Part Four: Follow the Golden Years Road of the Last

                       

nce upon a time, a not so young man was swept away by the sudden swirl of events into the Land of the Last.

There he was sent on a quest to find the Magical Nursing Home that would rescue his mother from the evil witches of Sunset City. It was to seem a daunting task, but he had a plan for following the Golden Years Road, although after a while it seemed more a maze of dead ends.

There were in this particular county 24 such places sometimes called Skilled Nursing Centers and sometimes called Long Term Residences. It would seem a lot of choices, but not so much for a poor boy.

Although it was not strictly a matter of cost, that certainly played some minor part. Throwing aside the Veteran's Administration Facilities, of which there were two, neither ranking well on the Medicare 5-Star Ranking System (1 Star for each or much below average), the average yearly cost for a home was $8,219 a month for a semi-private room (slightly more for a private room at $9,223 a month). These ranged from a high of $14,752 a month (a place that rated 4-Stars or Above Average) to a low of $5,627 a month (and a rating of 1-Star or Much below Average).  Cost did not always correlate with the ranking. A home that charged $9,794 a month, the sixth highest, only received 2-Stars or Below Average, while the second cheapest (not counting the VA Homes) at $7,300 a month got 4-Stars or Above Average.

The place where the not-so-young man's mother was imprisoned ranked eleventh in cost, about the middle of the pack, at $9,277 a month, but was one of only two in the county to receive but 1-Star, or Much below Average.

Do you see why he needed to rescue her?

If cost was not a real criteria, the fact his parents had no real resources was. They would have to go into a home under Medical Assistance or not at all, and not every home accepted Medicaid. He could eliminate eight immediately for this reason.

Of course, Sunset City was where his mother lay, so it was subtracted from the mix. So could one home because his mother had insisted from the beginning he must stay away from there, although he never understood why since several people recommended it and the home had a 4-Star rating. Also eliminated was one of the two VA facilities, because his dad said he never wanted to go there.

That left 14 facilities that would accept Medicaid.

The Not-so-young Man eliminated three as being tucked away in a bewitched far corner of the county. They would be places of last resort.

He then contacted the remaining 11 Skilled Nursing Facilities and it began to seem to no avail. He toured four and was placed on the waiting list at three (these included Mushmouth Manor). He did not apply at the fourth because it was the only one in the county to require an application fee. The fee was $250 and since he was now applying for both parents (explanation will be in following posts) that would have cost $500 just to risk being rejected, another last resort home.

He learned from another source that his parents would never get accepted by Mushmouth Manor with their lack of money, confirming his earlier impression of the place.

He was advised at the first home he contacted that he should put them on at least four waiting lists and if one offered a bed to snatch it up. "Demand is high," the lady said, "and everyone has long waiting lists." This was proving true as he searched on.

Two quickly let him know they would not take his parents, one or the other, and the remaining five were not returning his calls (including the one VA facility he had contacted) and as time passed it seemed they never would.

He had reached out even beyond that county, but it was going the same elsewhere. He even went back to PassingGo Home, begging them to reconsider since they did accept Medicaid and that was now what his folks were applying under.

And just when it seemed his plight could not get more desperate, it did. His mother's insurance company dropped her coverage.

Indeed, he wasn't in Kansas anymore.



(Photo on left is from the 1925 silent version of The Wizard of Oz, co-wrote and directed by Larry Semon, who also stared as the Scarecrow [he is on the left]. The Tin Man in the middle is Oliver Hardy, who gained much greater fame later when partnered with Stan Laurel. The actor on the right is O. Howe Black [you read it right], who not too surprisingly was cast as the Cowardly Lion.)

Part Three: Lost in the Land of the Last

I had exhausted the lineup of homes my mother and her friends had suggested. It was time to step away from the few to the many. But how?

I began by that new old fallback, Google. I thus stumbled upon a website that listed every Nursing Home known to man and then some. It gave general information, such as name and address and phone number, a few tidbits such as number of beds and affiliation and lastly the Medicare Rating.

Medicare has a Five Star Rating System for all Nursing Homes that accept Medicare. 5-Stars are the most a home can receive and I am told by professionals in the Medical Field this is very difficult to get. The lowest is 1-Star. There is no such animal as a Zero-Star nursing home. Everybody gets something, even if only a Certificate of Participation.

For Instance, Sunset City only had 1-Star; translation -- Well Below Average, while my mom's vaunted Mushmouth Manor managed 2-Stars, or below Average. Her latest ideal of PassingGo Home wasn't bad at all with an above average rating of 4-Stars.

But these were out of the running for a permanent solution at this point. I needed fresh storage space in the warehouse district of the elderly.

Since Medicare ranked every Nursing Home they came in cahoots with I had some pruning to do. The list did allow you to select by state, so I started with that, but it didn't go so far as allowing the selection of  county. (Later, after more hard-knock education in this field I did find the actual Medicare ranking site and it did allow selection by county, even by individual home. Here is the website to save you the trouble of Google fishing for it if you are ever interested or need it:)

http://www.medicare.gov/nhcompare/include/datasection/questions/proximitysearch.asp?bhcp=1

I then spent an eye-glazing, mind-numbing time scrolling through all the Pennsylvania Nursing Homes and copying all located in my parents' general area to an Excel worksheet. From that list, which in itself was fairly long, I selected those homes rated above average. There were very few near my parents stomping grounds. I then contacted around six homes by email or phone.

Email seemed the better way I found. You could say more and might get a quicker response back. Telephoning connected you to an automated voice allowing you to choose from a menu of buttons just to get to someone's voice mail where you could leave a message, which may or may not ever result in a return call.

From those I emailed, I received an email response, mostly acknowledging they had my email and would contact me in the near future. These places obviously calculate the near future in a different galaxy than mine for I still await that follow-up contact from them.

From the phone calls I received brochures from one, a "Don't call us, we'll call you if we ever decide to care," and a polite but firm turndown from another.

One home did call and invite me to take the tour. My wife and I went on the appointed day and promptly got lost. Once again a road with a hidden part, much like Mushmouth Manor. When we did arrive it was to the wrong building. We finally got to where we were supposed to be and the Admissions Director was very kind and gracious, although we quickly learned there was no hope of placing my parents there. They not only didn't accept her particular form of medical insurance, but they did not accept Medicaid.

