Wednesday, February 24, 2010

Use caution when moving your parent to a new state

Moving your parent to an ALF or nursing home near you seems ideal but it could cause financial duress and mean your parent doesn't qualify for financial assistance.  Some states will not approve financial assistance (medicaide) until a person has established residency.  In my Mom's state, that's 30 days and proof that she intends to stay.  In another state it's six months!  At $3-5000 a month, that's a substantial amount to pay until they qualify.

The best practice - do research LONG before your parent or elder might move closer to you.   Contact your state medicaide office to understand VERY clearly the residency requirements, asset limits and application process.

How can I move my parent to a new state? moving my parent near me, state aid and moving my parent, 

Excess Vitamin D poisoning especially concerning for diabetics

A friends Mom died from too much of a supposed "good thing" last year.  She was a diabetic with poor kidney function and an overdose of vitamin D meant she suffered a lingering illness and painful death.  Given the increases in diabetes we see in the US, I feel  that sharing her story here is the responsible thing to do and I hope to prevent the same tragedy. 

Before I continue I must include a disclaimer:  I am NOT a health care provider - no dietisian, no nurse, no physician.  I am an educated middle-aged woman with some common sense and desire to share information.   I urge any reader - anyone for that matter - who has questions about Vitamin D to talk with their health care provider or do their own research.   There are several very credible sources (Mayo Clinic for example) that post more information about the benefits and risks of Vitamin D and other supplements, please seek them out.    

Vitamin D is necessary for many functions in the human body and especially important for elders since it helps the body absorb calcium and retain bone mass.  Too much vitamin D can have painful side effects - the most severe  - and risky to elders - are high blood pressure, kidney stones or a build up of calcium in soft tissues like the heart and kidneys. In My friend's case, her mother died of kidney failure due to calcium build up.  She had so much calcium in her blood that her kidneys worked like mad to filter it out. The calcium built up there in her kidneys.   She had reduced kidney function due to the diabetes and the increased demand was more than her damaged kidneys could tolerate.

What was the source of the vitamin D? Her supplements, her vitamins. For several years, my friends Mom ordered special vitamins from a pharmacy out of state.   Due to an error at the pharmacy too much Vitamin D was added to a certain batch that was shipped to this elder.  The vitamins looked just the same as always. With no way to know about the excess vitamin D, she took her pills faithfully as she'd always done.  After a couple few weeks she began to feel bad; after three weeks she ended up in the hospital with kidney failure.  No one had anyway of preventing this error, except the pharmacist that made her vitamins and his supplier who changed the wholesale packaging and concentration.    Had she known about the risks associated with her supplements, she might have been in tune to slight symptoms before she was too ill to recover.   I hope that anyone with diabetes, will learn the risks and subtle signs of early vitamin D poisoning.   

Being a necessary pain in the ass - my latest role

I am a pain in the ass - or at least I'm made to feel that way all too often.  The past few weeks with each call I make on Mom's behalf I get attitude, impatience and the brush off.   My latest situation is Mom's dentures.  Nearly two weeks ago her lower denture was lost at the nursing home.   The social worker there assured me they'd take care of all the arrangements to get a new denture - except payment of course.

Without the denture Mom can't eat many things and I worry that she's passing over nutritious food.   She can talk fine but when tired she is not clear. We want her to meet others so speaking clearly is important when those hear by are hard of hearing.  And, for the sake of her dignity, she wants her teeth back;  she doesn't want to appear like a "toothless old crone".  On Monday I started to call the social worker (SW)about the appointment.  I leave 2 messages - Nothing. Tuesday I call twice and leave messages.  Nothing.   Tuesday late afternoon I reach another social worker who tells me that Mom's SW has been out sick. (Note no back up to check her messages or forward the phone! BAD, bad)  She checks and says they are waiting on the Transportation Coordinator to schedule the appointment.  Coincidentialy, the Coordinator has left for the day (it's 2pm where Mom lives :\). 

