Wednesday, August 12, 2009

Mom's address book is a poignant tale

I found a sad and poignant reminder of the entirely of Mom's life the other day. I was helping her put together some clippings and a letter to her uncle when I opened her address book and something struck me as odd. Many of the names were crossed out with a single stroke, in many cases all the entries on entire pages were marked. Each stroke was deliberate and just the same. Mom began at the lower left corner of each entry and quickly drew a slash up and to the right over the city, over the middle of the address and the last part of the name. Reading the names, I realized they were friends or family that had passed away.

I asked if she had done it all at once or as people passed away. "All at once about three years ago. I update it when I learn that another one has died." I could picture her, looking for an address then realizing that there were more dead listed an alive. This list was of the people most important to her - aunts, uncles, distant cousins, friends from the years of church service, PTA, boy and girl scouts, politicians who helped with a tax battle, democrats and neighbors who moved away.

Her entries were always tidy and in ink. Early on each letter is clear; each digit carefully spaced for readiability. As she added new entries for grand kids, medicare, supplemental insurance, doctors and such, her writing became a little more slanted. Often the letters hovered above the straight lines or crowded another. For the most recent entries, I found an extra consonant in names or cities and states but the names were fine. The precision wasn't as important to her anymore as the recording of the information. Details are all there but her presentation is no longer tidy. It's like her hair, white, wiry and harder to control but still there making a white glow around her little head.

Meeting with ALF Administrator shows some quick results.

Five days ago I met with the ALF administrator and outlined my concerns in detail; already I see an improvement in Mom's care plans. I began my discussion by telling the Administrator that the request of Mom's physician to move Mom was forcing me to talk with her. The Administrator responded very positively to me. Over all, she claimed that more training was required for all the aides. I agreed but also said that the shear number of residents required MORE aides. At some point it becomes a matter of safety.

I tried to be tactful, to site specific examples, names and dates. This approach was well received. She took the complaints about the food in stride and said most residents complain about it because it's one of the few things that people feel they can control. Food likes and dislikes are also quite different across people so each person is bound to have some complaints at some point.

The personnel matters I described were another matter completely. As a project manager, the behavior I saw on the part of the LPNs and RN indicate that there is an antagonistic relationship building and that the LPNs have no desire to work as part of a team. It's a hard thing to tell someone - that their direct reports are manipulative shirkers - and that I believe it stems primarily from having TOO MUCH WORK TO DO. Two LPNs to coordinate meds and doctors orders and one RN to over see treatment is just TOO few staff to safetly monitor 170 to 180 people. Some time, someone, some where will fall through the cracks. I just hope that the victim does not suffer needlessly. Until we can move our Mom, we need a strategy to ensure Mom receives quality care.

I, my brother, his wife and daughter realize that we must ensure that Mom doesn't fall through the cracks. We hope to plan our schedules so that at least one of us visits daily for the next couple of months. By then we hope a single room opens at the smaller assisted living residence. I hope this new approach will suit her physician and give him some confidence that Mom is getting good care.