A Daughter's Journal

The Sound & the Fury: Signifying Plenty

by Ann D. Gross

If I had known my Mom was going to enter a nursing home, I never would have worked so hard to get a Masters degree in gerontology; understanding her behavior makes it so much harder for me to do what I need to do as a daughter, especially when I hear from the SNF staff about what a "difficult patient" she is.

I wish I could just be like other family members who have made the transition toward seeing Mom as "an old lady." Not only is she still the leading lady to me, but I refuse to see her as "old." I'm sure, in part, it's about my own mortality. I look at her and see her beautiful face, those high cheekbones still amazing. She fairly howls when she looks in the mirror, and has been known to spend hours on end cursing the wrinkles on that face, and practicing how she might look with that ever-elusive facelift.

Each time I go back home to New York, she'll tell me, "you'll really be shocked when you come down next time and see how much I've aged." I guess, in a way, it encourages me to come back that much sooner. Of course each time I return, I see the same face, the one that has always been a shape starlets envy and men take notice of. I see the face my father fell in love with, I believe, some 55 years ago. I am a majority of one.

I still see the heads turn when we go out together, and not just to get out of her way when she has her walker. And I still answer her when

"Because Mom, they don't make people as classy as you anymore. You dress like a young city dweller (even though she lives on Florida's West coast). And you are beautiful."

Usually about three rounds per day of that exchange satisfies her, and it's about my limit too.

Like Charlie Brown

Truth be told, what makes her so difficult for the Director of Nursing and the staff to deal with is that she still plays for the team that has not lost its fight. She is the star of that team--Charlie Brown's team--the one that's always going for that football, without bothering to worry about whether anyone is really holding it or not. They'll all fall down (and break their hips) before they stop kicking at the darn thing. I believe the team slogan is, "Damn the consequences. Full speed ahead." Of course, full speed is a relative term for her and her teammates.

And as a gerontologist, I'm trained to encourage that independent spirit in older adults. The whole premise of gerontology is that we need to understand the art and science of aging. During the course of my studies at USC we studied the psychological, sociological, and physical aspects of aging, including both the neurological and behavioral issues within those disciplines.

I learned a great deal, much of which was not great news. The biology of aging is not for the faint-hearted. Some insist that aging itself is a "disease state," that senescence by definition is about the "breaking down" of processes and cells. But I prefer to set up my tents and computer in the camp where they believe that it's a matter of change. It's a matter of adapting to changes. Ah yes, easy to say on a starry summer night. Less easy to cope with in the confines of an SNF.

I must have missed class the day we had the lecture on "coping with your own mother's defiant behavior while in an SNF." I probably was out the whole week we studied that.

Do Not Go Gently

The problem is simple: the behavior that makes my Mom such a difficult patient is also the behavior that keeps her alive and "kicking" (as it were). I remember my conversation with my cousin who lives out in San Francisco, a free-spirited woman, who has always been my Mom's great admirer, if from thousands of miles away.

Mom had entered the SNF secondary to a hospital stay for her recurring Clostridium Difficile (C. Diff), and a possible stroke. She was weak as a newborn foal, and about as capable of standing or walking unassisted.

Yet my Mom, bless her heart, was hell-bent on going home from the SNF within a few days. She was horrified at the very idea of a nursing home, no matter how many times the staff and I insisted on calling it a "skilled nursing facility." Let's face it; to my Mom, the semantics were hardly the issue.

"How's my Auntie doing?" my cousin asked, during a telephone call about a week after Mom entered the SNF.

"Um..." I hesitated. At that point, I was worn out from the struggle; Mom complained day and night and in the wee hours in between. She refused to eat in the dining room and took all her meals in her room (she still does, except for special Friday night meals).

It seemed the entire staff from the Administrator, to the DON, to the Director of Food Service were working full-time to make her "adjustment" (as it were) an easy transition. It seemed they would do anything to make her happy.

I could have told them they were pushing boulders up a steep hill until they reached the top and rolled down again, but they truly aimed to please.

A Daughter's Role is Unlike Any Other

"Well," I responded to my cousin, "She's having trouble adjusting to the routine."

"Good for her!" my cousin yelled gleefully into the phone. "She should be!"

And I realized the difference between my cousin, out in San Francisco, and me.

For my cousin, way out on the other coast, it would have taken interplanetary travel to get her to "where I lived." That is to say, my cousin lost her own Mom at a tragically young age. Her father, my mother's beloved younger brother, had died a few years ago. While she surely missed out on the joys of aging with her parents, she also missed out on the cold reality.

Here were our choices: Mom could "acculturate" to the SNF that housed her, or she could find a way to get herself admitted back into the hospital. But as she was, the hospital wouldn't keep her any longer.

Since her doctor had diagnosed a TIA or possible full-blown stroke, she was able to stay in the hospital's skilled nursing unit; and stay she did, for some three weeks. The nurses and CNAs at the hospital were amazing with Mom. Mom had the best room--right out in front of the nursing station. Not only did she hear all the gossip, but she always had the security of knowing someone was right there. If ringing the bell didn't bring immediate attention, some well-timed yelling could. But Mom was too much of a lady to ever resort to the latter (not to mention, the staff went out of its way to respond quickly, especially my friend and soul sister, Everlena).

But we were told daily by the unit's administrators that she could only stay as long as she was "showing progress," and once she showed enough progress, she would be discharged. It seemed to me the ultimate geriatric Catch-22. Moreover, Mom couldn't do any of her ADLs, and technically, the unit wasn't supposed to keep patients who needed help toileting.

Nowhere to Turn

The cold ugly truth down there in hot Florida was this: when she lost the ability to take care of herself independently, there was nowhere else for Mom to go but into a SNF. Even Medicare policymakers had realized this before I did: in the wisdom of the keepers of its flame, Medicare provided for 90 days of inpatient skilled nursing care, if needed, all expenses paid (including prescription drugs), subsequent to a hospital stay of longer than two days. No wonder many health care crusaders chant, "Medicare for all." Seems like an excellent deal to me.

Our rich Uncle Sam Medicare notwithstanding, it was an astounding realization to face after she got out of the hospital, that Mom's only workable choice was to go into the skilled nursing facility. And it was a lucky thing this excellent facility had room for her just when she needed it.

Right. So back to my cousin on the phone from San Francisco.

"Uh, yeah, good for her," I say, with all the strength I can muster after several long days of struggling alongside the others to push that boulder up the hill only to watch it roll down again.

"Absolutely!" says my cousin. "I hope she never adjusts! She should just keep fighting!"

I groan, but my cousin probably doesn't hear me. Besides, how could I ever explain the situation to her?

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