Furnance

Found a document in Mom's files re: furnace. Action Services (2419-B Wade Hampton Blvd, Greenville 29615 864-292-5600) put in a Quatro (100,000 btu) Upflow Gas Furnace in on Nov 10, 1994 for $2,040. Also notes a 20-year warranty on heat exchanger (whatever that is) on the document.

I asked Maggie to see if there was a document in the furnace room; she found something with a different furnace name but with a 20-year guarantee so don't know if it's the same one (no date on the guarantee). We'll bring a copy of the document we have and check this out this weekend. Hopefully, Mom's furnace is still under some type of guarantee.

In the meantime, can we confirm that we're using the same furnace people that are on the 1994 document? If not, they might not be aware of this guarantee.

Mom's Eye and Kathy Green, Connection One

Since we'll be coming up this weekend, we thought we'd take Mom to the eye doctor. We can't make it by 9:45am tomorrow morning due to rush hour traffic in Atl so I called Dr. Ballinger's office to see if he had another appt time. Talked to Paige, his assistant, who said as long as Mom doesn't have pain in her eye, which she doesn't, we could wait until Monday at 9:00. So that's what we'll do unless Dan or Tom want to take her tomorrow, which is OK with us. If her eye gets a lot worse, or she develops pain, Page said we could call the doctor-on-call and bring her in over the weekend.

Also had an initial assessment call with Kathy Green (2 hours) who will help us get into the UMG Senior Center of Greenville Hospital System for a geriatric evaluation, develop a care plan recommendation and advise us along the way. She was very impressive. She sent me the referral form that the Center requires Dr. Pugh to sign. I put a call into Tracey (Pugh's assist) and sent the form over via fax. I'll let you know if there are any concerns or delays. We are trying to get Mom into an appt on Nov 29 which Kathy had reserved for another client but is now cancelling. No guarantees but we're hoping to benefit from Kathy's influence/contacts here - otherwise there is a several month waiting list.

AMBULANCE TRANSPORT

Vic - A question about the ambulance services you called. Will they enter the house and take Mom out on a stretcher? This is what we need. I'm just looking forward to any need to get Mom to the eye doctor. As Dan states, we are confronting a nightmare if we have to get Mom out of there consistently.

A move downstairs? Should we do it? Does it make sense? Do we go ahead with not only the chair lift but the furnace? Getting a new furnace will require some effort, i.e., shopping for the right one, etc. I don't think it's something we should simply just settle for. But maybe I'm wrong here. Other thoughts?

Let's keep our eye on the ball here so it does not become too burdensome on any one person.

Thanks.

Eye problems

Maggie called me this afternoon to report the left eye is getting red. Gwen will treat the left eye the same as the right eye tonight and Maggie will report how it looks tomorrow. I have a very bad cold that I can't shake and plan to go to the doctor myself tomorrow. I've been sick since last Friday. Tom is riding with his boss tomorrow. After Maggie reports Mom's condition, I'll call the eye doctor seeking treatment advise. If they insist on office visits as they have done in the past (ie, every other day or even once for that matter), we have serious problems.

Dan

Mom's confusion re: where she lives

Maggie called me this afternoon somewhat distressed. Before she could even get into what the problem was I could hear Mom crying out in the background that she "wanted to go home, somebody help me, I don't want to be here". Evidently as Morris was leaving several minutes earlier and told Mom he was going home, Mom launched into a confused discussion about where he was going and why was he leaving her there - she wanted to go home too! This went on for a bit as both Morris and Maggie tried to explain to Mom that she was already home and that Morris was just going to his apartment. Mom wasn't accepting any of that and continued on.

Morris left and then Maggie called me because Mom was still carrying on and she didn't know what to do for her. I got on the phone with Mom and tried to explain that she was already home, which she didn't want to hear from me either. I then tried to get her to describe her "home" to me so that I might be able to tell if she was talking about Pittsburgh, Indianapolis, etc. She was angry, didn't want to talk about it, handed the phone back to Maggie, and continued to call out.

I then suggested to Maggie that she get Mom into her wheelchair and take her to other parts of the house so that she might get her bearings and realize where she was. Believe it or not, it worked. Maggie took her back to her bedroom, combed her hair (which helps calm her down at times) and asked her if she remembered this was her bedroom. "Of course, I do" and then all was well and calm. Maggie then took her back to the kitchen.

Maggie told me that Pam had told her a similar thing had happened last week - Mom not realizing she was home, thinking someone had left her somewhere. Trying to reason with Mom doesn't seem to work; playing along and saying, "OK, let's take you home" and then taking her around the house, etc. seems to work. I mentioned to Maggie she might want to let everyone know that when the time comes to leave, just leave with as little fanfare as possible - not making it a big farewell telling her you're going home.

