Tag Archive | dementia

Dear Dad…

Dear Dad,

It’s been almost 11 years, and I don’t know that I’ve ever missed you more than I do right now. I’m writing this in a chair beside Mom’s hospital bed. She’s been in the hospital for four days, as I suppose you know, and she doesn’t seem to be improving yet. In fact, there’s been a new complication every day. I sure wish I could ask you what to do.

She’s having trouble eating. She ate pretty well on Saturday (after two days of keeping down nothing but liquids), but on Sunday she had no appetite at all and had to make an effort to take a few bites. A couple of times she muttered wearily, “Gotta eat to stay alive.” It reminded me of the last year or so of your life, when you had to take in all liquids through a feeding tube because otherwise you aspirated into your lungs, and how you used to talk about all the hours you spent in a day “just staying alive.” I remember when you asked me to find that Bee Gees song, and I decided to make you a whole CD of music I thought you’d like, including “Stayin’ Alive”… but I didn’t finish it in time. Sorry about that, Pops.

Anyway, back to Mom. She ate almost nothing yesterday, and when I was there at dinner I discovered that the issue was more than having no appetite or feeling too tired to make the effort. She couldn’t seem to remember HOW to eat. She let me spoon feed her a little bit of pudding and I think that was all she ate all day except for a Boost shake at lunch. This morning I fed her breakfast and she actually seemed interested in the food for the first time, telling me “Now the applesauce” or “Give me a bite of that yogurt.” But when she tried to feed herself, she was missing her mouth and dribbling food down her chin. What does this mean, Dad? Is it going to get better, or is this where we are now?

I wish you could tell me what it means that Mom is “dreaming with [her] eyes open” and talking to people who aren’t here. A couple of times she’s seen someone in the room. I don’t know if it’s just the multiple infections, or a side effect of one of the many medications, or if she’s starting to see between the worlds. She hasn’t mentioned seeing anyone who I know to be on your side of the veil yet, which is a comfort to me. I’m not quite ready to let her go. You’ll have to wait a little longer for your dance partner, OK?

* * * *

LATER: I put this aside to help Mom, and then they brought her dinner tray. I started feeding her some mashed potatoes and gravy, and after a couple of bites she said, “Let me feed myself!” She moved slowly and a little clumsily, but she didn’t miss her mouth this time. She ate some mashed potato, a couple bites of the fish (too tough), some applesauce and some pudding. And when she’d eaten all she could, she actually picked up the word search puzzle book I brought her for the first time. She didn’t do more than flip through the pages and put it down again, but it’s an improvement. I feel much more hopeful than I did a few hours ago. If you had anything to do with that, Dad, thank you.

One more thing, Dad… I wish I could have seen your reaction to the smug know-it-all hospitalist, though I’m pretty sure I know what it would have been. His behavior was just like the surgeons you used to complain about at the dinner table back when you were an anesthesiologist. I wanted you here to put him in his place when he was so condescending and dismissive to the nurse who had been so wonderful with Mom. No wonder the nurses at Franciscan appreciated you so much.

I have to get some sleep now. Thanks for keeping an eye on Mom. I love you.

Dad Sleeping

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This is a hard part

I’ve been procrastinating blogging because I had wanted to share the story and photos from Mom’s 90th birthday party in June, but first I was too busy getting ready for my annual retreat… and then when I came back, I got a shock that I’m still trying to figure out how to deal with.  It’s been so stressful for the last six weeks, I just can’t get myself into the right frame of mind to write a cheerful birthday post. I promise I will, eventually. Right now, I need to get some of what’s been happening off my chest.

The shocker: The owner of the care home called a meeting with me the first week of July to discuss “the level of care for your mother.” I walked into that meeting with my stomach in knots and the adrenaline rush making me almost dizzy. I was afraid she was going to tell me that Mom needs to be in skilled nursing and we’d have to move her. Thankfully, that didn’t happen. She outlined all the ways in which Mom’s care needs have increased in the four years she has lived there (without there ever being an increase in the charges) – from walking with a walker to wheelchair bound, from partially incontinent to fully incontinent (both bladder and bowels), the number of medical appointments they’ve been taking her to, and finally, behavioral changes.

She had mentioned a couple months ago that Mom sometimes gets agitated when the caregivers are trying to get her to do something she doesn’t want to do (e.g., toileting or get out of bed in the morning) and strikes out, slapping their hands away or even pinching them. Apparently this is only getting worse and she’s even started spitting on the caregivers. I was floored, to say the least. Here I’ve thought we were so fortunate that Mom hasn’t had the kind of personality change that is so common with dementia patients, but apparently I just don’t see it. I’m like the non-custodial parent, who comes in once a week to take the kids out for ice cream and a movie. I’m not the one who has to enforce rules, make her take her pills, etc. “She is totally different when you are around,” the owner told me.

