I met with Ping Ye, one of Mam’s doctor and Wendy the case worker and the nurse admin Tracy. Ping Ye did most of the talking.

She explained to me a few cases where a palliative care already in place might help. For example:

• One of the nurse finds Mam having very low oxygen level. She would have to urgently call the doctor on call and make a quick decision as to whether to send Mam to the hospital. Not having palliative care in place might just stress everybody out. Maybe they would even do something that might stress Mam unnecessarily.
• If Mam gets a pneumonia, without the palliative care in place, the nurses might be acting more aggressively in curing Mam, instead of just providing comfort. In some cases, the right treatment for someone not in palliative care would be to send her to the hospital. But in Mam’s case, that might not be the right choice.

I think I understand what they’re trying to do. Nevertheless, I feel somewhat unease with this. I understand the purpose of palliative care is to let nurses and staff know what to do in case of emergency or acute situation. But I fear that Mam might be neglected on day to day basis just because of her palliative status. I fear that they would make decision on things first before notifying me.

I have stressed these to the case worker: I want the communication to still flow to me as soon as possible, when Mam falls into an acute condition. I want the day to day care to not be reduced.

I signed the paperwork today. Mam is officially under palliative care. Let’s see if I notice any of her care getting worse.

Mam’s guardianship hearing was supposed to be on the 14th. But the Travis County court wanted to get some confirmation about where things were left from the California court. So they rescheduled it to today.

It was supposed to be at 10 am. I met Candice Bocock, the probate lawyer I hired to help with this, at her office around 9:30 am. Then all three of us (Candice, me and her intern assistant) drove to the court a few blocks away.

There was another guardianship case in front of us. It was a guy wanting to get guardianship of person (GP) with full control over his dad. Both he and I had to watch a 20-30 minutes video of what being a GP meant.

Then both of us and our lawyers were called to the court room. The judge arrived. The guy went first. His case took a lot longer to hear. But the judge eventually granted the guardianship to him.

Then it was my turn. There was a question from the judge whether the California court expected us to transfer the guardianship of the estate (GE) to Texas then close in Texas, or was it already closed. Surprisingly, Candice did not know the answer to this and said that she was expecting a phone call back from the California lawyers. The judge did not want to wait for the phone call. Instead, he said, he’s going to assume the GE was already closed in California based on the fact that California had approved the *final* accounting.

So we proceeded with the hearing. I did not sit in the witness stand like the other guy did. Judge said I could sit on the bench next to Candice. Darn!!!

Candice asked me questions that she already prepared me for: why we chose to move Mam here in Texas instead of Washington with my brother, how long I have lived here, etc. Then Mam’s appointed lawyer: Brooke somebody, asked me a few more questions: how I’m planning to pay for the nursing home, etc.

Then the judge granted the guardianship. And that was that.

This would be my first time to actually *be* in a court, part of a case. I was called on jury duty before but never made it to be part of a case.

My impression of the people in this court: they were quite friendly and reasonable. They did not look and act authoritarian or argumentative. The actual hearing went by quite fast.

I am now the official guardian of Mam.

Last month (May), Mam weighed 127 lbs. This month (June), Mam weighed 122 lbs. She lost 7 lbs in one month.

This triggered a flurry of phone calls from Park Bend. They notified me of the weight loss. They notified me of the Speech therapies. They notified me when they put Mam on diet supplements. I don’t mind these calls. But I saw Mam on 109 to 110 lbs before when she was in Malang. I think 122 lbs is still quite ok for Mam.

This weight loss also triggered the Park Bend staff to offer us their Palliative Care package. Palliative means

1.to relieve or lessen without curing; mitigate; alleviate.
2. to try to mitigate or conceal the gravity of (an offense) by excuses, apologies, etc.; extenuate.

I met with the nurse practitioner Wendy and the head of nurse Jennie at the end of May. They tried to explain to me what Palliative Care was all about. Basically, they want to concentrate on providing comfort more than providing cure. They told me that Mam has gotten worse cognitively. She used to assist the nurses when getting dressed, getting up, or even eating. Now, she’s quite passive and let the nurses do all the work. At this point in Mam’s dementia case, it makes total sense. I don’t have a problem with this concept.

