Predicting the Future: Part 2

Since writing Part 1 the other day, I had a conversation with someone who asked what I planned to do in the long run with respect to Kate’s care. I told him that was a good question and gave him the following answer.

My desire has been and still is to keep her at home. There are several things that have influenced me to feel that way. First and foremost is the fact that three of our four parents remained at home. After Kate’s father had a stroke, he required round-the-clock care. Kate’s mother learned of someone who could move into their home and provide that care. Her father only lived four months after the stroke. That arrangement worked well. Her mother had a series of TIAs that led to vascular dementia. That also led to the need for 24/7 care. Through their mother’s friends, Kate and her brother, located someone who moved in with her and supervised three shifts of people who provided the needed care. After a year or two, the friend who had moved in to serve as a supervisor had her own health issues. That is when Kate and I brought her to Knoxville to live with us. She lived with us five years and three months with round-the-clock care provided by shifts of CNAs we engaged through an agency.

During this same period of time, my mother was diagnosed with dementia. My dad did not have the same financial resources as Kate’s parents, nor did he have the inclination to have help in their apartment. My brother and I tried any number of times to engage in-home care or to move them to an assisted living facility. Dad tried in-home care but didn’t like it. He ended up caring for my mother at home the entire time. The only help he did accept was an adult day care center. He dropped Mom off every Wednesday morning so that he could attend his Kiwanis meeting and shop for groceries. I regularly brought in meals the last year or two. Before that Dad shopped and cooked on his own. I have a new-found respect for him now. He said next to nothing about any problems he had taking care of her. I was able, however, to observe the toll it took on him. I was quite relieved to discover that he bounced back after her death. He even had a significant other who developed vascular dementia and cared for her until her death. Dad lived 11 years after my mom died and 4 years after his significant other died. He was quite a man and caregiver.

With that background, I was naturally inclined to keep Kate at home. If Dad could do it, I could as well. Besides we have long-term health insurance that will cover a large portion of the financial costs. Dad didn’t.

Since Kate’s diagnosis, I have learned much more about dementia and caregiving. I’ve read a lot of books written by caregivers. I have also followed several different forums for caregivers of PWD. It has also been almost 7 years and 8 months since the diagnosis. I’ve had vastly more personal experience as a caregiver than I had with our parents. All of that gives me a better grasp of the challenges to be faced than I did before. For quite a few reasons I have mentioned previously, I’ve had the good fortune of having a load that is  lighter than that of many people in my shoes.

That leads me to an important conclusion. I don’t believe there is one approach to caregiving that works for everyone. I believe that each caregiver has to assess the numerous ways to provide care. What are the pros and cons of care at home? Care at a facility of some type? Having a good idea of the options that are available will help the caregiver and family determine what is most desirable.

Then it is time to get practical. Do we have the financial resources available to have most or all of the options? (That rarely happens.) How well-suited am I to play the role of a hands-on caregiver? If I want to bring caregivers into the home, should I go through an agency or try to hire and manage caregivers? In either case, what kind of manager would I make? Am I ready to have people in the home 24 hours every day. What about my own family situation? What other responsibilities do I have? Am I employed now, or will I have to continue working to meet expenses?

Caregivers also need to be honest with themselves concerning their own personalities and those of the person needing care. Some people are natural caregivers. Others are not. Most of us fall somewhere in between. I continually ask myself the questions above. So where does that leave me? My desire has always been to keep Kate at home for the the entire time. Am I beginning to have reservations as she enters the final stages of her illness?

My current answer to those questions is that I am still optimistic about staying the course. Nothing new has happened to change my mind. On the other hand, I continue to keep all my options open. I do that because I don’t know what lies ahead. Kate has been very easy to care for up to now. Based on the experience with my mother and Kate’s mother who were also easy to care for, I believe Kate’s attitudes and behavior will continue to be very much like theirs. I should also add that I have never thought of providing all of her direct care myself. I have always intended to work through an agency who will provide 24/7 care. Thus, I am optimistic, but I believe I will always keep an open mind concerning what is best at the time.

