Dad had another good PT session last Friday, as well as today. Lucinda mentioned last week that PT, per Medicare guidelines was about to run out...she indicated last Friday that he probably only had one more week, but then when I pressed her, said she could probably do two more weeks. The burden is apparently to be able to show that what she is doing in PT that can't be done with caregivers and others at home. This week we scheduled today and Friday.
Haydee was there last Saturday morning and Tuesday and reported Dad was taking walks with her and doing better. She said that yesterday he was getting up to walk with just her help. Anna worked Sunday-Wednesday morning (7-11am) and today told me that Dad has been walking with her and also doing the leg exercises (counting up to 100 at times, though not always doing the exercises.) SHe said that the mornings are getting better but it is still a little difficult to get him to get to the edge of the bed. Al chimed in that he is not complaining much anymore or shouting out when doing it. They have also been using the lift to get him into bed at night to ensure he is positioned well on the bed (as he won't scoot himself).
Today, at PT, Lucinda wanted to see how Dad got in/out of bed, so we walked to his room (and he did quite well), and then he sat on the edge of the bed. With the head of the bed raised, we prompted and assisted having him lie his head down and lift his legs up to rest on the bed. He did a tad adjusting, but he was too close to the outside edge of the bed, and we couldn't prompt him to bend his legs and try to lift his butt to slide over. It took more assistance to then get him up, (partially because I think he was too comfortable on the bed!), but again, with assistance, we helped move his legs to the floor and help him sit forward to get to the edge of the bed. He continues to show good strength and motivation in doing the sit to stands. Lucinda wants to try this sequence again on Friday. Obviously, he does it each morning as well.
We also talked about being proactive with some sort of bed alarm. Janice mentioned that for another resident (in another house) they have a floor mat type alarm that goes off when it is stepped on. THis might be better than something on the bed, which might be more prone to go off with irregular movements...does anyone have any thoughts on this? The cost of the floor mat type might be around $200, which I think would be well worth it to hopefully help prevent a fall in the future. Al sleeps just outside of Dad's room (on the couch in the living room), so could be there quickly. I think, if Dad continues to get stronger, it is inevitable that he will return to this pattern of getting up without assistance, and this is the best thing I can think of to help prevent a fall.
One of Haydee's days became available, so I am now planning to use her on Thursday morns (7-11), Saturday morns (7-11) and Tuesday afternoons. Anna is working Sun-Wednesday morns, 7-11. During these hours, they are assisting with the morning routine, doing PT exercises and walking, taking him outside when possible and providing companionship. I think offering the extra care (including the PT) has also been valuable from the perspective of Al and Juana perhaps not feeling quite as overwhelmed and also being able to see how the additional care has been so effective for Dad. This is all conjecture on my part, but I definitely feel good about what appears to be everyone's show of support and team effort in helping Dad to recover from this, including having a better understanding of Dad's moods and how best to deal with them constructively.
My family has a trip to Maui planned right after school is out (June 10-20) to celebrate Paul's niece's high school graduation. It is my intent to maintain the extra help as described above at least until after I return. Dad has a doctor's appointment with the Ortho surgeon on Friday, June 4th.
Wednesday, May 26, 2010
Wednesday, May 19, 2010
Mon/Wed
Dad had good PT sessions both Monday and Wednesday. He is continuing to walk. Today, I arrived towards the end of therapy and Lucinda reported that he walked 2.5 times down the hallway. He continues to say "I can't do it" as he is doing it! I had to return home to pick up something, but then returned and talked to Dad for awhile. He said he wanted to straighten his back so I asked him if he wanted to get up, and he said yes. Note that he was adjusting himself in his chair as well. Then, he initiated all the proper movements for starting to get up (getting his feet underneath him, leaning forward, etc.) Just gave him a little bit of support in moving from sit to stand, and absolutely no cries out from him. Once up, he started to walk, and also saying "I can't do it." We just moved a little, and he sat on the couch. A little later, said he was ready to get up, and again he initiated the proper movements, including coming forward from a semi-reclined position on the couch...this is key as this is still the trouble they are having in the morning, so the more he does it the better. Anna mentioned that this morning when time to get up, Dad had his legs out of the side of the bed, as if he was trying to do it himself. Of course that's good news and bad, as we certainly don't want him to try and get him and fall again. I think I will talk to them about a bed alarm.
