Friday, February 20, 2009

My Eulogy to Mom

I've always said that you never really know someone until death or divorce. That has been confirmed once again. I know my mother, but she exhibited even greater strength, love and grace in these past days than I have ever seen before in her.

Sister and I have always known how special our Mom is -- and as Daddy always said, "Nothing good comes easy". Well, Mary P. was good but she sure didn't come easy. You had to be tough, soulful, have a good sense of humor, be submissive or very tolerant to be able to truly appreciate just who "Mary P." was inside.

She was beautiful -- and beauty is about the best thing that God creates. She was candid, she was "in charge", she was smart, she was brutally honest and Lord knows, she was strong. "She is a strong spirit" as one good nurse said to us.

My Boss sent me a quote on Feb 17th from Hermann Broch that describes so well the impact of Mom's passing:
No one's death comes to pass without making some impression, and those close to the deceased inherit part of the liberated soul and become richer in their humanness.

These past few months Sister and I have both witnessed times when we SAW Daddy melded into Mom. A friend of mine said maybe that was Daddy's way of helping Mom. We know Daddy alerted us that this process was beginning and I'm sure he's been with us and her throughout this process.

These past weeks -- and in some instances, in this past year -- we have seen parts of Mom's personality and character appearing in each of us. Confirming that quote and ensuring that her personality and character will live on -- with us -- forever.

Mom touched so many lives and many are here -- physically or in spirit -- and I believe that speaks volumes about a person's heart and soul.

The last words I heard her speak -- her last instructions to all she cared for:

I love you too. You all be careful.

Tuesday, February 17, 2009

It is Over

Mom passed away peacefully in a hospital hospice room at 3am February 17th, 2009.

End of Blog

Saturday, February 14, 2009

Nothing is Easy

Yesterday was like an emotional rollercoaster where every dip just fed our stress levels. Each day it seems you wake up and think "this should be a quiet or normal day" -- well, that always ends up being a fleeting thought.

Yesterday started by Sister receiving forms from the rehab -- requiring signature -- stating that Mom's nursing and therapy end on the 17th. Attached was the written assessment from the clinical psychologist. This assessment confirmed that Mom has "senile dementia" and definitely needs to be moved to a memory support facility AND she has severe depression. We won't go into the whole fiasco regarding the antidepressant medication we were told she began January 16th! Bless her heart! The assessment did make me cry when I read that Mom told the clinical psych FOUR times that she "doesn't want to be a burden to her daughters -- doesn't want to mess up their jobs". BLESS HER HEART!

So, we begin panic about getting things resolved at TNF. Now the woman working on that end has been FABULOUS! We owe her so much as I think she spent most all of her week working on Mom's stuff! She worked so hard -- financial approval, physical for Mom, lining up their nurses to assess Mom, etc.

So, we received word from TNF, that we were approved financially. Now their nurses were reviewing all the documentation from the rehab on Mom.

Well, guess what the doctor at the rehab checked the "NO" box to the question of whether the patient has significant cognitive impairment! Well that clearly goes against the clinical psychologists assessment. Then the doctor left one of the last questions blank. The form has to be correct! We learned this about 3pm Friday!! Now, we have been advised that Mom must move out by 11am on Wednesday, other wise we must provide $13,000 -- even if just for a day or so extra!! I kid you not! So, I naturally shot the administrator an email about the errors on the form and advised that if these errors caused a delay, we would not be paying for it! Arggh!!

So, we had to contact the rehab who had to locate the doctor and it get it corrected! Wonder how many folks' healthcare or medications were impacted by errors made on forms?

It got corrected and TNF's nurses will be chatting with Mom for their personal assessment Monday morning at 8:30. HOPEFULLY, this will complete the process except for the logistics of the move.

We're working on planning that now -- what she'll need from the house, what we have to get from rehab, when to move stuff, etc.

I'm heading to the coast Monday for a week or more, depending on the 'transfer trauma'. Goal is to get this move done, get Mom feeling comfortable at the new apartment and then try to enjoy some vacation time with Mom.

To be Continued...................I'll update when I can but not sure about wireless access availability.

Thursday, February 12, 2009

Discharge Notice

Just as I was emailing the Social Worker at rehab to find out about the psych evaluation, she was emailing us to inform us that Mom's discharge date is set for the 18th! GULP!

So, after having a few hours of actually feeling like myself this morning -- for a change -- everything went into high speed.

The wonderful assistant at TNF worked so hard today to push everything through -- THANK YOU! She obtained information and provided answers to the finance department, she faxed over the form for the attending physician at rehab to perform Mom's physical AND she obtained a copy of the psych eval so TNF's nurses could have for their assessment -- which she also scheduled for Monday.

The Rehab's doctor was in the facility today, so hopefully she got the form and conducted the physical.

Mom's eval said she did have some dementia but more importantly she was severely "depressed". Huh? We thought she was on an antidepressant - Remeron -- remember her first week at rehab -- the family meeting? They were going to start Mom on that which would treat her depression AND supposedly increase appetite. Also, when the confusion was coming out we questioned whether it could be the antidepressant causing the confusion -- we were told they didn't believe so.

Well, I guess not since she wasn't even taking any! However, she has been through all of this crap since December 19th and has had no med for depression. When I get to the end of my life, IF I get depressed, do me a favor -- give me some drugs for it! I mean WHY should you not go for something to help you deal with that tragedy? Unbelievable.

So, they started -- WE THINK -- Mom on Zoloft today. Well, at least they said they were going to start her on it. At least this time we know to follow up.

Now we have to learn all about how best to handle this move with Mom. Hopefully the skilled staff at TNF will guide us and teach us. They sure jumped into gear to help with the stipulated date.

Oh -- and if we can't move Mom on the 18th -- based on rehab's current 'policy', we would have to fork over tens-of-thousands of dollars just to get a few extra days. Well, that "may" be negotiable with the Administrator -- but he didn't respond to our request for a call to discuss that part.

Hopefully we won't need to negotiate with them -- hopefully we'll get Mom in a good place.

Now we must ready our responsibilities at work to ensure sister and I keep our jobs while supporting Mom in this move. Fortunately, we both have had great support.

To be Continued...........................................

Wednesday, February 11, 2009

The Process

We finally received a call this morning from the POC at TNF (The New Facility) -- she is out of town at a conference. So, we cleared up need for some additional financial information and passed that to her assistant who confirmed she is pushing info to their financial team today. Hopefully we can get through this negotiation and paperwork by end of this week.

There is so much to do in this situation:
  • existing assets such as house and cars -- how much do you maintain and how about protecting these as no one is living there right now?
  • little things like mail, paying the bills
  • taxes -- quarterly -- and how do these change with her move to ALF (Assisted Living Facility) and those associated costs?
  • what if we need to sell the house -- to either reduce expenses or continue funding care?
The list just goes on and on. We're fortunate in a lot of respects because Sister led the charge years ago to setup a Living Trust through an estate planner that really did a great job putting all necessary pieces in place. Things like "Durable Power of Attorney", "Living Will", etc. These are critically huge documents to have BEFORE you begin declining. Thank you Sister, Mom and Dad! We should all make sure we prepare so well.

Makes me think twice about long term care insurance as well. We need something to pay for our care -- I just recently read somewhere that only about 10% of the elderly die quickly. I want to live long (naturally healthy) -- but I want to die quick. Not many of us get that route to the end, so we should prepare so our loved ones have less of a burden. Of course, none of us can be sure what kind of care will really be available in another 30 years.

