The following is a thank-you piece submitted to San Angelo LIVE! by retired San Angelo Police Chief Russell Smith: 

“Mr. Smith, if you don’t put your mom in a nursing home, you are going to bury your sister.” The Interim Healthcare - Hospice nurse didn’t mince any words, “She isn’t going to be able to walk in a few weeks, her dementia is moving into a new stage and she has (the) Sundowners (Syndrome) which is only going to get worse.” The call came a week before Thanksgiving in 2022.

My mom, June, was born in Milan, Tennessee and was reared by her grandmother until she moved to Uvalde in 1945 when she was fourteen. She married my daddy and they spent 58 years together before he died in 2006. We moved her and my sister, Becky, to San Angelo shortly thereafter.

Mom was 91 when I received that telephone call. Dementia, according to the Mayo Clinic, is a term used to describe a group of symptoms affecting memory, thinking and social abilities. We had seen her slip, get mixed up and tell stories differently than events had actually happened. Her physical capabilities were declining but she had still been walking around the house with the aid of a walker, though otherwise we pushed her around in a wheelchair.

“I am going to wait until after the holiday to tell her,” I told the nurse, and was soon researching the local living facilities when I came across family caregiver deaths. I quickly learned that over half of such people who take care of a loved one die before the patient.

Telling a love one that you are going to have to put them in a nursing home is not easy; but, in the end, I handed Mom a piece of paper that said 70% of family caregivers die first. It took a while but she finally got the message. Ultimately, and finally, she chose one particular nursing home – mainly because the assistant nursing director had given her the tour, and had talked to her through-out, with little notice given to us until we finally went back to the office. We moved her in a few days later.

The nurse was right. Mom was in a wheelchair within a few weeks. Her mind was moving farther back into the past. One example happened when Becky and I took her for a ride one afternoon. She didn’t recognize our houses any longer, didn’t recognize my son’s, and, when we drove across the Lake Nasworthy bridge, she excitedly exclaimed, “The mighty Mississippi!” Of course, she had grown up not far from that wide river.

I started to spend every other afternoon with Mom in her new home. After a few months I really began to get a different picture of what my sister had been going through – and I also began to understand that all my former thought processes about what a nursing home was, were mostly wrong.

You only hear what some perceive as negatives but I quickly learned that it takes very special people to care for our loved ones, or care for those that may not have anyone who does. The staff members have to see that each person living there is fed three meals a day, must give them their meds, take them to physical therapy and specialized doctor visits, keep their rooms and clothes clean, and deal with family members who come to visit. They have to bath folks, many like my mom who can’t get up or move around, some who outweigh even two staff members.

I should mention, in Mom’s case, that Interim Healthcare staff actually came to the nursing home to bath mom several times a week, sometimes with assistance from a C.N.A. They had been doing that when she lived with Becky and they just changed locations and kept accomplishing the task. One of their nurses also came to check on things once a week, though there was a nurse and two C.N.A.s on the floor each time I was there. Vitals were taken by nursing home staff every day and meds delivered per doctor’s orders…

I learned one very important aspect of living in such a place right after Mom moved into her apartment. A woman would gather them up inside the eating area and see that they were entertained. They played games, sang songs, had church services and surprise visits by special guest speakers and members of civic clubs. They won prizes. I played games with them some, especially after Mom lost her ability to participate, and I realized it takes a special talent, a very special person to entertain people who have different levels of understanding at that time of their life.

The phone call came just before midnight, not too many weeks after Mom moved into her new home, “Mr. Smith, can you come to the nursing home. Your mom is okay but we have a situation you might be able to help with,” said the woman.

My wife, Linda, and I were soon dressed and headed across town. Walking through the front door, we immediately saw my mom in her wheelchair, swinging a wooden back-scratcher at two nurses and two CNAs (certified nursing assistants). Linda immediately took the weapon from her and said, “June, I can’t believe you are acting like this!” Mom then blurted out, “I knew you’d take their side!”

Cutting to the chase, earlier in the night Mom had pulled herself into her wheelchair and literally destroyed her room. Of course, she was screaming so the south-end staff went right to her and saw her try to throw a walker out the window. When they approached her, she hit a nurse and the C.N.A., breaking the latter’s personal iPad.

It took us over an hour to talk her down, to get her to tell us what had caused her to act the way she had. She was in her bed when she saw two bad people up on a shelf in her closet. They slid down into some wires and moved over to her. She said she had fought them… This is an example of what can happen when an older person suffers from the Sundowners Syndrome. Sundowning, according to the WebMD site, is a group of symptoms that many people with dementia get in the late afternoon and early evening. It includes confusion, trouble sleeping, anxiety, wandering, and hallucinations. Fading light seems to be the trigger.

Nursing home staff took the event as just another day at the office. My sister and I bought the C.N.A. a new computer. The staff also started having Mother stay with them at the nursing station after she had supper each day and would tuck her into bed after she said she was ready.