I am very encouraged by Dad's increased strength and motivation to return to his former abilities. He was also verbally responding that he was doing "better" and also saying "it's going to take a few more walks to do it myself."
I am very encouraged by Dad's increased strength and motivation to return to his former abilities. He was also verbally responding that he was doing "better" and also saying "it's going to take a few more walks to do it myself."
Friday, May 14, 2010
Even Better Therapy today!
Dad did really great in therapy today. Again I arrived late, but before I got there he had walked down the entire hall, and even gone outside to the front and sat outside! When I arrived, he was heading back down the hallway. The entire time he was saying "I can't do it" and expressing some pain as he would move the right leg (and thus put weight on the left.) But when asked if he wanted to keep walking, he would respond "Yes!" He made it all the way down the hall!
AFter the walks, Dad rested a bit, and then Lucinda had Dad do his leg exercises. He participated in the counting today. He was also interacting more with Lucinda today...in one of the photos you can sort of make out Dad's ever so slight smile towards her.
Lucinda told me that per typical Medicare schedule, Dad would have transitioned to only 2x/week therapy next week, but she said, based on his progress, she thought it would be no problem to keep him at 3x/week, at least for one more week.
Anna reported that yesterday, Dad had walked from the bathroom into the family room. She also said the mornings are going better, though there are still occasions when they are using the lift. Still, getting him from bed to the edge of the bed is still difficult, and he does "cry out" when being assisted to stand, but commented that his stability in standing is much improved.
After therapy, I took Dad outside in his wheelchair to enjoy the sunshine in the backyard. Tried to initiate a game of dominos but he seemed content just to relax, so I gave him a little neck rub and also strolled a little too. When I brought him back in, before leaving, I asked him if he wanted to stay in his room or go into the family room, and he said the family room.
So hope this progress continues!!!
AFter the walks, Dad rested a bit, and then Lucinda had Dad do his leg exercises. He participated in the counting today. He was also interacting more with Lucinda today...in one of the photos you can sort of make out Dad's ever so slight smile towards her.
Lucinda told me that per typical Medicare schedule, Dad would have transitioned to only 2x/week therapy next week, but she said, based on his progress, she thought it would be no problem to keep him at 3x/week, at least for one more week.
Anna reported that yesterday, Dad had walked from the bathroom into the family room. She also said the mornings are going better, though there are still occasions when they are using the lift. Still, getting him from bed to the edge of the bed is still difficult, and he does "cry out" when being assisted to stand, but commented that his stability in standing is much improved.
After therapy, I took Dad outside in his wheelchair to enjoy the sunshine in the backyard. Tried to initiate a game of dominos but he seemed content just to relax, so I gave him a little neck rub and also strolled a little too. When I brought him back in, before leaving, I asked him if he wanted to stay in his room or go into the family room, and he said the family room.
So hope this progress continues!!!
Wednesday, May 12, 2010
Walking today
Dad had a good session with Lucinda in PT today. I arrived late and he had already walked two times, more than 15 feet each time! He did it again after I arrived. He required very little help with the rising from the wheelchair, and then instinctively started walking, holding himself relatively straight. Interestingly, he kept saying "I can't do it" though not angrily, and he still continued to do it. They said he did that the first two times as well. After the walking, he appeared to be tiring. He participated a little with the leg exercises, though he wouldn't count and was mostly looking down as Lucinda motioned him through it.
Anna reported that in the morning, Dad is still showing resistance to moving from the bed to the edge of it, though wasn't so "grabby" today. Before therapy she said he was pretty awake this morning...they had played with the ball---she said he was kicking it quite well. She also mentioned that he was talking to her about "taking deductions from her pay."
I went to pick up a prescription for Dad, then returned. He was still in the wheelchair, eyes closed, apparently listening to music on the TV. Janice had started the bingo game, so I moved him over to the table, though he seemed like he was going to be too tired to participate. He did participate in the bingo games last Friday.
Anna reported that in the morning, Dad is still showing resistance to moving from the bed to the edge of it, though wasn't so "grabby" today. Before therapy she said he was pretty awake this morning...they had played with the ball---she said he was kicking it quite well. She also mentioned that he was talking to her about "taking deductions from her pay."
I went to pick up a prescription for Dad, then returned. He was still in the wheelchair, eyes closed, apparently listening to music on the TV. Janice had started the bingo game, so I moved him over to the table, though he seemed like he was going to be too tired to participate. He did participate in the bingo games last Friday.
