Posts Tagged ‘sarah’

Beethoven’s 1st and 4th symphonies

Sunday, November 30th, 2014

When I woke Sunday morning, a text message from my mom was waiting in my phone:

Sounds like peeps in Sugar Land are sick. Are you or Bill available for HSO tomorrow 2pm?

Although I haven’t listened to much classical music since high school in the 1980s, and I’ve played even less, I do enjoy attending the symphony, and going with my mom is a treat. Jean told me they would perform Beethoven’s 1st and 4th symphonies, and I remembered that Gran’mom especially enjoyed Beethoven. Bill agreed to cover naptime so I could go.


Jean and Bob en route to Jones Hall

As Bill came outside to snap this photo of me and my mom, a lone monarch butterfly appeared out of nowhere. It swooped toward us, then just as abruptly, flitted away. I immediately thought of Gran’mom, and I turned to see if Mom had seen it too. Her eyes met mine and she smiled, and I knew she was thinking of Gran’mom, too.

* * *
Houston’s symphony has a new music director — Andres Orozco-Estrada — who is not only more animated and visibly enthusiastic than Hans Graf, but also reassuringly beats his baton in rhythm with the piece. He’s fun!


Andres Orozco-Estrada

Beethoven’s 1st symphony in C major is a cheerful piece and it sounds Beethoven-y. I enjoyed it, and intend to seek out a recording of it so I can listen again. Beethoven’s 4th is striking in how light and modest it seems compared to his 3rd, 5th, and 9th symphonies. The program quoted his contemporary, Schumann, who described it as a “slender Grecian maiden between two Nordic giants,” and I can kind of see that.

The middle piece of today’s concert was a Schumann cello concerto in a minor key. I liked it well enough, although my appreciation of the tone and tenor of cellos goes most of the way toward enjoyment before the specifics of a given piece.


HSO cellist Brinton Averil Smith

* * *
When I was a teenager, my mom brought us to see Houston Ballet’s production of the Nutcracker. Later, in honor of my 20th birthday, she brought me to see Swan Lake. (She also gave me a bouquet of 20 pink roses in a vase that I just used to start some paperwhite narcissus bulbs that we bought together at Buchanan’s this afternoon.)

I played the flute from 4th grade through high school, and as a senior, I earned first chair and solos in symphonic band. So I got to hear our “symphony” perform every spring.

But I’m pretty sure it was Gran’mom who brought me to my first real symphony performances. In 1998, I was single and working for Plaut as an SAP implementation consultant. I was working in rural Georgia and most weekends I came home to my parents’ house in Galveston. (I needed a tax home in Texas and it seemed silly to pay a lot of rent for an apartment I’d only use 10-12 days a month. So I paid a little rent to my parents and enjoyed their company, too!)

My client paid for me to fly home to Texas every Thursday, but several times I flew to Florida instead, to play with Gran’mom. That fall, she bought a pair of season tickets to the Orlando Symphony and I scheduled a couple of visits so that I could attend the matinees with her. I recently unearthed the letter in which she wrote me excitedly to say she had our tickets. Gran’mom thought of me as her “little playmate.”

I just remember how sophisticated she made me feel. I didn’t think either the suits or the khaki pants and sweaters I wore to work were appropriate attire for concerts, so she took me shopping along Winter Park Ave. She introduced me to Ann Taylor, where I found the pale green silk pant suit that I later wore to the rehearsal dinner before our wedding. I also found my slinky black ankle-length opera dress.

She prepared delicious meals with fresh, local ingredients, introduced me to meat seared in herbes de Provence, and taught me to appreciate chardonnay. She read the newspaper and Newsweek, watched the MacNeil-Lehrer News Hour, and wrote letters to the editor and to her Congressman. She listened to classical music and made me feel special.

* * *
As I sat in Jones Hall this afternoon, immersed in the 4th Symphony, I was struck by how incredibly lucky I was to have Gran’mom dote on me. I really miss her. And she would have enjoyed the Beethoven today.

