Thursday, July 23, 2015

Patient Advocate Issues



When you’re ninety to ninety-five years old who will watch over your best interests? The duty falls heavy on my heart ensuring that my mother and her sister are well cared for at the skilled nursing home where they live. 

For the previous ten years, they shared a home in the country with a fenced yard, private bedrooms, bathrooms, and a fully equipped kitchen, where they shared meals, watched television and spent quality time together.

In 2014, a nasty fall while taking care of her cat sent Louise to the hospital. She needed physical therapy, rehabilitation and rest. A month later, there was an opening for a bed and Mom joined her at the skilled nursing facility. At eighty-nine, unable to hear well and finding it hard to remember her address or dial the phone made it unsafe for her to remain alone. The potential for disaster became clear after a grease fire in the kitchen nearly took its toll. When it came to taking prescription medication, meal preparation, kitchen cleanup, shopping for groceries, or performing household chores, things were no longer simple for these two home-bound ladies. They tried to manage for a time with a home health aide and maid service. Ultimately, it was clear the best solution was to take a room at a skilled nursing facility where they would have a full time staff of nurses, dieticians and aides.
It's been fourteen months since they moved in. This week at the quarterly family conference to discuss how things are going with residency, satisfaction on food service, meals, their treatment by the nursing staff and their medication issues, I had a list of concerns to bring to the table.

Last Wednesday, I arrived at 8:00am for breakfast with the ladies. Mom had already finished eating, yet, Louise was still not at the table an hour after her usual time. Heading down the hall to find her, an aide yelled that Louise was "on the way". I found the door to their room open and the bathroom door open. My thoughts went to the privacy, dignity and respect this lacked. Louise was on the toilet crying saying she needed help to get up and back into her wheelchair. She had been sitting there for an indeterminate time, long enough to become agitated and distressed. She told me she had a bad headache and her eyes were runny. Standard procedure is to get the residents up and on the toilet where they hand them a warm washcloth to clean up before getting dressed. She was already dressed but had not washed.

The problem touched me on several levels. No, she had not pushed the nurse call button. She is afraid of technology and doesn't want to bother anyone. Whoever put her on the toilet already knows she's there and knows she needs help. Wouldn’t they check on a patient after a while? Some training on compassion might help matters.

Directed at the food service manager was the issue that her apple juice had been poured an hour earlier and set out at the table next to my mother. There were two flies sitting on the glass. Had I not been there, she would have consumed that tainted juice and never known. I suggested they serve the resident after they arrive or at least put a protective cover like cellophane wrap on the glass. Also requested was that Mom’s daily food menu have a notation about black pepper allergy and no onions and remove the note that says, “No bananas.” She likes bananas. This is the second request to change her food preferences.
Mashed potatoes with black pepper

A week before this meeting, Mom asked if there was a chance they could move back to the other wing where they spent the first months before moving to long-term resident’s wing. Her belief was they received better service and treatment in the other location. When questioned at the meeting, she meekly said, “No, they're treating us better now that they are getting used to us.” In one week, I was doubtful that things had improved much; rather, she didn't want to make a fuss and have people angry with her.

The last topic was on concerns over the added medications in the past year of residency. When admitted to the facility in April 2014, Mom was taking only three prescription drugs and two over the counter pills (for acid reflux and a laxative). 
Med List March 2014
A three page report received from the insurance company listed more than a dozen prescriptions in the past month. The staff printed out a list of her current medications and we reviewed these medications line by line. 

For a fact, she currently has nineteen medications on the list, some taken daily, others, on an as needed basis.

My primary concern is about drug interactions and side effects of the added drugs which include:

  •  Increased risk for heart attack or stroke 
  • Increased blood pressure 
  • Increased heart rate and heart palpitations 
  • Breathing problems, upper respiratory tract infection (which she had when taking this Rx in the past) 
  • Cough (the issue for which the product was prescribed) 
  • Muscle pain 
  • Shakiness, nervousness, dizziness

Results: Six medications that were duplicates have now been eliminated (or DC, discontinued) including one for Hydrocodone (Tier 2 Narcotic Drug for pain) which I have asked twice to be removed due to ongoing issues with dizziness. Once I spoke to the Doctor directly and he said he would mark this as an allergy so it would not be ordered again. At a later time by phone I requested the same thing with the physician’s assistant. The medication appeared on the list of current prescriptions today. I was assured the order would be discontinued.