Tuesday, May 11, 2010
Fri/Sat/Monday
Dad's therapy session on Friday at 1pm went quite well. THe therapist put a phone book down between his feet, and I explained to him about keeping his feet apart, so he did his sit to stands much better. We actually had him do several repetitions of that (as opposed to taking steps and walking) and he was doing it quite well, with very little assistance in the lifting. I left about 1:45pm after therapy, but spoke later with Haydee who was working from 2-4. When I called she said they were sitting outside (nice day), playing cards and enjoying the weather. Haydee also worked on Saturday morning from 7 to 11. She said Dad did his exercises in bed, and then he got up (with help from Haydee and Al) without the need for the Hoyer lift. She also played card and threw the ball with him, but then she said he got quite sleepy around 10:30am.
THerapy yesterday was not quite as good. Dad was very sleepy and more unresponsive and didn't participate much in the leg exercises. We did eventually do a few sit to stands with some success, though not as good as Friday. Seemed a bit more sensitive today to minimal touches of his arm/back area. When the therapist left, we had moved Dad from the recliner to the wheelchair, so I took him outside to enjoy the sunshine. Couldn't get him to talk much or play ball, so I rubbed his neck/back a little. Walked around some more and he appeared to perk up a little bit from the movement, though when I crossed him over the threshold into the house he screached some "ows" from the "bumps" he must have felt from the wheelchair (though it was very slight.) I left him in his room to watch the baseball game...beef stew was on the stove for dinner a half hour later.
Hopefully therapy will go a little better tomorrow. Haydee is unavailable to work this week and not until the end of next week (planned vacation). Anna worked Sunday Morning, this morning and tomorrow morning...will try to get a report from her tomorrow.
THerapy yesterday was not quite as good. Dad was very sleepy and more unresponsive and didn't participate much in the leg exercises. We did eventually do a few sit to stands with some success, though not as good as Friday. Seemed a bit more sensitive today to minimal touches of his arm/back area. When the therapist left, we had moved Dad from the recliner to the wheelchair, so I took him outside to enjoy the sunshine. Couldn't get him to talk much or play ball, so I rubbed his neck/back a little. Walked around some more and he appeared to perk up a little bit from the movement, though when I crossed him over the threshold into the house he screached some "ows" from the "bumps" he must have felt from the wheelchair (though it was very slight.) I left him in his room to watch the baseball game...beef stew was on the stove for dinner a half hour later.
Hopefully therapy will go a little better tomorrow. Haydee is unavailable to work this week and not until the end of next week (planned vacation). Anna worked Sunday Morning, this morning and tomorrow morning...will try to get a report from her tomorrow.
Wednesday, May 05, 2010
Today's therapy session
Lucinda and I both arrived at the same time this morning, 10am, for Dad's Physical therapy session. When we arrived, Anna was with Dad in his bedroom, Dad in his wheelchair, and she was tossing the ball with him. Since the weather has improved, the sliding door from his room was open to the screen and it was quite pleasant and light.
Anna reported that Dad was able to get out of bed yesterday and this morning without the lift...he was a little more "grabby" today, but did assist with the transitions, and stood for awhile in the bathroom while being changed.
During the leg exercises, Dad was participating with the movement okay, but was less inclined to count, and seemed a bit more unresponsive. Though when asked how he was feeling, said "easy goes it"--he said something else that had me, Lucinda and Anna laughing, which I can't recall, but know that it was a nice example of Dad's ability to still tell a joke.
We moved into the hallway (very wide, with wood floor) as Lucinda wanted to see how far Dad might walk. In our first couple of attempts to stand, he got up fairly well, but as he had done on Monday, moved his right foot close to the left, and was leaning far right, not wanting to put any weight on the left leg. Lucinda wanted to try having him do the same in the bathroom shower (quite open) where he could grab the bar in front of him, and hopefully force him to stand straighter. When we did that, he did pretty well, and also let out quite a rip of gas. I think that seemed to help...we moved him back in the wheelchair, and suddenly he seemed more alert. I was asking him if he wanted to stand up again and he said Yes, emphatically, and also, "I want to walk." He stood up quite well and this time was standing much straighter. We were prompting him to lift his right leg, and also to shift his weight to his left, which he then did, though gingerly, and managed to lift his right leg slightly. We also stood for awhile. Sat down for a rest, and did the same thing again, just as good, and then moved him into the recliner to rest.
