Email to Roshelle and others (Senior Resources @ Home) on 3/18/2015

From: Rick Dulaney
Sent: Wednesday, March 18, 2015 2:54 PM
To: 'Roshelle Ford'
Cc: Sela Nissenbaum; Judy Arellano; Kris Hermanson (khermanson@jtm-esc.org); Sharon Shnell-Hobbs (SShnell-Hobbs@jtm-esc.org)
Subject: RE: Services for Bruni

Hi Rochelle,

I just sent an electronic check from Bank of the West for $540, which is the amount of this bill excluding the charges for Aug 2013 and June 2014.  Per our previous conversation and my previous emails with SLV, my mom (Bruni Dulaney) should not be charged for the caregivers in August 2013 and June 2014. 

In June/July 2013 SLV decided that Bruni should be moved to assisted living, and once that decision was made, ordered regular caregivers.  My mother did not want those caregivers, objected to their presence (although not to them personally, they’ve always been very sweet), and felt this was unnecessary.  You should know that Bruni is on a very low fixed income and that it places a hardship on her to pay these amounts.  I had several conversations with Beth Hitchcock, who assured me that “we would work something out”.  At that time I had not yet assumed responsibility for my mother’s accounts, although you may remember that you and I exchanged emails on this a couple of months afterwards.

By June of 2014 staff became concerned that my mother – by then living in assisted living – was in constant danger of becoming lost or disoriented.  This was largely based on an incident the evening of May 30 2014 described by some at SLV as an elopement and by my mother as getting confused by the construction.  Among many other issues was the idea of 24-hour caregivers; I informed SLV that was fine but my mom could not afford that.  (See my email of 6/2/2014)  Out of these concerns my mother was moved to SNF.  Apparently, this period triggered the $3956 invoice, but again these were orders that my mother did not agree with.

All the other charges are fine.  And none of this is a complaint about the caregivers – in fact, my mother routinely praises them (which is a rare thing).  I want to be fair and pay what she should pay, and I’m sure my mom would feel the same way (although I try not to discuss her finances with her since it just upsets her).  Given the amount of conflicting intents surrounding these episodes, I’m willing to draw down her bank account and split the bill for those two months with SLV – However, it’s important to realize that she may well run out of money in the next few years.  I would appreciate knowing whom at SLV to speak with about that.

Please let me know your thoughts.

Thanks, RIck

Rick Dulaney | RickDulaney@westat.com | 301-294-3984

From: Roshelle Ford [mailto:RFord@jtm-esc.org]
Sent: Friday, February 20, 2015 6:08 PM
To: Rick Dulaney
Cc: Sela Nissenbaum; Judy Arellano
Subject: Services for Bruni
Importance: High

Hi Rick,

   Here is the list of invoice for Bruni. We’ve received a limited number of payments (maybe just one) since May 2013. We need to bring the account current and have a new agreement signed by you before we can provide any service for her.

Dulaney, Brunhilda

Invoice

05/26/2013

202

Due Upon Receipt

05/26/2013

102000 · AR SLV Community

634

126.65

Mailed statement 1/29/15

Invoice

06/09/2013

253

Due Upon Receipt

06/09/2013

102000 · AR SLV Community

620

49.85

Invoice

07/07/2013

7220

Due Upon Receipt

07/07/2013

102000 · AR SLV Community

592

23.00

Invoice

08/17/2013

537

Due Upon Receipt

08/17/2013

102000 · AR SLV Community

551

1,793.90

Invoice

11/04/2013

838

Due Upon Receipt

11/04/2013

102000 · AR SLV Community

472

92.00

Invoice

12/23/2013

1111

Due Upon Receipt

12/23/2013

102000 · AR SLV Community

423

46.00

Invoice

01/09/2014

1187

Due Upon Receipt

01/09/2014

102000 · AR SLV Community

406

15.00

Invoice

03/17/2014

1428

Due Upon Receipt

03/17/2014

102000 · AR SLV Community

339

15.00

Invoice

04/12/2014

1577

Due Upon Receipt

04/12/2014

102000 · AR SLV Community

313

46.00

Invoice

05/14/2014

1646

Due Upon Receipt

05/14/2014

102000 · AR SLV Community

281

57.50

Invoice

06/10/2014

1706

Due Upon Receipt

06/10/2014

102000 · AR SLV Community

254

3,956.00

Invoice

08/05/2014

1822

Due Upon Receipt

08/05/2014

102000 · AR SLV Community

198

69.00

Total Dulaney, Brunhilda

6,289.90

Kind regards,

Roshelle Ford, Program Manager

THIS JUST IN -- MOM WENT TO EMERGENCY ROOM!!

Got call from Sela at SLV that my mom was found non-responsive at 345pm today; they called 911 and took her to the emergency room.  (Originally said Santa Rosa Memorial but they meant Kaiser 707 393 4800)

FOLLOWUP:

• It took a while to figure out she was at Kaiser, not Santa Rosa Memorial
• She is apparently fine, according to her through nurse
• Spoke with Verna the RN at SLV -- they found her groggy and unresponsive and were worried that she had a TIA (minor stroke) so called 911.
• I haven't spoken to her yet but seems OK

Need to post up about discussion with Elaina Serotte

Had a conference call with Elaina Serotte (formerly with Mass Mutual, now with Golub, 650 212 2240) and her successor Dylan Malot (at Mass Mutual).