Despite this she was extremely helpful and still gave us the tour. This was another lesson learned. Medicaid was not universal in the Land of the Last. I needed more than Medicare ratings, I needed to know who accepted what.

I received about this time a packet from the Department of Aging. Within was a list of the county homes and most importantly whether they accepted Medicaid as well as Medicare. I now changed my approach from less shotgun to more rifle.

TO BE CONTINUED

Part Two: In the Land of PassingGo

Ever since the subject of a Nursing Home reared its ugly roof, I was hearing Mushmouth Manor. It was becoming pretty apparent that wasn't going to happen.

But somehow around this time a new mantra appeared, PassingGo Home. I can't remember who said it first, I just remember I got asked about it and told it was nice. Mom's Speech Therapist also spoke about it to her.

Why an employee of one Nursing Home would bring up another I don't know for sure. My guess is it was an indirect comment and came about from some casual conversation. My mother one time years ago worked for the Valley Maid Potato Chip Company. They really made the best chips around, but eventually they were acquired by Bachman and after that the chips were so-so. One of mom's fellow workers who she had befriended was now a resident in PassingGo Home. Apparently, the Speech Therapist had some business at that Home and when mother mentioned this lady's name told her the woman was in PassingGo.

Now my mother was fixated on that place.

I decided to visit PassingGo next time I went to visit mom. I skipped dad that day and went early, going what I considered a more direct route. It was at least one that took you to PassingGo -- eventually. It twisted and turned about the fields above This City, where my mom was, and I was almost certain I was lost when it popped into vision ahead. A tall building with a curvaceous parking lot and long path up to the front doors.

I went to the receptionist and told her I wanted to get some information about the place.

"Do you have an appointment?" she asked.

"No."

"You should have called and made an appointment," she snapped.

She picked up the phone and called someone. She hung up and pointed me down a hallway.

"Go to the third door on the left and see Maude."

I did as I was told. I came to the third door, which was half open and I saw a couple women inside. One was a somewhat stocky lady with a stern face. Turned out this was Maude, the Admissions Director.

I began to tell my tale of woe when she abruptly stopped me. She took me to meet Madeline Mild, her assistant. Madeline was very sweet. An older lady with a gentle voice. She gave me the ten-dollar tour and then we sat while she showed me the admittance form to be filled out and returned. As we parted she asked me to send her a copy of my mother's insurance cards so they could see if it was acceptable. I said I would.

I then went back to This City and visited mother. At least I could tell her I was at PassingGo.

From that moment on I was to hear PassingGo every visit and then within emails from her friends. I had to get her into PassingGo. When would we hear from PassingGo? How much longer until she went to PassingGo?

But as usual these things took time. I emailed a copy of her insurance card to Madeline Mild the very night of my visit. I waited a week and heard nothing. I called her on the phone. It was her day off, she wasn't there. I called the next day. No, she never got the email. She had been out, she said, and perhaps someone else got it and didn't know what it was. Could I send it again?

I sent it again and then called her again. She was not there; she had left for the day. It was very difficult to establish when this lady actually worked. Finally I got ahold of her and yes she had received the email. She had forwarded the copy of the Insurance Card to the business office. We would have to wait until the business office found out if they accepted that insurance.

I waited a week and called Madeline Mild again.  Gloryoski, she was in, but she didn't have the answer. This time the Business Manager had been gone, all week on vacation. She had just returned and Madeline Mild didn't want to bother her until she got caught up. So I waited some more.

After another week I finally got my answer. Sorry, but PassingGo Home would not accept that insurance. Do not pass GO; do not collect your mother and try to bring her here. Go directly to jail in Sunset City.

I now began a search in earnest. I looked first at the sheet the This City Hospital Social Worker had originally given me and saw I could have saved myself a lot of time and trouble. PassingGo Home was one of those crossed out because it didn't take my mom's insurance.

But even so, my mom and her friends kept up the chants for PassingGo Home as if constantly repeating its name would overcome reality.

As it were, I wasn't quite completely done with the place, but the rest of that story will come later. I had a lot of other stops in-between this end and that end.

TO BE CONTINUED

In the Land of the Last Stand, Part One

My mother's directive: "Larry, get me out of here," sent me on a quest for an open door somewhere. A month and a half later I felt I had gone about things backward. I should have dug deeper into my mother's purse and discovered it full of moths and looked to the financial future first, but I've had professionals tell me I did things right.

Anyway, I began by looking for a better "Home".

I began with the obvious, another visit to Mushmouth Manor, the place my mother pined for, though only she and God know why.

This time I called and made a set appointment. I also now knew exactly how to get there, thus I arrived at its doorstep over a half-hour early. I almost hate showing up early as much as showing up late, and I really hate showing up late. Showing up late is rude and inconsiderate. It inconveniences other people and it says to them, "My time is more important than your time." When I worked in the corporate world there were managers who came late to every meeting for that very reason, just to show they were somehow the more important person.

So I went a bit out of the way, stopped at a drugstore and bought a soda. I then went on to Mushmouth Manor where I parked in the back lot and drank the drink. Around five until the hour I ambled in and presented myself at the reception desk. The receptionist told me Ms Fingerrub would be right with me and please have a seat.

Mushmouth Manor had a large lobby, like a medium hotel, unlike Sunset City's modest entry with a table and one sofa. Mushmouth Manor had many sofas and chairs and tables and vases of flowers.

In the back, where the people were stored, it was not distinguishable from Sunset City at all. Long hallways lined with ancient citizens in wheelchairs or shuffling along with the aid of walkers. Every home was equipped with poor souls sitting still along some wall, hands folded in lap, back bent like a question mark and head down. It was as if you could order these people off Amazon.com for the singular purpose of decorating your nursing home hall.

I had downloaded two copies of Mushmouth's application and filled one out for each of my parents. After the tour I presented these, and was told there was a waiting list. My father might get in quicker than mom, but there was a wee bitty problem. Because of my mom's current condition she would qualify for Medicaid, but my father would not. He would have to come in as Private Pay (which would run around $9,000 a month), unless he might be eligible for veteran's benefits.

