Adequate Care: Five levels, five differences in adult care facilities
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CEDAR HILLS, Ore. – It's one of the toughest decisions a family faces: where to place a loved one when they become too old or sick to take care of themselves.
And the recent death of a patient with dementia has sparked questions. On Thursday, Washington County sheriff's deputies found the body of 69-year-old Brant William Koller in the backyard of a Cedar Hills home. He had walked away from his care facility on Southwest Roxbury near Highway 217 Tuesday afternoon.
There is a big difference in care facilities. There are five levels of care facilities in Oregon with different levels of security. Some have special certification to deal with Alzheimer’s patients. The state says the quality of care and security often comes down to how much money a family pays.
The home where Koller wandered away from is called Fireside Homes for Elders. It's an adult foster home.
According to the state, adult foster homes can house a maximum of five people, are less expensive and have the lowest amount of security of adult care facilities.
"In the facility I worked at it was easy to walk out. Very easy," said Kelly Davis who worked in a much larger adult care facility unrelated to the one where Koller lived.
Davis quit last month because she was frustrated by the poor quality of care she saw in the facility she worked in.
"They don't pay the staff a comparable wage," she said. "I hate to use the term, you get what you pay for, but unfortunately we do."
More security and more supervision certainly cost families a lot more money. The Oregon chapter of Alzheimer's Association says families need to know wandering is a symptom of the disease that gets worse.
"They may be acting on a memory maybe from their early years and they will leave a premise," said Kristrun Grondal with the association.
According to the association, patients with dementia wander so often you should expect it. It says 70 percent of patients take off at some point during their care.
"One of the things you don't want to do is having to move people many times," Grondal said. "You want to find a setting that fits the personality and the needs of the person – also the needs of what's coming in terms of the disease."
According to regulators, Fireside has a clean record and passed its latest inspection last month.
Helpful links when choosing a care facility:
State of Oregon tips for choosing a long-term care setting
Alzheimer’s Association 24/7 phone line – provides information and support to people who need assistance figuring out where to place a relative
State of Washington Aging and Disability Services Administration
I know of the Fireside Adult Foster Home and it is a very good home, the owner is a longtime healthcare provider and is very dedicated to her residents and caregivers. Unfortunately, this is one of the risks of adult foster homes as opposed to the instutional lock down facilities. There are over 1500 adult foster homes in Oregon and they serve a very vital purpose to the residents of our state. They provide care in  a home like setting where you know your caregivers personally and share the home with only four other residents. The assisted living facilities and instutional alzheimer facilities have their problems too.
IMHO. No one fool yourselves! These people are probably MORE at risk in a Care Facility. If you can find a good Home care situation (look HARDER-ASK) I feel you are better off at the 1 to 5 ratio.
The State of Oregon has brushed seniors (especially seniors with dementia and disabilities) under the rug. They have totally overburdened DHS which is supposed to be in place to protect them and also prevents them from doing a proper job. This results in lack of real supervision and rubber stamping care problems at a Care Facility as ok. This also results in rubber stamping the very frequent deaths that occur and are never questioned. I have been told NUMEROUS times that my mother is dying of Alzheimers and to accept the inevitable...only to intervene...and find that she had a bladder infections, was not being fed properly, had incorrectly prescribed medication and was wearing rotten mold infested dentures which had not been taken out of her mouth for at least two weeks. She routinely had damage to her hands from careless care aids and several times gashes and bruises on jher feet. Â They have cut/restricted any State support available for volunteers (gas allowances etc) for those willing to help. Good luck finding an available Omsbudsman (sp?)The entire situation is DEPLORABLE. If you would like to be a senior advocate you must be willing to do it on your own. Judging by the huge number of folks I have seen dump thier parents and ignore thier care, only visiting on Holidays, if at all, the pool to draw from is very small. I commend those who go above and beyond to visit and CARE what is happening to thier parents and others and volunteer thier precious time and efforts to be a watchdog for all. I was one of those people and am despised by the Facility for my troublemaking.
