Dad’s New Digs

The Horror of Senior Care

My 94-year-old father dove down the basement stairs backwards June 26, 2015. The gash in his head left a pool of blood on the cement floor where he landed; a trail of blood indicated his progress as he crawled back up the steps to the kitchen and tottered from room to room. The towels he grabbed to staunch the bleeding were found balled up and encrusted with blood in unlikely spots throughout the ground floor by my brother days later. The two armchairs my father sat in to recover, then dial 911, had to be discarded.

After a week in the hospital and two week’s rehab, he was back home, sharp as ever, but physically altered. His walking was impaired. His hearing and vision had worsened. Even the timbre of his voice had changed, which we couldn’t help but interpreting as shaken confidence. He was alone now as well. His ailing 95-year old companion had, of necessity, been whisked out of the large, three-story house during his absence by her daughter. And driving was forbidden him till his vision returned to normal. For us progeny, who lived in other states or countries, these aftereffects signaled a sea change: Dad had to move to a place more convenient to his lifestyle, more comfortable, and safe. But he was alert as ever. That meant the decision to move had to be his, and he did not want to move. He felt he could carry on alone in the house as well as ever. That was something we could not in all conscience allow, which meant we had to persuade him to move. My brothers hesitated. Granted, it was too soon to start in on him about that. My watch came up. I arrived from Germany August 17. The agenda was enormous. I decided not to think about it.

You must realize the horror of moving into a senior care home. Yet, within two weeks of my arrival, Dad had viewed the pleasant two-room accommodation just become available, been evaluated by the home’s administrators for physical and financial fitness and accepted, and committed to move in just two more weeks’ time. The rapid pace startled both of us. We were rolling. It drew a line under the enormous amount of paperwork already completed, and signaled the start of a great deal more. Not the least of the chores ahead was arranging the move of Dad’s few chosen furnishings to his new digs. For me, it added the enormous task of preparing the vacated house for sale. Although I had been cleaning and disposing of decades’ worth of accumulated rubbish since the hour I arrived, I decided not to think about selling the house. I concentrated on moving Dad instead, which turned out to be traumatic, even for me. The upheaval it must have meant to Dad I treated with less sensitivity than I should have and it was due to pure ignorance on my part.

Moving Dad’s furniture, several paintings, standing lamp, and clothing took less than an hour. Two moving men arrived at the house at 10:30 a.m., loaded the truck, followed me to the home, conveyed the small load up to Dad’s new place chuckling at the ease of the job, and had driven away by 11:30 a.m, papers signed and tips dispersed. That was a Saturday. The man himself was to move on Tuesday. The man himself decided to postpone to Wednesday. When the man himself decided to postpone to Thursday, the man’s daughter protested. Dad had wanted me to extend my stay so that I would be there for some days after his move to help him adjust. I had extended my stay for that reason. If he kept postponing the move, I pointed out, there would be no transition days left. He moved docilely on Wednesday about three p.m. The horror closed in on us during the “orientation” meeting that was held in the home’s conference room at four.

A new woman, Woman “B,” settled herself at the conference table opposite us. When we asked where Woman “A” was, the woman with whom we had dealt in the weeks prior to the move, Woman “B” answered simply that she wasn’t there and moved briskly to the business at hand, a stack of forms waiting at her elbow to be initialed by my father. It turned out to be extremely convenient that Woman “A” wasn’t anywhere, apparently, because the rosy circumstances she had painted for us were exposed point by point by Woman “B” as a product of our misunderstanding. Like transportation. Move-in fees. Care-level assignment. Use of personal assets. Time “off campus.” Telephone charges. Let us visit each, if briefly, in turn.

Transportation. It had been a special point of concern for Dad before committing to the move to ascertain that he could get transportation when he wanted it for shopping, doctors’ appointments, and visits to his house less than five miles away to check up on things. Woman “A” had smiled broadly at such a simple and basic request. That, she had said, was no problem, and I ticked it off my list. Woman “B” reacted with consternation. Dad would have to make arrangements a month in advance to get a ride anywhere. She divulged the reason readily, sincerely: the several establishments “on campus” had only one bus between them. Evidently, the home’s realm of possibility did not admit the recourse of getting more buses.

Move-in fees. Dad was to write out a check before leaving the room, with right now being best, for the $2,930 required to cover the last two weeks of September at $162 a day for his assigned level-one care plus a one-time $500 move-in fee. Move-in fee? Woman “A” had never mentioned a move-in fee. Woman “B” regarded us with less-than-empathetic astonishment, but remained silent. There was nothing to discuss. On looking over the “2015 Daily Rates” circular later, we did indeed note the last point, after kitchenettes, which mentioned a $500 move-in fee.

Care-level assignment. This represents by far the most lucrative sleight of hand the home practices on every new resident. During the orientation, Woman “B” flew over the establishment’s 17-page “Personal Care Admission Agreement.” On page three of that agreement, it states: “Resident, at the time of execution of this Agreement, shall receive services at the following level of care: 1 {     initials}…” Woman “B” asked Dad to initial the care level of “1” assigned him and he did. Neither he nor I had any qualms about it; we both agreed that Dad required the lowest level of care offered.

On poring over the contract later in his rooms, Dad realized the mistake. The home’s “Descriptions of Level of Care” circular states: “Level 1: Individual requires prompting and supervision for performing activities of daily living (getting into bed, rising, dressing, hygiene, and bathroom assistance, etc.) and monitoring of psychosocial needs.” My father requires none of that. What my father and I failed to remember during the orientation was that the lowest level of care the home offers is Basic. For basic care, the resident “requires assistance with medical supplies, physician appointments, transportation, and medication storage.” Please note, my father does not require such assistance, but does welcome it.