She gave me a business card. "This is our Veteran's expert. Call him and he will help you with your dad's benefits."

We bid good day (which was in reality goodbye) and I left with the same feeling I had the first time, Mushmouth Manor primary interest was dough-re-me. Some weeks later, an Elder Lawyer told me my parent's would not get into Mushmouth Manor with their bank account, confirming my initial gut reaction.

Many weeks and much aggravation later I was told a tale by a close friend of my parents, one of the coterie that had been looking after dad since mom was struck down. One whose husband was one of the most vocal about the indiscretions of Sunset City.

"I went through this with my father," she began. "He fell and broke his him and went into to Mushmouth Manor. Oh, what a terrible place. I came to visit and it was meal time. I don't know what was on his plate. It was a mess, pardon me, but it looked like dog dirt. I said, 'He can't eat that,' and the person told me, 'He can have a hot dog instead if he doesn't want that'.

"And while we were there I heard his roommate say something from the bathroom. He had been in the bathroom when we arrived. I asked, 'Do you need help?'

"'Yes, he said. I've been waiting in here for over an hour for someone to help me, but no one's come.'

"So, I got the man back to his bed and I went out to the nurse's station and told them, 'Have my dad packed and prepared to leave at 1:00 tomorrow. We're taking him out of here.'

"They said he needed a Doctor's permission and this and that. 'No,' I said, 'we're taking him out of here tomorrow.' I came the next day at 1:00 and he was prepared to go and we left."

I thought, why didn't you tell that story to my mother. Maybe she would have stopped yammering at me about the Great and Wonderful Mushmouth Manor. By the lady told me this story it didn't matter anymore.

In the time between my second visit to Mushmouth Manor and this lady's tale of woe, my mother had picked up a new mantra, PassingGo Homes.

It was mainly my own fault.

TO BE CONTINUED

Between the Black and the Red

Several months back I decided to visit a "Home". My wife and I are in good health and shape, but time goes faster when you reach your seventies and eighty isn't so far down the road. At this age a decade can bring a lot of changes.

I knew we couldn't stay here in our present home for several reason. One biggie is financial. It was a monthly struggle to meet our costs and still have some quality to our life, and a year ago I had a part time job. I didn't see how we could afford to keep this place up in the future. Not only to pay for repairs and maintenance, but even to do the regular chores one does. I don't try to kid myself into thinking age is only a matter of mind. It is a matter of body as well and I don't have the strength, stamina or energy I had even five years ago. A little of these things slip away with every birthday that passes and another birthday is coming this month. Although I walk in the forest every morning, up and down rocky trails and such, I am having more and more trouble with stairs and steps, especially if carrying something such as laundry. Besides, our house is too big for us anymore. It was great for raising three kids, a bedroom for everyone and plenty of room to play indoors on a rainy day.

And so I took a tour. I went to a place that had some small cottages as well as apartments. My wife preferred the sense of having one's own place.

The tour was lovely. There was a group of us trailing behind a charming guide. We traipsed long halls decorated with beautifully framed paintings and vases of flowers. We visited a couple in their lovely two-bedroom apartment with its modern kitchen. We saw the expansive rehab room, the chapel, the small cafe and the gift shop. We finished up with a delicious meal in the large, elegant dining room beneath its chandeliers. Some of the residents joined us at the tables to brag about life in this place. As desert was being served, the chef and the servers came out to take a bow for the marvelous luncheon.

What a wonderful atmosphere to live out your final years, except if I could afford to live there I wouldn't need it. At that time the entry fee to just get in the door started at $120,000 and then $2,600 a month and that was just for a small 500 square-foot Studio Apartment. The prices went up with every foot of floor space you added and don't even think about those little cottages. Twenty-Six thousand dollars a month? Our Social Security checks added together don't even reach that before Medicare is taken out. By the time we jumped to a two-bedroom apartment, which is the least we would prefer, the monthly fee would have eaten up my pension as well. The two-bedroom apartment is just over 1,000 square feet, but you do get two baths.

Wait, that's not all! Buy now and we throw in one meal a day, you may choose breakfast, lunch or dinner!

Now granted, you don't have to worry about some catastrophic illness laying you low. You end up needing constant care you are covered.

I'm not knocking the place exactly. I still think if you are wealthy enough to afford living there you are wealthy enough not to have to live there. I am a bit annoyed the place was founded and is owned by a Protestant Denomination. When Jesus charged his followers to take care of the widowed, orphaned and aged, I don't think this kind of opulence is what he had in mind.

I was disappointed so many of the more upscale of these places have church affiliations. You know, the rich will find a way. I think Christian organizations should be more concerned with the less-than-rich.

Believe me, my parents are not headed for Chef-prepared meals or 1,000 square foot apartments. Of course where they are headed is several steps up from what they may have faced a hundred or so years ago.

They didn't have Nursing Homes for people like us way back then. You grew old and had no money and your family couldn't take you in it was off to the Poorhouse or Workhouse. Do you not recall Ebenezer Scrooge.


"Are there no prisons?" asked Scrooge.
"Plenty of prisons," said the gentleman, laying down the pen again.
"And the Union workhouses?"  demanded Scrooge.  "Are they still in operation?"
"They are.  Still," returned the gentleman, "I wish I could say they were not."
"The Treadmill and the Poor Law are in full vigour, then?"  said Scrooge.
"Both very busy, sir."

It was from such places the Nursing Homes came about, you know, and through the endeavors of the churches. People of age were sent to the Poorhouse along with the riffraff, petty criminals and debtors.

The churches took umbrage at this deplorable situation and thus was born the Almshouse. Alms is an old word meaning to give necessities to the poor. The various churches began establishing these Almshouse to bring the aged poor out of those public government run Poorhouses.

Very commendable, but not as altruistic or charitable as it sounds. In my opinion the motive was less Christian than pride. The congregations and their leaders of the day thought it deplorable that a Christian should have to rub elbows with guttersnipes, pickpockets and the unsaved (you know, the kind of people Christ rubbed elbows with everyday). Not only did you have to be a Christian of good standing to go to the Almshouse, you had to be a member of its founding denomination.

We have come a long way, baby, from those early beginnings to the modern day Nursing Home. Yet there is still an obvious class distinction of what you will be living in until called up yonder.