My mother has been in a so called 'Good' demntia Care Facility for several years. The care is not IN ANY WAY sufficent for the care these people actually need. Add to this the fact that they employ cheap workers imported from other countries for the job, who can barely communicate in a language our parents understand. The turnover is unbelieveable as well, always requiring 'new' workers to be trained. Also a problem is the lack of staff which frequently results in doubling and tripleing shifts creating fatigue and mistakes. I have seen workers 'doubling for days on end. I have also observed that communication is a serious problem between staff and frequently results in medication and care errors on a daily basis. I cannot tell you how many times my mother has been injured and I get a blank and uncomfortable "We do not know how it happened."
Sad Ending: Mom passed away during a recent flu epidemic. One day when I went I was told there was a flu virus going around. I decided to check on her and found no warning of any kind that there was a problem and no masks or gloves available for my visit. The med nurse (this is who is actually resonsible for the care workers and the actual medical care given) had no clue as to where I might find a mask or gloves to prevent the spread of infection. The staff were not wearing masks either and seemed surprised that I asked for one. The next day I complained and the unit was put into formal quarantine. At least five people died (I heard more but cannot confirm) eventually of this virus.
Here is another horrible part. Hospice never showed up for the 4 days I sat with her and held her hand till she died. The med nurse told me Hospice had prescribed Morphine (which they were told never to prescribe without my knowledge ANY RX-another mistake) which I suspect she was allergic to and contributed to her death. The death paperwork was sent to the absent Hospice, which was then signed by some Hospice doctor my mother had never even seen. Moms personal belongings were stuffed in 5 black bags along with her dead roomates' (the flu too...never saw a family member) and piled on a cart for me to pick up. Her other belongings were stolen AND damaged after her death and will never be recovered as the Facility have washed thier hands of her. Did I mention her room was painted and stripped of carpet despite the fact that they knew I had prearranged clearing out her room. They will not give me a contact number for her former roomate so that I can return the family mementos I was forced to go through, in order to find my mothers things. It is all about the bucks here people!
I REALLY wish there was a SITE to RATE these Memory Care Kennels and self-serving Hospice agencies in Oregon. There SO much MORE I could say in warning and about the care of your elderly loved ones. It would also be great if there was one for the funeral homes as well. That experience was a complete and horrifying disaster as well. PLEASE have care and pay attention to EVERYTHING to do with finding a place for your loved ones. They are not garbage just needing to be recycled at the first place you choose. AND VISIT!
Apologies for the rant ahead of time. There is no one to tell and I am hearbroken at the loss of my mother and the others and need to try and WARN people.
 @Billy BattsÂ
@BeenThereDoneThat that's horrible! I'm glad you cared enough about your mother to be there for her and make sure things were as the care center claimed (or in this case, call them out on their glaring, (fatal?) errors.
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My mother in law was hospitalized with the flu once and it morphed into pneumonia- they notified us after a few days that they were transferring her to a care center for the remainder of the illness.
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While my husband was getting her checked in and settled in to her room, I was walking around the premises just sort of checking out the facilities. Initially I was impressed that there was a hair salon and several lovely common areas. I then settled down in the waiting area and opened up a book. This book is one they are all required to keep up front, and it lists (in graphic detail) any violations the facility has been hit with. In horror I read instance after instance of incorrect or no medications, patients with horrible bedsores, on and on and on, and my thoughts were "why are they still open???". Getting Medicare to agree to move a patient to a different facility is a daunting process, so we simply went and spent time with her EVERY night to make sure she was OK. Fortunately she came through just fine, but most days it was pretty much impossible to find a nurse when you needed one.