Even with all the proper documentation there is so much to learn, plan, execute and consider. It is becoming rather exhausting.

VACATION

So, let's think about vacation at TNF. Sister sent a picture of Mom to my cell phone this evening and just in 3 days of not seeing her she looks like she has lost a bunch of weight! She is NOT eating. Look how thin she is in this picture -- --- BUT hair is done and lipstick on!


Bless her heart!!!

So, I decide to pull heart strings -- everyone has a Mom so everyone can sympathize -- right? The following email went out this evening to the ladies at TNF:

Do me a HUGE HUGE favor -- do whatever you can to expedite our Mother’s transfer to TNF as soon as possible. In this process, please assist us to make it as smooth and easy for Mom as possible so she is not distressed or worried……..well as best we can all do for her. My sister and I are preparing to be with Mom as much as you all will allow her first week or so.

Mom is losing so much weight so quickly – she is just not eating that crap they serve over there. I mean look at the attached pictures – the first “CellTakes…” was from January 9th – just ONE MONTH later look at her – the second picture “Mom 004”. Now Mom has done her part – she worked at exercise and rehab really well…………but the food – yuck!

Ladies – I plead with you to help us. My mother has shared her WONDERFUL personality in the last week – once listening to a 40s music female singer (at the current facility on Saturday) ……..second was just strolling (Mom in a wheelchair because we didn’t want to make her ‘hike’) around outside in the sunshine (Saturday and Sunday).

I WANT MORE of her. I want my sister and I to be with Mom and have days to enjoy each other and her personality in the comfort of TNF. I want Mom, Sister and myself to enjoy the activities and facility at TNF – I want to go on a “Joy Ride” with her. I want the 3 of us to have Mom’s last “vacation” at TNF.

Please hurry as to us she is deteriorating so quickly. I want this vacation for all of us.

Doesn't hurt to ask.........we have no idea how long she has, I don't want to waste any of it.


To be Continued.................................................

Tuesday, February 10, 2009

Where is the Fortitude and Patience?

Every day continues to test us all. I can't imagine how Mom must feel -- maybe it is as Daddy's doctor told me once -- dementia/Alzheimer's may actually make it easier on the patient.

So according to the nurse Mom has indicated 'tremors' but not stroke. Yet when Sister went over there this afternoon to get Mom squared away for hair appointment, she finds Mom "wobbly like jello". What is that about?

We learned late this afternoon that the psych doctor is sick now with whatever virus is running rampant on that peninsula.....so evaluation will now be Thursday morning. Sister is also now sick -- which just adds to our inability to maintain composure. Appears she nor I are doing too well these past couple of days. At least Sister has an excuse -- she has a cold. We both feel the physical toll of all of this -- as Mom is no doubt feeling it more than us.

We are still awaiting movement on the new facility side -- having the main point of contact out of town is in fact delaying that process as the "assistant" is not as active. Oh well,.....where did that patience go?

There is a reason for everything, so we'll wade through this snail's pace process.

I thought several times today about being with Mom at the new facility and spending that first week with her. I hope she remains sweet and doesn't go through many days of that dreaded "transfer trauma". I want to enjoy time with her those days, enjoy her personality, participate in the events with her -- they have a fantastic calendar of events every day. A typical day at The New Facility (from now referenced as TNF):
  • 9am Daily Chronicle (Current events) OR Joy Ride (around the peninsula)
  • 10am Music & Movement OR Courtyard Stroll OR Gentle Yoga
  • 12pm Lunch at the cafe
  • 3:30 Bingo OR Bowling OR Piano Music OR Elvis Impersonator
  • 6:00 Movie & Popcorn OR Reminisce OR Resident's Choice

Now, my goal is to get Mom into a "vacation" mind set. She's always been good at setting her mind to doing something and just doing it. So, I want to set her mind to
"I need to be here for a while, so I'm going to view it as a vacation and just enjoy myself as much as possible."
That's my goal.

At least current facility staff are being very nice -- I apologize for my rush to judgment last night. It's our Mom, and we want everything "right" and "now" ;-)

No long blog tonight, need more rest.

To be Continued.....................

Monday, February 9, 2009

Strokes?

This morning we touched base with the rehab team to find out about the psych evaluation schedule, request a physical for Mom for the new ALF (Assisted living facility), and request the nicotine patch go back on Mom.

We also contacted the ALF person's assistant, as the main contact is out of town but her assistant is to continue the process for us this week.

Finally we obtained approval to allow Mom's hairdresser back in to the facility tomorrow to fix her hair.

This evening nephew and ANIL (Almost Niece-in-law) go by to see Mom and find her in pretty good spirits. Mom was calm, sweet and never mentioned cigarettes -- ahh the nicotine patch.

Then sister goes by and the angel roommate informs Sister that Mom had a bad morning. She said she looked over and could see Mom's eye trembling and Mom said she couldn't control it. They called the nurse or CNA and they asked Mom if she had any pain and she said No. So, they left her alone.

After a while the Therapist came by and tried to get Mom up for exercise and Mom couldn't stand because her entire left side was weak!!! So, the Therapist just puts her back to bed!!

NOTHING was done and they never even bothered to communicate this to us! AND we were sharing emails with all of them around the time this occurred!!

Sister approaches the evening nurse to inquire about what happened. Nurse looks through chart and sees some notes about tremors but nothing else and says she will watch her tonight. Sister asked -- well, what was her heart rate when this was occurring -- nurse had no idea!

Now this evening Mom is walking and can move just fine. She walks sister to the door, etc.

So email sent this evening to facility administrator, head nurse and social worker. This is just unreal!! PRAY that we get Mom into the new facility ASAP - please pray for that for us. Even if she just has a day, a week, or a month -- it will be better than she is getting now!

My sister was informed this evening by Mom’s roommate that this morning Mom had an episode of trembling – uncontrollably. They got the nurses or CNAs or someone in there and they asked Mom if had any pain and then left her.

A while later the Therapist came in to get Mom up for therapy. Mom could not stand up because her entire left side was too weak to hold her. The therapist put her back in bed and she was left for the day.

Upon learning this my sister asked the nurse on duty this evening what happened to Mom this morning. The nurse found some sparse notes about trembling but no details. My sister asked what Mom’s heart rate was when this happened and the nurse could not find any information.

Thank God for (roommate's name) and her clear mind so that we could even know this occurred!!

WHY would her heart rate not be checked and noted? WHY would we not be called when something that appears to be a stroke is occurring?

We are trying our best to keep these communications open and working for Mom’s best interest. I’m surprised that none of this was communicated to us – not at the time nor even later.


Psych eval should occur tomorrow. Hopefully we'll hear something in response to these "strokes"? And HOPEFULLY, the new facility and us can get the contractual stuff out of the way and get that transfer process moving. I'm hoping I can get Mom to accept the new facility with an attitude of
We don't know how long we have but for now, enjoy this as a vacation at a nice resort and relax for a little while.


Everyday is a challenge and a test of our fortitude and faith. My faith is getting stronger, but there are minutes and hours where strength fails me.

