## Preparations, and eventually The Homecoming -- and a bumpy start ## ## Mom was finally scheduled for discharge from the nursing center, back to ## her original independent home, with private-duty help scheduled to come in ## daily per some still to-be-determined schedule to help with various living ## tasks. My first wild-ass guess at this was a morning shift and an afternoon ## shift, to cover making breakfast in the morning and then pre-dinner prep ## later on, and then other stuff as needed such as going out on shopping ## runs, taking walks, laundry, bed-changing, etc etc. Since the facility ## already provides a weekly housekeeping service anyway, that sort of thing ## wasn't even part of that. ## ## But seriously, what would a hired-in person do on a 4-hour-minimum shift ## after spending one hour making breakfast and cleaning up, and then sitting ## around staring into space for the rest of the time? We knew this would ## need some tailoring and likely reduction, as we got into this new mode. ## ## In the intervening time the various safety equipment arrived from Amazon, ## and it was pretty easy to install so I did that. Goodwill came with a ## truck and hauled the empty cabinetwork away. A few more bills got paid, ## and payee entries added to the online-banking "billpay" setup. Our pair of ## "his-n-hers" debit cards on one of the trust accounts arrived. So things ## were reasonably ready for Mom to return home a little later in the week. ## A whole crew of people accompanied her over, to make sure she had all her ## stuff with her and would be able to settle into a safe situation. That ## afternoon was spent getting reorganized into the house, with me letting ## the private-duty caregiver do most of the legwork instead of me. I saw ## my role as transitioning to observational and advisory, to make sure the ## mechanics of this would all ultimately work in my absence. ## ## One important change to her email setup was that we were now sharing it ## because I needed to see what came in as finance-related. Mail would now ## have a rule to split a copy to a special mailbox, that she was to never ## delete anything from, and I'd manage that section. It wasn't hard to set ## up the right filter matrix across our separate Thunderbird configs to ## make that work fairly nicely. ## ## Unfortunately, the next morning's expected care shift was a fail, and then ## a whole lot of other frustrations bubbled up while dealing with that, and ## I wound up sending a bit of a rant off to the facility folks in the loop. Date: Fri, 21 Oct 2022 07:14:53 -0500 Subject: Early report on Mom at the house Hi, I'm reporting on Mom's "triumphant return home". Sorta. Well, rather unexpectedly, Mom took another minor fall yesterday afternoon, even after doing so well in all the rehab and our own walks around the area. Unhurt, as usual, and it was probably from being tired from the "big day"of the move back. She's okay, but I'm already making some observations... I'm not sure that the supposed return to "independence" is going to really work out that well, even with hired-in help. Mom's forgotten some parts of what she managed before, and is focusing on less-important details rather than the bigger picture of getting through life. The private-duty people need input on how to schedule their people with regard to vehicles, because not all of them are able to take us to Publix or someplace else, something about insurance and the quantity of free seats in their cars. So what I thought was a scheduled store run this morning, that we had agreed with the service, Mom is now insisting that she doesn't want to go. This sort of thing is going to frustrate everybody up and down the line long-term, and I don't want to see that entire relationship degrade as a result. And guess what? This morning they had a "sudden cancellation", and couldn't dig up anyone to substitute until 8am. Meanwhile, *I* had to cook Mom's bacon and eggs. She's already pretty annoyed with the care agency about missed shifts, and I don't think any other agency would do any better. Maybe this will settle down, but with the Northeast getting cold snaps and my house still in summer mode with NO heating yet, I *cannot* stick around to manage this much longer -- I need to be on the road this coming week. She also has to walk quite a bit farther in general to get anywhere in the larger space of the house. This increases the chances of a fall, and as more frustration over the basic mechanics of living builds up, that's not going to do anything positive for her overall mood. I realize that being back in the house is provisional, but I really think getting her into someplace like assisted-living would ultimately be best -- where she could be in a smaller space, actually have 24x7 help available when needed, and have meals served by far more competent cooks. She was really enjoying the food service at Carroll, even if relatively little else about it. It would seem that assisted level of care would be a more comfortable middle ground that would be more satisfactory, and if the shrink's assessment has concluded that Mom's okay primarily by herself, I don't see what's standing in the way of that other than a waiting list. I really think it's in everyone's best interest to get this process moving ASAP, or have a good explanation otherwise that's more detailed tnan "heavily state regulated". I have no idea what that actually means. Please forward this around as you see fit, we need to have solid understanding all round as this situation continues to develop. Thanks _H* ## This evidently came as a bit of a shocker to the recipient, who thought ## everything was fine and dandy after the previous day's delivery to home. ## She duly sent it around and replied, CCing the others now in the loop. Date: Fri, 21 Oct 2022 13:56:28 +0000 From: [another social-services person] CC: [various other powers-that-be] Subject: RE: '(EXTERNAL)'Early report on Mom at the house Good morning, I forwarded your email to [the others]. The Director of Health Services is not in today but some others are, and we discussed the situation and some options. Social Services will be contacting you today with some suggestions that could help. We can certainly understand the frustration of undependable service. ## A long phone call then happened, and within 24 hours of the return home it ## was decided that only one slightly longer shift a day, in the morning, was ## preferable to the morning/evening I had originally proposed. That's what ## I get for pulling a schedule out of my ass, because I frankly had NO clue ## what would