So two times now within a week - could be a new phase of her dementia. Thought you should all know and not be surprised if it happens to you.

Weekend Update

My weekend was similar to MK's, and I was alarmed at the changes I saw since my last weekend 4?5? weeks ago. Even with one and a half Ambien pills Mom slept very little. She cried out a lot, and every time I went to check nothing seemed to be wrong unless it's the bed sore. She ate very little, and it was hell trying to get her to take her pills. Can we get these meds in liquid form? We tried to crush them up and put them in food, but it was difficult. Since my last visit I noticed a significant change in dexterity. She cannot grasp pills anymore. Sometimes she can with difficulty, but it's slow going and frustrating for her. She can still hold a fork, but with the same slow effort. Also I noticed that she doesn't read anymore. On Sunday Jackie came over and gave a short prayer service with communion, Mom conversed with her, smiled at the jokes, even made some of her own now and again, so she's still active mentally. We watched "The War" dvds and movies on TVand she's perfectly fine talking about them. Four weeks ago she was able to "slow dance" to the bathroom, but she told me very clearly this visit that "she can't go in there." She can hardly stand up. Was this a down cycle? Permanent trend? I guess we''ll see.

Back to the Sleeping Issues for a second

Talked to Maggie this morning. Ambian (at 5 mg - one pill) isn't really giving Mom the relief that she needs. I called Dr. Pugh's office and they recommended giving her two pills (10 mg) to see if that will give her the sleep that she needs. I gave Maggie the info and she will give Mom that dose tonight. We'll see how that goes.

Heating problems

I had to call out a service tech for the heater last week and this week. They replaced the main board last week and the heater worked for a few days then failed again. Maggie called me late Friday (3PM) and I got the service tech out there again but there was nothing they could do until today.

They had to replace the same main board so they think something else is causing the failure so we should expect it to fail again unless it was coincidental that the replacement board also failed. Today they replaced the main board along with the thermostat because it is relatively inexpensive and worth the try. If the main board goes out again, we will need to replace the furnace. The rough cost will be $2700 installed assuming the newer units fit in the existing space.

It will be getting cold here starting tomorrow (low 30's) so we will need to pull the trigger quickly if the furnace needs to be replaced so be sure funds are available in the account. I suggest putting $3-4k in there at all times so that we can quickly handle these sort of issues.

Dan

SCHEDULE NEED

As we all know, Maggie is going to be on vacation from and including December 20 and flying back on January 3. She will be available for work on January 4 per the usual Schedule.

Jane arrives on December 20 at 8:00am which is no problem for any transition since this would be morning that Gwen would be covering. Jane will advise on outside help needs after her Thanksgiving weekend extended stay so we'll address the transition time at a later date.

MORE IMPORTANTLY, HOWEVER, Jane leaves at 10:00pm on WEDNESDAY, JANUARY 2. We'll be OK for the overnight since this is a Gwen night, but we have an issue for THURSDAY January 3 from 8:00am to FRIDAY January 4 at 8:00am.

Any suggestions or volunteers? I'm thinking that PERHAPS someone would have availability since this is a slow week after the holidays typically.

If there is no family member availability, we'll have to schedule a combo of Visiting Angels and possibly Gwen to cover (maybe the overnight?)

Let me know as soon as you can so that we don't this hanging out there as a To Do.

Thanks.

Also, I'm working on the January-February-March schedule. Please advise if you know of any times or dates you will be or will not be available, if you already know them.

Thanks again.

Eileen

Sleeping Issues

Talked to Tracey at Dr. Pugh's office and explained Mom's difficulties re: sleeping.

She looked at the list of meds she had on file for Mom and thought that she already had Ambien but I explained that that was discontinued a while ago (I'm not sure when or what the circumstances were). She will be talking to Pugh but felt that he would surely prescribe Ambien again. I suggested that they prescribe the lowest dose possible and that we increase it if the lower dose doesn't do the trick. We'll likely start with 5 mg and then go to 7.5 mg, or 10 if that doesn't work (not sure what she was on the last time or what the negative impacts were). Tracey says that Mom has the signs for Alzheimer's/dementia - mixing days and nights and calling out for help during the night. This sleep med should help her get into a better cycle. Also, I asked Maggie to start keeping track of Mom's sleep patterns - when to bed, when to rise, how the day went, how the night went, etc. - so that we can give Pugh good feedback in a week or so re: Ambien.


I'm waiting for Tracey to call me back to confirm that they've called the prescription into BiLo.

