Tuesday, April 24, 2007

A Huge Blunder?

Last night I wrote in my journal, "So she's now in Country Villa. Not that bad."

This morning I woke at 5:30 am, worrying about Mom. At 6:30 am I wrote in my journal:

What the hell have I done?
Skilled nursing?
How to shield her from this reality?
What will happen when she realizes her loss?
When they wheel her into the hall to sit in a row of living corpses to pass her time?
When she sits in the crowded dining room and looks around?

By midnight I was writing,

Horror. I have made a huge blunder, I think.

Earlier in the day I thought I had done well, accomplished something.
After visiting Mom briefly at Country Villa, I met the movers at 9 am at Ocean View Assisted Living.
By noon they were moving her furniture and boxes of belongings into her room at Country Villa. Fortunately, she was not present to see this; she was in the dining room.
The movers took her old bed and a bedside table to my house.
During the afternoon I set up Mom's room, put her clothes in the wardrobe, located her toothbrush, etc.
She was having a Lewy Body sleepy day and hadn't eaten any breakfast or lunch. At 3 pm I got her to eat a cookie and some milk and juice.
At 5 pm I was able to wake her up a bit. I took her to dinner, and she was ravenous.
The food didn't arrive until 5:20, so I gave her a can of V-8, then a cup of greenish horrible looking fake-lemonade. She drank it immediately and was reaching for the other cup, so I pushed it to her.
She took a drink from it but quickly spat it out.
"This is water!" she said. "I don't want water."
She poured it on the table. The attendant cleaned it up.
When her tray came, she ate well but at one point knocked over her cup of orange juice, which the attendant and I cleaned up.
I noticed that there was no one in the dining room to cut up the meat or to provide prompting like "Drink your juice." The attendant was only serving trays and picking them up, not interacting with the residents.
After dinner the toileting and care given by Mom's CNA, Christina Vasquez, was a disaster.
I explained Mom's care to Christina--remove false teeth, put them in cup with Efferdent, floss, brush--but Christina did not interject reassuring comments like, "Oh, I see. That's good."
Finally I asked, "When do you plan to brush her teeth? Now or at 9 pm when she goes to bed?"
Christina had a blank look on her face.
"Quando lavar los dientes?" I asked next in broken Spanish, and Christina answered immediately.
It's a big problem if Christina and I can't communicate, and even greater if Christina and Mom can't interact well.
Instead of toileting Mom myself, I decided to watch Christina do it. A kind supervisor, Linda, had assured me that the CNAs could do this, even in such a small space as this bathroom.
But Christina is a large person. She could hardly squeeze into the room around the wheelchair, which was between the sink and the wall, directly facing the toilet.
Once in, she had difficulty maneuvering Mom onto the toilet and standing her up again to put the disposable pants on.
One problem was that the bathroom did not have a bar located where Mom could hold onto it while her pants were being pulled off or pulled back on again. There was a short bar but it was behind the toilet to the right, where no one in a wheelchair could reach it.
Mom was expected to grab onto the edge of the sink and counter, about 8 inches wide, too big for her small, weak hands.
Another problem was that the SNF didn't have Depends, as I had been assured. What they had was refastenable "Attends," a loose padded rectangle with two tabs of tiny plastic tape on each side. After fastening the weak tabs earlier in the day, I noticed that one side popped open while I was fastening the other.
Note: Depends are fitted with elastic around the waist and legs; the tabs are Velcro and hold well.
As a result of all these factors, the toileting was difficult to watch. Mom had to stand there grabbing the sink for two minutes, and her feet got tangled and bent as she was placed back in her wheelchair.
She screeched in pain and then reached up to pull Christina's curly head of hair in retaliation, but Christina pulled back in time to avoid a yank.
In Mom's former residence, two people were often assigned to toilet Mom, but in this tiny bathroom two people wouldn't fit around the wheelchair.
Next we put Mom's nightgown on and took her to her recliner.
At one point I accidentally stepped on her foot, and she yelled, "Dumbbell!"
The medicine nurse came in to give Mom her evening pills, but Mom was upset and refused to open her mouth.
He and I cajoled her, trying to get her to take the spoon with applesauce and meds in it.
She took one spoonful and spat it out because the bitter medications had been crushed and mixed into the applesauce.
Then quickly she reached her bony fingers toward his face in a threatening menace.
Her eyes were rolling wildly as she clamped her mouth shut, refused more contaminated applesauce, and tried to defend herself against what she viewed as the second attack in a few minutes.
It's hard for me to see Mom in pain and combative, twice in one night.
At 8 pm I went late to an Al-Anon Parents meeting, sat there, and cried. Afterward I came home and reflected: This skilled nursing facility was supposed to be easier for me, not harder. The care was supposed to be better.

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