The bottom line is that they need to increase the monthly charges so that she can cover her increased staffing costs. I understand that and it’s not unreasonable at all, but the amount by which they are increasing is problematic for us, to say the least. Right now the amount Mom pays to the board and care each month is within $10 of her monthly income from social security and my dad’s VA pension. The monthly cost is going up by $500. I have no freaking idea where that money is going to come from. Also, re: the behavioral issues, the owner asked me to talk to her doctor about prescribing some kind of medication to “keep her calm.” I’m afraid that if we don’t do that, she might tell us that Mom has to move.

Mom got referred to a new neurologist (because Dr. O is no longer part of her insurance network), and I asked him about prescribing something to help with the agitation/aggression, but since this was his first time seeing her, he was reluctant to do that and told me to talk to her primary care doctor. I brought it up with the primary care nurse at her most recent visit, but didn’t have a chance to talk to Dr. G when Mom wasn’t present. (And there was no way I was going to discuss her spitting on the staff in front of her — she’d be horrified, and she’d never believe she does anything like that.)

Meanwhile, she’s had a cough with chest congestion on and off since late June. When I visited her on July 4 after 9 days away, I learned her oxygen saturation had been dropping into the mid-80s and they were giving her supplemental oxygen. I called her primary care doctor and he ordered a chest x-ray, which was done on July 6 and showed “a little fluid in her lungs.” Long story short, after a visit to the pulmonologist and another visit to the primary, she is still coughing and the one thing they prescribed (albuterol in a nebulizer) seems to help the symptoms for a while but doesn’t stop it. I am both concerned and starting to get really frustrated.

I don’t write much here about what’s going on in my own life, except as it relates to being a caregiver, but here are a couple of things that have happened in the last year. On September 1 of last year, I was laid off from my job after almost 7 years in that position and a total of 13 years with the company. I got a good severance package, so I wasn’t too worried at first and I was grateful to be able to take time off to devote to Mom’s care. I started job hunting in January, never imagining it would take so long to find a job. Then in April, I got really sick with a flu that turned into pneumonia. I spent two weeks in bed and another two weeks slowly regaining my strength. And because I was sick in bed, I missed out on the opportunity to interview for a job that I think would have been a perfect fit for me. I did finally land a temp-to-hire position through a temp agency, which I started in early May. But it pays about 2/3 of what I was making at my old job, so my monthly paycheck doesn’t even cover all of MY regular expenses, much less allow me to subsidize Mom’s care to the tune of $500/mo. Most of my severance pay is long gone, and I’d been holding onto what is left in the hopes of paying off one of my substantial credit card bills. But unless I get a better job in the next couple of months, I’m not going to be able to avoid spending the last of the funds just to keep the bills paid. And I have no idea what we’ll do when my savings runs out.

So, yeah, it’s been a little stressful.

The one bright spot on the horizon right now is that I’ve applied for Medi-Cal (California’s version of Medicaid) coverage for Mom, and an eligibility specialist who did a review for us has assured me that she’ll qualify for the full coverage without a share of cost. Medi-Cal won’t pay for board and care costs, only for skilled nursing, BUT they will cover all her prescriptions and co-pays and her monthly premium for Medicare Part B, which would give her about another $125 a month.  And if they will pay for incontinence supplies, that would help even more. It’s not enough, but it’s something. And in the event that she does eventually require skilled nursing, we will at least have that option. Though I HATE the idea of her living in some horrible nursing home like the place she’s been after her hospital stays, and I will do everything in my power to keep that from happening. And I also hear that it can take months to get a Medi-Cal bed in even a mediocre nursing home, so it’s not an option in the short term even if we wanted it.

Well, I have to wrap this up now so I can take Mom to get a chest x-ray. The last round of labs showed an elevated white blood cell count, which may indicate an infection, but Dr. G didn’t want to prescribe antibiotics without first getting a chest x-ray. I’m hopeful we’ll get to the bottom of what’s causing this chronic cough soon and that there will be something they can do to treat it. I’m trying to stay hopeful about the financial situation too and trust, as Mom does, that it will all work out. But that’s a lot easier said than done. If anyone has any advice on that front, please feel free to comment here or email me, if you have my email. Thanks for listening.

 

Trouble with Names

I spent a couple of hours with my mom this afternoon. When I arrived, I found her slouched down in her recliner, knees tucked up, reading a book. It’s the first time I’ve seen her even pick up a book in months. The last time I visited, I cleared a tottering pile of books and magazines off the little folding table next to her chair; taking the books back to the bookcase in her bedroom and discarding the old magazines. I’m glad now that I left her a couple of books by her chair, as it was one of those she was reading.

