Sep 27, 2014 5 min read

BURGETTSTOWN – Anna Snatchko is back under hospice care – at least for four months.

But her daughter and primary caregiver, Betty Brooks, will take it, and she is very grateful for it.

“I just needed more time,” lamented Betty, referring to the abrupt announcement last month when she went to visit Anna at the Donnell House during a respite stay that Anna would be removed from hospice care by week’s end.

The hospice doctor, Betty was told, could no longer justify Anna’s participation to the insurance company because her diagnosis was changed from congestive heart failure to dementia. Betty was shocked, then overwhelmed when she realized the volume of alternate arrangements that would have to be made for Anna’s medical equipment and medication in such a short period of time.

The following week, Anna visited her new physician at Cornerstone Care, who recommended the 86-year-old be returned to hospice care. After an in-home examination, a nurse practitioner from Heartland Hospice agreed. Heartland is affiliated with HCR ManorCare, which provides home health, hospice, skilled nursing, memory and post-acute care.

During the exam, Anna’s oxygen level dropped and her heart rate increased when her oxygen was removed for just 10 minutes. The nurse practitioner changed Anna’s diagnosis to Chronic Obstructive Pulmonary Disease. Anna has been on oxygen 24 hours a day for several years now.

The caveat with the hospice order, however, is that Anna will be re-evaluated in 2 1/2 months. That evaluation will determine whether the four months is extended. If it isn’t, at least Betty said it will give her six weeks, which is more than enough time, to change her mother’s prescriptions and medical supplies, if required, through Southwestern Pennsylvania Area Agency on Aging.

Anna also is scheduled for a brief respite stay through Heartland in November so that Betty, her family and friends can attend a purse auction Nov. 7 sponsored by the Observer-Reporter that will benefit the Alzheimer’s Association and caregivers through the Area Agency on Aging. Betty has been looking forward for weeks to the “Girls Night Out” at the Meadows Casino.

In the meantime, Anna’s demeanor has not changed much.

The day a representative from Heartland Hospice arrived to complete Anna’s paperwork, Anna quietly sat in her recliner, oblivious to all of the activity in her small Burgettstown apartment. Her son, Larry, who is Anna’s power of attorney, and his wife were there, as were Betty and the Observer-Reporter.

Anna rarely spoke, even when others tried to engage her in conversation. But when she saw the Heartland representative, she did say, “I want to go with him.” During lunch, Betty had to help feed Anna, who paused repeatedly while trying to spoon food into her mouth.

After switching to Heartland, Anna also received a new wheelchair that is lower to the ground. It prompted Betty to do something she’s been wanting to do for months: take her mother outside so Anna could put her feet in the grass. Anna hasn’t been barefoot in the grass for years.

Betty said Anna showed no reaction, but it certainly did warm Betty’s heart, much like the early-morning comments Anna sometimes makes when she is most alert. It’s almost like old times, when mother and daughter were best friends and shared their secrets.

“The other day she said, ‘It’s time for me to get up and get a shower,'” Betty said. “She’s lucid in the morning, and I like that.”

The evening is often a different story, and despite living with her mother’s dementia for years, Betty sometimes continues to feel her way around, making adjustments until she finds what will work best in certain situations.

One evening when Betty was trying to get Anna to sit on the toilet before bedtime, Anna would not cooperate, refusing to grab the wall bar. When Anna becomes obstinate, she is very strong.

At one point, when Betty was trying to manuever Anna on to the commode, Anna’s foot slipped and she fell, and Betty could not budge her. She called her niece, Kara Snatchko, who is sharing caregiving duties part time again with her aunt and Betty’s daughter, Katie Fehl, and Kara helped Betty lift Anna off the floor. Anna sustained several scrapes and bruises in the fall, but the bruises had faded by the time of my next visit. Betty has decided to change her mother’s diapers and clothing earlier in the evening.

More recently, Betty said, Anna keeps repeating one phrase, and it bothers Betty. “She keeps saying, ‘You’re not going to leave me, are you?'”

Each time, Betty reassures her mother that she will never leave her.