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This problem is not a new one by any means, though. My own mother died of cancer when I was 11 and was in and out of nursing homes. My most vivid memories of that place were of wandering around and seeing the loneliness and desperation, and the filth...I remember one time hearing faint cries for help. I listened to them for about 10 minutes and grew worried. My 9 year old self wandered down the hallway trying to trace the source. Finally reached the end of the hall and there was a frail little old woman in there with tears streaming down her face, her upper body had fallen partway off her bed, and she was clutching one of her arms with the other as though in great pain. Don't know how I did it, I was always a small girl, but somehow I got her righted up. She just started beaming. I sat there with her for a few minutes and got her some water, and was about to leave when she signaled me to wait. She managed to struggle out of bed and into a chair, and started pointing out all these pictures of her family and grandchildren. She couldn't say more than a few words, but the pride in her grandchildren and her vast loneliness were evident in her gestures. I don't know how long I stayed in her room with her, but I have never forgotten her, and I felt that she hadn't seen her family in a very long time.
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Anyway, I agree with you completely, and wonder how many others have horror stories like that. I also wonder how many relative stay away just because they are incredibly sad and uncomfortable places to be in. :(
@WhenCowsAttack @Billy Batts What a great story. There are volunteers and people like you who visit, who step up to the bat and I want to hug every one of them. They are the only ones besides family and friends who come in and spend some time, who see beyond the promotional BS, beauty parlour and arranged activities and smiling (instructed to be) workers.
There were several long term workers who were also devoted to the residents but they were few (and powerless to change things) and far between the changing staff. I would also like to commend them for thier devotion and care.
Also, the residents absolutely love visits from children (like you), pets and anything that will light up thier lives. Since there were mostly women, my son-in-law never failed to make them titter like young girls (he is 6'5" and has some tattoos) when he invited them to dance or sing with him when he visited.
It is very HARD to go visit I can agree, there were days I had to literally force myself, but when I left there I always felt like I was doing something REALLY meaningful with my life for a change. There were also days when I cried my head off in the parking lot, but it was worth every precious second I got to stay with mom.
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In my youth, I went with my dad to visit a church-member who was in an adult foster care facility. I think there were anywhere from 3-5 residents in the home at any given time, and it seemed like always 2-3 proprietors/care-takers there. I recall shortly after the church-member left, we ran into the proprietor at the grocery store, her eyes were still welled up from the loss of her resident, when you were in that home, and later spoke with her, you could tell that they didn't just take care of these residents, they loved the residents as part of their family.
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I've vowed since I was 19 or 20 that I'd never want to spend 5, 10 or 20 years in a nursing home, to me, it doesn't seem like living. I'd possibly consider something along the lines of a qualified adult foster care home if I were unable to continue living alone. Family can be a great resource for care, if they are willing. My mom hopes to live in her home until the very end, though only a small fraction of the family (mainly myself) check at the house weekly to see if anything needs to be done.Â
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Our nation has something to learn from the other cultures, (specifically Asian) in regards to caring for elders. I realize that sometimes, caring for an elder can feel like taking on multiple full time jobs, and may require giving up a paying job to do so. I think we have a long way to go in perfecting "elder care" in this nation. There are great options out there, but there are also options that aren't as desirable.
My husband and I own and operate 2 Adult Family Homes in WA. I do feel bad what happened to this resident, this should NEVER happen. However, I'm sad by some of the resposes on this site. Please, don't put all AFH in the same category. Some of us work hard and have only the best interest of the residents at heart. My husband and I are in the homes 24/7. We hardly ever get a day out together, because I feel that I need to oversee every step. We have more staff than what is required by law. Our staff is trained well beyound requirements. We have an open door policy, just walk in anytime. The state does not compensate us enough for residents on Medicaid, we have very good inspections. This job is a job of passion, commitment and understanding. I have been known to go through several empoloyees to find one good one. However, this is a commitment we made when we decided to go into this line of work.
We have had several wanderers. I found a device online under a wildlife tracking website that works for our residents. It has a base that sits on the counter in our kitchen and a wristband the resident wears. It has a setting up to 300 feet of an invisiable barrier, so the resident can go outside and walk around up to the barrier and than the alarm at the base goes off, which is audiable throughout the whole house. It is expensive (about $1000) and each resident has to have their own unit, but it is well worth it, The resident feels like that they have some freedom being able to go outside without a caregiver hoovering around them.
I do feel that as an AFH provider you do need to know your limits on what kind of care you are able to provide and DO NOT let greed get in the way.
