist you our your loved one at home, they want YOU to work for them! Suddenly, the market for Certified Nurses' Aides (CNAs) is huge, and training sessions are springing up everywhere to prepare those who wish to enter the workforce in this capacity.

This is good news, right? With so many people out of work, hasn't the boom in this market has come at a great time? The answer is both "Yes" and "No." CNAs can make between $7 and $10 or more an hour, working in nursing homes, assisted living facilities, and private homes. But not everyone is suited for this work. And therein lies one of the "rubs." Working as a nurses' aide is not glamorous, by a long shot. It is hard work, with lots of heavy lifting and sometimes unpleasant duties. While there are situations where CNAs care for delightful patients who are a daily joy, CNAs often clean some big bottoms and deal with every bodily fluid imaginable. Patients who are suffering from dementia may be violent, or at best, unpleasant and unruly. Facilities are notoriously understaffed, so a CNA may be in charge of the care of well over a dozen patients during a shift.

There are those who become CNAs because they truly enjoy the work... and/or, like my niece, they are working toward a nursing degree, and this job is great experience and helps pay the bills. For countless others, this is "just a job." The difference between "just a job" flipping burgers at McDonald's or stocking shelves at Wal-Mart and being a CNA is that CNAs are caring for someone's parents or grandparents. And let's be honest, we all want our loved ones cared for as well as possible. Should we come to a point where we need extra in-home care for Grandma or Poppa... or worse, they require nursing home care... we expect high-quality treatment. So we want CNAs who are working with our loved ones because they WANT to be there and enjoy caring for them... not those who needed a job and this one paid best. And we don't want this care managed by a company that is impersonal and cares more about the "bottom line" than the quality of services rendered.

While there ARE legitimate, well-run, caring businesses opening to provide caregiving services, particularly home health care, this business trend also shows signs of becoming the next "bubble." Our population is aging rapidly, and as baby boomers begin to get their AARP cards and enter the world of senior discounts, Medicare, and retirement villages, all sorts of markets are developing to meet their needs. And high on the list in the years ahead will be services and care that can allow seniors to continue to live in safety and good health within their own homes.

This trend has not escaped the notice of entrepreneurs who see an opportunity to start a new business venture and, hopefully, make a nice chunk of change. So we see Bob leave the real estate company where he was an agent to start a Home Health Care agency. He gets all of the requisite permits and hires a dozen or so CNAs to represent him and actually do the work while he manages the office. Sounds simple enough, right? Maybe... but this situation is ripe with opportunity for misstep.

A person with a good business "sense" and organizational skills may very well be able to surround himself/herself with qualified people who will "make the company look good." But suppose Bob doesn't have a Registered Nurse on staff or the consultation services of other qualified medical personnel. Who will check on the CNAs in the field to ensure that their work is appropriate, caring, and meets standards and guidelines for quality care? Will Bob have the knowledge and skills necessary to comply with all insurance regulations, bill clients fairly, and troubleshoot problems? Will Bob be genuinely concerned with providing quality care for his clients at a fair rate? Or will he charge $25 an hour, pay his aides minimum wage, and pocket the difference? Will the aides who work for Bob be experienced, caring, professional assistants? Or will they view their work as an hourly wage position that requires showing up, doing the least that has to be done, and collecting a paycheck to feed their family?

Do not misunderstand me. I am a huge proponent of home health care. Without this service, my 97-year-old grandmother would have been placed in a nursing home more than a decade ago, and I am quite sure she would not be alive today. Quality home health care is invaluable, and my grandmother has wonderful, caring, professional CNAs who see to her needs several days per week. Her aides work for an agency managed through our county health department, and Medicare pays for their services. Sadly, the aides do not get as much of the hourly rate paid by Medicare as I feel appropriate, but that is another debate completely. My grandmother's care also includes frequent visits by registered nurses who assess her health in-depth, administer necessary injections (B-12, flu, etc.), and notify her doctor when anything seems amiss with her physical well-being.

A private-care franchised Home Health Care company recently opened for business in my community, and all reports indicate that qualified, caring CNAs on staff are providing excellent care to local residents. The fee is $15 an hour. I have no idea how much of that is paid to the caregiver and how much the business pockets, but at such a low hourly rate, neither can be getting rich. But I am happy to hear that those in our community who need this service now have another option.

So what are we to do? When we find ourselves needing home health care... either personally or for a loved one... where do we turn? Here are some questions to ask potential Home Health Care provider companies as a starting point...

1. How long has the company been in business?
   
2. What is the owner/manager's background for operating such a business? Does this person have personal experience with Home Health Care?


3. Is this person a Certified Nurses' Aide and/or a Registered Nurse? Does the owner/manager have other medical background?
   
4. How large is the staff? What are the qualifications of the staff? Is everyone certified? Does the staff include nurses and other medical personnel? Is everyone properly certified and licensed?


5. What are the rates for services? Are staff members adequately compensated? Is experience and good job performance rewarded?


6. Are references available? Can current clients be contacted for feedback?


7. What is the mission statement of the company? Is the goal of the business to service its clients with utmost quality and care, or did this simply seem like a good new business arena to enter?

The Home Health Care business is just one of many that will "ride the bubble" of meeting the needs of an aging population. Others will surely follow... and this is a good thing. But we must be diligent in ensuring that our goods and services are worthy of our hard-earned dollars... and that our needs, and those of our loved ones, are met with care and professionalism. Home Health Care may indeed be a "business bubble," but it appears to be a service that is here to stay. How well these services are delivered will be mandated in large part by the recipients. Over time, we can hope that the cream will rise to the crop, and those wishing to merely make a quick buck will fall by the wayside.