What I have problems with was when they said: in case Mam developed a fever, they might not send her to the hospital, but instead just kept her in Park Bend. Well…. if Mam got a fever, shouldn’t they be calling me and discussing with me the care options? They said they would still notify me. Then I didn’t see a point of signing a paperwork. Anyway, if there’s an important event, I would be notified and I would be able to discuss with the nurse or doctor what’s the right thing to do for that case.

Park Bend was very aggressive in having me sign the paperwork to put Mam in Palliative Care. They called me several times to discuss this. I am a bit turned off and suspicious of why they so urgently want this. I told them I did not understand the point of signing a paperwork, if there was not going to be any change in how they provide the care and how they’re notifying me.

The case worker, also named Wendy, suggested to me to have another meeting with Ping Ye, Mam’s doctor.

I got a call from one of the nurse of Park Bend today. She told me Mam was in the activity center, when suddenly, the activity directory noticed Mam “slided” down from her wheel chair to the floor. The nurse who called me had an accent and I had difficulties understanding her. She did not use the word “fall”. So my impression was that there was no injuries.

She wanted me to talk to Mam on the phone to see if anything was hurting Mam. Ugh, oh, I am not sure Mam knows how to talk on the phone.

But I did talk to Mam on phone. I asked Mam in Indonesian: “Mam, did anything hurt?”. She said “No”. I asked Mam, “Did you fall just now?”. She said “No”. So I am not sure if she actually understood me. But she was not hysterical, she was not crying.

But that was probably my first conversation with Mam on the phone since a long time.

I came back to see Mam, after shopping for more pants for her, in fear that the laundry situation had not been fixed. The laundry situation seemed to have been fixed, thankfully. Mam’s dresser is full of clean clothes, pants and shirts. She’s good to go now. Nevertheless, I had bought her more pants.

I found Mam in her wheelchair, again, in the hallway. She was in a better mood. No crying. I said hi and talked with her. Then I wheeled her around. I walked her around the hallways.

Finally, I tried something new. It was pretty decent temperature outside. Still on the hot side, but not unbearably hot. I wheeled Mam outside. I did not want to just walk her outside, afraid that Mam would learn how to get out on her own. I believe she is physically capable of doing that.

There is a gazebo just outside the nursing home building. I took Mam there. She was in really in good mood, talkative, pointing at flowers, pointing at grass. I asked her many questions, most of them she no longer knew the answers. Things like: what’s the Indonesian word for a bee (I truly don’t remember). She didn’t know. We stayed outside for 15 minutes before she started patting her head/hair a lot. I asked if she’s hot, she said yes. So I wheeled her back inside.

We stayed in the TV room for a little bit. She liked watching I love Lucy and there happened to be one playing. I left her in the TV room watching TV.

I am contemplating of getting her a TV. But I am not sure where to put it. Her roommate sleeps most of the time. If I put at TV there, it might disturb her. Also I am not sure if Mam would just twiddle with the TV and might break it. I actually looked around for a small LED/LCD TV/DVD combo. It is at least about $200-$300. Should I get it???

I took both kids to see Mam today. I found her sitting in her wheelchair in the hallway. That’s where I usually found her when I visit. This time, I found her crying and sobbing. This was the first time I actually saw her crying after she moved here.

I asked her what’s going wrong. She never could explain. In front of her, stood an old lady. At first, I thought she was a nice old lady. She was trying to ask Mam why Mam cried. I explained to the old lady that Mam was sometimes crying if she was left alone doing nothing. Old lady kept trying to talk to her. I explained that Mam no longer spoke English. Old lady did not want to move.

I finally started motioning to the old lady that I needed to wheel Mam off to the TV room. Old lady still stood in front of Mam, so I could not move Mam. Mam was still sobbing. Kent was running around in the hallway, unsupervised. Ananda was no where to be seen. I really needed to move Mam.

Finally, I said to the old lady, could you move away please? Then the old lady stepped aside.

I wheeled Mam to the TV room, called the kids to come over. Ananda brought her diary and she sat down at the table and immediately immersed herself in writing something in her diary. She’s completely oblivious of her surrounding. Kent played around, climbed around, ran around, laughing out loud. Mam immediately got distracted of this little somebody that had lots of energy. She stopped crying.

At some point, Kent got a little out of hand with his climbing the couches, tables and chairs. So I sternly scolded him to climb down and sit down next to me. He refused. I gave him a count of five and he started crying. Interestingly, Mam started crying too.