Adventias: Grateful for local family…

Saturday, October 5th, 2013

I don’t remember exactly, but I began accompanying Sarah to all routine physician visits sometime eight or nine years ago. At some point, I began taking notes on my laptop instead of on paper, and that Word doc goes back to July 2006.

Along the way, I shepherded Sarah through the emergency room on several occasions. While I am impressed by the breathtaking array of diagnostic tools and tests that modern medicine presents, I am more convinced than ever that no one should ever go to hospital alone.

Having someone to hold a patient’s hand and offer reassurance is nice. But having someone to pay attention, take notes, and make sure that the care received over time remains consistent and appropriate seems essential.

The 11 days I spent in hospital when our girls arrived did little to disabuse me of this view.

Physicians and nurses both vary by day and time. Continuity of care in a hospital setting relies on written notes in patient charts, and oral summaries passed along at each shift change. The longer one is in hospital, the more cursory the hand-offs seem to be. Many times, I have served as third party glue holding Sarah’s treatment on course.

With that in mind, I am immensely grateful to our family for being there for Sarah when I cannot. In particular, huge thanks to our cousin Sharon who, again, dropped everything to be the first family member on the scene when Sarah arrived at the Methodist ER. In addition, Sharon stopped by to check on Sarah and query her nurses every morning on her way into work, at a time when I had to be home tending to toddlers. Thank you, thank you, thank you!


Sharon

Thanks also to my Mom for covering Sarah two days so that I could go into Central Houston and concentrate on my shiny new job. I don’t have any photos of your visits, but I’m glad you were there. Finally, thanks to my brother, Chris, and his family for coming to visit Sarah, too.


Chris with Sierra


Shawnacy with Alles


Izzy with Alles


Chris and Bob

Adventias: Well, that was unexpected… part II

Saturday, October 5th, 2013

In June 2013, Sarah fell and hit her head. The ER attending physician wrote an order to transition to hospice care.

Sarah did not yet meet Medicare eligibility requirements for dementia, but qualified under “failure to thrive.” At just 85 pounds, Sarah had become a tiny slip of a thing.

The hospice physician recommended, and we agreed, to discontinuing all vitamins and mineral supplements. It made me sad to concede that long-term risk of malnutrition is no longer a meaningful concern for Gran’mom.

But then, a funny thing happened. When we stopped filling Sarah’s belly every morning with tiny rocks of calcium, vitamin C, and other supplements, her appetite increased. She ate more food, and she gained back a few pounds. Weight gain is not consistent with end-of-life behavior, and the hospice physician determined that, under Medicare’s rules, Sarah was no longer eligible for hospice care.

So at least temporarily, she “graduated” from hospice on Tuesday, Sept 24, 2013… the same morning that a Belmont nurse found Sarah on the floor by her bed with a fractured hip.

* * *
By all accounts, any hip fracture is a serious injury. Several months ago, our Gran’mere in Ohio fell and cracked her pubis. She was “lucky” to be able to begin PT immediately, without surgery.

In contrast, our Gran’mom has osteoporois. The Methodist Hospital ER physician said the x-ray revealed that when she fell, the neck of Sarah’s right femur was “crushed like a Coke can.” In a young, healthy individual — say, a cyclist or snowboarder — the probability of successfully repairing this injury surgically is around 30-50%, and the risks of complications are significant. In the elderly, treatment almost always requires surgical replacement, followed by months of physical therapy (PT).

However, the purpose of physical therapy is partly to strengthen and primarily to teach someone how to adapt to their new physical (dis)abilities. Because of her dementia, Sarah is not a good candidate for PT. She’s incredibly unlikely to learn how to move without causing herself tremendous pain. In fact, a week later, she is still surprised every time someone informs her that her hip is fractured, which is why she’s hurting.

* * *
After ruling out surgery, Sarah’s prognosis is grim. She will never walk again. Unable to sit up well, she requires someone to feed her and offer her water. Within days of becoming bedbound, her ancient and fragile skin is already breaking down, on its way toward developing painful sores and potentially, infection. The fracture will never heal, so she will endure chronic pain, and require opiates for pain relief. As her body acclimates to the opiates, she will require larger doses for less benefit. The morphine will suppress her appetite and her respiration.

