By Joni Johnson

When we arrived at RVM in April 2019, my husband was just beginning to show signs of the Interstitial lung disease that had dogged him during the last three years.  And with each month he progressively got worse.  The last six months of his life got more and more difficult.  I never had to take on the traditional role of caregiver, but basically I took on the role of delivering things because he couldn’t get them any more, and being there for him more and more both emotionally and physically.  We were lucky in that we were able to talk about his dying and what he wanted and needed.  But it was very hard to watch him diminish physically with each passing week.

He was on Palliative care for much of the time we were here.  That meant that he had a weekly visit by a nurse, and earlier in our stay was able to get home physical therapy.  Palliative care is available for those patients who are still seeking treatment but need outside extra support.  According to cancer.net, the care can include prevention, early identification, comprehensive assessment, and management of physical issues, including pain and other distressing symptoms, psychological distress, spiritual distress, and social needs. Whenever possible, these interventions must be evidence based. Palliative Care was prescribed by Tom’s pulmonologist.  Tom’s connection to his nurse, who came every week to check up on him and give support, was wonderful for him, especially as he became more incapacitated.

About three months before his death, I was attending a party in Ashland when I suddenly got a call from someone who said that she was a Hospice nurse and the “palliative care team” had recommended that she call and let us know what Hospice was all about.  It freaked me out.  I was not as kind to her on the phone as I could have been.  Hospice to me meant that death was imminent, and while I mentally knew that we were heading in that direction, I was not prepared for it emotionally.  However, I did promise that I would talk to Tom, and if he were interested, we could set up an appointment.  I was expecting Tom to balk at the suggestion and was rather surprised that he thought it was a good idea.

When Nancy Heyerman, The Hospice nurse, came to visit, she explained to us the difference between Hospice and Palliative care. Basically, Palliative Care provides relief from the symptoms and stress of for people with a termal diagnosis regardless of their prognosis. The goal is to improve quality of life for both the patient and the family as treatment continues. Care begins after diagnosis and during treatment.  On the other hand, Hospice is for those who have decided that treatment is no longer beneficial, and the main goal is to provide as much comfort care as possible.  It is specifically end of life care when the patient has less than 6 months to live.  Under Hospice, the person must give up all of their treatments, which include specialists. A tremendous amount of medical support is available from the Hospice team, but none of it can be curative.  As Nancy said to me, “Statistically we know that patients who are on hospice live longer and more comfortably. Generally it is not ‘curative’, however patients often recover to a ‘non-terminal’ condition although their disease may still be present and we then discharge them from hospice care.”

For us, it would include a lot of free medication delivered to our door as well as ongoing nursing support and a Hospice physician for prescriptions and other advice.  We would be allowed to choose the one doctor we wanted to stay with, but Medicare would no longer pay for any visits to other physicians or any treatments or blood tests.  They would provide a hospital bed and some care options like help with showers and pedicures.  They also provide religious support through a chaplaincy service.  But we did not want to give up going to the pulmonologists nor give up the blood tests that let us know that his kidneys were doing fine in spite of the very heavy doses of diuretics.  So we politely declined.

As Tom’s condition worsened, I kept asking how long he had to live and how would his death manifest itself.  I spoke with the palliative and hospice nurses and also with Tom’s pulmonologist.  In the end, his pulmonologist recommended that he consider “death with dignity” as a last resort.  She confirmed that he could die from heart failure, which would be easier, but if not, the disease progression could be very difficult and he might want another option rather than to go through it all.  We did start all of the preparations for “death with dignity”.  Luckily, our primary care physician was willing to consider it.  And we asked the pulmonologist to be the second doctor.  Then it required paperwork plus two conversations with the doctor at least fifteen days apart that convinced him that this was a decision that Tom was making on his own.

The Hospice nurse again called us to find out if we wanted to meet with her.   Again, this call out of the blue was very disconcerting.  We were not ready.  We knew what it meant and we did not want to give up our options.

In the mean time, Tom’s condition was deteriorating more rapidly.  Two weeks before we had absolutely declined hospice service.   Suddenly, now, on a Sunday, we decided that we were ready.  We realized that there wasn’t much that could be done for Tom and his disease.  Now we wanted Hospice help.

