Reluctant Caregiver: The Pros and Cons of Hiring Your Own Caregivers

help wantedYou’re struggling to hold down a job and take care of your mother with dementia.  You need help!  Do you hire caregivers on your own, or sign up with a home care agency?

Before you decide, you need to take stock of your resources.  How much money is available? How much time and patience do you have to manage the process?

Here are a few things to consider while you make the decision:

Benefits of hiring caregivers on your own:

  1. You get to choose them. You can sift through as many applications and interview as many people as you wish, until you find the right fit – for both you and your loved one.
  2. Your house, your rules. Agencies have rules about what their employees can and can’t do.  Need the aide to take out the dog?  Drive Mom to the doctor?  Give Dad his insulin shot? Some agencies prohibit such tasks.
  3. You can communicate directly with your caregivers. Many agencies don’t let their employees have the client’s telephone number. This is horribly inconvenient, but designed to keep aides from working “off the books” for a client.
  4. Not working out? No problem! If something goes awry, there is no middle man to get in the way. You can simply fire them on the spot (this could also be a con).
  5. You set the schedule. Agencies often assign their employees to more than one job in a day.  If their relief didn’t show up at the house before yours, or they run into traffic, you could be faced with skipping your own doctor’s appointment or leaving Mom alone.  You can also offer things like their birthday (or their kids’ or significant other’s birthdays) off – little perks that make working for you a little bit better.
  6. You set the pay rate. Agencies need to make money and pay their overhead; therefore, they pay their employees less than they would make at a private duty job.  Caregiving is hard – you know, that’s why you need help – and those aides who are paid fairly tend to do a better job. I also paid overtime on days that aren’t considered bona fide holidays by most agencies – Christmas Eve, Mother’s Day, Valentine’s Day, etc.  Nobody wants to have to work on a day that is special to them.
  7. It’s cheaper. Agencies charge upward of $18 an hour, while paying their employees a fraction of that.  I know one client who paid their agency $21 an hour, while the agency paid the personal care aide $9 an hour.  I’ve hired aides who made minimum wage ($7.25 an hour in Virginia) at an agency.  No wonder aides quit to work retail or in the fast food industry – if you’re going to be making minimum wage, flipping burgers is a lot easier than wiping butts.
  8. Employees are plentiful. Many agencies are understaffed and can’t meet the demand for their services.  There can be a waiting list of days to weeks – which makes it difficult if you need to go back to work right now.  Place an ad on care.com or another platform offering a decent wage, and you will be inundated with potential employees.
  9. You do your own background check. Sure, agencies conduct the standard background check offered through a service or a local police agency. Depending upon state laws, they might hire an employee prior to doing the check, then dismiss them later if something disturbing appears.  In addition to the traditional check that you can conduct for a small fee (usually $30-$50), you can delve deeper into the employee’s background.  Sure, they list references, but you can talk to others at their previous places of employment.  You might call a former instructor.  Stalk their social media accounts.  Agencies don’t go to that much effort, but you will.  After all, these folks will be practically living in your house.
  10. Bonuses. Most reputable agencies prohibit their employees from accepting bonuses or gifts from clients. But as an employer, bonuses are a valuable way to keep up morale. I gave bonuses on the employees’ birthdays, as well as at Christmas.  I gave Mom’s day aide – who had the brunt of the mess (and smell!) when Mom had c. diff – a special “poop bonus.”  Appreciation works.

While hiring your own caregivers could be more economical and better for your family, there are some serious reasons why you shouldn’t take it on.  Here are some of the cons of hiring your own caregivers:

  1. Payroll. While there are numerous programs and apps to make it easier, you still have to do it. Track hours, write checks or send money transfers, and the worst of all – pay taxes.  Yes, you should do this.  While it’s easy to pay someone “under the table,” it’s also illegal.  And it deprives them of paying into essential programs like Social Security and Medicare.  They will thank you one day.  Really.  Agencies take care of all of the bookkeeping and paperwork.
  2. Red tape. This is related to payroll. If you hire someone to work in your home (or your loved one’s home) and pay them more than $2,000 a year, you are considered a “household employer” by the IRS and state tax departments.  You must obtain a Federal Employer Identification Number from the IRS.  It’s a fairly simple, online process.  Different states have different rules for withholding and paying taxes as well as signing up for the state’s unemployment insurance program.  Also, the state and feds might have different schedules.  For example, household employers can pay their withholding and “nanny taxes” when they file their personal tax return.  Some states require quarterly reports, and there is a penalty if you don’t get them in on time.  I know – yours truly paid a hefty sum to the Commonwealth of Virginia for procrastination. Agencies eliminate the need to declare yourself an employer.
  3. No backup. Someone is sick, or their babysitter doesn’t show up, and they can’t come to work. You have to scramble to get someone to cover.  Agencies often (but not always) have someone else they can send to fill in for the absent employee. They also are more likely to have someone who can stay overnight if you travel for work or pleasure.
  4. You’re the boss. With the control of doing your own hiring and firing, you get the responsibility of doing the hiring and firing. You can’t blame something on the big bad boss at the agency – you have to discipline the workers, and even fire them, if necessary.  Not fun. Agencies take on the Big Bad Boss role for you.
  5. Medicaid. If your loved one runs out of money and needs to sign up for Medicaid, the state-federal health care program for low-income people, already being signed up with an agency that participates with your state’s program will help immensely.  Even if you opt for “consumer-directed” Medicaid services at home (where you hire your own aides), you still need an agency to accept the Medicaid payments and pay the caregivers.  The program won’t pay families or pay your caregivers directly – you have to have a “Medicaid facilitator.”
  6. Insurance. If your loved one has long-term care insurance, using an agency will make the process much easier.  Depending upon the terms of the policy, you might not be able to hire people on your own.  Providing the documentation and paperwork will fall to the agency, which is a load off of your shoulders.  Also, if your loved one needs equipment such as a wheelchair or hospital bed, agencies have contacts and expertise to make this happen without adding to your task list.
  7. Liability. Your Mom’s aide hurts her back lifting your Mom off the toilet.  That’s a worker’s compensation issue.  An agency is covered.  Are you?  If the employee abuses your loved one or steals from you, the agency has procedures as well as insurance to cover it.
  8. Licensing. Licensing issues for Certified Nurse Aides or other professionals are murky when it comes to household employment.  This is both good and bad.  For example a CNA for an agency or facility can’t give medications or injections, even if they know how.  There isn’t that oversight in your home, which can make life easier for you.  However, if they do something like abuse their patient, do drugs, or otherwise break the rules of their profession, you would want to deal with that with the state licensing authority.  Having an agency with a pipeline to the licensing organization makes that easier.
  9. Contracts. You really should have contracts with each of your employees if you are hiring yourself.  If you use an agency, your contract is with the business to provide the services.  They take care of their own employee contracts.  Less work for you.
  10. Bridging distance. If you don’t live near your loved one who needs help, it can be very difficult to recruit and manage caregivers from afar.  With an agency, you have a level of supervision and management.

Regardless whether you use an agency or hire caregivers on your own, research is essential.  Make sure you do your homework before you dive in. If you are considering hiring your own caregivers, the IRS has a handy guide for household employers.  You can compare home health agencies on Medicare’s website.

 

Ginger Thompson has been a family caregiver since 2015. 

 

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How the System Fails the Frail

MomPixieatConsulate
Mom with her grandog Pixie at the SNF that kicked her out because she couldn’t pay a month in advance.

Today for me was a lesson in how the long-term care system is failing.

Mom was home a little over 24 hours last week when she had to go back to the hospital. She became unconscious when we had her in the lift changing her Saturday evening. I had already had to call the paramedics on Friday, about 2 hours after she came home, because she slid out of her wheelchair and I couldn’t get her up.

She was discharged today to a Skilled Nursing Facility (otherwise known as a nursing home with a physical therapy department) for rehab.

After she was in the ambulance on the way to the SNF, the SNF received a Notice of Denial of Medical Coverage from Humana, her Medicare PPO. I got on the phone and filed an expedited appeal, which takes 72 hours.

Meanwhile, the facility admissions director was telling me that since she was coming in as private pay, I needed to go to the business office and pay for 30 days up front, or $8,280. I told her I couldn’t do that, but I would pay for a week up front to leave her there long enough for me to get things ready to bring her home.

