Tactical Execution

I was up in Canada for 19 days and spent most of it coordinating a move for my aging parents from the hospital to Crofton Manor, a seniors living facility in Vancouver, Canada.  My sister, Denise, flew in as well and we worked through the process together.

The pictures lining the left-hand side of this post are in chronological order.  They begin with my sister sewing identification labels on all the linens at the house.  From there, we got things ready for the move, had the movers come in, got everything moved into the nursing home and then finally transferred my parents from the hospital to their new home.  Here’s the full story.

My father has Parkinson’s disease and has been in the fight of his life for the past four years now.  Last year, things took a turn for the worse and his mobility is now quite limited.  He also has a difficult time communicating – an extremely frustrating reality for a retired quantum physics professor.  He’s a smart guy but he can’t get the words out.

My mother had a brain tumor in 1997 and finally got it removed in 1999.  Unfortunately, we all suspect the surgery didn’t go that well and she has struggled ever since with hissing in her head and mounting confusion.  Today, she has Alzheimer’s disease with dementia and struggles with all the changes taking place as a result of her (and my Dad’s) aging.

Since August 2007, my parents have had 24-hour in-home care and that has helped them deal with all the medical requirements that have become part of their daily lives.  But it hasn’t been easy.  The careworkers represented a major intrusion into their privacy and my mother, in particular, was upset about their involvement.

The 11 months of homecare were marked with almost unbelievable stories of physical accidents, frustration and confusion.  It was becoming clear that the medical realities my parents were struggling with were making regular living almost impossible.

In late June 2008, the public health system in Canada determined that it wasn’t safe in the house anymore and transferred them to the hospital for a formal assessment.  After a few days, it became clear they would be healthier and happier in a nursing home and my sister and I made plans to fly into Vancouver to help with the move.

I arrived on July 15th and my sister arrived on the 17th.  In between our daily visits to the hospital, we began organizing the house and preparing for the move.  My parents have a lot of antique furniture and beautiful old paintings so much of the focus was on the selection process – deciding what to bring and what to leave behind.

The daily visits were also very important.  The locked ward my parents were in was a challenging place, full of patients all struggling with their own psychological problems.  Although my mother had made friends, they were both very eager to get out of there.  I don’t blame them.  The days drifted by slowly for them and we were all looking forward to walking out of there as a family.

On two different occasions, I took my Dad to the house while my sister kept my mother company at the hospital.  It was important for him to be involved in the process and go through some of the papers that had accumulated on his desk.  It had been very difficult for him to keep up on everything but he was aware of a lot of details we had no idea about.  It was also an opportunity for him to say good-bye to the house.

The job of going through all the receipts, documentation and unopened mail was daunting.  We literally found bags of un-opened mail and my sister continues to work on that job.  Amongst the monthly statements and unpaid bills, we found five undeposited checks totaling almost $13,000.  The money came from their investment accounts, pensions and tax refunds and the largest check had already expired.

Once we started getting a handle on the situation, the selection process went fairly smoothly.  My sister measured out a detailed floor plan and we marked in every piece of furniture we wanted and where it would go.  By the end, we had a detailed list of items to be moved.

The movers showed up on July 22nd.  They were excellent.  They showed up and got straight to work.  With a couple minor stumbling blocks, we got everything into the truck and drove up the road (less than a mile) to Crofton Manor.  There was another truck there at the same time, moving in some other resident but we got a parking spot fairly close to the door and started moving stuff in.

My sister and I were there much of the day but went back to the house for dinner.  After getting our grub on, we drove back to the nursing home and stayed there late into the evening.  We were hoping to get everything ready but it was just too much to do.  We went back to the house and decided to come back the following morning, before picking up my parents at the hospital.

In the morning of July 23rd, we had to do some grocery shopping to stock the place for my parents regular living requirements.  But after that, things went quickly.  We put up the remaining pictures and fined-tuned the layout.  It really looked good, like a dollhouse version of their previous life.  All the important things were there and the pictures were hung in the same configuration as the house.

We left Crofton and went straight to the hospital, arriving about 10:30.  The nurses had already helped my parents pack their things so we were out the door within about 30 minutes.  We couldn’t carry everything in one load so I made arrangements to come back again in the afternoon.  But the important things fit – my Mom and Dad.