When I entered the world of the Nursing Home searching for a place for mom and dad I discovered this reality and the fact when it comes to the offspring of the Almshouse -- we  still have a long way to go.

We Pause in our Tale for Milestones

My mother and me with her dog Nellie, 1943. Nellie had been around much longer than me at that point. I'd been born a couple years earlier in June.

June was a big month for our family and still is I suppose. Lot of us arrived along with summer, including friends.

One of my two best life-long buddies was born in June, three days after I was. That was Stuart Meisel. On that same day, my wife's life-long best friend Evelyn Weinmann was also born.

My Grandmother, who was very close to me as I grew up, was also born in June as was my mother.

And then my mother and father married on my mother's birthday, which is June 21. Everybody got pulled into a celebration even if not born in this month. After all, there is Father's Day, which happens to be today and has in times past fallen on my parent's anniversary or mom's birthday, however you want to put it.

Here are some photo just to pay tribute to this month of June and we June Bugs.

I don't know why they waited so long to take my picture.

Mom at age three.

Dad the year he was born, 1918. You know what, he still looks like that.

See hasn't changed a bit, except for the glasses.

Dad when he looked like me, age 17.

Dad with his shipmates aboard the Destroyer Escort USS Jaccard off Manila in 1944. Dad is the one squatting on the far right.

1946 in Virginia, my Grandmother is the lady seated on the far left. My Aunt Edna is sitting next to her. The woman on the far right is my cousin, Millie Wilson, who was Maid of Honor at my parent's wedding.

My Grandmother in her garden, 1939.

Grandmother in another Garden, 1954

Grandmother 1967 with Jet.

Her last birthday on this earth, June 1987. She died the next year.

Mom at the Ship Road School, 1934. She is seated center. She would be either 13 or 14.

The two Millies, 1936. Milly Wilson left and mom right.

Mom in Kerr Park 1944.

Mom and Dad at Laponte, pa. 1939

Mom and Dad, 1938. Dad was 5 foot 11. Mom was 5 foot 1 and weighted 98 pounds.

Dad and Mom 1939

1946, not long after dad returned from serving in the Navy during WWII. he is squatting in front. My mom is on the far left and my grandmother on the far right. That is me leaning out the car window in the background. The other ladies were Mary Lukens, wife of a Navy buddy and Peg, a friend.

June 21, 1940, the wedding picture. L. to r.: Milly Wilson, Maid-of-Honor, Mom, Dad and best man Bill Hill.

June 21, 2010, my parents cutting the cake at their 70th Wedding Anniversary celebration.

Lois and I at my parents' 70th. Look how happy Lois is to have her picture taken. June 21, 2010.

June 21, 2010. Mom and Dad renew their wedding vows.

What Do You Fear, My Lady?

"A cage. To stay behind bars until use and old age accept them and all chance of valor has gone beyond beyond recall or desire." -- J. R. R. Tolkien

It is the Monday morning after the Friday evening before and my first of many visits back to Sunset City to see mom.

I roll dad into the room and the first words out of mother's mouth are, "Larry, you gotta get me out of here!"

"I'll try," I promised.

When I was a child I began to learn how to do magic tricks. But there is no such thing as magic, only tricks. Magic is optical illusion, deception, distraction and false panels. This was real life and no optical illusion. There were no false walls around my mother's bed. She was not a rabbit to be pulled from a hat. She was an old woman thrust suddenly into a system we seldom think of in the course of our lives. And she was a lady fearful of being caged away in Sunset City forever.

Sunset City was a closed system. Everything that had been in her outside world was exactly that -- outside. She couldn't be examined by her long-time personal physician. He had "no jurisdiction" in Sunset City, as a Sunset City manager put it. She had a new doctor, a stranger to her, someone who was under contract to visit the facility once a week and visit as many inmates as he could.

I called Dr. Whatzit at the end of mom's first week in this new world and asked about her prognosis. He was as optimistic as ever and said that she could eventually get off the feeding tube, but he then said he could give me no info about her condition. He hadn't seen her since she left the hospital. He couldn't visit her in the nursing home. If she came home again in the future, then he would be her doctor again, but for now the nursing home supplied her medical care.

I began asking about mom at Sunset City, trying to find someone who could give me some clear data about her condition, situation and future. Just as it had been in This City Hospital, it was like chasing a ghost. Maybe such a thing existed, maybe not. Finally I ran across a lady, the social worker, named Helen Hooters. I know, I know, terrible name for a woman to be stuck with. If that was her maiden name I can imagine the teasing she got growing up. (Helen Hooters is not her real name, of course, but her real name was just as bad, maybe even worse, and everyone you told it to would kind of smile and chuckle a little.)

She told me they would arrange a "Care Meeting".

In the meantime little tales circulated and found the way to my ears along with a growing chorus of, "You got to get her out of there." Problem is, I was never able to determine what was real and what was imagined.

On the first visit she said there was a young black man in her room, an aide of some kind, and he wouldn't give her her teeth. She asked several times and he wouldn't do it. Finally she rang for the nurse and the nurse came and handed her the dentures. Mother claimed the next morning she saw the young black man in the hall talking to a couple women who worked there. She heard him say he got fired. She felt she got him fired.

A couple days later she told people she woke up and thought she was having another stroke. She rang for the nurse and one came. Mom asked for a doctor. The nurse said, "We don't have any doctor here," then walked out of the room without doing anything and no one else came back in to see her.

But did these things happen? Remember in the hospital my mother saw strange woman talking in her living room one time and a mystery man entering her room in a wheelchair another time.

We brought up such complains at the Care Meeting and the Floor Nurse went out and checked the daily log and no such instances were recorded.

My mother's main complaints were the staff was rough on her when they changed her or moved her to make the bed. She would tell them it hurt, but they wouldn't stop. Yet, her condition was such moving her would hurt and some staff may have been more gentle than others. She and her friends who visited were annoyed because mom's requests weren't answered at once. Was she truly being ignored or were other duties more important at that moment to drop and attend to my mom's want?

I don't know.

