Category: Advice Column

For the last two weeks, I have spent 12-16 hours a day packing and moving two houses into one. I have finished unpacking and decorating the new house that will combine the household of both my mother and myself. Even though I donated two carloads of household items and clothes to Goodwill, I still managed to have things for which I cannot find a good spot in the new house.

At the same time I have been unpacking, the handyman has been working on modifications to the home for Mom. He is building a ramp in the garage that will accommodate her wheelchair and allow her easy access to enter the home. The next project is her room and bathroom, which requires new flooring and fixtures. We hope to have most of it finished by end of week. I have planned to move Mother in Friday evening. The cost to make this home handicapped accessible is going to be close to $8000.

I am now interviewing in-home care givers, as well. This industry appears to be quite competitive since there were many choices to call in the area. I scheduled appointments with two companies that seem to offer the type of flexible service that Mother will require. The representatives appear to be very eager to help and their follow up has been excellent. The decision of which to choose is ultimately which company offers the service and care that best fits the needs of Mother.

The costs I have been quoted float around $21/hour with a 4 hour minimum. They will provide care givers for multiple shifts and 7 days a week, if needed. Doing the math, if one required 8 hours a day for 7 days a week, that runs $1176/week. On a 4 week month, that is $4704/mo. You will pay time and a half for holidays or overtime. A working family may need more than an 8 hour day. I expect to have a caregiver at least 9-10 hours a day, so that will push the numbers up to about $5500/mo. I know it sounds high, but considering that the assisted living situation costs almost $2000/mo. more and we had to pay a $4000 reservation fee, living at home will be a savings to Mom and a better quality of life.

In-home care assistance is just as much a need for the family caregiver as it is for the loved one that requires the care. The responsibility to help with a ill, handicapped, or memory-impaired person is huge. It can easily consume your life. Some people are able to handle the task on their own and do it well. For most, including me, it can be exhausting and time consuming. Occasional days of this work is doable, but every day would not enable one to have a life of their own, offer time to work, and add a tremendous amount of stress. It is important to enjoy your time with your loved one and keep your sanity.

For many, adjusting to life with a caregiver in the home will take some time. In the next coming blogs, I will write about the experience of this process.

Getting used to an assisted living situation does require an adjustment – not only for the resident but the family members, too.  It is not unusual for the resident to be angry in the beginning.  This is especially true for those loved ones that suffer from memory issues.  They will often feel very confused and lost.  The caregivers and nurses at a memory care facility are trained to handle an upset resident.  These tactics usually involve some type of diversion.

I found it especially helpful to attend a family support group the first couple of months that Mother was in assisted living.  The responsibility and guilt that family members go through can be overwhelming.  It was interesting to hear about everyone’s story and experience.  Although everyone was different, much of the issues were the same: a spouse that feels so guilty about leaving their loved one behind, the stress of being yelled and cussed at for putting them in this place, and the financial responsibility of paying for two different residences.

Mother understood where she was and why she was there.  She had to warm up to participating in activities.  I encouraged the social directors and caregivers to make sure she was involved in the various activities.  It was important that she develop a routine of getting out of bed every morning, getting dressed with full makeup and jewelry, eating meals in the dining room, and socializing.  Attempting to get her life as normal as possible, I felt, was of great importance in Mom’s recovery.  One small thing that meant a great deal to her was to get her hair done in the salon every week.

She also began another 6 weeks of therapy.  It was a goal to keep the momentum of improvement she had started at the acute care rehab.

Scooting across a bed or bench, standing up and maintaining her balance for 10 minutes, keeping her paralyzed right arm and hand flexible, working her brain in order to improve her speech, and improving her ability to read and write were important in her recovery.  After that round of therapy, she had shown great improvement.

As the holidays approached, decisions needed to made in regards to how we could celebrate them with Mother.  We requested and were approved to get a couple more weeks of therapy to train myself and one of Mother’s granddaughters on transfers.  We wanted to be able to take Mom out and that meant learning how to move her from wheelchair to car and back. We also had to learn how to get her in and out of bed and in and out of the bathroom.

