I made more phone calls.  A social worker said that David wouldn’t qualify for county services until he had spent down his assets.  Another social worker said well, frankly, clients are prioritized by urgency of need, and you’re too competent.  At last, the primary care clinic offered to send a home health nurse to evaluate David’s safety at home.  That sounded useful.

The home health nurse missed his first appointment but showed up for the second.  He plopped down on David’s couch and admired the mid-century modern furniture and the artwork.  He asked about David’s medications, and we explained that David had started Aricept.  The nurse brightened.  He opined that David should repeat the test (the neuropsych exam) after taking Aricept for six months, and he’d probably be able to start driving again. 

Maybe it’s a good thing that rage choked me – I’m not sure what would have come out of my mouth if I’d been able to speak.  The exam had been devastating, and it had cost $750 out of pocket.  We had already separated the man from his Mini.  That blithe remark planted false hope, and that hope persisted for years.

The nurse made himself comfortable on the couch and talked about his mother for the better part of an hour, then picked up his bag and prepared to leave.  Hold on, I said. Could you walk through the house and look for any safety issues we might have missed? Sure, he said, if you want.  Yes, we wanted that.  He heaved himself to his feet and ambled into the kitchen, where he admired the fixtures and then set down his bag to put on his shoes.  What about the stairs and the upstairs?  His knees were bothering him, he explained, so he didn’t want to climb the stairs —  but judging from the downstairs, David’s house was safe and well-equipped.

Setting aside the rage and dismay: from a visiting nurse perspective, David’s house was safe and well-equipped.  The garbage hadn’t piled up, the utilities weren’t shut off, he wasn’t emptying his pill bottles into a bowl, like the elderly couple that geriatrician Louise Aronson had described on Fresh Air.  I could still open pill bottles, and I could minimize the hazards — pop off the stove controls, unplug the oven, buy an electric kettle that turned itself off.  And in the end, nothing the nurse could have pointed out became unmanageable. Two years later, the problem would be the stairs, the selfsame stairs that the nurse didn’t feel up to climbing.