I was standing in the social worker’s office, explaining the appeal and how it will take 72 hours, when the Executive Director came to the door. He’s a tall, burly man, with a crew cut, and a sour look. Standing in the hallway, he told me quite tersely that I needed to go to the business office and pay for 30 days. I told him I didn’t have that much, but could pay for a week. He said no. I asked him why, and he said, very rudely and loudly, “Company policy! If you do not pay for 30 days, she cannot stay! She has to leave now!” He was getting really loud. I was crying. People in the hallway and lobby were looking at us. I looked at the social worker and said I would take her home. He said, “Good!” and spun and left.

This was the same SNF she had been in just a week prior.  Her Humana Medicare PPO had required her discharge on Sept. 2, but I kept her there a week on private pay, to a tune of nearly $1,700, in hopes of winning an appeal.  I didn’t.  Ironically, I got word that my appeal was denied yesterday, too, just a couple of hours prior to this incident.  Had Humana authorized her to stay longer, she probably wouldn’t have ended up back in the hospital a little over 24 hours after coming home.

Apparently, Humana has given up on Mom — believing she can’t improve with rehab.  No matter that she walked with a walker prior to her first hospital admission on June 26.  Who would be able to get around well after spending the most of two-and-a-half months in a bed?

The ambulance company brought Mom home and put her in bed because I can’t transfer her from wheelchair to bed, etc. One of the aides I use works at the assisted living facility where Mom used to live, and is trying to rustle me up some extra help.

This is an example of how the system sets people up to fail. Denying her rehab means she will continue to decline. This is how people die. And this is how family caregivers have nervous breakdowns, have to quit their jobs, etc. Luckily, I have a job that is flexible with a company that “gets it.”

Something has to change. As our population ages, more and more of us will need help like Mom. And there are more and more of us to slip through the cracks of the system.

Be aware. Plan. Save. Most importantly, advocate for the frail.

A day in the life of a #ReluctantCaregiver

118142600_8f7251c825_bIt was 1:44 a.m. on a Thursday morning when the electronic box by my bed started blaring a very loud tune that was way too cheerful for the hour.  It meant Mom had pushed her “call button,” a wireless device I had purchased so that she could summon me when she needed help.

I jumped out of bed and, in a zombie-like state, headed for the stairs.  When I arrived in Mom’s room (previously the master bedroom), the lights and TV were on, as always.

“What’s up?” I asked.

“I’m cold,” she answered.

Mom complains daily that my house is too cold.  At an average of 75 degrees (my heat pump is on its last legs and I can’t get it any cooler), I think it’s rather balmy most of the time.  Mom wears long sleeves and a sweater, or wraps up in a blanket, as she goes about her day.  But at night, she insists on sleeping without covers.  Her feet, especially, must be exposed.

This is the second time she has called me to cover her up.  I make a mental note to make sure the sheet and comforter are within her reach next time.  I cover her up, and head back to bed.

At 7:24 a.m., the machine blares more annoyingly perky music.  I had hoped Mom would sleep until her aide arrived, but not today.  She has to go to the bathroom, so I help her get up.  She complains again that I took away her bedside portable commode at the behest of her physical therapist.  She needs the exercise of walking to the bathroom if she is to regain her mobility.

She’s wet, so we begin the process of cleaning up and dressing.  I insist she wash the parts she can reach, and wash the healing pressure ulcer on her bottom with wound cleanser spray.  Then I slather her in Calmoseptine ointment — a kind of diaper rash cream for incontinent adults.  I check her blood sugar and write it down in the chart I created to track her health and activities.

The hardest part is the compression stockings.  I bought her some snazzy argyle ones — and they are just as difficult to put on as the hospital-issued ones.  I sit on the hard bathroom floor and finally get them on her.

Breakfast is next — tricky for someone with kidney failure.  Not too much protein, sodium, potassium or phosphorus.  Cereal with blueberries and coconut milk, coffee with coconut creamer, and a dinner roll with coconut spread (we’re avoiding dairy as much as possible). It seems like a bad meal for a diabetic, but you can make up for the carbs with insulin.  There’s no way to counteract the excess phosphorus, protein, and potassium in foods like eggs, oatmeal, orange juice or bananas.  A diuretic takes care of the sodium, but we still watch her intake and try to keep it under 140 mg per serving.

Finally, her aide arrives.  I fill her in on the morning progress and head upstairs and back to work.  I’m lucky that I have a flexible job that permits me to telecommute regularly — otherwise, I could become one of those family caregivers who has to take a leave of absence to care for a loved one.