What a wise decision.  Tom was home and never needed real care.  I had hired a person to come once a week from Care Team to give him whatever help he needed plus extra help for me.  We had long term care with a 90-day waiting period once the claim was made.  However, under Hospice, our long-term care company (CalPers) waived the 90-day period and started paying for our Care Team help, retroactively.  Nancy, from Hospice, appeared on our doorstep on Tuesday, and by Wednesday the contract was signed and that night we had a knock on the door with small doses of liquid morphine, Oxycodone and all sorts of other medication.  We had access to Nancy by phone and text.  We had access to 24 hour support through their telephone number which was invaluable.  Tom got his pedicure and we had a wonderful talk with the chaplain even though Tom was a died-in-the-wool atheist.  There was support for me if I needed it.  Luckily, I had been seeing Linda Bellinson for quite a while, so I had my own support already in the works.  So for the three + weeks before his death, we got the amazing treatment and support that Hospice provided.  It was quite wonderful.  Even the morphine was helpful on occasion to help his breathing.  Tom was lucky in that he was never in pain.  If he had been, the medical support would have been even more amazing. And luckily, his death came very quickly and easily.  I am not even sure we knew he was actually dying until the last few hours.

Am I sorry that we didn’t go to Hospice sooner?  We weren’t ready.  But, it was wonderful to have that amazing service at our doorstep. And after Tom’s death, they were still providing support.  I could have had individual counseling.  Covid messed up their groups but that is in the works for the future.  People called to make sure I was ok. Another benefit, if you are under Hospice care, when your loved one passes, Hospice calls the funeral home and therefore an ambulance or firetruck does not appear at your doorstep.  Tom was picked up in a large SUV. No markings.   When people say that Hospice is wonderful, they are right.  If you have any questions, please feel free to call me at 6150.  I can’t say enough about their help and support.

FOR THE COMPLEMENT!

 

OK, folks, let’s have a little chat.  You read the Complement.  You may even enjoy it — some people tell us they do.   And it is a giant freebie — no subscription, no ads, nothing more arduous than clicking a link on your computer.

All of this wonderfulness is brought to you by a handful of core staffers, supported by another handful of pretty regular contributors.  Dedicated, selfless, inspired volunteers, to a person.  And like most volunteer groups they are stretched very thiiiiiin.

This is where you come in, or where you should come in if you have an ounce of community spirit and another ounce of minimal skills.

We’ll deal with your shabby excuses later, just read the pitch first:

We need reporter types, to think up and chase down stories and features.

We need editor types to (1) make sure that the reporter types are comprehensible and (2) pay attention to format and design and layout.

We need backstage boffins to get in and manipulate the software to make everything beautiful and effective.

Based on considerable experience with volunteer activities, let’s dive right in and dismiss a number of very well-worn excuses.

1.  “I travel a lot.”  Big deal, so do something useful while you are at home.  We’re looking for people to be part of a team and back each other up so the rest of us can take vacations too.
2.  “I don’t know anything about (fill in the blank)”  If you think those of us putting out the Complement arrived on the job perfectly qualified by training and experience, think again. And again, and again.  We figured it out from the ground up, are still doing so, AND WE CAN HELP YOU LEARN.  They say such activity is good for the ageing mind, AND, for a very special bonus, it’s FUN!
3.  “I’m just too busy!”  Doing what?  Slurping coffee in the Bistro?  Trying to decide on y our next library book?  Playing games?  Give yourself a break and try something that produces a real product that other people appreciate.  Challenging, but very gratifying. We are  team that really enjoys working together — come join the party!

Full-time commitment not required, just a reasonable degree of reliability.  Contact one of the staff, or email openinforvm@gmail.com. Soon.

The staff:  Bob Buddemeier, Joni Johnson, Connie Kent, Reina Lopez, Diane Friedlander, and Tom Conger

By Bob Buddemeier

From the Welcome section of the 2021 Resident Handbook:

“Your Residence and Care Agreement sets forth the obligations of Rogue Valley Manor to you. That agreement also requires you to abide by all of the policies, rules, and regulations of Rogue Valley Manor, including those set forth in this handbook, all of which are subject to change.”  (emphasis added)

Some residents are probably not aware that distributions of updated handbooks are the only notice they will receive of changes to the policies and contractual agreements under which they are living.  Handbooks have been issued in Fall 2013, June 2017, March 2020, and September 2021.  Over that period there have been many changes at RVM and in the world around us.

While most people justifiably regard a history of rules and regulations as little more than a good cure for insomnia, there are important lessons to be learned by comparing where we are now with where the various cohorts of residents started out.

We will take a look at how four topics evolved over the course of the Handbook editions – two fairly trivial but directed toward resident behavior, one significant past transition, and a more recent, potentially controversial change.

