More jumble...
...just like my journaling has lately been, this time under the heading:
Stuff I Want to Remember

• The problem of administration and stockholders in regard to the ability to render adequate care at Mom's rehab facility is not a subject under wraps among the staff. Yesterday, as I was plying the halls on a variety of care errands related to making sure my mother's care reaches a minimally adequate level, I overheard two separate conversations between relatives of patients on the rehab/Medicare wing discussing with a CNA and a PT exactly why there are noticeable problems in regard to the care of their relatives. Both the CNA and the PT were explaining the understaffing/overworked problem from the perspective of the shareholders and the administration. Then, as one of the social workers, an extremely competent person, was conducting the first of what I expect (from watching Mom's roommate's discharge) will be more than a few such discussions, she handed me a form to complete on which I am to rate various aspects of my mother's care. I mentioned to her, after scanning it, that I am well aware that a lot of the problems we have are directly related to flagrantly inadequate staffing and that these problems cannot be blamed on the staff. I continued that I was going to make this point in the "comments" section, even though I doubted that it would have much of an impact. She nodded vigorously and encouraged me to do so, adding that, as I had already mentioned, this is an industry-wide problem with roots deep in the economic set-up of such institutions, that her experience in other institutions confirms this, she was glad that I recognized this and, despite what seems like the futility of such an exercise, I should definitely mention what I understand.
• After the second day of observation of my mother's PT and OT I am so confused that I have no idea at what level her native abilities may be. Despite being told, a little over a week ago, that she walkered "30 feet and back", her knees weakening only at the end of the return trip, it was obvious that my mother didn't have this in her yesterday. Suddenly, I understood what the term "inconsistent" means as applied to her. It also brought into question all the reports I've been given in the last few weeks that she was having "good sessions". This and another discovery strengthened my resolve that I will have no real idea of what strength she can recover until we get her home;
• Because Mom and I had an appointment at 1000 (moved up to 0900) for her PT, which I was going to attend in order to take advantage of the opportunity to learn supporting techniques for when she moved around at home, I was extra sensitive to anything that might inhibit Mom's performance during therapy. I noticed that she was suffering from congestion that she was having lots of trouble clearing, despite her breathing treatments, thus rendering her breathless. First I asked the nurse to listen to her lungs. The nurse heard some base lung congestion that was clearing, little by little, as my mother coughed. However, it wasn't clearing very quickly. I realized I had a choice of having Mom rehabed as she was laboring to dissipate lung congestion, which the nurse told me was "common" for Mom in the morning, or when she was laboring under what I call "lunch stupor" in the afternoon. I decided to choose "lunch stupor", since, at least, she wouldn't be breathless, and changed the PT appointment to afternoon, explaining my reasons to the PT, with which she agreed.
• Yesterday I was determined to see to it that I managed to hydrate my mother enough, while I was there, to make sure she stayed relatively well hydrated while I wasn't. It wasn't easy, since I had to apply "water torture" to my mother, which she resisted constantly, but I did it. However, even with me trying to stay alert to needed brief changes, Mom, of course, leaked through her first brief. I began to realize that one of the reasons dehydration probably takes place in these institutions is because the more hydrated an incontinent person is, the more brief changes are needed and these require time and attention that simply isn't available. Easier to keep people, under these conditions, a little underhydrated so that brief changes aren't as necessary.
• Then, yesterday while my mother was eating her lunch I was engulfed by a wave of exhaustion so irresistible that I decided to lie down on my mother's freshly changed bed and close my eyes until I heard the sound of her final placement of her utensils on her plate, signaling that she was done. I was down for maybe 15 minutes and apparently dozed, as one of the CNAs who has come to know us very well awoke me by patting me on the butt and asking if "this girl needs to be changed". As I arose from the bed I was seized by a coughing fit that lasted about three minutes, which is completely unusual for me. I just don't ever cough unless I am obviously sick. In passing I mentioned it to Mom's OT, with no ulterior suggestion or motive. She mentioned to me that this happens to "many" of the residents and explained that it is probably an allergic reaction to the cleaning agents "that have to be used" on the linens in order to make sure they are cleaned and sanitized. Suddenly I began to wonder: Among the mold in the bathroom (which the lingering smell tells me hasn't been addressed), the possible allergic reactions to the indigenous detergent, the continued evidence that my mother is fighting a virus, the constant, low level but obvious dehydration which creates a problem in itself and adds to her constipation problems, the unusually high carb "carb controlled" diet and the lack of opportunities for movement, was it even wise, in the first place, not only to put her into live-in rehab but, as well, to keep her there through her Something Fights in the hope that she would continue to rally and improve.

