Public service announcement - Estate planning

I have taken too long to thank Dad for very practical help that he gave me to deal with his stroke and what followed: planning. Many years ago, he executed a durable power of attorney, naming me his attorney-in-fact. He also gave me a list of institutions where he had financial accounts, insurance policies, etc. These tools, especially the POA, have been immeasurably helpful. Of course it has been a challenge to drop into his affairs and get up to speed on the bills, accounts, and all, but if I hadn't known where to look and then had the legal authority to take action, it would have been so very much harder.

The other key tool has been his email account. I lucked into access to this one: I saw him entering his code to unlock his phone at the hospital, and I used the phone to get into the email.*

Which is to say, if you are an adult, please take the time to make some emergency plans. Find that person you can count on and make sure that they have the legal authority and key information to help you out if things go sideways in a hurry.

* In fairness to Dad, he also provided me a vast list of account passwords, including his email. Unfortunately, the code that he used to disguise the passwords, while perfectly transparent to him, has stumped me. So when you do give that information to a trusted someone, make sure that you aren't _too_ much cleverer than they are.

Life at the new house

I haven’t posted about Dad since his move to the residential care home. It’s not a very good excuse, but it is a case of no news being good news. He seems to be quite comfortable. The caregivers are very nice. He is eating well. He was receiving physical, speech, and occupational therapy for a few weeks; OT has now stopped. He has a few pictures from his house on the wall of his room: a couple of his mom’s paintings, one of his dad’s mechanical drawings, and a watercolor of unknown provenance that was at the house in Tulsa as long as I can remember. He asked for a TV in his room, but I’m not sure how much he actually watches it.

Until yesterday, I was able to visit Dad at the gazebo in the backyard. I was masked and staying six feet away, but now that has come to an end; all visits have been suspended indefinitely. It’s a bummer, but given the still growing number of covid cases in Dallas, it makes sense.

I’ll be writing Dad notes. I’m happy to drop off notes from others at the same time, or please feel free to write him directly. Thanks.

Belated moving day

On Tuesday, Dad made a fairly smooth transfer from the rehab hospital to the residential care home where he will be for the foreseeable future. As I think I described previously, there are seven other residents in the house, each with their own room. There is a nice living room with couches and comfy chairs, plus a couple of dining areas, a back porch, and a gazebo. There are two caregivers during the day and one overnight.

This describes several residential care homes in the area. The killer app for Dad's house is that it is actually in our neighborhood. It's a ten-minute walk away. I haven't wanted to mention this detail, for fear of jinxing it, but he's now been in the house for two days, so I think it's safe to go public. He can receive mail there; please contact me for the address if you would like to start sending things directly to him.

I was at the house a good while yesterday, helping to get him moved in. It was a long day for Dad, so I was glad to pop in this evening to see him relaxing after dinner. He looked very comfortable and happy. He'd had a shower and a shave. Well, most of a shave; he seems to be growing a mustache. We'll keep you posted.

Almost moving day

June 2 remains moving day for Dad. Kerry and I were able to have two hours of "family training" at the rehab hospital, which ended up being two hours in his room, first with PT/OT, then with his speech therapist. Getting to see Dad in person for that long was an unexpected surprise. He was using his left hand to eat, a remarkable change from when I'd last seen him, in mid-March, when we were excited over finger wiggles. His speech was easier, and there seemed to be less of the compulsive fidgeting I'd seen in Tulsa. On the other hand, we were told that there has been little progress with his left leg; mobility/independence, even within a home, will be limited. And we played a game of Uno, which prompted mixed feelings. While it was good to see him participate in the game, it highlighted, in a very personal and specific way, how his brain was damaged by the stroke. Dad and I would play cribbage while having a running, unrelated conversation. When the family played hearts, he was always the one counting cards. And now, he needed coaching to play a game of Uno. I am grateful for his rehabilitation to this point, and I trust that recovery will continue, but at the risk of stating the obvious, his condition is very different from three months ago.

I'm looking forward to Dad getting settled in a new home. I know it will take time for him to adjust to yet another new setting and new group of people, but I am optimistic that this will be pleasant and comfortable for him. Whatever you are inclined to offer for this next transition - prayers, lit candles, cereal box tops, hugs - I accept on Dad's behalf with gratitude.

Looking ahead

I've kept planning to provide an update once I've had a chance to talk with Dad, but after last week's flurry of phone activity, I hadn't been able to connect with him. I finally got through. It turns out the ringer had been silenced on his room phone.

