Things I wish I knew before my grandmother passed away

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On Sunday, April 2, 2022, I got a frantic call from my mother telling me that my grandmother Loeb had fallen ill and that I needed to go to my father’s house to check on her.

Getting these types of calls is becoming the norm. Since the fall of 2020, Grandma’s health has deteriorated due to age, and I am sure two years of stress, uncertainty and loneliness due to the pandemic. As part of covering the pandemic in Oaklands, I shared personal articles chronicling how my family and I kept it safe from COVID-19.

Since 2014, the grandmother has been in and out of hospital with an ongoing series of strokes, including a hemorrhagic stroke in 2015, and was left with a condition called Broca’s aphasia, a loss of language. The aphasia affects the left part of the brain responsible for speaking, understanding, and writing.

A few months before my grandmother got sick, my family decided it was time to buy a funeral and cemetery package. My mom was offered monthly payments as a payment plan – the cost of the first payment is close to $2000, and the monthly payments are about $400 a month. The cremation package alone (my grandmother’s wish) was about $7,000. The total package we signed up for was $16,250.

Death is not cheap, and it is getting more and more expensive. According to the National Funeral Directors Association, the average cost of a funeral with cremation has increased more than 11% over the past five years, to about $7,000. We knew that when the time came, actually having a plan would be easier than trying to get that kind of cash, all at once.

The day after her grandmother fell ill, she was entered the emergency room and sent home with medication for a urinary tract infection. Two days later, she was back in the hospital. By Friday, her condition had deteriorated and she had complications from a urinary tract infection and pneumonia in her left lung from aspiration, which occurs when food, saliva, fluid or vomit reaches your lungs instead of passing through your esophagus and into your body. stomach.

By Friday, the medical team informed us that the grandmother was in moribund, and we had to decide how we wanted her to move.

In 2019, my mother, sister (a neurological nurse practitioner) and I sat down with my grandmother to get over her cravings when she could no longer make medical decisions on her own. In California, a two-part document called an Advance Health Care Directive is required to designate someone to make health care decisions for you, including when to provide, withhold, or withdraw medical treatment and pain relief. The form must be signed in front of two witnesses (not related to the blood of the individual) or notarized. A copy of the form must be kept with the person’s belongings, and one must be given to their medical provider.

When we completed the advance directive, the grandmother made it clear that she wanted to die at home, not in the hospital. She did not want to be resuscitated or to be kept alive artificially.

Writer Azucina Rasella with her grandmother. credit: Azucina Rasella

In keeping with her instructions, on Friday my mother and sister at the hospital chose “comfortable care” — a method that prioritizes pain relief over invasive or painful medical interventions — and requested that palliative, or end-of-life care, be delivered at Grandma’s home. According to the National Hospice and Palliative Care Association, more than half of Medicare recipients received one or more days of hospice care in 2019.

Government programs such as Medicare, The Veterans’ Administration (VA), and Medicaid offer coverage for hospice care. Private insurance plans may or may not cover hospice care, and holders of these plans are advised to check. Those who are uninsured can request hospice care at low or no cost through a variety of nonprofit programs and funds, and the California Department of Public Health offers a database of hospice care facilities.

By Sunday, the hospital had arranged a shelter-in-place for Grandma’s home. While I was in the hospital watching her next, my family at home took charge of rearranging her bedroom to receive the medical equipment she would need for comfortable care: a medical bed, an oxygen machine, and other medical supplies.

The next day, the grandmother was taken by ambulance home.

Before leaving the hospital, she was given a sedative called Ativan. Shortly after giving her the potion, Grandma fell into a deep sleep. By the time Grandma was home, she was no longer responding and remained asleep.

Grandma Loeb with her grandchildren celebrating birthdays. credit: Azucina Rasella

Nothing can ever prepare you to see a loved one enter the dying stages. She first noticed the change in the degree to which her extremities were cooler, her legs and feet becoming darker in color due to poor circulation. The worst part for me was something called a “death rattle” – the sound that dying people make when they can no longer swallow or cough properly to remove saliva. In writing about this, I hope that readers will be more willing to navigate some of the more challenging aspects that the death of a loved one can present.

The grandmother was in a shelter for three days. On Wednesday, April 13th at 11pm, she took her last breath surrounded by her children and grandchildren. My sister has arrived from the East Coast to spend the past few days with her grandmother. As a medical professional, she was the first to announce her grandmother’s death.

After Grandma passed away, there were a number of calls we needed to make. The first call was with an aged care provider, so that a nurse could come home to legally declare Grandma dead. That same nurse called the mortuary we chose to start the process of collecting Grandma’s remains. She chose to cremate her corpses and place her ashes in a sacred place.

Once the nurse made those calls, we had a few hours to be with Grandma and say goodbye. In the early hours of that Thursday, April 14, the morgue came to take the body to the funeral home to await cremation. I needed to get all of my grandmother’s personal information, as well as a copy of her advanced directive. After filling out the papers, the mortuary technician entered the room to take Grandma’s remains. She was transported on a stretcher to a morgue truck.

The next morning, the funeral director called me to request additional personal information in order to process the death certificate. Where was my grandmother born? Her parents’ names, date of birth, ethnicity, address, etc. Death certificates, which must be signed by a physician—in the case of a grandmother, a physician from hospice care—are filed with the Alameda County Department of Public Health’s Vital Registration Division. Each copy costs $24, and you will need several copies to close accounts and transfer the assets of the deceased.

According to the county health department, death certificate requests typically take up to two weeks to be processed once they are requested by the funeral home and payment has been received. But the process can be speeded up if necessary for religious burial rites.

Because of Grandma’s Catholic faith, we paid an extra $300 to prioritize her cremation, $525 for an urn to put in her ashes, and $48 for two certified death certificates, plus additional state fees. Although we paid extra to prioritize her cremation, her cremation still took five days.

Although we thought we had prepared ourselves financially by signing a contract early with a mortuary for funeral and burial services, this was not the case. Altogether, we had to pay more than $5,000 in additional upfront costs – over $3,000 for cremation and over $2,000 for down payment (to keep paying) on ​​where she put her ashes.

Despite our best efforts, my family was not prepared to bear the financial burden of my grandmother’s death. While I was able to advocate for my family and help us deal with all the complicated and expensive paperwork, we could have been better prepared.

For those looking to avoid the same challenges, the A Consumer’s Guide to Funeral & Cemetery Purchases, published by the California Department of Consumer Affairs’ Bureau of Cemeteries and Funerals, is a great place to start. So is the book by Oakland author Jessica Mitford, American way of deathAnd Exposing the American funeral industry and its predatory practices towards grieving families.

Grandma Loeb’s 90th birthday in 2020. credit: Azucina Rasella

Earlier this week, I was watching the Country Music Hall of Fame induction party for Wynonna Judd and her late mother, Naomi Judd. During her acceptance speech, Judd said, “It’s a very strange dynamic to be shattered and that’s blessed.” Like Judd, I feel happy that my job as a journalist gives me the opportunity to write personal articles like this in the hope that my words will help others. At the same time, as a grieving granddaughter, this was one of the most difficult stories I’ve ever written. I hope it helps other families have an easier time dealing with the unimaginable pain of losing a loved one, and dealing with what comes next.

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