GENERAL CONDITION: Weak but hanging in there. BP the same. More moaning/groaning in general. Harder to sleep. We have in the Depends 24 hrs/day now. She noticed them at first but Maggie and I just told her that they were her panties with the pad built in. She is accepting them. In a huge way, they take some pressure off of her and the caregiver. She is more incontinent, i.e., doesn't even know that she is urinating. Is becoming more accepting of the bedside commode, but at times there is still a struggle to get her on it. She will be very vocal, but cooperative if you insist. However, at least twice, she has physically resisted me putting her on it. So be prepared. My take on it is that she has the Depends on. I did not force it.
Had a BM that she was unaware of once over the weekend as well. Depends makes it easier to clean up but you must lie her on the bed. She is not capable of holding herself up long enough for you to finish. If you can consistently get her on the commode, this is not an issue. Sometimes you jut hit it right - and that's a lot of fun too.
Morning routine: wake up, keep her in bed, remove clothing, bathe her (she's been in a Depends all night that will be completely soaked through), sit her on commode, while she is sitting, have her brush her teeth (this keeps her occupied), she will typically do her thing at that time, finish getting her dressed while she is sitting on the commode, move her to the walker and proceed to the kitchen.
SKIN TEAR WOUND and PRESSURE SORES: Dan left work early and he and I took her to Pugh today because infection setting in in the skin tear wound. Not serious at this point but he gave her a mild antibiotic. This will take MONTHS to heal. If the skin does not reattach itself, a surgeon may need to remove the dead tissue. Fluid retention is an issue in terms of keeping infection at bay. As Pugh described it, she is between a rock and a hard place in that increasing diuretic puts more pressure on her kidneys that are already compromised. He has recommended an increase in the metazalone (sp?) to 4x per week (she currently is taking it 3x per week) until risk of infection is gone which could be several weeks or months. To give you an idea of what we are talking about, to call it a tear does not quite describe what it is. It is deep and not simply the outer layer of skin. It is healing from the inside out. No scabbing. Raw healing. It will heal best in a moist environment so it is being kept covered with polysporin and wrapped each morning. Just once a day wrapping is all that is necessary as long as it stays in place. Mom is not in discomfort because of it except when it is bumped.
Pugh is ordering a Home Health Nurse to monitor the wound. This Nurse will also monitor the pressure sore and make recommendations on air mattress to aleviate pressure sore recurrence. My research reveals that Medicare will pay for an air mattress for the bed. I think we should push for one for the chair as well.
EATING SUPPORT: Interest in food there, but more difficult time seeing it and getting it to her mouth. Recommending a bib (paper towel, hand towel) to cut down on spills onto her clothes. She can see those blemishes for hours and hours and they bother her.After some keen observation on my part (ha! ha!), Tom and I figured out a way to better support her self-feeding. Raised the tray table to its highest height. It's supporting leg that extends out can then fit under her legs between the chair and the stool. Her feet have to be on the stool and the chair has to be in a way up position. Make sure her elbows are free from the pillows and she can maneuver a spoon or whatever.
Fill glasses only half full. They are too heavy otherwise. Smaller drinks, more often is the rule. Small bites, hand foods are perfect. She does better at this than with utensils right now, although she loves her soup and a soup spoon works well.
REVERSE MORTGAGE. Dan, Mom and I successfully completed the HUD counseling step. The certificate she gets will be good for six months so we have six months to put the mortgage in place. Have been advised that we can get it done within 30 days by the banker I've been conversing with. As a side note, it just so happened that Morris showed up for a visit at the time we were starting the call. He sat in on it.
NURSING HOME SEARCH: There is only so much we can do prior to checking her in. Unless we are prepared to move her "now" we have done all we can do. It all depends on who has a bed available. It is at that time that you fill out an application, etc. I am recommending we all get through a weekend or a time period of caregiving and then circle back to discuss how to proceed in this regard. Lots of communication and commitment to the home-care environment required now going forward.
Let me know if you have any questions or comments.
Thanks.
Eileen
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3 comments:
Just getting back tonight and unfortunately heading to a 2-day meeting in the morning. Sounds like the challenges continue to grow and I am anxious to get to Greenville myself. Thanks for all you're doing there! Do you think our caregivers are holding up OK?
Caregivers are holding up beautifully! They are all calm, consistent and persistent. I try to stay out of the way, unless there is some way I can assist and at times, I need to because of the physical nature of the decline. (Will be interesting to get feedback from them after I am gone and they are here alone.) They are actually better at getting her on the commode consistently. She does not seem to fight them as much as she does me.
And yes....you need to experience it to know what I am talking about. I'm hoping not to sound that it is dire. It is not dire. It is different. She is more frequently uncooperative and very vocal about it and it is more physical than ever. However, the danger of falling (except if you drop her) is gone and the trips to the commode have fallen off. She does not get good sleep. She says she is in pain everywhere, all the time. No chit chat.
When you are here, I'd recommend that you ask Maggie either to be there on Friday night, or at least be there for the bathing routine on Saturday morning. She is a pro and there is a lot you could get on "how to get it done" if you do it with her - just one time even. She keeps telling me "I'm only a phone call away....".
And I am very happy to have had the chance to be here to do something. I will be starting a new job on October 29. I don't know yet how I will be able to physically participate in the near term. I'm hoping that as time goes by, I'll have a better feel for their time off tolerance and if I can work from SC as I was able to do with Citi. I'm a little concerned, but I'll do the best I can.
"Time off tolerance" - that's a good way to put it.
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