I was definitely encouraged with the attitude shift I noticed with regards to Dad wanting to walk today, and that once he had said that, got himself prepared to do so (leaning towards the walker to grab it for example, and not needing as much prompting.)
Anna reported that Dad was able to get out of bed yesterday and this morning without the lift...he was a little more "grabby" today, but did assist with the transitions, and stood for awhile in the bathroom while being changed.
During the leg exercises, Dad was participating with the movement okay, but was less inclined to count, and seemed a bit more unresponsive. Though when asked how he was feeling, said "easy goes it"--he said something else that had me, Lucinda and Anna laughing, which I can't recall, but know that it was a nice example of Dad's ability to still tell a joke.
We moved into the hallway (very wide, with wood floor) as Lucinda wanted to see how far Dad might walk. In our first couple of attempts to stand, he got up fairly well, but as he had done on Monday, moved his right foot close to the left, and was leaning far right, not wanting to put any weight on the left leg. Lucinda wanted to try having him do the same in the bathroom shower (quite open) where he could grab the bar in front of him, and hopefully force him to stand straighter. When we did that, he did pretty well, and also let out quite a rip of gas. I think that seemed to help...we moved him back in the wheelchair, and suddenly he seemed more alert. I was asking him if he wanted to stand up again and he said Yes, emphatically, and also, "I want to walk." He stood up quite well and this time was standing much straighter. We were prompting him to lift his right leg, and also to shift his weight to his left, which he then did, though gingerly, and managed to lift his right leg slightly. We also stood for awhile. Sat down for a rest, and did the same thing again, just as good, and then moved him into the recliner to rest.
I was definitely encouraged with the attitude shift I noticed with regards to Dad wanting to walk today, and that once he had said that, got himself prepared to do so (leaning towards the walker to grab it for example, and not needing as much prompting.)
Monday, May 03, 2010
Dad's Friday & Monday
On Friday morning, I had planned for the caregivers to hold off on getting Dad out of bed until I could arrive at 8am so I could observe the morning routine. With my prompting and assistance, we were able to get Dad to get up out of bed without the lift (though we did have to sort of "pull" him up using the lift blanket as his pattern is to push back instead of lean forward.) During that time, I also observed the "grabbing" he does with his hands, where, because of what I think is his presumed fear and/or unhappiness about moving/being moved, he will grab a person's arm or hand. Caregivers had previously reported this and that sometimes the grabbing is quite hard and/or he will scratch them (not intentionally, but inadvertently I believe.) Anyway, he did ultimately stand by the bed so that Anna could remove his wet pjs/diaper and then transition him to the wheelchair. From there, he moves into the bathroom and we transitioned again by using the walker to help Dad stand up from the wheelchair and then sit down in a bath chair (that has a hole in it). From there, he was crying out when they were removing his Pajama top...not sure what that is about except yet another example of having to touch his arms to assist him. Don't think it could be about being could because the bathroom was quite warm. From there he seemed to enjoy his shower, and then after he had one more transition from the bath chair, stand to the walker, and sit back in the wheelchair. In all cases, I would say he did well with the standing. After that he had a hearty breakfast (raisin bran, scrambled eggs, english muffin with jam) where he digs right in and goes for every last drop.
Shortly after, the PT Lucinda arrived. Dad was a little more sleepy and not quite as cooperative as the day before (which we attributed to the earlier time and having just gone through the morning routine), but did help some with the counting and exercises. We also got him to stand up two or three times, and on the third try, had him sit in the recliner.
In talking to Anna, who is the 3rd caregiver that currently works Thurs/Fri/Sat, I found out that she was looking for more work. I discussed with Janice the administrator and said it would be fine if we wanted to hire her privately to be the one-on-one support for Dad in the mornings (though of course she would only be available Sun-Wed). Haydee would be available on Saturday mornings, so I decided that would be at least worth a try, rather than having to hire someone new.
Anna's first day was this morning...I arrived at 12:45 to meet with the PT for therapy. The PT had already gotten Dad started with exercises and he was doing well and seemed in fairly good spirits, assisting well with the counting and not complaining of any pains with the leg exercises. Anna was still there (though officially had stopped working for Dad at 11am.) She reported that the morning routine went better and they did not need to use the lift, and that Dad wasn't complaining as much (though did do some grabbing.) She had done the leg exercises in bed before getting him out, and she thought that was helpful. She had also helped him participate in card playing and had walked around in the wheelchair outside (beautiful day here today.) The PT showed her some more exercises to do while there.
