Plan B, as it stands today - Part 2

Yesterday mom expressed a surprising desire to go to a nursing home. We had a good discussion about her fears, concerns and thoughts. I reminded her that her focus has always been on returning home and she should consider giving it a try so she can make a decision based on experience rather than fear. I also reminded her that she is very determined to do as much as she can and her continued positive outlook is an inspiration and motivator for many of us.

The plan for Byron & Colleen to stay at the house has changed. After much soul searching they realized that with their other commitments and schedules it just would not be possible. Their hearts were in the right place and the offer appreciated, but realistically just not feasible. Colleen did say she will be able to do the wound dressing twice a day as planned.

Like Val, I'm hoping the change in weather will provide the opportunity for visits from friends and even if she can't walk the sidewalks, they are pretty bad, she can and did walk her driveway frequently and as long as someone is with her and she should be able to resume that activity as well.

Not sure about baking cookies, but who knows.

Plan B, as it stands today

After our disappointing and frustrating foray into the world of assisted living, and weighing the options -- nursing home or going home with lots of assistance -- we've opted for the latter. The plan at this writing is to make the necessary changes (carpeting the kitchen, putting in a new stove, getting a hospital bed delivered, having cable and internet installed) and bring Mom home, hopefully on Easter or Easter Monday. Initially Byron and Colleen will stay with Mom at night Sunday through Thursday, and Dave and I will alternate weekend nights and days. We'll get a granny sitter (who should be able to do housekeeping and other tasks) for Monday through Friday daytime. Fortunately Dave is here this week so he will do most of the leg work in getting this arranged.

After a couple weeks we'll reassess and possibly hire someone to stay with Mom during the night as well as during the day, but continue to alternate the weekends. Or we may find that a nursing home placement would be more realistic. This won't be easy, but (a) she has wanted to come home all along and (b) not being in a nursing home environment will lessen her exposure to infection. We can do the twice a day wound dressing changes. Having her home will definitely have drawbacks; she will be isolated, and in an institutional environment, she has more opportunities for longer strolls down the hallways. But now that it's (finally) spring, perhaps more people can get out to visit her, and we could always take her to a mall, Meijer, or church for a longer stretch of walking (we found after she broke her hip that sidewalks are not very walker-friendly).

So with any luck, today should be her last Monday at Heartland. Fingers are crossed!

Now For The B Plan

Byron, Val & I spent several hours at Sunrise-Troy last Saturday, discussing Mom's possible move there. We talked about their assessment of her, expressed our concerns about the wound, but were told that she most likely would be able to move in, providing nursing care was arranged to attend to her wound. The nursing director wanted to see the wound herself, and said she'd visit Mom on Monday.

All of us liked the facility, and after viewing several rooms we chose one we thought she'd like. The measuring tape came out so we could determine furniture placement, Val wrote the check for the deposit, and after grabbing lunch (and watching a bit of March Madness), we visited Mom at Heartland and talked with her about moving into Sunrise for at least three or four months, until she regained more strength and the wound healed more. She reluctantly agreed that it would be a good thing and we moved on to discussing the move, which we planned for this coming weekend.

Kathy, the nurse from Sunrise, visited Mom Monday to assess her wound and review her medical records. She reported back to her higher ups at Sunrise, and on Tuesday we were notified that Sunrise's corporate office determined that because the wound is still Stage 4, she would not be eligible to move into Sunrise at this time. Needless to say we are disappointed.

Now for the B Plan. We don't exactly have one. Mom will continue at Heartland for the time being with efforts being made to either get her placed in an "active" nursing home, or have her return to Meadowlark. We are looking at home health care, 24/7 care and what modifications will be necessary to accommodate her continued use of assistance devices.

When I spoke with Mom last night, I shared the news that Sunrise was out for now because of the wound. She accepted this with her usual stoicism and is quite content at Heartland for the time being.

I'll be back in town tomorrow and will stay for a while to assist in any way I can. Val will come down Saturday and Tuesday when we take Mom to the wound clinic again.

That's it for now.

Another Field Trip

Yesterday mom and I visited Sunrise-Troy, the assisted living facility at Crooks & South Blvd. We toured the facility looked at two types of accomodations and enjoyed a pleasant lunch in the dining room where mom was able to talk with some of the residents. It was very enjoyable and while she would never admit it, I think she can imagine herself living there. A representative from Sunrise did an assessment of mom this morning and they see no problem with her becoming a resident. Stay tuned, there may be a new address soon!

We also spent a pleasant hour or so with her lifelong friend Priscilla, who has been in Evergreen Nursing & Rehab for a few weeks. It was a pleasure to see the two of them together and I made myself scarce so they could have a nice private visit. We returned to Heartland so mom could have her dressing changed, lay down and get some rest.

When I spoke with mom to remind her of the assessment today, she said felt the rooms were too small and wouldn't accomodate a wheel chair. She toured the facility, to include the rooms, in her wheel chair yesterday with no problem so I think she's just looking for excuses. I look forward to seeing her this afternoon and spending an hour or two with her, talking about this pending change to her living situation. Should be fun!

The Week So Far

I arrived at Heartland Monday afternoon about 4:30 and spent an enjoyable hour with Mom before heading to Meadowlark and unloading my car. She had her hair done earlier in the day and was looking quite nice. We sat in the hall by the window enjoying the warm sun and getting caught up. I reminded her I would be taking her to the Wound Clinic on Tuesday and Dr. Hale on Wednesday. We also discussed the plan to contact the facilities Darcy mentioned to see about moving on to the next phase of her recovery. It was late in the day so I didn't get much of an argument and encouraged her to think of assisted living as a short term stay, 2-3 months. She could think of reasons why not to go, it's not Meadowlark, and was unable to come up with anything positive to mention. She appears to be willing to try this option, though, so we will see what happens.