Looking Ahead and Making Changes

During the course of Kate’s illness, I’ve always tried to anticipate the future and make necessary preparations. With her changes over the past few months, I’ve been doing a few things that I have held off for some time. The biggest one involves the yard. A year or two after Kate began her “extreme pruning” activity, I began to wonder about the long term impact it would have on the shrubbery. At first, I thought it might be beneficial, but it would come at a time when she could no longer appreciate it. It wasn’t long after that when I suspected the shrubs might be permanently damaged. At the time, she had three things that occupied her time – pruning (“pulling leaves”), editing photos for a photo book on her computer, and working jigsaw puzzles on her iPad. Pulling leaves was her major activity when weather permitted. She could spend as long as 6-8 hours a day in the yard. Because she seemed to enjoy it so much, I made a conscious decision to let her pull leaves as much as she wanted even if it meant having to replace the shrubbery.

When this past spring arrived, it became clear that most, if not all, of the shrubs would have to be replaced. I didn’t want to move too quickly. I thought it might bother Kate. I didn’t want her to feel guilty. I realized she might never make the connection between her pruning and the demise of her shrubs. On the other hand, I didn’t want to risk it. Two or three months ago, I hired someone to start the project. I wanted it to be gradual so that Kate wouldn’t notice. He began by cleaning out the weeds. That’s been a big job. He is still working on that. He has another fulltime job, so he only works on Saturday. Along the way he has taken out four or five good sized shrubs. There are probably another twenty that will have to go. I think we should have the clean up done in the fall. Then we will look at planting new shrubs.

I have been surprised that Kate has had no reaction at all. She has seen the man and his wife working in the shrubs and hasn’t expressed either interest or irritation that I’ve initiated this without consulting with her. In addition to the cleaning out the flower beds, I asked them to use Kate’s existing pots for plants on our patio. I told Kate this was an anniversary present. I had hoped that she might take an interest and enjoy tending to potted plants as she has done in the past. This was an idea that flopped. It turns out that I am the one who tends to them. I really hadn’t wanted that, but that may be good therapy for me

For a long time, I have felt the need to do some serious work to the inside and outside of the house itself. I recently had all of the windows replaced. The next job is painting the outside. I’m going to wait until fall for that.

Our housekeeper passed away in April. Her daughter filled in for her until the end of July. Through a friend I found someone else. She started yesterday with a deep cleaning of the entire inside of the house. She brought a helper, and the two of them worked twelve hours. Like most people, we’ve accumulated a lot of “stuff” that we never use. I’ve spoken with her about helping me clean out a lot of these things. Chief among those are clothes that Kate will never wear again. Most of these are too small for her now. I’m going to feel better when we get organized again.

These changes are a direct result of the changes in Kate’s condition. I wanted to allow her to continue to be the one in charge of the house. That has been her role in the past. Of course, I recognize that I have gradually come to be the one to assume that role, but I haven’t wanted to do anything that I thought she might not like. At this point, I don’t think she will even notice much of what is done. A couple of years ago, I took out the tall entertainment center and the 42-inch TV in our bedroom and replaced it with a much lower cabinet with a 65-inch TV on top. I don’t think she ever realized the change. She never commented on it. By now, of course, she would not remember at all.

Memory is fading away.

As you have probably detected from my recent posts, Kate’s world is changing. Its getting smaller and smaller. As it does, mine changes as well. I am taking charge of things that just a short time ago, she was doing for herself.
This morning I had an example. She walked into the kitchen where I was working on my computer. She was dressed for the day. I got up to greet her. She said, “Don’t get too close. I haven’t brushed my teeth.” I said, “Well, you could do that now while I get your pills ready for you.” She said, “Where can I find the toothpaste?” I told her there should be toothpaste and toothbrushes in each of the bathrooms. Then I said, “Let’s go to our bathroom, and I’ll show you.” This was a first. She has been brushing her teeth in all three of the bathrooms for years. This goes along with her forgetting how to get ice out of the dispenser of the refrigerator or locating the cabinet that keeps her cups that she takes with her when we go to places like Panera.