During PT, Dad was counting and assisting with all the exercises for the most part. He wasn't quite as responsive to specific questions (instead answering "thirteen---fourteen", in other words continuing to count and not answering the questions, though sometimes we got the words out of him on various things. When time to stand, he got up from a lower position in the chair which was good, but once up, would move his right foot to be right next to his left foot (I think because he is favoring it, but obviously that gives him much less of a base of support. We got him to start walking and he did take several steps. First time we did eight, and then stood for awhile (Lucinda and I giving him support under his arms at all times). Second time he walked ten steps. Did the same a third time. Each time, towards the end, he was sort of saying "I can't do it" but not too loudly or with near as much complaint as previously.
All in all, I'd like to say things are improving, if only slightly. Thursday was good, Friday was not quite as good, but today the therapist thought it was Dad's best day, so it's up again. Tomorrow I'll be checking in in the afternoon with Haydee and then will return on Wednesday at 10am with PT again.
Summary of additional help:
Sun - Wednesday, 7am to 11 am (Anna)
Tues/Thursday or Friday, 1pm to 3pm (Haydee)
Saturday, 7am to 11am (Haydee) though she's not available the next two Saturdays.
PT currently 3x/week (45 mins to 1 hour)
The hope is that with the additional assistance, and reinforcement of exercises and transitions, Dad will develop the strength and confidence to do it more and more on his own. I'll re-assess after about a month to see if the additional help is making a difference.
Shortly after, the PT Lucinda arrived. Dad was a little more sleepy and not quite as cooperative as the day before (which we attributed to the earlier time and having just gone through the morning routine), but did help some with the counting and exercises. We also got him to stand up two or three times, and on the third try, had him sit in the recliner.
In talking to Anna, who is the 3rd caregiver that currently works Thurs/Fri/Sat, I found out that she was looking for more work. I discussed with Janice the administrator and said it would be fine if we wanted to hire her privately to be the one-on-one support for Dad in the mornings (though of course she would only be available Sun-Wed). Haydee would be available on Saturday mornings, so I decided that would be at least worth a try, rather than having to hire someone new.
Anna's first day was this morning...I arrived at 12:45 to meet with the PT for therapy. The PT had already gotten Dad started with exercises and he was doing well and seemed in fairly good spirits, assisting well with the counting and not complaining of any pains with the leg exercises. Anna was still there (though officially had stopped working for Dad at 11am.) She reported that the morning routine went better and they did not need to use the lift, and that Dad wasn't complaining as much (though did do some grabbing.) She had done the leg exercises in bed before getting him out, and she thought that was helpful. She had also helped him participate in card playing and had walked around in the wheelchair outside (beautiful day here today.) The PT showed her some more exercises to do while there.
During PT, Dad was counting and assisting with all the exercises for the most part. He wasn't quite as responsive to specific questions (instead answering "thirteen---fourteen", in other words continuing to count and not answering the questions, though sometimes we got the words out of him on various things. When time to stand, he got up from a lower position in the chair which was good, but once up, would move his right foot to be right next to his left foot (I think because he is favoring it, but obviously that gives him much less of a base of support. We got him to start walking and he did take several steps. First time we did eight, and then stood for awhile (Lucinda and I giving him support under his arms at all times). Second time he walked ten steps. Did the same a third time. Each time, towards the end, he was sort of saying "I can't do it" but not too loudly or with near as much complaint as previously.
All in all, I'd like to say things are improving, if only slightly. Thursday was good, Friday was not quite as good, but today the therapist thought it was Dad's best day, so it's up again. Tomorrow I'll be checking in in the afternoon with Haydee and then will return on Wednesday at 10am with PT again.
Summary of additional help:
Sun - Wednesday, 7am to 11 am (Anna)
Tues/Thursday or Friday, 1pm to 3pm (Haydee)
Saturday, 7am to 11am (Haydee) though she's not available the next two Saturdays.
PT currently 3x/week (45 mins to 1 hour)
The hope is that with the additional assistance, and reinforcement of exercises and transitions, Dad will develop the strength and confidence to do it more and more on his own. I'll re-assess after about a month to see if the additional help is making a difference.