As soon as Dad pointed out the mistake to me, I called Woman “C,” who had evaluated my father and assigned his care level. She explained readily and sincerely (everyone in that establishment answered readily and sincerely; they were indeed, as I noted more than once, highly trained professionals): She had used a form to evaluate my father, as if that explained it. I obtained a copy of the form. It does nothing more than list the six activities for which the resident may or may not require assistance: eating, drinking, selecting meals, transferring in and out of bed or chair, turning in bed, and moving from place to place. A selection of numbers from 0 through 3 is listed by each; the number indicating the level of assistance required is circled during the evaluation. The level of care assigned a resident is determined by totaling the circled numbers. The resident is not informed of the level of care assigned as a result of the evaluation, nor shown the form used to arrive at that assignment.

Basic care is provided to those who accrue as many as 10 points; my father would have been awarded none. My father does not qualify for level-one care, period. (Certainly, the help can come around to tell Dad it’s dinnertime, which they have done while I was there; that doesn’t mean he needs to be reminded of it.) But, Woman “C” went on somewhat rashly, every resident on being admitted to the home is assigned at least level-one care for good measure, with reevaluation to take place at some later date.

That good measure is for the home rather than the resident, I should think. Basic care for a resident living in a one-bedroom accommodation such as my father has costs $145 per day, level-one care costs $162 per day. Until they are reevaluated, incoming residents requiring basic care pay an extra $510 per month. The next questions are: Does the home bump up all care-level assessments for good measure? When does a reevaluation take place? Are residents refunded retroactively for charges they paid for care they never needed? How hard do residents have to fight to be reassigned down a care level, when that is appropriate to their needs?

By the time the orientation meeting got to use of personal assets, I was feeling pretty wretched, aware that I had delivered my father over to the devil. When I saw that the “Personal Assets” form stated that Dad was forbidden to engage in “frivolous gifting,” but was to spend his money exclusively on health care and services supplied by the home, I intervened brusquely: “Hold off on signing that one, Dad.” For the first time, Woman “B” appeared slightly put out. She flustered a bit about how the form didn’t mean anything. I remained firm. The form was put aside for the time being.

The stipulations about time “off campus” was just one more jab to the gut: The home filled in an Absentee Validation form required by Dad’s long-term care insurance company. What on earth for? I wanted to know. Out came another foul secret: If Dad chose to spend a night “off campus,” which he could and certainly should do if he wanted to, the insurance company would withhold Dad’s long-term care coverage for those 24 hours, that is to say, Dad would get docked about $100 for every night he spent somewhere else. In order to be able to fulfill its reporting requirements to the insurance company about Dad’s absenteeism, the home had to maintain 24-hour surveillance of Dad’s whereabouts; it filled out the Absentee Validation form to keep track. Worse, an insurance company official called each month to get that report. Dad would be spied on 24/7 by two different institutions.

By the time Woman “B” told Dad his telephone service cost 90¢ a day, all he had to say was: Any other hidden charges? Well, no, she returned with jovial intimacy, as if she and Dad were great pals by now, and gestured in a sprightly manner at the empty spot by her elbow: she was at the end of her stack of forms. Her recitation of meal times punctuated the ordeal nicely: 8 a.m., noon, and 5 p.m. Just the right times for eighty- and ninety-year-olds, n’est pas? And, she added, a complete inventory would be taken of Dad’s things as soon as we got back to his rooms. Wasn’t that something we could put off? I asked. We were pretty tired. It would take no time at all, was the answer. And sure enough, shortly thereafter someone came around to list on yet another form every single stick of furniture, electronic device, pair of trousers, and cardigan my father had brought with him. If he should bring anything else, he was advised, he should let them know. No one ever said what purpose such a detailed inventory served, but we were too exhausted to ask and too disgusted to want to know. What difference would it make? All we could have done, as astute observers of reality, was add my father as an item in that inventory.

My suddenly much poorer level-one-care Dad did find another cost hidden among all those papers. On page two of the “Personal Care Admission Agreement,” it states that as part of basic services the community will provide the resident with “(f) furnishings consisting of a bed, chair, storage area for clothing (i.e., chest of drawers and closet), bedside table/shelf, mirror and lamp.” My father had spent over $2,000 for a bed, mattress, and chest of drawers especially for his new living quarters. Not one staff member of that place had ever hinted that the home was in a position, in fact, obliged to provide anything of the sort.

Dad hadn’t slept anywhere but in his own bed at home in over 47 years. In just under a month, he was camped out at his new digs, feeling as exposed as a puling babe on a rocky Grecian slope. He has not slept well since his move. Understandable. Neither have I.

3 thoughts on “Dad’s New Digs

  1. A wrenching essay though you had informed us of its contents already. The pile-up of particulars in paragraphs somehow made the whole situation seem worse. I went to see your dad day before yesterday.He seemed to have adjusted to his new situation with a sort of philosophic calm that impressed but did not surprise me (coming from him). I was also glad to see that his physical condition seemed to have improved, it was not unlike what it had been last Easter before all his troubles had begun. In other words, he’s made a remarkable recovery. The home is depressing–gorkland to use the terminology common among interns and residents of Vicki’s era. The public spaces were for the most part deserted, all the inmates had retreated behind closed doors apparently. The few people I passed in the halls seemed not altogether to know what (you notice I didn’t say who ) I was. And yet I was not totally disheartened inasmuch as your dad seemed to be moving forward, not giving up, doing his best (much better than I would or may eventually have to do in a like situation). It was a bit of an inspiration to go visit him I would say–he provided a study in courage

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