Overall, I was pleased that they took time to address each of my concerns and (hopefully) will take action to remedy these issues.

The main point is to bring awareness that although the competent care of a loved one is something to be expected, for the patient advocate it's an ongoing process requiring constant vigilance. We’ll see if any of the changes actually take place.

Saturday, July 11, 2015

Treasure Hunt in Farmersville

Singer Sewing Machine
The tiny downtown of Farmersville, Texas always yields a treasure or two and today was no exception. The stores have changed somewhat over the years, somehow adding more sophistication and newer things. Or perhaps it's me who has changed.

Red Door Antiques moved across the main street into a newly remodeled space. It's beautifully decorated and full of lovely things. Even so, I miss their old space that was drafty and dusty, just like I like it.
Downtown Farmersville TX


Found amid the current items that seem to outnumber the aged and vintage things of previous days, an enamel dishpan from the 1940s, white with red trim awaited. Another customer remarked that they used to bathe their small child in a pan like that. Yes!
Enamel Dishpan with Red Trim

At my favorite store, Main Street Antiques, there was a vintage Singer Sewing machine, the hand crank kind like one that sold in my own store long ago. Of course it was a must purchase after spotting the twenty percent off sign. A little Goo Be Gone and a wipe down with a cotton rag and it sparkles like new.

The best find of all today was a Christian Hymnal that contains most of the songs we sang in church as children. This book was published in 1961 and has a soft cover along with a classic image of the Savior rescuing a lamb. Sweet!
One of my Dad's favorite tunes...

Monday, June 22, 2015

Rainbow Bridge


Saying goodbye is never easy. Today was one of those days when it was necessary to bid farewell to a good friend.

Probably tougher than it was on us, it was harder for Tony who has watched the recent decline in his constant companion.

She's been with him since the day he arrived as a nine-week old puppy who wanted nothing more than to play with and lie next to his big sister for the past five years.

His surrogate mother, nursemaid, friend, playmate and bunny- chasing pal left for Heaven today.

For a couple of weeks she's been unable to walk after a few months of needing help to get up and get outside. We've been dragging her around on a comforter to whatever room we happen to be occupying. Otherwise, she let us know with her constant barking that she was not happy to be left behind.

Over the past week, she's lost interest in food. That and her whimpering and heavy panting, gives us indication that she's not at all comfortable. As the last of the fearsome foursome - Slick, Dolly, Buddy and Cookie - it was a tough decision to let go. It's not one for the feint of heart, probably the worst phase of pet ownership, this responsibility.

Our veterinarian is a kind, compassionate man who has cared for Cookie for the past fifteen years. I do not envy his task in this part of his practice. But it is done and as we made our way back home with reddened eyes and sore noses, we did not look forward to breaking the news to Tony.

Wednesday, June 3, 2015

Four Star Chocolate Chip Oatmeal Cookies

With the possibility of our first ninety degree day of the year, I decided to bake cookies in the cool of the morning.
Of all the recipes I've tried that include oatmeal, this one is my favorite. It comes from my old Farmersville Garden Club Cookbook published in 1994.

The book is full of amazing food ideas, recipes, emergency substitutions and household cleaning tips. This recipe came from Mary Pope.
The recipes remind me of pot luck dinners and social gatherings where families would bring their favorite casseroles and desserts tightly covered in aluminum foil, ready to peel off and share.

The ingredients are simple, the prep time is quick and the results are delicious.

Ingredients:
1 Cup plus 2 Tbsp. Unsifted All Purpose Flour
1 Cup Quick Cooking Oatmeal (Not instant)
2 Tbsp. Unsweetened Cocoa
3/4 tsp. Baking Soda
3/4 Cup (1 1/2 Sticks) Butter or Margarine softened
1/2 Cup Granulated Sugar
1/2 Cup Firmly Packed Light Brown Sugar
1 Egg
1 tsp. Vanilla Extract
1 6 oz. Package Semi-sweet Chocolate Chips
1/2 Cup Chopped Walnuts or Pecans (Optional)

Preheat the oven to 350 degrees.
Stir together the flour, baking soda and cocoa in a small bowl.
Beat together the butter, granulated sugar and brown sugar until it's light and fluffy.
Add the egg and vanilla extract.
Add the flour mixture and blend at a low speed until combined.
Hand stir in the oatmeal, the chocolate chips and the chopped nuts.