Now it's Wednesday and I call again.  I called the main number and get the Exec Director on the line and learn that the Transportation Coordinator is probably gone already, again...  Hmm..."I've called for two days now.  I really want to know if she's made an appointment for my Mom" (translation, I'm not hanging up until I have an answer). The ED agrees to "go to the other end of the building to check." (Heavy sigh)  Next thing I know, the phone rings and Pam answers.   I have to explain things all over to Pam and ask if she's the Transportation Coordinator.  "Yes. Why!?"   Her tone is immediately defensive even though I politely say, please and thank you and "I know you're busy, but ...".  She tells me they are waiting on the denture service to verify Mom's status with Medicaide.    I say, "that's fine but I'm willing to pay because I want her to have teeth so she can eat". Pam doesn't care. Pam insists that they are waiting on the denture service; it's "their fault." even though I've not said anything negative about the delay. (I'm beginning to understand why they let her leave early everyday.)  I ask for their number.  This time I get a "tsk and ugh" and I could feel the eye roll through the phone.  I hate TSK's... I'm not some whining child - I'm a grown woman who's trying to do something for her Momma!!

I call the denture service and get more attitude.   I finally say, "Look, I just want to get my Mom in there so she can eat; I'm worried that she's not eating enough because she can't chew most foods well." The woman's attitude softened a little.   So - the woman there asks if I'll hold, "As long as you need." I tell her..... I hear her talking to someone, "open, now bite down. That needs to sit for a few minutes. I'll be right back..." She comes back to me rather out of breath and apologizes, "There are only two of us to do everything..." She explains that they are waiting for medicaide to confirm Mom's status and if they'll pay.  I tell her that it's okay, I will pay for the teeth.  If Medicaide comes through before the appointment and billing are done great, but it doesn't matter.  With that news, she's nicer. She's willing to call the nursing home to make an appointment for the next week.   She's trying to rush me off the phone by now but I don't let her get away until I ask that the appointment be after 2pm so my brother or sister in law can be there with Mom.  I also tell her I'll call the nursing home to confirm the time.  (Honestly, I don't want to talk with Pam again but I do want to be a bother to her since she was sort of rude. Passive aggressive perhaps, but I don't care.)

So - 3 days, 5 messages, 4 phone calls later - someone will call someone else to set an appointment for Mom's teeth.  Though Mom still doesn't have an official appointment, I believe it will get done.  If it's NOT done by tomorrow afternoon, no one will be surprised when I send attitude, tsk's, heavy sighs and eye rolls through the phone.  (I've actually learned that silence after a question, especially "WHAT??!!" is really, really effective. It's like they think you're ready to blow up.)  They immediately get nice and escalate your issue to get attention of someone who can actually DO something about it.

I've learned NOT to get pissy and mean even though often I really, REALLY want to.  I've learned to politely tell people who I am, why I'm calling and what I need.    I generally do not say "I want", I say "can you help me with..insert  topic here ". I always say please and thank you -  always "thank you" even though you don't mean it.  Don't include any sarcasm in the "thank you" they can feel that immediately.   I keep logs of who I speak with and note who will take what action by when.   When I call them back I remind them, very politely, " After we spoke last week, I hoped Mom would have insert concern here by now.  How that's coming?"  I never blame; never say "you".  When it's necessary I will say, "Someone should be accountable for this....insert your topic here."  That only comes after lengthy discussion of the facts, dates, details - so they are not surprised when I expect someone to take responsibility. When I, or someone in my family has made an error, I own up to it immediately and I work to fix it. They can't accuse of us being unreasonable.

All of this is really discipline. The discipline to take detailed notes, to keep every thing straight, to be responsible. Discipline to call or show up when I say I will. I pay when I say I will.   Thus I get especially frustrated when I'm dealing with people who make this sort of thing their profession and they are rude or can't get things done.  I get frustrated when they act as though my calls about Mom's care are a surprise and inconvenient for them.   They should expect calls and be prepared to answer in a professional manner.   They should NOT treat family members like a pain in the ass! 

It ticks me off, it's hurtful and I HATE it but I must take it.  They are in the power position; they are there working with my Mom.  They are there with her daily and I don't want them to take their frustration with me out on her.  I must say that has happened only ONCE after she had surgery years ago - I'll save that for another day.   95% of the time Mom's care givers are nice, patient and respectful.  I'll deal with their attitude as long as she's content and feels good.