Tuesday morning I contacted Wynwood of Troy and scheduled an assessment appointment for Wednesday the 17th. I also called, and visited, Sunrise of Troy, and discussed an assessment with them after a brief tour of their facility.  We'll go there Thursday morning for a tour and assessment and then visit Priscilla. The weather has been so wonderful, it's a shame to stay inside all day.

After a nice lunch with Mom and Val we prepared to depart for the Wound Clinic. Cousin Tara & her daughter Andi (aka Dr. East) accompanied us on the journey to Beaumont. Val & Andi participated in the unveiling and assessment of the wound in Dr. Ordano's office while Tara and & visited in the waiting room. The staff at Heartland had commented that the wound is healing and looking pretty good. They didn't mention anything about the dead tissue around the wound resulting from Mom not getting out of her chair with any regularity and either standing or laying down to relieve the pressure. Dr. O did say the wound is healing, but is still considered a stage 4 wound. That being the case, twice daily dressing changes will continue until the wound reaches a point where a Vac-Pac can be used.

While her assessment for Wynnwood was taking place, I sat in the hall reading the Free Press. While paging through the paper I saw an obituary of someone I was sure Mom knew and noticed the memorial service was scheduled for 11:00 this morning at FCCRO. After the interview concluded I showed her the paper and she decided she wanted to go to the service. After she took care of her personal needs we made it to the church with about 10 minutes to spare. Following the services Mom enjoyed visiting with her many friends and admirers (surprise) and held court in the fellowship hall while eating a terrific church food funeral luncheon.

Seeing Mom sitting with her dear friends, watching her interact with people that came by to visit with her was such a treat. Her whole demeanor changed. There was a wonderful smile on the her face, she sat up straighter, was pleasant, caring and concerned to everyone who she saw. She looked and acted like she didn't have a care in the world. It was great.

We finally got out of church about 2 p.m. with enough time to get to Heartland so she could use the facilities, have her wound dressed, and get to her 3:00 appointment with the infectious disease doctor, Dr. Hale. Dr. Hale discontinued the IV antibiotics and the PICC line will be removed at Heartland this afternoon. We returned to Heartland, Mom needed to rest and I needed to get this post out. Sorry it's so long, but I wanted to get everything out before I forgot things. I'm sure there are some things I failed to mention, but will add to my next entry, if I remember. It'll be interesting to see how the visit to Sunrise goes on Thursday. They say they can accommodate a stage 4 wound; we just have to pay for the nurses to come in and deal with it.

That's it.

Next steps

Mom was delightfully surprised by a visit from Tim, Lori, Travis and Trevor Tuma on Saturday around lunch time. She walked with them from her room to the day room, where they enjoyed a nice visit. It's always good to see Tim and his family, and Saturday was no exception. Later that afternoon Margie, Mom's roommate until last Wednesday, came by with her sister and brother-in-law to visit and deliver several boxes of Girl Scout cookies.So if you stop by to see Mom, she can now properly entertain and offer cookies.

Last Wednesday Byron took Mom to her appointment with Dr. Hale, the infectious disease doctor. Mom continues to receive intravenous vancomycin for MRSA, and seems to be responding well to it. She'll see Dr. Hale again this Wednesday. She has an appointment at the wound clinic on Tuesday, and I'm curious to see how things are going because Mom says both Dr. Hale and the wound team at Heartland say her wound is healing quite well. Dave, who's coming in on Monday, and I will take her to the wound clinic appointment. 

Mom's Medicare eligibility for rehab expired on Saturday, but she's staying at Heartland for a bit longer as a private pay patient in order to finish up her IV therapy and determine her next living situation.She will not be receiving physical therapy, so visitors, take heed: that means she's likely to be in her room if you wish to visit. The geriatric case manager we met with felt that despite what St. Anne's said, Mom was a good candidate for assisted living and identified a few places that could do the wound care that she requires. One of the tasks Dave has on his dance card is to have Mom assessed by one or more of these places and hopefully move ahead on this. Mom, of course, would prefer to go home, but understands (or at least on Saturday understood) that assisted living is the best place for her to go next. Hopefully in a couple weeks we'll announce a new address for her.

An RB shop connection

Just after lunch on Wednesday, Mom and I met with Darcy, the geriatric case manager. She spent several hours with us, asking questions and listening to Mom's answers. She also assessed Mom, using the same tool that they used at St. Anne's. 

In response to Darcy's question about what kind of work Mom did, Mom said she had been in sales and for years managed the RB Shop in Royal Oak and later Birmingham. Turns out Darcy's father was a regular there when he needed to buy a gift for Darcy's mother. Mom claimed to recognize the last name; who knows, it's possible. The RB Shop connection elevated Darcy's credibility in Mom's eyes (never mind the nursing degrees and other credentials), but not that she needed it; we both felt at ease with her and it was clear she knew what she was talking about.

Darcy will use the information we provided, plus Mom's medical records, to recommend a placement for when her Medicare runs out at Heartland (March 13). Mom can stay on at Heartland as a private pay patient, too. A couple of the challenges we faced are the wound and the MRSA infection; they're two things no extended care facility likes to have.

After our time with Darcy, we dashed off to the wound clinic for our bi-weekly visit. It looks like we'll be making this trip for the foreseeable future for wound debridement. They'd like Mom to limit the amount of time she sits to two hours three times a day.

Tomorrow my cousin Tara and her daughter Andrea, who's a surgery resident at U-M, will be visiting Mom in the afternoon. It'll be interesting to get Andy's take on things. We're also looking forward to Dave's return in the middle of the month.