Attention span and memory are MS symptoms that can confound interaction with Patti.
Reading holiday cards to Patti though has been some of the more successful moments. Watching her light up with recognition and often have her share a memory is enjoyable.
Cards are colorful and visual. Holding them and seeing whatever she can see seems to enhance the moment for her.
Never underestimate the power of a simple card or note from a friend.
The deck is too often stacked against home care for many benefits to a patient. The 'system' basically does not trust the home caregiver. An institution is trusted because it can be regulated.
Physical therapy is an excellent example. Through years of homecare armed with the best of private insurance and Medicare we could never manage more than a dozen home visit sessions and that was ONLY following hospitalization.
I could only shake my head as I reviewed a recent Medicare Summary Notice “paid in full” for 43 physical therapy sessions between just October 5th and October 31st. I am glad Patti could get the help. However it is soooo frustrating that she was denied the same help at home simply because she was ‘at home.’ Same disease, same diagnosis, same prognosis, same doctors, same insurance, only difference is that she is in a care facility and not at home.
And it is not just “running up the bill”. Over half the sessions involve restorative eating therapy and unquestionably Patti is demonstrating positive results. The remaining sessions involve her adapting to recent progression and learning new ways to help others to help her transfer.
There are many aspects involved in the transition from homecare to a care facility. Increased options to the patient as in this example is a factor that cannot be ignored.
CHRISTMAS EVE
Picking Patti up for Christmas was full of high hopes only to find Patti unaware it was even Christmas Eve or that she was going home for the holidays, such is MS and memory. <grin>
Bowel incontinence torpedoed the evening’s agenda. The associated custodial care involved in clean up, bathing, and laundry was difficult. It’s been 9 months since I did this level of home caregiving 24/7 by myself or have been accustomed to the daily routine.
Patti’s strength has increasingly failed in that time and symptoms of spasticity have not only had their advent but also progressed. Wow! Does that double punch multiply the level of difficulty in handling Patti by oneself. I better understand the increasing use of Hoyer Lifts by care facility staff.
Associated stress and exhaustion yielded to gloom, I doubt visions of sugar plums danced in anyone’s dreams.
Christmas
Patti who NEVER wakes early, of course, was up early. <grin> Patti’s only remaining contribution to self care is some ability left to put on her own socks and shoes. The process of getting her up, bathed, changed, dressed, and laundry of bed linen and soiled bed clothing turns any morning into slow motion.
To balance the family aspects of ‘Christmas morning’ with caregiving is tricky. A late brunch followed by gift opening worked better than expected.
Patti’s parents stopped over in route to a larger family gathering, taking our daughter along to give her the counterbalance of an “able bodied” Christmas.
Patti’s napped the better part of the day. Her brothers and their families were able to visit later. The final guests making it just as Patti was ready for bed. Patti rallied for company and did rather well for the extra time before succumbing to fatigue and ‘abruptness’.
Repeatedly reminding and explaining to Patti the differences between living in a home environment and care facility seemed to help extend her cooperativeness. It took effort on her part and wasn’t easy for her.
Absence of vehicle transfers and consistency of environment stacked the deck in favor of a good day. Patti wanting a good time and trying her best was the rest of the formula of success for a Christmas Day at home. It wasn’t the kind of Christmas that you dream of or sing about, “…just like the one’s I used to know…” . It was an ‘alternative’ Christmas - the best of possible.
On a lighter side, for whatever reason Teazer, our 18 yr old cat, was obsessed with climbing all over and sleeping on top Patti when she napped and slept. Patti thoroughly enjoyed this disruption. <grin>
THE DAY AFTER
Now THIS morning Patti slept in until almost Noon! <grin> Again we moved through the slow motion process of lifting, bathing, changing, dressing, laundry and feeding.
You cannot box yourself into a timetable with homecare. In a care facility with increased staff that is another story because you have so many people available to do simultaneous functions.
We decided to wrap up the time with a movie matinee of “Meet The Fockers”. One of those zany comedies Patti can enjoy and did. Sealing the weekend with a couple hours of laughs.
It also provided somewhat of a ‘regular’ outing ending to an unusual weekend. It seemed such a segue way might make the most sense for all.
EPILOGUE
Asking Patti if she had a good time or enjoyed the visitors or being home? She thought for a moment and responded that she, “enjoyed seeing Megan and the cats!”. <GRIN>
Only 9 months ago Patti could still assist in her own transfers, had no symptoms of spasticity, and could somewhat dress her self with minimal assistance. Now, multiple times daily needing to lift Patti in and out of bed and completely change and dress her are progressed needs and new and physically demanding caregiver functions.
I am not only sore and aching in different muscles but also grateful that we timed the transition to a care facility when we did.
Was it all worth it to have a Christmas at home? I don’t know. <grin> I just know I had to try. And Patti's smile in the last picture says more than words can ever try.
From the Caregiver’s Home Companion:
“The holidays are such a time of joy for many people. That joy is greatest when the people around us are healthy and like their lives and future. But for the rest of us in caregiving roles, the holidays can be a time of great frustration -- our loved one is ill. …
If your loved one is in an assisted living facility or nursing home, what will work the best for them?
