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</o:shapelayout></xml><![endif]--></head><body lang=EN-US link="#0563C1" vlink="#954F72"><div class=WordSection1><p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri",sans-serif;color:#1F497D'>Sorry, this is late but I thought I sent it early this morning…looks like it only went to Leonard. See below. Marcia<o:p></o:p></span></p><p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri",sans-serif;color:#1F497D'><o:p> </o:p></span></p><div><div style='border:none;border-top:solid #E1E1E1 1.0pt;padding:3.0pt 0in 0in 0in'><p class=MsoNormal><b><span style='font-size:11.0pt;font-family:"Calibri",sans-serif'>From:</span></b><span style='font-size:11.0pt;font-family:"Calibri",sans-serif'> Marcia Wick [mailto:marciajwick@gmail.com] <br><b>Sent:</b> Thursday, January 23, 2020 9:19 AM<br><b>To:</b> tuchyner5@aol.com<br><b>Subject:</b> Marcia's January submission<o:p></o:p></span></p></div></div><p class=MsoNormal><o:p> </o:p></p><div><p class=MsoNormal>Documentable Decline<span style='font-size:11.0pt'><o:p></o:p></span></p><p class=MsoNormal>Marcia J. Wick, The Write Sisters<o:p></o:p></p><p class=MsoNormal>January 2020<o:p></o:p></p><p class=MsoNormal>Word Count: 719<o:p></o:p></p><p class=MsoNormal><o:p> </o:p></p><p class=MsoNormal><o:p> </o:p></p><p class=MsoNormal>Medicare requires that a doctor determine a body could die within six months, and therefore is entitled to hospice care, also known as comfort care, at the end of life’s journey. My 95-year-old dad, a World War II B-24 navigator, has been receiving hospice care at home for 12 months, yet he is still alive. Considering that he has lived six months beyond the six months he was allotted, Medicare may withdraw hospice support unless there is “documentable decline” every 60 days moving forward.<o:p></o:p></p><p class=MsoNormal><o:p> </o:p></p><p class=MsoNormal>“Documentable decline?” <o:p></o:p></p><p class=MsoNormal><o:p> </o:p></p><p class=MsoNormal>During the year Dad has been on hospice), he has declined from using a walker most of the time to relying on a wheelchair all of the time. His master bed has been dismantled and replaced by a hospital bed which can be raised and lowered to help him sit up and eat when he can’t get out of bed. It’s equipped with a motorized air mattress to help prevent bed sores, and guard rails to keep him from falling out. His trousers and belt, shoes and socks, and jacket for the outdoors have been replaced by pajamas, slipper socks, and a fleece throw blanket. <o:p></o:p></p><p class=MsoNormal><o:p> </o:p></p><p class=MsoNormal>He used to shower daily; now he only tolerates the ordeal once or twice a week, peri-baths or bed baths occur more frequently. He used to assemble his own breakfast of toasted waffles, O.J., and hot tea; now he’s fed breakfast after waking at lunchtime, soft foods prepared by a caregiver. He used to sit outside on the deck or ride his stationary bicycle; now he stares at the screen saver without sound or the innocuous Hallmark channel on TV. News of the day has faded; confusion each day heightens. The vocabulary of the chemist, teacher, and author has been reduced to “How did I get here?” Dad’s world has narrowed. He worries that if he doesn’t know where he is himself, how will his wife know where to find him. We assure Dad that we’ll tell Mom where he is, without reminding him that Mom died more than two years ago.<o:p></o:p></p><p class=MsoNormal><o:p> </o:p></p><p class=MsoNormal>Dad’s hands and feet swell from inactivity; we had to call the Fire Department before Christmas to cut off the wedding ring he has worn for more than 70 years. Arthritis in his knuckle prevented its removal any other way. We’ve replaced Dad’s upholstered arm chair and ottoman with a remote control recliner to help elevate his feet and adjust his position when gravity scrunches him into a ball. The recliner also reverses to help Dad “stand,” now that he can’t do it unassisted. To help Dad transfer from the recliner to his wheelchair, one of us gets Dad into a bear hugs while one or two others hoist him by handles on a gate belt and perform unique dance steps to pivot 150 pounds of “dead” weight 90 degrees. Each day in this way, we transfer Dad from his bed to the wheelchair, the wheelchair to the toilet, the toilet to the wheelchair, and the wheelchair to the recliner where he drifts off to sleep. If his eyes open, however briefly, his children or caregivers offer beverages and nutritious snacks. Even though Dad is sedentary, he haven’t lost weight; with prompting, he picks up the sippy cup or spoon. Sometimes when finished, he plays with his food, pouring his juice into his soup, spooning his soup onto the tray. He wears a cloth bib to make cleanup easier. <o:p></o:p></p><p class=MsoNormal><o:p> </o:p></p><p class=MsoNormal>“Documentable decline?”<o:p></o:p></p><p class=MsoNormal><o:p> </o:p></p><p class=MsoNormal>Dad’s heart is strong. His blood pressure is normal. His oxygen intake is stable at 90 percent. Here’s the thing. If he no longer walks, he can’t walk less. If he’s incontinent, he can’t become more so. If most of his words have disappeared, he can’t lose many more. If he can’t bears his own weight, if he doesn’t recognize his children, if he doesn’t know his home of 40 years, if he doesn’t remember he was a mountain climber, what is there left to decline? As long as we feed him, he could linger this way for months or even years.<o:p></o:p></p><p class=MsoNormal><o:p> </o:p></p><p class=MsoNormal>He still reads the name badges of caregivers. He still smiles and giggles when we approach. We manage his home. His belongings remain untouched. We maintain the semblance of living. We’ve haven’t compose his obituary as if the need for it won’t come.<o:p></o:p></p><p class=MsoNormal><o:p> </o:p></p><p class=MsoNormal># # #<o:p></o:p></p><p class=MsoNormal><o:p> </o:p></p><p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri",sans-serif;color:#1F497D'><o:p> </o:p></span></p></div></div></body></html>