Dr. L, the wonderful internal medicine doctor who has supervised Sarah’s care at Methodist Hospital, says that he is unsure how quickly Sarah will decline, but he does not expect her to “bounce back” or even plateau. He’s clear on the direction of her trajectory, if not the slope.

After spending six nights at Methodist Hospital, Sarah was transferred to nearby Houston Hospice. There is a small potential that Sarah will stabilize, continue to eat, and require transfer to a long-term skilled nursing facility. But our current expectation is for Sarah’s care to focus on attempting to keep her comfortable while she winds down to a gentle end.


Dr. L listening to Sarah’s erratic heart rhythm


Sarah gazing up at her niece, Sharon

Adventias: No more shots

Friday, June 28th, 2013

Yesterday, when the Vitas hospice representative was telling Jean and me about their bereavement counseling and support groups, I bravely asserted that I don’t expect that I will be overcome by Gran’mom’s death. The Gran’mom that I knew has been leaving bit by bit for six or seven years.

This afternoon I met with the hospice admissions nurse. We reviewed the list of Sarah’s medications to decide which ones she should continue taking, and it was harder than I expected.

Hospice care sees “less as more” when it comes to meds. Some meds, like the B-12 injection were somewhat easier to end: how can you comfort someone with dementia when you stick them in the arm and they can’t understand why?

Likewise, alendronate (Fosamax) can damage the esophagus in someone who has trouble swallowing effectively (not that Sarah is there quite yet). Osteoporosis is not her most-pressing concern.

However, admitting that she no longer needed vitamins, minerals, and antioxidants, because she probably won’t live long enough to develop malnutrition, was tough.

Confirming the order to suspend a bunch of Sarah’s meds made me weepy. But I know that it’s what she asked for in her advance directive, and it’s the right thing to do.

Adventias: Starting hospice care

Thursday, June 27th, 2013

I reread Gran’mom’s advance directive to physicians this morning. In it, she says in plain language, that in the event she develops a terminal or incapacitating illness, her physicians are directed to withhold all treatment and ensure that she is comfortable until she reaches a gentle end. Ok. Got it.

It turns out that here in the fourth-largest metropolitan area in the U.S., there are more than 60 hospice providers. Selecting one to shepherd our Gran’mom through to a gentle and dignified end was a daunting task.

Recommendations from friends and Sarah’s current healthcare providers narrowed our consideration set down to five providers. A pushy and opportunistic sales weasel helped drop the list to four: Houston Hospice, A-Med, Vitas Innovative Hospice Care, and Hospice Compassus.

The costs of hospice care are covered 100% by Medicare, so providers are not differentiated by price. Our decision criteria came down to:

  • who do we trust to respond promptly and effectively to Sarah’s changing needs (even after hours and on weekends and holidays),
  • who can we count on to partner well with the existing staff of her assisted living facility,
  • who agrees to keep Sarah’s neurologists at Methodist apprised of her progress, and
  • who best supports the family through the death of a loved one, both with social workers to facilitate ahead of time, and bereavement counselors and support groups afterward.

On that basis, we eliminated A-Med, because they only have one physician and one social worker for their entire patient base. We ruled out Hospice Compassus only because they haven’t yet worked with Belmont or Methodist.

Of the last two, the Belmont care director likes Houston Hospice and has other residents under their care. The Methodist team likes the end care Vitas has provided many of their patients.

Based partly on Methodist’s recommendation, and partly on our greater confidence in the Vitas representative we spoke with, my mom and I decided to go with Vitas. The intake assessment is scheduled for tomorrow afternoon.

That said, I asked Bruce at Belmont to let me know how things go. If the Vitas nurses and aides don’t work well with Belmont’s staff and procedures, we’ll shift gears and switch to Houston hospice.

It’s reassuring to be moving forward, and also reassuring to have a fall-back plan. One way or the other, Gran’mom will now have a team coming to her who can assure that her end, whenever it comes, will be painless and peaceful.