UPDATE on Tuesday: The head nurse called just before lunch and advised that it did NOT appear that Mom had a stroke but she did have a tremor and she has had these before and could be related to medications or the exercise. She said that they do NOT notify family unless indication is in fact a stroke -- drooping mouth, unable to talk, unconscious, etc. The Nurse Practitioner is in today and is going to check Mom over just to be sure. All Mom's vitals yesterday were fine and she is alert, moving and talking today. Oh well......another lesson.

To be continued...............

Sunday, February 8, 2009

Memory Support Facility

There is one comforting thing about Mom’s confusion – her personality is still there and we can still enjoy time with her. Saying the same ol’ things, talking the same ol’ way, joking the same ol’ way and just hanging out with Mom. I’m thankful for that at least.

Friday evening I went in to see Mom and she was laying in bed but smiled and said, “well , look who’s here”. She was tickled to see me and it warmed my heart. We hugged & kissed and then I sat on her bed and we chatted. After a while she sat up a bit more and
she said, “Well I might as well go to the house with you”. GULP. I said, “you can’t yet Mom, you have to complete your therapy.” She said, “Therapy, , I know how to do what I need to do.” I said, “yes, but you can’t be home alone yet and Sister and I both have to work……and you don’t want any stranger in your house with you – do you?” She said, “no, but I sure didn’t think I would be in here this long. This is going to cost some money.” I said, “don’t you worry about it – insurance is covering this.”

Then I proceeded to say that this rehab got her from laying in bed to being able to walk around, etc. The next therapy will focus on getting her back into her daily routines – dressing, bathing, getting her hair done, and preparing her something to eat, etc. She was a bit suspicious but did agree we had to work.

Sister and I visited the first of 3 facilities Saturday morning. It was ok – really very similar to the facility Mom is currently in, except it has carpet throughout and is locked down with a courtyard.

Then we visited that facility that Mom and I used to pass and she would say,
“If I ever get down, you put me in there.”
Oh, that place is so nice – it looks just like a resort’s lobby when you go in and they have a “concierge!”. We spent some time talking with the lady about the facility, the services, etc. We reviewed the costs and asked if we could negotiate the rate -- there IS a business side to this as well. We certainly have to be smart and not venture into something that cannot last as long as necessary.

Now, this facility has built a lot of cottage homes and they typically do not take in patients for “Memory Support” or their nursing home facility because these are reserved for the home owners. However, they have availability and the fact is it is a business and the Memory Support unit is only half full – negotiation seems reasonable to me.

We toured parts of the facility and especially the Memory Support area. It was so entirely different from the first facility. Folks were up, moving around and seemed very well adjusted. Everyone spoke to us and smiled and/or waved. None of that slumped over in a wheel chair in the hall crap. These people were up and moving. The layout has all rooms opening into a common area, they have a living room area with big screen tv and gas fireplace, a sun room, a courtyard and dining room. They also have within the community a hair salon, library, billiards room, fitness center, swimming pool, etc. It is like a resort!
They will get Mom on a schedule for getting her hair done and when it’s time they will get her and say “it’s time for your hair appt” and just take her right on. They also have a cafĂ© downstairs that they take them too periodically and they go on “Joy Rides” in a van a couple of times a week -- family can go too. They have music, bingo, yoga, “sittercise”, etc. Sister and I were both so impressed.
We walked out with a schedule to go to one other facility that we already didn’t like the location. We were walking across the lot and I looked at sister and noted the time and that we should really go by and see Mom to see if we could get her to go out for a milkshake before it got late. But, what do we do about the other place. Sister suggested we skip it. YAY!
So, does that mean you like this one? “yea” YAY!!
That’s how I feel too – Mom will be well stimulated, well cared for and pampered – and she should have that. We may not be able to afford it for 5 years, but we can certainly try to negotiate a rate that we may be able to cover for 3 or 4. I want her last years to be as good as possible.

We headed for the rehab center with paperwork in hand to fill out later (tomorrow). Got to rehab and found Mom dressed but laying in the bed. She was pleasant and glad to see us. I told her we were hungry and how about her and her roommate loading up in the car and let’s go to Sonic? Mom didn’t want to leave the place, but said for us to just go and pick up something. Oh well, rather her be that way than a ‘wanderer’. So, we ran out, grabbed some food and came back. We all munched a bit and then we said, “let’s take you two ladies outside for some sunshine”. It was sunny and 64 degrees out side – a beautiful day. So, both ladies in their wheel chairs and sister and I pushing we went for a stroll outside. Then we sat around the benches and chatted….both ladies enjoyed the warm sun. They were playing music inside, so we decided to go in and listen. Mom said, “let’s go sit in the back row” HA – the room is just tables – but we chose one in the back corner of the room. Mom hummed and really enjoyed the music and the people – one old lady would stand up periodically and shake her hips! Sister and I looked at each other and grinned – we both were thinking how Mom is really going to like that other place.
I told Mom, “Remember I told you that other building you’re moving to in a few weeks?” She nodded. I said, “well, that building has an Elvis impersonator” She said, “Really?” and grinned. I said, “yea, and it’s a really nice place”.

We are planting that seed but we also are trying to prepare ourselves for the transfer. We learned today that there is this thing called “transfer trauma” that lasts about a week. Folks with dementia will get very agitated, confused and upset when transferred as change is so difficult for them. We worry about that time but we will do our best and we have faith in this facility’s ability to help all of us get through it. One thing is for sure – ALL the patients there were VERY well adjusted and Mom will get that way too. I can actually envision visiting her there and being able to tool around that “resort” and really have some quality time to ‘hang out’ with Mom. This will be Mom as the person she is – her true personality will be there – that’s what we’re seeing now. Amid the confusion, there is still that personality that likes music and laughs.

This train is still moving fast and I feel so darn exhausted. So, much to learn, so many decisions to make, so much to do and then somehow, we are to maintain OUR normal lives and work! At Mom’s house Saturday night I felt that longing – missing Mom and Dad. We’re taking care of what we need to and we are doing the best thing for Mom, but this takes a toll on us all and the heartache doesn’t end, it just takes various forms.

Sunday morning I found myself falling into one "pitty party" after another and very emotional and sad. After packing I ran the vacuum and put out all the trash as I tried cleaning up throughout the weekend. I went to see Mom about 10am and found her sitting on her roommate's bed talking to her roommate -- totally confused and very uncomfortable about the confusion. She turned and saw me and was so relieved! She said she had tried calling the house and didn't get an answer -- I said, "Well, that is because no one is there." She said,"God, but I figured someone would answer" I said, "no, cause you're here" She asked where Sister was. Then she asked about Daddy.
I looked at her, she looked at me, I looked at her roommate, stunned, not sure how to respond. Looked back at Mom and said,"Mom, Daddy has been gone for some time" She said, "Oh, I know that, damn.....I'm so confused and got so worried that I didn't know how you all would find me". I hugged her and said, "awww, it's going to be ok, maybe its the medicine causing the confusion. But, don't worry (big hug), we know where you are and we're not going to let you get away."

She calmed down but she had really been in a tizzy. I talked her into getting dressed and going outside as it was another beautiful day. We started out with her and her roommate -- roommate was motoring her wheelchair with her feet and I was about to try and push both when one of Mom's neighbor's showed up to assist. So, we strolled outside and then sat in the sun on the benches. She had some very confusing moments and it was tough but I held everything in until I left.
Once Mom shook her head and said, "I don't know how I got myself into this mess."