It was not the most encouraging call. I'm hoping that he was just distracted by the TV news in the background, but he was very quiet, and what he did have to say was, in essence, "I want to leave," and, "Therapy isn't getting anywhere." Of course it's natural that he wants to leave and that he should have times when he is discouraged. Hopefully, though, this is just a down morning, not how he's been feeling for the last week.

But as far as leaving goes, that is scheduled for June 2. We are making the arrangements for him to move into a residential care home, a converted house with as many as seven other residents. Everybody has their own bedroom. There are two caregivers there during the day and one overnight. The food is all prepared there in the house, and all medical/therapy care is provided there. Speaking with Dad's therapists and case workers, as well as some friends with elderly parents, the clear consensus has been that a home, with a higher caregiver ratio, would be a better fit for him than a larger care facility. And I also think Dad will be more comfortable in a house. It won't be his house, but it is as close as we can get, at this point.

Pa Bell

Out of the blue, I got a call from Dad this morning, on the phone in his room. He's had a room phone in all of his facilities since the stroke, but this is the first time he's used one. We talked for 20-25 minutes. It was a slow conversation, but a long one, and notable that he did it on his own, without assistance.

I asked Dad about being able to answer the room phone; I think he said that he could, but I'm going to test that (and his cell phone), before announcing that he'd like to receive a lot of calls.

This morning a friend sent me some questions about Dad that you might also have. And as he might be calling you next, I thought I'd share some answers.

Q: How aware is your dad of what has happened; what his condition is?

A: Pretty aware. He certainly knows that he's had a stroke and how it's affected him. One disconnect is that he wants to "go home". If someone talks with him about specific tasks that he finds challenging (eg, getting around a room), he will acknowledge the challenges and that they would be obstacles to going home. But when they try to put it all together, he still wants to and thinks that he can go home. According to his last speech therapist, a reasoning breakdown like this is more likely to be a consequence of the damage to his right frontal lobe than inherent stubbornness. He also seems to forget that he is in Dallas. (Admittedly, there aren't a lot of visual cues - no life-sized JR Ewing cut-outs - inside his room.)

Q: How aware is he of the pandemic?
A: Not sure. I've mentioned it on the phone and in writing. I've not wanted to dwell on it, but a) I want him why no one has come to see him in almost two months, and b) it's kinda hard to talk about our lives without mentioning it. He has expressed no curiosity about it and has never brought it up on his own.

Q: Is he able to read/comprehend a lengthier note (a typed letter...and should it be in larger print if he is?)
A: Yes, he can understand longer letters. My notes to him have typically been 1 to 1-1/2 pages, and by all accounts he's read and understood them. Typed is probably better than hand-written, unless your handwriting is much better than mine. But I'm just using 12-point font, nothing wildly big. And way back in March, when he started reading The Hobbit, that was an old edition with little print, so I don't think the visual part of reading is a challenge.

Moving (again, and not for the last time)

Dad transferred today from skilled nursing to an in-patient rehab hospital. The plan of keeping him in skilled nursing until he started to "plateau" ended up lasting about a week. As the therapy team only meets weekly, that's about as short as it could have run. At in-patient therapy, as in Oklahoma, he'll receive physical, occupational, and speech therapy, at least an hour of each per day. I'm glad for him to continue to receive intensive therapy.

I've heard initial estimates of one to three weeks at this hospital, at which time he'll discharge to a long-term care facility or residential care home. This next move should be his last for quite some time. We're assembling a short list of candidates nearby and will do our best to get a sense of them by phone interview and video tour.

The plans they are a' changin'

Yesterday, Dad's therapy team decided, based on the progress he's been making in his current setting, to extend his stay until May 11 (one week). I was a little surprised by the extension, as they've been angling towards in-patient rehab starting May 4 for a couple of weeks now, but I'm comfortable with the decision. He does seem to have made noticeable progress in the last 7-10 days; extending in that environment makes sense to me. Apparently they'll take stock at their weekly meeting each Tuesday, and as long as he's still progressing, they'll probably keep extending.