Adventias: Falling

Tuesday, June 25th, 2013

My brain is so full it’s overflowing.

Gran’mom fell this morning and bonked/cut her forehead while a PAL was trying to get her into the shower. In retrospect, the PAL observed that Sarah had seemed weaker and less verbal than yesterday. It seems that Sarah’s experienced another step-down decline in cognitive function.

Belmont’s nursing staff sent Sarah to the ER by ambulance, to rule out internal bleeding. Sharon raced over to meet the ambulance and supervised Sarah’s care until I arrived. I’m again thankful for having her so close!

Sarah was particularly uncommunicative after the fall, and her pupils were tiny, constricted, dots. It was hours before she expressed anything that looked like she recognized me, and then only briefly.

Her neurologist, Dr. Roman, says her CT showed extensive atrophy of the brain and “relatively advanced Alzheimer’s”. He said that sensory processes become disconnected and “she’s not seeing the world through the same eyes as you and I.”

He also asked if we would consent to let them remove and examine Sarah’s brain post mortem. I’m confident that as a 40+year clinical scientist, Sarah would be delighted to be able to contribute in this way.

She was discharged by 1 pm, and transported back to Belmont by ambulance. She slurped down a chocolate Ensure shake, with help from the nurse, Joel, and then went straight to bed.

Before I left, staff had managed to get her to the dining room for dinner, but her PAL admitted that she’d been pushed on her wheels. Chris popped by after work, too, to give Sarah a hug and check on her.

Sarah’s physicians and nursing staff feel that her end is nearer now than it was, and that she would benefit from complementary hospice care. I spent the afternoon researching and contacting hospice providers. I have more calls to make tomorrow, and if I’m lucky, we’ll get her “admitted” tomorrow, too.

* * *
Tonight, I had helpful conversation with another hospice provider, perhaps the one we’ll use. I then connected with Melinda, a lay leader from St. Stephen’s, for a good talk about death and dying. I’m grateful that we connected via Facebook.

* * *
It takes me about 20 minutes to drive home from Belmont. I’m grateful that that’s long enough for me to call and catch up with my mom, and then, switch gears mentally to start thinking about our girls.

* * *
Both girls slept through the night last night. But tonight, Sam woke up crying for Mama and Dad around 11:45 am. After locating her binky and blankie, she asked for “Mama… chair” several times, so I sat down to cuddle Sam in my lap.

As I nuzzled my cheek against Sam’s hair, I thought also about holding Gran’mom this morning. It struck me that there’s a 95-year spread between the people I cared for today. That’s boggling. But the how of the care is really the same, and that helps.

Unexpected Easter, part I

Monday, April 8th, 2013

Gram Nancy and her sister Betty each have two kids, who are each married with kids of their own. When Nancy realized that Jenni and her kids would be in from Atlanta the same weekend that Barb and her family would be up from Mission, she had a good idea.

Last Saturday, she brought us all together for an Upchurch family reunion, with 17 family members present. Only husbands Rich and Foster were missing. (As always, click for larger.)


Gram Nancy with sister Betty


Nancy, Betty, and Jerry with four kids, 8 grandkids, and 2 spouses

The idea was simple: get everyone together in the Park at River Plantation to visit and have some food. There would be cupcakes to celebrate Barb’s birthday. And finally, Barb’s three older kids hid plastic Easter eggs in the field for the five little kids to find.

Cate, who had been unable to nap during the afternoon (she’s teething all four canines at the same time. sheesh.), was unenthused and hung back with Dad. But Sam had fun toddling across the field toward brightly-colored plastic eggs. Mostly, the older boys dashed in and snatched up eggs before Sam could get to them, but her cousin Sarah graciously ensured that Sam collected two or three.


Sarah helping Sam hunt eggs, while Colton dashes in


Sarah and Barb helping Sam and Addison (re)hunt their eggs


Betty, Jerry, Jenni, Caleb, and Gram Nancy


Sam was entranced with openable plastic eggs, while Colton and Caleb worked through them quickly looking for treats


Bill with a very-tired Cate


Cate eventually ventured forth to check out Colton’s eggs

After the egg hunt, when everyone gathered to sing for Barb, Cate and Sam remained on the field, entranced with the mountain of plastic eggs.


