Picnic lunch

Mom and her roommate were sitting outside their room when I arrived around 11:30 Saturday morning. Since theirs is the last room in the wing, and there's no room across the hall from them, it's like they have another room -- their lanai. I brought their tables out so they could eat lunch there; it was like a picnic, sitting in the sunny hallway.

Once Mom and I were alone, I told her I had some bad news, that the people at St. Anne's said they couldn't admit her to their assisted living. As many of you know, she is quite stoic and kept up a good front, saying that she figured as much and that she wasn't surprised, but I detected some waivering, the trembling lower lip thing.

She is worried about what is going to happen to her. I assured her we would make sure she had the best possible care, and to that end, explained that on Tuesday, a case manager was being brought into the mix to help us sort it out and make recommendations. Even though Dave, Byron, and Colleen have looked at different nursing homes, I want to make sure we have enough information to make the best decision. I told her that the case manager would give her a test similar to the one they did at St. Anne's (but didn't suggest she practice her subtracting from 100 by sevens) and carefully look at her medical records. Her Medicare coverage for rehab ends March 13, so there is some time to weigh the options and make a decision before she has to leave Heartland. Staying at Heartland as a private pay is also an option.

Mom is on antibiotics for her infection, and having her usual gastrointestinal reaction to them, poor thing. Besides the visit from the case manager on Tuesday, she has an appointment at the wound clinic again to which I'll be taking her. The fun never ends.

Some new developments

The wound clinic notified us Wednesday that our stalwart Ruthie has acquired several bacterial infections, including the nasty methicillin-resistant staphylococcus aureus (MRSA). Whether this knowledge was the result of samples taken at the wound clinic last week or at Heartland yesterday we do not know, but we were told she needed to see an infectious disease doc ASAP. Fortunately this afternoon Byron was able to get her into the infectious disease physician who saw her during her last in-patient stay at Beaumont. And fortunately this physician's office where she sees patients on Wednesdays is less than a mile from Heartland. Tomorrow Mom will have a PICC line inserted (which they can do at Heartland) so she can receive intravenous antibiotics. 


We're relieved they can do this at Heartland instead of her having to be admitted to the hospital, but concerned about where we're headed, especially since learning on Monday that she is not a candidate for assisted living (which she doesn't know yet, but I will tell her on Saturday). To help us figure out what our options are and what would be the best placement for her, I'm meeting with a geriatric case manager next Tuesday who will do an assessment on Mom, including a review of her medical records, and recommend a care plan. We want her to be able to live in dignity and be pain free. It's really not that much to ask.

Mardi Gras

February 16 was another busy Tuesday for our gal. When I arrived at Heartland around 11 a.m., she was in physical therapy, doing leg lifts and knee raises. After a quick lunch we headed to St. Anne's Meade so they could assess her for assisted living. Even I struggled with some of the questions they asked (counting backwards from 100, by 7, tripped her up, as well as remembering three words). For the most part, she did okay with the mental acuity portion. Her walking is unsteady, although she's determined to ambulate better. The biggest obstacle she has is the wound. As a rule, St. Anne's does not admit people with wounds such as hers to assisted living as it requires regular nursing care. We may be able to hire nurses to change her dressing twice a day or engage hospice services for that purpose, so we're hopeful things will work out.


Immediately after our visit to St. Anne's we headed to her late afternoon appointment at the wound clinic. I've been taking pictures of her wound at each appointment so I can see if there's any progress, and there was a little improvement from two weeks ago. She has new directives for activity, however. She's to sit for only three hours a day and spend the rest of her time either lying on her side, standing up, or walking. Anyone who knows Mom will agree she won't take to lying around all the time very well. But in order to maximize the healing of the wound, she needs to do this. They also emphasized the importance of her getting adequate protein.

Institution food gets tiresome after awhile, so following the wound clinic appointment we got some take-out from Panera Bread for dinner. The dining room at Heartland was decked out from a Mardi Gras party that afternoon, so we were able to enjoy our soups and salad in a festive atmosphere.

Mom is on her third roommate since returning to Heartland after her January hospitalization, and it's likely she'll have yet another as this roommate is scheduled for discharge next week. Mom's occupational therapy ends this week, but physical therapy will continue and because of the wound, Medicare will cover her stay until the eligibility expires (mid-March). There are pros and cons to her staying at Heartland until then. Having medical care available 24/7 is a plus, but getting her settled into her new living situation, with her own things, is important too.

Groundhog day

It was a busy day for Mom. Besides physical and occupational therapy, she participated in her care conference then had an appointment at the wound clinic. The care conference (attended by Byron and me in person, and Dave via phone) revealed what we anticipated, and that is the recommendation for Mom is to go into assisted living when her stay at Heartland ends. The physical and occupational therapists feel she has another three weeks of therapy, and she could probably stay until the end of the Medicare coverage, March 13, because of her wound. Mom has gradually acknowledged that she is too weak to live on her own. Our task for the next couple weeks is to identify where she should live. Mom said that Byron and Colleen should choose the facility that is most convenient for them, which isn't an unrealistic consideration, but as her wound needs to be treated twice a day, she needs to be at a place where she can get that level of care.

The visit to the wound clinic was uneventful. Her wound was cleaned and treated, it's still hideous looking, and we discussed with the doctor what the outcomes would be if she chose not to do hyperbaric oxygen therapy. Mom spent quite a bit of time since the visit two weeks ago studying the literature the clinic gave her regarding wound treatment and hyperbaric oxygen therapy, and she decided she does not want to pursue it. Whether she does or not, it's unlikely her wound will ever completely heal. She can always change her mind, too. For the present, though, she finds it too confusing and scary.

We got back to Heartland just in time for dinner (tilapia). It was a busy day for the old gal, so I'm sure she got to bed early.