Still a Teacher

Anyone in education knows that this time of year is busy, stressful, and exhausting. That would describe my last few weeks, although this past week offered enough time for me to see Billy each day. The week before was packed, and I didn't see him from Monday until Friday - a long time for him and for me. 


This week was a good one for Billy also. He interacted with us each day, and he was usually happy. According to the nurses, he's had more anxiety than usual this past week and required more medication for it. By the time I saw him in the evenings, he was usually calm except for one night. He was worried or concerned, but he could never articulate what it was. When I spoke with the evening nurse, he said that one of the other residents had followed him around all afternoon, and that seemed to agitate him. It's so hard to communicate with him now, and that's frustrating. Our conversations are superficial at best, but it's always important to him that I know how much he cares for me. 


In the last few months, several people at the nursing home have asked what career Billy had. He's always been there when they asked, and I would say, he was a teacher. Each time, Billy corrected me and said, "I still am." The same thing happened tonight as we had dinner with some long time friends. Billy has known them since he was a child, and we all ran around together as young married couples. We moved away from the area when our kids were very young, and after twenty years in another part of the state, we returned to this area. When we left the area, Billy was in management with a retail nursery that transferred him, and when we returned he had been teaching school for some time, and they asked him how long he had taught school. He was very quick to say, "I'm still teaching." I remember the time when Billy knew he had Alzheimer's, and it was so hard for him. He was angry and frustrated, and he really didn't believe he needed to quit teaching. We've reached a point where he doesn't know, and I think it's easier for him. 


Billy's been living in the nursing home for almost four months, and in that time, his cognitive level has declined so much, but he's strangely happier. Several factors play into that I believe. His life is much more routine. He has a set schedule every day, and he doesn't have to be concerned about how he will get somewhere. No more riding the bus or being concerned about getting picked up. He also has constant medical supervision, and that has helped get his medications where they work more to his benefit. When he came to live here in January, he still had some grasp on reality, and as the disease progresses, he is less aware of reality. While that saddens me, it also relieves some of his anxiety. 


I've not mentioned the financial side of this disease in a while. Billy was accepted into the nursing home on Medicaid Pending status which meant that the financial director of the home felt confident that Billy would definitely qualify for Medicaid benefits, and that when we could apply and he was accepted, the nursing home would be compensated for the time he's been there. The only part I would have to pay would be his applied income which is basically most of his annuity he receives from Teacher Retirement System of Texas. It's not much, but it has certainly helped make ends meet since the time he had to quit working. It helped with his daycare costs, but it didn't come close to covering it all. I turned in my portion of the Medicaid application along with required documentation in March. The nursing home financial director actually submitted the forms (as is the practice), and he submitted the information they are required to turn in. I received a call about six weeks later from the person who was processing the application. She told me that this was the only application she remembered processing that had all the documentation needed from the family - in our case it was 100 pages. However, the nursing home had not given them a form to document that Billy's entrance into the nursing home was a medical necessity. She had tried to reach the financial director to have that submitted and had been unable to do so. She was calling me to ask why Billy is not on Medicare. I got to tell the long story of why Billy's not on Medicare (or social security disability) AGAIN! Of course the VAST majority of residents in a nursing home - no matter the age - are on Medicare, and if you are on Medicare, the transition to Medicaid is basically showing you have financial need. Because Billy is under age 65 and does not receive Medicare, he must have this letter showing Medical Necessity. She told me that it appears that Billy does meet the financial qualifications for Medicaid benefits, but without the very important missing document, it would be denied. About a week later, I received a letter denying Billy Medicaid benefits. I can apply again, and if all the paperwork is correct, he should qualify. I have to fill out the application again (about 10 pages), but I do not have to submit the documentation again. I remain hopeful. Frustrated and weary - but hopeful.