The hallucinations still occurred though but in a much different fashion. “Oh Russell, you should have been with us. We went to Brazil by ship last night and had such a wonderful time.” She THOUGHT she went with staff members. Sometimes it was to Europe, South America or to one of their houses, for a party or to watch television.

My afternoons with Mom moved into suppertime especially after her verbal skills started to diminish along with her physical ability to feed herself. I would roll her down in her wheelchair while CNAs helped get others to the dining area. I watched these staff members get drinks for all the residents as the chef and food staff pushed out carts covered with the food trays. Diabetics had mostly different menus and their levels were taken by the nurse. Clients could ask for a second-choice entrée if it was more to their liking.

Staff members, CNAs or a nurse, fed my mom when Becky and I weren’t there. Of course, staff members also fed others who could not do it for themselves. Anyone who had to stay in their room were fed by the staff as well.

Mom had quickly learned to push her wheelchair up and down the halls and it was pretty common to find her in the television room in mid-afternoon. It was also where we were sitting when she suddenly teared up one day and yelled, “I want my baby!”

I was astonished because she hadn’t been able to speak for months… I told her that Becky (the baby) would be there the next day. But she looked right at me and said, “But she’s sick.” Mom didn’t eat that afternoon even when I offered her a spoonful of scrumptious-looking desert; she just shook her head.

I rolled her back to the nurses’ station where a Certified Nurse Assistant took her from me, pulled her up close and she said, “Hi June Bug!”

The nursing home administrator, Latifou, called me about 9:30 the next morning. “I think you need to come to the nursing home.” Mom was still breathing but they had not been able to wake her. I called Becky and we were nearby when she passed away about fourteen hours later.

The nurse documented the time and the funeral home was called. The home was divided into a north and south side but staff members from each, even though it was just after midnight, came to offer their condolences.

Becky and I, the following Monday, were doing the things that you do after someone passes. Suddenly her stomach swelled and she started burping. Later, at the Shannon Hospital, we learned that she had a growth on her pancreas.

Cutting to the chase, the following night she was transported to the Methodist Specialty Hospital in San Antonio. She was there for most of two months, with specialists trying to heal an infection that was resistant to their medicines. I say “most” because she did attend mother’s funeral in Uvalde and spend a few days in San Angelo with us over the holidays.

Linda and I prepared our guest bedroom thinking that we would care for her there, but in the end, after returning to the Shannon Cancer Center and a short stay in the main hospital, she decided she wanted to spend her last days in the nursing home that mom had chosen.

Nursing home staff members were moving new recliners into each of the apartments the day we moved Becky and her furniture into hers. It wasn’t long before I realized, after having managed a number of employees and a large budget myself, that new owners and/or corporate don’t always see things for what they are…

Staff members were starting to remove the recliners. They had a dire look in their eyes and one of them, with tears in her eyes, said, “They fired the administrator.” I learned he had personally bought the chairs so everyone could have one.

Latifou had been a hands-on type of administrator. I saw him there during the day but also some nights and weekends. He wanted everything to be right.

Becky’s friends came to visit over the next ten days, mostly those that hadn’t visited her in San Antonio. Her best friends stayed at her house, and one, a young woman with a child of her own, was named Rebecca after my sister.

I walked into her apartment on a Friday. She was saying goodbye to someone and put down her phone. “It was Jimmy and Debbie,” she said, our first cousin and his wife. She never picked up her phone again. My cousin told me later that she’d said, “I can’t wait to meet Jesus.”

Becky and I spent a lot of quality time together during her last three months. We talked about past experiences, precious memories and the special people we’d come to know. An Interim Hospice nurse named Bailey was one of those…

There was a change in my sister’s condition that started on Saturday and moved through Sunday. She quit talking and just looked at peace. It was about three on Monday morning that she seemed to be looking toward the ceiling, but, though it is hard to explain, not at the ceiling. Then her eyes changed color.

I called Bailey and she came to the nursing home to make sure Becky was comfortable. She helped me organize my phone so it would play "I Can Only Imagine" over and over. Nursing home staff, the floor nurse and CNAs kept dropping by to see if I needed anything or if there was anything they could do.

I made a few calls. “You probably need to come now,” I told my wife and daughter, my son and daughter-in-law and Rebecca. It was not long after that the room and hallway were full of friends and loved-ones. Our pastor Jay Clatworthy noticed Beck had passed an hour or so later…

There is no doubt that I will never forget the healthcare people who helped me with June Bug and Becky. Ashley, Autumn, Cassandra, Jessica, Judith, Kim, Mona, Nicole, Norma, Sarah, Shelby, Sylvia, Tammy and Velma will always hold a special place in my heart, along with a number of others whose faces I will remember if our paths ever cross. I don’t know the names of the chefs and attendants in the kitchen, but I’ll never forget the times they came into the dining room and asked my mom, “Do you want some ice cream?”

I would like to express my appreciation to all those who provide healthcare and hospice services in the Concho Valley, and everyone who helps those in need in assisted living centers and nursing homes. You probably don’t hear this enough, but you are very special people. Thank you for everything you do.