Caveats for Caregivers (7)

This is my seventh essay on caregiving, first published on another website on February 1, 2013.

After my mother died last September, I wrote what I thought would be my final essay in this series, discussing palliative care and hospice.  I remember thinking at the time that there were one or two things that I wished I had covered in the earlier essays, but I dismissed them as not important enough to worry about.  At a time like that, not much else would seem important. But it keeps coming back to me that these remaining pieces of information would have been very useful to me at one time, and it was no fun having to learn them the hard way.  Having thus reconsidered, this will be the first of what I believe will be my last two remaining essays.

We have all seen those reports on the news or on some show like 60 Minutes that reveal how horrible conditions can be in nursing homes, with patients being neglected or physically abused. Fortunately, in my experience with nursing homes, I never saw any problems like that.   The situation reminds me of my father’s experience after World War II.  My father was in the navy, and in the early months of the war, his ship went down. He spent the next three-and-a-half years in a Japanese prisoner-of-war camp, where disease and starvation resulted in the death of all but just over a hundred men out of a crew of over a thousand (about half died when the ship went down). When he got back home, he had to listen to his family talk about how rough they had it during the war, what with Meatless Mondays and sugar rationing.  So, with apologies to anyone who has ever had real problems with nursing homes, I will now venture to discuss a relatively minor problem that I encountered.

When it became clear that my mother would have to go into a nursing home permanently, I had already had some experience with such facilities, and so I picked the nicest one of the bunch. It had only one disadvantage:  it did not accept Medicaid.  Except for the patients that were there for only a few weeks of therapy, which Medicare paid for, everyone else was private-pay.  My mother was not rich, but she had enough money and income to pay privately for about eighteen months. So, I decided to start at this private-pay facility, and use it as a base of operations, as it were, from which I could take my time investigating Medicaid facilities in the area.  Then, when she finally ran out of money, I would know where to transfer her.

I would have preferred to have her in a private room, but that would have cost about $7,800 per month, as opposed to just $6,500 for a semi-private room (plus about $500 worth of extras). Since the latter would allow me to stretch her money further, thereby keeping her at the private-pay nursing home as long as possible, I went with that option.  And this leads me to the problem that gave me the most stress, the one that used to keep me up at night:  the problem of noise. Imagine being in your living room, with a curtain down the middle.  On one side of the curtain, your half of the room, you are watching television.  On the other side of the curtain is your roommate, watching another television, but tuned to a different station. Since the sound coming from each television interferes with the other, there is a tendency to escalate, each set being turned up a little louder in order drown out the other.  And when you turn your set off, deciding to go to sleep, the other set remains on. That is what it is like to be in a semi-private room.

In the hospital, it had been different.  There she had a remote that allowed her to do everything: adjust the bed, call for assistance, control the television.  More importantly, the remote had the television speaker in it.  So she could turn the volume up loud enough for her to hear it, but without disturbing her roommate, and vice versa.  But not a single one of the nursing homes that I toured had that set up.  In every case, there were just two ordinary televisions, with regular speakers.  I suppose that the primary reason nursing homes do not have that kind of setup is that most nursing homes, to keep costs low, do not supply televisions.  You have to bring one in yourself. Headphones naturally suggest themselves as a solution, but they would have to be wireless, or else people would be tripping over the wire; and wireless headphones are a little too complicated for people in nursing homes.  By “complicated,” I mean, among other things, you have to turn them off to make sure the battery does not run down.  In any event, I never saw anyone in any of the nursing homes using them.

When I would go to visit my mother, she would tearfully plead with me to get her out of there. She said that her roommate’s television was driving her mad, because it was on all night long. Since my mother was suffering from dementia, I could never be sure of anything she told me.  At lunch, however, she used to sit at the same table as her roommate, who casually mentioned one day that she never got more than four hours of sleep at night, which meant that the television was probably on twenty hours per day.  After one long, miserable month, I moved my mother into a private room, which meant that her money would only last her about a year.  When she did run out of money, she would have to have a roommate, because Medicaid will not pay for a private room.  But at least this would postpone my mother’s nightmare a little longer.

In a way, it could have been worse.  At least my mother’s roommate did not have any hearing problems.  Being old, a lot of residents in nursing homes cannot hear, and the television is so loud that it is earsplitting.  I walked by one room where the television volume was up full blast.  Inside was a man, wearing a hearing aid, sitting right next to the TV in his wheelchair, and leaning slightly forward, presumably so he could hear better. Being in that room would be like being in Guantanamo, subjected to what some are pleased to call harsh interrogation techniques, but which I call torture.  I half expected to see a couple of CIA agents in there, demanding that the man’s roommate tell them where the weapons of mass destruction were.  In another room, with a television playing equally loud, the resident would often leave and wander down the hall, without bothering to turn the set off, while his roommate, who was confined to his bed, had to just lie there.

The second major source of noise was raving.  Some of the residents would cry out for help, and then scream to be left alone when the caregiver went in to see what they needed.  Others would beg forgiveness from God, sorry for whatever sin they had committed.  Others still would cry for their mothers. Unlike the problem with the televisions, raving only occurred occasionally. But when it did occur, it was unnerving.

And so, I said a little prayer to the politicians of Texas, to please have mercy on my poor mother and those like her, to change the Medicaid rules, and allow everyone to have a private room, for just a little peace and quiet at the end of their lives.  But I fear I prayed to a heartless pantheon, who are more likely to cut Medicaid than supply it with more funding, which will only make things worse.  As a harbinger of a grim future, one of the nursing homes I checked into had four patients to a room.  I did not even bother to tour that facility, and I shudder to think what four televisions must sound like.  As our politicians wax virtuous about the need to cut the entitlements, of which Medicaid is one, I fear that a Merciless Providence will eventually ordain a return to the wards: large rooms with twenty beds each, and a couple of minimum-wage caregivers running back and forth, trying to attend to the patients who occupy them.  Of course, each bed will have its own television.

Through a circuitous process that I covered in my fourth essay, my mother eventually ended up in a semi-private room with a roommate who slept all day.  As a result, she never played her television, and, equally important, my mother’s television did not seem to disturb her roommate. After all, my mother was not completely innocent in all this, for she liked to watch television too, and being hard of hearing, she tended to play it a bit loud herself.  So I had to worry about the noise problem both ways.

At any rate, the problem being temporarily solved, I began investigating the Medicaid facilities, for which purpose I found the website Medicare.gov extremely useful.  By typing in my zip code, it would tell me which nursing homes accepted Medicaid and which did not, and how many certified beds they had.  Unfortunately, no distinction is made on the website between beds that are certified for both Medicare and Medicaid, and those that are Medicare certified only.  That information needs to be obtained with a phone call.

Although a nursing home with a small number of beds may sound cozy, suggesting that the staff will find it easier to care for an equally small number of patients, I realized that there was a distinct disadvantage in selecting such a nursing home.  If my mother ended up with a noisy roommate, the option of moving her to another room would be limited. When I checked out a nursing home that had three hundred beds, however, the woman in charge of admissions mentioned, without my even having to ask, that they would work hard to find my mother a compatible roommate should that be necessary.

There is another reason why big is good.  When I said that my mother had enough money to pay privately for about eighteen months, that did not mean I could keep her at the private-pay nursing home for the full period. Most nursing homes have waiting lists, so I knew that I would have to put in an application to a Medicaid facility at least six months before she ran out of money, and even that might be pushing it.  I finally decided on nine months, just in case.  In any event, the larger the nursing home, the greater the turnover, resulting in a shorter waiting list.  If the number of certified Medicaid beds is small, however, getting one of those beds may not be possible.  One place I called, which only had six beds, told me not to even bother getting on the waiting list, for it might be years before one was available.

So, I went with the big nursing home when the time came for me to transfer my mother, and the good news is that the roommate my mother ended up with had good hearing, and thus played her television low.  And as my mother had reached the point where she no longer watched television, because she no longer understood what was going on, I did not have to worry about the noise problem on her end.

Running parallel to my effort to protect my mother from noise were problems concerning money: her money, my money, and the government’s money.  But that is for another essay, which I expect to publish soon.

Caveats for Caregivers (6)

This is my sixth essay on caregiving, first published on another website on September 21, 2012.

It had almost become routine.

My mother had frequent urinary tract infections, and they often resulted in her becoming even weaker than she already was, and more confused than usual.  So, when the nursing home where my mother resided called me early in the morning to tell me that my mother had become unresponsive, and that they were sending her to the hospital, I was not surprised.  I went straight to the emergency room, arriving there just before the ambulance did.

But then something happened that was not routine.