We went back inside just before lunch and got her started on eating before I finally left. She kept trying to understand why she was there and why she had to stay.

VERY DIFFICULT but we are doing the right thing. I know we are, we just have to stay the course.

Sister went by this evening and Mom was craving a cigarette and finally coerced Sister's man to take her outside and she bummed one from him. What the heck? Why not? They stopped her nicotine patch about a week ago and a few days later was the first time she started thinking about cigarettes. Now at this point, why in the hell would you take away the woman's nicotine? This causes her to look for her cigarettes which causes her to wonder where her pocket book is which causes her to think about keys, house, cars, etc. Just really drives her into a rabbit hole of confusion. No need for that!

So, sister requested the nurse give patch back -- but have to wait for ok from Doctor tomorrow. We also noticed they are checking Mom's sugar every day -- Saturday it was 171 and this morning it was 189. The nurse says they don't do anything about it until it is over 200. (more reading required on this one).

Well, now we have to email the rehab to see if they got the psych evaluation scheduled and could they please ask that doctor to recommend some medication? No need for Mom to suffer these anxieties from the confusion.

We also have to request the rehab doctor do a full physical to provide to the new facility. We also have to talk to new facility about processing financial paperwork, scheduling their nurses' assessment and then coordination with both facilities for the transfer. Sister and I both believe the sooner the better as Mom's care will be improved at the new facility. Maybe we can get lucky and get her moved week after this.

We have to coordinate moving some chairs into the new facility -- they provide bed, wardrobe and dresser, but we need to include some visitor chairs and the TV and a couple little tables. We have to coordinate some time off for both Sister and I as we need to be with Mom for the first week or so as she needs family with her until she gets used to the place and gets to know some people.

A lot to do, but we'll get through.

To be continued……………………….

Thursday, February 5, 2009

ICT - In Crisis Training

Well, things continue to move so fast and this requires such quick learning. It is unbelievable how fast this train is moving and so much to absorb before making decisions.

This morning many calls coming in from Assisted Living facilities -- that lady at "A Place for Mom" is really reaching out for us :-) THANK YOU!! Each facility sounds very nice and we will visit them on Saturday.

The rehab center called as well to inform that Mom has about 2 weeks of therapy left and then she would be discharged or have to go to private pay. Well, if we are going to private pay, then Mom is going to be in a much nicer facility -- that's for sure. So, another piece in the puzzle, is what is her official mental or memory status? So, the rehab center is going to arrange a psych consult for Monday (hopefully Monday). That will determine if this is mild dementia -- or what kind -- hell, I didn't even know there were different kinds -- or Alzheimer's, etc. This is important for establishing Mom's care and preparing ourselves and Mom.

I pray with all my heart that Mom doesn't fight us on this and that we can all get through this with cooperation and understanding. If she fights, it is going to be hard for us. We know in our hearts and our minds this is the correct thing to do at this time. The future will tell us if it is right for the long term or the short term.

One of the Assisted Living staff members told me this morning that they have many women that if you just chatted with them you wouldn't think there was anything at all wrong with them. She said if you spoke with them for a few hours you could tell. They refer to these ladies as "the golden girls". I like that because I prefer that Mom be paired with someone that is similar to her -- with only mild memory issues. I think that will be easier for Mom.

Well, looks like in two weeks we'll be moving Mom and I understand that WE actually move her. I'm not sure how she will feel about that but we'll certainly see. One person advised that we tell Mom whatever we believe will keep her the calmest. At this point we are thinking that we should say she is going for her next phase of rehab since she has done so well with physical therapy -- now this therapy will focus on regular living stuff like food preparation and laundry. ?? Honesty is the best policy and we have been forthright and honest with Mom throughout this, so we'll continue that pattern and address the fact that Mom just is not capable of living alone right now. Unfortunately sister and I are dependent on our jobs and must keep them. Neither of our homes are very suitable to caring for her there and certainly not her house (way too many steps).

Oh the challenges and the stress of these decisions. It is similar to caring for a child except this is your parent and they have more to say about things!

Fortunately there are a LOT of resources on how to handle these kinds of moves -- THANK GOD for that!! Since there appear to be more and more people ending this journey with dementia or alzheimer's, there are many organizations to provide guidance and resources. I collected several documents providing advice on how to handle the move, how to tell your parent, how to determine what items to take and even how to handle the actual moving day. I'm thankful for this guidance because up until now, everything has been handled by medical folks -- either the hospital or the rehab center. WE are responsible for actually moving her to the assisted living facility -- this includes setting up her new apartment, transporting her and getting her settled. Fortunately the latter part does include assistance from the assisted living facility staff.

I suspect the first few weeks in the new facility will be really hard as Mom settles in because surely this will cause great confusion and uncertainty. I dread that time as it will be hard for all of us -- Mom, me, Sister and family. But, I am so sure this is the right thing and best thing for Mom. Our confidence and positive attitude will make a difference.

This evening Mom was very sweet to Sister but was very confused. Mom even stated,
I just don't think I can keep doing this much longer ...... Sister asked her "keep doing what?" ....... Mom said,"keeping up with everything because I'm just so confused". Bless her heart!!


Do you believe in fate?

Well years ago whenever Mom and I would drive past the "Baptist Home" near our neighborhood (which was quite often) -- Mom would say
"If I ever get down or out, just put me in that place. It looks nice and that is why we're saving our money -- so we're not a burden on you girls."

I went to the home a few Christmas seasons with the church choir and sang and was always impressed with the place -- assisted living NOT a nursing home. Since those days we have watched that place grow. They have added cottage homes and apartments and become more of a place for seniors to move to earlier. Then the facility will step them into other units as their capabilities decline. We looked into this place when Mom was in the hospital but found they typically do not take in folks mid-stream.
Well, that WONDERFUL woman at "A Place for Mom", contacted the lady at this place and talked to her and found they have availability in the memory unit. She called me and it really surprised me and she explained she had been contacted and they did have availability. I got the rate -- yea it certainly costs more - and info for us to visit on Saturday. This is a really upscale place but we also have to consider cost -- a little. But, I know my sister is like me -- if it's worth it, we'll pay it for Mom.
The lady at "A Place for Mom" called me this afternoon and talked about this facility and what a great opportunity. She reminded me that it is still a business and they have a budget to meet....hence their willingness to bring some in since that unit is not very full.
Hmmmmm. Not very full. Hmmmmm. More attention to the patients that are there. Hmmmmmm. Is this a negotiable thing? Why not try?

I really hope Mom ends her days feeling comfortable and enjoying her surroundings. I hope she can be social, have friends, have plenty of stimulation and be happy during our visits. More than anything, I hope she knows that "her girls" are doing the best for her care that they can do!

To be continued.....................

Wednesday, February 4, 2009

Assessment Results - Now Where?

So the Nurse Practitioner's assessment -- along with council of the Medical Director and Director of Nursing --
Mom's blood gases are in acceptable ranges

Remeron is not causing confusion


AND -- she is progressing well through therapy and they are working on scheduling a Home Visit but they are concerned about her understanding safety with cooking.


Well, Mom never was much of a cook except during holidays and she hasn't cooked at all in probably 10 years, so no worries there.

We begin wondering -- do we really try to get "in-home care" service? What if she does have Dementia? What if we get her home and she refuses assistance?

None of these decisions are easy and you want to make the right decisions when it comes to your parent -- or spouse -- or any loved one!

