We just got back after a flying trip back to see family and another short vacation. Mom has been on Aricept now for about a month and I can tell a subtle difference. Even she says she can tell a difference, although she believes she is recovering from the stroke. She still forgets things about 5 minutes after they happen, but it is a subtle personality change that I could see. I don't know how to explain it other than her personality doesn't seem so shallow now. That could be because the last time we saw them, in November, her obsession with her cats was almost constant. Now she was able to carry on a conversation for quite some time without talking about or looking for the cats. She still has periods where she gets focused on where the cats are and asks Dad repeatedly to go look for them, even though they were located within the last 10 minutes. He gets frustrated and ends up by yelling. I know he ends up feeling like the husbands that attend my Caregiver Support group, he gets frustrated, explodes, then feels guilty. I think I'm going to create a spreadsheet for them where every hour he can write down where he last saw the cats. Then maybe if she sees it in writing, it will calm her until the next hour.
The exercises that she is supposed to be doing following the stroke are an issue as well. She thinks she is doing them. He reported that the week before she did not do them for 4 days out of the 7. I've noticed one of the issues she has is that she will talk and talk about doing something but just can't seem to get the impetus to actually do it. For instance, I gave her oil paints for Christmas. She says she has been too busy to use them. I guess she is busy looking for the cats most likely. I have a new resident that is going to move in that is in the same point. He has great daughters who want to support him but not take over. I was telling one of the daughters the other day that they are going to have to give him a nudge because he just can't do the planning and follow through required on his own.
Speaking of families, this week has been tough because I have a resident whose dementia seems to be progressing after doing really well for several years. I look at one of her children in particular and I can see the pain of watching his mother become someone he doesn't even know and his losing the mother he did know. I actually said out loud to myself the other day, "maybe Mom will have a big stroke and it will be all over before it progresses to that point". That is very unlike me. I have prayed for years for God to give my parents health and long life. I don't feel ready to be the foundation generation yet. But maybe losing her quickly would be easier on us all that losing her slowly.
So after a short break, I'm back, asking God to help me help residents and their families and to give me the wisdom to know what to do with my own family and the strength to do it.
Sunday, May 26, 2013
Saturday, May 4, 2013
Avoiding hospitalization
The latest edition of Care ADvantage, the magazine put out by the Alzheimer's Foundation of America, had an article about trying to prevent hospitalizations for individuals with Alzheimer's and how to make the best if someone does go to the hospital. I saw first hand this week another aspect of what happens when someone with dementia goes to the hospital.
One of the residents at the assisted living went to the hospital about a month ago. It was not a preventable situation. While in the hospital, she did not get up and walk. So after addressing the issue that sent her to the hospital, she needed a rehab stay at a skilled nursing facility because she had lost so much strength and ability to walk on her own. So off she goes for the famous 21 day stay at rehab. I understand why it happens, yet that doesn't make it any easier to watch. While at both the hospital and rehab, she was restricted from walking except when there was a staff member to walk with her. Because of her dementia, she was not one to use the nurse call system when she needed to go to the bathroom. So if she didn't call, they didn't walk her to the bathroom. She walked during the physical therapy sessions, but that was about it. And I firmly believe the old saying, if you don't use it, you lose it. And she did.
The staff at the skilled nursing facility told the family that her inability to walk now (when she was slow, but able before going to the hospital and the reason for the hospitalization had nothing to do with her walking) and the fact she was not feeding herself was because the dementia had advanced. Now I can't see into her brain so I can't say it wasn't. I just think it was more a function of how the system is set up that isn't beneficial for people with dementia. First of all, I don't like to just write a decline off to dementia progressing. I think that can be an easy explanation for people to fall back on. Secondly, I have worked in a skilled nursing facility and I know with the pace there, it can be much more efficient to just do things for a resident, feed them, wheel the wheel chair to the bathroom, or just change pads if they don't make it to the bathroom. And I'm not against facility care. I know there is a need for it and I know there are lots of facilities out there that are really trying to do the best job they can.
So when I went to evaluate her for coming back to assisted living, she was not in any shape to come back. We are lucky in assisted living because even though we see our residents decline and need a higher level of care, we don't watch them deteriorate to the extent I did when I worked in a skilled facility. That doesn't mean it isn't hard to see. Not only was it hard for me to watch while she ate when fed, but not on her own, but I could see the future for my own mother as well. It used to be when I first started in long term care, I accepted people where they were at the time and it was okay. I hadn't known them in the younger days as young wives and husbands, parents, grandparents. All I knew was how they presented at that time. Now as a family member myself, I understand how hard it is to watch the person you once knew disappear. And just as hard is the saying good bye to the family member that has become a part of your family as well. Giving the daughter a hug, her looking you in the eye and you both know this move out of the assisted living is the beginning of the end.
I do love my job and I love being able to help residents and family members. And I guess if I really didn't care, then it wouldn't be so hard to watch a resident decline or have to say good bye to a family member. I just pray this experience helps me to be a better person, to be a better care-giver, to help families more and to be better at caring for my own mother.
One of the residents at the assisted living went to the hospital about a month ago. It was not a preventable situation. While in the hospital, she did not get up and walk. So after addressing the issue that sent her to the hospital, she needed a rehab stay at a skilled nursing facility because she had lost so much strength and ability to walk on her own. So off she goes for the famous 21 day stay at rehab. I understand why it happens, yet that doesn't make it any easier to watch. While at both the hospital and rehab, she was restricted from walking except when there was a staff member to walk with her. Because of her dementia, she was not one to use the nurse call system when she needed to go to the bathroom. So if she didn't call, they didn't walk her to the bathroom. She walked during the physical therapy sessions, but that was about it. And I firmly believe the old saying, if you don't use it, you lose it. And she did.
The staff at the skilled nursing facility told the family that her inability to walk now (when she was slow, but able before going to the hospital and the reason for the hospitalization had nothing to do with her walking) and the fact she was not feeding herself was because the dementia had advanced. Now I can't see into her brain so I can't say it wasn't. I just think it was more a function of how the system is set up that isn't beneficial for people with dementia. First of all, I don't like to just write a decline off to dementia progressing. I think that can be an easy explanation for people to fall back on. Secondly, I have worked in a skilled nursing facility and I know with the pace there, it can be much more efficient to just do things for a resident, feed them, wheel the wheel chair to the bathroom, or just change pads if they don't make it to the bathroom. And I'm not against facility care. I know there is a need for it and I know there are lots of facilities out there that are really trying to do the best job they can.
So when I went to evaluate her for coming back to assisted living, she was not in any shape to come back. We are lucky in assisted living because even though we see our residents decline and need a higher level of care, we don't watch them deteriorate to the extent I did when I worked in a skilled facility. That doesn't mean it isn't hard to see. Not only was it hard for me to watch while she ate when fed, but not on her own, but I could see the future for my own mother as well. It used to be when I first started in long term care, I accepted people where they were at the time and it was okay. I hadn't known them in the younger days as young wives and husbands, parents, grandparents. All I knew was how they presented at that time. Now as a family member myself, I understand how hard it is to watch the person you once knew disappear. And just as hard is the saying good bye to the family member that has become a part of your family as well. Giving the daughter a hug, her looking you in the eye and you both know this move out of the assisted living is the beginning of the end.
I do love my job and I love being able to help residents and family members. And I guess if I really didn't care, then it wouldn't be so hard to watch a resident decline or have to say good bye to a family member. I just pray this experience helps me to be a better person, to be a better care-giver, to help families more and to be better at caring for my own mother.
Subscribe to:
Posts (Atom)