Cate and Sam after the egg hunt

The schedule ran way past bedtime. The upside was we were late enough to enjoy “golden hour” light on the field. The downside was our girls were really strung out by the time we got them home, and we had a rough night. But it was good to visit with seldom-seen cousins, and a good time was had by all.

Adventias: Gran’mom and the girls

Thursday, February 21st, 2013

I used to think it was really cool that my family now spans four generations, from Gran’mom and Gran’mere down to Sierra, Izzy, Sam, Cate, and now Ali. And then I realized that it isn’t meaningful if the great-Grans and the little people never interact.

One of the obstacles is geography: Gran’mere is in Ohio, which is 1,200 miles from here. Sierra and Izzy have been there once, but Cate, Sam, and Ali have not yet. I aspire to fly the girls to Columbus sometime this year, but I can’t at all visualize how I would manage it.

Another obstacle is mental. When Gran’mom came to our house for Thanksgiving dinner in 2011, I was eager to introduce her to our new baby girls. I anticipated letting her hold and cuddle one of our tiny bundles, perhaps sitting on the couch. But Gran’mom recoiled when I tried to bring a baby near, insisting (incorrectly) that she would infect her with something. One of Sarah’s medications makes her nose run constantly, for as long as I can remember. But dementia leads her to believe that she’s contagious when she isn’t. I tried to reassure her that it was safe to greet the baby, but she was visibly uncomfortable being too near the babies, and I desisted.

Since then, I have broached the subject several times of bringing my daughters to visit her at Belmont. Every time, she has declined. At first, she said no outright, insisting that it wouldn’t be safe. Later, she softened her position to, “I don’t think so. Not yet, anyway.” Given that she is always startled when I refer to having children at all, it’s probably no surprise that she doesn’t jump at the chance to meet them.

But today we all went anyway. I needed to go see Sarah and transact several items over there, and I planned to go while the girls were napping at home with Claudia. But today involved precious little napping. They spent most of an hour declining to nap in the morning. So we had lunch and tried again, but they only napped for an hour. Rather than leaving them at home, I decided to take them with me, and I’m so glad that I did!

Despite Sarah’s past concerns over hosting babies, once real, live, toddler girls were actually in her room, she enjoyed them immensely. She waved back when they waved at her, and she reached out to touch them ever so gently. She also enjoyed watching them interact with Zachary, her cat, who is considerably more approachable than our Tibbs.

When I got out the laser pointer, I was amused to discover that Zachary wasn’t the only one motivated to chase the bright red dot around the carpet. But unlike Zachary, Sam detected in under a minute that I was controlling the dot and came over to investigate the object in my hand. Nice!

Sam also pushed Sarah’s rollator around a bit, and even climbed up and flipped over the top of it at one point. Sarah seemed fascinated to watch Cate, Zachary, and Sam all play together, and declared excitedly (at least a half dozen times) that, “this is the most action there’s been in here in… as long as I can remember!”

We also had cookies. I think Gran’mom was in her 80s before tea and cookies became a daily ritual. When I came to visit, she always shared them with a funny line about, “aren’t grandmothers supposed to provide cookies?” With her dementia, our roles are reversed and we (Jean, Chris, and I) bring cookies to her. Today we had oatmeal raisin cookies, and I decided to share them with our girls, too. They have never had cookies until now, and judging by the speed with which crumbs disappeared and small hands returned to fumble for more, they clearly met with approval.

It felt really weird to have my daughters and Gran’mom in the same room together, when I’m used to devoting my complete attention to one or the other. But I think all three of them enjoyed the visit, and seeing them interact with each other makes me very happy. I intend to get us all over there again in the not-too-distant future.