Shortly after my mother was brought into the emergency room, the nurse asked me if I had spoken with a social worker.  “Well, not today,” I replied. In all the previous times that I had been to the hospital with my mother, the social worker was someone who showed up the next day to discuss whether my mother lived alone, and what kind of care she would need, or whether I needed help selecting a skilled nursing facility.  I had never talked to one in the emergency room, especially before a doctor had even seen my mother. But five minutes later, a social worker showed up, and the first question out of her mouth was, “Have you considered palliative care?”  As the name would indicate, palliative care focuses on making the patient comfortable rather than on treating the illness.  It is like hospice, only you don’t have be diagnosed with a terminal disease with only six months to live to qualify for it.

Clearly, they had come to the conclusion that my mother’s health had declined to the point that ordinary treatment was no longer appropriate. They didn’t have to convince me.  I had come to the conclusion that hospice was the best thing for my mother almost a year earlier. However, my mother was not ready, psychologically speaking.  In her mind, hospice was a halfway house to euthanasia, and I was of the same opinion.  It is for people who want to die as quickly and as painlessly as possible, and if that is not your attitude, you are not ready for hospice.  Every social worker will deny this. “People in hospice often live for years,” they will tell me.  “It’s just a different approach to end of life care.”  But I knew better, and so did my mother.

She would sometimes tell me that she hated her life, that she wanted to commit suicide, but that she couldn’t figure out how to do it.  “Well, Mom,” I would say, “if you are really tired of this, I can put you in hospice.”  She would become silent, and then, after a couple of minutes, she would begin talking about something else.  Nevertheless, such thoughts persisted.  I usually was the one who gave my mother her medicine in the morning, explaining each pill to her as she took them.  “And this one is your stool softener,” I would say, while holding it in my hand. “Suicide pill?” she would ask.  “No, Mom.  Stool softener.”  This happened on at least three different occasions. So, clearly it was on her mind.  And yet, not surprisingly, she could not quite bring herself to go into hospice.  Once, when she was really sick, she just barely managed to get the words out, “I can’t take this anymore.”  “Do you want me to put you in hospice?” I asked. Without hesitation, she said, “No.”

But palliative care was different.  At least, it was a different term, one without the connotations of a death sentence.  Of course, my mother already knew that she was dying. But it is one thing to accept the fact that you are going to die, and it is quite another to give up.  Perhaps, with this concept of palliative care, I could get for my mother all the benefits of hospice without the disturbing connotations.  As it turned out, however, my mother declined to the point that I realized she probably would no longer know the difference.  So, notwithstanding my mother’s wishes, I decided hospice would be best for her.  I had already signed a do-not-resuscitate order on a previous occasion, but now I signed a do-not-hospitalize order as well.  I felt as though I was signing a death warrant.

Is there a term for the opposite of “control freak”?  Some would suggest “easy going” or “laid back,” but that is not what I have in mind.  It is not merely that “control freak” is a substantive, whereas “laid back” and “easy going” are modifiers that makes them inadequate. It is the fact that these latter terms fail to capture that strong aversion I have always had to deciding what is best for others or telling them what to do.  I once refused a promotion to manager for that reason.  Instead, I recommended a coworker who was younger than me by a generation.  He became manager, along with a raise, and I took my orders from him, which suited me just fine.  I never wanted to be responsible for anything but my own actions or for anyone but myself. Well, whatever the term for it might be, for the past year, I had been forced to make decisions for my mother, in some cases, contrary to her wishes.  For starters, I had put her in a nursing home.  On many occasions, at the end of a visit, she would ask me, “Can’t I go home with you?”  Saying “No” was a soul-crushing experience.  And now I had made a life and death decision for her.

Two weeks later, she became unresponsive again.  But this time she did not go to the hospital. For a day and a half, she received nothing but morphine. And then she died.  If I had let her go to the hospital, she would have received fluids intravenously. They could have intubated her to help her breathe.  And I could have had a feeding tube installed.  She might have recovered again, and then returned to the nursing home, after which she might have lived several more weeks, months, or even years.  But she received none of those things, because I denied them to her.

Now I have dreams that I forgot about my mother and left her somewhere—how frantic I am that she is lost, and how relieved I am when she manages to find her way back to me.

Caveats for Caregivers (5)

This is my fifth essay on caregiving, first published on another website on July 12, 2012.

In my first essay in this series, I wrote about my discovery that the federal government does not recognize power of attorney as having any legal standing, and that for each agency, office, or department from which my mother receives a check, it would be necessary for me to become her representative payee.  They each have their own set of conditions, but especially challenging was the Office of Personnel Management, who said that their preference was that I be my mother’s court appointed fiduciary. Their alternative conditions I was unable to meet, and so I called a lawyer and began the process of becoming my mother’s legal guardian.

My mother had direct deposit for each of her checks, and so there was no immediate need for me to become her representative payee.  There was, however, the problem of her mail.  Having shut down her apartment, I had the Post Office forward her mail to my apartment as a temporary measure. Then I called Social Security and had her mailing address changed, no questions asked.  The Office of Personnel Management, on the other hand, required a letter from my mother.  So, I typed one up and got her to sign it. Owing to her dementia, she did not know what she was signing, but I guess the federal government would rather have the genuine signature of an incompetent person than that of someone with power of attorney.  Moving right along, when I called the Department of Defense, the woman I spoke to asked if my mother was present, so that she could talk to her and get her approval for me to discuss her affairs.  I told her that she was not present, but that even if she were, she would not understand what was being asked of her.  As a result, the woman said I would have to become a representative payee before she could even talk to me about my mother’s mailing address. I learned long ago that if you call the federal government, and you do not like the answer you get, call back the next day.  There is a good chance that you may like the second answer better.  Consequently, the next day I called the Department of Defense again, and the man who answered changed my mother’s mailing address without further ado.

At this point, you may be wondering why I would need to do anything else. Her checks were being directly deposited in her bank account, and the bank recognized my power of attorney. Now that her mailing address had been successfully changed, it would seem that I could just coast.  However, it would be just a matter of time before my mother would run out of money and need Medicaid.  My mother’s three checks would not be enough to pay for her nursing home expenses, yet they give her an income above the limit allowed by Medicaid.  To bridge this gap, many states have qualified income trusts, often called Miller trusts.  Once I set up the Miller trust, I will have to direct her checks to this new account, and in order to do that, I will have to be her representative payee.  So, it had to be done.

Since I would have to become my mother’s legal guardian to satisfy the Office of Personnel Management, I decided to wait until I had that document before dealing with Social Security or the Department of Defense. The elder care attorney that I had talked to about the Miller trust did not do guardianships, but he recommended someone else.  The someone else was actually a divorce lawyer who had done guardianships in the past, but was reluctant to take my case. The fact that my mother had already given me power of attorney, coupled with the fact that I was an only child, precluding the possibility of there being a challenge to my case from one of my siblings, persuaded my attorney that a trial would not be necessary, and that my situation would present no difficulties.  So, she agreed to take my case, and I wrote her a check for $3,500 (damn that Office of Personnel Management anyway!).

My lawyer had a busy schedule, so nothing happened for the first two months.  Eventually, however, I signed some more forms, and the application was filed.  A few weeks later, while I was visiting my mother in the dining room of the nursing home, my mother was served papers, notifying her of my attempt to become her legal guardian, and advising her of her rights, should she have any objections.  Of course, my mother was not able to understand the papers, and I was the one who actually took possession of them, but otherwise, all was in order.  An old woman sitting at a nearby table looked at my mother, gave me the evil eye, and then looked back at my mother, and said, “Whatever you do, don’t sign anything!”  My mother was engrossed in her soup and did not hear her, but it sure made me feel as though I was doing something sneaky.

A couple more weeks passed by, and a court investigator showed up.   I guess I should mention that since I am retired, I am able to visit my mother between 10:00 A.M. and 2:30 P.M. every day, which accounts for how I happen to be there when these people show up unannounced. She talked to my mother about the legal guardianship, and my mother sort of understood and approved of it, so all went well.  But as can be seen from the dire warning of the old woman of the previous paragraph, some patients in nursing homes will vehemently resist the guardianship process, which can necessitate a trial by jury.  Three weeks later, my mother’s attorney ad litem showed up.  She is the attorney assigned by the court to represent my mother’s interests.  As with the court investigator, all went well.

Technically, I was my mother’s adversary.  Now, it only made sense that her attorney’s fees would be paid for by her.  But the $3,500 I paid my attorney was also paid for by my mother, thanks to my power of attorney.  In other words, my mother was forced to pay for the attorney of her adversary. Strange, but apparently legal.  Then I had to put up a bond of about $500, against the possibility of malversation on my part.  No problem, Mom paid for that too.

