Archive for February, 2008
Who’s Minding the Store?
Tuesday, February 26th, 2008
There’s no job more important than being a tireless advocate for your loved one.
Part Two of What We Learned at the Skilled Nursing Facility
Common Sense is Not Common
You don’t need a crystal ball to figure out that a frail 90-year-old stroke patient with a blood clot in her brain and a previously fractured hip and wrist might need rails on her bed. It was late at night when we finally completed the transfer from the hospital to the skilled nursing facility. We did not do a complete assessment of her accommodations. That was a big mistake.
Carolyn (who was wheelchair-bound before the stroke) forgot that she was not ambulatory. She tried to pull herself up by yanking on the curtains and fell out of bed. She broke her ankle and had to be transported by ambulance to the doctor’s office where they encased her leg in a bright blue cast.
The skilled nursing facility staff continued to insist that they did not have a bed with rails. After some "gentle persuasion" on our part, they miraculously found one. Then they put her call button on her right side–the side weakened by the stroke. Because she could not lift her arm, she could not push the button to call for help.
Just Following Orders
The robotic nursing staff continued to carry out the doctor’s orders whether they made sense or not. During one visit, we found them trying to force Carolyn to swallow an ibuprofen tablet. She was not in pain and had stopped eating. I was afraid that pain pills on an empty stomach could lead to bleeding or a stomach ulcer. The doctor agreed with my diagnosis when I called him, but he never gave an order to cancel the pills.
One of our greatest fears was that Carolyn would aspirate or choke on her food. At first, we insisted that a human "feeder" be present at every meal. Later, the cafeteria staff continued to deliver huge trays of food despite the fact that she was no longer able to swallow. Even sips of water pooled in her mouth. I don’t blame the kitchen workers. They had no communication from the nursing staff.
Doctor Disconnect
"I’m always optimistic." That’s what her doctor said every time we called him. That was because he had not seen her.
We visited almost every day and called the charge nurse at least twice daily. In a bizarre role reversal, we would visit Carolyn, make observations about her refusal to eat, her congestion, or her rapid descent into dementia, then report back to the doctor–rather than the other way around.
At one point, we reported that whenever we were there, she never seemed to eat. We inquired whether they monitored her input and her output. We asked to see what information was being captured in her medical chart. That’s when we learned that she had lost 14 pounds in two short weeks.
When we demanded to know how often she was seen by a physician, we were shocked to learn that at this skilled nursing facility, the doctor only visits every 20 days.
The doctor did send us a reminder card for her routine physical. It arrived the week after she died.
What Nobody Tells You About Nursing Homes
Wednesday, February 20th, 2008 
I have book shelves and file cabinets filled with caregiver resources. I still had a lot to learn.
As we juggled two businesses, my mother’s health and our own health issues, we spent as much time as possible at the skilled nursing facility where Paul’s mom was a patient. We drove more than 50 miles each way to visit almost every day and called several times each day.
It all happened within a few days–first a stroke, then a rapid descent into dementia, infections and more. For everyone’s sake, we needed to transfer Carolyn to a facility closer to us. We didn’t have time for all those lovely checklists about how to choose a nursing facility. We needed a bed and we needed it now!
Here are some of the things we learned along the way.
Admission Roulette
"Your mother will have the next available bed."
That’s what we heard day after day. After three weeks of daily assurances, we called the corporate office to expand our search. That’s when we learned that the facility had a referral coordinator whose job it was to put people (other than Carolyn) into the open beds. We learned that any doctor who is discharging or otherwise concerned can refer patients who bump you out of the queue, regardless of promises that, "You’ll have a bed by the end of the week, for sure."
Don’t rely on the promises of admission directors. Work more than one lead at a time.
Insurance Catch 22
If you attempt to transfer your loved one to a skilled nursing facility closer to you, you may find that you can’t get there from here. The nursing home won’t accept your relative until they secure insurance authorization. If you transfer the insurance before a bed is available, you are up a creek without coverage.
If your loved one is enrolled in an HMO, there’s a good chance that her medical insurance is tied to the location where she presently resides. If you try to move her to a facility closer to you, you must complete a change of address form and other paperwork by the 15th of the month for coverage to be effective the following month.
Before that happens, you must find an IPA (medical group in human-speak) in your area, and a physician must be willing to accept your relative as a new patient. This relates to the medical portion of the care received at the facility and not to the custodial care that is not covered at all unless you have long-term care insurance.