During the day, I try to stay hidden away so that I can work.  The occupational therapist arrives; I greet her and return to work.  The home health nurse is next — I have to be there to help Mom answer questions, because she doesn’t remember her symptoms.  The nurse checks the sore and declares it healing.  Yay!  A victory!

At 1 p.m. the aide from an agency that I reserved through a “backup care” benefit offered by my employer comes to relieve the morning caregiver.  While I work from home, I have found it difficult to be interrupted every 40 minutes when Mom (who has urge incontinence that is probably due to her dementia) has to go to the bathroom.  So I called in extra help until she is strong enough to make it to the restroom alone.

My dog needs to go out, so I take her out to the front yard.  When we come back inside, she decides to scoot her butt along the wood floor and all of the throw rugs — making a mess two days after the housecleaner had mopped.  I decide to take care of it later and return to work.

The rest of the afternoon rolls along smoothly, with the aide keeping Mom company and helping her out by getting snacks, refilling her water-glass, and making sure she changes position regularly.  And of course there are the frequent bathroom trips.

The aide leaves at 5:30 p.m., and I take my computer downstairs and continue to work, in an effort to avoid too many trips up and down the steps.  During one of her bathroom breaks, I mop the floor.

After about an hour, I start dinner.  I’m putting rice on to cook when Mom calls me to help her go to the bathroom. Again.  I get her settled on the toilet and go to check the rice, hurrying to the stove — where I step, with bare feet, on my dog’s bone.  The hours of her gnawing on it have sharpened it into a dagger, and it’s sitting on the floor like a jackrock.

I scream with pain as the sharp bone punctures the bottom of my right foot in the arch.  I hop around a bit, cursing the bone and the dog.  Finally I hop into the bathroom where Mom sits on the toilet.

“Is something wrong?” she asks with a deadpan look when she sees the tears on my cheeks.

“Didn’t you hear me screaming in there?!” I ask.

“Yes, I wondered what was going on,” she said.  It was obvious she had forgotten hearing my hollering.

She offers to help me clean up the wound and bandage it, so I hold my foot over the bathtub and pour hydrogen peroxide over it, leaving a trickle of blood going down the drain.  Mom applies a bandage, and I help her get up and back into her recliner.

At dinner, she claimed not to be hungry, but ate a steak, rice, and a salad.  Then she asked for dessert.

We sit on the porch and I drink wine while she repeatedly asks why I don’t have blinds on the porch.  I’ve learned she hates the dark, and insists on pulling the curtains as soon as dusk arrives.  I repeatedly answer that I enjoy looking out into the dark.  She repeatedly asks if anyone (meaning an aide) is coming tomorrow, who is coming, and what time they will be there.  The answer is always the same:  “Yes. Ashley. 8:30.”  I’m used to the repetition and don’t let it bother me.

By 9 p.m., I’m exhausted and head her to her bedroom.  She complains it’s too early to go to bed.  I insist that I’m tired and need to retire to my quarters.

The bedtime routine ensues — blood sugar check, insulin shot, cleaning up, nightgown on, teeth brushed.  Then the hard part — the adult “nighttime” diaper that her experienced aide advised she wear.  Unlike the Depends she wears during the day, this garment has tabs like a baby diaper.  She can’t stand up long enough for me to fasten it.  Attaching it while she’s sitting causes it to sag.  She complains about the sag.

I give my usual answer:  “Sorry, Mom, I never had kids.  I don’t know how to do this stuff.”  She laughs.

Within 40 minutes, she’s in her hospital bed, bare feet propped up.  No covers.  The woman who has been freezing all day is now overheated, even though she is more scantily clad.

This time, I push the sheet and comforter beside her on the bed and make sure she can reach it.

My glass of wine and I go upstairs — so that we can do it all again tomorrow.

Ginger Thompson is one of more than one million family caregivers in Virginia who take care of a relative at home in order to keep them out of facilities.  She feels very lucky to have flexible work hours, the ability to telecommute, and the financial resources to hire experienced caregivers to help her care for her mother, Helen, who suffers from kidney failure and mid-stage dementia.  Follow her on Twitter @gingwrites, with the hashtag #ReluctantCaregiver.  Her mother’s anecdotes are hashtagged #HelenQuips.

