The Family Costs of Dementia - Part One

Putting someone into a nursing facility has its own issues - emotional and psychological.  These will be explored in Part Two.  

For the purposes of this post, I will be exploring the financial costs of care for the patient suffering from dementia.

In 2013, A RAND (Research And Development) Corporation study estimated the national costs of dementia to between $159 - 215 Billion (The High Cost of Dementia).  Some of that is absorbed in the MediCare system, but for many, the costs come from the pockets of either the afflicted or their immediate families.  

So, what are the costs?  

Let’s say you’re caring for your parent and you know you need assistance, because they can’t possibly be left alone.  So, what are your options?  Daycare and/or In home services.  Services are out there which can provide some respite - for instance, doing light housework, companionship, and other assorted chores (for which you may be too exhausted to tend to yourself).  On average, this will cost approximately $21 an hour (2012 figures) for home care workers, and just slightly less for a homemaker to come in ($20)  (MetLife 2012 Home Care Costs Table).  So, in your budget you might have them come three times a week for 3 hours a time.  That adds up to approximately $360 a month for help.  Of course, there are those who hire these people to come in and work for them while they go to work, and this could be 10 hours a day 5 days a week.  So, that would add up to approximately $4,515 a month (or approximately $54,180 per year) - pretty incredible, right?!  Do the math.  It’s expensive to care for someone and work, as well.  

So, you might opt for Adult Day Care.  The national average for this is approximately $70 per day  (MetLife 2012 Adult Day Care Costs).  “Aha!” you say.  This would be much cheaper than in home care.  Per month, this would cost about $1,540 (or approximately $18,480 per annum) which is much much more affordable.  But the other factors to consider are whether or not your parent can adapt to the locale, if you’re able to come on a moment’s notice in case something happens, and how good the care is at the particular facility (as it must be considered as well as workers, or any other type of placement for your loved one).  

Next, you might have considered Assisted Living.  Many find this a necessary option as they may have to wait for an opening in a particular Memory/Nursing Care facility.  People in Assisted Living can no longer tend to their own needs, and need the extra supervision and help to perform their daily living tasks.   While more expensive than Adult Day Care, it allows for the patient to have their own space while feeling more independent and allows for the family caregiver to breathe a bit more easily.  The cost?  Well, according to the same Metlife survey the cost on a national average is $3,550 per month or approximately $42,600 per year  (MetLife Assisted Living Costs 2012).

Before I turn to Nursing/Memory Care, I would like to also remind the reader that we haven’t yet discussed insurance premiums, MediCare costs, Plan B or any other supplemental plan(s), Doctors, Dentists, or any Pharmacy Costs, which will also need to be added to the costs.  

So, now we need to take a look at Nursing/Memory Care for our parent.  Many facilities have different rules attached to their populations; believe me, there are some who will tell you to find a different placement for your loved one once they reach a certain stage, which will only serve to create more issues for the patient and the family.  However, this is something that needs to be considered when considering a viable placement for your family member.   

I’m not going to be going into different aspects of care, as this post is to outline the costs, on a national average, so you can be aware of what you may be facing.  Are you ready?  Okay.  The national average for nursing care in the United States is $222 per day for a semi-private room (or approximately $81,030 per year), or $248 per day for a private room or approximately $93,184 per year (MetLife 2012 Nursing Home Costs Table). Wow!  .

Keep one thing in mind, though, by hiring an Elder Law Attorney, and having all your papers in order, you might be able to work through the mire and mess of the financial sting to the benefit of the patient.  There are programs which allow patients on MediCare to live in facilities you might assume are beyond yours and your family’s abilities.  

We’ll explore more about these in the near future posts.  

Until then, Happy New Year!.    

Part Two

The Financial Costs of Dementia

(My Brain Test)

No one really considers the financial burden of dementia on the populace, as a whole.  We are more prone to accept fundraising for cancer, heart disease, birth defects, and other foundations while pushing the plight of the elderly to the side, for the most part.   However, it has become increasingly clear that dementia costs are dramatically higher than for those others, and those costs are about to grow exponentially.

There is an article in the New York Times, as well, which exemplifies the costs of dementia are growing quickly, as well! (Costs for Dementia Care Far Exceeding Other Diseases …)

To put things into perspective, insofar as the costs, let’s look at the chart below, which demonstrates the costs of dementia compared to the revenue of two major corporations:

(alzheimer a doença, você e eu)

If Dementia were its own country, it would be the 18th largest economy in the world.  The costs are nearly double the revenue of Exxon Mobil!  And these are the figures from 5 years ago!  Since then, the numbers have only grown.  