While all this was going on, however, the Department of Defense got wind of my mother’s situation.  My mother’s Navy annuity is based on my father’s service.  Every year, she receives a Certificate of Eligibility form, asking about her marital status. Apparently, if she were to remarry, she might no longer be eligible for the annuity.  If this seems like an intrusion into my mother’s private life, be reassured.  At the bottom of the page, it clearly states that “disclosure is voluntary.”  It also states, however, that “failure to provide information will result in suspension of annuity payments.”  At the time that my mother received this annual request for voluntary information about her marital status, she had recently fallen and broken her hand. Moreover, her dementia had progressed to the point that she would not have been able to sign even with a good hand.  Consequently, out of the expedience that comes with exhaustion, I just signed the dang thing with my power of attorney and sent it in.

Now they knew.  And now they wanted me to become her representative payee.  For this purpose, I had to send in a doctor’s letter stating my mother’s incompetence, and I had to sign an application.  I couldn’t believe it.  Unlike the conditions required by the Office of Personnel Management, these requirements by the Department of Defense were simplicity itself. Well, there was this one snag.  My signature had to be witnessed.  The employees at the nursing home could not witness my signature, but there were many patients there who were mentally sound, not to mention the visitors who were always about.  I asked a several different people if they would witness my signature, and they each looked at me as though I had asked them if I could sleep on their couch for the next two weeks.  So, I gave up on that and went to a notary who witnessed it for free.

In any event, the day of the hearing finally arrived, five months after I started the process, and I was made the legal guardian of my mother’s estate and person.  I sent a certified copy to the Office of Personnel Management, along with their forms, and hopefully that will do it.  I thought maybe I could do the same with Social Security, but they want a doctor’s statement anyway, and I have to go to their office in person for an interview.

In the meantime, the Aid and Attendance benefit that I had applied for my mother, based on her wartime service as a Navy nurse, was finally approved, after ten arduous months.  As part of the application for the benefit, I had sent in a doctor’s statement to the effect that my mother was totally incompetent. Therefore, the Department of Veterans Affairs wants me to become her representative payee.  For this purpose, my legal guardianship document was as worthless as my power of attorney.  The Office of Personnel Management might regard my status as a court appointed fiduciary as being of significance, but the Department of Veterans Affairs has higher standards than that, by George. What they require is my mother’s signature on a form appointing me as her representative payee.  In other words, they require that I be her representative payee, because they know she is incompetent; but her signature on a document, however incompetent she may be, is worth more than the court document that states that my mother is incapable of handling her affairs, which includes such things as signing documents.  My mother has since regained her ability to sign her name, but she has become uncooperative of late, so I am unable to get her to sign anything.  The VA says I can get her fingerprint on a document if she won’t sign, but it has to be witnessed.  I don’t want to go through the degrading process of having people rebuff me when I ask them to witness something, and I don’t want to drag my mother to the notary to have them witness it. I have heard there are mobile notaries that will come to the nursing home, but if my mother refuses to sign her name, she will probably fight any attempt to fingerprint her as well.

I don’t mean to end this essay with a cliffhanger, but I have gone on long enough, and how all this turns out will be revealed in my next essay, if I haven’t completely worn the reader out this time around.

Caveats for Caregivers (4)

This is my fourth essay on caregiving, first published on another website on May 4, 2012.

You know you are getting old when you hang a pendant around your neck with a button on it. Now, I know you have seen that commercial where the woman falls in the bathtub and lies there, unable to move, until her daughter shows up four hours later.  As horrible as that prospect sounds, there are two reassuring features about that commercial:  first, it was not her son that found her in that situation; and second, at least there was someone, daughter or otherwise, who had the key to her house and came over to see her that same day.  If I fell in the bathtub and broke my hip, no one would find me until the landlord decided to evict me for not paying the rent.  And so, around my neck the pendant hangs.

On the one hand, a medical alert system allows us to keep our independence, in the sense that it allows us to continue living alone instead of moving in with our children (if we have children, that is).  But on the other hand, it is an acknowledgement that we need some kind of assistance, even if it is only from the operators who are ready to help us should we fall, something that never crossed our minds when we were young.  By hanging that pendant around your neck, you are made aware of the fact that you are losing your independence in the very act of trying to preserve it.

But that we can joke about.  The real loss of independence begins when we give up the keys to the car, knowing we will never drive again.  Then what? Setting aside the question of cost, a not insignificant consideration, the next logical step in trying to preserve some degree of independence is having people come to our home to provide us with various goods and services, such as transportation to the store, help with bathing, and Meals on Wheels.  Or, we can move into an independent living community, which is essentially an apartment complex replete with all sorts of amenities for the elderly, such as a shuttle to take people to various stores, bathrooms that have grab bars, and a cafeteria on the premises.  When it is no longer safe for us to be around an oven, or when we cannot remember to take our medicine, we can move into an assisted living facility.  And finally, when our mental or physical limitations become severe, we give up the last vestige of independence and move into a nursing home.

I once imagined that my mother would proceed through each of these stages in just that sequence, in what might be thought of as a natural progression. However, because she had me to help her, she never needed to be in an independent living facility, and then, all of a sudden, she went to the hospital, and from there to the nursing home.  For the next two months, a nursing home was exactly what she needed.  But then she got better, at which point, putting her in assisted living became a genuine possibility.  Not only would the cost be less, but also she would have a private room.  And, inasmuch as my plan met with the approval of the nurse practitioner and other professionals in the nursing home, I decided this was the thing to do. What may be critical to what follows, however, is that this was the reverse of the natural progression.

I cannot, of course, speak for all assisted living facilities.  I can only relate my limited experience in this matter, which you may regard not as laying down a set of absolute truths about all such facilities, but as something to be aware of as a possibility.  First, there was a fee to “enter the community,” which was a thousand dollars at one place and two thousand dollars at another I considered. Second, they required thirty-days notice in case my mother should need to move out.  To put these two items in context, it must be borne in mind that at this stage of life, a lot can happen in thirty days.  In other words, I might have paid the fee and moved my mother in, only for her to undergo a sudden decline in health two days later, necessitating a move back to the skilled nursing section, forgoing the fee and a month’s rent in the process.

Then I found out that the rooms were not furnished.  Maybe I should have known better, but I thought the rooms would come with a hospital bed, a dresser, a chair, a lamp, and so forth, just like the rooms in a nursing home. They did not. Fortunately, the manager had a lot of donated furniture in storage that he let me borrow at no charge, or else I would have had to spend a lot of money setting it up.  The bed could have been a real problem.  My mother needed more than just a twin bed; she needed a hospital bed. Fortunately, again, the administrator was able to get Medicare to pay for a rental.

Then I had to buy sheets, towels, wash cloths, and the like.  In other words, stuff that was supplied automatically in the skilled nursing section would have to be supplied by the tenant in an assisted living unit.  At the department store, as I was about to buy three sets of sheets for my mother’s bed, I had the good fortune to be waited on by a woman with experience in such matters (she had been a caregiver for her father).  She informed me that a hospital bed needed extra long sheets, since hospital beds are slightly longer than twin beds.

As for the towels and wash cloths, you may be wondering why I didn’t just use the towels and wash cloths that my mother had had in her apartment. The answer is that I had already let go of her apartment, and had found it necessary to throw away a lot of good stuff that was simply impossible for me to stash in my own place.  So now I was going to have to replace much of what I had just thrown away.  One of the CNAs (certified nursing assistants) told me that I would need towels not only for my mother to dry with after bathing, but also for the CNA to wipe up the water on the floor that would inevitably be there when she used the handheld showerhead to wash my mother.  Without giving it a second thought, I bought a bunch of white towels.  When she saw them, the CNA announced, in a manner that would brook no exception, that I would have to buy colored towels, because white towels must never be put on the floor.  I was so awed by the gravity of her demeanor that I accepted this pronouncement without question.  As I had already put my mother’s name on the towels with a marking pen so that the laundress would know to whom they belonged, it was too late to return them.  So I bought a bunch of colored towels, and put them in the cabinet next to the white ones.  Three days later, I saw another CNA, who had just bathed my mother, wiping up the water on the floor with one of the white towels.

Then there is the toilet paper.  Even that had to be supplied by my mother, which is to say, by me.  Now, I was not worried about the cost of the toilet paper or other sundry items (facial tissues, soap, toothpaste, etc.).  The problem was that even with the availability of a shuttle to go to the drugstore, my mother was not really capable of handling money or remembering what to buy.  And while I visited her every day, and would normally be able to buy the items myself, I do get sick from time to time.  A mere cold can incapacitate me for a week.  What would happen if I got sick just when my mother needed more toilet paper?  In fact, I had surgery scheduled for myself the next month, and I could not be sure how long I would be convalescing.  In other words, when my mother was in the skilled nursing section, the room was furnished and supplied automatically, and even should I be sick for a month, I would know that she would be completely taken care of.  In the assisted living section, the situation was somewhat more precarious.

