My email June 2: Bruni Dulaney, 6/2/2014

From: Rick Dulaney
Sent: Monday, June 02, 2014 2:38 PM
To: Sela Nissenbaum (snissenbaum@jtm-esc.org); Kris Hermanson (khermanson@jtm-esc.org)
Cc: Andrew Dulaney (andrewdulaney@comcast.net); Christine Dulaney (ckdulaney@gmail.com)
Subject: Bruni Dulaney, 6/2/2014

Good morning,

I’m writing regarding my mother, Bruni Dulaney.  There was some discussion on Saturday about moving my mom to the skilled nursing facility, although I couldn't tell if that was considered as a permanent move or not.  That conversation was based on what Sela saw as an “elopement” and my mother saw otherwise, after my mom left the square dance on Friday night.

I have some questions and some thoughts.  I’ve copied Kris Hermanson based on my conversation with Sela; hopefully that’s correct, since my notes weren’t perfect.  I’ve also copied my brother Andrew and my wife Christine.

First, having spent some time in SNF at SLV and other places, I do not believe my mother belongs in SNF.  She does not need skilled nursing, since her main needs are help managing her medications and help with daily activities, which she gets in assisted living.  Although the SLV SNF unit is the nicest I’ve ever seen, moving to SNF would clearly be a negative factor in her quality of life.  My mother also does not want to move to SNF.  What she may need is more oversight of her comings and goings.

Second, it seems to me that requiring 24-hour caregivers is a very strong response.  She spends most of the day in the "L" unit and takes many of her meals there.  Having a person shadowing her even while she's sleeping or watching TV seems like overkill.  My mother has been in the "L" unit for five or six months, and has had this one episode.  Sela mentioned that my mother sometimes gets disoriented on shorter trips around the campus, but she still takes herself to visit people in SNF and to the main dining facilities and bistro areas.  Those activities are very important to her quality of life, and my experience of her is that she "trains" well.

Third, there may be options other than 24-hour caregivers.  Is there a procedure for checking in and out of the "L" unit?  When the building first opened, there was a sign-out book, but it was kind of out of the way and I don't know if was a rule or an idea – but it seems like there should be clear procedures for the conditions when she leaves and some expectation of where she is and when she'll be back.  If those exist now, please let me know and I can reinforce them with my mom.  Another item is that the first building she moved into ("K") had a counter next to the door so that SLV staff knew when people were coming or going.  This seems like a worthwhile thing to have in this situation.

In general, my mom's health condition seems to be complex.  One the one hand, when I speak with her, she is generally very lucid and able to describe her recent experiences very well. This was the case on Saturday.  Other times she has trouble with things like locating her glasses/checkbook/purse/remote control/etc.  My mom often seems very irritated about day-to-day issues, but she also interacts positively with other residents, according to Sela.  I receive periodic updates from Sela in which it seems that my mom is often angry and confused. In general, it does seem that my mother fixates on things that she can no longer do, and things she feels she is prevented from doing, and generally sees the glass half empty.

When I described one of my recent conversations with my mother to a friend, he pointed out that these were classic symptoms of depression and she should possibly be evaluated for that.  I had an email exchange with Sela about that a few weeks ago, and I do feel that should be part of the way forward.

When Beth and Sela first proposed moving my mom to assisted living, there was an idea that she could be appropriate for a memory management building.  I think Sela said that this unit is now scheduled to open in August, although it sounds like the construction has lasted a lot longer than anyone expected and this schedule also might slip.  I'd be happy to discuss whether my mom is appropriate for such a unit.

When I spoke with Beth a couple of months ago, she was going to request and send me a copy of my mother's lifecare agreement.  That seemed easier than trying to find my mom's copy.  I haven't gotten that yet, and understand that Beth just left, so perhaps someone else could help me there.  I feel somewhat uninformed about lifecare and her coverage.  If I need to contact someone else about that, please let me know who.

I believe we are all on the same page about moving her health insurance from Kaiser to SLV.  Although I'm not exactly sure yet what’s involved there, I’ll reach out to Kaiser for advice and forms.

With regard to 24-hour caregivers, my mom cannot afford that really at any level. My mom asked me to take over her finances in 2013, and it's been a bit of a struggle.  She has an extremely small income from social security, and is spending down her remaining assets.  At current levels, she should be OK for a few more years.  But if caregivers are say $20/hour, that's $480 per day or $14-15,000 per month -- at that rate, she'll be out of money in weeks or months.  So we'll need to discuss and resolve that before she incurs additional caregiving costs.

I look for your guidance on how to go forward.  A couple of specific items are that I will contact Kaiser about changing insurance coverage, and I would appreciate from SLV a copy of my mother’s agreement.  Beyond that, however, I would like to have an approach in place that maintains her quality of life, that balances the oversight necessary for her safety, and that addresses her possible depression.

I’m always available by email, or on my cell (301-250-0698).  You may also text my cell, which is sometimes more useful if I’m in a situation where I can’t take a call.

Even though this situation and conversations are stressful, I would like to acknowledge again, as I have in conversation with Sela and others, how much I appreciate the SLV staff and community.

Thanks, Rick