§ If you take them to a family gathering or to your home, will it be too stressful for them? You might want to look at how they handle it when you take them out at other times of the year. If it has been too stressful, then don’t take them out now.
§ If you don’t take them out, arrange for family and friends to visit. You might want to have people visit on a schedule on one certain day. You also need to decide how many people should visit at one time, or in one day. Think back over the year. How did they react in both situations? Use the past (especially the recent past) as a guideline for the present...."
RECENT visits home or to her parents’ home have ended up negative for Patti. Transferring and confusion, I believe are catalysts in these experiences.
We ARE planning to bring Patti home for Christmas. My hope to improve the odds is to bring her home Christmas Eve so by Christmas Day she will BE in the same environment without transferring. At our house we have the facilities for changing and bathing a wheelchair confined person and Patti can nap at her convenience. I am taking on the jobs of three shifts of staff but I have done that and am comfortable I can do it again.
Christmas Day will be a NO TRANSFER / NO CHANGE IN SURROUNDINGS DAY. Family and friends that want to spend any Christmas Day time with Patti can visit with her at her home. Too much progression has occurred over a year and too much volatility in symptoms in recent visits makes it impractical and unfair to haul Patti around for the convenience of able bodied people. I think Christmas will be better at home than at the care facility, of course I am guilty of imposing my own able bodied and able minded thinking on the holiday. My only defense is that Lord knows it is NOT for my own convenience. <grin>
6 AM Temp 7°F ..... NW Wind 18 MPH
“Realfeel Temp” -17°F
Stepping outside this morning with a steaming cup of coffee into the predawn darkness with the cats was MAGNIFICENT!! Embraced with wind chill dropping to -17°F was like the bear hug of a long wished for friend. Welcome home, winter!!
Caregiver alchemy was mentioned a couple posts ago to “create” time.
It may seem outdated today, but years ago as a caregiver I still drew on cave walls while being put on hold. Minutes became hours and so on. One day I calculated it was actually “weeks” that I was spending ‘on hold’ when totaled together.
I acquired the necessary software and hardware to make my PC a fax machine. I started to fax my calls to doctors, labs, pharmacies, medical supply companies, etc. Because of my abnormal caregiver hours I prepared my communication overnight on the PC and faxed it out. My faxes were sitting in office fax trays when they opened in the morning, and I slept in. <grin>
To my surprise almost 100% responded most favorably. This method improved their lives also. In many cases I had answers before offices even traditionally opened for business.
‘Business’ reacts to a fax differently than to a phone call.
Additionally with the faxes I was essentially able to communicate to multiple offices at the same time, rather than have to choose which office to be ‘on hold’ with first. Another plus was a ‘paper trail’, critical with many insurance and government processes.
Email for whatever reason has never caught on. I think because one has to choose to open it. Fax drops into an office and someone HAS to deal with it.
To be sure it did not eliminate ‘on hold’ however it so dramatically reduced it that it’s become a non factor. Most important it created time beyond my expectations, not just hours, but weeks of my life.
As far as alchemy it didn’t exactly turn metal into gold, but for a caregiver creating time is better than gold.
As distracting and stressful as this time of year can be we were successful in chipping out some family time today.
I’m slowly learning to call ahead and advise Patti’s unit staff of our plans to pick her up and take her out. More often than not they are able to adapt their rotation and change and dress her by the time we get there. It really is a luxury and time saver from a caregiver perspective.
We popped out to the movies to see the opening weekend of “Lemony Snicket's A Series of Unfortunate Events” starring Jim Carey, Meryl Streep, Jude Law, … Patti could easily follow the mini stories within the story and laughed her way through the antics of the villainous Jim Carey.
The ongoing “restorative eating” therapy at her care facility continues to have wonderful success. Monitoring her consumption of bag of buttered popcorn was never easier. Re-learning to eat and pace herself even allowed for a fun food stop on the way back. Time out together without choking or accidents is a gift.
No question about it Patti is benefiting from 24/7 care. Slowly we are learning to best use those benefits to maximize time together. We even had time to read her some newly arrived Christmas cards and put up some more decorations before tucking her in for her mid-day nap.
However, the best part of the day is typing this with snow falling outside and a fire in the fireplace. <grin>
Caregiving can all too often be focused on the mundane. Countless hours of the caregiver are consumed by paperwork and more.
You would like to think you are doing something valuable or noteworthy. Yet, time spent “on hold” quickly becomes hours. Paperwork becomes a full time job.
Not only do these details distract from the human side of caregiving but also they dramatically shrink your available time for housekeeping, employment, parenting, yard and garden, and the other responsibilities of a caregiver.
Every caregiving situation is unique. I know for me hard work and efficiency isn’t always enough. Creative thinking and approaches are necessary to “create” time.
Caregivers MUST “create” time.