When we got to the bathroom, she asked me to look at her top to see if it was on backwards. It was, and she started to take it off. I left the room. A moment later, she called for me. When I got there, she was tangled up in her top. She said, “Can you help me?” I took the top and identified the label in the back and then held it up for her to put arms into the sleeves. She took over from there. This was another first. She does have one long night gown that I have had to help her with several times, but this was an ordinary top similar to all the others she wears. Getting into her night clothes is beginning to be a challenge as well. It is not uncommon for her to start to put on her gown and then put on the clothes she was just wearing.

She is also being more careful to ask for my hand when going up or down curbs and stairs. She has tried to retain her independence with respect to that for a long time. She used to be offended when I tried to help her.

Yesterday she asked me more questions than usual. They were almost all the same ones I hear regularly. The difference was that they were repeated so often during the day. They mostly related to the names of her parents, my parents, and our children. Last night she again picked up the photobook her brother Ken had given her in May. She enjoyed it as much as the first time she had looked at it.

Although she doesn’t express any concern or frustration with these changes, the fact that she continues to ask and to look at her photobooks seems like a serious effort to retain some control of her life. I told her the other day that I would be happy to write down the names of our parents, children, and grandchildren as well as a few things like how long we have been married, places we have lived, and a few of the special things we have done during our marriage. She seemed to like the idea, and I have started with a few of the basics.

When I see changes like these, I always wonder about the future. I always have potential plans for things that may or may not come to pass. One of those has been another possible trip to Chautauqua. Last year I was convinced that going this year would be out of the question. More recently, I have thought that we might be able to go for just a few days rather than staying a full week. I have just about decided to stick with my original plan and not go.

This is our year to have Thanksgiving with Kevin and his family in Lubbock and Christmas with Jesse and her family in Memphis. It is too early to make a decision on either one of these. Right now I intend to make both trips, but I will have to see how Kate is doing as we get closer to the holiday season.

I think we should be able to continue day trips to Nashville for the foreseeable future. I might even consider an overnight trip to either Asheville. At the moment, I believe it is best to continue doing what we have done in the past – take it one day at a time.

Thinking About Long Term Care

Yesterday, one of the people I follow on Twitter posted something that caught my attention. She made the point that the decision about the best place to spend one’s senior years is a matter of personal choice. I share her opinion. What is best involves one’s personal preferences as well as the situation in which one finds herself. The research shows that seniors overwhelmingly prefer to remain in their own homes, but circumstances can make that impossible. As with so many things, “One size does not fit all.”

Kate and I have experienced that with our own parents. After her father’s stroke, Kate’s mother wanted to bring him back home. She discovered a man who had retired and had started providing in-home care. Although he was married, he moved into their home and provided 24/7 care. He was able to get away to run errands and visit with his wife who sometimes came to Kate’s parents’ home to see her husband. It was a unique situation that worked well.

A few years later, Kate’s mother had a stroke. In that case, she had a close church friend who served as a personal assistant for her mother. She knew about a woman that was retired and looking for a place to live. Kate, her brother,  and the assistant arranged for the woman to move into her mother’s house and serve as a manager of several caregivers who provided 24/7 care. That worked well until the manager developed her own health issues. At that point, Kate, her brother, and I decided to bring her mother to Knoxville.

Kate contacted a friend whose husband had recently passed away and asked her about the help she had used. Kate called the agency and arranged for five or six caregivers who provided 24/7 care for her mother in our home for almost 5 ½ years. Periodically, Kate and I were able to get away. When we did, her brother Ken came to Knoxville and stayed until we returned. That turned out to be a terrific arrangement for her mother and for us. Until the very end, she came to the table three meals each day. Although she was mostly non-communicative for most of that time, she was able to live in a normal home environment. We were glad to have her.