 

#ReluctantCaregiver: Dimensions of dementia

Dementia-75Today my Mom thought she was in the town where she grew up.  Everyone she saw, she thought had some connection to her hometown.  It doesn’t matter that she hasn’t lived there in 40 years — that’s where her mind resides today.

While waiting for a CT scan, we ran into an aide who works at the assisted living facility where Mom lived until she moved into my house two weeks ago.

“How’s everyone in Webster?” Mom asked her, referring to her hometown deep in the West Virginia mountains, hundreds of miles from here.

Being accustomed to dealing with people with cognitive issues, the aide deftly handled the question without correcting Mom.  What I found most interesting was that Mom was so happy to see a familiar face.  Fortunately, she has forgotten that she wasn’t particularly fond of that aide.

After her doctor’s appointment, where we learned that she does NOT have lung cancer, the disease that killed her mother and maternal grandmother, we returned to my house.  On the way into the neighborhood, she asked, “Are we going to your house or my house?”   I just answered “Yes.”

That’s the wrong answer.  I should have said, “Your house.”  My answer was probably confusing to her, or shaming to her for forgetting she now lives with me.  The question was one she always asked after appointments.  Sometimes we would return to her assisted living apartment, while other times we would come to my house and hang out, have lunch, and play with my dog.

Now she lives in my house, and the master bedroom suite is set up in a way that is similar to her former apartment.  I’ve moved upstairs, cramming my bedroom furniture into a room a fraction of the size of the master.

The private aide I hired to help me take care of Mom finally convinced her to write Easter cards.  She proudly brought them to me, saying Mom would only write two, even though I bought her 12.

I glanced at the envelopes.  Her handwriting isn’t the neat cursive it used to be.  It sloped down the envelope at an angle.  But the most glaring issue was that the card addressed to my sister used my sister’s first name — but the last name of Mom’s sister.  The card addressed to my niece and nephew included their first names, but again, the last name of my mother’s sister.

Mom’s sister died in 2008.  Usually, Mom forgets that information.  She has been forgetting it for quite some time. Last week she remembered her sister’s birthday.  I couldn’t ascertain whether Mom remembered that she had passed away.  Perhaps she remembered this time.

Every now and then Mom has been confusing my sister with hers.  She remembers her sister as she was in the 1970s — a young married woman with two little children struggling financially.  I believe that is a better memory than the one of her laying in her casket, victim of a devastating disease at the age of 57.

My sister’s life is currently similar to our aunt’s in the 1970s — except it’s more than 40 years later.  She has two small children, and her husband was unemployed for a time, causing financial stress.  Their names also begin and end with the same letters and both are two syllables.  At first one might think she is simply misspeaking — but in reality she has the two women confused.

I hired two caregivers to help take care of Mom.  One is here on weekdays, the other weekends and one evening during the week.  Mom is very fond of the day aide; the evening/weekend CNA, not so much.  Every evening she asks at least five times, “Who is coming tomorrow? What time?”  Each time, the answer is the same.  When she wakes up in the morning, it’s “Is someone coming today?  What time will she get here?”

I was fortunate to be able to get the same physical therapy assistant to work with Mom at my house who helped her in assisted living.  She loves the man, and will walk through the house without complaining with him by her side.  When her caregivers or I encourage her to walk, she complains.  I finally realized why she likes him so much — she thinks he’s a guy from my hometown.  When another home health care staffer asked her if she knew him, she said, “I’ve known him all his life!  We used to go to church together!”

Mom also occasionally melds her two husbands into one person, attributing something one of them did or said to the other.  However, she can deftly tell you that she was 52 when my father died, and was single for 11 years before she remarried.  She can’t tell you how long ago her second husband died.  Sometimes she gets the month and year right, but rarely remembers in what city she resides.  She is clueless about the street address.  She will  wrack her brain for the name of the President of the United States (I think she wants to forget).   She also can remember a random comment someone said to her 50 years ago, but can’t remember what she ate for breakfast.

Many people think that Alzheimer’s and related dementia are all about memory.  Memories of past activities or people are not the only thing a dementia-afflicted brain forgets.

Mom’s physical symptoms of the disease have recently become more pronounced; namely, she eats a lot more than before.  She will say she’s not hungry, but then eat a complete meal and ask for more.  This is because she forgets she has eaten.  She also has become more incontinent.  This is because her brain forgets what it feels like to have to go to the bathroom. Conversely, sometimes she has to go to the bathroom all the time — this is because the urge to go is overwhelming and new for her, because she forgets what it feels like or how to “hold” it.

