| Summary: | How are you doing with all of this?” asked the hospice social worker. We sat in a small recreation room in the skilled nursing facility. I had just signed the paperwork to put my 81-year-old mother on hospice. I didn’t know how to answer the question. In the last three months, my father had passed away, my mother had fallen and broken a hip, and then fallen again in rehab and broken her other hip. Post hip repairs, instead of recovering, Mom had almost stopped eating; had a hard-to-shake urinary tract infection; developed a pneumonia that needed IV [intravenous] antibiotics; and, worst of all, had a rapid cognitive decline.
Mom broke the first hip in the driveway of her home while walking to get the mail. She wasn’t found for some time, so in addition to the break, she developed hypothermia. When she broke her second hip, it was 18 hours before she was transported from the nursing home to the ER. Delirious with pain, she began undressing in the exam room, and the ER doctor recommended hospice for late-stage dementia. We opted for a second hip repair.
Back in rehab, she developed multiple infections and kept running out of Medicaid coverage for PT [physical therapy] because she wasn’t making progress, probably due to the infections. We appealed the Medicaid decisions and won, but Mom’s progress was still limited. While she recognized my sisters and me and had moments of clarity, she slept a lot, was often unresponsive, and was sometimes delusional.
I don’t remember how I responded to the social worker’s question about how I was doing. I might have shrugged. There was too much to put into words, I was so tired, and the rapid decline was overwhelming. I lived about three hours from Mom’s home, and during each emergency either my sisters or myself would need to drive back to manage the crisis. We were also driving back and spending hours each weekend with Mom, urging her to eat, observing her physical therapy, and wheeling her around the nursing home. We consulted with her surgeon and her primary care doctor and the social worker at the nursing home, who set up consults with a speech therapist. A psychiatrist had evaluated Mom via computer because of the rural isolation. We had advocated for Mom the best we could since her first hip break, but her decline continued.
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