My mother had dementia. My father cared for her at home the entire time. My brother and I tried our best to get help for him. At one point, he accepted, but that didn’t last long. It really bothered him that much of the time the caregiver was sitting around watching TV or reading. He did use a day care center where he left my mother every Wednesday for four hours while he attended his Kiwanis meeting and did his grocery shopping. He was still driving, so he and my mother were not restricted to the house. Even in the latest stages of her illness, he took her with him whenever he went out. He was 89 when she died. She was wheelchair bound for the last one or two years. I was amazed that he would and could take her out so much. Her care took its toll on him, but it was what he wanted. He bounced back after her death and lived to celebrate his 100th birthday.

Seven years after my mother died, Dad had a stroke that affected his mobility and, for a while, his swallowing. He spent the balance of his life, almost three and a half years, in a skilled nursing facility. Although there were many things we didn’t like about that option for him, it seemed like the right thing. Even now I believe it was the best option. The major downside was that he was more mentally alert than 95% of the other residents. I tried to compensate for that by visiting him every day. In addition, he was a very outgoing person and had attracted a lot of younger friends who visited him periodically. He had been very active on email. That led me to create a distribution list of more than fifty friends and family with whom he had been communicating a long time. I wrote frequent emails using his email address and his name. Under his name I wrote, “And Scribe.” This brought him lots of responses that I read to him when I visited each day.

Given this experience, you might ask what Kate and I have planned for our future. The short answer is that we are like most seniors in that our preference is to remain at home if that is possible. We have long term health insurance that will take care of a substantial portion of the expenses associated with in-home care. Note that I said, “if that is possible.” I don’t know what lies ahead. We are familiar with the options available to us in the Knoxville area. There are at least two or three continuing care communities that I would consider if that seemed appropriate. There are also assisted living facilities, but I doubt that I would consider them, especially knowing that Kate is likely to need more personal care than they typically provide.

Kate and I were glad to have played a significant role in the care for all four of our parents, but we both agreed long ago that we would do what we can to minimize our children’s responsibilities. That could even involve a move from Knoxville to Texas or Virginia to make things easier for them. At the moment, I don’t see a move on the horizon, but I am not closing any of the possible options. As our situation changes, the most desirable options will likely change as well.

When I read the tweet that prompted this essay, I responded with my own tweet that said, “The matter of where to live for seniors is a big issue. Wouldn’t it be nice if seniors and their children worked together to make the appropriate choice?” I believe that’s a good idea. That is especially true in our case since our son is in the elder care business.

I’ve tried to keep both children abreast of our situation. This journal alone should do that. I have also made sure they are fully informed of our financial situation, something that most parents don’t think about in advance. In addition, several years ago, I put together a list of our doctors, attorney, accountant, insurance agent, banking information and medications. I am in the process of revising that information right now. We also have arranged the appropriate powers of attorney for them should I become incapacitated. I know our children are bound to discover some things that I have overlooked, but I believe our openness will make our children’s lives easier than they would have been if we hadn’t taken the proper steps to prepare for the future.

Good Visit with the Greeleys

Yesterday we went to Nashville for a visit with Greeleys. We arrived around 11:30. Jan prepared lunch for us followed a little later by Ben and Jerry’s ice cream. We had a great afternoon of conversation on many topics. It was refreshing that no mention was made of our current president who dominates the news these days.

As I probably have mentioned, Kate’s relationship with Scott extends back to the cradle. In fact, their mothers were good friends and pregnant at the same time. Although they didn’t live in the same town while growing up, their families maintained periodic contact during that time. As I understand it, the parents always thought it would be nice if the two of them became a couple. It just never happened.

Scott has, however, remained a very special friend to her. We have always had good visits with Greeleys. With this background in mind, I was eager for another visit. I was not disappointed. As it turned out, this was not just a good visit with them but another in a succession of good visits with friends in the past two weeks. Each of the couples with whom we visited are among our regular friends with whom we had had visits over a long period of time. It is a bit unusual, however, for us to visit so many of them in such a concentrated period of time. This was deliberate on my part. As I have noticed Kate’s transition to a time when her memory is even weaker than now, I have wanted to maximize her contact with our closest friends.

