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This past week has finally convinced my mom that the time has come to place my dad in care.  Friday, she started calling around to the various assisted living facilities (ALF) that their home health service had recommended to her to see if there were any vacancies and, if so, would they take a patient with a colostomy. She had had her heart set on one of the places that was near Indiana Avenue, as many of the places she goes to a lot are located on or near this main north-south artery, and it would be so convenient for her to drop by and check on my dad.  Sunday afternoon, on my way home from daddysitting, I also checked out the facility that is across the street from the duplex I moved here from, and their home health aide had told my mom about a place she knew of on Avenue Q that was just opening up. There were only two places that had vacancies:  one of the ones off Indiana and the one on Avenue Q (which just happens to be in the same block but one street up from where my brother used to live.)  Both these facilities had private room vacancies, and both of them would take patients with colostomies, but the one on Indiana was more expensive.

One big selling point for people living in their own homes as long as they possibly can is that the fee for care facilities starts at around $2500(£1553) a month.  A place where you’d actually feel comfortable about leaving a loved one (i.e., one with nice clean facilities and a caregiver to patient ratio of under 1/10) is going to run you anywhere from $2700 (£1677) to $4000 (£2485) a month.  This applies not just to an actual purpose-built facility like a nursing home but also to those that are located in private homes (whether someone’s actual home, or a private home purchased for the purpose) to house and provide care for patients.  Both of these places that mom had narrowed the search to were facilities set up in private homes.  Usually these types of facilities have a capacity of only 8 to 12 patients, depending on the ratio of single occupant to double occupant rooms they have.  Monday afternoon, I went over to stay with dad while mom and her friend CK went to check them out.  They decided they liked the one on Avenue Q best because it was cleaner, newer, and she liked the atmosphere and the caregivers there.  The fact that it was the least expensive of the two just sweetened what was already pretty much a done deal.

My dad will have to have a doctor’s exam before they will let him move in (he has an appointment for Thursday afternoon), just to document his current state of health, and because the equipment he will have to have (i.e., a hospital bed, a bedside commode, an “egg-crate” foam mattress topper to help prevent pressure ulcers, etc.,) will have to be prescribed by a doctor so Medicare will pay for it.  Their home health agency will make the arrangements to get those things.  The home health aide who has been coming to their house to bathe him will continue to do so, and the home health nurses that come by to check on him periodically and take his blood pressure and temperature, etc., will continue to do so. Both mom and I are pleased about this, as we already know and like these people and they know (and like) my dad, so there will be continuity of care.

Because this ALF cares for patients with dementia, they have a keypad entry on the outside doors.  If you were to just open the front door, an alarm would go off.  This is to prevent any of the patients from eloping — doubly important as this place is on the corner and the side street is a wide and very busy street.  Family members are given the key code which allows them to open the door without the alarm going off.  Significant is that there are no set visiting hours.  Family members can just walk in any time and stay as long as they like.  That tells you the level of care is consistent and they are not afraid you are going to catch them out neglecting patients.

It looks like we’re going to be moving him in next week so mom can get him settled in as her friend CK, who took her around to look at the two ALFs Monday, has also been planning for some time to throw a 90th birthday party for my mom the fourth week of September, and mom wants my dad settled in before then.

Obviously, there are going to be some issues that my mom is going to have to deal with once my dad goes into care. It’s going to take her a while to come to terms with and become comfortable with the idea of surrendering the responsibility of the minute-to-minute care of the love of her life to others, and to be able to trust those others to do a good job. Then, she’s going to have to actually do it.  She’s been watching him like a hawk in case he decides to get up on his own and head out somewhere.  She’s had to sleep with one ear open …  It’s going to be hard to let go, especially since she’s a Virgo.  They are born worriers.

Another issue she’s going to have to confront is that once my dad is in care, she’s going to be by herself at home.  This November will be their 68th wedding anniversary.  Both of them retired in the 1980s, so they’ve been at home together all day every day for 30+ years. Now, all of a sudden, she’s going to be alone in that house, and alone in that bed.  She’s going to have to be coming face-to-face with the reality that there is going to come a day . . .  It’ll be like training wheels for widowhood.

What’s going to make it worse is that caring for my dad was consuming pretty much every waking moment of her time.  Once he’s in care, she’s going to have a lot more free time, and she’s going to have to figure out what to do with it. She needs to have a massive garage sale, for one thing.  She knows it, too.  I mean, massive.  She has stuff under every bed in the house, and all the closets are jam crammed.  But when she’s been afraid to be out of sight of my dad for longer than five minutes at a time in case he tried to get up by himself, there was no point in even thinking about it. Now that dad’s going into care, getting ready to have a garage sale, maybe in early October, would certainly keep her busy, and would help her transition through this difficult period. Naturally, I’ll help. But there’s going to be tons of stuff that’s going to need sorting through.

The thing that scares and concerns me the most about this whole business is how much my dad understands about why he’s being put into care, and even if he does understand, it’s not going to be a lasting understanding.  Two minutes later, the memory of the conversation, and whatever meaning he got out of it could just evaporate. It’s been hard enough for my mom to come to grips with the need to put him in care and actually start the process.  That, in and of itself, is going to be guilt provoking enough, but if every time she goes to visit him, she has to deal with him asking her to take him back home, it’s just going to tear her up into little tiny pieces.  Me, too, come to that.

That said, my dad can be quite engaging and charming, even now, and all along, he has always been very grateful for everything we do for him, always thanking us, and saying how sweet we are, etc.  I am hopeful that he will bond with and engage with his caregivers, which will make them inclined to fuss over him, which is just what he needs to help him over this difficult transition.

These next few months are not going to be easy.

Watch this space.

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