A note of caution: The material that follows is the product of the author’s judgment and interpretation. Each reference is identified by date of handbook, page, and paragraph.  All of the handbooks are posted in pdf format and available for reading online or downloading.  This allows the readers to verify quotes and descriptions, to form their own opinions of the handbooks, and to explore for topics of interest.

To access the handbooks, click the appropriate link below.  The file will open in a new tab on your browser; in order to return to this document, simply close the tab.

2013 Resident Handbook

2017 Resident Handbook

2020 Resident Handbook

2021 Resident Handbook  (also available on MyRVM)

1. Smoking

Those of us who arrived before 2017 found that both our Agreements and the Handbook explicitly authorized smoking in many of the residences – a provision that changed progressively over time.

SMOKING – 2013 (p.76, para. 6):  “Smoking is permitted only in Cottages and Skyline Plaza apartments. No smoking is permitted in any area of the Manor, Manor Terrace, or licensed areas. Residents who smoke in Plaza apartments may be required to purchase and use an approved air filtrations system for the apartment if the smoke affects other residents on that floor. Also, never smoke in bed. Smoking in bed puts everyone at risk.”

SMOKING – 2017:  “Smoking is permitted only in designated areas. If you have questions related to the designated smoking areas on the RVM Campus please contact Resident Services at EXT. 7392.”

SMOKING– 2020 (p.60, para. 8), and 2021 (p.67, para. 4):  “RVM is essentially a smoke-free campus. Smoking is permitted in designated outdoor areas only. No smoking is permitted within any buildings.”

This provision continues in the 2021 edition.  No mention is made of vaping.

2. The Dress Code — A long-running tempest in a teapot –

A reliable source of heated discussion whenever there is a complaint, the dress code tends to lie dormant with gradual evolution in between debates.  There have been two components.

In 2013 and 2017, there was a dress code for public areas:

“DRESS CODE FOR PUBLIC AREAS — 2013 (p.68, para.1):  Residents are required to dress appropriately when leaving their apartments or cottages. Inappropriate attire includes robes, wrappers, and swimwear. This applies to all public and/or common areas of the Manor, Manor Terrace, and Plaza, including hallways and elevators.”

This provision disappeared from the 2020 edition, and has not reappeared.

A more consistent feature has been the Dining dress code:

DRESS CODE FOR DINING  — 2013 (p. 19, para.5) : 6 paragraphs, 21 lines devoted in large part to acceptable and unacceptable items of clothing.

The Dress Code for Dining was essentially the same in 2017, and basically the same in 2020 (p. 40, para. 7).

In 2021 (p.45, para. 1):   The most recent dress code statement has been reduced to 13 lines and three paragraphs, with almost all of the list of forbidden dress items removed.  It relies much more on qualitative appeals to good taste.

The 2021 Code is extremely non-specific making one wonder if it is enforceable, and if so, how and by whom.  The handbook says “Failure to abide by the dress code may result in being asked by dining staff to leave the dining room and return in appropriate attire.” (2021, p. 45, para. 3).

This seems reasonable in terms of authority and responsibility for the facilities, but it’s at odds with the assertion that the Dress Code is the will of the residents, expressed via the residents Council.  Since it’s not clear who is in charge of the Code, it’s probably fortunate that the issue of enforcement seldom arises.

3. Contract and Residency Agreement

From the 2013 Resident Handbook, Fall 2013, p.1, para. 3:   “Your Residence and Care Agreement (Residency Agreement) sets forth the obligations of Rogue Valley Manor to you. That agreement requires you to abide by all of the policies, rules, and regulations of the Manor, including those set forth in this handbook, all of which are subject to change. If anything in this handbook should appear in any way to conflict with your contract, your contract prevails. “  (emphasis added)

The 2017 Handbook, June 2017, p.1, para. 2 contains the same paragraph, without the underlined sentence.

Resident Handbook, March 2020, p.10, para. 4.

Contract, Handbook, and RVM Management

“Rogue Valley Manor and PRS are also related organizations, with PRS serving as the ‘parent’ and sole member of Rogue Valley Manor. As the sole member of Rogue Valley Manor, PRS has the exclusive authority, as set forth in Rogue Valley Manor’s Bylaws, to appoint the Board of Directors for Rogue Valley Manor, and to make certain decisions on behalf of Rogue Valley Manor. Some of these decisions (e.g., approval of budgets and fee adjustments) may affect the Community and your Residence and Care Agreement. Rogue Valley Manor’s Bylaws, including the reserved powers of PRS are subject to change by PRS from time to time. “

(Note:  underlined sentence specifically mentions, but does not limit, changes to the Agreement)

The 2021 Handbook (p. 10, para. 3)   contains essentially the same paragraph as 2020 with added reference to the Residents Council appointment of Directors.