This is our new reality.  This is dementia.

 

 

 

 

The Reluctant Caregiver: When the Brain is Living in Another Time

Recently, when Mom asked me the date — as she often does — she said, “Cathy’s birthday is tomorrow.”

Cathy was Mom’s first cousin who was raised by Mom’s parents from the age of four.  In reality, they were sisters, although Mom was 14 years older.

The next day, Mom asked me the date.  Although she has a “memory clock” that informs her of the day of the week, the date and time, whenever we are together or talk on the phone, she asks me the date about four times.  That’s because she forgets about the clock that expresses the precise date.

“Today’s Cathy’s birthday,” Mom said.  “I wish Cathy and Kenny would come visit me, but they probably can’t afford it.”

I was in her closet, hanging up her clothes.

“Probably not,” I answered.

This would seem like a normal conversation under usual circumstances.  However, Cathy died in 2008 at age 56 after a long battle with leukemia.  It wasn’t the leukemia that killed her; a blood stem cell transplant cured her of the cancer.  But years of chemotherapy weakened her organs, and she succumbed to heart failure.

In 2008, I drove Mom to Cathy’s funeral.  She was there and mourned with Cathy’s husband, children, grandchildren and other relatives and friends.  Cathy’s widowered husband, Kenny, has since remarried.

In their later lives, Cathy and Kenny were financially secure, traveling and enjoying themselves despite her disabilities from her illness.  In their younger days, when they were first married, they struggled as many young couples do.

It is the young, newlywed Cathy and Kenny that Mom’s mind remembers. The disease of dementia has destroyed the part of Mom’s brain that remember’s Cathy’s illness and ultimate death.  The part of Mom’s brain that stores the memories of Cathy’s young married life is the one that survives.

I told the story to a friend, who asked me why I didn’t tell her that Cathy was dead.  Couldn’t she learn that Cathy is dead?

The answer is No.  Mom has dementia and isn’t capable of learning new things.  The part of her brain that remembers Cathy’s demise is destroyed.  She has stored her memories of Cathy is an area of her brain that is not yet damaged — but it’s the section that remembers Cathy’s youthful newlywed days.

My rationale is that it is better for Mom to remember Cathy as a young newlywed instead of the middle-aged woman lying in her casket at the funeral home in 2008.

Dementia destroys memories.  But sometimes it destroys the painful memories and leaves the pleasant ones to live on forever.

.

 

 

 

 

The Reluctant Caregiver: Picking Your Parent’s Nursing Home

FullSizeRender (2)Many years ago, I bought my mom a gag gift.  It was a crafty sign that hangs on the wall that reads, “Be Kind to Your Children, they Pick Your Nursing Home.”

Fast forward a couple of decades.  Today, I chose my mother’s nursing home.

That shouldn’t be a big deal.  I work for an organization whose mission is to “disrupt aging.”  I analyzed our local facilities a few months ago when my significant other’s father needed to be in a facility temporarily.  Ironically, I had just thrown all of that information away.

When my mom was in good health and of sound mind, I would joke with her about the time when she couldn’t live on her own anymore.  I would jovially say that I would send her to the nursing home near her house.

When the hospital where she was a patient said they were going to discharge her to a skilled nursing facility for rehabilitation, she chose the nursing home near her house.

My sister and I sounded the alarms.  That facility gets very bad scores on Medicare’s Nursing Home Compare tool.  One star!  Much below average!

Mom, like most older people in her position, wanted to stay near her home.  But most of all, she wanted to stay near her dog.

Mopsey is a Lhasa Apso who is at least 15 years old.   She got him soon after her border collie, Jessie, passed away.  He had been abandoned near the local veterinarian’s house, and the vet thought Mopsey would be perfect for Mom, who was grieving for Jessie.  He was right.  They became fast friends and constant companions, even when my mom met and married her second husband.

My stepfather passed away after 10 years of marriage to Mom, but Mopsey was still her constant companion.  Grandchildren were born (my sister’s kids), I moved further away, but Mopsey was always there. An odd dog, he wasn’t lively and high strung like most small breeds.  He was sedate, almost depressed.  Perfect for Mom.

