There’s No Place Like Home

Between the advances in medicine and the development of so many wonderful pharmaceuticals on the market today, the lifespan of the average American is increasing. On the surface, this sounds like a wonderful extension of the fulfilling life many have come to know in their prime. However, oftentimes it is just the opposite.

I have become acutely aware of this recently as I have assumed responsibility for my own mother’s care. This began at her age of 85. Mom is completely in control of her mental faculties; still insisting to add all her expenses each month in her head rather than using a calculator. She routinely corresponds with those she has known all her life from NY and elsewhere. She remains active in her Civic Association and serves as Crime Watch Coordinator. She is a real pistol. But mom’s age is taking its toll.

After a successful mastectomy surgery last fall, mom suffered an extremely serious bout of osteoporosis leaving her all but paralyzed for several months. After much rehabilitation thanks to some terrific nurses at a rehab facility and affiliated with home health, her mobility was restored. But, she would never be the same. She is no longer able to drive and does not possess the strength to manage her daily activities without assistance. Here are some of the things I encountered when taking over her care:

Medications

Although in what most would consider very good health, my mother was prescribed and taking 17 different pills each day. This onslaught of chemicals consisted of vitamins, heart medicines (blood pressure, blood thinner, pulse regulating) and painkillers. As with anything-coming into this regime cold from zero to 17 was quite startling. But, for mom, she would sit at the dining table looking much like a chemist preparing all her dosages before breakfast; taking certain ones before eating and others after. It was impressive that she was able to keep them all straight; impressive, but not consistent. While using one of those day pill dispensers (S,M, T, W, T, F, S) she lost track of what had been placed where. In fact, she had placed two of the same pill in one of the days. The pill she happened to double was metoprolol. I caught this and corrected it – but the outcome would not have been favorable.

Rehabilitation

The purpose of a rehabilitation facility is very specific: to restore the patient to his/her level of physical competency as noted one day prior to their most recent hospitalization. Most insurance providers allow for a maximum of 60 days in which to accomplish this. Therefore, if the physicians and nurses have done ‘medically’ all that can be done for you, a rehab facility is there to bridge the gap between hospital discharge and home. It is NOT a permanent solution.

While in a rehabilitation facility, mom regained much of her ability to scoot in her wheelchair and eventually walk with a walker. However, the population in that facility was a mixture of men and women; some older some younger, ranging in capability from physically incapacitated to just short of catatonic. Her roommate was withdrawn, disoriented and confused most of the day which left mom virtually isolated unless outside of her room in the main areas. Aside from visits from myself, neighbors and friends – her interaction was limited unless she entered the main areas of the facility.

Assisted Living

Depending upon level of functionality and social involvement, assisted living can be a wonderful step towards maintaining a modicum of independence. It is particularly well-received when the person entering already knows others in the facility such as friends grouping together. They are able to maintain their prior relationships while enjoying additional freedom of having meals provided and services offered to care for those areas of their lives they are unable to keep up with themselves.

Nursing Home

For those who reach a declining health, nursing homes provide 24/7 care. Doctors see patients much in the same manner they would be seen in a hospital. Charts are maintained, medications provided as needed. As with the other two facilities mentioned earlier, grooming services are available at additional cost to the resident.

For both Assisted Living and Nursing Home facilities, cost is the elephant in the room. This, of course, is dependent upon what part of the country you are in, the amenities you are expecting and level of care. When looking into this (and I did this only briefly) what I found most disturbing was the eagerness of the administrative staff offering to help us ‘liquidate’ my mother’s home and assets to put towards her admittance.

How to Calculate Costs

As I researched the internet to find information around cost, I came upon this calculator which, when key information is populated, will provide you with at least an estimate of your potential expenses:

http://www.aarp.org/relationships/caregiving-resource-center/LTCC.html

How to Choose

When making any major decision, one tries to gather as much information as possible. If purchasing a new vehicle, minimally a test drive would be in order. There is, however, no ‘test-drive’ for entering a facility. The only way you find out if this is a good fit for you or not is to enter it. Most facilities will allow a tour for a prospective resident and his/her family, but there is no real way to tell if you will like it. Here are some suggestions of what to look for:

• Is the staff engaging? Do they speak to the residents in a friendly manner?
• Are the residents engaged? Are there activities for them to participate in and are they often or sporadic? Are the residents interacting with each other? Do you see conversation between the residents or are they sitting staring at television or even the nurses’ station?
• Is the temperature to your liking? Some like it hot – others like it cool. If you happen to be in a room with someone whose preference is not the same as yours, it can present a problem for both.
• Do you see personal affects? Are there pictures of loved ones in the rooms?
• Are the areas well lit?
• Are there alarms? Spend enough time visiting the facility to experience when an alarm goes off. Often alarms are there to sound if a door opens to alert staff. At one facility we visited, the alarm was so deafening and sounded so often there was literally no rest to be had. This went on throughout the night, every time a staff member went outside to smoke, get something out of their car, etc.
• Is the menu appetizing? It is difficult to settle in to a new place if the food is not to your liking. Check the menu and ask to eat a meal there to see if the food is to your satisfaction. Three meals a day of food you do not find appealing makes for a long, hungry day.
• How are your personal possessions accounted for? One facility kept meticulous records of everything you brought in or out for your loved one – which was excellent. But inquire if they will mark his/her clothing? Some facilities will take a black marker and write the name inside the items. Perhaps you would prefer a name label which can be purchased rather inexpensively and sewn in.

Our Decision

After much deliberation, our family decided to keep mom at home with us. We are fortunate to have a home with enough space to accommodate bringing mom and her most prized possessions in. This also means that we are responsible for mom keeping all her doctor’s appointments, prescription refills, etc. Because our family is large, there is always someone available to help manage her appointments. The fewer the number of able bodies you have to keep up with this, the larger the impact on your own life taking in a parent or loved one will be.

We now keep records of EVERYTHING: what and how much mom eats during the day, medicines taken, etc. This is not intended to micromanage mom’s daily activities but rather provide a baseline of information should a medical professional need this information in order to treat a new health issue. It also provides a good indicator if health is declining slowly over a long period of time. i.e., if the quantity and frequency of her consumption is decreasing.

These decisions are very personal. What works for one may not work for another. But, as with any difficult decision, knowing all your options as well as understanding the needs of the patient will enable you to deduce what is best for everyone.

…and if all else fails – ask yourself, “How would I like this?”

The Roaring Ellie