When things work right: housing and supportive services

My mother died April 1. She was 86, in increasingly poor health, and had long been ready to go.

We encountered some troubling problems with the medical care system at the end. But I'm going to leave those behind and talk about what went right.

When Mom started having more trouble managing in the independent apartment in Oshkosh, Carmel Residence, where she'd lived since 2000, we moved her into the community's assisted living facility, Gabriel's Villa. There was an interlude of illness, skilled nursing, and rehab in between, but that's not really germane to this part of the story.

The apartment was lovely, and Mom quickly made friends with the residents and the aides. The food was superb, and she actually started eating three squares a day. She began walking around her apartment using only her cane, and generally was managing better than she'd been for the past two years.

But things got worse again. She developed pneumonia and digoxin toxicity, the congestive heart failure worsened, the implanted defibrillator started going off frequently despite an increase in potent drugs for arrhythmia. Her mental state became altered.

Gabriel's Villa operates under a residential care apartment complex (RCAC) license. As a result, the staff were able to be very flexible, providing more care as needed for an additional fee. They began administering her medications and checking her every two hours, later every hour.

After we decided to turn off Mom's defibrillator and let nature take its course, her plan all along, Gabriel's Villa agreed to let us bring home hospice into the apartment. No one wanted her to move her again.

Mom died a few hours after we'd returned there, before hospice care could begin. I stayed with her, with much loving attention and help from the aides who were with us, getting her ready for bed, when her big heart went into ventricular fibrillation. A few minutes later, she died, held by my sister and me.

It was as she wanted it-- a good death, I think. For that, we owe much to the dry sounding notion of "elder housing with supportive services."