30 January 2025
Just as my new financial advisor at Raymond James opened the door, I get a call from Dmitri, the Kaiser placement agent. I promise to call him back but it takes a while because after I talk to the financial advisor, I have to visit the attorney to get the original invoice for the work done on my mother's house last summer, a story in itself.
So I call Dmitri back when I get home (and Loren the Social Worker calls as I chat with him). Meanwhile he lays out the territory for me.
He says there are three levels of facility: large ones with 100-plus patients, medium ones with 30-40, and room-and-boards with 6-12.
The nurse-patient ratio is the key to judging the level of care. At Golden Heights, with over 100 patients, it's 1-7. At large facilities, which have all the amenities, it's 1-12. At medium facilities, it's 1:6 for $7k-13K/month. And at small ones, which are typically a converted home, it's 1:3 for $6K-7K.
I suggest, based on my chat last year with Thomas Rocas, who runs ANX Hospice, we look at a room-and-board. Dmitri promises to check availability and set up tours.
I call Loren back and she says Golden Heights has agreed to extend Joyce's stay until Tuesday, Feb. 11 or Monday or Wednesday so we can get her transferred to another facility. She agrees Golden Heights isn't helping her.
She asks if I have any room-and-boards in mind and I mention the two Rocas had mentioned. She knows them and is impressed. "They're very good," she says. Now we'll see if they're on Dmitri's list.
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IT'S AFTER NOON when I take a 43 to Forest Hill and an M to Stonestown and a 28 to Daly City BART where I get a SamTrans 120 to Golden Heights.
Joyce is in bed, still waiting for the first VAC dressing change.
I sit on the bed and tell Joyce what the financial advisor, who had agreed to look over her situation as well, said to me and the importance of setting up a trust so whichever of us survives is taken care of. She follows the conversation but admits she has no idea what to do. I point out I'm trying to take care of her. She acknowledges that. No argument.
I also tell her I talked to Dmitri about placements and show her the two Rocas recommended on my phone. I tell her they're a half-way house to coming home.
"Why can't I just come home?" she asks. Because you need 24-hour care, I point out. And in my hour-plus there it will take three of us to care for her in fact.
I tell her what it will cost. Then I tell her Andy had sent me a link to an agent who places classic cars with still and video productions. So maybe the Alfa can pitch in with a few guest appearances. Ha ha.
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I HUNT DOWN Anne the Wound Nurse but she's surrounded by nurses asking her questions when Binita the Other Wound Nurse comes up to see if she can help. She's actually going to do the dressing change now, she says. She was waiting for supplies to arrive. I mention the blood and that I wanted an opinion. Even today the fluid is brown coming through the tube.
So we go to the room to do the dressing change. Joyce screams in pain because they did not have the petroleum dressing yet. So pulling the black foam out of the raw wound hurts. Even the pulling the tegaderm off her skin annoys her, though.
Meanwhile it turns out that Joyce has refused to have a diaper change three times after an earlier bowel movement inspired by a suppository because, apparently, she had been constipated again after so much diarrhea.
So after the VAC dressing is sealed but not yet tested, the CNA comes in to change her diaper. The CNA is frazzled because it has dried on Joyce's skin, making the cleanup difficult. But Binita helps.
Once her diaper is changed, Binita finishes connecting the tubes and testing the dressing. It doesn't create a vacuum but I don't hear a leak. She reseats the canister after redoing the dressing and it works. She used one piece of tegaderm to cover the wound and set the valve at the knee-end of the wound to avoid where Joyce would sit. Everybody does it differently.
But once she was done, Joyce was comfortable.
It was late, so I dashed out, taking a SamTrans 121 to BART, a 28 to Stonestown where I shopped a bit at Trader Joe's, a 47 to West Portal and a 48 up the hill with my heavy bag of groceries.