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Monday, 16 November 2009

The Last Goodbye

The Last Stop? Versailles,
or Motel Six?

By Liliane Clever
Junto Staff Writer
It was all on the spur of the moment.

My sister called to let me know that Midge was moving into a nursing home on November 2.  Annick sounded overwhelmed. Already exhausted from all of her previous research touring various homes, making numerous phone calls, and organizing just about everything, she worried aloud about managing the final move on her own.  As soon as I hung up the phone, in Philadelphia, I knew that I had to go to France to help her.  I bought a ticket to Paris.

The weather in Paris was rather gloomy and cold when I arrived.  Annick was waiting for me at the airport.  She looked tired, as I had expected, but also looked happy and relieved.  We talked more about the nursing home.  It is located in Saint Cyr, in a Paris suburb  near Versailles, and only about 15 minutes away from Annick's house in Chaville. The home is part of the group seniors santé.  Annick told me that the home was amazing.  She called it 'Club Med for old folks.'

 I had looked at the web site and liked what I saw, but I could not help be apprehensive.  I have never visited a nursing home in France, but my experience in the States has not been very pleasant.  For the most part, the two nursing homes I have been to have been depressing, with aggressive unpleasant smells as soon as you go in, and an overall look of despair.  A dear friend of mine had a massive stroke five years ago and is in one of these nursing homes.  My heart aches each time I visit.

The afternoon we drove down to Saumur to collect Midge and bring her back to Paris.  Right away it became obvious that it would have been extremely difficult for Annick to do this by herself.  Since her last fall, Midge has become afraid of taking a step on her own, and has to be helped out.  It became my responsibility while Annick left with Midge's suitcase and bags to get the car.  The trip back was fine.  Midge was in a good mood.  She was happy to have both of us with her - - such a rare event.

The next day was a completely different story.  When we left Annick's house early afternoon, Midge asked, "Where are we going?"  We told her that she was going to the nursing home we had talked about.  The look on her face was complete puzzlement.

"I am not going home?"

"No Midge, we already told you."

"How long am I going to stay there?"

"This will be your new home."
"What happened to all my things?"

I looked at Annick. Focused on her driving, I could tell that she was getting very upset.  Fortunately, Midge's attention span is that of a two-year-old.  By the time we reached Saint Cyr, she had quieted down distracted by Versailles, the chateau, and its magnificent gardens.

The nursing home, called  Le Parc de l'Abbaye, was built in 2007, and is part of a new development on the outskirts of town.  It blends in completely with its surroundings -- mostly new condominiums -- to the point that without the exact address it might have been difficult to find it. As soon as we parked in front of the main entrance, two staff members came out to greet us.  They helped Midge out of the car and took her inside while I followed with the luggage and Annick parked the car.

My first impression could not have been more positive.  We entered a large bright hall, with high ceilings, comfortable sofas and chairs, bouquets of flowers, and best of all, without not even a faint hint of any unpleasant odor. We continued into a large room, where the residents were kept entertained by one of the three full- time activity coordinators. The next room, the TV room with a large flat screen television mounted on the wall, was empty.  I took that as a very good sign!

We went up to Midge's room on the second floor. The hallways looked like a 4-star hotel.  I was pleased to see that the room looked exactly like it did on the website.  By then, Annick had joined us again.  We checked everything.  From the clean private bath room to the views outside the two windows, it all looked perfect.  Midge was sitting on the bed with that puzzled look on her face again. The director came in to introduce herself and Midge started to smile.

When we left, I felt the exact same way I had felt on my son's first day at day care, years ago.  Even thought it had gone quite well, the day had been emotionally exhausting.

Le Parc de l'Abbaye is an EHPAD.  In the French politically correct terminology, EHPAD stands for 'Etablissement d'Herbergement pour Personnes Agees Dependantes.'  EHPADs have medical staff onsite, and are equipped to care for residents with Alzheimer's.  At Saint Cyr, Alzheimer patients are kept on a separate floor as they require more supervision, but except for residents too severely handicapped to be moved, all other residents share the same common facilities. The director, a very cheerful and dynamic woman, explained to us that this was by design to facilitate socializing among residents.

Le Parc de l'Abbaye is a private institution and all residents must be able to afford to pay for their stay. The final price varies based on what is called the 'dependence level.'  This level is calculated through psychological testing and basic everyday observations. The only financial relief is a monthly housing stipend paid to senior citizens by the French government. This housing stipend, which varies based on several criteria, comes as a reimbursement to the resident rather than a direct payment to the institution.

I was rather surprised by the seemingly casual administrative approach regarding Midge's admission. Annick had previously sent a medical report from Midge's doctor, so it could be determined if Midge qualified for admission. But no financial information had been requested.  I suppose it is one of these 'if-you-ask-you-can't-afford-it' kinds of thing.  I do not doubt that these important details will eventually be discussed once the polite welcoming phase is over. Still, I imagine that in the States, future residents would be asked to provide financial statements to ensure that they have the financial means before being shown to their room.

Midge's monthly fee comes to 3,000 euros.  This is nothing to sneeze at, especially if you have long been retired and on a fixed income.  But it is nothing compared to the $9,000 monthly fee that my friend is charged by his nursing home in America.

Needless to say that he has long gone through his insurance benefits and personal savings.  His only income comes from his social security check. The  majority of his cheque is turned over to the nursing home; he is able to retain a small chunk to cover personal needs. The remaining balance is covered by Medicare/Medicaid.  In other words, his care is entirely covered by our tax money.

Ironic for a country which, for the most part, is against 'socialized medicine.'  But this irony would be just fine with me if my friend received the same level of care in his nursing home near Philadelphia, than Midge will receive in her EHPAD near Versailles.  Unfortunately, my friend's nursing home is as far from being 'Club Med for old folks. More a Motel 6 than a Four Seasons.

Sad really. But yet just another example of the US having the highest cost for medical care in the world while ranking last. I looked -- 37th!

It is too early to know for sure that Midge will do well in her new home.  But I can't help think that if she is unhappy, it will not be because she is not well cared for. The institution provides activities everyday, mornings and afternoons, seven days a week to stimulate residents.  While nobody is forced to participate, it is greatly encouraged.

When we  left Midge late Friday afternoon, she was in a group trying to solve a giant Sudoku with one of the coordinators.  She looked absorbed and at peace.

She never even looked our way when we waved our final goodbye.