After about six weeks in assisted living, my mother fell twice, each time in the middle of the night.  Since the assisted living section is less staffed at night, I was told I would have to hire a sitter for her during the nighttime. This additional cost would have completely defeated the purpose of having my mother in assisted living, and so I moved her back to the skilled nursing unit, where, with hindsight, I guess she really belonged.

I hope that I will not be misunderstood.  Assisted living is perfect for many people, and the one where my mother briefly stayed was excellent.  I simply was not prepared for all that was involved in placing my mother in an assisted living facility, the result, no doubt, of backing into it from a nursing home, instead of following the natural progression.

Caveats for Caregivers (3)

This is my third essay on caregiving, first published on another website on April 25, 2012.

Having just put my mother in a nursing home the previous week, I was anxious to get over there to console her, since she was positively distraught. However, I had to make a deposit, so I was standing in line at the bank, thinking about all the things I needed to do.  I would have to empty out her apartment, which meant deciding what to keep, what to give away, and what to throw away.  I needed to drive across town to get help applying for the Aid and Attendance Benefit from the Veterans Administration. Unfortunately, I did not have much faith in the car I was driving, which the garage had lent me, because my old heap needed to be in the shop for extensive repairs (seven weeks worth, as it turned out).  Moreover, I had just discovered that I would have to become the representative payee (see “Caveats for Caretakers (1)”) for each of her three government checks, and I was wondering how involved that would be.  And, as the pièce de résistance, I had just found out I would need to go into the hospital for some minor surgery.

“What next?” I asked myself.

“Your driver’s license is about to expire,” the bank teller informed me, as she proceeded to record my deposit.

At this point, I guess I should mention that I live in Texas.  I don’t know how it is in other states, but from the time I arrived at the driver’s license office until the time I renewed the license and was heading out the door was three hours and forty-five minutes. Considering all the other problems I had to contend with, this was an inconvenience indeed.  “Oh well, at least that’s over with,” I said to myself as I got to my car.  And then it hit me. Since my mother has dementia, I carry her driver’s license around with me.  I looked at it, holding my breath.  Sure enough, her license would expire in four months.

Now, obviously, she would never drive again.  But she would need a photo ID, since that is one of the first things they want to see when you go the doctor, a hospital, or a nursing home.  I could see the ordeal unfolding before my eyes. I would have to get wheelchair transportation.  I would have to hire an attendant to help my mother go the restroom, which she would surely need to do during a four-hour wait.

“There must be some kind of exception made for people like my mother,” I thought.  And since this must happen all the time to people in nursing homes, I asked one of the administrators at the nursing home if she knew what usually happened in such situations.  She did not have the slightest idea.  The head nurse had no experience in such matters, and I even drew a blank with the social worker.

I went to the appropriate website, but my question was apparently one that is not frequently asked, and nothing seemed to fit my particular problem.  I looked at the contact number. You know you are in trouble when the contact number is not toll free.  It’s not the cost of the call that worried me, but the attitude that this phone number represented, that they were really not interested in hearing about my problem or helping me solve it. The woman I spoke with, however, was quite helpful, and she had some good news.  For people who are homebound or in a nursing home, Texas has a policy of sending someone out to photograph the person and do all the paperwork. Unfortunately, the woman informed me, I would have to go out to the driver’s license office in person to set it up.  “Don’t bother to try to get them on the phone,” she cautioned me.  “It’s impossible.”  I tried anyway.  It was impossible.  So, back I went to the driver’s license office.  For this situation, which could have easily been handled over the phone, I only had to stand in line for forty-five minutes (not to mention the commute, which was the better part of an hour).  I was told that someone visits homebound people or those in nursing homes once a month, and that I would be contacted sometime next month.  I asked for a contact number, just in case.  I did not get one.

All’s well that ends well, I suppose.  I was contacted, and a couple of state employees came to the nursing home. They took my mother’s information, took her photograph, and then tried to get her to sign the form. Unfortunately, my mother was too confused to sign her name or even to make a mark.  So, one of the state employees told me to sign for her.

“Do you want me to sign with my power of attorney?” I asked.

“We don’t accept power of attorney,” she replied. (There it was again, the government’s mantra.) “Just sign her name for her,” she said.

And so, I signed my mother’s name, and within a few weeks, my mother received her photo ID, with my version of her signature right there at the bottom. “If I need to forge my mother’s name on some document,” I thought to myself sardonically, “the signature will be a perfect match with the one on her photo ID.”

As noted above, none of the employees in the nursing home were aware of this service provided for people that are homebound.  For this reason, I have told this tale, to make the reader aware of a service that may be available, depending on the state in which one lives.  I would only add that one should not wait until the driver’s license is about to expire.  As soon as you are sure that your mother will never drive again, start making arrangements right away to get her a photo ID to take its place.

In the opening paragraph, I referred to the Aid and Attendance Benefit that is available to veterans who have served in wartime and their spouses.  The benefit may be as much as $1,700 per month.  If you think your mother may qualify, ask the social worker at the nursing home about it.  She will probably be able to give you a contact number of a government employee who can assist you with this.  My first effort was with someone at the VA, but the nursing home directed to me to a county employee, without whose assistance I would have long since given up. Unfortunately, it takes a long time for the claim to be processed. The odds are very good that you will have to put your mother on Medicaid before she ever receives anything, at which point she will no longer be eligible for the benefit (it will be reduced to $10).

Caveats for Caregivers (2)

This is my second essay on caregiving, first published on another website on April 16, 2012.

“We don’t accept cash.”

She must have misunderstood me.  When I offered to pay cash, she must have thought I was about to reach into my pocket, like some character from Mad Men, pull out a fat money clip, and begin peeling off hundred dollar bills until I got what I wanted.

“What I meant was,” I said, anxious to reassure her, “I could write you a check for the difference.”

“We wouldn’t know what to charge.”

“Well,” I continued, still not fully appreciating what I was up against, “I could put up a big deposit, and you could refund whatever you don’t use.  Or I could just give you my credit card.”

“We don’t accept cash.”

Maybe I should start at the beginning.  A little more than a year ago, my mother had to go to the hospital.  After she was there for about a week, she was still not well enough to go home, but neither was she sick enough to stay in the hospital.  So, a social worker stopped by my mother’s room to help me select a skilled nursing facility.  A skilled nursing facility provides care or therapy for people who have been released from a hospital, but are not ready to go home.  Medicare will pay most of it for 20 days, after which there is a co-payment for about 100 days.

The social worker suggested three such facilities, and I picked the one closest to where I lived. What I did not realize at the time was that a temporary stay at a skilled nursing facility is an opportunity to try out a nursing home.  In other words, the typical nursing home, providing long-term care, is often combined with a skilled nursing facility, providing temporary care.  In many cases, the rooms are the same:  someone who goes into a skilled nursing facility for therapy, but then undergoes a serious decline in health, requiring long-term care, will not even have to change rooms.

Medicare, of course, does not pay for long-term care.  I knew that if my mother should have to stay in a nursing home, she would soon run out of money, at which time I would have to get her on Medicaid.  When I happened to mention this to the woman in charge of admissions, she informed me that they did not accept Medicaid.  As I had naively supposed that all nursing homes accept Medicaid, this came as a surprise.  Moreover, I realized that an opportunity had been lost.  I had inadvertently selected a skilled nursing facility that would not be suitable for my mother, financially speaking, should she ever need long-term care.  Had I selected one that does take Medicaid, then from my mother’s temporary stay there, I would have known whether to bring her back when she needed to stay somewhere permanently. With this in mind, if you want to find out which nursing homes in your area accept Medicaid and which do not, I recommend medicare.gov.

After about a month, my mother was released, and she returned to her apartment.  As it was close to my apartment, and as I was retired, I was able to spend a lot of time over at her place attending to her various needs, like shopping, cooking, and cleaning.  But after a few months, she had to go to the hospital again.  As before, she needed to be released to a skilled nursing facility, and this time I selected one that would accept Medicaid, especially since it appeared that this time she might have to stay for good.

However, the admissions coordinator informed me that GEHA (Government Employees Health Association), the insurance my mother had in addition to Medicare, was not a supplemental policy, but rather a secondary one, a distinction I have yet to fully grasp.  The practical consequence was that GEHA would not pay for the portion that Medicare did not cover.  “I’m sorry,” she said, “but we will not be able to admit your mother.”

I had already been through this with the previous nursing home, but in that instance, I was simply told that I would be responsible for paying the difference.  All I could figure was that the woman I was now talking to must be used to dealing with poor people, who cannot afford to pay anything out of pocket.  “Oh, that’s no problem,” I assured her, “we can pay cash for whatever Medicare does not cover.”

