Dad's Care Meeting

Lima holds a regular (monthly?) 'care' meeting for those in the medical unit (or at least for Dad).  They had one yesterday.  Liz and Mom were there.  Dave and I were on the phone.

Here are notes from the meeting:


Present: Suzanne (nurse), Nancy C. (social services and activities), Karen (nutrition services mgr)

Therapy will be reduced from 5x/wk to 3x/wk starting tomorrow - not clear whether all therapies are affected (Phys, Speech, Occup.), need to ask the therapy dept

• some discussion of medicare B - Medicare A is related to hospitalization, so any therapy that was related to the hospitalization was covered by Med A.  The reason for hospitalization was a sugar low, and it sounded like they can't claim that as a reason for PT or OT any longer.  May be able to stretch it for Speech Therapy.  Again, said to ask the therapy dept.
  

Walking program -- Dad uses the walker (escorted) to get to 2 meals a day; goes to breakfast in the wheelchair due to time constraints (on the part of the aides, I believe).  I think his walking is noticeably stronger, more upright.

Diet same, mechanical-soft -- start thin liquids next week, with monitoring for aspiration  (this change is as a result of the barium swallowing test on Wed.)

• starting at beginning of week allows them to monitor (not around on weekends)
  
• permission for thin liquids is required for ice cream

Dad still needs help with everything (ADL - activities of daily living).  Suzann said that they have reservations about his ever being able to move to Oakbridge, but also said it was too early to say for sure.  I said that there are still definite things he can work on to make him more independent than he is.  They mentioned that he will not be in room 27 permanently anyway, unless he wants to keep a single room (cost of $72/day extra).  Said that if we were considering keeping this room we should mention it to them as soon as we could.  Said also that as a permanent resident of Willowbrooke, if Dad is hospitalized for any reason, his bed is held for him.  As a temporary resident, if he is hospitalized he may not find a bed open at Lima when he is released.

Weight 131 (measured weekly)

Dad complained about food:

• about thickened liquid
• food doesn't look appetizing

Dad said that the dentures are his biggest problem.  Mobile dentist is coming Mon.  We asked about leaving his dentures out for eating - I don't think they said either "yes" or "no", because the discussion veered off into how easy it is to lose the dentures if you take them out at meals.  Anyway, no one said he wasn't allowed to take them out.

He is still not permitted to eat at Oakbridge with Mom.  The issue is not getting his special meal transferred, but that he still requires supervision while eating.  I guess I should've asked what drives the need for supervision - will it continue after he has adjusted to thin liquids because of his other swallowing problems?

Dad has breakfast at 8, therapies during the morning, then lunch.  Sometimes therapies aren't completed and are continued in the afternoon.  There are "social activities" scheduled in the afternoon, too.  Dad complained that he is sometimes taken to these activities without being asked if he wants to go.  Suzann said she would arrange that he would be asked first.

I talked to Nancy R. (Dad's reg daytime nurse) after the meeting:

  She said some of the bloodwork results are back (and look fine, a little low in protein due to diet probably), but not the zinc level results.  If the zinc level is normal, she agreed he could use extra Fixodent until the dentures are fixed.

  Blood sugar levels are consistently good - range from about 75 to 100.

  Said she will cut his fingernails and check when the foot doctor last checked his feet and cut his toenails (answer: Dec 21, and he does this service every 2 months unless asked to come earlier).

  She said it's fine to leave the nightstand where Dad can reach the phone.

  She checked to see if Dad had standing doctor's orders permitting him to leave Willowbrooke for an outing (asked this because of the memorial service at the church Sat.).  Answer was that he had no such orders - Nancy then called his doctor to arrange for those orders, so they are now in place.

  Said that the alarm on Dad's chair/bed was a trial period (or a period of trial, to Dad), and I didn't see the alarm anywhere while I was there.  I guess it was removed.  But they found him standing in the bathroom this AM, on his feet but looking shaky, arms and legs spread for balance; he hadn't pushed the button to call the aide or nurse to supervise his getting out of bed.  I asked Dad to please call them when he needs to get up, he asked "why?"