We talk with some very fine folks at a few of the organizations that provide in-home care. We talk with folks that are very familiar with the different types of care and all options. We learn about "Assisted Living Memory Facilities".

These are facilities that are as we think of "assisted living" or "retirement communities" but skilled with memory challenges -- such as Dementia and Alzheimers. WOW! They provide apartment or residential style settings and can provide all levels of care and really know how to care for the elderly. There are 3 in that area -- 1 is 100% full -- so we have two to visit. We are going to tour both facilities this weekend and have been told that we will be impressed -- GOOD!

Next step is we need to determine just where Mom is mentally. Sometimes -- we learn -- elderly folks have mild dementia after an illness or trauma like Mom experienced -- and sometimes they come back later on. However, these experiences can accelerate some mild Dementia or Alzheimers into full speed. If it is mild or recoverable, then Mom could end up back home -- with some slight assistance. If not, then going home could just create a worse situation and more confusion. Mom's safety and well-being are at stake here. We will have to learn how this mental/memory evaluation is done and by whom.

This evening Sister finds Mom just talking and acting like typical Mom but certainly confused.
Confused such as her and her roommate went to the dining room for dinner but ended up carrying their trays back to the room -- but Mom told it as they went to town and got some dinner but there were all old people there, so they just brought the food back home.
It appears that Mom does very well with her roommate -- so if she ends up in assisted living -- maybe having a roommate would be better than a private room?

It seems to me a nice facility built, staffed and run by people that understand memory issues that can provide residential style living with potential for friends and activity would be far better than living alone or with limited assistance if you do have Dementia. I know at this point in my life -- when I'm mostly of sound mind and body -- that I would like to be in such a facility if I wasn't all together upstairs. Hopefully I could socialize, play Wii games and just hang out. ;-)

To be continued...............

Tuesday, February 3, 2009

Dementia or Drugs?

So, my mind rolled all night wondering does Mom now have Dementia or is it a drug or something else? We owe it to her to investigate and not just ignore these symptoms -- I cannot do that to my Mother -- I wouldn't want someone to drug me and cause me to appear I have dementia when it was really a drug!

So, 6:30 am I send the following email to the Administrators and nurse at the facility:

This has rolled in my head and I got up this morning and did more research.


Folks

I’ve been worried about my Mom’s confusion ALL NIGHT. I’m an analyst at heart and have spent about 30 years (my entire career) having to research and learn all kinds of things – so I have a LOT of experience at researching and analyzing and learning. I also know my mother – I know her well and so does Sister.

I just read that early studies of Remeron did note that the drug did cause Dementia in some patients.

Until Mom was started on Remeron WE did not see the confusion that we (mostly Sister since I’m out of town) see now. I understand that you all stated you experienced some confusion – I understand that – but not to the level we see now.

I saw my Mom get TOTALLY confused one evening back in November – and it was COMPLETELY a reaction to some cough syrup her doctor prescribed for her. Once that got out of her system – next morning – she was back to normal. So I have SEEN drugs throw her into a tail spin.

I realize that what we are seeing may in fact be some dementia – I’m accepting where we are with our mother and the various things we may experience. I do accept that.

However, WHAT if Remeron or carbon dioxide IS the cause of her confusion? We would be doing that woman a TERRIBLE INJUSTICE if we did not figure that out – wouldn’t we?

Is oxygen still required 24x7 for Mom? If so, why? She didn’t need oxygen before her lungs started filling with fluid from the heart failure. When she was admitted to Regency she still had fluid in her lungs. Does she still have fluid in her lungs? Does she need the oxygen full time? WHAT if there is a build-up of carbon dioxide in her lungs causing the confusion?

What are the ramifications to stopping Remeron for a few weeks? What do we have to do to get her blood gases checked?

Please help us out with this and help us at least investigate whether there is something causing the confusion.

Thanks!

Well, what do you know -- Sister goes by facility at lunch time -- Mom is very confused again. Talks to the Nurse Practitioner and last Monday they did check Mom's blood gases and found it was at 35. Normal is 20-29. "Hypercapnia" is when the CO2 level is greater than 45 and that is life threatening! A little more about Hypercapnia:

* The blood contains carbon dioxide, a "waste product" of cellular metabolism that is exhaled by the lungs at the same time that oxygen is taken in. The normal concentration (partial pressure) of carbon dioxide in the blood is 40 mm Hg. Hypercapnia is when the carbon dioxide level goes above 45 mm Hg. (though it usually needs to be higher than this for symptoms to occur). * Hypercapnia commonly occurs in severe Emphysema. Oxygen given to patients with Emphysema may reduce their ability to breathe, resulting in Hypercapnia. This is why exact doses of oxygen are usually figured out for those with Emphysema so that they receive neither too little nor too much oxygen. Note: if a patient is actively short of breath, never withhold oxygen from him.

Now -- note that Mom was classed as having COPD but she was NOT having breathing problems prior to December 30th. As far as we know, the oxygen level has not been adjusted since December 30 and note that above information states oxygen level must be set just so -- not too much and not too little. Really? Wonder who is monitoring that??

So the Nurse Practitioner does 'assessments' 3x week -- I think that is what Sister said and then the local medical conglomerate comes in on MWF to collect blood for various tests. So, if they check Mom's blood gases again it won't be until tomorrow.

Also learned that Mom has on same clothes for the 4th day now. Could be she is requesting those?? So, I called the asst. Administrator this afternoon and asked about blood gas check -- results of nurse's assessment and about clothing/bathing.

The Nurse Practitioner has decided she wants to assess Mom tonight -- sometime. Maybe even wake her up to assess her. She said Mom may have had Dementia (D from now on) for some time but able to control it or catch herself and now not in her normal environment she cannot catch it.

So -- how about being at home? Time now to research IN HOME CARE SERVICE PROVIDERS. Find our options, check the companies and people out and compare company and pricing (not that pricing take precedence -- it doesn't but we certainly have to be able to afford it). Then assuming we find suitable care -- will Mom agree to someone in the house with her? This could take some time, but we want to do all we can and it is would be better if she could be in her own home but it depends on whether she will be cooperative or not. This is tough.

This is so not where this woman wanted to be...............But......God has a plan and we will survive and learn. We can only try to do the best we can for her every day -- one day at a time.

To Be Continued................................

Monday, February 2, 2009

Cause of Confusion?

I emailed the facility administration this morning about that shower schedule. They have made a "process improvement" to better monitor and audit the schedule YAY! So, Mom's getting a real shower today and then is scheduled for every Tuesday and Friday -- bathing between showers.
The CNA approached Mom before lunch today about a shower and Mom responded that she didn't want one. The CNA got the DON (Director of Nursing) and she talked to Mom and again Mom said No. The DON said "your daughter wants you to get a shower" Mom responded,"I don't want one, I can make my own decisions and I don't care what she says". Well, now...hmmmm.......

We were also informed that the urinary analysis came back negative. Hmmmmm. So why is she confused? Mom didn't have this confusion prior to going into the rehab facility. She was naturally somewhat confused but all that was normal considering what she had been through and slept through in ICU and the hospital. She exhibited real confusion ( and delirium per her roommate) on her third day of taking "Remeron" -- an antidepressant. We asked the nurse then to STOP the drug but she suspected a UTI being the cause of the confusion, not the Remeron.