“We don’t accept cash.”

And thus began the surreal conversation with which this story opened.  I called the social worker at the hospital.  She offered to call the nursing home herself.  Ten minutes later, she called me back to tell me that the situation was exactly as I had described it.  I selected another nursing home.  In this case, the woman in charge of admissions did not even bring up the subject of payment.   After my mother was released from that place, I received a bill and paid it.

Hopefully, the cash-refusing nursing home is just an anomaly.  But it is something to be on guard against, in case it turns out to be the beginning of a trend.  In particular, in selecting a supplemental insurance policy, it might be a good idea to find out how much it covers of skilled nursing care.

There is one more thing you need to know about skilled nursing facilities.  A lot of nursing homes have waiting lists.  If you are hoping to get your mother into a nursing home, it may take months to get her admitted.  And I am not just talking about the really nice nursing homes for rich people, the ones that do not accept Medicaid, like the first place my mother stayed in. I once took a tour of a nursing home that looked like a cheap hotel where they rent rooms by the hour.  And they had a waiting list!  But if your mother enters a nursing home directly from the hospital, by way of the skilled nursing unit, she will move to the front of the line.  In fact, once she has a room there, they are unlikely to ask her to leave, should it turn out that she needs long-term care.

Officially, everyone is treated equally.  It is whispered, however, that when it comes to waiting lists, preference is often given to those who can pay privately for a while.  The reimbursement from Medicaid is not generous.  A Medicaid bed is better than an empty bed, but not that much better.  With too many Medicaid beds, a nursing home may end up having to close its doors.  It needs a certain proportion of the more remunerative private-pay beds in order to cover its costs.  Therefore, a prospective applicant who can pay privately for many months is more desirable than one who needs to get on Medicaid right away.  So, if you need to put your mother in a nursing home, and she can pay privately for a while, you should casually mention this fact when talking to the person in charge of admissions.

Now that I think about it, it might not be a bad idea to have one of those Mad Men money clips after all.

Caveats for Caregivers (1)

Beginning in 2012, on another website, I wrote a series of eight essays based on my experiences in taking care of my mother in the last years of her life.  I have decided to publish them here as well, with very few changes from when I originally wrote them.  One change is that I have replaced the word “caretaker” with “caregiver,” which seems to be the preferred term today.  Although one may be a caregiver for different family members or even for a friend, in giving advice to other caregivers, I will assume, for convenience and ease of expression, that the loved one is the caregiver’s mother, as will often be the case.  This first essay was originally published on April 10, 2012.

 

Seventeen years ago, my mother and I decided to take the advice one so often hears about getting one’s affairs in order.  We went to a lawyer and had her draw up a will, medical power of attorney, directive to physician, and durable statutory power of attorney for each of us.  Regarding this last document, it requires a physician’s statement attesting to incapacity or incompetence for its execution.  This turned out to be very difficult to get.

A little more than a year ago, my mother had a seizure, which permanently affected her physically and mentally.  I decided it was to time to execute the power of attorney document. The attending physician in the hospital expressed reticence about providing the necessary letter.  My mother’s bills needed paying, so the next day I brought in a couple of checks made out to the cable company and the electric company.  The nurse said that owing to my mother’s mental state, she was not allowed to sign documents.  So, I whipped out the power of attorney and asked her if she would have the doctor put that in writing so that I could execute the document and sign the checks myself.  She referred me to the doctor who was there for the weekend. He said I would need to wait until Monday to speak to the aforementioned attending physician.  On Monday, I spoke to a third doctor, who said that the attending physician had gone on vacation, and she also refused to provide the needed letter. “What about these bills that need to be paid?” I asked. “Just have her sign the checks,” she replied.  So, my mother, who didn’t know what was going on, and was having hallucinations, signed the checks and the bills got paid.

A question occurred to me:  Was this legal?  I doubt it.  I am not a lawyer, but I suspect that it is illegal to knowingly get a mentally incompetent person to sign a check or other document. What I have discovered, however, from this and subsequent incidents, is that there are things that are illegal but acceptable, though no one will ever come right out and say so.  To qualify for this category, two conditions must be met:  (1) You must not be doing it for your own personal gain; and (2) you are only trying to get for your mother that to which she is legally entitled.  Meet both of these conditions, and there are many health care workers and civil servants who will look the other way, because they know you are in a catch-22 situation.

The next time my mother went into the hospital, I decided to try again.  I asked the attending physician on that occasion for the necessary letter.  He referred me to my mother’s neurologist. The neurologist opined that the letter should come from the attending physician.  So, I gave up.  Fortunately, my mother continued to sign whatever I stuck in front of her.

Eventually, my mother’s cognitive ability declined to the point that I was able to get her primary care physician to provide me with the necessary letter.  From my first attempt to obtain this letter until I finally succeeded was nine months.

When I went to my mother’s bank, which is also my own, and gave one of the bank officers a copy of the power of attorney, accompanied by the doctor’s letter, the bank officer looked at the power of attorney document and said, “Oh.  It’s too old.”  “But the whole idea,” I replied, somewhat stunned at the remark, “is to have this drawn up in advance, while you are still mentally sound.”  After discussing it with the manager, she accepted it, possibly because my mother and I had been doing business there for twenty years.  In general, you should speak to the financial institutions in which your mother has money to find out if they have special rules or forms to fill out before you contact a lawyer about drawing up a power of attorney document.

The power of attorney document that my mother signed clearly states that I have the power to handle her Social Security checks and any other federal benefits or pensions.  It might just as well have stated that I have the power to jump over the moon.  Now, my mother is a triple dipper.  She receives a check from Social Security, the Office of Personnel Management, and the Department of Defense.  They all have one thing in common: they do not accept power of attorney.  Instead, they each require that I become her representative payee.  Not one person in a hundred has even heard of this expression, including, apparently, my lawyer.

You might suppose that there would be one procedure for becoming a representative payee, which would then apply to each agency or department. But that would require the application of reason and common sense. Instead, each agency or department has its own rules, regarding which there is no coordination or reciprocity.  Of the three, the Office of Personnel Management proved to have the most onerous conditions.  They sent me a letter saying that in lieu of my being my mother’s court appointed fiduciary, I could become her representative payee by sending in a doctor’s statement and two affidavits from two people stating my mother’s condition and incapacity.  As I am a bachelor and an only child, there is no one else in my family who could sign such an affidavit.  The only people who know firsthand what my mother’s condition is are the nursing home employees where she presently resides, and nursing homes have a policy of not allowing their employees to sign affidavits.

As an added obstacle, each affidavit would have to state why it is that I have not become my mother’s court appointed fiduciary. When I read this letter, I thought to myself:  “How is anyone supposed to know why I have not become my mother’s court appointed fiduciary, when I don’t know the answer to that myself?”  I suppose the answer would be that I thought my power of attorney would be enough.  But how would a prospective affiant know that unless I told him?  And my telling him would not provide the independent information that the affidavit is supposed to represent.

The result is that I am now in the process of becoming my mother’s legal guardian.  This will allow me to become her representative payee, which will give me the power to handle her Social Security checks and any other federal benefits or pensions.  At least, that is what my lawyer tells me.  Maybe this time she is right.

The Lady Vanishes (1938)

The Lady Vanishes (1938) was released a little less than a year before the outbreak of World War II, but about a month after the signing of the Munich Agreement.  British Prime Minister Neville Chamberlain declared that with this document, he had secured “peace for our time.”  This will forever be despised as an act of appeasement, although I can’t say that I share that sentiment. Though Alfred Hitchcock, who directed this movie, is primarily concerned with entertaining us, yet one suspects that the movie is also being presented as a cautionary tale against such appeasement, against pacifism and complacency.

The movie begins in the fictitious, Germanic-sounding country of Bandrika, which is ruled by a dictator.  A bunch of people planning on traveling by train are waiting in a hotel lobby, two of whom are Charters and Caldicott, portrayed by Basil Radford and Naunton Wayne, a comedy team that began life with this movie. As they wait, they express their concerns about the last report they heard, “England on the brink.”  From their conversation, we wonder if England is on the verge of going to war.  Eventually, we find out that they are worried about a cricket match.  Pace the British, cricket is a sport the rest of the world thinks is ludicrous.  And the obsession with cricket on the part of the characters that Radford and Wayne subsequently played in other movies became a trademark gag. From time to time, we see them reading about that cricket match on the back pages of the newspaper, while the serious political news on the front page is ignored. They represent the dangerous complacency of the British people.