According to the Lewy Body Dementia Association:

The total economic cost of dementia in 2010 was estimated to be $109 billion for care purchased, and $159 billion to $215 billion when the monetary value of informal care is included. The range of estimates reflects two different methods researchers used to place a value on unpaid care. The per-person cost of dementia was $56,290 or $41,689. Medicare paid about $11 billion of dementia-related costs.

Researchers say the main component of the dementia costs is for institutional and home-based long-term care rather than medical services. The cost of nursing home care and formal and informal home care comprise 75 percent to 84 percent of dementia costs.(Cost of Dementia Tops $157 Billion Annually in the United …)

So, what does that mean for you and me?  It means that paying attention to your family members and being willing to understand that this syndrome (yes, the medical community is moving toward having dementia made a syndrome, as it  has so many more components than originally understood) will affect more people around you than was understood in the past.  

President Obama, in 2011, signed the National Alzheimer’s Project Act, which tracks the costs of dementia, and ensures good care is provided while also seeking more treatments and research to help with the problem of rising costs and rising patient numbers.  

According to the New England Journal of Medicine:

The estimated prevalence of dementia among persons older than 70 years of age in the United States in 2010 was 14.7%. The yearly monetary cost per person that was attributable to dementia was either $56,290 (95% confidence interval [CI], $42,746 to $69,834) or $41,689 (95% CI, $31,017 to $52,362), depending on the method used to value informal care. These individual costs suggest that the total monetary cost of dementia in 2010 was between $157 billion and $215 billion. Medicare paid approximately $11 billion of this cost.(Monetary Costs of Dementia in the United States)

To be honest, it is quite difficult to find any care center that will charge much less than $5,000 per month; we were fortunate to find such a place.  I hear stories of people who are paying between $6-10,000 per month- and that doesn’t necessarily cover the medical bills (doctor, neurologist, medications, etc).  Some of these placements, too, will care for the patients until they are unable to be mobile, and at that time need to find another placement (I find this absolutely cruel, as the change of placement and the confusion that surrounds it could compound issues for the patient, leading to a faster demise).  

In home care, too, can be quite costly, unless you have a compliant patient ( the opposite of Mom), and a solid network of resources for respite.  There are adult daycares in most areas which will help with mildly demented patients, but after a time these will not be a viable option, either.  Visiting Angels is a great resource I’ve known people to use (for cancer patients, dementia, and other illnesses), and they charge about $20.00 per hour, which for some might be steep on a limited income, and they are not replacements for nursing care.  

According to the Alzheimer’s Association when planning financially for dementia, the list is as follows:

Common care costs include:

• Ongoing medical treatment for Alzheimer's-related symptoms, diagnosis and follow-up visits
• Treatment or medical equipment for other medical conditions
• Safety-related expenses, such as home safety modifications or safety services for a person who wanders
• Prescription drugs
• Personal care supplies
• Adult day care services
• In-home care services
• Full-time residential care services

Are you prepared?  Luckily, Mom was a saver, and what she had combined with her SSI and pensions helps pay the costs of her care, as well as the sale of her home (which was invested).  So, we are fortunate with that aspect.  But, have you and your family considered a plan, just in case?  It might be wise to avoid being a statistic.

One of the greatest gifts I received this year for Christmas was a donation made in Mom’s name to the Lewy Body Dementia Association.  Words cannot convey the depth of feeling this parlayed, as it came from such an unlikely source, as was so very generous in spirit and amount.  

If you believe you have the capacity to donate to either the Alzheimer’s Association, or the Lewy Body Dementia Association at some time in the future, please do.  Every bit helps, and the sooner we can begin to understand the facets of the syndromes, the sooner we may be able to allay the unforeseen costs.

The Gift of Vitality - OR The Week Ending 12/27/2015

Today we received our first snow of the year - it wasn’t sticking everywhere, and when I visited Mom it still hadn’t arrived.  The air was cold and the traffic wasn’t very thick, probably in anticipation of the weather.    As we left the dog park this morning, watching a few random flakes fall, I began thinking over the week for Mom and how it was so different this year than the last.  

On Monday, Mom began walking about with the walker - under heavy advice (she didn’t want to use it) - and participated in all the activities.  She was alert, accepting, and cheerful.  

Tuesday brought more of the same.  Surrounded by the decor, Mom might as well have been anywhere else.  None of it meant anything to her, but she said she liked it.  She ate well, and, again, participated and walked a great deal.