Something sounds different

The title of this post is somewhat misleading. When I spoke with Dad this morning, he sounded different from what we've been hearing since the beginning of March, but much more like himself pre-stroke. His voice was less croaky, and he was able to get out a lot more words. He said that it was still hard work talking, but it seems like LS's suspicion (mentioned back on 7 April) was correct: his vocal cords were spasming shut. It's clearly taking some deliberate effort for Dad to relax the cords, as the croaky, halting speech went and came while we talked, and he allowed as he needed a break after 15 minutes, but still, it was a wonderful conversation. The whole family here got to hear a lot from him.

Standing

I received a video call from the physical therapy gym yesterday and saw Dad standing up. It was with some support, mind; he was holding on to something like a walker bolted to the floor. Nonetheless, it was much more than I had seen since the stroke. His therapist said that he had been standing for about five minutes. Speaking to Dad's longer-term progress on this front, as the left side strengthens, he is listing less in that direction, and can right himself - no pun intended - as he does. Transfers are getting easier as he can assist more. His control over his left arm is improving, as well. I think I mentioned previously that he had used both his hands together to open some mail; the therapist also reported that Dad is better able to release things once he gets hold of them with Lefty. (Aside: I had always thought of a stroke as damaging the ability to do certain things. But one thing I've learned is that, at least for Dad, the damage often manifests as the inability to stop doing certain things, even things we think of as voluntary. This has applied in both the physical and cognitive realms.)

The plan is still to write an order next Monday for him to go to in-patient rehab on May 4. The rehab facility will need to review his case, to see that he is making progress, to accept him. Given what I've seen over the last seven weeks and within the last ten days, I am optimistic that he'll be accepted.

Update

For whatever reason, I woke up this morning and realized that I hadn't shared any updates for a week. There are indeed updates to share.

Most of Dad's sutures came out a few days after his fall. Everything seems to be healing fine. Beyond the wound itself, he had some bruising on the forehead and around the eye.

His care team wasn't happy about him spending another two weeks confined to his room, so they tested him for SARS-CoV-2. It came back negative, so now he's got a little more freedom within the facility.

We're still on the outside, of course, but the staff arranged a time for us to meet at a distance. A great distance, in fact, as he's on the 8th floor. But nonetheless, last Saturday morning, Kerry, Owen, Katherine, and I were standing in the median of the road outside his building, waving up to him. He sat at the window, and with assistance, stood twice, waving. Of course this being this modern life, we were also Facetiming, so there were moments when we were standing in the median of the road outside his building, huddled around my phone to talk with him less than 100 yards away.

I think these sorts of connection mean a lot to Dad. I know they do to me. In that vein, thank you very much to those who have sent Dad cards and emails via me. Please send them as often as you like.

Dad's care team thinks that he would benefit from another round of in-patient rehab. He would receive at least 3 hours of therapy per day, as he did in Tulsa. This makes sense to me, given what I've heard about most stroke recovery happening in the initial months after the event. If all goes to plan, he would move to a new facility for in-patient rehab on May 4.

After the fall

I Facetimed with Dad today. It was another good conversation, not quite as good as the one last Friday, but pretty good for a guy who has a fresh bandage on his head. His therapist, LS, also shared that he has been intentionally using his left hand (eg, to open an envelope).

But, as every silver lining has a cloud, my fear was confirmed: Dad's little jaunt to the ER caused his 14-day covid quarantine to reset. Yesterday had been day 14, but it became day 1. In truth, this is a relatively small limitation, as all group activities (eg, dining) are suspended. Nonetheless, once he gets past 14 days (again), he'll be able to go to the gym for physical therapy and use the full suite of equipment there.

Never a dull moment

This morning, Dad took a tumble out of his wheelchair, reaching for his shoes. He landed on his noggin and needed to go to the hospital to get some stitches. That sounds bad, but apparently it wasn't so bad that he didn't finish his breakfast before going to the hospital. They also did a CT scan there to confirm that there was nothing more serious going on inside. There wasn't.

One week update

Dad has been in Dallas for a week. My updates have come from his speech therapist, LS, who has helped Dad to call/Facetime me, but also to talk with me, to learn about Dad and to let me know what she's seeing. In short, there is not much change in his condition. He did eat his breakfast entirely on his own this morning, without any prompting. LS speculates that he may have spasms in his vocal cords, slamming them shut when he tries to speak. This would account for his croaky voice, as well as the extreme effort it seems to require at times for him to start speaking.

I don't know about physical and occupational therapy. I should learn more during a call this Thursday.

All of the staff are wearing face masks all the time, so patients can only see their eyes. This is an extra challenge, with mouths entirely hidden and facial expressions limited to eyes and eyebrows. LS was asking me about Dad's interests, so that she would have more things to talk about with him. I really appreciate her reaching out.