We went to dinner at Olive Garden before coming home. The Greeleys got to be a part of our lives at the end of the meal. Kate went to the restroom before we hit the road. I got up and went far enough with her that she could see the restroom door. Then I stood up beside our booth which enabled me to see Kate when she came out. Jan and Scott both got up and stood with me. As we chatted, we were facing the door to the restroom. It took a while for Kate to come out. Jan asked if she should go and check on her. I told her that Kate often takes a while and even mentioned waiting as long as twenty minutes for her to come out of the restroom on another occasion. We waited a little longer, and I conceded to Jan’s interest in checking on her. Jan came back and indicated that Kate wasn’t there. When she said that, I assumed she would be at the front of the restaurant waiting for us. The three of us headed there where we saw her seated at the bar drinking a glass of water. When she saw me, she calmly said, “I’m glad to see you.” I said, “I’m sorry. I let you slip by me.” That was all that was said. She got up from her chair. We walked over to the Greeleys and walked to the car. It was a good illustration of just how easily I can lose her. In this instance, we were in a place where we were not likely to experience any serious consequences; however, it reinforces my concern about traveling with her. On our previous trip to Lubbock, I got the locations of all of their family restrooms in the Atlanta airport so that we could use them on a future trip.

One week from today, we fly to Buffalo for our annual visit to Chautauqua, and no doubt our last. I will be especially attentive to how things go on the trip, both the travel portion and the time at Chautauqua. This will be especially influential in my plans for a trip to Fort Worth in mid-October. At the moment, I am doubtful that we will make it. I will make a concerted effort to do so as this would be Kate’s last trip home. In addition, it will be special because or grandson, Brian, will be a freshman at TCU this year. His family plans to come over from Lubbock. Kate’s brother and his wife also plan to come from San Angelo. It will be a special family time.

Event planning

As a caregiver, I sometimes feel that I am an event planner. As we begin this new year, I have been reflecting on ways to address Kate’s boredom. That has led me to take several steps this week. One of our church friends who has been in a memory care unit for the past 2-3 years had a birthday earlier this week. We have not been to see her in quite a while because I was concerned about how Kate would react knowing that she (Kate) is traveling the same journey as our friend. The visit went very well. Kate made no mention of any reaction to her condition. She had done so on the previous visit, but she hadn’t given any sign of being disturbed by how she was doing. This time she didn’t say anything except in response to my comment about being glad that we made the visit.

The next day we visited two of my Sunday school class members who have not been able to attend for as long as three years. Since our class disbanded in December, I wanted to deliver a couple of remembrances for each of them. One was a list of those who were members of the class when we ended (both those who were active and inactive) along with an acrylic square with the person’s name, the class name, and the name of our church on it. The other was a list of all the deceased members of the class that I a aware of. It totals 95. I am sure there are some that I have missed. I thought it might be a good outing for Kate to go with me. When I asked, she gladly accepted. We had an hour-long visit with one of the members. She is 93 and in far better shape than I realized. The other visit was much shorter. This person is also in a memory unit. She knew us the last time we visited six months or so ago. She did not this time. She was quite confused. We left as they were preparing for dinner. Once again, Kate made no comment that would indicate this was a problem for her. I was relieved. It makes me think that we may be able to do it again though I am going to wait a while.

There are still three other class members I need to visit. I’ll try to do that soon
I have also made plans for us to attend the last performance of Ringling Brothers circus when it is here next week. We are taking a church secretary and her daughter who have often looked after Kate’s plants while we are traveling. In addition, I have booked a hotel room in Asheville for Memorial Day weekend. This coincides with our 54th anniversary and is the time we usually attend Asheville. Our church choir is having a fundraiser on February 10. It will be a Italian dinner with music and a silent auction. I’ve put that on our calendar. The next evening Renee Fleming will give a concert  in Nashville. I am planning to get tickets to that event today or tomorrow. I have already contacted our friends, the Greeleys, in Nashville to see if they would like to join us or a least get together earlier in the day for lunch.