Wednesday, Mom received a treat - some of her favorite candy and cookies - Mount Rainiers, Snickerdoodle (or Rich) Bars, and Russian Tea Cakes.  I brought her tub of them, knowing she would like some every day.  She seemed apathetically pleased; she said she liked them, opened it up, took a Mount Rainier, and then told me to put it in my room (meaning her room).  I did.  There was no fuss, but she ate it with a smile.  That was good enough!  

She conversed amiably with the woman across the table from her, but all other words and thoughts were either jumbled in her mumbling, or they didn’t track to make sense.   She was presented with her paper soon after lunch and she began reading it - there was no one else present in her mind.  I stayed with her for a bit, and then realized my presence was for my own good so I took my leave.  

Thursday, Christmas Eve, the RLC arrived for their weekly visit.  Here is their summary:

Dear Tony,

Thursday was a good day for us to visit Norma.  We got there at 11:30, and found her sitting at a table across from a lady who was working on a puzzle.  They were not communicating with each other; your mom seemed sleepy.  But she perked up when she saw us.

Connie had brought a copy of the Wall St. Journal, and Jean had brought two puzzles--only 24 pieces each. Then they noticed the other lady was working on a puzzle that size.  Jean did not write Norma's name on the boxes; anyone can use them. We could see that puzzles of various sizes are popular with some residents, and hold their attention. It's one way to avoid being bored for those who look for more stimuli.

Your mom had apple juice in a glass, and half a cup of coffee.  Jean offered to heat it up, but she said no.  Later when Jean offered she said yes.

We admired the decorations in the room, and Jean picked up that darling  piece showing a living room with fireplace, Santa Claus, a tiny dog, stockings hung on the fireplace, tiny milk, and cookies on mantel--even tiny gifts showing in the stockings.  She carried it to show to the several residents and gave them a few minutes to see all those details.  We had it at our table for a while, then Jean returned it to the table where the little machine was playing Christmas music.

Caregivers were bringing bowls of tomato soup to residents. Norma and Connie were having some; Jean asked for a cup instead of a bowl. Much less effort to drink it than to carefully  scoop up a spoonful at a time. We all agreed it was a good soup.

Lunch plates showed a good serving of (I think) cole slaw, some finger food of ? and a lovely half sandwich of white meat with cheese, slightly melted. It had been lightly cooked with an egg batter. Norma was interested in the salad only; could not entice her to eat anymore. We were surprised; we had not given her any candy to dull her appetite.

Came pill time...oh my!  Lynn leaned from the opposite side of the table with offer two pills to Norma, telling her they were for her back pain.  Norma was NOT about to take them: "I don't have any back pain" was her message.  Lynn said the doctor wants her to have them; Jean said they would prevent future back pain.  Nope! Connie gave it a try; Morina came to add her persuasive words.  (There were two pills; we wondered if one was an anti-anxiety pill.)

Plan B: return the pills to where they are kept.  Again--NOPE!  Pills were already in Mom's hand, and she clutched them defiantly with her mouth pinched tight.  Lynn tried, Jean tried, to say they had to be returned to where they are kept, but it a losing battle.

All of us felt some sympathy for Norma, who has control over fewer and fewer things in her life.  We almost laughed, since it was so Norma.  But we all sympathized with her wanting to make her own choices.  At that time, she definitely made a choice.

We had been there two hours and soon said our goodbyes, saying we would see Norma in a few days. She bade us goodbye nicely but did not unclutch her hand, even as she had the WSJ opened to peruse it.  It was a good visit, all things considered.

The next day was Christmas.  I had been asked to bring more Depends for her, and I gladly obliged.  She was in her room dozing in her chair.  She could hardly keep her head up, let alone finish a sentence before she was sound asleep, once again.  I stayed for a short time, wondering what would make a good visit in the near future.    She did eat some candy - she finished the Mount Rainiers!  but she left an ample supply of the others.

She spent the rest of the day engaged, later, in walking around the cottage for a goodly amount of time.  

Saturday, Mom spent her time much the same as on Friday.  She was quite congenial all week, which was quite a gift to the staff.    , She did go back to bed, for a while, then came out for dinner wearing her nightie.  Rosa took her back in to make her a bit more presentable before she ate.  Mom put up no struggles!

Come Sunday, Mom slept in a bit later than usual.  She arose though still around 8 am.  She ate an ample breakfast and then spent her morning sleeping and with her paper at the table.  It would appear that the methadone puts her into slumbers soon after it’s administered, but then she peps back up in a relatively short amount of time - I tend to pop in when she goes down for the short count.  