The drive from the hospital to the nursing home took just 15 minutes but felt like a world away, especially for my Mom.  By the time we arrived, she thought we were in Switzerland, her home country.  It took her a few days to get oriented in the new place but she was definitely a lot happier than she was in the hospital.

My parents were happy with the work my sister and I had done but there was definitely some sadness in the air.  My Dad knew the house was now a thing of the past and had to take some time to get used to the new environment.  But the furniture and paintings brought the feeling of ‘home’ to this new place in a remarkable way.

Lunch was being served almost as soon as we got there so we had to rush to get down there on time.  We arrive at 12:45 and lunch officially ends at 1:00.  It takes my Dad a long time to eat and we stayed until after 2:00.  The staff was very accommodating but it become clear already that my Dad’s eating patterns would likely become a problem.

As it turns out, my parents would later have their meals transferred to the “care side” of Crofton Manor.  The good news was that my father would no longer be rushed through his meals but my mother didn’t like the new environment at all.

The “independent living” dining room was larger and more elegant.  The people had fewer medical challenges and interacted more with each other.  On the care side, the interactions were heavily influenced by the medical conditions of the people who live there.  In particular, the other dementia patients made conversations difficult.

It may sound strange to hear that other dementia patients were frustrating my mother, a dementia patient herself.  There’s a reason.  My mother has no idea she’s sick.  That’s the whole point behind Alzheimer’s.  You forget stuff.  You forget that you have a problem.  You might be completely confused but just seconds later, you forget and still think you are perfectly normal.

Alzheimer’s is a tragic disease.  It reduces those affected to rubble.  They quite literally go crazy but have no idea it’s happening.  Meanwhile, the efforts of those trying to help are perceived as threats and Alzheimer’s patients often believe a giant conspiracy surrounds them and everyone is against them.  That has been the case for my mother and she has already tried to ‘divorce’ her kids (including me and my sister) and change the will.  She absolutely can’t accept that we are helping, not hurting, her situation.

It’s important to acknowledge that my parents’ four-week stay in the hospital allowed the medical community to calibrate her medications and she is now far calmer than she was before.  That makes life much more pleasant for my Dad and has allowed this transition to a nursing home to go far smoother than I had originally expected.

Another development has gone in our favor.  My mother has had swollen feet for most of her adult life but the condition has become much worse in the recent time and she now has open sores on her ankles, one on each foot.  The public health system sends a nurse in every two days to change the dressing.

This wasn’t the first time my parents received such care.  My father had severe bed sores on his heels from his month-long stay in hospital last year.  The sores became infected and that infection ended up getting right into his bones.  At that point, things became critical and nurses were coming in regularly to change his dressing and give him heavy-duty intravenous anti-biotics.

The difference is that it was now my Mom getting the care.  All this time, she has always believed that the only one requiring care was my Dad.  That’s not true.  She needs care as much or even more than he does.  And even though the care she is getting relates only to her ankles, she is seeing that she needs support as well.  That’s changing her perspective a bit and helping in other areas.

After my parents finally moved into the nursing home, my sister and I had more time to address smaller details.  We went shopping and got my Mom some specialty wide shoes, made specifically for older people with circulation problems.  My Mom says they look like nuns’ shoes but they take some of the pressure off her feet and make it less painful for her to walk.

There were a number of other smaller requirements.  Although we had brought a ton of stuff, there were still a lot of things that needed to come in.  My sister maintained a long list that we constantly added things to and crossed things off of.  Whether it was diapers for my father or a large garbage container we could discard them into, my sister and I went back and forth from one store to the next, trying to get all the things they needed.

Of course, there was also the phone and internet connections.  We probably waited too long to get that part organized and my parents were left without phone service for the first three days.  And although I’m embarrassed to admit it, my Dad’s internet connection is still not working.  We have a technician coming in on Monday to change that.  But the nice thing is that they still have the same phone number and email addresses.

It’s important to mention that my parents are NOT flying solo in this place.  They are on the independent living side of the facility – something neither of them qualify for.  We agreed to it because it was the only opening they had and Crofton was one of the only places that would accept my parents together.  Most of the other places would require they sleep in separate rooms and that would be a disaster for them.

