family, and her son arranged for a homemaker to help her while she recovered.
Assistive devices
During her recovery, Mrs. Martino was in a lot of pain. Her physician changed the type of painkillers she was on and also suggested she use some assistive devices. An assistive (or adaptive) device is a piece of equipment that assists the user in the operation of self-care, work, or leisure activities. Eyeglasses can be considered an assistive device. If an assistive device is deemed medically necessary, some insurers will cover the cost. For example, Medicare will pay for some medical equipment as long as the equipment —
• can withstand repeated use,
• is primarily and customarily used to serve a medical purpose,
• is generally not useful to a person in the absence of an illness or injury, and
• is appropriate for use in the home (e.g., wheelchairs, hospital beds, walkers).
Mrs. Martino purchased a tens (transcutaneous electro nerve stimulator) machine. This machine reduced the need for medication by using an electrical current to cut the nerve pathways for pain. With the pain under control, she could lie on her side for short periods and eat comfortably.
However, she could not raise her head to watch tv, nor could she hold a book. So, for entertainment, the library provided “talking books” that kept her occupied when visitors were not there.
As time passed, Mrs. Martino became troubled by her loss of sight. She could not play Scrabble anymore because she could not keep score. Her son bought her a large-tiled Scrabble board, but not being able to keep score or read the dictionary made playing too difficult. Her son also bought her a large tv, and she learned the remote control buttons by experimenting and just turned the volume up until she could hear. Bridge was becoming a problem, even with the large playing cards. Usually one of the four could see well enough to score, but even using the big cards were getting difficult.
Transportation
She was still driving her car but not during the evening, because she knew she could not see at night. She did not want to give up driving because it gave her so much independence. Actually, Mrs. Martino was a menace on the road. Many jurisdictions require people over the age of 65 or those with a medical condition to take a driver’s re-examination every couple of years. If you have trouble checking over your shoulder, or seeing at night or in poor weather, you may be putting yourself and others at risk.
It was past time for her to give up driving, but she had to make the decision herself. After an incident where she ended up driving on the sidewalk, she reluctantly stopped. It was one of the more difficult decisions for Mrs. Martino to make, and she was not used to spending money on taxis. However, over time she realized that there were some benefits to not driving. She could sit back and relax as a passenger, and she could save money by not having to maintain a car. Also, she learned that she could take her disabled parking permit with her to use for any vehicle in which she was a passenger.
Mrs. Martino was getting lonely and loathed cooking and eating by herself. Her son suggested that she contact her local health board and sign up for congregate meals. This would prevent her from being tied at home every day at noon to receive the volunteer and would also put her in contact with other people. Volunteers served the meals in an apartment common room a few blocks away from her apartment.
Because her blindness and chronic congestive heart failure prevented her from driving, Mrs. Martino qualified to use the local elder transportation service run by her health board. By making a phone call, she could book the minibus to pick her up and deliver her back to her apartment. They would also drive her to her medical or other appointments. The only problem was that she had to book the bus well in advance because it was often full.
Mrs. Martino liked eating with other people and enjoyed the good nutritious meals. When she couldn’t take the elder minibus, she took a taxi. Luckily, because her physician had assessed her unable to take public transport, she qualified for taxi savers and paid only half the cost of the taxi fare.
Private home support
Mrs. Martino still swam every nice day and had visitors. With the help of her son, they found a suitable cleaning person and he and his family had her over for dinner once or twice a week. During this year, she had another congestive heart failure attack. Luckily, her apartment neighbor heard her cries and called 911. She was taken to the hospital to be stabilized for a few days, then returned home.
After the heart attack, Mrs. Martino became weaker and needed more help. Her son called a private agency to hire a homemaker to supervise the bath and make two meals daily. The homemaker also did the shopping.
Mrs. Martino was not pleased with the arrangement because she still did not like to have strangers in her apartment. She resisted any formal help and felt that her son could give her all the help she needed. Her son felt otherwise. He explained to his mother that he wanted to be a son, not a caregiver, and he felt that having to do the cleaning, grocery shopping, and preparing meals when he came to visit cut down on their time together.
After a time, Mrs. Martino came to know and trust the homemaker, and the agency assured the son that the same person would be there daily. Mrs. Martino hated paying so much for help, but luckily the private home support agency was cheaper than the government agency through the regional health board.
Environmental support facilities
As Mrs. Martino became frailer, she needed to make environmental changes to her apartment to make things easy and safe. Getting in and out of the tub was a problem, so grab bars and a hand-held shower were installed in the bath to make it safer. Her son looked at the apartment to see how barrier free it was. With a few exceptions, it was almost barrier free: the step-off platform on the balcony and the sliding door tracks to the balcony were not recessed. Her son installed a sloping cover on the raised door tracks to make the balcony accessible, and a small ramp on the raised step-off platform of the balcony allowed her to water her plants.
If the hall furniture was removed, it was wide enough for a wheelchair or walker. Neither the kitchen nor bathrooms were designed to accommodate a wheelchair. However, the master bathroom had room to transfer from a wheelchair to the toilet.
Private personal care homes
In her 87th year, Mrs. Martino was having a difficult time. She hated not being able to see, she was tired all the time, and if she did any kind of activity, she was short of breath.
She looked into a private personal care home nearby where she had some friends. Personal care homes are private, nongovernment-supported institutions of more than three people that provide some nursing care to clients (usually less than a half-hour per client per day). Because the facilities are private, they are usually fairly expensive.
This private facility had independent living with congregate meals. Mrs. Martino thought it would be nice to have her meals provided and a place to entertain. If she got sick, she would receive 24-hour nursing care in a special area until she got better. Unfortunately, if she deteriorated until she could not walk and was assessed at an extended care level (see Chapter 3), she would be transferred out of the facility. This meant that she would not be able to age in place.
This private home called Mrs. Martino on a number of occasions to say a room was available, but she always declined in the end. A move was just too much trouble, and her son kept assuring her that