We had the Care Meeting on April 26. A day short of two weeks after my mom was admitted to Sunset City. This was the first I got any input about what was going on with mother. It was almost comic. It was like a meeting of the United Nations to discuss some diplomatic crisis. I arrived with my dad in tow (or push as it was) and a friend of the family who they trusted. Helen Hooters came into mom's room at the head of a parade.

They trooped in, each saying hello as the formed a semi-circle about us, seven of them. There was Ms Hooters out in front (sorry, couldn't resist the pun) and then the Activities Director, the Floor Nurse on duty, the Physical Therapist, the Occupational Therapist and the Speech Therapist. I forget the function of the last woman. Heck, she could have been a patient who just followed along for all I know.

Each introduced themselves and explained their function. The Floor Nurse went out to check the daily log, as previously mentioned and promised to look into my mother's complaints. They did say that a report was filed weekly to the insurance company. As long as my mother was making progress, things would be fine, but that the insurance company could stop the coverage at anytime if it felt she had plateaued. They promised to fight against such a thing. They also said each therapy was limited by the insurance company to only twenty minutes a day. Remember these things, they will come up later in another post.

Finally, they trooped out and then the Director of Nursing paid us a visit. She assured up she would see that my mom got out of the bed more often and taken to activities.

Everyone had been very pleasant and professional, except perhaps the Floor Nurse, who just seemed nervous throughout. Or am I imagining things now?

At any rate the meeting was very assuring that mom was being taken care of. Still, the next time I visited mom's first words were, "Have you made any progress getting me out of this place?"

"I'm working on it, mom, I'm working on it."

And boy was I ever. This getting her out of there had become a 24/7 job with no benefits and no pay and a seemingly impossible goal. I had entered the Kafkaesque world of the Nursing Homes.

What Grandmother Said

My grandmother (pictured to the left in 1967 with my dog Cynthia) always use to say, "This family can't do anything once if they can do it twice." What she meant was nothing ever worked the first time and we always had to do it over again.

When I left This City Hospital to go visit Mushmouth Manor they were wheeling my mom out to have a feeding tube implanted in her belly.

When I called my dad Thursday morning to ask how the operation went, he said, "They didn't put the tube in."

"What?" I actually though he was confused about the days. "When I left her yesterday they were wheeling her to the operating room."

"She didn't get the tube," was all he could tell me.

"I'll be up tomorrow," I told him and left it at that.

Not long after I got a call from the Admissions Director of Garden Green at Deep Pond. Ms Bubbly must have contacted them about taking my mother. She was calling to explain why they couldn't. They were a small facility, she said. They only had 20-some beds and she didn't have the staffing to deal with my mother's needs.

Okay, so Garden Green at Deep Pond was out and I had never even got to see the place.

I went up that Friday afternoon, having had to tend to some other business that morning, and took my dad to the hospital. When we ambled into room 261 my mom was hooked up to more tubes. (We didn't actually amble in, of course. Dad rolled in upon a wheelchair and I plodded behind pushing it.) There was a new addition to the IVs and monitors, the feeding bottle.

She did indeed now have a feeding tube, but it hadn't been easy. My grandmother had been close to right. We didn't do it once. We didn't do it twice either, but three times. It didn't get done on Wednesday after all. They had some difficulty doing it. They rolled her down again on Thursday and again failed to complete the mission. Finally, on the third try they got the tube inserted.

Now she was getting nourishment equivalent to eating regular meals every day, just without the pleasure of chewing and swallowing and tasting and enjoying. Her meals came in a rectangle bottle hanging above her head on the IV stand. It was a brown unappetizing liquid.

We were no sooner in the room when a young woman came in and informed us they were going to get my mother ready to be moved to Sunset City. Whoa, Nelly, they plugged that tube in and were wasting no time getting rid of her.

I looked around. Where was Ms Bubbly? Didn't she say she'd be right by my side the whole way? Where were the hugs today?

Shortly after two paramedics appeared with a gurney. The lead medic did all the talking. He was very cordial, introduced himself and his partner, asked what else we wanted shipped off with mom and assured us they would be gentle.

One of each got on either side of the bed, grabbed the sheet beneath my mother and on the count of three whisked her through the air onto the gurney and were off. I handed dad a couple potted plants my mom wanted and wheeled him out and down to my car.

We drove around the block to where Sunset City was located not far from the hospital. The ambulance was already emptied. It was nearly 5:00 now. I got dad his walker and took him inside and grabbed a convenient wheelchair left along a wall. There was no one to greet us. There was a counter for a receptionist, but no receptionist behind it. There was certainly no Ms Bubbly. I did not know where they took my mother.

Presently two young aids came out through double doors to a corridor where patients resided on the first floor. I waylaid them and inquired about my mom. They knew nothing and were in fact leaving for the day, but one graciously went to find us help. After a bit of a wait, another woman well decorated with tattoos appeared. She told us my mom was in Room 313.

Was any of this a good omen. The day was April 13, Friday the Thirteenth, and she was in Room 313.

I took dad up in the lone elevator and down the long hall on the Third Floor and into her room. There were three beds in the room and mom was in the middle. No one was in the others at the moment. There was an oxygen pump by the head of her bed, sending the pure gas up a tube that fit into both nostrils. It was very loud, as if not all bolted down tight.

I left dad and went back down to move my car from in front of the entrance to the parking lot. The lobby was again empty. I pressed the bar on the front door and nothing happened. The door did not open. I tried its twin to the left. Same result, the front doors were locked. How do I get out?

Just then a delivery guy pulled up behind my car and he came to the door with a package. He reached over on the wall and pressed a code in a keypad fastened here. There was a click and he pulled the door open. I breezed out.

I parked my car, wondering how I would get back in. I saw the ambulance parked nearby, the one that brought my mom. The two paramedics were standing nearby. I walked over. As I approached the one, the talker, hid a cigarette behind his back.

"You didn't see that," he said.

"I couldn't care less," I told him and asked how I got back into the building. He told me there was a button near the door. Press it and someone should come and let me in.

I walked back up the long path to the door. I found the button and pressed it. Nothing happened. I stood and waited and waited and waited. No one came. I saw a little card attached to the glass on the door. It said if no one answered the button, to call a number, which was given.