After about three weeks of twice-a-week training, I took Mom out to lunch in a restaurant.  She was so excited and was waiting at the door when I arrived!  We had a nice afternoon of shopping and lunch.  The next big event was to bring her home for an overnight stay.  We did that on Thanksgiving night.  I will not say that it was easy.  There were definite challenges and it is a lot of work.  I took me two hours to get her up, showered, dressed, and hair done.  Due to all this, the family decided to hire an in-home caregiver at Christmas. (In a later blog, I will discuss in-home caregivers.)

As the next few months go by, Mother’s verbal improvements were great. She was happier and we were able to reduce her medications in half.  This was very important to Mom.  She was put on an anti-depressant medication within a couple of weeks of admission in the skilled nursing facility. She complained that it was making her “foggy” and she objected to taking it from the very beginning.  I refused it at first, but the nurses and therapists insisted that it was necessary. The ability for Mom to get out and do normal things also helped her improve.  Her verbal accuracy was over 80% at the 8th month mark.

The cons of the living situation for Mom was that she was getting extremely bored with the mundane and repetitive routine day after day. She would often cry and express her desire to spend more time away with me.  She missed her friends and her social life.  When her physical therapy ended, her exercise was reduced to almost nothing.  She began to lose some of her strength.  Also, once Mother was up and dressed, she could move about on her own with little assistance within the facility.  Due to this fact, the caregivers would mostly ignore her much of the day.  More dependent residents got their attention. If Mother didn’t want to wear her brace or put her armrest on her chair, which was important to maintain her flexibility, the caregivers didn’t insist. The result was a slight regress in her condition.

All of this help lead me to the conclusion that talking to Mother about living at home with me, with the assistance of in-home caregivers, might be in her best interest.  Stay tuned on her reaction and what happened next ……

The morning that Mom was to be transferred from the acute rehab facility to the memory care assisted living facility was stressful.  The social workers from both facilities had been organizing the transfer for a couple of weeks, so you would think it would go smoothly.  It started off when I arrived at the hospital and found Mom still in bed eating breakfast.  The ambulance was supposed to arrive in 40 minutes!

As I tried to get her dressed, she began questioning me about where she was going.  She had apparently forgotten the details I had previously shared with her about the new place.  She had been happy at St. David’s. She was confused and thought I was taking her back to the old skilled nursing facility.  She got very upset and it took much assuring to calm her down.

The ambulance attendant arrived a little early with a gurney.  I questioned him as to the need of a stretcher, and he said that was what they were told was necessary.  A wheelchair transfer would have been less expensive, but that was not what was requested.  He wanted to know about the responsible party for payment.  That subject had never come up before.  I had expected that the transportation to the assisted living facility would be complimentary with the prices they charged.  That was not the case! Mom did have to pay for that ambulance ride, which cost about $800.

Since we are talking about costs, it would be important to point out here that assisted living places do not provide beds and wheelchairs.  The social workers made arrangements for Mom to have an adjustable bed and a wheelchair with accessories delivered to her new room.  Medicare will pay for this type of equipment; however, they will only rent them.  You cannot just buy one outright unless you pay for it yourself.  An adjustable bed from a medical supply place typically rents for about $135/mo. and a wheelchair for about $75/mo.  You will own them after about 12-18 months of rentals.  If you do the math, the end cost of the adjustable bed costs $1620 – $2430 and the wheelchair costs $900 – $1350 .  If you go online, one can buy a similar bed for $700-$1200 and the wheelchair for $120.  This is why any government supported medical programs are in a crisis.  In a later post, I will tell you more about the charges to Medicare from the skilled nursing facility.  It will blow your mind!

Once Mom was on her way to the new place, I went ahead to meet her there.  I had expected a whole team of people to greet her as she arrived. The reality was exactly the opposite.  I had to chase down someone to help direct us and soon discovered that they were not ready for her.  Her bed and wheelchair had not been delivered and no one had any idea of their status.  The ambulance attendants placed Mom in a chair in the common area and left.  An hour or so later, we were told that some of the items ordered for Mom had been back-ordered.  The bed was on a truck and should be arriving that afternoon.  They found a wheelchair she could use temporarily and suggested we go into the main dining hall and have lunch while we waited.  Two hours later, her bed arrived.

In the next blog, I will tell you more about life in assisted living.  The pros and the cons.

I will do my best to help answer your questions regarding any topic related to a seasoned life person and transitions issues.  We also can help with organizing and downsizing suggestions.

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