When Mom fell and broke her wrist, Mopsey was there.   She was taking him out at the time.  Her health was a downward spiral after that.

After her fall, Mom hired caregivers to stay with her – mostly at night.  She professed a fear of falling.  But I believe a fear of being alone, and a need for someone to care for Mopsey, drove her to spend several thousand dollars she really didn’t have on caregivers who didn’t do that much for her.

Let me note it’s not the caregivers’ fault.  Mom didn’t give them many tasks, other than running a few errands, taking Mopsey out, and sleeping in her house.

Her health became so bad one of the caregivers called me in alarm.  Mom was getting worse and wouldn’t let them do anything.

My sister intervened.  She lives about 2 ½ hours away and went for a visit.  Disturbed by Mom’s condition, she convinced her to go to the closest university medical center.

That brings us to today.  Mom was in the hospital for nearly two weeks. They conducted a multitude of tests, two procedures and treated her medical problems.  It was time to talk about next steps.

Mom had been adamant she wanted to go to her hometown nursing home.  No matter how many times we joked we would send her there, my sister and I did not want her to be a resident.  We read the reviews, the inspection reports, etc.  We heard from people in the community who had opinions.  If she went there, she would get even more seriously ill.

As luck would have it, her neighbor who was caring for Mopsey needed to go out of town at the same time I planned to visit.   He inquired regarding my plans for the dog.  I learned his schedule was about to become very hectic, and there is no room in it for a geriatric pup.  I said I would bring the dog home with me when I visit.

Low and behold, Mom determined that Williamsburg, Virginia, is where she wants to reside during her rehabilitation.  Not because it’s a major retirement mecca.  But because it’s where her dog will be living.

That’s OK.  Mopsey is a sweet pup.  We have many good options for long-term care in Williamsburg.

Today, I chose my mother’s nursing home.

This is a new journey for us.  Despite the fact that I work for the world’s leading advocacy group for people age 50+, and have the world’s experts and research on aging at my fingertips, I’m scared as hell.

But then I step back and think about what it must be like to be my mother.  She was in a giant hospital, underwent numerous tests, and she couldn’t name the president of the United States.

This is sad.  I remember the day President Obama was elected, and my mom’s elation.  She was glued to the TV.  She followed every moment of the inauguration.  She commented on Michelle’s dress.

Today, she can’t remember the name Barack Obama.  It’s sad.  It’s scary.

I never had children.  It was a choice I made, not fate.  But here’s my mom, needing the guidance of an unruly teenager.

I see a challenging journey ahead. Stay tuned!

Ginger’s Soapbox: The Affordable Health Care Act

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Congress passed the Affordable Care Act, a.k.a. Obamacare, and the world didn’t end.  The U.S. Supreme Court basically upheld most of the important parts of the new law.  The world didn’t end.

There have been millions of words written about all of the dire consequences of a law that gives most Americans health care coverage.  But I want to concentrate on the good things.  Let’s go over a few:

Preventive care benefits are covered at 100%.  Regardless of your policy – and there have been many complaints about the policies available through the ACA – your well-woman, well-man and well-child services are completely covered.  No copay.  No deductible.

You can keep your kids on your policy through age 26, regardless of whether they are in school, living on their own, or married.

Medicare benefits are enhanced.

I read one article where a man complained that his ACA premium was over $400 per month while his girlfriend’s premium was completely covered by a government subsidy.  He made over $60,000 a year, while she earned $18,000.

My first thought was, “Why does this guy begrudge the woman he loves affordable health care?”  If he resents subsidizing his girlfriend’s health insurance, he certainly doesn’t want to help total strangers.

And that’s what’s wrong with this country.  It’s completely contrary to the principles under which this nation was founded.

What happened to the common good?

I subsidize my boyfriend’s health insurance.  He’s a retired military officer.  He doesn’t pay a premium for his health coverage.  I also subsidize my mail carrier, the federal prosecutor, the local FBI agent and all of the active duty military members, just to name a few.

Then there are the school teachers, state highways workers, and other government employees.  My tax dollars pay for health care for all of these people.  I used to pay for my member of Congress, but the ACA makes them buy health insurance through the exchange, and none of them qualify for subsidies.

Let’s give a crap about our fellow man, be thankful for what we have, and do something for the common good.  Acceptance.  Love. Tolerance.