Nurse error nearly cancels Mom's physical therapy

A few days ago I caught a nurse in an error that could have cost Mom a chance at some physical therapy. She really needs some regular PT to keep her as limber as possible and it's also some diverse activities to keep her mind active.

Here's the scenario:

• Mom's doctor calls the ALF to order some physical therapy but the nurse tells them that the Physical Therapist (PT) won't return because Mom refused it last time.
• Doctor's office calls me to get Mom to agree to do the PT and tells me she refused it. I tell the Doc's office Mom did NOT refuse it that she was discharged because they could not make any headway since her knee was so bad.
• NOTE: The doctor was about to cancel his PT order until he heard from me that the ALF was mistaken.
• So, I call the LPN at the ALF and ask her to check Mom's records. She INSISTS that Mom refused more PT. I had to press her to look in the files and she saw that Mom refused one day because she was ill but that she was discharged from by the PT.
• The LPN then called the doctor's office to confirm that Mom HAD NOT refused PT so it was ordered and she began this week.

This scenario really got me worked up. This nurses ASSUMPTION based on something she was TOLD nearly cost Mom a chance for some needed physical therapy. The nurse would not have checked unless she had been pressed by ME. The PT is necessary to strengthen her muscles and keep her as limber as possible. It's necessary to keep her mobile under her own power even though that's limited.

What about those residents who don't have pushy family members? What about those who don't have doctors willing to call daughters to get another perspective? I realize that the ALF has budgets to worry about; I realize they are short handed and everyone does more than their share of hard work but..... My concern must be my MOM not their work load. If they can't handle it, they need to hire more people.

2 weeks in town and I'm tired and angry with the ALF...

For the past two weeks I've been in Idaho visiting my Mom and family. I always make a long to do list before I arrive but then something always happens to blow my plans and schedule totally out of the water. It always seems that I spend the last day or two cramming a couple of days worth of work into a few hours. That's one thing that all my friends mention as well - they never get enough done while they're visiting their parents. Whether it's for work or pleasure, they all want to do much more than time, energy and money permit. I like to think it's because we're such good people, we WANT to do too much.

I feel as though I'm doing a half-assed job of everything - visits with Mom, cooking for my husband and I, exercise for myself, visits with family or friends, my job search, my blog.... I don't seem to be able to do anything well... One thing is certain, Mom seems happier when I'm there and I'm rallying the care givers at her assisted living facility to pay her more attention and be more cautious.

This week the administrator asked to speak with me and she outlined what she did to address the 8 or 9 items I brought up to her two weeks ago. She was kind and understanding even when I added a couple of things to the list. I'm really irritated that I feel it's necessary to add to my list of concerns about this ALF! I feel like I must be on guard all the time. That's what we PAY THEM to do but... ... they can't train on common sense I guess. So, I'll just keep raising concerns and getting them addressed.

My latest concerns are these - these seem so very basic to me and I'm really frustrated that I'm forced to complain about something so basic:

• Make the bed properly: Mom's bed is not placed properly after it's made. Often the top mattress sticks a foot out from the bottom box spring. If she were to fall against it, there would be no support there and she'd hit the floor. Sometimes the box spring and frame protrude out past the top mattress but the frame is hidden by the large comforter. I stubbed my own toes on the frame and cried because it hurt so very bad. If mom had done that with her osteoporosis, she might have broken a foot.
• Move the commode then empty it: Six times now I've found that her bedside commode was not emptied. The commode is placed near her bed during the night and moved to the bathroom during the day. This is a tactic to keep her moving by getting her to walk to the bathroom. Visiting in the afternoon or early evening, her room reaked of urine so I checked the commode; it was properly moved to the bathroom but it was full, very full. To me it appeared not to have been emptied for a couple of days, not just one day. The first four times (I should've complained after the 2nd but I'm too patient) I noticed this full commode, I emptied it and told an aide what I did because I knew that they were busy. The fifth time, I was mad and told them I was mad. The sixth time, I hit the roof then told the administrator that it was unacceptable to pay more than $3000 a month for Mom to smell piss!!!!!! It seems to happen more on Fri, Sat, Sun and Mon - it makes me wonder if they are short handed for the weekend. Anyway - I'll ask my brother and sis in law to stop by now and then to check on it. When it happens I'll just call the Nursing director or the administrator.
• Nurses fail to check details on Mom's care: There have been a couple of incidents where the LPNs or RN tell me something - generally negative - about Mom so I press for details. When they look in her file they can't find any information and tell me that they've confused her with another resident. This REALLY concerns me because it means that doctor or his nurse could get incorrect information when they call. Please see the blog entry Nurse error nearly cancels Mom physical therapy.

So - for now I'll continue to stand guard so to speak. I'll return to our home in Indiana soon and hope that Mom will be fine until I can return in November.

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.