——————————————————————————————————————

The roughly 70% of the residents who entered prior to mid-2017 should be aware that their Residence and Care Agreement may not now mean what it did when they signed it.  From 2020 on, if not before, PRS has the power modify the agreements, with distribution of a new edition of the Handbook serving as the only notice in some cases.

4. Firearms

In the 2013 and 2017 documents, there is no mention of firearms

FIREARMS — In 2020 (P. 59, para.5) and 2021 (p.66, para. 1), the following statement appears

“For the safety of everyone, firearms are NOT permitted on the premises. This policy applies regardless of whether the person has a permit to possess the firearm or whether it is otherwise legal to possess the firearm. Any resident possessing a firearm must store it offsite. Any non-compliance with this policy may result in termination of residency.”

———————————————————————————————————————

Without entering into the politically charged issue of firearm ownership, it seems worth pointing out that many US citizens own guns.  This is likely also to be true of RVM residents, so some number of us are in violation of a significant policy.  A conversation with one new resident indicated that the prohibition was never mentioned by Marketing or in any of the intake processes.

The Bottom Line:

Changes in the Resident Handbook are not accompanied by notices to the residents (other than distribution of the new edition) or public discussion.  The Handbook is long (70+ pages) and covers many topics, some of which will be of little interest to many residents.  Its organization varies from edition to edition.  However, the significance of some of the changes (e.g., “…non-compliance may result in termination of residency”) suggests that a careful reading of the handbook is worthwhile.

Moral of the story:  Read your current Resident Handbook.  You may find something interesting, or even important.

by Bob Buddemeier

Not long ago, I had some replacement body parts installed. As often happens, this was followed by a modest procession of helpers to supervise the breaking-in period.  One of these, the instigator of this story, was a nurse and self-proclaimed safety advocate.

“When was the last time you fell?” she asked, which many people in the health professions seem to feel is the most appropriate gambit for starting a conversation with an older person.  Well, if we discount that very minor episode involving the cat’s leash, it has been quite a long time.  When so informed, she persisted “What would you do if you fell and [more ominously] couldn’t get up?”

“I’d crawl or roll to the bathroom and reach up for the string on the alarm switch,” I said.  As you probably can guess by now, she had a story of a client whose hip was so badly shattered that she couldn’t even crawl.  She followed up with, “You should have a fully charged cell phone with you at all times.”

That gave me an opening to regain a little ground in the game of Disability Chess.  “You mean when I get up in the middle of the night to go to the bathroom half-asleep in the dark I need to have a cell phone in the pocket of my jammies, and be able to get it out and turn it on and dial something?  I can barely do that in the daytime when I haven’t fallen.”

She fell back tactically, but continued to hammer away on the strategic point of having emergency notification capability readily at hand.  Which I admit is not a bad idea, even if it did start off as somebody else’s.  So I made conciliatory noises, and when she left, swung into action.

If you go onto MyRVM a-a-a-all the way over to the far right of the menus bar (Emergency Preparedness), open that page, and then scroll about half-way down the right side, you come to Emergency Pendants.  I called in a work order for one.  The next day Rick Ramirez showed up with two options, neither of which looked like the pictures on MyRVM.

One option was a necklace with TWO pendants – an old-fashioned push-the-button one and some sort of new-fangled accelerometer that detects when you are falling.  I reflected on how much fun it would be to wear that to bed and tangle it up with my CPAP fittings, and quickly decided on the bracelet.  Two days later Rick was back with the bracelet – a demo, a test, and bingo, I’m one button press away from safety, for fifty-ish dollars.  If my left arm is not broken too badly to push on the bracelet.  I guess there’s always some loophole.

Where does it work?  On campus, but not in the gardens or on the golf course.  If you’re at home it knows exactly where you are, but if you’re out among the cottages and hit the mayday button, you get triangulated by sensors that are about on every third building, and should be able to place you within a quarter-block or so.

PS-1:  The Revenge of the Pendant – Rick told me to just throw my original necklace pendant in the trash when I found it.  I did, on Monday, and early Tuesday morning got a call from Jens Larsen about an emergency signal from my cottage.  No explanation, until I realized that this was about the time when the garbage truck was compacting the trash in my area.  A technological death rattle.

PS-2:  Don’t believe everything you read – MyRVM says the bracelet is waterproof; Rick says water resistant, not waterproof (= shower but not pool).  Worth paying attention to, since I suspect that the only way to tell if it has drowned is to press the button without a result.