Speaking of reaching out, while there are no visitors, and phone calls/Facetime are touch and go, Dad can definitely receive mail. It's probably best if you send things to me, and I'll bring them over; I don't know when his location in the facility might change, or how good their mail forwarding is. If you'd prefer to do it electronically, you can email me, and I'll print out and take things to him. For content or questions, I'm at rtdunbar-at-gmail-dot-com. Thanks in advance.

The move to Dallas

Dad moved to Dallas today. It went very smoothly. He had medical transport, riding in a reclining wheelchair in a van, while I followed behind. At 10:00 he was ready to roll, and by 2:05 he was here.

Dad quickly was whisked away to his room, and that was the last I saw of him. I passed the covid temperature check outside, so I was allowed into the lobby and admission offices, but that was all. Beyond the restrictions on visitors, as a new arrival, Dad will be limited to his room for the next 14 days. It's a stinker, but I understand the rationale.

After admit paperwork, I spoke with a physical therapist and the admitting nurse, introducing them to Dad. They were nice. Later I got a call from a case manager, and I phoned a nurse or tech on Dad's floor to plug in his heart loop monitor base station. So, good communication. What's more, his building is new, with a lobby decorated like a chic hotel. Don't know what else I can hope for in the first six hours.

Unrelated to the day's events, but delightful, I'll share a story from Cousin Kathy:

   ... from the 50s and 60s when my family and John's spent time on Cape Cod for many summers. There was lots of beach time and card games. The women in the crew were avid knitters and there were lots of knitting instructions to be found in the cottage. Your Father entertained us all by reading these instructions out loud verbatim. Who else could crack up his audience with renditions of:
   Cast on 37 sts
   Row 1: K1, *P1, K1; repeat from * to end
   Row 2: P1, *K1, P1; repeat from * to end
Lots of percussive Ks and Ps to the great delight of his audience.

Really funny and off-the-wall. I'd never heard that one.

Moving on Tuesday

Tuesday remains discharge/moving day. While I've been in Tulsa, Dad and I did get to wave to each other through the closed door at rehab. We Facetimed twice. The second time, he got to see cousin Debbie and Chopper, his dachshund, which he enjoyed. I also learned that he walked 34 feet in the harness seen in a blog post last week.

Fingers crossed for a smooth trip and transition from care in Oklahoma to Texas. At least we shouldn't have to worry about traffic on the drive. It's all silver linings...

Moving plan

Dad's discharge on 31 March has been confirmed. I'll head to Tulsa today, and next Tuesday, I'll caravan with medical transport van back to Dallas. He'll enter skilled nursing only a couple of miles from our house. There he will continue his current therapies, albeit at about half of the time per day that he's had during rehab. This will continue for an unknown amount of time - on the order of weeks, we expect - as long as he's "showing progress".

The weird part about this exercise for me is that, due to covid-19, I won't be able to see Dad in person until he discharges on Tuesday morning. And once he's admitted here in Dallas, I'll have to say goodbye again, not even able to see him into his room. I understand the reason for all this, and I'm confident that the facility here is good, but it's still a very strange feeling.

Up and at 'em

Here's Dad at PT, in "the harness":

I think "the harness" is helping him get back the feel of using his legs to walk. I also know that it is not "the ambulator", and may be more demanding than that contraption. 

Facetime time

I had a very good video chat with Dad early this afternoon. He spoke with me in those few minute as much as at any time since the stroke, and his "lag time" was noticeably shorter than when I left Tulsa and on the phone last Friday. It was very heartening.

He says that in PT he's now using an ambulator - I think I heard that - which helps him to "move his legs where they need to go". In my mind, it looks like this:

In reality, it's probably more - dare I say - pedestrian.

Here in Dallas, I had a long talk with someone from a second facility that Dad might transfer to. Once again, getting more information from people who've been through this process is a big help.

No news is all the news

I got to speak with Dad for a minute or two last Thursday. As no visitors are allowed, hopefully a call can become a regular part of speech therapy. It was short, mainly me talking to him, reminding him that we're thinking about him.

Dad is still scheduled to be discharged from the rehab hospital on March 31. We have confirmation that one skilled nursing facility near us in Dallas has a place for him at that time. Trying to find out about a couple other options, but knowing that at least one is available is comforting.