UPDATE FROM EILEEN – October 20, 2007
(I apologize for its length, but I was very busy this last two weeks. I will be starting a new job on October 29. I will stay involved, but others need to be more actively engaged in order for us to make any progress.)

Based on what follows, here is recommended Strategy:

MEDICAL ATTENTION:

1. Get Home Health Nurse in. Pugh was supposed to order it for skin tear and pressure wound monitoring (and so we can get an air mattress, but so far, no contact. We can get direction from the Nurse as to how to work towards getting Mom some of her mobility back (simple, in-home exercises? Pam has offered to help us here if she is given OK and some instructions.)

2. Get Pugh to refer Mom to the Center for Success in Aging (brochure in kitchen on desk) so that we can get a geriatrician to give us guidance. I’m not so sure Pugh is up to it, but that could just be me. See below.

3. Schedule Conference with Pugh to discuss the recent down-turn and how to go about improving it and or alleviating it. Mom needs pain management care. She constantly complains and can not sleep because of it. Consequently, neither can the overnight caregivers who are then less effective in the day, every day.

Someone who has a relationship with Pugh and/or his office needs to get this done. In addition, someone needs to take the lead on Mom’s continuing and developing medical needs. Who will that be?


HOME EQUITY:

We need to get the equity in the house to a “liquid” state, but we have made progress (See Below). We can have a reverse mortgage in place in 30 days. In order to make any decisions on how to proceed, we need to know as closely as possible, just “how much money” we have.

I will continue to be the main point of contact and will work with Dan and Mary Kay to complete. This can not be done without a POA.

CONTINUE IN-HOME CARE OR MOVE TO MEDICAL FACILITY?
I have felt completely ill-equipped these last two weeks to make a rationale decision on how to proceed. That is why I think we need some medical advice and some idea on prognosis and what we can expect to happen. We can get it from the Home Health Nurse and Pugh immediately, or find our own geriatrician and get an appointment ASAP. We can get a better picture from the Center for Success in Aging, but we can not get an appointment until late December/early January. Whoever is taking lead on medical needs has quite a few options here.

Center for Success in Aging – an evaluation service of the Greenville Hospital System that “will provide a comprehensive geriatric assessment team approach to diagnosis and care planning”. To get an appointment, Dr. Pugh must call and make a referral. The earliest available appointment is end of December/early January, once he calls.

In-Home Care is our only option at this time in the short term, with potentially more need for outside care. Perhaps the Action Steps I have identified will provide us a different answer or more hope in the Long Term. Mary Kay&Bob, Vic, Tom and Dan need to stay in touch and stay involved. You are going to be needed.

I can not see us moving Mom to a Skilled Nursing Facility. Once we have a medical opinion, we might change our minds, but we can not just simply decide this and do it. Assisting Living places can not take her right now because of the pressure sores and skin tear. They would not be allowed by law to admit her.

OTHER THOUGHTS:

HOME-CARE ALTERNATIVE – Will Take Some Time to Get in Place
- I have located what I believe to be the “right” spot for Mom – The Cottages at Brushy Creek (depending on what the evaluation noted above reveals)
- Everyone should make an attempt to visit it while they are here
- It is a skilled nursing facility that has the feel of an assisted living facility (more like “home”)
- Private Pay + Medicaid
- Waiting list is “long” – 60 people for private pay consideration/100 people for Medicaid consideration
- Admittance is not necessarily “first come-first served”
- Application is submitted which generates a second paperwork step that is more comprehensive
- Team of Social Workers gather to review applications and determine which applicant can benefit the most from their services
- I made the case to this Social Worker that Mom’s recent decline could possibly be related to an overall inattention to her physical and social needs as a result of the in-home care – the initial reaction seemed positive from the SW who said “yes, this would be the type of thing that would receive more attention on the application.”
- Application is coming. I will take lead on getting it completed and returned.

ASSISTED LIVING and SKILLED NURSING FACILITY SEARCH
- Because Mom has a pressure wound and a skin tear, she would not be eligible for any Assisted Living residence until they are healed
- It is hard for me to imagine that we could make a move to a Skilled Nursing Facility, which is an institutional alternative, that she would outright reject – (think NHC-Mauldin and the rehab facility – that’s what they are like)
- In my opinion, we would be better off making her move downstairs and get the benefit of more activity to be provided by the home caregivers than to force this alternative (EXPLANATION: What I like about AL settings is the level of activity and socialization that they get – exactly what they don’t get in a SNF)
- Admittance to both AL and SNF is based on bed availability – we could make advance application, but it seems to me that we have to first decide that this is the route we are going to take – otherwise, we should put our efforts into determining how to continue in-home care and

- IN THE MEANTIME, wait out The Cottages at Brushy Creek which seems to offer exactly what we need

CONTINUING IN-HOME CARE IN THE LONG TERM
Outside Caregivers are committed to continuing, but they will need more of our support than ever in terms of additional expenditures on supplies and equipment as required (wound care and air mattress, for example) if not our physical presence when we are able to be there.
We have to continue In-Home Care for the time being, but we need to re-assess our resolve for the long-term. When you are here, please consider very carefully your ability to provide the level of physical care that is required on an on-going basis. What I am suggesting are two things: (a) We might need to provide Maggie with additional help in order to keep her going; and (b) You might need additional help from Maggie or someone over the weekends you are now taking (3 nights/two days).

We need to keep any decision-making we do in the context of the impact on Tom and Dan. In my opinion, if I had not been here for the last two weeks, Tom and Dan in particular would have had to been very “hands-on” with getting everything “set up” for this new phase of Mom’s physical condition. Maggie, Pam and I have experimented, analyzed, adjusted, purchased items, etc. to keep things going.

FINANCING CONTINUED HOME CARE OR MOVE TO A FACILITY
· We received the HUD Certificate that was the required first step for getting a reverse mortgage in place. (Thanks, Dan!)
· The Certificates are valid for 6 months
· If there are alternatives to the reverse mortgage, we need to get them on the table
· If there are no alternatives, we need to make it happen
· One of those with financial POA has to be involved now to the end of the process
· Next step here is reviewing take-down options and getting it in place
· Once this mortgage is in place, we will know exactly “how much” we have to work with