Uh, oh, I guess disciplining Kent did not work well in front of Mam. So I let Kent be. Mam stopped crying as soon as Kent started laughing again. She even attempted to play with Kent, making funny noises and smiling at him. I guess for this, I am kind of glad to bring Kent along.

When it was time to go, I left Mam in the TV room. I went to Mam’s room to check on her things. I noticed Mam ran out of pants. There was a pile of dirty clothes sitting in the hamper that I had bought for her. This did not sound right. I went to see the nurse. The nurse explained, usually family members bought a hamper if they wanted to do their own laundry. The staff was probably confused seeing the hamper there. I told the nurse, I bought the hamper because someone told me I needed to. She said: oh, no. So she took the dirty clothes to the laundry and suggested I bring home the hamper. Hopefully, this fixes the laundry issue.

When I was talking to the nurse about this laundry business, the old lady that was standing in front of Mam earlier came to me and asked me accusingly: “Have you done anything in your life?”. I told her: “I have done many things in my life.” In the corner of my eye, I saw the nurses smirked. The old lady continued: “My children would not have put me up like this.” Not sure if I understand that comment. I just stared at her. I don’t think this old lady who seemed nice is actually nice.

Yesterday, the law clerk from my Family Elder Law firm I retained to do Mam’s Guardian transfer called me to tell me that Mam has been served a citation for the guardian transfer.

Today when I visited Mam and went to her room, a pile of the paperwork sat on the night stand.

It amazes me how rules and laws are unbent-able, unchangeable even when they don’t make sense to follow anymore. Given that the ward has Alzheimer, does not even understand this situation anymore, is not even able to read anymore, the court still sent someone to hand deliver the citation. What a waste of resources!

Today, when I visited Mam in the dining room around lunch time, I saw she was seated at a table with the Chinese lady. I have seen this lady before. She was I thought always strangely staring at my brother and me when we were visiting.

When I started speaking to Mam in Indonesia, she started speaking something to me. At first I did not understand her. Her voice was kind of hoarse. I was shaking her head to her to indicate I did not understand. I continued talking to Mam. She kept trying to talk to me. I finally caught what she was saying. She was speaking Indonesian to me!!!

I was quite surprised. I guess I had forgotten the Park Bend’s staffs had mentioned before that there was another Indonesian resident. This lady’s name is Julia. She told me she’s 85 years old. Her mind is still sharp. She asked how old Mam was. She told me she tried to talk to Mam but Mam did not answer. I explained to her that Mam did not understand much anymore. She told me she no longer has a good hearing (budek). She told me the name of her kids, who live in Austin and I am planning to find them (or at least their e-mails). I kept telling Mam to talk to Julia, but Mam did not even look at her.

I am not sure if Mam could be or need a friend, but tante Julia is there if Mam wants to befriend her or need to talk to someone. I am a bit excited for Mam.

I got a call from Park Bend’s Social Worker two days ago. Her name is Gillian Jacobs. She wanted to meet with me to discuss Mam’s well being and plans.

That meeting was today. I met with Gillian, the head nurse (I forgot the name), Addie (the activity coordinator), and Reyna (nutrition nurse).

Basically, the meeting was to learn or get more information on what Mam’s state was before she entered Park Bend. They needed to know this and would use this information as the base information. We would have this meeting every 90 days to communication any changes, any digression in Mam’s psychological, physiological, and cognitive state.

The main thing and the first subject they brought up was that Mam is a major fall risk. She is mobile now, but she does not understand it when her body someday fails her. She might still try to get up and would end up falling. The head nurse said Physical Therapy (PT) would try to get/teach her to walk in an enclosed walker. This would allow Mam to walk everywhere she wanted to, and at the same time, minimize her risk of falling. I asked the head nurse when PT would want to teach her to walk using this walker, she said PT still needed to see the funding of this. I think they are trying to figure out the Mam’s Medicare status. I need to get Pomona to fax me the Medicare card.

The second topic they brought up was the language issue. They are having a hard time communicating with Mam.

I learned from this meeting that Mam sometimes did burst into tears for no reasons. They asked if this was common. I said yes, a while back, she did go into crying spells every day. I told them that I thought with the medication this was sort of under control. But I actually don’t know. I don’t talk to the Pomona Vista folks much. I heard about her beating and slapping herself, but I thought that was in the beginning of her stay at Pomona.