There are many resources available to help you calculate what portions of the care will be covered by Medicare and when private payment kicks in. We listed some of these resources on the CAREGIVER page of this site and in our Amazon Associates store.
Find out everything you can about your parents’ insurance coverage BEFORE they need medical care. If a crisis happens, it may be too late to make arrangements and you may find yourself stuck in limbo. I’m reminded of that great line by Helen Hunt in "As Good as it Gets"–the one where the audience erupted into spontaneous applause.
No Good Deed Goes Unpunished
Saturday, February 16th, 2008
This week it’s diet soda. A new research study in the journal Behavioral Neuroscience suggests that low-calorie sweeteners may be more fattening than sugar. They may even contribute to weight gain.
So much for good intentions.
We’ve all done it. Maybe we trained too hard and tore a muscle. Or we went for a walk and tripped on the curb. The news about superbug staph infections in locker rooms is enough to keep many of us away from the gym.
It can seem that no good deed goes unpunished. My last visit to the dentist is a case in point. I know all the horror stories about gingivitis. I know that gum disease can become a systemic threat. So I embarked on a campaign for oral health.
I bought a Sonicare® electric toothbrush. I followed up with manual brushing. I flossed. I used my Waterpik® religiously. I thought for sure my dentist would be pleased. Silly me.
Instead of praise for my zealous oral hygiene, I got a stern lecture from my dentist and the first of what may be several fillings. Why? My manual brushing was the culprit. I brushed too hard and caused abrasions on my gums. In Dr. O’s words, “My dear, you caused this with your own hand.”
Have you ever had a health-promoting resolution backfire?
Sucking the Life Out of Me
Monday, February 11th, 2008 
“When all is said and done, killing my mother came easily.”
—Clair Knightly in The Almost Moon, a novel by Alice Sebold
So begins a chain of events that will hold you spellbound. This is a book that I couldn’t put down. It’s a bit like driving past a car crash. You don’t want to look, but you can’t help yourself.
Reader beware. Clair’s tale is not for the squeamish or faint of heart. It’s filled with profanity, explicit sex, and the grisly tale of a daughter who murders her mother.
Clair Knightly is a fictional character, but her story is all too real. Sebold opens a wound– one felt by many baby boomers who are caring for their aging parents. According to the California Department of Social Services, 93,517 cases of elder and dependent adult abuse were reported between 2005-2006. In more than two-thirds of the cases, the abusers were family members.
The Almost Moon touches upon the themes of love and hate, mothers and daughters, diapers and dementia. If you are a family caregiver, you may secretly relate to Clair’s feeling that, “She’s sucking the life out of me.”
This story is haunting and scary in a real-life kind of way. Helen’s murder, while horrendous, is a chilling reminder about what can happen when caregiver burnout goes unchecked. It’s elder abuse up close and personal.
I did not include this book in my Amazon Associates store. I don’t want to make a dime from the sale of a book about mother murder. Still, there’s that car crash thing. Besides a great escape, reading this book might help someone look in the mirror and say, “There but for the grace of God go I.”
Get help before you think you need it. Learn about elder and dependent adult abuse.
The California toll-free elder abuse hotline is (888) 436-3600. For more information, contact the Department of Justice or the California Attorney General’s Crime and Violence Prevention Center at (916) 324-7863 or www.safestate.org.
If 60 is the New 30, Why Do I Feel 80?
Tuesday, February 5th, 2008
Apparently big pouty lips are out. Cheekbones are the feature du jour.
Everywhere I turn, I see photos of gorgeous celebrities who are turning 60. They tell me that “60 is the new 30.”
My hair is thinning. My middle is expanding, and my teeth don’t glow in the dark. I didn’t look like these people look when I WAS 30.
Call it sour grapes, but I can’t help but wonder how these timeless beauties would look without the collagen injections, without plastic surgery, hair extensions, oxygen facials, teeth bonding, liposuction and personal trainers.
Oprah’s magazine ran a story about “How Not to Look Old.” I thought the model labeled “The Opposite of Sex” looked sensible and comfortable. After two emergency surgeries last year, my abdomen looks like a football with scars going up and down as well as across. I guess Sports Illustrated won’t be calling me for their swimsuit edition.
I just spent the last half-hour trying to thread a damn needle. I passed my driver’s license test without contacts or glasses, so I know my eyes aren’t that bad. I swear there must be a conspiracy to make me feel old.
I figure that I’ve paid my dues and a few crow’s feet and gray hairs are testimony to the miles I tracked along life’s path.
How about you. Are you comfortable with the skin you’re in or have you made plans for a nip and tuck?