Interesting and somewhat appropriate “food for thought” regarding MS and this holiday season in this recent AOL Health Newsletter. A study on BIRTH month and MS risk plus the ‘hot button’ topic of stem cell HOPE. Most fascinating, NOT controversial embryo stem cells but rather stem cells taken from adult nerve tissue. And last but not least “STRESS LESS” …
[click on highlighted headline for full stories]
MULTIPLE SCLEROSIS NEWSLETTER | WEEK OF DECEMBER 12
Health News Headlines
Which month carries the highest risk of MS and which has the lowest? Plus, find out what this research says about the possible origins of the disease.
Stem cells might be able to reverse damage caused by MS. How far away is the technique from becoming reality?
EDITOR'S PICKS
The holidays can provide plenty of joy. But they can also give you extra helpings of all the things that can fuel MS symptoms. Check out these expert tips for taming the stress.
Caregiving over time created a 'black hole' into which disappeared the thoughts, feelings and passions of the caregiver.
Three fourths through this transitional year and unexpectedly that 'black hole' is beginning to reverse itself. Lost pieces of me are starting to come back.
Confusion is unsettling. Stoicism was my keystone of caregiving. Too often, I ‘feel’ like I am in an emotional rip current.
This was not in the plans.
Wednesday was a CARE PLAN REVIEW meeting at Patti’s facility.
Assisted Dinning Room was the lead topic. It was a change since our last meeting, though in my opinion that is the proper placement for Patti. No “ifs ands and buts” Patti absolutely must be monitored and assisted when eating. It’s taken 8 months but we all seem to be on the same page. <grin> That’s not surprising to me, even among family and friends I’ve fought an uphill battle over Patti and dinning.
They label it ‘restorative eating’ and don’t just feed Patti but work on therapy for living with Dysphagia. I must say I have noticed recent improvement in Patti’s dinning behavior when out or at home. She is much more conscious of the consequences of either choking or vomiting that can and will occur when she eats beyond her abilities.
Patti’s early bed time was another round table topic because it has a ripple effect across many departments. Bottom line is that Patti’s insistence upon going to bed at
7 PM or often immediately after dinner short circuits most evening procedures. Often whomever is available simply assists Patti into bed ‘as is’, raises sides on bed and appropriate staff come around in turn to change and dress her later. Behavior problems related to bedtime through safety concerns over risk of Patti falling trying to climb into bed herself have necessitated this process.
(MS progression has created significant challenges for Patti in Cerebral functions. Emotional Lability, for example, can stun new or temporary staff with the spontaneity and intensity of a mood change if Patti encounters stress when she wants to go to bed. She cannot always regulate the appropriate emotional level or even assign the correct one. She cannot always process or reason through a verbal command. Telling her “not to get into bed”, will not stop her from trying and falling even though she “knows” her legs do not work.)
Related, Patti had raised to me that she thought she was not getting her sleep medication. A check of her records confirmed this was basically true. I learned that what was happening is that Patti’s sleep medication is “upon request of patient” and at 8 PM medication rounds, Patti was sound asleep. It is not their policy to wake a sleeping resident to ask them if they want their sleeping aid. Makes sense to me.
Related personal hygiene questions about bedtime care, brushing teeth, etc also fell into this category. Patti refuses to get back up out of bed later to use the sink when dressing attendants come by to change and dress her for overnight. They do the best they can at this point as if she was a bed ridden patient.
Even her bed time snack of PBJ sandwich and chocolate milk a long time favorite has gone unclaimed from the snack cart for much of the last two months, as she is already asleep by the time the snack cart comes around.
That tunnel vision about getting to bed is a function of the MS fatigue factor. Yet like 'all things MS' it is unpredictable because other nights Patti willingly participates in evening activities.
Physical Therapy had begun following last care review to improve Patti’s ability to assist with transfers. She had been tucking her legs up and they are noticeably straighter now when she pulls herself up. Rather than an ongoing physical therapy, it will be used as needed to address problems in her ability to assist in transfers. This I agree 1000% with.
Previously they were engaged in a program with a goal to get Patti to walk. Patti's inability to walk is not just related to MS physical progression but mental progression. Failure of the walking program had led to abandonment of physical therapy.
Addressing Patti's ability to adapt to each level of progression is the best that physical therapy can provide. In Patti's case it cannot reverse anything. Enabling her to assist staff in her transfers is the best goal at this point.
Toileting Experiment had just begun. This also enabled because of improvement in ability to assist in her own transfer following physical therapy. Too early to evaluate. In concept, monitored time is devoted daily to using a commode with assisted transfers. Extraordinarily labor intensive program; however the theory is to reduce sheer volume of daily bladder and bowel incontinence and as a result potential for associated rashes and infections. – The time and personnel hours involved could only happen in a care facility however if successful in reducing cost of associated medical risks and treatments necessary it would be more than positive.
Though brief these reviews are excellent opportunities to talk 'across' and with their shifts and departments. I’ve learned that in homecare symptom management and issue management are the same. In a 24/7 care facility they are not. The management of teamwork is a different world than ‘hands on’ homecare. At these reviews the minds can come together and share.