Elaina never had anything to do with taxes.
Did recall a 5-year annuitydesigned to support her for a while, ended in 2014

Elaina recommended PFAC - hire a fiduciary to represent and advocate for Bruni locally.

I'm very grateful to Elaina for all the time she spent with my Mom and for taking the time today.

FOLLOWUP:

Professional Fiduciary Association of California, http://www.pfac-pro.org/ looks pretty good.
Will contact Connis Aust of the Council on Aging.

Discussion with psychologist Dr. Alicia Ligourie 707-799-9623

Discussion with Alicia Ligourie
- contracted with SLV to provide mental health
- sit in on med meetings
- Thursday meeting reported 3 incidents, noise was getting her agitated, she was grabbing staff people, and actually causing problems
- Want Dr Ligourie to check her for depression, pain, etc.

-- CALL INTERRUPTED --

Care Conference 9/10/2014 with SLV

CARE CONFERENCE, Sep 10, 2014 1pm Eastern via phone:
- Nursing: Maryann
- Dietary: Karen
- Activities: Evelyn
- Social service: Marty

INCIDENTS
PSYCHOLOGIST
MEM MANAGEMENT

Reason for this is quarterly state requirement - talk about how things are going.
- Will go over medications, weights, etc.

Nursing:
- over the last 3 months, doing really good
- no changes from time she got here
- independently walking around the halls, but we are there to re-orient her
- independent for daily activities
- meds ok, no pain complaints, sleeping well with melatonin
- behavior: issues, several incidents
- started with seroquel after that incident, then refusing care, Kaiser doctor started her on that,

EVELYN:
- we thought might be triggered by noise, so we moved her to a different hallway, so should be quieter
- she tends to be distrustful
- when she moves to Maggie's Place (memory care) attached to assisted living
- think this will be good for her
- I have taken it over and shown it to her
- hping that is a good move for her
- she does come to some activities, pretty hit and miss, but sometimes social events
- she sometimes participates, but she is skeptical and leery of staff
- that is part dementia
- pretty good relationship with Laura, who will be at Maggie's Place

Rick
- mention Dr. Ligourie
Karen
- because of seroquel, suggested Dr Ligourie
- seroquel is anti-psychotic med that helps her with aggressiveness
- does it have side effects?  Yes grogginess and confusion
- psychotropics meeting: risks vs. benefits - is she experiencing the side effects and do the benefits outweigh the risks.

Karen
- slight improvement with her weight, put on 3 pounds (from 104)
- she is petite, but good to see an increase in weight rather the opposite
- she eats what she wants, and we honor her choices
- feeding herself with no difficulty, which we keep an eye on for dementia patients

- she also has dinner on Wed ngihts with her friends
- she was out yesterday with a friend

Marty - other?
Rick - incidents
Marty - sleep deprived on 100 hall, seems to be better on 200 hall
- she declined coming to the meeting
- she has the sense she is going to be on trial
 You can reach us any time.

Maggie's Place - probably open around 10/10
- are there floor plans yet
- no but will let you know

Call 8/29 from SLV - Mom aggressive with staff member

Had a terrible episode.  Had a delusion today that someone was

stealing her husband’s jewels.  Pulled a housekeeper from behind and

bit her.  In lobby, crying outburst, then catatonic.  Was able to

de-escalate, went into “why am I here?”, wanted to apologize.

With dementia this is a problem.  Might want a single room, might help.

- Certainly OK with me

Advanced directive – will need to sign again.

My 7/2 email to Kris and Sela

Hello,

I’ve been having some trouble reaching my mom lately.  I had a number (707-537-4277) but now am directed to a main number (707-538-8400).  Yesterday I was told that my mom was in a room with no direct phone line, which I think means that she moved rooms.  Why did she move?

I’m also wondering if we are going to reschedule her care conference.  We had one scheduled for a couple of weeks ago, but wanted to wait until her memory assessment came back from Kaiser.  My mom has left me a couple of distressing messages (fearful, etc.) but Evelyn yesterday reported that she seemed to be getting along well.  So I would appreciate your take on how she is doing as well.

I’d also like to renew my general sense that my mom may be suffering from some depression.  This perception is obviously not clinical, but I just observe that she seems generally in a low mood, often unable to take any pleasure in activities she used to enjoy, constantly exhibiting a sense of low self-worth, abandonment, helplessness and regret, as well as feeling that she is the source of others’ problems as well.  She has not always been this way – I think of her as quite social, empathic, and generally pleasant and satisfied.  I would be interested in a professional opinion on this.

Finally, I’m planning on being in Santa Rosa with my wife Christine and our son Daniel for several days starting July 22.  I’d very much like to spend some time with my Mom outside of Spring Lake Village – for instance, I’d like to take her to visit Andrew, and I’d like to take her to Grace Cathedral in SF on Sunday morning (you may already know she has a columbarium spot there).  We don’t have a specific plan yet, but I’m imagining a combination of day trips and maybe staying with us for a night or two.  We are planning to rent a house with enough bedrooms for my mom to stay, so hopefully that can be arranged.

Thanks, Rick