    Don't worry, I'm not beating myself up over this last, late realization. I've been as present and as diligent as I can be, as is, in fact, probably possible while laboring under the exhaustion that such presence and diligence implies, while Mom has been at the facility, and as hopeful, which I'm sure hasn't hurt her, so I see no reason to fault myself for not coming to this realization earlier. And, we're getting her out on Monday. Despite the problems under which my mother is laboring at the facility, I still need to be adequately and realistically prepared to support her (physically) at home and these last two days of attending her PT/OT sessions have not only helped immensely, I am sure that I will benefit from the sessions that will take place through Sunday. My muscles are telling me that I need this benefit. I know, too, that my mother will not be irreparably harmed in the process and any recovery of which she may have been capable as she entered the facility on May 27th still applies. I want to record and remember all this, though, so that, perhaps, someone else will be prevented from making some of the mistakes to which I was prone, the most glaring of which has been keeping faith with a broken institution simply because the staff was excellent even under the shackles the system requires that they bear.
    There are people who benefit from the therapy. These people, though, are those who are alert enough and fearless enough to not only speak up but to be aware of the inherent institutional problems under which they are laboring; who do not require external motivation from their PTs/OTs and their environment, as well as supportive relatives and friends, to perform; who have not been labeled "Fall Risk", which automatically restricts their attempts to move on their own or with "unprofessional" help; and, who have local doctors who are fully aware of the problems inherent in institutional rehabilitation and have the authority to cut through the masses of red tape in order to hasten recovery and discharge.
    Final word: My mother's new roommate is a 93 year old native Arizonan who is thoroughly enjoyable and of extremely stubborn character (which I salute) and is less demented than my mother but enough so that she, too, does not understand the concept of a call button and is beyond advocating on behalf of her own needs, and, sometimes, incapable of being aware of those needs. She is in for an episode of CHF which has severely swollen her legs. Her daughter and granddaughter, who are local, have visited twice, both visits on the same day, since she was taken into the facility a little over a week ago. I watched while the staff ignored, for three full days, the fact that she remained in the same set of clothes, awake and asleep, despite the fact that she came with an adequate wardrobe. I watched while, during those same three days, she was scolded by staff to wear her "teddy socks" (full length leg socks that exert pressure on edemic legs and help move fluid around and out), which she diligently told staff she could not put on herself (which is true), then told that she needed to use the call button every morning at 0600 to have them put on, then, again, use the call button at 1800 to have them taken off. I mentioned to various members of the staff that this woman, like my mother, had no concept of the call button procedure. I've even triggered the call button for her on numerous occasions...twice I witnessed staff come in, tell her they would "have someone" come in to apply the socks, then disappear for long periods of time. She has been wearing the socks, lately, but, yesterday, she got into an argument with one of the nurses when she flatly refused to have the socks applied and was threatened with never being able to be discharged from therapy if she didn't wear the socks. As well, she is supposed to be on fluid restriction and, yet, the amount of fluid put in front of her to consume is well above the 1500 ml restriction she's on. Having no problem with her thirst sensors, she's been drinking everything put in front of her, which includes a three-times-per-day Boost drink because she is a picky eater and refuses to eat most of her meals.
    What else can I say?
    Oh, yeah, no more cold pill days. The cold pill didn't work, yesterday.
    Time to shower, pack up and head out.
    Later.
- posted by Gail Rae @ 04:46   email  this post