There was another consideration.  Crofton Manor is well known as one of the nicest senior living facilities in the Vancouver area and it’s located less than a mile from my parents’ old house.  It’s the same neighborhood and their church is only about two blocks away.  Getting them into Crofton was a blessing.

Anyway, my parents didn’t quality for independent living but the management agreed to it as long as we maintain ongoing private homecare within their senior living facility.  So we have a team of workers that come into the nursing home and help my parents through the day.  The only time they are left alone is during the night.

The arrangement also puts my parents on the waiting list for a spot on the care side.  That’s where the story takes a turn for the worse.  After all the effort we’ve put into this move, it’s really sad to think they might need to move again soon.  The rooms on the care side are much smaller than those on the independent living side and some of the furniture pieces would have to be taken out.

My sister and I are both really disappointed that this will be happening.  It also presents a challenge because one of us will likely be needed to help with that transition.  It’s just not easy for us to leave everything and run up to Vancouver every other month.  As it turns out, I’ll be up there for the 2008 Internet Marketing Conference in September so I may be able to help out, but still.  It’s an ongoing distraction and we see no end in sight.

Personally, I am starting to feel like my parents could stay in the independent living side as long as we keep the care in place.  Is it more expensive?  Absolutely.  But my parents were lucky with their investments and there is enough money to pay for it.  Besides, they are already eating on the care side so they are receiving some of the benefits already.

That leads to another important topic: cost.  A lot of people believe that Canada has socialized medicine so all this care is covered by the government.  Nothing could be further from the truth.  There’s no question that Canada has a good national healthcare system but they do a financial assessment before they pay for anything and if you have money of your own, they don’t cover much.

The nurses that come into their home to change dressings are indeed covered and I have nothing but good things to say about them.  They do an excellent job.  Also, my parents’ stay at the hospital didn’t cost anything and they were in there for four full weeks.  But the homecare is a different story.

The homecare has ranged in price dramatically.  For the first few months, we hired workers privately and registered my father as a business in Canada.  We had to pay all the necessary taxes and benefits but the cost was only about $7K per month.

As I mentioned earlier, my mother had a hard time accepting the care workers and tried multiple times to kick them out of the house.  Finally, on her seventh attempt, she succeeded and we hired a professional homecare company to provide the service.  That increased the monthly bill to almost $18K.

Now that they’re in the nursing home, the homecare is back down to about $8K but that’s in addition to the $6K monthly fee to be a resident in the facility.  So we’re still around $14K per month.  This stuff is not for the faint of heart.  It costs a ton of money.

Indeed, if my parents had no money, the public health system would take care of it.  But it would be a very different service level.  There’s no way they would be in Crofton, that’s for sure!  Instead, they would be in a public facility and I suspect it wouldn’t be nearly as nice.

Anyway, everything has worked out fairly well and I’m absolutely trilled to be home.  Before I left Canada, I drove my father’s Toyota Corola to Edmonton to give my brother, Tom.  He and his wife, Jennifer, just moved there from Toronto and could use a second car.  Since my parents have both lost their driver’s licenses, it made good sense to let my brother benefit from having one of them.

The drive to Edmonton is 13 hours long.  Beautiful but long.  I was planning to do the drive in two days but the cheapest place I found in Jasper was $170 for the night and I only had another four hours to get to Edmonton.  I decided to do it all in one run and finally arrived at my brother’s place at 1:00 in the morning, just in time for a cold beer!

I stayed in Edmonton for three days and flew home last Sunday evening.  Now, it almost feels like a dream.  With any luck, things will continue to go smoothly for my parents.  I’ve got my fingers crossed.  And for the rest of us, I suggest we try to live each day to the fullest.  Getting old sucks.  And although some people have active lucid lives until they’re 95 years old, most don’t get so lucky.

My primary reason for writing this post was to have a convenient way to share all these photos with my siblings.  Yet, I know many people who might stumble on it will not be family.  If you are one such visitor, you have just received a first-hand glimpse at my family situation.  Please respect that.  And if you have any comments or suggestions, please use the contact form (rather than the comments below) to send them to me privately.