PS: Mom now has two air mattresses - one for her bed and one for her wheelchair. Maggie says she's been sitting in the wheelchair a good part of the day in the living room or in the kitchen watching TV - awake, and not complaining, most of the day. She has been very resistant to sitting in the living room for a while so this is a good development - a nice change of scenery.

Last Weekend Update

Don't feel I really need to go into a lot of detail since we experienced very much of the same as others have described. BP is low 90's, which I think is OK but lower than she has been recently. Mom is very weak and looks like she's lost a lot of weight since the last time we saw her (she's too weak to stand so she hasn't been weighed for several weeks). She drinks several glasses of juice, water, coke, etc. but only eats a bite or two of sandwich. We bought some Ensure to bolster her nutrition somewhat and she seems to like that somewhat.

Transitioning her from bed to commode to chair, etc. is doable but difficult. Lucky for me, Bob did most of those transitions; I'm not sure I could have managed, at least not very easily. Once she's out in the kitchen and doing her thing everything went very smoothly - it's really the transitions and the toileting that are challenging. With a little more "training" I would probably get a lot better at it (per Maggie, who seems to manage fine.) The Interim physical therapist suggested a special belt that she will provide that Mom would wear and give the caregivers something to hold on to other than Mom's arms, etc. (trial basis only).

Two problems we encountered - taking pills and sleeping. It was very difficult to get Mom to take her pills even though she has always been a very good "pill-taker". It was an all-day affair rather than 4 times a day. If you're not careful, she'll hold them in her mouth and spit them into a tissue when you're not looking. When Lisa was there on Friday we discussed the potassium pills, which are the largest and most difficult pills to swallow whole (though the antibiotic is also difficult). Lisa said a symptom of low potassium is leg cramps. Saturday morning Mom woke with a very bad foot cramp. Concerned that it might have other implications, we called Pugh's office and talked to the doctor on call who suggested cutting the potassium pills into 4, which we did. Also, recommended giving her quinine, which is found in tonic water, which we did. So far, she seems to be taking the potassium and likes the tonic water with OJ and no recurrence of leg/foot cramps.

First two nights Mom slept all night, almost 12 hours each night. We had given her the Lortab and attributed her sleeping to that. Sunday night we did the same but she was awake most of the night. Per Maggie, she slept Monday night but last night Gwen said she was up all night. For those who haven't experienced it, Mom calls out for help continuously (like a mantra, "help me, help me, somebody help me") but doesn't seem to be in pain or need anything when we go in to check on her. At times she seems to be half asleep and not totally conscious of what she's doing - but keeps calling out. At one point we let her continue to see if she would tire herself out and go to sleep but she didn't. She can go on for hours. While she can sleep in the chair the next day, she's probably not getting good sleep. Even after the two nights of 12 hours of sleep a night, Mom still sleeps most of the day even when we try to engage her with something to keep her awake. The Lortab prescription is not renewable and will soon run out. I know there are some downsides, but we could consider asking Pugh for an actual sleep medication so that both Mom and the caregivers can get a good night's sleep.

I think that's it but let me know if you have any questions.

Oct 31 2007

v good info on transport ... big pricing discrepancy ...

Note on blog settings: I unknowingly disabled comments when updating blog settings, as in no comment-capability on Vic's post ... should be back now ... also changed settings so now comments open in new window ...

Transportation

Eileen, thanks for all the work you did while you were down here. Sounds like you guys got a tremendous amount done. I'm going to visit the Brushy Creek place if I get a chance. Rose is going to join me Sat. afternoon so I may be able to get there. For what it's worth, I looked up some ambulance services in Greenville. If it helps Tom, Dan and the caregivers here's the info: Bowers Emrg. Svcs 269-7888, $125.00 plus $3/mile. round trip. Medshore Amb. Svcs. 235-8888, $30,one way and $2/mile. There's a Kadi Med. Svc, but they haven't responded to my request yet. Mom needs to be in a wheel chair for transport and Maggie can go in the ambulance with them, but they have to know if she's going in advance. If Mom is non-abulatory they'll put her on a stretcher. Both companies need at least 24 hrs notice, and payment is due when services are rendered. Bowers said they would file for ins and refund the fees if they got paid. They don't stay while Mom is at the doctor, but come back to get her when called, so there would be some waiting time involved. I have no idea if insurance would pay. At any rate it might help with the "heavy lifting" and time away from work for doctor visits.