@redsagebud I don't think anyone is saying that all AFH's are the same, just stating that there is a HUGE problem (as evident in the number of personal experiences) and that it's so very important to use great caution. Moreso, of course, because if one is touring a facility they of course want to accent the good parts of the facility. They aren't going to just offer up info such as "in the last 4 years we have been violated 6 times because of patients with bedsores or inadequate nutrition". Families must be diligent in researching these things.
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I am glad you are one of the good ones.
In the state of Washington, we are required to post past inspection where everybody can see it. It lists on it all the infractions Which I think is great.
 @redsagebud See the story I posted below for LuckyLucky. There are certainly good and there are bad homes. The one I mentioned appeared, other than the substantial language barrier, to be a rather decent home and I know it was when my friend was living there (because I sometimes helped her -- but they spoke better English).
I volunteer at an adult foster home doing activities. The lady that owns the two homes that I volunteer at goes far and above what is required by the state for staffing. I see what goes on in these homes on a daily basis. The RCM (resident care manager) and caregivers work hard to make a homelike environment for the individuals who live there. In the case of this gentleman, I am so sorry for he and his family. I also feel for the home caring for him. When the state/county only requires one person to be there at a time it is difficult to keep an eye on everyone at once. These people, although adult, are like caring for small children at times. They wander off or even run away. Think of this scenario: The caregiver is assisting one (1) client with a shower, another client is outside enjoying the weather, when he/she notices the coast is clear and bolts. How is the caregiver supposed to keep everyone safe at once. This is why there are two people on shift all day and one at night here, above and beyond the state requirements. The state doesn't pay her to have the extra people working but she does it to protect her residents. The state does require her to have an activities director but doesn't pay for that position either. That is why I volunteer my time. The state has budget requirement that are so substandard it is ridiculous. I see her go way beyond what is required. She sees to it that her clients are as healthy as possible. To be in this business you have to have a big heart and not in it to get rich. If you are looking for more than showing love to those who need it and for a mere comfortable living you should look elsewhere. This is a job for someone with a huge heart & eyes in the back of their head.
 :-)
 @Becky It is very easy to tell that this person is in the business, because she loves helping people, and not in the business of trying to make a large profit. She and her clients are very lucky to have someone such as yourself volunteer with activities.
@pdxd Everyone at the homes that I work at are just as caring. I know others in this business and they care too. I am so sorry for the people that are in the business to make a fortune because not only is it not there but the residents suffer too.
 @Becky Your clients are lucky to have you for a caregiver. We need more of your kind!
@str1ngb3nd3r @Becky
I am not special. I care as do all the other people that I work with. Love...Compassion...& Care is what it takes.
I feel for the family of the man that died.  However let us get real. Our state licensor's that come to our foster homes there is only 3 for the entire state of Oregon the blame does not belong to the licensor's but to the State of Oregon that has cut budgets and programs for the DHS office. These people are under paid and over worked. These people are there to give the provider support and also inspect the homes. Yes I agree the providers of these homes should be paid more the staffing is not that great I staff much better that is required. But look at the nursing homes day shift 10 residents to one care giver swing shift 15 to one care giver and night shift up to 25 to one caregiver.  The foster care system is one to 5. If the provider of the home takes more than one care giver can handle then it is there respondibility to the residents to staff to take care of them. I staff 2 during the day and one at night and no the state does not pay me for that my residents deserve that. So if anyone out there thinks that providers are in to this for the money please think again
 @ksÂ
Lots of AFH providers are in it for the money - look at some of the huge gorgeous homes they live in. 3K to 5K per resident x 5 is 15-25K in monthly income. Many of these homes are run by spouses and no hired help. That's a hell of a lot of income and their expenses are food and utilities, half of which go to their own family. In truth, many only provide care for 12 hrs in 24, abandoning residents and putting them in diapers (they don't provide those, family or the state does) and beds they can't get out of overnight while the caregivers have their family time and sleep.