She asked how I’ve been, so I talked about my new job… and then I switched to sharing family news. I mentioned that Sarah is in Colorado this weekend because Ashley graduated from high school on Saturday, pulling out my phone to find an Instagram photo of Ashley in her white cap and gown with her older brother Josh. Mom looked at the photo blankly. “Who are they?” I explained that these are two of her grandchildren, and Mom shook her head. “I haven’t seen them for so long,” she said. I declined to mention that she saw Ashley just three weeks ago. With her memory, even yesterday can be long forgotten.

What took me by surprise was her reaction to Sarah’s name: “And Sarah is who, again?” She’s seen a lot of Sarah the last couple of years and always lights up when her oldest granddaughter comes to visit or joins us at church. I gently reminded her that Sarah is her oldest granddaughter, the one who goes to church with us sometimes. Mom nodded. “I’m having trouble with names lately,” she said. I squeezed her hand. That’s OK. It happens.

She’s also apparently having trouble sleeping. One of her caregivers told me that last night Mom sat up around 11:00 p.m. and rang the bell by her bedside, saying she couldn’t sleep and wanted to get up and read. So they brought her out to her recliner and she sat up and read until 6:30 this morning! Then they gave her breakfast and she finally went back to bed and slept until 11:00 a.m.  I asked Mom if she’s been having trouble sleeping and she said yes, just lately. “There was one time when I didn’t sleep for 30 hours!” she told me. “I was up all day and all night and half the next day before I finally fell asleep.”

I don’t know if the 30 hours part is true — that’s the kind of thing I would expect the owner of the care home to notify me about — but I’m going to call her primary care doctor tomorrow and see what he suggests. I’m hoping there’s something over the counter that she can take safely for occasional sleeplessness, because it will be July before I can get her in to his office.

As for the names thing… I’m just thankful she still recognizes people when she sees them in person, whether she knows their names or not.

 

 

She gave me a scare

I called to check on Mom this afternoon. The phone was answered by the caregiver who speaks only broken English, so instead of asking for an update, I just asked to speak to Mom. I heard her saying “It’s Lira” and then Mom mumbling “What do I do?” After a longish pause, she said hello. It sounded like she had a mouth full of marbles.

I asked her how she was doing and she mumbled something. What was that? “Tired!” she repeated, loudly. I asked if she had been sleeping and there was a long pause again, then she said no. I asked her if she wasn’t feeling well and she answered, “No, I’m not. I’ve been sick all week. Will you come and take me out of this place?” She sounded quite distressed, so I replied (as calmly as I could, considering the adrenalin that was now coursing through my veins) that I would be there in about half an hour. “Good!” she said firmly. I asked if Maria (the head caregiver) was there, and she replied “No, nobody’s here. It’s just me.” I repeated that I would be there soon and we hung up.

I had started to make myself lunch, but I put everything back in the fridge and grabbed a protein shake instead. I texted the owner of the care home, asking why no one had called to tell me that my mom is sick, and then I started gathering up what I would need for a trip to Urgent Care or the ER — Mom’s folder of health info, my phone charger, water bottle, etc. The owner texted me back to say that she had been at the facility all morning and Mom was fine, that she had been napping when I called and that’s why she seemed disoriented. It was a relief to hear that, but I headed over anyway to see for myself.

Sure enough, I arrived to find her sitting in her recliner with her favorite blanket over her legs, drinking coffee and eating a donut. I kissed her on the forehead and asked how she was feeling. “As well as can be expected at my age,” she answered cheerfully. She seemed tired but otherwise perfectly fine, and she had no memory of talking to me 20 minutes earlier.

Damn, Mom, don’t scare me like that!

 

 

Bad Days & Batty Ideas

The last couple of days haven’t been good days for Mom. Yesterday when I arrived mid-afternoon, as arranged, to take her to get her hair done, she was just starting to eat her lunch. The staff explained that she was having so much pain in her knee that she’d refused to get up from her recliner to eat or even go to the bathroom. I knew she wasn’t going to be up to the hair salon, so I just sat with her while she ate her lunch. Before I left, I leaned down behind her wheelchair and hugged her. She gripped my arms tightly and said softly, “That feels good. Comforting… Reassuring.” I kissed her forehead and told her that I love her and I’d see her tomorrow.