Drop by rounded teaspoonfuls onto greased baking sheets and bake for ten (10) minutes.
I like to use two cookie sheets and prep the second one while the first one is baking.

Remove the cookies from the oven and leave them on the warm baking sheet for about three (3) minutes before transferring onto a wire rack to cool.

This recipe makes about four (4) dozen cookies.

To change it a bit, I deleted the nuts, substituted two (2) sticks of butter and added a couple of Tablespoons of additional flour rather than grease the cookie sheets. The cookies come out firm and round and disappear quickly.






Saturday, May 30, 2015

The Rain's a Pain and Falling On the Plains

Highway 78 Spillway Creek
The Texas drought has been replaced by the hundred year floods. For the past two months we've had rain nearly every day taking the Lake Lavon level from fourteen feet below normal to eleven point one feet above normal.

Old Highway 78 which is often used as a fishing pier, where the cows wandered freely on its dry lake bed is now completely submerged. Even Thompson Cemetery next to the lake has suffered with rising lake levels.


We feel lucky to be on an elevated location where the saturated ground drains away from our house. Even so, the yard is pooling with water making it impossible to mow.


The Weather Experts have predicted this morning's rain will end the long running stream and record breaking amounts of rain these past weeks. Hopefully, the yard will dry out enough to trim back the jungle.

The blueberries are getting plenty of water.
Those who live closer to bodies of water aren't as lucky as we've been with Duck Creek in Rowlett overflowing its banks and flooding homes. White Rock Lake and the Trinity River have overflowed their banks and are affecting neighboring communities flooding homes and sending many to shelters from the storms.

Even major highways have felt the impact of too much of a good thing. Northwest Highway was closed yesterday morning about 5:30 am when an underpass became flooded with over six feet of water. Despite barricades and warnings to "Turn around, don't drown," seven cars attempted to traverse the water and ended up being rescued by the National Guardsmen in floating rafts. It's expected to remain closed for a couple of days until rain water can be pumped into overflowing drainage canals that feed the already swollen waterways.

I'm wondering if all the prayers for rain during the drought over the past four years have finally reached their destination.
No more drought like we had in 2011 - 2014

Tuesday, May 12, 2015

Man Caves, Controlled Chaos


Some say that a messy desk is the sign of an organized mind. That might explain the explosion of chaos that reigns supreme in this man cave. Despite the disarray, this is the haven of dreams for many men.

At first glance it might seem like an accident waiting to happen. True, there may be wires dangling, floor jacks lurking, paint booth plastic drop cloths hanging from the ceilings and ladders to travail, but there is also order to the dusty decor. You have to learn the secret handshake to get inside.

This week's project has waited since the early nineties when the roof trusses were originally installed. So many projects have taken priority in the meantime.

The four foot spans between trusses are quickly being supplemented with a rafter installation in between the gaps. There is renewed hope that a ceiling will be installed so that air conditioning can become a reality. For the past two decades, this has only been a dream despite Texas summers with three digit temps.

Project that is now on the back burner.
The El Camino project has taken a back seat to the ongoing ceiling construction. Everything has to happen in a certain order.

The ceiling construction is a prelude to building the Powder Coat Oven, a device large enough to cook automotive intake manifolds and large specialized equipment.

The old oven from the house is used exclusively to bake auto parts.
The old oven from the house remodel is used exclusively to bake his auto parts now. Once used with the chemicals in the process, it can't be used for food anymore.

Here is where the magic of powder coating happens when it comes to turning carburetors into masterful works of art.

This is a link to the  hubby's videos on  How To Powder Coat a Carburetor explaining in detail how he does the entire powder coating process.
Holley Carburetor
 In case you have gotten lost in the maze of projects in this 32 x 64 foot garage, there is still a small path to let you find your way back out.

Go into the light if you want out.

Sunday, April 5, 2015

Nice Ride - 1968 Chevelle

Helping out a neighbor is easy when they have a ride this nice.

When Jeff came over and asked for a bit of help rebuilding his big block Chevy engine, it was no trouble for Jim to take a look and give some prudent advice.

Together, they spent four days working on reassembling this 454 cubic inch Chevy, bored thirty over with flat top pistons.

With its Pro Comp aluminum heads with oval ports along with a Pro Comp intake, a nine and a half to one (9.5 to 1) compression ratio was attainable.