I traipsed back to my car, retrieved my cell phone from the glove compartment and returned up the long path to the door. I dialed the number and waited. I though this was another dead end, but then someone did finally answer and that someone did finally come and let me in.

I headed to the elevator and I wondered, "How will we get out of here later?"

The convoluted world of Nursing Homes was just beginning.

And where the heck was Ms Bubbly?

A Grand and Glorious Entry

Sunset City sits centered in a city street. Mushmouth Manor is mounted upon a hill. It looked down upon me all the way up its drive and into the parking lot. I looked at the clock. It was exactly 1:00. I had just made it, although such timing was in my own head. I had made no such firm appointment here. My email had said I expected to arrive around one.

I walked up and entered into the lobby. It was quiet different from my morning visitation. Sunset City had an entry the size of my living room with a counter to the rear and a small sofa and table off to its right. Mushmouth Manor had a cavernous lobby worthy of a hotel. It was supported by columns and festooned with plants. There were a number of chairs and sofas facing in various directions and end and coffee tables. (The photo is not Mushmouth Manor's lobby, but of some grand hotel in Asia.)

I told the receptionist my name and that I had emailed, but she already had me on her schedule and said the Admissions Director would be with me shortly. She bid me have a seat. I choose a plush chair facing toward the counter. When I am waiting to meet with some personage I always prefer to be facing the direction from which I expect them to come.

The lady arrived shortly and led me back into the residence halls. I noticed when we passed into these corridors it wasn't so grand and glorious. The rooms where my mom would be housed were not noticeably different from those at Sunset City. As we walked and my guide chattered on about the benefits offered by Mushmouth I felt a vibe. I am not exactly certain why. It probably was something in the tone and attitude of the Admissions Director. I came away not particularly liking her, although she had given me no real reason for my feeling. Still, when I left I was negative toward the place with a distinct impression they were more interested in money than people.

But this was the place my mother preferred above all others at that time and I knew I couldn't change her desire because I had a gut feeling. It would be on my list.

I thought I would visit Garden Green at Deep Pond in the next few days and perhaps a couple of those homes further south, but when I arrived home I had a voice message on the phone from Ms Bubbly.

Ms Bubbly was the Social Worker for the hospital. She was the one who told me not to worry she had my back, she'd be by my side through the entire process and she would be my guide and guardian angel through this whole ordeal. She even gave me a hug. I was never to see Ms Bubbly again.

Her message was, "I need three names of Nursing Homes immediately," like now, like stat, like before you take another breath.

Go visit several homes before making a choice, she had said, and she now needs the names two days later? Who did she think I was, The Flash?

I left her a voice message in return, because of course she wasn't available to answer my phone call live. Nobody ever is anymore. I told her Mushmouth Manor and Garden Green at Deep Pond because they were my mom's two favorites. I threw in Sunset City because it was really the only one left in that area and the only one I had a chance to visit other then Mushmouth Manor. It seemed okay and besides it was last on this short list. I hoped she'd go for the number one choice and get mom to Mushmouth Manor.

I was pretty sure Ms Bubbly would do just that.

Stuck on Skittle Motoring to Mushmouth

As they were rolling mom down to the Operation Room, I was rolling down the road in the direction of Mushmouth Manor. I had not made a formal appointment. I had sent an email to the Admission Direction early in the morning saying I'd be in the area for a drop-in around 1:00.

It was just after 12:00 when I waved so long to mom, plenty of time to get there by one, after all, I was just going from This City to That City, a distance of 12 miles give or take. Of course it was unfamiliar territory to me now. Fifty years ago I knew all these roads well, but you forget a lot in that many decades.

I had the address, Skittle Road just off This City Pike. I googled it the night before and on the Google Map the place sat just where This City Pike intersected with Skittle Road on the That City side. Skittle actually split off This City Pike toward the This City side and ran parallel to the Pike for several miles. Pretty simple route, I thought.

So I'm burning up the pike and off to my right I see the street sign Skittle Road flash by. Whoa, I can travel right up that way to the door of Mushmouth. I turn into the next street and go straight on the guess it will cross Skittle in the not so distant future. I prove right and now I am heading in the direction of That City on Skittle.

The road isn't Hog heaven, but more Pig Alley. There are a few homesteads among the forest and weeds, but they are modest and in need of some paint for the most part, Picker country. It doesn't look like territory you'd find any Mushmouth Manor in, but it is Skittle Road. I go its length until it dead-ends into another road that is a hop and skip from The Pike.

I have seen nothing resembling a Retirement Home. I turn up this side road in a direction away from The Pike, just in case it is tucked back in the scrub somewhere. I go a bit and nothing like I want to see. I come back and go down Skittle in the other direction. Halfway along I see some hikers on some kind of trail. I ask them where Mushmouth Manor might be hiding. They never heard of it.

The one fellow asked, "What's the address?"

"Skittle Road at the Pike," I tell him.

"You want to go straight way you're going," he tells me gesturing that direction with his hand.

"Toward This City?" I ask.

He nods, I thank him and continue on. Maybe it is. I hadn't turned in where Skittle joined missing its sign. I'll go to the end this time, although I still felt sure the Google Map showed it more toward That City than This City.

I came to the Pike and nothing, so I turned around and went back up Skittle again. Maybe I just didn't see it.

I came to the side road and was as much without Mushmouth Manor as before. There was a parking lot across that side road, a lot with no apparent reason to be. I pulled in and parked. I saw the hikers appear and realized the lot was for that hiking trail's travelers to use. I pulled out my seldom used cell phone from the glove compartment and called Mushmouth Manor.

I could hardly hear the person who answered, but I asked, "Where are you?"

"We're right at the split of Skittle Road and This City Pike. Where are you?"

"I'm in a lot where Skittle joins The Pike, but I don't see you."

"We're on the right," she says, "you can't miss us."

I thank her and hang up. Can't miss them, eh? Well, I don't see anything to the right that looks like the place. Across the pike are a store of some kind and some houses up the side road. There is a line of trees along The Pike. I get out of the car and cross the highway. I think maybe this place is hidden by those trees. She did say they were on the right.

I walk pass the line of trees and stand in shock. There is a street running off to my right and its name is Skittle Road. The blasted thing was cut in half by The Pike. I get back to my car and start driving up this new Skittle.

