Aug 30, 2014 7 min read

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Anna Snatchko, 86, of Burgettstown, flashes one of her trademark smiles at the camera.

Katie Roupe/Observer-Reporter

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After dinner, Anna Snatchko fiddles with oversized Legos and a deck of cards.

Katie Roupe/Observer-Reporter

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Anna Snatchko had ice cream with fruit after dinner one evening. When asked if she wanted to eat the fruit, Anna declined. When asked if she wanted ice cream, Anna was quick to say yes. Her granddaughter, Katie Fehl, topped the ice cream with fruit, and Anna ate it all without hesitation.

Katie Roupe/Observer-Reporter

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BURGETTSTOWN – Two weeks ago, Betty Brooks was enjoying the last hurrah of summer with her daughter and twin granddaughters on a pleasant Sunday afternoon at Kennywood.

But no amusement ride rocked her world half as much as the news she received the following day when she went to visit her mother at the Donnell House, where 86-year-old Anna Snatchko was spending the last of a three-day respite stay.

Not long after Betty arrived, a caseworker informed her that Anna no longer qualified for hospice care and would be removed from its program by week’s end. The doctor had changed Anna’s diagnosis from congestive heart failure to dementia, and he could no longer justify Anna’s participation in the program. His decision was based, in part, on hospice criteria that stipulates a patient must exhibit a weight loss of 10 percent or more in the last four to six months.

Betty was stunned.

“I cried. I cried for me,” said Betty, who is Anna’s primary caregiver. “I was counting on these days at home when she goes on respite care. Then it was pulled out from underneath me. I felt bad for me.”

The self-pity didn’t last long. When she awoke in the middle of the night, she thought, “What a hardship this is going to be on my mother. Whenever she gets sick, we’ll have to call an ambulance, and she’ll go to the hospital. They’ll dope her up. The worst part is, she doesn’t understand.”

The upshot of the decision, however, was much more far-reaching than Betty could have imagined. No longer would hospice provide prescriptions for two of Anna’s medications – Lasix and nitroglycerin, both prescribed for her congestive heart failure – and hospice nurses would no longer make home visits three times a week to check Anna’s vital signs or physical and mental well-being.

“I’m worried about her medications,” Betty said at the time.

In addition, a hospice representative stopped by Anna’s Burgettstown apartment two days later and took inventory of the equipment it had provided, and told Betty’s daughter, Katie Fehl, who shares in Anna’s care, that the hospital bed, wheelchair, walker and oxygen would be removed, as well.

Betty pleaded her case with the hospice doctor, mentioning that in mid-March hospice aides were instructed to stop giving Anna showers and bed-bathe her instead because of Anna’s physical limitations, and that sometimes when she feeds herself, Anna will freeze while the spoon is in mid-air because she forgets what she is doing.

But the doctor had no choice. He couldn’t ignore the hospice criteria.

Needless to say, the next few days were a whirlwind of activity for Betty as she juggled her mother’s care, made countless phone calls, filled out paperwork and visited the pharmacy, trying to make alternate arrangements for everything hospice had handled.

“They should have given me more time,” she said.

Betty’s first phone call was to Southwestern Pennsylvania Area Agency on Aging. Betty spoke with a caseworker with whom she had worked for years before Anna was placed on hospice, and she has guided Betty every step of the way. Betty learned she can register Anna with Washington Rides, which will provide safe, cost-effective transportation to doctors’ appointments, and AAA will provide a host of support services and case management.

In addition, Anna is eligible for 30 days of respite care per year. That’s half of what she was eligible to receive through hospice, but Betty never really took advantage of that until recently, when her husband had a cataract removed and she took a mini-vacation with her kids and grandkids in July. Betty also used three days in August just to give herself a break, and had two days lined up this weekend before Anna was removed from the program.

Betty took Anna on Thursday to a new primary care physician at Cornerstone Care to ensure there would be no interruption in Anna’s medical care, and Betty received some encouraging news. The doctor, Betty said, was surprised to learn that Anna was eliminated from the hospice program, citing her congestive heart failure, chronic obstructive pulmonary disease and severe dementia. She noted that Anna is “completely wheelchair-bound and incontinent,” and she recommended “looking into a different hospice.”

Also, the company that had supplied Anna’s medical equipment thought it prudent just to switch ownership to another company not affiliated with hospice to avoid removal of the equipment from Anna’s home. That, too, eases the burden on Betty.

Meanwhile, Anna remains oblivious to the turmoil, spending much of her day, as usual, eating and sleeping. As always, she continues to have her good days and her bad days, and never are they predictable.

One day, Betty said, Anna refused to take her medication, spitting out her pills and pulling hard on Betty’s neck and shoulders in defiance. The next day, however, while waiting for Anna’s ride to the Donnell House, they went for a walk on the trail near Anna’s home. Another day, they picked berries on that same trail.

Most of the days I’ve seen Anna have been good. She’ll greet me with her trademark smile and a mischievous twinkle in her eye, then start chatting away about nothing in particular. Sometimes, the words are garbled; other times, they are distinct and completely off the wall.

I visited Anna several times during her respite stays in late July and mid-August at the Donnell House. The first visit was quite entertaining as she regaled me with stories about playing softball. But her language at times was rather crass, and when I chastised her, she said, “I’m allowed to talk like that now.”

When I told her that Betty and I had lunch together earlier in the day, she said, “Oh, did you? Did Betty eat?” When I answered yes, she said, “That’s good.”

The next day, her daughter-in-law, Peggy, was visiting when I arrived. Anna was feeding herself pudding, holding the dish in one hand and spooning it into her mouth with the other. When Peggy would recall stories from Anna’s younger days, Anna became very talkative.

I’ve also witnessed some of Anna’s bad days, and most were at the Donnell House, away from her familiar surroundings. One of the worst experiences was the day after Peggy’s visit. Anna spent a lot of time staring vacantly at the blank walls, where she would “see” George, her deceased husband, or three “red, white and blue horses.” Once when I asked her what she saw, she responded, “Grandma Moses.”

Her most recent stay at the Donnell House, however, was by far the most troubling. Even Betty was taken aback by her appearance. Anna wasn’t wearing her dentures, her hair was disheveled, and she did not acknowledge my presence. For the longest time, she merely played with the hem of her hospital gown, trying to fold the bottom together.

Once she returned home and readjusted, she was back to being Anna. On one occasion, Betty and Katie were looking through old family photographs and news clippings, some of which brought outbursts of laughter. Anna laughed right along with them.

Another day, when Katie went to help Anna off the recliner for lunch, which usually involves Katie placing her arms under Anna’s armpits and lifting, Anna took one of Katie’s hands, got up, turned and sat in her wheelchair with ease. Another day, she “danced,” with Katie’s help, of course, her way into the wheelchair, breaking into a contented smile the moment she took her first step.