be best even as a first cut. We would still take the extant ## afternoon one for Day 2 at home, maybe for a shopping run. Several other ## options for food supply were discussed, including delivery, but someone ## other than Mom would have to wrangle the inevitable online aspect of that. ## Another option for multiple shift per day could be to juggle two different ## care agencies and thus draw from a larger pool of available people, but ## with immediate reduction to one per day we didn't have to start casting ## about for that right away. We now had a longer list of them in hand, to ## keep in reserve in case we needed to call up more troops. ## ## As the week settled in, though, things looked a little more promising. Date: Fri, 21 Oct 2022 21:55:26 -0400 From: [close friend who's also dealing with parental-care fun] Subject: re: Medicare mysteries Hiya, I just read through a few weeks of your updates...hadn't realized how far behind I was, sorry! Medicare is federal, right? So what I've learned re [elder] should apply equally to your mom. As I understand it (per the home's business office & social services), Medicare gives you 100% coverage for the first 20 days of rehab (in or out of a facility), and then you have a co-pay (of 20%?) for days 21-100. Coverage is also contingent on progress being made wrt PT/OT/etc; if there's no progress, they give you 48 hours notice before kicking you out. Beyond day 100, you have no coverage. If there's 60 days 'between incidents' the clock resets...Did your mom not have the 60-day gap, maybe? Was she getting 'skilled treatment' at the house? My aunt also sent me this link, which doesn't jibe with what the home told me: https://www.medicare.gov/coverage/inpatient-rehabilitation-care In other news... Glad your mom is back home & I hope that works out. I went to the library yesterday & grabbed a bunch of books on buying/renovating/environments houses. Will try to cram through them before looking at more houses. Good luck, ## Date: Sat, 22 Oct 2022 10:54:16 -0500 To: [close friend dealing with parental-care] Subject: Re: Medicare mysteries Yeah, I kept doing updates but not spam-blasting everyone for every entry. Yesterday's fiasco triggered another appropriate batch of text. I still need to dig out the back-in-time stuff and post more about the summer... Medicare is stupidly complicated, and I think Mom's second rehab stint was out-of-pocket for the therapy at the nursing center. But now, back at the house, she'll be getting visiting therapists in which apparently is covered 100% again [one is coming within the hour as I type this, so it'll be good to get that rolling]. They keep differentiating between PT and OT, where occupational is the business of getting through daily life rather than condition/strength building. I want them to analyze how she functions alone in the kitchen, because a lot of stuff is pretty clumsy and potentially high risk there. We're reducing to the one morning shift per day, and I'm kinda worried about self-made dinners when I'm not there. I know there'a a crapton of info at Medicare's site; I was reading the equiv in the thick booklet that showed up in the mail and still not getting it. So I guess the info is all there if you dig far enough. Fortunately, the health providers have internalized all this and can more or less explain it. We took a monster store run this morning, the caregiver driving in her late model Corolla [not too jerky, I warned her "minimal lateral G please"] and basically stood back while she and Mom did it all including arrival home and bringing everything in and stashing it. That fit nicely within the 4-hour morning block so that, especially smaller runs going forward, will work okay. The caretakers have this spiral notebook where they scrawl observations about each shift, most of which is illegible chickenscratch, and that's what they appear to deem "group memory" per client. But nobody reads it coming in, so it ain't good for much. Fortunately they seem to have assigned the gal from today to Mom every Sat. morning so that'll be the shopping time if needed and then there's some direct personal memory in play. Many that I talk to sympathize with the whole "going through this with elders" thing, a lot of them have been through the same thing already or are in the middle of it while trying to live their own lives. I'm privileged to have the leisure to dedicate as much time to this as I can, and it evidently shows as I get glowing reviews about how "organized" and attentive I am. Basically, I'm trying to program a slightly nondeterministic system to do what I need with some modicum of remote management. This is not your daddy's shell script... I'm targeting Tues morning to depart, so I may very well be back by the 30th. Stops are minimal, might swing by a publisher in Stamford CT daytime, and I have offers of stopover from some of Mom's old friends in mid-Joisey which I think I'll skip till the next southward haul. Hopefully the chargers will actually work right this time; the summer was kinda dicey. I got my flushot here but Walg was out of Pfizer , and said I had to wait 2 weeks for the covid booster if I couldn't do them together in the same day. So it'll be at my usual one back home. First task will be get the heat running right, and then it will be leaves leaves leaves. Then maybe more leisure for further runs after the yard is fundamentally dealt with... _H* ## The one visit per day schedule that we settled on seemed to work well ## enough over the next few days, in the mornings for 4-hour shifts to first ## make breakfast, and then tackle whatever else was needed. The care agency ## had trouble even staffing that much, as healthcare in general is really ## strapped for people nowadays and it's super-hard to find appropriately ## trained help. They do have a big "We're hiring!" sign out front of their ## office, so they're trying. Mom was reasonably confident that she could do ## a lot of the activities around the house on her own, and kept leaning toward ## wanting *less* coverage instead of more. She had a point, and it also ## lightens the load on the agency itself. Their scheduling is very on-the-fly ## and driven by day-to-day circumstance. There seems to be no real plan or ## fixed assignments; their dispatch department has to allocate everything on ## short notice and scramble around to staff the slots. ## ## Whatever. At least it was something, and more than we'd tentatively set ## up over the summer, so the result was still a relatively stable situation. ## ## Meanwhile, it was time to start packing the car for my run home.