On account of an avalanche, the train cannot continue on its way, so everyone has to seek accommodations at the hotel.  Charters and Caldicott are forced to occupy the maid’s quarters, consisting of a narrow bed intended for just one person.  The maid, Anna, is an attractive woman, though slightly bigger than either of the two men, whom she looks at flirtatiously when she finds out they will be sleeping in her room, much to their discomfiture.  Apparently, one of the two men sleeps in pajamas and the other does not.  For the sake of modesty, presumably, they share the pajamas, Charters wearing the tops; Caldicott, the bottoms.  At one point, when the two men are squeezed into the bed, Anna barges right in to put her hat back under the bed and to retrieve some other articles of clothing.  Charters moves his body in front of Caldicott so that Anna can’t see his nipples.

Earlier, when three young American women seem to be getting the royal treatment by the hotel manager, Caldicott dryly remarks, “the almighty dollar.”  One of the women, Iris (Margaret Lockwood), is soon to be married.  A friend proposes a toast, “To Iris, and the happy days she’s leaving behind, and the blue-blooded cheque chaser she’s dashing to London to marry.”

It’s an old story, a rich American woman marrying an impecunious British aristocrat for the sake of a title and a coat of arms, which apparently is more important to her father than it is to her.  She refers to herself as being an “offering on an altar.”  Love is not involved, but that doesn’t bother her, saying that she’s been everywhere and done everything, so she might as well get married.  Once happiness has lost its charm, you might as well slam the door on it forever.

There is one bright spot about being married, however.  That way you can have an affair.  Adultery is fun, at least in the beginning, as we learn from another couple, Mr. Todhunter (Cecil Parker) and Margaret (Linden Travers).  They are both cheating on their spouses.  Todhunter had no qualms in the beginning about openly carrying on with her, but now he insists on separate rooms for the two of them.  His passions having cooled somewhat, he is worried that a divorce would spoil his chances of becoming a judge.

Anyway, after Iris’s friends leave, she finds it impossible to sleep because of the noise being made by Gilbert (Michael Redgrave), the guest in the room above her.  You know the type, someone that thinks it’s his God-given right to make as much noise as he wants, and who cares nothing about how much it disturbs his neighbors.  And like most inconsiderate neighbors, he believes that anyone who complains about the noise he is making is the one who is in the wrong.

When he refuses to quit making so much noise, she bribes the manager to have him removed from his room, so Gilbert barges into her room and acts as if he will have to sleep in her bed, threatening to tell people she invited him to sleep with her if she complains.  This forces her to call the manager and get him his room back.  We know we are supposed to smile at this obnoxious behavior of his, regarding it as charming and endearing, because he is tall and good looking.

Charters and Caldicott end up at a table with Miss Froy (Dame May Whitty), an elderly governess, returning to England now that her charges have grown up.  She comes across as whimsical and sentimental, boring the two men with her talk about the beautiful mountains and the lovely people of Bandrika, saying, “Everyone sings here. The people are just like happy children, with laughter on their lips and music in their hearts.”

“lt’s not reflected in their politics,” Charters replies dryly, but as Miss Froy parts from them, she says that we should not judge a country by its politics, noting that the English are quite honest by nature. The implication is that the British government is not honest (and that means the government presided over by Neville Chamberlain). The idea is that the people of a country can be betrayed by their government, but that the goodness of ordinary folks will ultimately prevail, clearly a populist sentiment.  This is ironic coming from her, since she turns out to be a part of the British government herself, a spy, to be exact.

She returns to her room, and just below her balcony, which is on the second floor, a man is serenading with a guitar.  She drops a coin out the window for him, not realizing he has just been strangled.  As we later find out, the melody being played is a coded message consisting of the vital clause of a secret pact between two European countries.

It must be a rather sophisticated code, for the simple melody is about sixteen bars long, all in one octave. If each note corresponds to a word, there is a vocabulary of about twelve words to work with.  Of course, we can expand that vocabulary by taking into account the length of each note.  I estimate we could increase the vocabulary to thirty-six words, given the melody we hear in the movie.

On the other hand, the notes might represent letters and numerals, and thirty-six different notes and their lengths would be just enough for every letter and numeral there is.  But then, it would have to be a mighty short clause.

In either event, the code is limited by the requirements of euphony.  A disagreeable combination of notes could not be serenaded on the sly, as a way of passing on the information to Miss Froy, so the number of possible combinations is constrained. And like most melodies, much of it is repetitive anyway. Notwithstanding all these limitations, the secret clause has somehow been thus encoded.

The person that strangled the man with the guitar knows that Miss Froy has the coded message, so he tries to kill her by pushing a flower pot out of a second-story window to land on her head while she is looking for her bag at the station prior to boarding the train.  But Iris was bringing Miss Froy her glasses, which she dropped, and the pot lands on her head instead, giving her a concussion. Miss Froy ends up taking care of her on the train, but after Iris takes a nap, she wakes up to find her gone.

Charters and Caldicott saw Miss Froy on the train, but they pretend not to have seen her, because they figure nothing really bad could have happened to her, and they do not want the train delayed, lest it cause them to miss the cricket match they hope to see when they get back to England. Todhunter pretends not to have seen her because he fears getting involved in an inquiry that might expose his infidelity.  The only one who takes her seriously is Gilbert, the noisy neighbor.

All those that are neither British nor American on that train act suspicious and untrustworthy, being either German or Italian.  Whereas Charters, Caldicott, and Todhunter merely deny having seen Miss Froy, the Germans and Italians deny she ever existed.  For example, when Iris asks the Italian magician and the German baroness in her compartment what happened to the lady that was sitting opposite her, they say there was no such woman.  Admittedly, this lets us know immediately that they are part of a conspiracy to deny Miss Froy’s existence, but in real life, such a tactic would be both unnecessary and unwise.  How much easier and less suspicious it would have been for them to say, “Oh, she got up and left the compartment a little while ago.”

Furthermore, it is inconsistent with phase two of their conspiracy, which had already been planned. When the train stops, a patient with bandages around her head is brought onto the train.  Dr. Hartz (Paul Lukas) is a brain surgeon, and he says he will be operating on her when they get off the train at the next stop.  But in reality, the supposed patient is a woman who dresses up like Miss Froy, while the real Miss Froy is then wrapped up in the bandages and put under guard by a fake nun.

But this woman substitute contradicts the story that Miss Froy does not exist.  The Italian that claimed that Miss Froy never existed now tells Iris and Gilbert that she came back.  They go to see her, but it’s a different woman.  As a result, whereas before, Iris was told that the bump on her head made her hallucinate the woman sitting across from her in the compartment, now she is told that there is such a woman as she described, only she’s German, not British, and her name isn’t Miss Froy.

Needless to say, if all the conspirators wanted to do was stop Miss Froy from taking the musically coded message to England, they should have strangled her and unceremoniously thrown her off the train.

Eventually, Gilbert finds evidence that Iris is right.  They pull a reverse switcheroo, removing the bandages from Miss Froy and putting them on her imposter, and that woman is taken off the train at the next station.  They are assisted by the fake nun, who is British, once she realizes Miss Froy is British too.  In fact, as it becomes clear that Miss Froy is in danger, most of the British passengers on the train begin pulling together.  Thus, the movie is optimistically saying that once the British people are shaken from their complacency, they will rally together and defeat the foreign aggressors.

The one exception is Todhunter. Though he is British, yet he wants to surrender to the soldiers trying to get control of the train, saying, “I don’t believe in fighting.”  He is derided as being a pacifist and compared to Christians who got thrown to the lions. When he insists on surrendering on his own, getting off the train waving a white handkerchief, he is contemptuously shot, falling to the ground and muttering that he doesn’t understand. So much for pacifism.  Of course, we all knew he was doomed the minute we found out he was cheating on his wife.  Margaret is spared, however, probably because she was already separated from her husband, saying at one point that he knew he would not be seeing her again.

Miss Froy admits she’s a spy and gives the melody code to Gilbert, in case she doesn’t make it. Before she leaves the train, she says, “I hope we shall meet again under quieter circumstances.” At first, I thought this was an allusion to Vera Lynn’s song, but that apparently was not published until the following year. Because she is the last person you would expect to be a spy, her example implies that the rest of us have no excuse for not doing our part. If a little old lady can risk her life in the fight against evil enemies, dodging bullets as she runs across the countryside of a hostile nation, then we all are capable of making at least some small contribution ourselves.

When they all get back to England, Charters and Caldicott find out that the cricket match has been canceled.  Iris sees her fiancé and hides from him, deciding to elope with Gilbert instead, because he is tall and good looking.  Just wait until the honeymoon is over, and he returns to being the inconsiderate jerk he was when she first met him.  In any event, the idea of marriage puts the “Wedding March” in Gilbert’s head, and when they get to the Foreign Office to pass on the code, he can’t remember the tune.  But then we hear the tune being played on a piano, and it turns out to be Miss Froy playing it, having made it back to England after all.  Apparently, she didn’t know how to decipher the code herself, or else she would have just walked in and stated the secret clause in words.

