After the Storm

Like a wilted plant that springs back up when given water, Mom recovered all her spunk and personality within 24 hours after returning to Ocean View Assisted Living.
I'm the one who's still in shock, grieving over the whole experience.
What a mistake to put her into skilled nursing!
Why did I do it?
I look back to my list of pros and cons on April 20.
I read my reflections: The SNF should be less work for me after she gets settled... doctor will visit her there, tests will be done there. But moving is a bit of work, and if she's not happy there, she could become more time-consuming there.
More time-consuming--no kidding. It was a terrible ordeal. She was declining fast, and I could focus on nothing else except what to do about her.
I thought that I could recreate her room in the SNF by moving her doll chest, her recliner, her television and CD player, her bureau with its photos and jewelry, her black desk and chair, and her closet full of clothes.
I've done this so many times before:
~~in December 2001 when we moved her out of her own home to the Meridian, an independent/assisted living residence in her hometown, Boulder, Colorado;
--in December 2003 when we moved her to Sunrise Assisted Living in Mission Viejo, California, near my sister, Emily;
--in May 2004 when I moved her to the "Reminiscence Neighborhood" of that Sunrise residence;
--in October 2004 when I moved her to Ocean View Assisted Living in Santa Irena, near me;
--in December 2006 when I moved her to a smaller room in the same residence.
But it didn't work when I moved her to the skilled nursing facility.
The presence of LVNs around the clock, an RN in the daytime, a doctor who visited her in her room; a physical therapist, speech therapist, and occupational therapist was excellent. Lots of medical services and attention. Blood tests, x-rays, catheterizations, IVs could all be done right there.
Yulia, the careful speech therapist, wrote the following note and posted it on the wall above her recliner:
Swallow Precautions--Evelyn E.
1. Place partials in for meals.
2. Sit up at 90 degrees.
3. Stay up 30 min. after meal.
4. Mechanical soft diet with thin liquids.
5. Small bites alternate with small sips.
6. Remind to take small, single sips.
Thank you! ~~ Yulia, S.T.
A lovely note--but the certifed nurse assistants (CNAs) have too heavy a work load to read notes and follow up on these great instructions.
No one put her false teeth in for her meals on Sunday. The previous Wednesday I noticed at breakfast that she had no teeth in, but I accepted their assurances that it would not happen again. Notes were put up on her bathroom mirror.
All the notes might as well have been invisible.
The only factor that really mattered was the ratio of CNAs to patients.
That was my big mistake: sloppy research in finding out this ratio. I took the word of Mariel, someone at the nurses station on Friday, April 20. The numbers she gave me didn't seem right, but I didn't quiz her further and didn't go to the director for confirmation. I discussed it with my sister and thought the ratios were 1/7, morning shift; 1/5, afternoon/evening shift; 1/4 night shift.
The numbers were 7, 5, and 4 as reported, but it wasn't a ratio. It was just the number of CNAs at work on those three shifts caring for 59 residents on the day I toured, 63 a few days later (68 beds maximum).
The person I talked to hadn't understood my question or perhaps didn't know what a ratio was.
I didn't investigate further.
Instead, I moved all Mom's furniture.
Twice.
The real ratios on Sunday, when I asked again at the nurses station, were 1/9, 1/12 or 13, and 1/15 or 16 (for 63 residents).
Had I understood those ratios, I would not have moved Mom, despite all the wonderful medical attention offered.
She does need a fair amount of nursing care, not just assisted living, but care begins with teeth and toileting. If she's not going to get that, all the MDs, RNs, PTs, OTs, and STs in the world are not going to make a difference.
Even more than nursing care, she needs facial contact and verbal interaction with her caregivers. That's what keeps her alive.
That's not going to happen with CNAs who are underpaid, overloaded, and don't speak English.
So the whole week is now just Anne's Big Mistake. Mom is no worse for the wear, I think. As soon as I recover my sanity and equilibrium, it will become history.
May this story be a warning to others looking for care for elderly or disabled family members: above all, check the ratio of caregivers to residents. Other factors are unimportant compared to this.