We did make it to the hair salon today, but it was a struggle all the way. Her legs were so weak, it took both caregivers lifting under her arms to transfer her from wheelchair to car. When we got to the salon, she and I struggled to get her out of the car. Usually she can push up with her arms and get to standing, but today she needed to be lifted. Once she had collapsed into the wheelchair, she looked up at me and said, “I’m a mess.” I shrugged that off with a smile, but I hate to hear her talk like that. It’s a strong indicator that she’s not feeling like herself.  The hairstylist helped me get her from wheelchair to shampoo chair; and to save Mom the extra strain on her legs, she let her stay in the wheelchair while she cut her hair and rolled it up on the rollers. Mom was practically nodding off in the chair, and by the time we got back to the car, she wasn’t sure if she could get up again. She was almost a dead weight, and when I managed to haul her to her feet, she just leaned her head against my chest and seemed to be having trouble turning around. She barely got her butt onto the edge of the car seat, but we made it.

I’m worried about her today, wondering if it’s the neurological issues progressing that is causing these mobility issues or if there’s a systemic issue making her so weak. Or both. Sigh. I’m hoping she’ll be up for going to church on Easter Sunday, which was the whole reason I put her through the trip to the salon.

Yesterday while Mom was in the bathroom, I was talking to Jenny, one of the other residents who also has dementia. “Do you know who came up with this batty idea?” she asked me, out of the blue. What batty idea is that, Jenny? “To cut off our arms and legs!” she replied, indignant. Yes, I agreed, that does sound like a batty idea. I wondered where it had come from, but then she continued… “I try to use my arms to push myself up, but they don’t want me to do that. They don’t want us to use our arms and legs. Your mother, too. Our arms and legs work just fine!” Well, I commented, my mom’s legs aren’t working too well right now…

I’ve been thinking about this today, wondering if the staff really are “cutting off [the use of] their arms and legs” by insisting on lifting the residents instead of letting them push themselves up and just giving them a boost as needed.  I know they’re trying to ensure  safety and avoid falls, but it’s so discouraging to see my mom losing the use of her legs. And her arms have always been strong, even when she had PT in the hospital. Use it or lose it, as they say. But I don’t know what to do about that.

 

More Like Herself

Happy to report that Mom is feeling better these last several days. We went back to church on Sunday, the first time I had taken her since her most recent hospitalization, and she enjoyed seeing all her friends from the seniors Sunday school class. I never know if she remembers them or if she just enjoys being made a fuss over whether she knows them or not. But she was all smiles, and that makes me happy.

Wednesday she had a follow-up with the pulmonologist, who pronounced her lungs “nice and clear” and says we can discontinue supplemental oxygen during the day (keeping her on 2 liters overnight), as long as they regularly monitor her oxygen level and it stays above 92.

This morning I picked her up to get blood drawn for the labs the nephrologist has ordered, and she was as energetic as I’ve seen her in months. When I asked how she was feeling, she said “Great!” And she remarked several times on how nice it was to get out of the house for a change, so after leaving Quest Labs I drove through a Starbucks for eggnog lattes and a cheese danish. We parked in the shade of a tree and sat in the car with the windows down, enjoying the pleasant breeze and each other’s company while we sipped our lattes and she ate her pastry. When I started up the car again to take her home, she thanked me for getting her outdoors and “allowing me to feel like part of the community.”

I pulled into the driveway, got her wheelchair out of the trunk and brought it around to her side of the car. She was already turned in her seat with her legs out, but when I pulled the chair up beside her, she looked at me and asked “What comes next?” I told her I would help her stand so she could get into the wheelchair. “What do I do now?” she asked. “You push yourself up,” I told her, “and I’ll help by giving you a pull.” That worked smoothly, but I was surprised that she’d needed to ask. This is how it is with dementia. She’ll be just like her old self… and then, suddenly, she’s not.

Back to (almost) normal

Mom was discharged from the SNF on Friday morning. Once I’d handed everything over to the caregivers and gone over the discharge paperwork with the owner of the board and care, I went home and collapsed for a couple hours. Yesterday I dropped by briefly in the morning when the home health nurse came to evaluate whether Mom will need skilled nursing services at home, and Mom was disappointed that I didn’t stay long. So I promised to come back for a longer visit today.

She was finishing her lunch when I arrived around 1:30. Her appetite seems to have returned, which is encouraging, and she said she was feeling good. I brought out the Scrabble game; and although she started out by saying she wasn’t sure she’d remember how to play, it came back to her quickly.  We played two games and she beat me by over 30 points both times! She seemed like her old self.

When I was putting away the game, she looked around and asked “Whose house am I at?” I told her it’s the house where she lives and she looked surprised. I pointed to the two caregivers who were working in the kitchen and asked if she recognized them, and she said yes and the house looks familiar too, “but I’ve been visiting around so much lately, I think lots of places look familiar.”

This is why traveling is hard for people with dementia. Staying in different places is disorienting and they can lose their connection with the place that is home. Today I know for sure that I made the right decision in discontinuing any travel with Mom, and I hope she’ll get to stay in her cozy board and care for a long time. I look forward to many more games of Scrabble.