Sister Christine and I attended Mom’s care review and planning meeting today. It seemed very productive, and the staff is indeed aware now of the few concerns that we’ve had, and for the most part, they’re attempting to address them as best they can. Details below…
We learned that we can contact the Nursing Supervisor at any time, day or night, with questions about Mom’s care and status. That direct line telephone number is: xxx-xxx-xxxx.
For billing questions, we are to call CT at yyy-yyy-yyyy. I’ll probably be the one dealing most directly and most often with her.
This meeting consisted of representatives from several departments at the home that each contribute significantly to Mom’s overall care. Those include: Dietician, Pastoral Services, Physical and Occupational Therapies, Social Services, overall care planning, and Activities. Each of these groups accepted feedback from us regarding their particular areas of expertise and services rendered thus far, and they offered information about Mom that they’ve been accumulating since she became a resident there. I’ll detail all of that that in the next paragraphs, organized by each department that spoke.
Dietician
Mom’s eating roughly 50% of what they offer her. That goes for both fluids and solid foods. She often does not like what’s on the menu. But we were advised that she can order from an a-la-carte menu, a week ahead, so that more of the food that she enjoys is available come actual meal time. We need to make sure she’s ordered for the next week each time we visit.
Mom would like more salt to put on her food. They said though, that they do salt the food while cooking, so that little more (if any) is required at the table. However, they’ll see if Mom’s dietary restrictions will allow for at least a little extra salt.
They’d like her to consume 12 to 16 ounces of fluid per meal. But she’s currently only drinking about half of that. So they and we are encouraging her to try and drink more.
Mom’s current weight is 166.8 pounds, and no areas are apparent that might indicate excessive skin pressures. So that means that she’s not lying around in bed too much. They do seem to be getting her up and about at least for several hours each day.
Occupational Therapy
This group continues to work on Mom’s board transfers. However, they feel that she’s not strong enough to move herself across the transfer board from wheelchair to the toilet; although they assured us that that is their goal and that they’re encouraging her to work toward this as well. But her mid-body strength is very low and so, she can’t easily bend and twist herself the way one must, in order to accomplish these transfers routinely and safely. She’s quite fearful of falling. So, they’re taking steps to convince her that these board transfers are indeed safe enough to attempt.
Mom will not be able to receive hospice services until she’s no longer receiving the physical and occupational therapies at the home. So, under advice of the attending therapists, Mom wants to continue with the therapy for a while longer, though she won’t likely be authorized to receive it every day. It may just be a two or three times per week thing, as her skilled nursing and accompanying therapy authorizations ran out yesterday.
But these therapists are seeking further authorization from her medical insurance company. If skilled therapies are not authorized further however, the home offers a restorative program; the charges for which are included in the daily rental rate for her room. This would not be as rigorous as what she’s been doing up to this point. But it’s a far cry better than nothing at all.
Activities
Mom does attend some activities — mostly table games and music groups. My impression was that they’d like to see her attend more, as Mom voiced that she “does not fit in.” She may have problems with assimilating into this new environment, given that most of the clients range anywhere from ten to thirty years older than Mom. She may in fact, be the youngest one there, but has health problems that normally do not occur until a person is significantly older. This troubles her and likely confuses some of the staff; especially the ones who do not read her whole chart before administering care. So we’re hopeful that visits from her friends who, are more her own age, will help cheer her up, and that the staff will care for her with greater sensitivity now that we’ve made them aware of this issue. These are mainly just settling-in issues that I’m confident will disappear once the personnel there all come to know Mom.
Pastoral Services
The woman pastor has visited Mom a few times since Mom’s inception, and encouraged Mom to seek her out anytime she needs to talk, about ANYthing. She seemed to like Mom, thought Mom has a keen mind, and she felt that she could help Mom deal with the myriad of questions Mom’s trying to answer for herself about this new and daunting stage of her life.
Social Services
I submitted the power of attorney papers.