I gave her some more of her candy, and she ate some, then told me to put it back.  And, off she went to her newspaper world.   I asked her about one of the articles, and she began telling me a story about some people and their children - it had nothing to do with the printed page.  Of course, sadly, most of what she stated was lost in the mumbling and the non-sequitorial mode in which she speaks, lately.  

I did compliment her on her participating more, lately.  She replied that I needed to watch what I said as it was quite rude and people would be very angry.  Again - she made no sense.

What can be taught from this week?  

Mom has regained her grip strength, can walk with the walker (although she really doesn’t want to - but they catch her without it), and is quite at peace.  Now that the issues of constipation have been dealt with it seems she has much more energy, but is still degrading at a steady rate - but not quickly; no, that might be in a few weeks time, or it might just simply progress like this.  

But, whatever the rate, she is content and at peace.   What more could one want?!

Holiday Stress and Dementia - Give the Gift of Being

The holidays are full of wonderful, joyous, and exciting events.  For those with dementia, though, the holidays can be quite stressful, despite all the glitz, glitter, tinsel and packages.  

While most are fighting crowds, looking for the perfect presents, dodging traffic, and attempting to bring cheer to everyone, the stress that comes with dementia is of a different, yet similar ilk.

Just for selfish reasons, let’s use Mom as our person with dementia.  First of all, being surrounded by too many people conversing and moving about creates a great deal of frustration; it’s quite difficult for her to hear, let alone follow, what they are all talking about.  Not only that but the sounds distract even if someone is having a face-to-face with her, which frustrates her and makes her rather cranky.  Who can blame her?  

Despite the festive nature, Mom is lost in her reality which doesn’t have a footing in the here and now.  We attempt to make her comfortable and aware of the jolliness of the occasion, but it’s all for naught.  What she wants is calm, serenity, and the knowledge she’s safe and secure - and with all that chatter and activity her sense of being is disrupted and gone.  

People ask why we don’t include Mom in the festivities and I need to explain it’s a lose-lose situation - she is miserable and as a result no one can enjoy themselves for worry about her.  There is no joy for her.  The better present is to visit her and enjoy her in her environment while presenting her with the gifts.  

What gifts to give?  What does she need?  What would actually bring her enjoyment?  Music? Towels? Sheets? Soaps?  Some new clothes?  Practical gifts that she could use and appreciate while not aware she is, as she will forget she ever had them within minutes.  Her cd player needs to be operated by someone else, and she is dressed with help from others.  Everything appears and happens as if by magic.  Her wish of being Queen has been granted.  That, in an ironic manner, is the greatest gift.

So, when believing there is a sense of necessity to include your elders, who may suffer dementia, in your activities, please understand that your need and their needs may differ; they may not appreciate or want to be included for whatever reasons.  Demonstrating appreciation for them and making time for them may be the best gift you could bring them - and not only for the holidays but throughout the year.  You’ll find yourself understanding more as you do.

Lewy Body Dementia Fluctuations - Why???

Lewy Body Dementia is still an enigma to the majority of those who are experiencing it, either through a loved one or personally.  It makes very little sense insofar as it begins rather meekly and then is finally present enough for a diagnosis.  Once diagnosed there is very little hope, in that between 60-80% of neurons have been decimated by the disease (this from a discussion on the LBDA forums pages, so where this information came from, I’ve no idea, but thought it interesting enough to share  Symptoms | Lewy Body Dementia Association).    

As we’ve seen with Mom, there are good days and bad days.  There are times when she seems rather cogent and others in which she is like a newborn babe, sleeping at every turn.  In some ways, I like to think of this as the Benjamin Button effect after the movie about the man who began life as an old man and then aged in reverse.   The underlying question, though, is what causes these fluctuations on a day-to-day basis?   We’ve no idea how we’ll find Mom, whether she’ll be sleeping or in a state of alertness; if she’ll be able to walk and eat, or if she’ll be far too weak to accomplish much that we take for granted.  

According to the LBDA webpage, (Symptoms | Lewy Body Dementia Association), the symptoms may fluctuate hour-by-hour, as well.  And nobody's quite sure what the reason is.  There is speculation that while there is neuron death the brain works hard to re-route the circuitry to make itself work as normally as it can - this would explain the bouts of sleepiness and then the surges of energy we’ve experienced in the past few months.  

