Scary Numbers

I'm waking up slowly on this Saturday morning, and then it hits me: October 1 and I haven't mailed Mom's payment to Ocean View Assisted Living.
For two years, since she moved to California and I took over her checkbook, I haven't missed a payment. It's always due on the first of the month, mailed to a billing office on the east coast, and I'm very careful about being on time.
But now I have blown it. I find the bill and write out the check: $7,267.
I must be crazy to pay this amount per month for my mother to live in a nice residence where there are caregivers, a nurse, housekeepers, cooks, and a team of medicine managers who wheel their carts around each floor four times per day dispensing medications.
But what are my alternatives? Caring for her in my own home? I couldn't even provide the wholesome meals three times per day, much less the medications and the constant supervision. And then there's John: whenever I mention the possibility of having her live with us, he puts his foot down: no.
My sister and two brothers are equally reluctant to take on full-time care. Therefore, Mom will be in a care facility near one of us, and I find it convenient to have her near me.
We have taken turns at caring for her: Jim did it while she was still living in her own home in Boulder, Colorado, and needed various kinds of assistance on a weekly basis. Bill and Sandy took her into their home for two months after she fell and got a crushed vertebra. When we moved her to California, Emily supervised her in an assisted living near her home, an hour and a half from me.
The situation changed when Mom broke her left hip in August 2004. After she spent ten days in the hospital and four weeks in Garden Grove Convalescent Home, the staff thought she should continue to live right there. After all, she needed help with showering, toileting, and transferring from a chair to the wheelchair; she had become fairly wheel-chair dependent, though the physical therapist had been able to get her walking 200 feet with stand-by assistance several times per week. The price was right--$4-5,000 per month, about the same as her income.
But Mom hated being there. Could we leave her in a nursing home for the rest of her life? We toured other possibilities in the area, but even the nicest SNFs look like a hospital. The nurses station is central; floors are linoleum; most people are in wheelchairs and pretty grim-looking; IV poles abound.
The price tag of Ocean View Assisted Living didn't look so bad when we figured she might not last there too long. We heard statistics that most people her age who break a hip don't live more than a year afterward, so wedecided to try for assisted living as long as possible. After all, she has a monthly retirement income of $4721 and a healthy nest egg from selling her home in Boulder four years ago.
It became a calculation of how long she might live vs. how fast we were using up her financial resources. She's 86 years old and in pretty good health except for her diminishing mobility and her diagnosis of Lewy Body. Which will run out first, her money or her health?
Early in October, 2004, we moved her into Ocean View on the memory-impaired, secure floor at the maximum level of care. She's surrounded by beautiful interior decoration and nice carpets. No nurses station is to be seen.
She spends most of the day in her private room, surrounded by her own furniture: her bureau covered with earrings and necklaces, a table full of mail and framed photos, a glass doll cabinet, an elegant black desk and chair, a television, walls with family portraits. Three times per day she wheels out to the cheerful dining room, passing the living room with television and fireplace. From the patio, in addition to various apartment buildings, there's a glimpse of the Pacific Ocean.
My greatest fear was that she wouldn't last even a month--that after moving all her furniture and clothes into the studio apartment, she would fall or have a health crisis that would take her right back to the hospital or a SNF.
Sure enough, she fell within a week after arriving. She couldn't remember that she needed a wheelchair or walker. If the staff left her sitting in an easy chair or on the toilet, she would get up and try to walk--and fall. If she were put to bed for the night, she would try to get out of bed to go to the bathroom. Full-length bedrails and restraints, either in bed or in a wheelchair, are not allowed because Ocean View is not a nursing home--it's not licensed for such things.
With a ratio of 4-5 caregivers for 25 residents, however, the staff could not watch Mom while she was on the toilet or in her recliner napping or watching television, which was where she wanted to be most of the day. She hated going to group activities in the common area.
When she fell for the third or fourth time, without any serious injury that would send her back to the hospital, I decided to hire a personal caregiver at night in addition to the staff at Ocean View.
I figured we could afford to pay the high monthly fee, plus $14 per hour for someone to keep an eye on Mom at night, for a few months. If she made it to Thanksgiving, or even Christmas, we could always move her to a nursing home early in 2005 or whenever her money ran out.
Somehow she made it, month after month, but only because we added a personal caregiver for 6 am to 2 pm, in addition to 6 pm to 6 am. At 2 pm I showed up to visit her, and at 4:30 I left her sitting in the dining room for dinner. That meant four hours of care that we didn't have to pay for, as well as all day on Sundays, when I took her to church and to my home. Emily did the 1-2 hr. drive to spell me one or two afternoons per week.
When summer came, I took a few weeks off and began paying for personal care around the clock. Bill and Jim visited, but none of us felt like saying, "Okay, it's time to save money by moving her into a nursing home."
So that's how we arrived at October 1, 2005, and a bill of $7,267--not counting the personal caregivers.