Well, since there is no UTI -- we must suspect the Remeron. So, I emailed the administrator again and asked that he investigate this with the Doctor and maybe Remeron needs to be discontinued. We don't want Mom being so confused -- and drugs can really play havoc on the elderly.

Man -- this is a full-time job to keep track of everything that is occuring with your parent in one of these facilities -- but also demonstrates why you HAVE to be very involved. Otherwise, these folks -- each nurse, therapist, etc -- look only at their schedule and muddle through their day -- they would continue current actions and those actions could drastically change the outcome of the elderly patients.

Well -- talking with a friend this morning about this confusion and lo and behold, she is going through something similar with her mom! Found out that
a build-up of carbon dioxide is likely in elderly that are on oxygen and have heart issues because the body cannot expel that carbon dioxide from the lungs and a bi-pap machine at night can take care of that and will completely clear up the confusion!!

So, I emailed the staff (administrators and nurse) about checking Mom's "blood gases" to ensure she does not have a build-up of carbon dioxide from the continuous oxygen! This email was sent to them before noon today -- hopefully getting this blood test won't take the week that the urine analysis required!

Sister went by this afternoon and Mom was doing good -- clear minded and even conducted some business. Then when they were leaving the dining room -- Mom says, "I need to use the bathroom before we head home." Sister guided her back to her room and she went to the bathroom. Mom's roommate told Sister that Mom gets real confused at nighttime. Sister asked if it was after any particular medicine, and asked if roommate could see if that might be the case.

What about drugs and the elderly? How much are these drugs doing to an elderly person's brain? How do we ensure that something that is prescribed to an elderly person is not making them confused? Think about how awful this would be and what path this could put a person on!! How do we prevent this?

Unfortunately not so. Mom came out of the bathroom and was very confused and started talk about needing her purse and coat. She again brought up about not staying there and about going home. During this Sister said some nurse/aide came in and asked if Mom had on her shoes and then came back and asked her roommate if she had on her socks. The roommate turned to Sister and said "see why we're crazy". Soon they brought in the dinner tray and once Mom started on that Sister departed.

So many feelings and thoughts about this journey. So difficult and you are faced with so many decisions. I know how difficult this is for me and for my sister and we are so thankful we each have the other to help in this -- but, Lord, what about all the elderly that don't have family involved?

I never wanted to see my Mom without a clear head -- she never wanted to be 'confused' or have Dementia. But, there IS a plan and through this we all learn much and our faith gets stronger.

One day at a time.

To Be Continued....................

Sunday, February 1, 2009

Third Week of Rehab

Mom made it through this week and didn't refuse any therapy and "did much better" according to the head of therapy. They were able to get her out of her room and even doing some rehab in the rehab room with the other patients. The therapist said she did get confused once when getting ready to leave that room -- she thought she needed her coat and shoes.

Mom finally was going to get her hair done on Monday -- but then the facility's boiler had broke and they were without hot water! So, that got rescheduled for Tuesday and sure enough -- she got her hair done! YAY! She looks like Mom a lot more now -- still has some hollow eyes but looks better.

We learned on Tuesday that some virus was running through the place and everyone was being restricted to their rooms. Lots of staff were out with the stuff too. Sister noticed on Tuesday that Mom's floor was filthy around her bed and she got her a clean sheet. The roommate mentioned that she hadn't known their sheets to be changed since she came in a week or more ago. Mom had not been cleaned up either and had on the same clothes from Saturday!

So we sent an email to the facility administrators on the following items:

1. The Director of Nursing stated yesterday evening that they were going to discontinue the “booster” dose of the antidepressant they were giving Mom to help her sleep as this appears to be the cause of her confusion and drowsiness on Sunday and last Friday – that is good news!

2. My sister spent some time yesterday cleaning up Mom’s area while she was getting her hair done as both her bed and floor around it were filthy. I noticed that on Sunday as well. We realize that you are struggling with staff illness/shortages, but cleanliness is very important – especially when you have a virus going around. Mom’s roommate noted to my sister that as far as she knew neither her nor Mom’s sheets had been changed since she came into the facility!! I know I personally changed the sheet that lays under Mom’s butt on Saturday myself as it was wet and soiled. My sister said she has done the same multiple times since Saturday. This type of negligence can easily lead to infections and disease – especially in the elderly with low immune systems (and when combined with lack of regular bathing – see #4 below).

3. Last night my nephew and fiancĂ© were in with Mom during dinner time and they noted she had “Glucerna” to drink. That is for diabetes – isn’t it? We questioned this note on her chart earlier and were advised that her sugar was monitored and it was consistently fine. We have not been aware of any diabetes food/treatment prior to last night. Can you elaborate as to why she was given “Glucerna” and is there in fact an issue with her sugar?

4. Yesterday Mom was still in the same clothes that were put on her on Saturday. As best we can determine – she has not been bathed since Saturday morning. Sister inquired about this with the nurse last night and she said that everyone is showered twice a week and sponge bathed the other days. My sister noted with the nurse that Mom had not received a shower since she had been there – we are aware that Mom turned down a shower opportunity last Friday. The nurse checked the “book” and did not see where Room 25 was on the schedule at all. So, it appears that Room 25 is missing the scheduled shower opportunities? The nurse said she would correct that and would note not to get Mom’s hair wet ;-) THANKS! I guess our concern here is the number of days Mom has been in the same clothes and without a bath and if Sister had not had this discussion, apparently Room 25 would not be on the scheduled list at all. L

5. Along with #4 – we were aware that Mom had a bit of a sore on her butt in the hospital and we noticed Saturday she was complaining a lot about her butt hurting her. If she has not been bathed since Saturday and in the same clothes – we assume same pull-ups and since the sheet under her butt on the bed has been soiled multiple times since Saturday – what if that sore is still there? What condition may it be in after no cleaning or treatment?


We did receive a prompt response and all items were being addressed. Never really did get a good response to the "glucerna" question but I guess 4 out of 5 ain't bad.

Sure enough Mom did have two sores on her butt, so they put some kind of patch on them that is supposed to be changed every 3 days....kind of like second skin or something. They got her cleaned up as well and we were advised they were bringing in help with staffing.

We were informed at the end of the week that they had shipped the urine sample off to be tested for Urinary tract infection -- which evidently causes confusion in the elderly. The test takes 48-72 hours because they test for exactly what bacteria so they can treat with the exact right antibiotic. So, looks like first of week before we'll know about that situation.

By Friday night, Mom was walking without a walker and was very alert. The nurse said that bouncing between confusion and regular was normal. Mom stated she couldn't believe she had been in that place for three weeks EGAD! She wanted out of there and we needed to have a meeting with those people. She finally agreed to stay there that night since it was already late, but she wanted to meet with them on Saturday. This freaked my sister out. I explained there was no need to react yet because by morning Mom may not even remember anything about going home. I suggested that we load her up for a drive-in snack or lunch and see how she does.

Saturday she was fine, very pleasant and normal.

Sunday, February 1, 2009


Today Mom was moving really well and her face looked good. Good color and looking more like herself. Sister shared some business of check signing with her and she was rather confused about all that. We've decided it may be easiest for her if we just handle all the business and then just provide her info when she asks. No need to add confusion or worry to her but we needed to try once to determine what is best for her. It would probably be easiest for us if she just has no interest in business and just lets us handle it. We'll see how things go.