This seems to be the great question with LBD that none can answer at this time.  Interestingly, though, they are finding the fluctuations also occur within other forms of dementia, as well, including Alzheimer’s, but whether or not it’s to the same extent as with LBD is unclear.  But, at this point in time, so little is actually known about LBD that researchers are still attempting to decypher the disease and its components that, perhaps, more will be understood in 10-20 years, as it happened with AD.  Who knows?  

So, as we ride this coaster we will try to keep our eyes and ears open for any clues that might help.  Sometimes answers can be right under our noses, but we are looking too intensely to spot them.

Further Information:

Lewy Body Dementias (UCSF Memory)

DLB  (Alzheimer’s Society of North Carolina)

Lewy Body Dementia: Information for Patients, Families, and …  (National Institutes on Aging and Health)

Dementia with Lewy Bodies  (Caregiver.org)

Lewy Body Dementia  (HelpGuide.org)

Diffuse Lewy Body Disease  (Parkinson’s Society Canada)

Lewy Body Dementia  (Lewy Body Society)

Dementia with Lewy Bodies (DLB)  (Johns Hopkins Medicine)

One Week Before Xmas, or The Week Ending 12/20/2015

T’was the week before Christmas and all through the home,

All the residents were stirring, some sitting like gnomes.

The decorations were hung and put out with glee,

And they listened to music  that brought spirits -lively.

This was a pretty good week for Mom.  In truth, you’d not realize she was on hospice at this point.  She ate a little better, she was determined to walk - and mastered her walker.  She is wearing clothing she shunned for some time, but now she has a goodly number of outfits that look quite comely on her.   She does still use the recliner, but usually, after she’s been tired out - how often this happens, I don’t know; but I do know the staff has told me she follows them about quite regularly.

She was pleasant all week.  She was engaged.  She has lost her speech - well, in regards to making a great deal of sense when the response calls for more than one or two words.  Her voice is quiet.  Her attention is more toward the colorful items around her, rather than anything else, and it can shift quite rapidly.

On Wednesday, Jean came by for a visit.  

Dear Tony,

At 2 pm I arrived at St. Anthony's, and what a nice surprise I found!  Just as I was about to code for entry to South Cottage, about 20 middle-schoolers came from North Cottage and went into South.  All carried 2-3 small wrapped gifts.  They lined up in front of the residents (at tables and, like Norma, in recliners) and sang "Jingle Bell Rock" with gusto.  Then they sang it again, after a "bridge" of giggles.

I grabbed a chair to sit beside Norma to enjoy music and the kids' with their packages.

Then they all circulated among residents, giving them gifts and handmade Christmas cards.  Alecia (?) gave your mom two packages,which I helped her unwrap...soft gloves and a bottle of lotion.How nice!

I asked Alecia where  they are from; St. Therese.  Norma smiled, seemed pleased, did not really say anything (unless I missed it, or forgot).

Cheyenne, a pretty little girl, had a third pkg.for Mom. Norma wanted to keep it wrapped, as I was about to help her--besides, I wanted to see what it was.

I asked Norma if she'd had a shower this am. Nope! I stay quiet to give her time to think and speak.

Her room was a mess!  I know it probably was fine when she returned. She did not seem sleepy, was watching everything, trying to express a thought, but not completing it. Did not seem frustrated, just stopped talking.

I brought another plastic cup for Norma, a copy of the first one. And I had a Christmas card for her. At my request, she read  aloud the note I had written. Read it perfectly, that is. No comment. After a while, I offered to put her gifts in her room,  where they would not be taken. (Besides, I wanted to see that third one.  It's lt.blue, a soft headband.)  Gifts are in a small drawer in her dresser.

We just sat together, watched Morina work on a puzzle. Morina reminded Norma that she and Norma had worked on it this am.  Lucille was sitting  and watching; a big smile when I spoke to her.

At 3:30 I said I wanted to get home before dark, and sure enough, it was darkening outside as I drove home.

It was a nice visit, good to see your mom looking a bit interested in her surroundings.  She wore a cozy white sweater, with the soft blue throw over her legs. She was okay as I kissed her goodbye.

God bless,

Jean

Mom was able to weakly recall the children caroling today when I saw her.

Saturday, Mom had a little issue with her pills.  She had been agitated all day - probably due to confusion.  She refused her pills, and when the aide asked for them back, Mom clinched them in her fist - quite tightly - and tried to swing a punch with the other.  She failed to connect, and they were able to finally take the medications from her for later.  

