Priscilla Clemons, a therapist, helps Marianne Tulis, 93, work a hair brush at Life Care of Hixson in Chattanooga. (Photo David Tulis)
My mother Marianne is 92. She’s lived in the United States for more than 60 years, having married an American engineer whose first job was with Combustion Engineering and later the Tennessee Valley Authority.
Marianne, about three weeks ago, fell and broke her hip. Today she is in Life Care Center of Hixson, which is part of a chain of nursing care and retirement care facilities run by multibillionaire Forrest Preston.
By David Tulis
What is in the best interests of the patient?
This is a difficult question because two parties have an interest in my mother’s care. Both parties are profit-seeking corporations.
On one side there is Life Care Centers of America based in Cleveland. It wants to have as many people in its rooms and as many people as it can muster right now.
Right now, the census at Life Care Center of Hixson is low, a staffer tells me. The dining hall is largely empty at lunch and dinner, at least partly because many people eat alone in their rooms.
Life Care Center of Hixson and its therapy staff want her to be a customer; they want to extend benefits to her as long as is possible under the rules would control her stay.
The rules controlling her stay are set by an insurance company which has a contract with the federal government and its Medicare division. BlueCross Blue Steel has in her case what’s called an Advantage plan.
The staffer at Life Care Center of Chattanooga says dealing with BlueCross Advantage is extremely tricky, difficult and unpleasant. Blue Cross because of its aggressive customs and manner, presumably saving the U.S. money in the leviathan gridwork of the code of federal regulations.
Tug of war
So we have these two entities tugging over the patient client. Perhaps the best interests of the patient are served in this conflict. Perhaps not.
We have a Life Care Center of Chattanooga on one hand wanting her stay to be as long as possible under insurance. On the other side we have Blue Cross Advantage which wants her to stay to be as short as possible if the patient is not showing measurable improvement. It doesn’t want here just to parked there for weeks.
What is the best thing for the patient? This question every relative or person with power of attorney of a senior citizen must answer.
Is it best to have her there, though she does not like to be there and would rather be at home? She gets therapy usually twice a day — physical therapy, occupational therapy and occasional interviews to test her cognitive ability.
The evening sun sets on a wall in a room decorated by a senior citizen’s artistic granddaughter. This room will be the home of my mother after she leaves a healthcare facility next week. (Photo David Tulis)
The way of the Amish
The Amish are known for being outside the system. They work outside the system. They trade outside the system. They live outside the system. They’re not part of the tax structure of our country, though I think many voluntarily file tax returns though they are not liable to under the statute. They’re not part of the industrial economy. They avoid many of the expensive toys and worthless fads of modern American life.
They are Christians. They have a concern for their elderly and elder care is part of what every family does. No family anticipates a senior member being cast on the government dole in any way. Or the insurance dole upon which my family finds itself today.
The Amish care for their own. I’ve heard recently from a friend in Middle Tennessee who knows the Amish and area nursing homes. He never finds finds an Amish person in a nursing home or on Medicare or under Blue Cross Advantage.
Why?
Because Amish families identify with each member even the old members. Old people have a place in the Amish home. Even old people who need a great deal of attention and care.
The fear I have about the care for my mother is a fear about what I’m tempted to do. The temptation is as follows.
Let my Mother’s Day in Life Care Center of Hixson as long as insurance lasts. She’ll be able to get therapy and people will take her to the bathroom when she needs to go and I won’t be bothered. When insurance money runs out, we’ll take her home — yes, gladly.
But I’m wondering if that’s true. I’m wondering if I let her stay as long as insurance allows it if I’m being faithful in adhering to the principles of caring for our own people. Is letting her linger in a senior care center caring for her? Is wanting Blue Cross to last longer a godly want? Or is it letting others bear my responsibility? Am I depriving her of therapy benefits if I yank her out before the deadline tolls? Or am I being a faithful son, bringing an old dear closer into family life after he years of living alone in the house next to mine?
She has asked me repeatedly when she will depart. “Mom,” I reply. “I don’t have a plan.”
Paralysis afflicts me. I am of two minds.
If the senior family member were at my house, she would get exercise care from a grandson, on a schedule. Leg exercises. Lifts. Squeezing a ball between her knees. Pulling against a larger rubber hand by clutching at a handle.
Family members will take a lot of little walks when she is mobile again to get her out of her easy chair, her wheelchair or her bed.
“Mom, you rot to death in bed” is a statement I’ve made repeatedly, as a kind of warning.
She can be part of family life.
She can take part in family worship which I try to lead every day.
My mother has a thin Christianity fed mostly by potato chips of the morning devotional variety. She’s not a big reader of the Bible, and finds herself satisfied with summations and abstracts — Daily Bread sermonettes she reads in the morning.
If she were in my house she would be getting a little bit more nourishment spiritually.
What do you think?
Marianne Tulis, 92, decides whether to dig into chocolate ice cream as her grandson, Jacob, 13, starts lapping. Mrs. Tulis will have spent 26 days at Life Care of Hixson before departing Wednesday. (Photo David Tulis)
A very honest inquiry of your own mind and motives.
This is something so many people struggle with and there are no easy answers. I cared for my husband at home for four years, until my own health was deteriorating so badly from the stress and lack of sleep that I wasn’t sure I would be around to take care of him.
I turned to nursing home care for two years. Then we brought him home again, thank goodness. I tell people today: If you aren’t spending 6-8 hours a day, every day, at your loved one’s nursing home, you don’t really have any idea of what their care or life there is like.
A few NH residents like where they live, but most are lonely and hate it. Families worry about things like cleanliness, proper feeding, physical therapy. Nursing home residents think about one thing: They want to be around their families, people who love them. Even if they can’t participate in family activities, the hubbub of home and family life is comforting and nurturing.
They feel wanted at home, part of something, like they belong to someone. But it’s a lot more complicated than that.
If you’re going to care for an elderly person who needs help with bathroom, feeding and other issues, you need to learn best ways to manage those things (there are good lessons to be learned from nursing homes on this). You need to understand the emotional strain it’s likely to be. An old or ill person can be very demanding emotionally.
There is often no such thing as enough attention. I’ve known many people who have worked themselves nearly into their graves trying to care for elderly relatives at home. You need a support system, the larger the better (something the Amish have). You need to learn from people who know how to change diapers, clean up, safely move the elderly, etc. You need systems.
You need patience (caring for an elderly person is one of the best ways to become a patient person). You need to accept that you can’t make anyone’s life perfect without giving up trying. You need to remember that it’s all about love. In making the decision about home vs. nursing home, the most important thing to remember is that even under the best of circumstances, a NH is a very, very lonely place, and almost every resident dreams of and lives for the day they’ll get out and go home.
I’ve spent hundreds of hours with many dozens of NH residents and can think of only two exceptions to this. I can’t count the number of times I’ve heard residents tell me their son or daughter would be coming to take them home any day. Deep down, they had to know they were lying to themselves, but it was the only thing they had to hold on to, the only thing that made the loneliness bearable.
My husband, who had become almost completely non-verbal due to his illness, laughed out loud when my sons carried him onto our porch when we brought him back home. He was so happy to be home. He didn’t live much longer after that, but he lived surrounded by love and it was clear he was deeply happy and content to be back where he belonged.