ASSISTED LIVING vs NURSING HOME vs HOME CARE

We need to discuss these alternatives with the Social Worker. While I agree there is a big difference between Morris and Mom in terms of Assisted Living, there is also a wide-range of Assisted Living facilities and tolerance levels for ADL (Activities of Daily Living) support. Not everyone in AL is as capable as Morris by any means. Morris and the people at Westminster are truly independent. This is not what you see at other AL facilities necessarily - and this is why the Nurse and maybe even the SW will be non-committal in terms of where Mom should go. It is the word "probably" that is the key word for me. Why is there no certainty around th is? What are the gray areas?

Also, perhaps if we could simply improve her transfer capability we would be on better ground to qualify her for AL in general. We could get her into The Havens relatively quickly, but there is no attached SNF. So another conundrum.

For the moment, we have to continue with Home Care, so I'd like to question both the SW and PT on how best to continue. Here is what I would ask:

a. What are we NOT doing that we should be doing? Can anyone explain why the walking ability just left so catostrophically? It seemed like it was overnight. Is there any way to get that back?

b. How would one go about evaluating just how Memory Impaired Mom is? Do we have a diagnosis on this? Is she truly impaired or is she merely exhibiting normal behaviour for an 82 year old? What impact would this have on an AL facility evaluation?

c. What other resources are there for assistance with improving her physical ability?

d. Is she losing her ability to swallow and is that why she is having difficulty in taking the meds?

e. Why is everyone non-committal about her qualification for AL? If it is not black and white, then there must be an AL facility out there that she would qualify for, right? There appears to be varying tolerance levels at AL facilities for additional care.

f. How does one prepare her for a "move" if this does not play out like we want it to, i.e., that she would be totally unaware of her surroundings or have a medical condition that would require hospitalization, then a move, etc. Would the SW help guide the conversation?

g. How is the best way to complete the application for The Cottages at Brushy Creek so that she can move up the waiting list? What conditions would need to be present to convince a table of Social Workers that Mom would be a viable candiate for the help they provide? (See prior posts. This is the facility with a 60 person waiting list that is a Skilled Nursing Facility that has the look, feel and operation of an Assisted Living Facility. It is THE place for Mom when we are done with Home Care.)

OTHER GENERAL QUESTIONS:
1. Would additional outside support on Sunday nights (and potentially for a short period of time on Saturdays for bathing/toileting) provide the necessary support for Weekenders to continue the Home Care Scenario for the time being? If yes, then how does this impact fund availability?

2. Should we set a "date" at which time we will abandon Home Care and move the Nursing Home Care?

3. Where are we now, on personal levels, in terms of where we think the best place is for Mom to be?


Believe me, there are lot more discussion points, I know. But these are constantly swirling around in my head. My fear and agita is over the very real possibility that Mom is not near the end and that she could go on and on for more than a few months just like she is. I think we are at decision time and need to reassess where we stand relative to Home Care vs AL/SNF. I for one hear and feel the Home Care commitment falling away - for many valid reasons. We are at a cross-roads.

Meeting With Interim health care Today I met with Lisa from Interim. I think most of us now the drill. She came in to evaluate Moms condition and attend to the leg wound. She told Maggie,Morris and Me that she will have a social worker call me and set up a time to discuss the needs of either assisted living or a nursing home. If anyone has any questions or ideas, please e-mail them to me.(tom.lanahan@bms.com) I will let everyone know when the appointment with the social worker will be scheduled..She didn't have a lot of information for me on this matter. She felt like it was to late for assisted living. Think about Morris's condition and compare that to Mom. A big diference in my opinion. The social worker would be able to give us better information on which way and how to proceed. I will get a call sometime this week and set up an appointment with the social worker.

She is also having a physical therapist call to evaluate Mom and to see if we make things easier on all the caregivers. This is also where we can get the information on an air mattress for the bed sores.She gave Maggie some diferent bandages and saline for all of Moms wounds. This way we don't have to change every day. Lisa will be back this Friday to replace the bandages. I'm sure everyone has a lot more questions or thoughts or ideas. Please let everyone know what they are.

As far as Moms condition- I agree with Eileen and Dan. It is a lot more dificult to attend to her needs. More help is needed. Dan and I can't be there on Sunday nights getting up every half hour to hour and a half and then go to work Monday am. This will not work for us. He and I will discuss who we will call for a Sunday night stay.

Tom

FURTHER THOUGHTS

After having been with Mom and the caregivers for two weeks, here are a few other thoughts:

1) We need to continue to insist that she feed herself. She CAN feed herself if she is positioned upright in the chair, with the tray as high as it can go, and with her elbows free. Put a "clothes protector" (bib) on her. Once this goes, we are again in a very different neighborhood. She has to be prodded. She's hungry because she asks for food, but will give up easily. Next step in my mind is to give her strictly finger food - no foods that require utensils.