Also, the Wifi installation at the home will not support Netflix movie downloads onto Mom’s Internet-ready TV. Apparently they do not have the necessary bandwidth for that. But they do offer regular cable TV as well as a Wifi access point for guests (so long as they’re not watching Netflix movies), free of charge. We asked for this password and they’re obtaining that for us.
They advised me to continue my work with the county assistance office, to file the Asset Protection form, which may allow us to retain some of Mom’s monthly pension money for incidentals, telephone, and other recurring expenses. I’ll know more about that tomorrow.
We will not actually apply for Medical Assistance payments until Mom’s total asset amount falls below $16,000.
Care Planning
Mom is currently taking three meds for depression, and her protines ( that drive how fast her blood clots) are checked on an ad hoc bases as the doctor sees fit. She was due for another test today.
Her current physician does not visit this particular home. So she’ll have to pick a doctor who does. We’ve asked for a list of all doctors who work that home to help her decide.
We told them that we expect Mom to remain at the home indefinitely barring some miraculous recovery. The reps clearly indicated that they understand this. Before this meeting, there seemed to be questions about that when I talked with the social worker yesterday. But it’s all straightened out now.
They informed us that we will be notified any time they make changes to Mom’s meds. Any questions about meds can be raised with Mom’s charge nurse or, if that person cannot be reached, the nursing supervisor can supply the most up-to-date information.
Mom raised concern about how some of the staff is treating her. Christine and I felt that these staff were probably just not made aware of the extreme weakness in Mom’s legs before serving her for the first time. So, they may have been leaning a little too much on her to get up and about, not really knowing the extent of her disability. The therapist there agreed to put notes in Mom’s chart and to personally inform all the parties that work with Mom about her rather unique and unusually advanced polyneuropathy situation. Hopefully, they’ll avoid ribbing her as much for not standing after this.
Additionally, they suggested that “the workers tend to be gruff” where Mom is, and offered to move her to a different part of the building, where workers are “softer,” as they called them.
I objected though, saying that Mom should not have to give up her nice room because someone in that immediate area is mistreating her. In fact, if moved, Mom would have to sacrifice her private-room status (quite probably forever) and have to share living quarters.
The notion was offered that this may simply be a matter of “style” or “personality” of the workers, clashing with Mom’s, and that this might be solved by putting Mom with different caregivers. But in order to preserve continuity of care for patients throughout the various areas of the home, they typically do not circulate staff around. It would be far easier therefore, they said, to move Mom than to juggle staff around to different positions.
But I feel that compassion should not be confined to only some of the areas of the building. Specifically, Mom should not be made to feel like a burden when she has to go to the bathroom, no matter where she resides in the complex. If one area is “nicer” than another, then that’s an administrative issue that they need to address not by simply having Mom give up perhaps the best bedroom in the facility.
They did say that if Mom feels neglected or otherwise mistreated where she is, that she can always let the nursing supervisor know. I told Mom that if workers treat her gruffly, then she needs to develop a thick skin and just ask for the supervisor if they won’t do what she needs. She has a cell phone too and can call one of us if she ever feels abandoned, and we can be out there in fifteen to twenty minutes if need be. The reps assured us that we have every right to expect that Mom’s requests be fulfilled in a timely manner, without any negativity in attitudes, abruptness, sighing, expressions of disgust or impatience, and out-in-the-hall whispering.
We assured Mom that the decision of where to room is ultimately up to her. But I did advise her that she has it pretty darn good where she is, and that sacrificing her privacy (again, probably forever) in order to get more gentle workers is probably not worth it. If they’re mean, I told her, you just calmly ask for the supervisor.
Again though, these tensions may no longer be issues once the therapists communicate the full extent of Mom’s malady to all involved workers. As her family and friends, we can also help by making sure when we’re up there that the nurses are treating her accordingly for her condition.
All in all, this was a highly beneficial and reassuring meeting for both the staff there and us, and the Oreo cookies were delicious. 
Christine seemed to like the coffee too.
Tom Hesley
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