Sam


Gran’mom regarding a stuck Sam


Zachary regarding Sam with a bag of cookies


Cate with more cookies and Claudia


Bob and Gran’mom



Adventias: Need to get going…

Monday, December 10th, 2012

Over the last year, we have successfully requested nearly all of our family and friends to call our mobile numbers instead of the house. We can go days without the house phone ringing at all, so I was startled when the phone rang Sunday night at 9:05. The caller ID said it was Gran’mom’s number calling, so I hastened to answer it.

Gosh. I haven’t written about Gran’mom in 17 months. I have pictures of Sarah and her brother, Frank, from a day in August when we all had lunch together in honor of Sarah’s 96th birthday, but I never found time to post them. I have seen her fewer than a dozen times since our daughters were born, so I have little else to post.

I admit that as I reached for the phone, I wondered if it would be a Belmont Village staff person calling to say something had happened. At 96, Sarah is quite inactive, terribly frail, and down to about 85 pounds. But when I said hello, a familiar shaky voice said, “Robin?”

As brightly and cheerfully as I could, I said, “Hi Gran’mom! How are you? What can I do for you?”
Sarah said, “I’m tired and confused and I can’t find anything. I can’t find my purse.”
I told her that I was pretty sure it was in her dresser drawer, and asked her what she was looking for.
She said, “I need to get out of here and I can’t find my car keys.” She said she was on her way to pick up Slover and she was late. They were going to a concert together and she was already supposed to be there.

There are many problems with this story. She hasn’t driven in four years, and my brother, Chris, now drives her car. She lives in the secure unit of an assisted living facility. And her brother, Slover, has been deceased since 2004.

We had a previous conversation like this one in February 2011, when Sarah first started taking Namenda, an anti-dementia drug. I navigated this one a little differently.

I reminded her that a long time ago, she asked me always to be honest with her, even if I feared it might upset her. But before I could ask her if she still felt that way, she interrupted to say, “Please don’t upset me. I have too much to do.”

OK. So instead of trying to confront her with jarring facts, such as relaying that her brother is no longer living, I decided to tell her that she just had the day wrong. I told her that it was after 9 pm on Sunday night, and assured her that no one was expecting her tonight. I told her that she could go out gallivanting tomorrow, but tonight she should go back to bed.

Sarah said that would be a relief, because she was tired.

Then she thanked me and said that she needed to get off the phone, because she was late and she had to get going.

So I tried again. I suggested gently that I thought maybe she had just had a vivid dream, and that’s why she was confused. I said again that I was confident that Slover was not expecting her.
She insisted no, that these were plans they made yesterday.
I said again that it was after 9 pm on Sunday night. When she said, “it is?!?” incredulously, I tried again to redirect…

Eventually, I convinced her that she could just go back to bed. But before we parted, she told me, “I thoroughly enjoyed our afternoon together. I am more grateful than you can ever imagine for spending the day with you.”

She sounded so happy that I had come to visit her… except that I didn’t. I was curious what she imagined we had done that brought her such joy. I asked her what was her favorite part? She said all of it, so I tried again by asking for just one part of this day that she had enjoyed. She said she would meditate on it and get back to me. It made me think that she lacked any specific memories — which makes sense since it didn’t happen — and just had a strong impression that I had visited.

Rather than disabuse her of this notion, I asked her if she’d like me to come visit again tomorrow, and she said, of course! So I will endeavor to get over there, and assess how up and about she is.

Bill will have our car at work on the west side, and Sharon is in North Carolina, so it will be Wednesday before I can get there. In the meantime, I hope that Sarah has happy thoughts about what she’s trying to do, regardless of whether any of it is likely to happen.

Adventias: Yet another moving day

Friday, July 15th, 2011

The last time I wrote about our Gran’mom, her brother Frank had just moved from Las Vegas to Houston to live in the same assisted living facility with her. Sharon and I were both optimistic that having a sibling in the same building would be both reassuring and entertaining to both of them.

I’m sad to say that’s not how things turned out.