It was beautiful today and Sister asked Mom if she wanted to walk outside -- but she didn't want to. She did tell them she was going to walk them to the door when they left -- they learned the door she meant was the door to her room. That was still better than she had been. Sister said when they left Mom was standing in the doorway to her room with hands on hip and watching everyone in the hall. Good sign.

I asked Sister what Mom had on and she said the same damn thing she had on yesterday -- evidently no baths this weekend and showers only during weekdays. Mom's roommate said she's only had one shower since she came and that was when she requested it.

So, goal for this week -- get Mom showered and resolve confusion -- if UTI, then begin antiobiotics. If not UTI, then we'll have to figure out what is causing the confusion.

One day at a time and hope for the best.

To be continued....................................

Saturday, January 31, 2009

The Rehab Facility - First 2 Weeks

The Initial Assessment
We learn that the facility essentially uses the first two weeks to "assess" new patients. It is typical too for it to take a few weeks for a person to get "acclimated" to that environment.

Mom was fortunate and had an empty room for about the first 4-5 days. Then we were very blessed to get a super roommate for her. A charming woman in her 70's recovering from a near death and bout in the hospital and now battling recovery and ovarian cancer. She is very mobile, just very thin and weak. This mobility surely inspires Mom.

Mom made progress as by the second week she was sitting up with assistance and then able to use the walker to walk to the bathroom! We actually could see "HER" in her eyes again!

There were moments of confusion the first few weeks and then the facility wanted to have a
"family meeting"
the second Friday of Mom's stay there. This meeting was attended by the facility Administrator, the Social Worker, the Therapist and the Nurse. Later we had to get the Medicare person in to answer some questions.

They told us that Mom had refused some therapy that week. Once was just Friday (January 23rd) morning when Mom "refused" the occupational therapist about taking a shower. We learn that Mom was confused and thought it was nighttime and said she didn't shower at night. So, that went down as ONE refusal. There are THREE therapists -- the occupational therapist that works with a patient in daily activities like personal hygiene and dressing; then the physical therapist that works her in exercises to rebuild her strength ; then last is 'speech therapist' which also works on cognitive skills and assesses her mental state.

If Mom refuses any one of these therapists 2 or 3 times consecutively, then that therapist will discontinue work with her. If all 3 therapists discontinue her, then Medicare will no longer pay for her to be there. But.....what about "must show progress"? Mom is certainly getting therapy because she is making progress -- Therapist says, "Yes, but she's doing it with the nurses or on her own". Well, what about Mom getting "skilled nursing" too? Well, she's not really - now if she gets a UTI and we have to treat the infection, then that is considered "skilled nursing".

We discuss Mom's mental state and discuss her 'depression'. Well, YEAH, she probably is depressed -- she was driving 5 weeks ago and living independently, her hair hasn't been done in over a month and she thinks she's dying and she's on all kinds of medicines. So, they are going to start her on Remeron which is an antidepressant that also stimulates appetite. It will take 2-4 weeks to know the affect.

Ok -- so if she does not participate in therapy but we're starting her on an antidepressant -- does that mean we get 2-4 weeks to see if it works? Well, no. So starting her on an antidepressant is not considered "skilled nursing"? Nope -- she could take drugs at home.

But - if the facility is going to discharge her, the would give us 5-days notice. If we need longer we could go to private pay @ $218 per day. Oh -- and you would have to pay one month security deposit and first month in advance -- fully refundable though.

Ok.

Off to see Mom and she looked great! Good to see those eyes again. Explained to Mom that should can't refuse these people anymore. She must agree to do whatever they ask otherwise Medicare won't pay. Oh -- and they agreed to let your hairdresser come in to do your hair, since the facility is between hairdressers right now.

2nd Hospital Admission

That Tuesday night, December 30, 2009, my sister and family went to Mom's and convinced her to let them call 911. The ambulance rushed Mom to the hospital and the ER doctor remembered seeing Mom
walk in
two weeks prior. He assessed her and reviewed her medications
sister had the discharge orders that had all the medications listed
and said Mom was severely dehydrated and way over medicated! The ER doctor said,
I want to know who discharged her with this medicine?
Mom was admitted to ICU.

The plan was to not give Mom anything other than occasional Tylenol and fluids and allow her body to process (flush) all the medication. This went on for days and of course there was mention of a pacemaker and Mom still said "no" or "we'll see".

By Friday her kidneys had shut down and her liver was beginning too shutdown. Friday evening we had a family meeting and presented Mom with the facts about her situation and that a pacemaker was the only way to live. She asked three questions:
1. How big an incision and where
2. what would she have to do later -- what would her life be like
3. How long might she live

The first two were easy but the third is anyone's guess as only God knows that answer. Mom agreed to get the pacemaker. The ICU nurse said, "She only agreed to get your sister off the phone" Nope, she asked Mom and Mom confirmed again.

That night they inserted a temporary pacemaker through her groin and she had to late flat on her back until the first of the week. Mom's kidneys were already working once she was back in ICU. Her liver took longer -- it was back to 75% function on Sunday morning.

On Tuesday they put in the permanent pacemaker and continued to 'tweak' her medications for the rapid heartbeat. They told us she would be in ICU another day, then transferred to cardiac telemetry for 2 or 3 days and undergo some therapy. She would then be discharged to a rehab. So, we're thinking transfer would be first of the following week. My sister asked that they make sure to call her before transferring Mom out of ICU so someone could be with her.

Well, Wednesday night (barely 24 hours after surgery) AFTER 9pm they moved Mom to the cardiac telemetry unit -- and naturally did not call anyone. We found out the next morning -- Thursday. We also found the doctor saying on Thursday that they needed to get Mom up and walking as she needed to be discharged. My sister just about freaked out and called me.

Time for Research
We contacted the hospital's risk management OR ambassador hotline OR patient advocacy group and explained that last time Mom was in (2 weeks ago) the hospital discharged her with too many medications that resulted in severe dehydration and over-medication. Now they were talking about discharge again and just the day before they were still adjusting medications for the rapid heartbeat. I DON'T THINK SO! That group was very empathetic and immediately put the cardiac telemetry unit's head nurse in charge of the situation for resolution.

We found that the doctor SHOULD NOT have said what he did and they were not going to discharge Mom before the weekend.

We began working and talking to the cardiac telemetry head nurse and nursing team and doctors. Mom improved slightly but was so very weak she could not even hardly sit up. This was a woman that had driven herself to get her hair done just 3 weeks prior and now she was in a hospital bed and could not even sit up without assistance.

January 9, 2009 - notes (personal thoughts) while with Mom in the hospital

Mom is in the hospital and says she is 'miserable' she said
"don't ask me to explain it i can't i just feel bad all over i feel exhausted"


The staff in the hospital are now trying to be very helpful and sympathetic. Yesterday though they were doing nothing for her and were talking discharge. this morning i called the "ambassador hotline" and said we needed time to speak with doctors and understand what is going on. I said that on 12/23 she was discharged with meds and then on 12/30 911 called and she was severely dehydrated and over medicated and i would be darned if they were going to discharge her without ensuring meds are right this time. That snapped them in gear and doctors responded. head nurse of cardiac floor talked to me and was so sympathetic she lost her dad last year and still hurting and totally understands the need to care for our parent!