The engine had returned from the machine shop in pieces and needed to be completely assembled starting with painting the block. They chose Chevy orange finishing it off with a clear coat containing a heavy gold pearl. This gave the engine block a similar appearance to the car's exterior without the five hundred dollar a gallon price. The pistons were already on the rods, so they assembled the short block, added the heads and Jeff went home to install the oil pan and the intake manifold.

Jim uses a makeshift stethoscope to detect odd noises in the engine
The guys made an appointment with Randy at Wayne Calvert Precision Engines in Denton to test out the performance of the finished product. The dyno session turned into a ten hour Marathon because of small problems that would have taken months to troubleshoot had the engine been installed as is in the car. They were able to achieve horsepower at four hundred seventy (470 hp) with torque of five hundred sixty pounds (560 LB/FT).



Friday, March 27, 2015

Salad of the Day


All week I've been eating salads for lunch. This one started out with a bed of organic baby spinach and Iceberg lettuce.

Then sliced strawberries were added along with strips of orange bell pepper. 

Then I added a diced Roma tomato and some Garbanzo beans. I like to open a can and run cold water over the contents to drain the beans. I use the lid as a strainer or sometimes break out my colander. Then, transfer the washed beans to a covered container for use during the week. I do the same thing with organic black beans.

To top the salad off I added a boiled egg and served it with Raspberry Vinaigrette dressing.


Baby Spinach leaves and a sliced strawberry
Strips of orange bell pepper and Garbanzo beans for protein


Diced Roma tomato

Topped off with a small amount of shredded Queso Quesadilla cheese and a boiled egg, this was truly a filling lunch.

Tuesday, March 17, 2015

Spinach Salad for Lunch all Week

It's what's for lunch this week - spinach salad. Crisp salad greens, sliced strawberries, a spoonful of rinsed black beans and a boiled egg make this a hearty meal.

Since the Christmas holidays, I've been struggling to drop the extra ten pounds that I gained with all the wonderful meals and gifts of cookies, candy and treats. Now I'm paying for my over indulgence.

I don't really mind eating healthier and not eating my own baked goods to drop the extra weight.

The produce came from Aldi where I found a beautiful head of iceberg lettuce for eighty-nine cents,  organic triple-washed baby spinach for around two dollars, a dozen eggs at a dollar twenty-nine and a pack of fresh strawberries for two twenty-nine.

Their store brand organic black beans are ten cents higher than the non-organic ones so I splurged and paid the seventy-five cents. Lemons were just a quarter each. I squeezed the juice from half of one over the top of this salad and then topped it off with some Raspberry Vinaigrette dressing.

Roma tomatoes were six for sixty nine cents so I topped Tuesday's salad with one and shredded a carrot to add color along with a spoonful of leftover canned corn. A bit of Quesadilla cheese over the top of the salad the second day added a bit of protein.

All together, the ingredients for my lunch all week made each meal reasonably priced at about a dollar per salad.

Monday, March 16, 2015

Red Dawn in Texas

Today held another spectacular sunrise in North Texas that rolled in with the early morning fog. It's rare to see a dawn as brilliantly red as this one was and it lasted for only a few delightful moments.

Before the skyline had a chance to brighten, I grabbed my trusty camera and ran outside in the cool mist and snapped a few photos.

The scripture describes it well, "The Heavens declare the glory of God" Psalm 19:1

He painted a wondrous morning greeting today.

Spring is popping out at an amazing rate with the Bradford pear trees, for the first time, covered in white blossoms. Within days, the green leaves will outnumber the blooms, but at the moment, it is the sure sign of warmer days ahead.

I nearly lost my sense of humor when calling the Medicare Replacement Insurance to get the phone number for Mom's hearing evaluation doctor. Their HIPA rules are more a barrier to progress than a protection against identity theft.

After a tense few minutes of denying me any information, I finally advised the representative that I was not seeking any top secret information on my mother's health or coverage, I simply need a phone number for a doctor who will take her insurance for a hearing test.

"Ma'am, this is the number to fax your power of attorney as her representative so that I can speak with you," she kindly informed me.

Grandma at lunch at the facility today.
I told her after ten years of faxing the power of attorney into what might as well be outer space, that I was quite frustrated that no one could keep track of this information, and by the way, isn't this a violation of privacy not to be able to maintain a patient's information?

We were assured when we signed up for this coverage that this would never be necessary, as the proper forms were submitted with the application, however, this has not proven to be the case.

We did eventually come to terms and she kindly provided me with the phone number for two doctors who promptly informed me that they do NOT take this insurance, despite repeated attempts at trying to remove their name from the insurance company's list.