2) Her body is giving in much sooner than her mind which is going to make caring for her much more physically demanding. It is already close to being too hard for one person to handle, with bathing and toileting being at the top of the list of difficulties. The alter ego who appears at 5:00pm ("Helene" as Maggie calls her) makes it even more difficult. She is not going quietly into that goodnight.

3) If we require more outside help, we'll be spending more money. Each of us needs to evaluate how we feel about continuing home care. I for one think we need a medical assessment so that when we are at the decision time, we have all the information we need. I do not know what would the the tipping point between Assisted Living Facility and Skilled Nursing Facility. I am a proponent for Assisted Living. The only thing disqualifying her presently are the wounds she has. Once these are cleared, the longer we wait, the more we are sealing her fate, i.e., a Skilled Nursing Facility (nursing home).

That's all.

Weekend update

Mom is declining much more rapidly than just a few months ago. This is not a temporary downturn or one we can reverse. We need to focus on what's best to manage the suffering and pain. Today a strong person can handle the physical care needs but soon it will require two people.

On Saturday, Mom was up during the night every 45 minutes moaning and calling for help. She seems to be in pain but can't really express where or what it is. I think the pain is all over but it's hard to tell because she can't really express herself well, especially at night. I filled the prescription for Lortab (pain med) that was given to her when she went to the emergency room for the cut on her leg. The prescribed dose is 1 -2 pills every 4-6 hours, I believe. On Sunday, I gave her 1/2 dose at bedtime but it did not help very much. She was up every 1 - 1.5 hours calling for help but there doesn't seem to be anything you can do to help. I'm not even sure she realizes she is moaning and calling for help.

I asked Maggie to try 1 pill (as opposed to the 1/2 I tried). She had Pam give it to her at 8:00 PM and Maggie reported today that Mom slept until 4:30 AM before doing same as above but then went back to sleep until 9:00PM. They will continue trying this during the week to see if this makes a difference or if it's just coincidence. If it makes a difference, then we can talk with Pugh about a long term pain med regimen.

I can certainly take the lead to sit down with Pugh to discuss the long term care needs but if we are considering seeking advice from someone else because we don't think Pugh is the guy to manage the care then I don't think it makes sense to speak with Pugh.

Dan

ADDITIONAL UPDATE 10 20 07 - ITEMS PURCHASED AND AVAILABLE

October 20, 2007

WHAT I HAVE ACQUIRED FORM COSTCO AND WHERE IT IS LOCATED and FOODS IN FREEZER*

*For those of you who think I may have squandered caregiver funds, fear not….I am contributing these items to the Caregiver Cause.*

What I have acquired from Costco and Where Located

Lysol Toilet Bowl Cleaner – In each bathroom
Pine Sol – In Mom’s bathroom
Baby Wipes – In Mom’s bathroom
English Muffins – In Freezer
Whole Wheat Bread – In Freezer
Depends – Size Medium - Mom's bedroom
Kleenex - In hall bathroom

Wound Care Needs that are OK for about another week and a half, but some will need to be replenished (these are all in the Wound Care Basket by Mom’s Bed):
Non-Stick Pads
Wrapping Gauze
Gauze Pads
Hydrogen Peroxide
Sterile Saline Water
Cloth, Non-Stick Tape
Polysporin (can only be found at Walgreens in a large enough size to make any sense)**

Food for Consumption in Freezer (Pam is going to take the soup out the day before and defrost it.)
Turkey Noodle Soup – She likes/accepts it.
Vegetarian Vegetable Soup
Beef Vegetable Soup
English Muffins
Whole Wheat Bread

Medications
Dr. Pugh refilled all medications, so refill numbers have changed. The paperwork is in the Meds basket with a reminder note. The only refill I have filled on the NEW meds is the furosemide. This is noted as well. (NOTE: If meds are not refilled by Pugh during an office visit, his office charges $20 to update and call in the refill to the pharmacy. The Pharmacy can not call Pugh's office on Mom's behalf - per Pugh's policies.)

Mom is having a very difficult time swallowing the larger pills. Be prepared. Best way is to have her stick her tongue out with the water close by, you put the pill on the tongue as far back as you can get it and instruct her to drink and swallow as quickly as possible. Per Pugh, if she misses a dose or two of potassium, we do not have to panic.

**Also only at Walgreen’s, but you have to ask for it, is a dry shampoo cap – it is awesome. It costs $4.99. Maggie and I tried it and it made Mom feel very good. Also tames her fly-away hair. Maggie is going to use it once every week or two, and in between, use the dry shampoo spray. Feel free to use it anytime you want to. Probably best in the a.m. while she is sitting on the toilet. Gives her time to move her bowels.

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