Best we can tell, Sarah is unable to internalize that her brother now lives in the same building. If Sharon or I get the two of them together for a meal or visit, and explain who’s who, Sarah understands who Frank is and they relate to each other. But most of the other times, he’s just “some old goat” who shows up at her door, wants to sit with her at meals, and meddles about what she’s eating or doing. Belmont staff told us that Sarah and Frank would escalate to bickering at each other in the time it took to walk together from her room and ride the elevator to the first floor, by which point, sitting together in the dining room didn’t work.

For Sarah’s part, she doesn’t remember these interchanges and is apparently not upset by them. But poor Frank is deeply concerned over the condition his big sister is in and really wants to help her stay as healthy and happy as possible. It really wounds him when she rejects him so callously, and it saddens me that we got them together too late to enjoy a robust sibling relationship. Sharon and I will continue to get them together for meals or other events from time to time, but daily togetherness isn’t working.

* * *

What’s more, it became clear that Sarah was becoming less copacetic in general. Some of the behaviors we/staff observed:

  • Refusing staff direction/help to bathe and/or change clothes, and wearing the same clothes nonstop for weeks on end
  • Telling staff she didn’t know where she’s supposed to be or what she should do, repeatedly
  • Standing aimlessly in the hallway, apparently uncertain where to go, and declining direction to join group activities
  • Standing in the middle of the dining room for 30+ minutes, unable to sit at a full table that she perceives as “her’s”, and unable to choose (refusing to choose?) an empty seat at another table instead

In addition, Sharon drove Sarah to lunch and observed:

  • In the car, Sarah declared, “Wow! I don’t think I’ve ever seen an all-white car!”, and then expressed the same revelation 20+ additional times during the 5-mile trip to and from the restaurant
  • At the restaurant, Sarah was repeatedly discomfited by their loud/gregarious waiter, and told Sharon, “If he ‘shouts’ at me one more time, I’m going to say something rude back to him!”

So two and a half years after we moved Sarah to Belmont, we made the tough decision that it was time for Sarah to leave the (large) “assisted living” section and move to the (small) secure dementia “Neighborhood,” where the higher staffing ratio provides more one-on-one direction.

Given that familiarity and routine are essential to help someone with memory impairment function, moving obviously poses serious challenges. We got really lucky in that the room available for Sarah in the “Neighborhood” was the same basic floorplan and orientation as her room upstairs, just a little smaller. That made it possible to move almost all of her furniture and keep it in essentially the same configuration. That was the first hurdle.

The second hurdle was figuring out how to effect the move with minimal disruption to Sarah’s existence, but we pulled it off on June 8, 2011. Sharon whisked Sarah away for a *long* (4-hour) “lunch” while staff moved her furniture and belongings to the new room, and Bill and I set everything up again, which went remarkably smoothly. Prior to the move, Jean and I talked with her about moving and while Sarah acknowledged the merits of having full-time staff help available, she said she “wasn’t interested in moving.” But once we brought her back to the new room, she didn’t get upset. She said that it felt “totally unfamiliar” but also thanked me profusely for all my help.

The next day, I went back to meet movers to pack and return Sarah’s excess furniture and clothing to her condo in Galveston. Thankfully, Jean met the movers at that end, saving me the 100-mile round trip. Two days of moving antics while four-months pregnant with twins was exhausting, and it took me two days of downtime afterward to recover. But I did what I had to do to minimize the disruption for Sarah.

disassembling #269

disassembling #269
Disassembling, packing, and moving out of #269

exploring #141
Sarah and Jean exploring #141 over the weekend before the move

pictures up
Pictures up in the same places feel familiar

Gran'mom in new room
Gran’mom in her accustomed spot on the loveseat, but in #141

Since the move, Sarah has not only come to meals without incident, she has even participated in the group activities, which is a welcome improvement. She is also now allowing staff to help her bathe periodically and change clothes almost daily. In general, she seems more copacetic than she did before the move.

As explanation, staff suggested that Belmont had become bigger than Sarah could process, which was overwhelming and agitating. But the “Neighborhood” is a smaller, more manageable scale, and easier for Sarah to wrap her head around. While I was very anxious about how she would handle the move, I am confident now that it was the right shift at the right time.