For the last nine months I've been living in Bastrop, TX to reduce the costs of taking care of my older brother Bill in his descent into dementia.
Twice in the last six months, Bill has be admitted to the hospital with bronchitis/pneumonia because he's losing his gag reflex, a significant complication of advanced dementia. The latest episode went down Thursday the 15th when, after he'd lost his appetite, I did a quick check with his doctor who told me to take him to the emergency room. "It'll take me three days to get back any test results from the lab and he could die over the weekend."
Enough said... we went directly to the ER. We did not pass GO or collect $200. After screwing around with all the tubes and wires, they had to put him in restraints. I sat and watched them try to treat him with nebulizer medication and while Bill managed to reach down to untie the wrist restraints from the hospital bed. After watching this bullshit for six hours, they finally sent Bill for an ambulance ride to St. David's Medical Center in South Austin. I followed in the car and signed off on the admission papers, DNR's and what not. After a dose of Haldol Bill mostly quit fighting his restraints and couple of hours later he finally went to sleep. I got in the car and drove back to Bastrop in the dark - not my favorite thing to do.
It was 10:00pm when I got a beer and sat down on the front porch to call my younger brother Rick, who to my surprise answered his phone. I apologized for waking him up, but it turned out he was just napping on the couch. We talked about Bill, and since I had an appointment with "Doc" Yount at nine on Friday morning, we agreed to set up a conference call to decide about what to do next. I was completely exhausted but it was still close to midnight before I crashed.
Friday morning I arrived for my appointment and after doing my blood sample and peeing in a cup, I got some good news/bad news: my average blood sugar was down to 170 and that was a significant improvement, but there was protein in my urine which might mean problems with my kidneys. So after the conference call I left the office with a giant fluorescent orange jug to collect a 24 hour urine sample to send to the labs for analysis. I tossed that into the trunk of the Chrysler and drove to Austin to visit with Bill, who was once more in restraints and trying to figure out how to escape.
Since this was the second ER trip and hospitalization for Bill in the last six months, he qualified for Medicare Hospice coverage. I got an officially witnessed DNR and Out of Hospital DNR orders from "Doc" Yount and when I arrived at the Medical Center, I hooked up with Ricky Mata, our assigned Community Representative from Heart to Heart Hospice. He'd arrived with a social worker, whose name I don't remember, and I signed off on all the paper work. They disappeared into the bowels of the medical center bureaucracy while I sat with Bill in his room and waited for all the "i"s and "t's to get dotted and crossed to discharge Bill and arrange medical transport to move him out of the hospital and into his new digs at the Bastrop Nursing Center. That only took another three or four hours.
Once again, Bill's transition happened at the worst possible time of day - Sundowner's time in the late afternoon. I followed the ambulance back to Bastrop and parked just as the EMT's were off loading Bill's gurney. I walked in behind him and met the Nursing Supervisor who informed me that the facility supervisor was gone for the day and would be back in the office on Monday at 9:00am. Again it was after 6:30pm so I left with no information about what this place was going to cost us. When I got back to the house I called Brother Rick and let him know what was going down. Thank G_D for beer and cigarettes.
Saturday morning I went to Walmart and bought some new jeans, a belt, underwear, socks and a pair of Velcro strap running shoes and then I dropped by the nursing home to see how Bill was doing to discover him up and about, freshly showered, changed out of his hospital gown and diaper into a fresh shirt and khaki slacks and trying the patience of the staff and his roommate. I apologized to one and all and thanked them for their patience. "Doc" Yount was there checking in on Bill and his other patients and doing paperwork as the facility medical advisor and we had a chat about what to do next. He said that we'd know more when the Administration showed up for work on Monday morning.
Rick drove up from Katy on Sunday morning and we went to visit Bill who was scarfing a plate of sweet potatoes, peas and such in the dining hall. His appetite had definitely improved. Rick and I went out for lunch at The Grace Miller Gracies, home of an "Award Winning" Chicken Fried Steak.
On my recommendation Rick ordered the CFS and I ate the Shrimp Alfredo. He was most definitely impressed and pronounced it "very tender and one of the best." We talked money and he told me that significant progress had been made with the dissolution and distribution of the family trust. I told him that I'd meet with the Administration first thing Monday morning to figure out how much we'd need to take care of Bill in the interim. I told him that I'd talk with Bill's landlady and might move from my tiny room in my current digs into Bill's place. We parted ways with a plan, but I thought that I heard some divine laughter in the back ground.
Sure enough Monday morning I sat down with the Administrator and Social Worker at the Bastrop Nursing Center only to find out that Bill was getting out of hand, wandering into other people's rooms and testing the exits. They didn't think he was a danger to the residents or the staff, but since the BNC wasn't a secured facility, they feared he might make a break for it and end up wandering out onto Old Austin Highway. The closest secured facility was 25 minutes up the road in Giddings, Texas. So now it's 1:09pm on Tuesday and I'm on my way to pick Bill up to take him to his new digs at the Oak Manor Nursing Center.