I said, "Good luck with that, would you like their fax number?"


Sunday, March 15, 2015

Birds in the Snow

The snow is gone now and spring is on the way. Last week was a different story with ice and snow completely covering the driveway and front porch.

I finally got out and cleaned the window that overlooks this bird feeder so that I can get a clear shot of Mr. Cardinal and his beautiful face.

They were flocking to the Audubon mix of seeds that were placed outside for them. I've never seen so many varieties sharing the same perch. It was fascinating to watch them come and go, resting for a few moments on the branches of the Bradford pear tree nearby. Soon they would take flight and resume their voracious feeding during the worst of the storm.


Monday, February 23, 2015

Winter Moves in Overnight with a Texas Style Ice Storm

Two o'clock this morning our heater stopped working. Wouldn't you know it? Last week we had temperatures in the seventies, but today we're in the twenties.

I'm not complaining, though, compared to our counterparts in the northeast that had an Arctic blast of deep freezing snow, we've had a mild winter. This is, after all, Texas. If we don't like the weather we can be sure it will change in a couple of days.

The birds were delighted to have an ample supply of bird food and were making a feast of it all morning. I was able to catch a few of them at the buffet.


They were taking turns at the bird feeder with Mr. and Mrs. Cardinal, a few sparrows, a dove and one stray blackbird who seemed to have lost his flock.

The best shot was when Mr. Cardinal decided to hop on the ground and scout for fallen corn.

When the Internet decided to take a short break this morning as well, I decided it was a good day to do some baking.

We purchased one of those huge bags of triple washed broccoli crowns from Costco last week.

After serving it a a couple of times steamed, it was time to put the rest of it to good use in a broccoli and ham Quiche. This was the perfect day to use the oven.


Here's how the Quiche came out. We had this for lunch today. Yum.


It turns out the HVAC compressor unit just needed to defrost a bit. Jane at Ross Air Conditioning, the service company that has taken care of us for over twenty years told us to turn it off for a few minutes.

After we turned it back on, we were delighted to get warm air out of the vents once again. Their company was iced in by the weather as well, so it's a good thing the heater is working. It's a nice warm feeling...

Back to bird watching.


Sunday, December 21, 2014

Christmas at the Skilled Nursing Home

Muddy Creek on McMillan Drive
Celebrating Christmas with the family will change this year. We'll be sharing Christmas Eve with the ladies at the Skilled Nursing Home. It's over the river and through the woods to get to their facility.

For the past twenty-five years, we've invited the girls over to our house for the holidays. When they lived in Fort Worth, we'd drive over and pick them up and they would stay with Mom. Now, this isn't possible due to things that most people take for granted. For one, getting up the front stairs has become a major hurdle. The most important consideration for someone in a wheelchair is access. I never gave this a thought until I knew someone confined to a chair.

Also, access to a bathroom is one of the key things one must consider in these situations. I probably know the location of every bathroom in every store we used to frequent from Kroger to CVS Pharmacy to Home Depot and every medical office we ever visited.

We're lucky that the ladies live in a place with a caring staff and nurturing caregivers. Their Wellness Director, Latrice, is a happy and energetic lady who keeps them involved, even visiting their rooms to make sure they remember events. Despite the personal invitation and flyers distributed to remind them, Mom had forgotten about the Christmas party that was scheduled for this past Thursday night. When we arrived, she asked us why we came to visit so late. It was six pm. We said, "We're here for the party." She said, "What party?"

After a little persuasion, she and Louise trekked down to the cafe where we found a nice place to sit together. Louise went on a tour of the party table and she oooh'ed and aaah'ed and said she wasn't hungry but that everything looked so pretty.

We asked if there had been any Christmas music. John usually comes to play his guitar three times on one day each week. Mom didn't remember at first, then she told us he comes three times on Thursdays. We said, today is Thursday. "Oooooh, yes, he sang today."

John plays his guitar for the residents each Thursday.
They always enjoy his songs, stories and interaction with the group that gathers for his performances. He remembers each of them by name and plays their favorite song requests.

We consider ourselves very fortunate to have such an extended group of people looking after our loved ones. It's never ideal to live in a facility nor is it what they really want. Thankfully, Mom realizes that it is safer and better for them to have twenty-four hour staff to help them with their needs. She told me recently, "You children made the right decision to bring us here".

Even so, these things are difficult and have changed the face of the holidays for us all.