I am driving and driving and time is getting away from me. I hope I am on the correct track now. I see a man walking by the edge of a lawn. I pull over and ask him if he knows Mushmouth Manor. Immediately I realize this guy is -- how am I allowed to put it in these politically correct times -- mentally challenged. But he does seem to have heard of the place and he points straight ahead.

I drive further and there is a junction back to The Pike and to my right upon a hill sits Mushmouth Manor. Sure enough, you can't miss it, as long you're on the right Skittle.

Express to Unhappy Valley

Why did I have meetings to attend on that particular Wednesday? I was retired from the business world. I don't have meetings anymore. I always hated those meetings anyway. I go to a poetry group once a month and that's as close as I get to a meeting.

The operative phrase in the paragraph above is "was retired". These meetings were the first of my new job; one that goes 24/7, is demanding, frustrating, constantly second-guessed and the pay is zilch.

When I was bopping about the shiny scrubbed floor of the hospital trying to find someone who really knew my mother's condition, I was met late in my searching by Ms Bubbly. Ms Bubbly was a Social Worker and the Case Worker for the floor. She introduced herself with a wide assuring smile. She told me she would be with me every step of the way. I had little to do, it was in her hands. She told me of a list and gave me a hug.

I'm not a hugger. I am uncomfortable with this touchy-feely approach to causal relationships. That was the second hug I got that day, which was two too many. The first had been at my dad's when a friend of his gave me one.

The magic list was laying on the tray table by my mother's bed. It was a list of 18 Nursing Homes. Ms Bubbly had told me my mother would be sent to a Rehab Center eventually, but she, Ms Bubbly, would handle all the details and the transition. All she needed from us were three preferred homes. She suggested I should go visit these homes and see which ones I liked.

Eighteen Homes sounded like a lot to visit, but it really was less than that. First of all several had been crossed off by Ms Bubbly because they wouldn't accept my mother's insurance. (My parent's had made a bad choice in the insurance they choose, but more of that later.)

Then I asked my Ma if she had any preference.

"Yes," she said, "either Mushmouth Manor or Garden Green at Deep Pond." She waved a finger on the hand that worked. "Stay away from here and here and here and here and over there."

So okay, with the one's my mother very insistently told me to stay away from and the one's crossed off because of the insurance issue, our list was down to eight and five of those were far down south in the county. I figured she would want to stay up in the region nearer her home so her friends could visit. My list of 18 was pared down to three: Mushmouth Manor, Garden Green at Deep Pond and Sunset City.

Okay, just in case somebody's a little asleep reading this, none of these names are the real ones. Believe me, no Old Age Ho...(sorry)...no Retirement Home, Frail-Care Center or Skilled Nursing Facility would ever use Sunset as a name; Sunrise yes, but never anything too smacking of the truth.

On Monday I contacted Sunset City and made an appointment to visit and take the tour. I also left a message (it is incredibly hard to ever contact an actual human being at any of these places, in fact, any where anymore) that I would be in the area on Wednesday and would like to stop by and see Mushmouth Manor. I didn't call Garden Green yet, it could wait until I saw the other two.

On Tuesday I got the call that Mom was getting a feeding tube plugged in on Wednesday.

Things were speeding up here.

Wednesday morning I made the trip north to This City for my appointment at Sunset City. When I drove about the building and parked I could see it was an older facility. It wasn't fancy, like some you see and certainly not opulent. The reception lobby was small, about the size of a large living room. The receptionist was friendly and the Admission Director was as well. She was very nice and she explained the place and took me on a tour.

Again, nothing lavish, but everything was clean. There was a clutter of broken down bodies in wheelchair here and about, a standard in such places I was to learn. She showed me the dining area and the large Rehab Center and a typical room. There were three beds in each of the Skilled Nursing rooms. Each bed faced a bureau and there were TVs on these bureaus for each bed.

It seemed a decent place, although you could see age on more than the residents.

My meeting was over by around 11:30 and since the hospital was nearby, I did stop up to see my mom. When I got to her floor I found her asleep, so I sat down on a chair and waited. After a few minutes a nurse came in to tend to mother in some way and woke her up.

After this person did her thing and moved from the bed into the bathroom, I said to my mother, "She did what I didn't want to do, wake you up."

"It's my job," said this nurse as she now departed the room.

I told mom where I had been and that it looked decent. The people were very nice. She then asked about Mushmouth Manor. "I'm going there next," I told her.

About then a nurse came in and said they were taking my mom down to surgery. I said I was told she was going at 1:00, but they said it was moved up. They preceded to get my mom on a gurney and wheel her away. I left and headed for Mushmouth Manor.

I thought they placed mom on a gurney. Actually it was to be on the express to Unhappy Valley. (And no, I haven't forgotten what I quoted Grandmother as always saying in my last post.)

Standing at the Corner of Stubborn and Quick

I had given up on the Doctor calling. After making it a point to stay home all day, hovering always within easy knowledge of the phone ringing, I counted this one a lost cause. Dinner time had come and now we moved into the evening. I guess I will trying calling him again in the morning.

We had retired after eating to the living room. You cannot her our phone here, for some unknown reason too lengthy to explain here. But if a call comes in a tiny message appears in the lower right corner of the TV screen informing us.  I had no sooner sat when such a little window appeared saying, "Pennsylvania" and a number. I almost missed it. I dashed through the house to the office and grabbed up the phone.

It was Doctor Whatzit.

He really did call after all.

My mother had a stroke...

Ut, oh, I heard that already, I hoped he had more. He did.

She had a stroke in the area of the brain stem called the Pons. It was a tiny artery, but it had affected her left side, mainly her left arm and left leg. They wanted to do an MRI in order to see more of what happened, but my mother refused to have one. She said she was claustrophobic and couldn't stand such a thing.

It had also affected the left side of the esophagus, which prevented her swallowing since the muscles on both sides are needed to push food down to the stomach. He told me she was receiving some nutrients from an IV, but they couldn't keep her on that for long. They might have to insert a feeding tube.

I said, she has a Living Will and it says no feeding tube.