Not all AFH get that much money for each of thier clients.  If you are looking at the 3k-5k per client than you are looking at special needs clients or private pay clients. The medicaid clients service payment for a standard foster home is 900-2000 per month pluse room and board. If the people are putting there residents in (diapers) adult briefs than they should be changing them at least once every two hours no exceptions. If they are not providing care for those residents that is abuse and they should be reported to protective services and be cited for the lack of care.   If the provider is not willing to provide the proper care to their residents they should not be in the buisness. For we all better remmember we will all be old one day and what you do now is how you might be treated later.  I make sure my residents are cared for as if they were one of my own family members.  These people are not a pay check they are one to be loved and be respected. I provide more staffing than required, I provide adult briefs if they run out for the state only provides enough to change a resident 3 times per day, I pay for the medications that are not covered by insurance to ensure that my residents have what the MD orders, as far as my electric and gas my home is set at 72 degrees year round cost of about 1000.00 per month, my grocery budget is 800.00-1000.00 per month after I have purchased orgnaic beef and pork purchased from a local farmer.  So income is only a perception my payrol for two homes is no less than 20,000.00 per month with my self working at least 5 days per week and on call 24/7. So some of us are very dedicated to our residents. Â
@ormom I will have to agree with you on that point.  It as all of us know that when one group gets a strangle hold on any service that purposes a problem with price gouging and poor services.  If the public would look back on the Ma Bell situation years ago that would surley tell them something. Maybe if a provision was in place that you could only operate two homes per county that would make it so that this situation of pricing would not take place.  And you are right that medicaid is voluntary and it is very sad that yes that alot of homes do not take medicaid and this is where the services are needed the most.  i serve 10 residents at two homes with only 2 private pay and that is the limit for my homes. I am here to serve the people that are in need the most I serve the people that most of the homes will not take behavior issues, drug addiction, tramatic brain injury etc.  in order to get into one of my homes you must have been refused placement from at least two other homes or evicted and are a hard placement. With the assessment that I do it is required not only do I do the assessment my self but my resident care manager is involved and it is talked about with all staff to ensure that the care can be provided with the staff we have.  Maybe all should raise the care standards for the residents they care for and not just think they are a pay check
 @ksÂ
I made no comment about how you personally run your business since I don't know you and I'm sure there are many good providers out there. But you made a statement above that foster home providers weren't in it for the money and I assure you that many are and I speak from personal experience. In a perfect world, the state or county would take action but I'm here to tell you they don't and these kinds of abuses and more are going on 24/7 with full knowledge of authorities.
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What Medicaid pays doesn't really matter because the homes are not required to accept Medicaid residents and many don't. It's purely voluntary and the private pay homes can and do charge as much as the market will bear. And that brings up another issue - a certain group has a virtual lock on the industry in some parts of the metro area and it's obvious what that leads to in terms of prices and services.
Oh no...so sad that he was not found safe. RIP Brant Koller :(
My wife's dad was in a care facitlity for about 5 months last year. He had two different types of dementia and they thought he had alzheimer's. Turned out he's was over-medicated for his Parkinson's and that caused very bad reactions. He's back at home now but we did get a great lesson in Adult Foster homes. That lesson is, "You do get what you pay for". The first home he was in was minimally staffed and there were problems. We ended up putting him in another more expensive ($5500 per month) by $1500 per month. The difference in care and was amazing. We all felt pretty bad for putting him in that first facility. Do your research and don't be thrifty if you don't have to be.
Adult Foster Homes are scary. Anyone can start one. There are a few that are decent, some that would give anyone the willies, and some I wouldn't let a pet dog stay in. There needs to be a lot more oversight into this industry.
 @Luckylucy Years ago I experienced a scary situation. My husband was driving home when he noticed an older man crumpled on the ground. He was near our house so he went home (pre-cell phone days) to get help and call 9-1-1. We rushed out to help (he was close enough we could see him from our house). I sat on the wet sidewalk near the man and cradled his head (he was bleeding and we didn't know if he tripped or had fallen nor did we know how long he'd been on the ground) and to warm him up. My Dad did the same near his core. My husband was trying to get information out of the man but he only spoke Japanese and my dad's Japanese was very rusty.
