10/10/07: What to do about Mom?

Background: Eleanor has been supervising the care of her mother Vic, now 96 years old. Vic has short-term memory loss (like Alzheimer's) and really bad knees, but is otherwise healthy. Since a bad fall in December 2006, we have had a number of part-time people staying with her so that, in addition to her day center schedule, she is never alone. Vic lives in her own apartment on Manhattan's Upper East Side, a walk and a bus ride (or a short taxi ride) from Eleanor's apartment on the Upper West Side. Eleanor has been hoping to be able to continue this arrangement, avoiding the immediate need for institutional care, which we think will be hard on Vic, who has great trouble now learning new things (how to get from her bedroom to the dining room in a new place, for instance).

I guess my wish to continue her at home by remote control from Canada is not going to be doable. This morning she lost her balance getting out of the tub and hit her head, before the helper could catch her. Didn't fall all the way, since she was caught, but bumped her head and cut her elbow. Helper was upset, called me and asked if she should call an ambulance. I said no, I went there, let Mom sleep until 10. Woke her up, she drank orange juice, I discovered a cut on the elbow, bandaged it, then changed sheets because of the blood!

I called the doctor and he agreed (with me pushing hard in that direction) that if she showed no other symptoms than a bump which was painful to touch (no vomiting, dizziness, headaches, etc.), no need to go to emergency room for a CAT scan. Good. She had a big breakfast, didn't seem any different; she dressed, and I took her to the day center about noon.

So, I can probably get somebody who could stay with her from 8:30 on, after the overnight person goes to her day job, but it's hard to find someone who will take responsibility for making these medical decisions -- and then implementing them if the conservative go-to-the-hospital path is elected. Also, Mom is having more and more trouble walking, which makes caring for her more difficult. Currently, we mostly urge her along, but if/when she just refuses, I'm not sure what we'll do. The doctor says there are gadgets (machines?) that make lifiting her easier for the aides.

Also, this was hard on the heels of a fall last Saturday morning, again while the aide's head was momentarily turned. Apparently, she slipped off the edge of the bed where she was sitting, and took a lot of skin off her arm (her skin is very thin and fragile, and this often happens). So now there are two bandages to change! We'll have to be more vigilant now, but nobody can guarantee that we can eliminate all such accidents.

I'm really discouraged about this. I think I've just been dodging the reality. We've talked about taking her with us to Canada, but Medicare won't work there, and I don't know if immigration will accept her and/or allow her to have health care, and we don't even have a clear idea of where we're going at this point. I'll try asking about case managers here in New York, but maybe it's best if Mom goes into a nursing home near my sister in Boston.