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</font></p><p class="yiv4824294963msonormal" style="margin: 1em 0in;"><u><span lang="EN" style="mso-ansi-language: EN;"><font face="Times New Roman"><font size="3">This
is a description<span style="mso-spacerun: yes;"> </span></font><font size="3">of a man’s loss of most
of who he is. Can he lose any more, in any category.</font><span style="mso-spacerun: yes;"><font size="3"> </font></span><font size="3">Does he still fit the description of what
he needs to have to be considered for Hospice help.</font><span style="mso-spacerun: yes;"><font size="3"> </font></span><font size="3">It is presented in a straight forward journalistic
way,</font><span style="mso-spacerun: yes;"><font size="3"> </font></span><font size="3">Yet the description is highly
emotional. It’s a very powerfl piece. I can’t see what I would change</font><span style="mso-spacerun: yes;"><font size="3"> </font></span><font size="3">Will you b able to continue to show he has
declined when he has so little left <o:p></o:p></font></font></span></u></p><p><font face="Times New Roman" size="3">
</font></p><p class="yiv4824294963msonormal" style="margin: 1em 0in;"><span lang="EN" style="mso-ansi-language: EN;"><o:p><font face="Times New Roman" size="3"> </font></o:p></span></p><p><font face="Times New Roman" size="3">
</font></p><p class="yiv4824294963msonormal" style="margin: 1em 0in;"><span lang="EN" style="mso-ansi-language: EN;"><font size="3"><font face="Times New Roman">\Documentable
Decline<o:p></o:p></font></font></span></p><p><font face="Times New Roman" size="3">
</font></p><p class="yiv4824294963msonormal" style="margin: 1em 0in;"><span lang="EN" style="mso-ansi-language: EN;"><font size="3"><font face="Times New Roman">Marcia
J. Wick, The Write Sisters<o:p></o:p></font></font></span></p><p><font face="Times New Roman" size="3">
</font></p><p class="yiv4824294963msonormal" style="margin: 1em 0in;"><span lang="EN" style="mso-ansi-language: EN;"><font size="3"><font face="Times New Roman">January
2020<o:p></o:p></font></font></span></p><p><font face="Times New Roman" size="3">
</font></p><p class="yiv4824294963msonormal" style="margin: 1em 0in;"><span lang="EN" style="mso-ansi-language: EN;"><font size="3"><font face="Times New Roman">Word
Count: 719<o:p></o:p></font></font></span></p><p><font face="Times New Roman" size="3">
</font></p><p class="yiv4824294963msonormal" style="margin: 1em 0in;"><span lang="EN" style="mso-ansi-language: EN;"><font size="3"><font face="Times New Roman"> <o:p></o:p></font></font></span></p><p><font face="Times New Roman" size="3">
</font></p><p class="yiv4824294963msonormal" style="margin: 1em 0in;"><span lang="EN" style="mso-ansi-language: EN;"><font size="3"><font face="Times New Roman"> <o:p></o:p></font></font></span></p><p><font face="Times New Roman" size="3">
</font></p><p class="yiv4824294963msonormal" style="margin: 1em 0in;"><span lang="EN" style="mso-ansi-language: EN;"><font size="3"><font face="Times New Roman">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></font></font></span></p><p><font face="Times New Roman" size="3">
</font></p><p class="yiv4824294963msonormal" style="margin: 1em 0in;"><span lang="EN" style="mso-ansi-language: EN;"><font size="3"><font face="Times New Roman"> <o:p></o:p></font></font></span></p><p><font face="Times New Roman" size="3">
</font></p><p class="yiv4824294963msonormal" style="margin: 1em 0in;"><span lang="EN" style="mso-ansi-language: EN;"><font size="3"><font face="Times New Roman">“Documentable
decline?” <o:p></o:p></font></font></span></p><p><font face="Times New Roman" size="3">
</font></p><p class="yiv4824294963msonormal" style="margin: 1em 0in;"><span lang="EN" style="mso-ansi-language: EN;"><font size="3"><font face="Times New Roman"> <o:p></o:p></font></font></span></p><p><font face="Times New Roman" size="3">
</font></p><p class="yiv4824294963msonormal" style="margin: 1em 0in;"><span lang="EN" style="mso-ansi-language: EN;"><font size="3"><font face="Times New Roman">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></font></font></span></p><p><font face="Times New Roman" size="3">
</font></p><p class="yiv4824294963msonormal" style="margin: 1em 0in;"><span lang="EN" style="mso-ansi-language: EN;"><font size="3"><font face="Times New Roman"> <o:p></o:p></font></font></span></p><p><font face="Times New Roman" size="3">
</font></p><p class="yiv4824294963msonormal" style="margin: 1em 0in;"><span lang="EN" style="mso-ansi-language: EN;"><font size="3"><font face="Times New Roman">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></font></font></span></p><p><font face="Times New Roman" size="3">
</font></p><p class="yiv4824294963msonormal" style="margin: 1em 0in;"><span lang="EN" style="mso-ansi-language: EN;"><font size="3"><font face="Times New Roman"> <o:p></o:p></font></font></span></p><p><font face="Times New Roman" size="3">
</font></p><p class="yiv4824294963msonormal" style="margin: 1em 0in;"><span lang="EN" style="mso-ansi-language: EN;"><font size="3"><font face="Times New Roman">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></font></font></span></p><p><font face="Times New Roman" size="3">
</font></p><p class="yiv4824294963msonormal" style="margin: 1em 0in;"><span lang="EN" style="mso-ansi-language: EN;"><font size="3"><font face="Times New Roman"> <o:p></o:p></font></font></span></p><p><font face="Times New Roman" size="3">
</font></p><p class="yiv4824294963msonormal" style="margin: 1em 0in;"><span lang="EN" style="mso-ansi-language: EN;"><font size="3"><font face="Times New Roman">“Documentable
decline?”<o:p></o:p></font></font></span></p><p><font face="Times New Roman" size="3">
</font></p><p class="yiv4824294963msonormal" style="margin: 1em 0in;"><span lang="EN" style="mso-ansi-language: EN;"><font size="3"><font face="Times New Roman"> <o:p></o:p></font></font></span></p><p><font face="Times New Roman" size="3">
</font></p><p class="yiv4824294963msonormal" style="margin: 1em 0in;"><span lang="EN" style="mso-ansi-language: EN;"><font size="3"><font face="Times New Roman">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></font></font></span></p><p><font face="Times New Roman" size="3">
</font></p><p class="yiv4824294963msonormal" style="margin: 1em 0in;"><span lang="EN" style="mso-ansi-language: EN;"><font size="3"><font face="Times New Roman"> <o:p></o:p></font></font></span></p><p><font face="Times New Roman" size="3">
</font></p><p class="yiv4824294963msonormal" style="margin: 1em 0in;"><span lang="EN" style="mso-ansi-language: EN;"><font size="3"><font face="Times New Roman">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></font></font></span></p><p><font face="Times New Roman" size="3">
</font></p><p class="yiv4824294963msonormal" style="margin: 1em 0in;"><span lang="EN" style="mso-ansi-language: EN;"><font size="3"><font face="Times New Roman"> <o:p></o:p></font></font></span></p><p><font face="Times New Roman" size="3">
</font></p><p class="yiv4824294963msonormal" style="margin: 1em 0in;"><span lang="EN" style="mso-ansi-language: EN;"><font size="3"><font face="Times New Roman"># #
#<o:p></o:p></font></font></span></p><p><font face="Times New Roman" size="3">
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