Today, Mom was happily reading the ads in the Sunday paper.  One of the newer residents sat at the end of the table and addressed Mother.  They had a very brief, yet pleasant, exchange.  Mom was quite glad to see me, and we had some coffee together.  She did recall she’d eaten some eggs for breakfast, but that was all I could decipher from what she was telling me.  

She read the two cards I brought her from her friends Helga and Sharon in Port Angeles.  She thought them beautiful, and they were.  

Later, I encouraged her to try the  crossword puzzle in the paper.  She liked that idea (remember, it’s been less than 5 months since she stopped solving these).  I found a pencil for her and we began.  One of the clues was:  Pomeranian (e.g.).  I told her it would be breed, but she took the pencil and began making pictures around the word ‘Crossword’ at the top of the page.  “Yes, it’s a puzzle,” she remarked.  This was her answer as I kept trying different strategies to get her to write.

We also chatted about the decorations.  She stated that this one resident, dressed in shiny red pajama-like clothes, was probably from South America, or something.  I laughed and she chided me for doing so.  I stated that the resident was from Portland, and Mom had gone to school with her when she was much younger.  Mom just stared at me as though I’d lost my marbles (to be honest, there really are times….!!!!!).  

As I left, Mom did state she would like some Xmas candy and cookies, which I offered to make for her for a little later in the week.  So, these will be arriving in a couple of days.  

Until then, Keep her in your prayers and thoughts.

Holiday Memories Then and Now

For years, Mom used to bake and cook for the holidays.  And then, beginning around the millennium, she began to do much less.   Of course, this was to be expected as our family was less inclined to travel to her home through the weather, and it was nicer to have her spend time with us at our homes.  However, as much as she cursed all the work, money, and effort of it all, she did present us with many goodies during this time.  

She made Mount Raniers, Sugar Cookies, Congo Bars, Lemon Bars, Almond Roca, Truffles, and other assortments of goodness.  This was the time of year when she could make Spanish Cream, make her grandmother’s Egg Nog (a wonderful blend!), and indulge.   

While the holidays were stressful (anything dealing with cooking/baking and company was stressful for her) she actually enjoyed the demands (we, as the targets of the stress, were not quite so enthralled).  But, she was present, and there was a joy in being able to share and nibble (some of us vacuumed with our mouths) those tasty treats.  

Today, Mom has no memory of any of this.  In truth, surrounded by the sounds and tinsel of the season, she is unaffected; she seems oblivious but rather enjoys the music (I believe I once mentioned her demands that we bring along the Christmas 8-tracks on our summer trips) somewhere in the recesses of her mind.  

No longer must she find a tree and decorate it - rather have me drive up, bring it in, put it up and decorate it.  No longer has she her Star of Bethlehem shining in her picture windows over the Straits of Juan de Fuca.  Many of the relic ornaments have been dispersed to family or others (those which didn’t fracture or just shatter over the years).  She has people serving her and she seems to enjoy it, not recognizing her plight.

This week and the next I will be making some of her favorites and I will bring them in for her to eat and share (hahaha!) with others, just to see if there is some recall of the season in her senses (if they truly remain).  

She no longer needs to worry about making it to Mass - the evening before or the morning of Christmas.  Of course, she probably misses those Irish Creams and the good beverages (mulled wine, anyone?) galore that infused the house with delight.  

Unfortunately, she will not be spending any portion of the holidays with any of us at our homes, at Mass, or outside of her residence.  We must bring to her what we can.  The stresses of confusion, unfamiliar sounds, smells, sights, are simply too much.  We can come and visit with her, bringing with us necessities, flowers, cards, and perhaps other items that the staff may find helpful for her.  Other than that, it’s just nothing that matters anymore.  

Her life has become simple.  She needs little at this time, but to be tended to.  

Consider the lilies of the field, how they grow without laboring or weaving. (Matthew 6:28).

She radiates from the knowledge that she’s safe, cared for, and requires no reason to suffer.  

Perhaps this is the best gift of all, and something difficult to swallow, but necessary to cherish and  hold in awe.

Recipe for Mount Raniers:

IN a large bowl:

3 eggs beaten  

Add 2 cups powdered sugar sifted

Add package melted chocolate chips 12 oz

1 tsp vanilla

pinch of salt

12-16 oz miniature marshmallows

1 cup nuts (walnuts) crushed.

roll into balls and then -

Drop into 1 large package angel flake coconut

Place on waxed paper.  Then place in the fridge until hardened.

A favorite of my nephew's - Mom used to send him these as care packages for years.