Yesterday I also called someone at the Alzheimer’s Association. I have spoken with her before about locating a support group for people with dementia (PWD). She still doesn’t know of anything but expressed a willingness to help me put one together. After speaking with her, I called a local senior center where caregivers can get a break and/or support. I thought maybe they might have something for PWD as well. It turns out that they do. They have some activities for PWD while the caregivers are in a support group. I spoke with the director who sent me a calendar with their activities. She invited me to drop by at any time just to look around. They have a café where caregivers and their loved ones can relax. I noticed on their calendar that they have a support group for caregivers and care receivers with early onset dementia. It meets the first and third Tuesday of each month. This may be our best bet yet. I am eager to check it out.

Couldn’t Sleep

Kate and I got to bed early last night (8:45). I knew I would wake up early. I just didn’t know it would be 3:30. I tried to get back to sleep but my mind kept thinking about Kate’s condition and the problem of her clothes and getting ready to go places. It makes me think that next summer life will be different for us. Since her diagnosis January 21, 2011, I have wondered how much time we have left when we can live a reasonably normal life. I am now seeing signs of the beginning of the end. I must admit that it frightens me.

We went in the pool around 6:30 last night. As we talked, she mentioned wanting to go to Ireland. We discussed doing that in early June 2015. Reflecting on that now, I am not at all sure that will work. If we go with a group, we will face the problem of needing to meet daily schedules that are likely to cause more panic attacks for her. If we go on our own, we face the challenges of travel from one location to another as I don’t think we can find a single location that will let us take day trips to all the places we would want to see. Being realistic, of course, it would be another trip like New Zealand in that we would go without any intention of seeing or doing everything. We could just find a place and stay there. I will do my research and come up with something.

We have often talked about staying at Chautauqua for two weeks rather than just one. Next summer could be the time. I had better look into that soon in order to get the accommodations.

I finally got up at 4:30. I figured that I could accomplish something rather than just lying in bed. It is now 5:05; so it is not far different from a rather normal waking time for me. I will probably shave and eat breakfast and then go for a walk around 6:00. That will still give me time to read the paper before we go to church.

Back Home and Taking Stock

We arrived back home from our trip to New Zealand on Thursday night, March 12. It was a truly fantastic trip, everything I had hoped it would be and more. Here are a few summary observations that are relevant to how Kate did on the trip and the state of things today.

Besides simply making the observation that the trip went well, I need to say that my guiding assumptions for the trip turned out to be correct. I deliberately chose for us to do the trip on our own rather than going with a group like Overseas Adventure Travel. I did this based on the fact that I felt under a good bit of pressure on our last trip with OAT to South America. There were so many times each day that we had to meet the group at a specific time that it put undue pressure on me to see that Kate was ready. That, in turn, put pressure on her that she does not like. Then we are both uncomfortable.

Second, I decided that we would go without any rigid plans other than the places we would visit and the lodging. I felt that we would do it in a leisurely way without worrying about trying to do everything. We would simply enjoy what we were able to do, and this is exactly what we did.

These two things made the trip go well. Even so, I felt a good bit of pressure during the entire trip. Prior to this trip I thought this might be the last trip of this type and duration. I am convinced of this now. It is simply too stressful for both of us. I think I will focus on more cruises in the future.

I am thinking this in large measure because of issues surrounding packing and unpacking her suitcase. This has been a problem for me on each of the recent occasions we have traveled. It is hard (no impossible) for her to plan what she needs to take with her. It seems she invariably doesn’t take enough underwear or socks. On the trip to South America and this one, there were occasions she wore my underwear and socks. When I tried to encourage her to take an ample supply of both of these items before the trip, she was resentful of my trying to tell what she should do when she feels she knows how to handle this kind of matter.

Prior to our packing, I did get her to agree that I would do the packing if she would give me the clothes she was to take. I noticed that she seemed to have a disproportionate number of pants and few socks and undergarments. To the best of my memory, she took 12 pair of slacks, 2 bras, 2-3 pair of panties, and 2-3 pair of socks. I bought her a duffle bag that had a bottom compartment in which I put all the slacks and a few other things likes blouses or jackets. I bought several packing bags in which I put all the others things in the top part of the bag along with 2 pair of shoes.