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The firemen pulled up and started their medical assessment and prepping him to take him to the hospital. He seemed to keep trying to insist that he was fine. The fire department also had difficulty communicating with him. Because of this, they conducted a more thorough investigation.
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In the meantime we were also trying to figure out where he lived. He gave an indication that he lived in a group foster home nearby. Knowing that my friends had operated one in high school, I figured I'd try their home first (they'd sold the home and business but it was still there). My husband and I knocked on the door and tried to talk to the owners who happened to have been Romanian (my friend and her family had been Romanian, too) and didn't speak ANY English.
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We tried to tell them one of the guys from their house had fallen when he was out walking. They couldn't understand. They tried to call their brother to translate but weren't able to get the on the phone. I frantically was pointing at a couple of the residents and miming falling to the ground and my husband was trying to grab the man's hand to indicate he was needed or needed to follow. Finally the woman seemed to get it and they both followed (leaving the other residents alone).
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We met up with the firemen and said we'd found where the man lived but apologized because they weren't going to be able to get any information from them, either. What a waste.
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I found it very disheartening that the residents weren't able to communicate with each other and neither of them could communicate with the people sent to help them out in an emergency.
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We have  been talking about DHS and this is another prefect example. I use to own a level Three Adult Care Home, the level meaning I could care for the most medically complex, behavior issue, there were only two type of care I could not do, IV and ventilators...I did hospice, bed bound and two every two hours, feeding tubes, strokes, Parkinson's, you name it, I cared for it and did and YES Dementia and Alzheimer's.Â
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DHS would do send out the "over paid and over worked" case manager to do the inspection of the home...They never look at the people, they never talk to them, they check the charting records, staffing plans, menus, progress notes, look to make sure the meds are properly labeled and leave. DHS never would notice IF there were five people with Alzheimer's sitting in that house. If one went missing, there is no way, you can leave the house to go looking for that person. And when they decide to wonder, you have to be right here on top of it or they will, not showering another patient, not cooking dinner, not dealing with a choking patient but diverting the wondering behavior. I had to install a six foot fence all the way around my foster home, bells and alarms on all doors...then DHS would call me down for caging them in.
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The kicker is that DHS would place that person (medicaid) in my home. Now that poor home where Mr Koller wondered away from, will be re-inspected, they will put all the patients in beds and make the ONE care giver do a fire drill where as that one care giver needs to get all four/five residents out to a safe spot in under four minutes. The home with it's clean record could be fined for taking a resident beyond their mean's of care. And it was DHS that without a doubt put Mr Koller in that home.Â
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Over worked under paid and pass the buck
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@Tyler Van Pelt
You were paid well enough to have 2 people on the floor duing waking hours.Â
 @Becky Â
Exactly.
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@Mike Smith McRib that please....
 @Mike Smith Jackass
I worked at a nursing home up in Washington when i was young, and remember having to go after one particular patient on a number of occasions when he wandered off. No security at all in that one!
This is why my family has chosen to take care of my elderly mom with dementia ourselves all the way to the end.Asian cultures are know for caring for their elders as opposed to putting them in homes.I know that putting her in a facility would break her spirit and it would be a death knell for her.
 @noneofyourbizzness "Asian cultures are know for caring for their elders..."
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I may be wrong, but I believe it's because they are ingrained at an early age to respect their elders.
@str1ngb3nd3r You are absolutely correct.I have beautiful,wonderful Thai family members who watch over her and take care of her every need around the clock.I still have a lot to learn from their patience and kindness.
I have a ,22 to put me to sleep before I end up having someone change my diaper - I did that enough after losing 10' of my lower intestines and spending 30 days in two different hospitals being homeless thanks to my ex. Never again, ever...
@boned My feelings exactly.I went through kidney failure and I promised to say "lights out" if I had to go on dyalisis.Not to be morbid,I have always said that I would rather be dead than homeless.One of my worst fears.I have no idea what you must have wen't through.