Saturday, February 15, 2014

A Trip by Ambulance

She crawled down the hallway to get to the living room
That dreaded call from across the street came in around nine on Saturday night. Mom relayed right away that Louise fell in her room and couldn't get up. She crawled into the living room and called out to my mother, who couldn't hear her from the other end of the house.

Louise couldn't get back into her wheelchair, yet, refused to go to the hospital insisting that she was fine. In her bedroom, I asked her to demonstrate that she could transfer from the bed to the wheelchair and back. She was able to do that, so I went home. I live across the street.

By Sunday morning, Louise was too sore to get out of bed. I dialed 911 and she was taken by ambulance to the hospital where she was admitted. She had a painful injury to her left ankle that had fusion surgery in 2007, and her left knee was bruised. They found she also had a urinary tract infection. After she arrived in the emergency room, a bruise appeared on her chin following the line of the cervical collar that had been placed on her during the ride.

Louise is a non typical 93 year old female who lives at home with her 88 year old sister. She dresses herself, prepares daily noon meals of sandwiches and washes dishes by pulling herself up to stand at the sink. She routinely maintains her own personal hygiene, showering and shampooing unassisted, performs toilet transfers, makes her own bed and takes care of her cat.

Feb. 11, Tuesday 4 pm - Patient was transported by ambulance from Lake Point Medical Center to a Skilled Nursing Facility arriving around 5 pm. Assigned to room 505 B.

Upon arrival at GH, patient was evaluated by Gladys and Rose, Nurse Techs who removed her street clothes and put her in a hospital gown for the initial assessment of her condition. Personal clothing (including nightgown) was available at the time of arrival provided by Niece who accompanied the ambulance. Clothing was placed in patient's dresser and closet. Dinner was provided. Patient fed herself and had a good appetite completing most of the meal. Bedside commode was positioned next to bed. Staff was briefed on patient's personal history prior to injury.

Feb. 12, Wednesday 10:30 am - Upon my arrival, Patient was found in bed still dressed in a hospital gown. After a discussion with the Nursing Supervisor, patient was helped to the bedside commode where she was seated with the door to the room left open in full view of hall traffic. Upon direct questioning as to the course of treatment and reason for remaining in bed, patient was seen by Occupational Therapy representative, Sara, who immediately responded by assisting in getting the patient dressed in street clothes and taking Patient to the Exercise room for evaluation. :)

Feb. 13, Thursday 11:45 am - Patient was located in the dining room following Occupational Therapy where her relatives (Niece, Sister and Friend) joined her for lunch of soup, Chicken Tetrazzini and pineapple cake. Patient's appetite was good and she fed herself without assistance. Visitors remained until 2 pm. :)
4:30 pm Niece received a frantic call from the nursing staff at the request of patient who was agitated to the point of tears asking that I return to GH. She was already in bed and had been dressed in a diaper (not pull-ups) and was extremely distressed by this action of the staff as she is able to use the toilet if assisted in making the transfer. :(

Feb. 14, Friday 10:00 am - Valentine's Day. Patient was located in the Occupational Therapy area with electrodes attached to her left ankle. She had refused her breakfast, yet when offered, drank a large glass of milk fetched from the kitchen. Kitchen staff was very accommodating even offering a banana. Patient had been showered and her hair had been shampooed. :)
3:00 pm Family members returned to find patient in distress, searching the closet for additional "pull-up" underwear. Staff informed family that patient was not to put on disposable underwear unassisted. (Grabbed them out of my hand and put them back in the drawer.) Patient was extremely tired and tearful, having difficulty in expressing her concerns. Visitors departed approximately 4:30 pm with patient stating she would eat the evening meal in her room.

Feb. 15, Saturday 11:45 am - Patient was located in the "Small Dining Room" seated at a table with patients who lack the skills to feed themselves or communicate verbally. Patient was in tears and visibly shaken by this development. Her hair was in disarray and uncombed. I moved her to the "Large Dining Room" where the patient fed herself unassisted after recovering her composure. She explained that someone had "fed her dinner" the previous evening in her room. Patient stated that the staff did not make eye contact during the meal, instead concentrated on a device held in the staff member's lap while distractedly shoveling food into the patient's mouth. Later, she rang and asked that the room lights be turned off along with the TV. Lights were turned off and TV was left blaring all night. :(

Following lunch, I asked a tech to assist in helping patient to the bathroom where staff member continued a conversation on her cell phone during the transfer from wheel chair to the commode. Patient was dropped from 6 inches above toilet where she landed on the seat and was left in my care. Tech did not return to assist patient back to wheel chair. I assisted with the transfer back to her wheel chair and in performing personal hygiene needs: hair combing, teeth brushing and washing of dentures not done earlier in the morning. :(
4:45 pm Patient was assisted in reaching the phone after 6 rings. She was tearful and tired and said, "Sometimes I don't even want to go on."
7:00 pm Patient answered the phone and seemed somewhat calmer, had been showered and was dressed for and comfortably in bed.

I called to report my concerns to the nurse on duty (Beth) who was compassionate and understanding and listened to my account about lack of respect and dignity being demonstrated by the recent developments. Monday I will make a report to the Facility Administrator. There is a distinct difference in the weekday staff and the weekend staff who operate with little administrative supervision.

Saturday, February 8, 2014

Community Attendant Program To The Rescue, Eldercare Blessings

I'm reminded of Pearl S. Buck's story, The Good Earth, in that I've been afraid to praise the benefits of the Department of Aging and Disability or DADS, as they're known, for fear of jinxing the program. At long last, following a lot of hoop-jumping, the ladies in my care are getting the help they need to remain living independently at home. Being homebound, according to their Medicare Advantage plan's definition, is that leaving  home is a major effort. That definitely describes the ladies across the street, who at 88 and 93, still maintain their own daily activities but neither own a  car nor drive. Thankfully.

With that independence comes other disadvantages like trying to cook meals, which has become a dangerous activity to someone in a wheelchair who is legally blind from macular degeneration. And to her younger sister, it is a matter of concentration, along with sense of smell and hearing, which seems to be lagging at times. Recently, a grease fire in the kitchen nearly sent the pair to well, we'll just say they were both fortunate that in a moment of clarity the flaming pan was moved to the nearby sink without harm. It was a real eye-opener for me.

Truly, I'm in denial about my Mother, who for the last twenty or so years, has remained so vibrantly active and able, not retiring until she turned eighty. Now as her skills diminish, I'm grateful that they have qualified for Home Health Services Care. With the two ladies living together, their combined allotted hours gives them a Community Attendant who comes five days a week, eight hours per day.

The real difficulty has been the inconsistency of schedule for the attendant since the middle of November when the program started. First, we had the Thanksgiving holiday, then a flat tire, then Christmas, then New Year's, then the stomach flu (out for 8 days) for which we remain grateful was not shared with the patients, then several days of ice and road conditions making travel too dangerous to come. If things ever settle down, it will be a lot better for the ladies who are fond of a predictable routine at their house.

The strange part is the element of coincidence (?) in the attendant's name. It has been strangely validating to be assigned a wonderful and enthusiastic twenty-one year old named Joe. Yes, a lady named Joe. I thought I was the only one with a name spelled like a boy. Other than my fictional character in The Pub novel I'm writing. Hmm. Strange. She's blonde and sweet, a young mother who takes pains in being creative with the meals she prepares for my Mother and Aunt. And what a major relief it is to have her help.

Good rice. It is good rice.