I did not expect her to remember where the items were, but I did want her to let me get things out for her and put them back. Nevertheless, she would start pulling things out of the suitcase. If she didn’t find what she wanted. she would throw the things on the floor. This meant that I was routinely re-packing. As the trip progressed, I was able to gain some control over this. I was never completely successful. I think this problem would be minimized on a cruise where we would not have to pack and unpack so frequently.

Even though our trip was leisurely there were times we had to be some place. That meant that there were times that I needed to prod her to get her ready. She moves very slowly and doesn’t like me to rush her. That is just as true at home as it is on a trip.

Additionally, there are many things she doesn’t understand. That can lead to problems when you are traveling. For example, in the Auckland airport, they have a line with a camera that takes a picture to match with your picture on your passport. This was new to me as well; so I didn’t realize until it was happening that I was having my picture taken. At any rate, I walked up to a doorway something like the security doorways at airports. There was a mark on the floor prior to getting to the doorway and a sign that asked that people wait behind that line until the person ahead was finished. Kate didn’t see it and walked up right behind me. The camera was “confused because there were two people. I got a message that they couldn’t clear me, that I would have to have special assistance. That meant that I had to go around another way and leave Kate to go through the line by herself. She was confused as to what to do. I had to coach her from the inside of the area where she was going.

The next time we went through equipment like this I was able to get through without any problem, but I think she moved while her picture was being taken; so she had to seek special assistance. Again, that left me on one side while she was on the other. Fortunately, there was visibility; so I could direct her where to go for help.

I also worried that we would get separated in some of the places we visited and knew that she would not know how to tell somebody where she was staying.

Despite these things, we really did have a great time and are looking forward to subsequent trips though they will be easier to manage than this one.

A Follow-up Talk With Kevin

Two days after I talked with the children, Kevin called to talk. He expressed his concern about Kate and his support for me. He wanted to let me know that he did not want to interfere with our own plans for the future, but that he felt given his work, he wanted to do whatever was best in the years ahead. He also sent a letter a few days later expressing the same sentiment. I sent him an email saying that I intended to be very open with Jesse and him and would send a letter to them after our return from New Zealand. In that letter, I want to let them know the situation a little more fully and to suggest that we work together but that I would like to take the lead at this time. My thoughts are that there is no urgency right now. I want them to know that we have talked about a move to a retirement community, probably here in the Knoxville area. I also thought about a move to Texas to be near Kevin should the need arise. At the moment I feel like that is what we will ultimately do although I am uncertain as to the timing. That would depend on my own health.

One other thing to note is that Kate has been especially sensitive lately. She believes that I don’t think she can do anything independently. Most of the time she is expressing herself in a light, almost humorous way, but underlying it, she is feeling torn between wanting my help and wanting to be independent. I frequently hear her say something like, “See I can be observant too,” or “See I can still do things for myself.” I am developing a concern that this may worsen before it improves. I know that eventually she won’t care.

Always New Frustrations

Thursday afternoon I bought Kate an iPad since her computer is in the shop again, and it seems that her computer is really a lifeline for her. When she is not working on a particular task like photo albums, she likes to play free cell. She also likes to get her email. I keep thinking that an iPad will be easier for her to use since she likes to use the computer in bed which can cause some problems with the connection to the power cord. That is why the computer is in the shop now.

A couple of times today she has had a problem doing simple things on the iPad. She simply can’t remember how to do things that she has learned recently. This goes back to earlier comments that it is the short-term memory that is the greatest problem. I try to help, but she hates to ask for help. She has expressed a lot of frustration today over her inability to do so many normal things.

In this regard, I am now in the planning stages of a family trip next summer to celebrate our 50th anniversary. After much consideration, it looks like we are going to either Jackson Hole or nearer to Yellowstone. It looks like a rather expensive trip between lodging and airfare for all of us, but I feel like this is a must and will be the only time we do anything like this. I am still uncertain of what Kate’s condition will be like after next summer. That is why I have arranged for the Galapagos trip next spring and the summer trip to Yellowstone.