He explained the tube wouldn't go down her throat. It was a Peg Tube (Percutaneous endoscopic gastrostomy), he said. It was inserted through the abdominal wall directly into the stomach and she would be fed nutrient that equaled normal meals. If they took her off the IV she would die. She would stave to death, he said, an unpleasant way to go. He reiterated they couldn't keep her on the IV feed much longer and said a rehab center wouldn't accept her if she was only on IV.

This was on Friday evening, April 6. That Sunday I traveled the weary route north. The traffic was not as bad on Sunday morning as other days. That was one consolation. My oldest daughter went with me. After picking up my dad, we went to the hospital. Mom looked a little better, but far from hardy. I had been asked to give the hospital her Living Will and I dropped a copy off at the nurses station.

There was a lady visiting my mom when we came, a friend of hers. I came back in and decided to try and persuade my mom to have the MRI. She insisted she wouldn't be able to stand that enclosed chamber. I was trying to explain it wasn't completely closed, when the friend chimed in.

"I don't know why you would need a MRI. I they took an X-ray. They know where the stroke was. I think they have enough."

I could have shoved her into an enclosed chamber, like a coffin after I smothered her with a nearby pillow.

My mother staunchly refused the MRI.

After the lady left, a nurse or some kind of hospital person came into the room. She came up to the bed and asked my mother if she would allow them to insert a feeding tube. My mother told her no. The person said, "Okay," and left.

On Tuesday my dad called and told me mother was going into surgery on Wednesday to have a Feeding Tube inserted.

I told him I had a couple appointments on Wednesday and wouldn't be able to take him to the hospital (someone else would), but let me know how it went.

What happened? There was this very stubborn woman who feared a simple MRI, had put down no feeding tube on her Living Will, had told them when they asked, "No feeding Tube" and as quicker than that was said, she was getting a feeding tube.

And as usual, things did not go smoothly. My grandmother once said that, "This family can't ever do anything just once." It seems she was right.

Well, Then How Do You Know There Is One?

"The Wizard? But nobody can see the Great Oz! Nobody's ever seen the Great Oz! Even I've never seen him!"


 Mother looked weary and mussed. She said, "They say my mouth is crooked."


She spoke much clearer than I had been expecting. There was perhaps a tiny slurring of a word here and about, but not much.


"Not very crooked," I said.


Dad sat down in a chair in the room. He was exhausted. I had pushed the chair near the bed. He took her hand.


"They say I had a stroke," she said, but she didn't know much else. She also kept drifting in and out of consciousness. She said something about them giving her morphine. When she floated back to us she told about the women.


"There were these women in my living room. I said, 'What are you doing here?' and they said, 'We're working.'"


Then she said, "Last night a man came in the room. He was in a wheelchair. I rang the bell for the nurse and she came in. 'What's this man doing in here?' I asked.


"'What man?' She said. 


"'The man in the wheelchair.' 


"'There's no man in here', she said


"'Well, I saw him,' I told her, but she paid me no mind. I swear there was a man in a wheelchair."


Maybe she had a premonition. The next time we came we commandeered a wheelchair in the lobby and rolled dad up to her room. The long halls were too much for him. Maybe she saw him coming in her room in a wheelchair before he actually did.


There was an oxygen tube plugged into her nose and IV's stuck in both arms. There was a control for the bed and a button at the end of a cord for calling the nurse. She was a tangle of tubes and cables. She had a TV remote on the bed, but she kept losing it in the web of blankets and hookups. She could lift her left arm, but not flex or open her hand. She couldn't move her left leg at all. 


I decided to go out to the nurse station and ask exactly what happened to her and what was being done for her. There was a young woman sitting behind the counter. (To be honest, they're all young women to me now. They could be sixty years old and I'd say the young woman at the counter.) She kind of ignored me until I said, "Excuse me". Then she looked up. 


I told her my mother was in Room 261 and I wondered if she could tell me exactly what happened to her.


Well, no, she couldn't. She wasn't a nurse, just some kind of clerk, I guess. I thanked her, because I'm polite that way. I saw another young woman come down the corridor who appeared to be a nurse. It is hard to tell who's who anymore. Nobody wears white, doctors or nurses. Maybe the cafeteria lady shows up in a white apron, but everyone else is wearing "scrubs", except the scrubs today look like the frocks Kindergarten teachers use to wear, gaily colored with joyful little images. My daughters wear the same kind of scrubs at the shelter where they work as VetTechs. But I was willing to bet the lady walking my way was probably not a VetTech.


"Excuse me," I proffered again, "can you tell me anything about my mother. She's in Room 261."


"She had a stroke," she said.


Yes, we knew that. "What is the extent?" I asked.


"Oh, you'll have to ask the Nurse-on-Duty for any more information."


"I though you were the nurse."


"No," she said and I said, "Thank you," and we went our ways.


When I finally caught up to the Nurse-on-Duty it was a different day and time, but same old conversation beginning with the same old, "Excuse Me".


"Can you tell me something about my mother? She's the lady in Room 261."


"She had a stroke."


"Okay, but is it going to improve? What is affected? How is it being treated?"


"I'm sorry," she said, "but you'll have to talk to the Doctor about those things."


"Where can I find the Doctor."


"He's not here today. This is his day in that other town. You could call his office." She told me the name of his professional association.


That afternoon when I got home I looked up the number for his professional association online. I called the number. A woman answered who was either having a bad day or just didn't want to be there answering calls from pests like your's truly.


"'Lo. Such and such Associates," she said in a flat, boring, annoyed voice.


I gave my name and my mother's name. I asked to speak to Dr. Whatzit's. I told her my mother was in Room 261...


"Which hospital," she spat at me like I was the dumbest jerk who ever came down the pike.


I told her.


"That's the other one," she said. "Let me transfer you," and zap I was waiting out a ringing phone.


The next voice was at least pleasant. 


"I am trying to reach Dr. Whatzit," I say.


"Oh, he's at that other hospital today," she says. I'll transfer you..."


"No, I was just transferred here by them. Can you just ask Dr. Whatzit to call me?'


She took down the pertinent information and said she would get the message to him.


I waited for the phone to ring the rest of the day.


It didn't.


I was beginning to learn how things were going to go in the days ahead. I would quickly learn I might not be in Kansas anymore, but there wasn't any Wizard either. There wasn't even a curtain.