Mom was so tired and couldn't sleep so i got them to give her sleeping pill. It just kicked in and now she is sleeping hard. They are moving us to a private room soon (its 11:30pm) so maybe I can get a few hours sleep before morning.

Just before the pill kicked in mom was blaming "them" saying they didnt care and i tried to explain that they were trying. She said "i can see you if you were like this you would have already laid a cussing on them" :-) yea maybe but i sure hope not! I hope i keep my trust and understanding of people all my life. I know i have it now at 50 and i know mom has never trusted anyone :-(


i love my mother but i am not her and she is not me - we are two entirely different people.

i pray her time comes quickly and the suffering is over soon. shes so tired and she seems so much like daddy did almost looks like him and talks like him. is he here?

January 10, 2009 -- more personal thoughts while with Mom in the hospital:

6:30am

just moved to private room - mom slept thru it. it is not the best room but don't have to worry with anyone else coming in and there are three chairs.

when nurse came in she said (before the move) that mom's heart rate spiked to 108 and asked was she doing Anything - nope just sleeping. maybe she had a dream.

when nurse was waking her up to give her a pill i said "can you believe 3 weeks ago this woman was driving herself to get her hair done?" nurse said "yea we get some people in here 5 or 6 times and each time they are so much worse. one lady that came in several times just died a few weeks ago". for some reason that really pulled my string and i was hit with that overwhelming heartache again :-(

i noticed yesterday that mom's house had not yet been straightened up - the pallet on the couch still :-( guess i'll try to rapidly address some of that when i go shower this morning. then kids are coming around 11:30 so sister and i can go visit a couple of the nursing homes in prep for discharge. maybe that will happen monday? up to doctors.

i have to go back to work by wednesday and was afraid to tell the boss that i have to take husband to doctor thursday to get staples from his knee replacement surgery New Year's eve removed - hell i've been out 3 weeks! fortunately 4.5 of those were holidays. .

9am

mom was so sweet this morning since she got sleep. She didnt drink much Ensure for breakfast and now back asleep.

doctor (heart) just came by and said her heart rate was regulating fine. her lungs are clearing but he said that could take weeks and requires getting up and moving around. he said she would feel better the more she does and noted she didn't eat breakfast.

she's back asleep now. maybe she'll get more activity later today




Which Facility?
Mom has to be transferred to a rehab facility as most available help for in-home care requires the person to be able to clean and dress themselves. Mom was no where near capable of that, so it was time for quick research to find a suitable and good facility.

There are several websites that provide review information and comparison data on nursing homes by zipcode. This data usually includes inspection results and possibly personal reviews. Important data to us was ratio of nurses and aides per patient and hours per day per patient for therapy and care....in addition to all the inspection results. It takes very little time to tap this resource of information and make an INFORMED decision in a short amount of time -- one weekend.

We chose a facility that was just a few miles from my sister's home and near Mom's best friend. The facility is NOT long term care, it truly is about rehab and Mom's friend spent three weeks there the year before to rehab from breaking her shoulder. Mom's friend even offered to go see Mom a lot if she could get in that facility. My sister and I visited the facility that Saturday and were impressed -- no smells, people looked good -- they even had a neighbor dog visiting :-)

So, that next Monday, January 12, 2009, Mom was transferred by ambulance to the rehab center. At this time Mom was not real aware and slept a lot and very very weak. She was setup in a room that did not have another patient -- an empty bed. We got her settled that day and tucked in for her first night.

..............to be continued................

Thursday, January 29, 2009

The Beginning .... of heart failure & some history

History
Mom turned 87 December 22, 2008. About 5 years ago she was told she should have a pacemaker as she was diagnosed with "sick sinus syndrome" -- meaning the heart had poor rhythm or arrhythmia. Mom didn't want a pacemaker....her feeling after seeing our Dad's final journey was a person may be better off is the medical society did not prolong the aging/dying process. Now most know that pacemaker's are pretty easy fix, but Mom was 82 and she just didn't want anything done that would prolong the inevitable. She even received confirmation that her decision was the right one as soon after she made the decision, there was this 'recall' of some pacemakers.
Arggggghhh!

In October 2008 we noticed Mom had this cough that was just hanging with her -- she was a smoker, so we were a bit slow to react. Mom had lost all faith in her general doctor and I don't blame her -- he paid her very little attention. She did finally agree to go and he simply listened to her lungs and wrote her a prescription for a standard antibiotic and some cough syrup
that should not be prescribed for anyone with a heart condition!
. The cough syrup was used only once at it made her loony and should not be prescribed to someone with heart irregularities! She completed that first round of antibiotics, had a chest xray in a few weeks as the cough was still present. She completed the second round of antibiotic (a different one) and then several weeks later went for another chest xray. This time my sister notices something on paperwork about "pneumonia" - hhmmmmph! So, by December, the doctor starts her on a third type of antibiotic and again a brand that should not have been prescribed to someone with heart irregularities! This woman was living independently and driving a couple times a week -- to get her hair done, or pick up food or go to the doctor / pharmacy or maybe lunch with a friend. She was certainly 86 but she was doing "ok" -- but this continued cough and multiple rounds of antibiotics was just taking it's toll on her. Prior to all this Mom only took a multivitamin and baby aspirin per day.

Mom started this third antibiotic on December 18, 2008 -- Thursday. I live about 5 hours away but called her every morning on the way to work and every afternoon on the way home. I knew that Thursday and Friday something was going on because you could tell she didn't feel good. My sister lives near her and also suspected something wrong.
Thursday morning my sister awakes from a dream where our Dad is telling her Mom is going to die that weekend. She awakes crying and distraught.
My sister goes to see Mom that Friday afternoon during lunch and sees her ankles swollen huge -- Mom is a petite and frail little woman. My sister calls me that evening and tells me about Mom and her dream. I recognize this as heart failure and I had suspected since October the cough may really be the start of heart failure. We talk and finally sister rushes to Mom's to convince her to agree to go to the hospital.

The first hospital admission
I guess we have been very fortunate as other than a hysterectomy when she was in her 50s and a mastectomy when she was 70, Mom has been pretty healthy and has managed to stay out of hospitals and away from medications. Well, December 19th Mom was admitted to the hospital's cardiac telemetry unit with heart failure. Mom's heart was racing (120-170 bpm) and throwing blood clots due to the arrhythmia. So, they start her on medications to slow her heart rate, get rid of the fluid build up and thin her blood.

Mom turned 87 in the hospital on December 22nd.

They discharge her on the 23rd with a ton of medications and instructions to have her blood checked in a week for the blood thinner. Oh -- and go ahead and take that antibiotic she started on the 18th since they had created cellulitis in her arm from the IVs. So, we go home with a pill sorter and begin R&R and building a new routine around all these drugs.

By that Friday -- after Christmas -- we realized the skin issues on her ankles are not from the previous swelling but actually from HIVES from that same $@(By that Friday -- after Christmas -- we realized the skin issues on her ankles are not from the previous swelling but actually from HIVES from that same $@($& antibiotic! amp; antibiotic!
Arggggghhh!
So we stop that drug. By Monday she is so weak, but goes for the blood test. They say her blood is twice as thin as it should be and to stop the blood thinner and come back Wednesday.

Tuesday -- the next day -- she is vomiting and has diarrhea and calls my sister. They have to call 911 and have her rushed to the hospital with a heart rate of only 20 in the ambulance!!!

To be continued................