Of course, as has often been observed, she could have called the Foreign Office from Bandrika and hummed the tune over the phone.

Pretty Woman (1990) and Philadelphia (1993)

Because Pretty Woman intends to be a modern mixture of Cinderella and Pygmalion, with an allusion in the movie to the title character being a princess who is rescued from a wicked queen by a knight on a white horse thrown in to boot, it hardly seems appropriate to criticize this fairy tale as being unrealistic. Suffice it to say that it is far-fetched that a rich, handsome man like Edward (Richard Gere) would not find the right woman until he met Vivian (Julia Roberts), a streetwalker who is so perfect that she even likes the opera. Perfect for him, that is, not for me. My perfect woman likes watching movies, and I leave the ones that like going to the opera to men like Edward.

Though this movie made no pretense about being realistic, yet there is one reality too stark to be ignored, and that is disease. Once upon a time, a man in a movie could marry a prostitute, and the audience would accept this without thinking about her having some kind of sexually transmitted disease. We never worried while watching Stagecoach (1939) when the Ringo Kid (John Wayne) decided to marry Dallas (Claire Trevor), who was a whore with a heart of gold. Because venereal disease was something people rarely spoke of, especially in the movies, they rarely thought about it while watching these movies.

But today we live in a world where it is impossible to think about sex without also thinking about getting an STD, especially if it is sex with prostitutes. And therefore, it was necessary for this movie to assure the audience that Vivian was in good health. Consequently, we are not surprised when Vivian says to Edward, when they first meet, that she is safe: “Look, I use condoms always. I get checked out once a month at the free clinic. Not only am I better in the sack than an amateur, I am probably safer.” Maybe prostitutes normally say that sort of thing to their customers, maybe not. I wouldn’t know. But if it sounds a little forced and artificial, we accept this bit of dialogue as necessary to keep us from thinking about disease when they eventually have sex. The movie could not afford to rest content with this one reference to condoms, however. To drive the point home, Vivian later produces her rainbow assortment of condoms for Edward to pick from.

But still, they are not quite ready for sex. That is, we in the audience are not quite ready for them to have sex. Apparently, we need a few more assurances. Therefore, in a subsequent scene, Vivian tells Edward that she does not kiss on the mouth. She says this is for emotional reasons: “Kit’s always saying to me, ‘Don’t get emotional when you turn tricks.’ That’s why no kissing. It’s too personal.” So, later in the movie, when they do start kissing, we know that they are getting emotionally involved. But the real reason for her having this restriction on kissing is so that we know there has been absolutely no exchange of bodily fluids, not even saliva, with any of her past customers.

In a movie about sex, we are not surprised if there is a bathtub scene, especially one in which both the man and the woman are in the tub together. But as there are two bathtub scenes in this movie, we have to wonder if the purpose is more than just erotic, if they are meant to make us think of Vivian as clean. This is not to say that taking a bath would act as a prophylactic against the transmission of disease. Rather, it is more about the association of ideas than logic. The cleanliness associated with bathing is supposed to support our belief that Vivian is sexually clean as well.

But the scene that really shows the extent to which this movie wants to assure the audience that she is safe to have sex with is the dental floss scene. Let’s face it. Most people do not floss during a date. I suppose a woman might, because she can carry the floss around in her purse. But even so, there is normally no need to have a scene involving personal hygiene in a movie, unless, of course, personal hygiene is important for some reason. As with the bathing, flossing will do nothing to prevent the transmission of venereal disease, but the movie is trying to suggest to us that any woman who flosses during a date must be so clean she could not possibly have AIDS, herpes, syphilis, gonorrhea, or crabs.

Still, under normal circumstances, if a woman decided to floss her teeth on a date, she would close the bathroom door, and her date would not dream of just walking in. But if he did interrupt her while flossing, she would simply stop what she was doing to see what he wanted. She would not hide the floss as if it were something shameful or embarrassing, the way Vivian does in this movie when Edward walks in on her. But the purpose of Vivian’s hiding the floss is so that there can be a big dramatic scene and discussion about it, one which cannot escape the attention of the audience, much in the way that her display of condoms for Edward to pick from drove home the point in a way that could not be missed either.

So, with the condoms, monthly visits to the free clinic, a ban on kissing, a couple of baths, and some dental floss, the audience can finally relax and quit worrying about whether Vivian has a disease, even if the opera she and Edward went to see was La Traviata, a story about a courtesan who dies of tuberculosis.

Whereas the title character of Pretty Woman did not have a venereal disease, despite our apprehensions in this matter, given the fact that she was a prostitute, the protagonist of Philadelphia does have such a disease as a result of some risky behavior of his own.   In this movie, Andrew Beckett (Tom Hanks) is a lawyer with a prestigious law firm.  In the opening scene, he successfully defends a client against what he calls a “nuisance suit,” as “an example of rapacious litigation.”  And so, if you did not know anything about this movie beforehand, you would correctly suspect that before the show is over, he will be bringing suit against someone himself.  And when he does, the lawyer whom he accused of bringing a frivolous lawsuit against his client, ambulance chaser Joe Miller (Denzel Washington), ends up being his attorney.

In particular, the partners of the law firm he worked for say that they fired Beckett for incompetence, but Beckett claims they fired him because he had AIDS, which he concealed from the partners in addition to concealing the fact that he was gay.  Beckett explains during the trial that he decided not to tell the partners he was gay when he heard them telling crude jokes about homosexuals.  Those who produced this movie made sure that the jokes were not funny, lest we get confused and start siding with the partners.  Actually, the movie never makes it clear exactly what happened regarding Beckett’s firing.  Beckett believes that someone figured out he had AIDS and sabotaged his work in order to justify dismissing him for incompetence, but we never find out for sure.

This movie is contemporaneously set in the early 1990s.  It was a transitional period.  During the early 1980s, when AIDS was first identified, there was no treatment.  I remember seeing people whose bodies were ravaged by that disease.  The sight of them filled one with pity and dread (we see examples of such at the clinic where Beckett goes to have his blood monitored).  The dread was especially acute, because at the time, no one knew how contagious it was or what the vectors of transmission were.  Was it airborne?  Could it be transmitted by mosquitoes?  We knew that blood and semen could transmit the disease, but we also wondered about saliva and sweat.  By the 1990s, however, research had pretty much established that AIDS was caused by HIV and that blood transfusions, dirty needles used by drug addicts, and unprotected sex, especially between two men, were the primary methods of transmission. And while our fears of contracting this disease have been reduced by this knowledge, it also helps that treatment has advanced to the point that we seldom see anyone with obvious symptoms, such as extreme weight loss.

And so, the aversion to touching or being around someone with AIDS, a perfectly rational fear in the early 1980s, came to be regarded as a manifestation of ignorance and bigotry by the 1990s.  Throughout this movie, we see Beckett being hugged on numerous occasions, more than you would normally see in a movie, even a movie about someone dying of a disease.  In this way, we are informed that those doing the hugging are enlightened on the subject.  On the other hand, we also see other people trying to put distance between themselves and Beckett, whom we are supposed to regard as wrongheaded, if not morally bankrupt.

In any event, the issue of the case was whether the law firm illegally fired Beckett because he had AIDS, or fired him because of incompetence on his part, which would have been legal.  Therefore, the question as to how he contracted the disease was irrelevant.  Nevertheless, we are not surprised that the question arises as to Beckett’s behavior, whether he contracted AIDS through reckless actions on his part.  A woman who had once worked for the partner who first noticed Beckett’s lesion is brought on the stand to testify on the part of the plaintiff (Beckett).  She had had AIDS too, but she told her employers.  The point is that the partner would have realized what the lesion meant from his experience with her, in which case knowledge that Beckett had the disease by at least one of the partners would be established, a necessary condition of proving that that was the real reason for Beckett’s firing.

Under cross examination, it turns out that she contracted the disease when she was given a transfusion after giving birth.  In other words, she got AIDS through no fault of her own.  That the occasion was when she had a baby even associates the event with motherhood.  You couldn’t want a more saintly innocent victim than that.  So, we know what is coming, an attempt on the part of the defense attorneys to blame the victim.  Sure enough, when Beckett gets on the stand, he is asked about whether he had ever been to the Stallion Showcase Cinema, a gay pornographic movie theater where men in the audience sometimes have sex with each other.  Beckett admits to having been to the theater three times in 1984 or 1985, and that he had sex with a man in the theater one time.  He also admits that he knew about AIDS at the time and that his actions could have endangered Miguel Alvarez (Antonio Banderas), the man he was living with at the time and still is.  The point of the defense is that Beckett is not an innocent victim, but someone who contracted the disease in rather seedy circumstances in full knowledge of the danger to himself and his lover.

