A Daughter's Journal

The Circle Game

by Ann D. Gross

"What I first liked about Maimonides, especially as the absolutes of my childhood grew murky, was that he offered assurances that reasonableness is always complex." -- Rambam's Ladder by Julie Salamon

How did it get to be December 2003 with Mom still in Room #404 of the nursing home overlooking the parking lot rather than overlooking Florida's Gulf waters from the balcony of her home? Last year at this time, my husband and I flew down to Florida to prepare for her homecoming, modifying her apartment with special remote light switches, a chair in the shower, risers on toilet seats, and double-sided carpet tape tacking down anything on the floor. I'd never seen my husband work as hard as he did getting Mom's apartment ready--as if the harder he worked, the faster she'd be home and well.

My brother Ed, Mom, and I only thought we had problems during Mom's first stay at the skilled nursing facility; now we've really got a problem. This time Mom landed in the skilled nursing facility with literally just the clothes on her back. She had left home to get an X-ray at the emergency room, was unable to walk, and was transferred to the skilled nursing facility. That was three months ago, and she hasn't been home since.

But the "$64,000 question," as my father used to say, is: Where will Mom go to live after this rehab period?

She seems to be enjoying her stay this time. Sadly enough, the skilled nursing facility feels like home to her. During her eight-month stint back home, she was constantly at odds with her caregivers, especially with Suzy. They were two lionesses fighting over turf.

Mom's Home: Paradise Lose

"Suzy runs this house now," Mom would say during my nightly phone call to her during the eight months she was able to stay in her home. "I don't even get to buy my own groceries. Your brother has given her my credit card, she drives my car, and now she's in charge. He never even talks to me about things. He only talks to her."

Mom would report a variation of this nearly every time we spoke. What fascinated and frustrated me was that I thought Mom's return home was the top of the steep hill we had to climb. Turns out it was only a resting place mid-way up a mile-high mountain.

Once Mom got back home, there was a brief "honeymoon" period--about a week--where she declared each of her caregivers "wonderful." She praised one of the caregivers, remarking, "She's so uncomplicated."

I took that as a personal insult, as all my life my Mom has considered me "complicated," which was not a valued trait in our nuclear family. Instead, it was metaphoric, like "She's a beautiful person," was in the 70s.

But after the brief honeymoon, Mom began complaining bitterly about not being in control of her life.

One evening I called Mom, and Ed answered.

"Oh, hi Annie."

"Ed? What are you doing there? Is Mom OK?"

"Yeah, she's fine, physically, if that's what you mean."

"Physically? What about emotionally, or mentally? What's going on?"

"Actually, Annie, could I call you back later and answer that? We're kind of busy now."

"Uh, OK," I said, reluctantly, as I searched my brain's hard drive for what might possibly be the answer to this riddle. "As long as everything's OK, pretty much--and it is, right?"

"Don't worry, Annie," he said. "I'll explain later. Bye." And he hung up.

Was Mom having a nervous breakdown? If so, why would my brother be there? Why wouldn't Suzy just take her to the hospital? Why wouldn't Suzy or my Mom call me? Why would they call my brother?

My brother is not the kind of person you want to have around while you're having a nervous breakdown. He's astoundingly efficient and doesn't cotton to people who aren't. And having a nervous breakdown is right down there with some of the least efficient behaviors, at least in the short run.

It seemed like hours before I heard back from him, but finally he called.

"Hi, Ed. What the devil is going on? Is Mom really OK?"

"Yeah. She's OK. But she and Suzy have been having some bad fights lately. And Suzy says Mom's fighting with the other ladies, too. She called one of them 'stupid' and has been very nasty."

"Oh," I said, having been on the receiving end of that behavior.

Sadly, once my Mom feels a certain level of comfort and intimacy, she begins to lash out. Maybe she feels safe, believing that people won't leave her. But people surely do "leave her" emotionally. One by one, the caregivers told me how charming my Mom is, but that she could be so mean and nasty. She also disdains people who try to take care of her--much the way a two-year old shows contempt for authority. She rails against those trying to take care of her, but when they are not available to her immediately, she bellows for them to help her do what she surely could do for herself. To suggest that it's hard on an hourly paid caregiver is a silly understatement.

A Wise Bargain

"OK," I said. "So what did you do?"

My brother, ever the CEO and good father, knew just what to do.

"I sat both of them down in the living room and asked them what the problem was."

"Oh, God, you're a better man than I," I said.

"Mom said the usual about Suzy taking over her life and being in charge of everything. Suzy was upset because Mom was being verbally abusive."

"Mmm. Same stuff. So what did you do? Did Suzy quit?"

"She threatened to quit," he said. "And Mom heard. So I simply told Mom that if Suzy quit, then her next stop was the nursing home. And she seemed to understand and accept that."

"Wow, Ed. Thank you. Wow," I repeated, for lack of better words. It conveyed both my admiration for him and the drama of the subject of Mom in her home, wrangling with her caregivers--especially Suzy.

Suzy is strong-willed, like Mom, which is what got her through the tough parts with Mom. She stood her ground. But when they both stood their ground, well, the lionesses nearly drew blood.

The odd part was that from then on, Mom often made remarks, like, "Maybe I'll just go to Rolling Hills Manor [the skilled nursing facility]. It wouldn't be the worst thing."

Even before the sit-down with my brother, I sensed that, although Mom had made it to the top of the hill by getting home, she was restless with the metaphorical view. Oh she surely loved the view from her balcony and having the sound of the waves lulling her to sleep at night. But I knew she missed the socializing she had at Rolling Hills--not with the other residents, except to serve as the "counselor"--but with the staff members, especially her physical therapists.

Let's face it: She was the queen bee at the skilled nursing facility. She thought of the other residents as old (and thus she ate in her room, as she didn't like seeing all the old people together), and thought of herself as a visitor. When the lovely admissions director asked Mom to make sure to hand in her Resident's Form, Mom reminded her, "I'm not a resident."

What Next?

So, the year is ending, and she is just beginning her stint there. Her hip is recovering ever-so-slowly from the surgery, and, as my physician friend says, "It took her six months to get home from the SNF and less than a minute to land back in there."

And so it goes. But those troubling questions at the end of Medicare's benevolent 100 days of inpatient rehab following a three-night hospital stay: What happens next? Where does Mom go from here? As the local offspring, will my brother be willing to cobble together caregivers on a 24/7 basis, and oversee the administrative process as he did for the eight months Mom was home? Would she reconsider the assisted living facility next door to Rolling Hills?

"I hate that place," she said, when we went to visit the assisted living facility. "It feels like a jail. If I'm going to have to be somewhere other than home, I may as well be at Rolling Hills," she said, surprising my brother and me.

Truth be told, we don't even know if she'll regain enough physical function to qualify for assisted living. She has to be able to "propel" herself. Oh she can propel herself--into all kinds of situations, but not in a way to qualify for living at the assisted living facility.

Mom speaks highly of the skilled nursing facility now. But when I remark to her (stupidly, on my part) how much she seems to like it there, she snaps at me, "Like it here? Don't be ridiculous. I just want to go home."

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