Addie, the activity coordinator, told me that Mam joined their church last week. The church was singing few church songs. The last song was Amazing Grace. And Mam just burst into tears. Addie was telling me: she didn’t know whether Mam was in pain, or she was happy to hear the song. I told her: no, if she was in pain, she would do other things first. I told her that Mam’s way of expressing pain was with a “eessshhh” (inhaling) sound. Another way would be to hit/slap the paint point. I gave them an example of when we were landing, the change of pressure hurt her ears. She was hitting her ears to make the pain go away.

Basically the Park Bend staffs felt because of the language barrier, they could not effectively help Mam. I am not sure what they could do in this front. I had told them that even in Indonesian, it was difficult for me to effectively communicate to Mam.

We discussed Mam’s liking, dislikes, and hobbies. I told them Mam’s main activities used to be walking. Mam is now in the “Walk to Dining” program. Come meal time, the staff will walk Mam, instead of push Mam in a wheel chair, to the dining room. They also walk her regularly from one end of the hallway to the other end. They said, at one point, they walked Mam and they sat Mam down again, but Mam kept wanting to get up. So it took them a while to explain to Mam that it’s time to sit back down. Hmm…. I asked if it was harder to let Mam walk then to just let her sit on a wheelchair all the time. They said, this was not anything new to them. They had dealt with this situation before. So they were not advocating that they stopped walking Mam. I am glad.

We talked about other things that Mam used to do: like cooking and sewing. But I think neither or those are possible anymore for Mam. We talked about watching TV. I told them that Mam seemed to like watching I love Lucy. Addie commented that she had tons of old black-n-white movies. She could show some to Mam.

I am due to visit with either Mam’s doctor, Dr. Frey, or her nurse practitioner, Dr Ping. I asked the head nurse about Mam’s medication. They did have stopped the Prozac, per our request. They gave Mam a couple of Ativan so far. I asked if they give that often, they said no. It is only as needed if Mam shows more agitations.

After the meeting, I went to see Mam. She was in her pretty dress, waiting to eat lunch. I did not stay for long. I went back to check her room. I saw she had no clean pants anymore. Her laundry hamper was full. I asked the front desk lady how long they normally do laundry. She said normally everyday. But Mam’s laundry has piled up for days, I think. She promptly made a call to take care of that. Hopefully, Mam has more changes of clothes tomorrow.

In general, I am pretty happy with the way Park Bend handles things. I am glad they have this meeting every 90 days. I am glad there is a chance to meet with the doctor or NP. I am glad Physical Therapy is working with her. I am glad she’s walking some.

Most of all, I am glad I can get updates and news about Mam from Park Bend’s staffs, since she can’t tell me herself how she’s doing.

I visited Mam today around lunch time. By the time I got there, she already finished lunch. I went straight to her room to put the stuff bought for her: laundry hamper, socks, a new pair of shoes, another pair of pants (maternity), and a list of common Indonesian words, which I taped to her dresser. I wrote her names on everything of course. Then I went to find the Admission officer: Alicia. I gave her all the forms that we needed to fill out, a copy of our application to transfer guardianship to Travis county, and a copy of her old medical directives from Pomona Vista.

Then I went to find Mam. The nurse in the front didn’t know where she was. Hmm…. So I just started walking around. I finally found Mam on a wheelchair in the middle of her hallway wing, fiddling with her nails. I said hi to her, asked how she’s doing. She seemed to be doing alright and fairly happy.

Then I went to her room to fetch her new shoes and socks. I put the socks and shoes on her feet. I asked how the shoes felt, which were actually a little big for her (couldn’t find size 8 1/2 and got her size 9). She proceeded to stand up and walked around, as if trying out her new shoes. She was actually attached to a monitor to her wheelchair. The monitor was designed to beep when detached from her, which was exactly what happened. The nurses all came running. They were all surprised Mam walked around. Actually, she did walked around confidently. She did not need much holding from my part. The assistant nurse (forgot her name: Cennelia or something like that) told me Mam’s always tried to stand up and walk. They did not know Mam could walk. I took Mam for a walk around the hallways. She walked with so much more ease, even I was surprised.

The assistant nurse asked if I wanted to register Mam for group walk. I said: sure! I guess once or twice a week, they take some residents for walks, either around the building or in the hallways. I am very happy about this. Mam likes walking.

I just hope this new ability to walk around won’t cause Mam some issues with wandering and trying to get out. We will see. I have to ask them how she’s doing in a few weeks.

Mam seems to be adjusting fast to the new place. Let’s cross fingers.