Of course, the attitude of the movie is that it is wrong to blame the victim.  More importantly, it allows the people in the audience to be smug in their sense of moral superiority, self-assured that they would never blame the victim the way some in the movie seem to.  But let us note that the movie also lacks the courage of its convictions.  It establishes that Beckett was and still is in a monogamous relationship, as it were, and that he just had a moral lapse one night.  In other words, the movie did not have the courage to make Beckett a man given to promiscuity, someone who had had anonymous sex on innumerable occasions in movie theaters and restrooms for over a decade.  That would really have tested us.  Instead, the movie is saying that it is wrong to blame the victim, especially when the victim, while not being totally innocent like the mother who had a transfusion, is almost innocent.  In so doing, the movie makes it all too easy for people in the audience to congratulate themselves in how right-thinking they are in this matter.

After much testimony from various witnesses, the case is turned over to the jury for deliberations, if you can call it that.  All we hear is one man, presumably the foreman, telling the other jurors that the case for the defense does not make sense.  That’s it.  No one has a dissenting view.  In fact, no one else says anything, except to mumble agreement.  The closest thing we get to a dissent is when the jurors are being asked one by one how they stand on the issue, and juror number ten says, “I disagree.”  This is not supposed to be a jury movie, of course, like Twelve Angry Men (1957), where an Ed Begley character could express bigotry toward homosexuals or where a Lee J. Cobb character could reveal that his prejudice stemmed from the fact that his son was gay, before finally coming around to the proper verdict.  But surely they could have done better than what we got in this movie.  Alternatively, if time simply did not permit, it would have been better to leave out the jury-deliberation scene altogether.  That’s what most trial movies do.

Midway through the trial, Miller comes over to Beckett’s place to go over the testimony Beckett will be giving on Monday.  Instead, Beckett wants to talk about the opera music that he has playing.  Like most people, including me, Miller does not much care for opera.  Beckett explains what the opera is about and what emotions are being expressed through the singing.  The intensity of his performance is bizarre.  I don’t know.  Maybe if you are dying from a dreadful disease, you can get a little more worked up about things than you normally would, but it all seems to be a bit much.

While his overwrought description of the aria was going on, I could not help but think of the movie Pretty Woman, which is why I decided to discuss both movies in a single essay.  In that movie, when Edward takes Vivian to see an opera, presumably the first one she has ever been to, we see her crying during a particularly moving scene.  In other words, in both movies, a major character practices a form of sex that many regard as likely to result in contracting a disease.  And in both movies, these characters are deeply moved by an opera, as if to say they have such great souls that they can appreciate art in its highest form with a passion that we philistines, with our sexually respectable lives, can scarcely imagine.  It just wouldn’t have been the same if Beckett had been listening to N.W.A., explaining to his lawyer with great emotion, “And here is the part where he gets his sawed-off shotgun, and they have to haul off all the bodies.”

How Same-Sex Marriage Would Have Resolved a $22,222.22 Moral Dilemma

Did you ever wish you had a rich uncle?  Well, I once did. Unfortunately, because he was straight, he married a woman, and they had two children. So, even when I was just a lad, some sixty years ago, I knew I would never see a cent of that money: when he died, it would go to his wife; and should she predecease him, his children would naturally get it all.

As a result, when I received a call from a genealogist about ten years ago, saying that a mysterious relative of mine had died, and that I might be entitled to part of the estate, the thought of my uncle and his millions never crossed my mind.  Instead, I was waiting for the man on the other end of the line to get to the part where this mysterious relative had been a Nigerian prince, and that for a few thousand dollars, I could clear away one or two legal obstacles standing between me and a large fortune.  Much to my surprise, he asked for no upfront money.  Instead, he was willing to disclose the name this relative, and pursue the inheritance for me, for one third of whatever I got.

My girlfriend thought that I should find out who this relative was on my own, and cut this interloper out completely.  But that would have required effort on my part.  Besides, by letting him have a third, I knew he would be motivated to get as much for me as he could.  I believe it pays to be generous with one’s associates.  So, I signed the contract, and sat back and waited for results.

It turned out that he had also contacted three of my cousins with the same deal, and so we all signed the same agreement.  Now, I wondered why two of my other cousins, William and Sandra, were not included in the deal.  I started to mention them, but then it occurred to me that this might entitle them to an equal share, and whatever the inheritance was, I knew it would go further split four ways than six.  Besides, I said to myself, their father, the above-mentioned rich uncle, would be leaving them a lot of money anyway, so why bother them with more?  So anxious was I to suppress all thought of those two undeserving cousins that it prevented me from realizing that one of them might be the mysterious relative in question.

As it happened, my uncle and aunt had died some years back, unbeknownst to me (as you can see, we weren’t close), and that somewhere along the way my cousin William had died as well, the entire fortune going to Sandra.  I had only met Sandra once, for a couple of minutes, after which she excused herself and went to her room.  Consequently, I did not know much about her. And one of the things I did not know was that she was a lesbian.  From what I could piece together from various sources, she had fallen in love with a woman named Betty.  Since there was no same-sex marriage at this time, Betty would have had no legal right to any of Sandra’s money in the event of her death. To rectify this deficiency, Sandra made out a will, leaving everything to Betty. As so often happens, the glow of love faded away, and they started getting on each other’s nerves, leading to a breakup.  Soon after that, Sandra fell in love with a woman named Caroline, and soon after that a new will was drawn up, exactly like the first, mutatis mutandis.

When Sandra died, Caroline took it hard, but Betty took it harder.  There she was with a will in her possession, leaving her all of Sandra’s money, which, had the affair lasted just a little longer, would now be hers.  Sandra had spent most of it along the way, but there was still about two million dollars left, and Betty could not sleep for thinking about what had slipped away. Convinced that this prior will must be worth something, she hired a lawyer to contest the will that left everything to Caroline.  Caroline was unmoved. As she saw it, she had the more recent will, and there was no need to let Betty have a dime. Things bogged down, and Sandra’s estate was frozen, with neither Betty nor Caroline able to put her hands on any of it.

Betty’s lawyer got creative, and asked the above-mentioned genealogist to search for missing heirs, in hopes of further complicating the case, thereby forcing Caroline to be reasonable. It worked.  He found four cousins, including me, and through a lawyer associated with the genealogical agency, it was expressed that Sandra’s cousins were most distraught at her passing, were even more distraught at being cheated out of their rightful share of her estate, and were prepared to seek remedy before the court to see that justice was done.

Caroline was still of the opinion that the will left everything to her, and that was the end of it.  She did not appreciate some of the finer points of the law, which her lawyer was at pains to impress upon her.  With a trial by jury, he pointed out, anything might happen.  To put it crudely, they might wind up with several jurors who were of the persuasion that homosexuality was a sin, deserving more of punishment than reward, the result being that the money might all go to the cousins, and none to either Betty or Caroline.  “Pay the two dollars,” he advised her.  Well, make that two hundred thousand dollars, half to Betty, and the other half for the cousins.  Reason prevailed, and she made the deal.

None of this would have happened if same-sex marriage had been legal. Sandra would have married and divorced Betty, who would have received some kind of settlement.  Then Sandra would have married Caroline, who would have inherited everything with far less fuss.  Any large estate stands a good chance of being contested, but a spouse with a will leaving her everything is hard to beat.  Same-sex marriage would have given first Betty, and then Caroline, the same established rights and financial security mostly taken for granted by opposite-sex couples.  And that is the way it should be.

In the absence of same-sex marriage, however, Betty and Caroline were left to fight it out in a less certain arena.  And the difficulties did not end with them, for they extended even to the cousins. As noted above, one hundred thousand dollars was granted to us four cousins to divide among ourselves, with the genealogist getting a third of each.  At least, that is what it would have meant, had not fate intervened once more.  One of my cousins died just one week before the deal was made.  I figured that meant her husband would get her share.  That is because, like Caroline, I did not appreciate some of the finer points of the law, which cut the husband out completely.  That meant $33,333.33 for each of the remaining three cousins, or $22,222.22 each, after the genealogist got his cut.

I felt bad for my cousin’s husband.  By all rights, he should have gotten his fair share.  The proper thing to do would be for me to give him a portion of my own inheritance, and to suggest to my other two cousins that they do the same.  But then it occurred to me that if I were going to give any of the money away, I should give all of my portion to Caroline.  After all, Sandra wanted Caroline, the woman she loved, to have her money, and not some indifferent cousins about whom she cared nothing.  As I could not resolve the question as to who was more deserving, my cousin’s husband or Caroline, I decided to keep the $22,222.22 until such time as my conscience should guide me to do the right thing.  Moral dilemmas can be notoriously problematic, and thus the issue remains unresolved to this day.