Dad is "downcast"

I had my meeting with Janice at Emerald Isle this morning. She shared that generally the caregivers are able to get Dad to stand briefly when getting up from the automatic chair, but will not assist with getting up out of bed and other chairs. Thus, they are using the lift often. Also in the morning while in the bed, when Dad is having to be turned to remove his pants/diaper, etc, he will often reach out and grab the arm of the caregiver, rather strongly, and sometimes causing a scratch. We brainstormed a bit and set forth a plan to see if we'll be able to get Dad back to the point of assisting more with transfers. We are going to pursue finding someone (that Dad would pay privately) to be a one-on-one with Dad in the mornings, say from 7 to 11. Duties for this person would be first of all, hopefully a friendly face, devoted to Dad to encourage him to do the leg exercises in bed, encourage him and assist as needed to get Dad out of bed, morning hygiene, etc. After breakfast, this person could take Dad outside for a bit (warming up now), try to initiate games and/or just be there to converse with. If things improve physically for Dad, the person could try another session of leg exercises and/or walk attempts. Janice said the owner might know of some individuals I could interview. I also put a call into Haydee---she is not available in the mornings, but has a friend who might be interested that I can talk to as well. I also talked to Haydee about having her see Dad for a couple of the afternoons that she is free for a few hours, as another friendly face and someone who can potentially get more activity from Dad.

As i mentioned in the last blog, I do sense withdrawal from Dad...more and more I'm starting to realize that Dad may truly be depressed, which is of course understandable. Today, after my meeting with Janice, I sat down with Dad. Started by trying to show him some of the numerous cards he has received (boy our cousins are sure good at sending nice cards!) He was in the mode of keeping his eyes closed for the most part, occasionally responding. Based on some of his responses, I again was sensing that he could definitely hear me, but didn't really want to respond. One time I asked him if he knew who I was. He said Yes and then I asked him if he knew my name, he responded "Suzie." At one point I had asked him how he felt and he responded "I'm a bit downcast." Tried to inquire more but go no response. Later I asked the same thing and he said "I'm downhearted." When I pressed for more, he sort of mumbled but nothing intelligible. At one point during the discussion, he even got angry, squeezing my hand tightly and saying loudly and repeatedly "Because of me, Because of me, Because of me!" In continued to try and console him, let him know I loved him, wanted to help him, etc. At one point he said he wanted to try and stand up to go eat lunch, but even with the automatic chair, he didn't want to attempt to stand at the walker, and even had another burst of anger when standing saying he's trying (though he's actually pushing back, not standing.) Eventually the caregivers needed to use the lift to move him into the chair. On one positive note, once he was moved to the table, he immediately grabbed the spoon and dug into the nice hearty bowl of soup in front of him (with a bowl of fruit on the side.)

I put a call into Dr. Gee to discuss this more (out of office until tomorrow pm) and I spoke this afternoon to my good friend's husband (Palliative Care doctor, head of the department at the hospital, heads the Hospice program), with whom Dr. Gee works with and knows well. My friend Glenn says of course to consult with Dr. Gee, but he thinks it's probably worth a try to increase Dad's prozac dose (he is currently on 10 mg, considered a low dose.) He also said to check with the doctor on the Aricept dose and consider increasing that as well. He pointed out that more than 50% of elderly that suffer a break like a hip or other die within a year of the accident, however, considering Dad's appetite and other things I mentioned, he didn't think that he would be considered eligible for "hospice" yet. Glen let me know that if Dad does take a downturn, first of all, we need to discuss whether we would want Dad to go into the hospital or not to be treated (for example, if he developed a UTI or a pneumonia, we can opt to provide in-home care, nurses and such that can offer oral antibiotics, pain management and comfort, as opposed to admitting him to a hospital for more aggressive treatment and IVs.) I'm assuming we would want to do the former, but of course want everyone's input on that.

Glenn also talked about the possibility of considering more intensive pain meds (given at really low doses---methadone is what he has done quite a bit in this kind of situation) at some point. If Dad continues to be less mobile, that would make Dad more comfortable for the caregiver routines of turning him, changing him, etc. He's suggesting we first try increasing the anti-depressant to see if that makes a difference. If we're not successful with that, he actually volunteered to come to Emerald Isle to see and assess Dad to help Dr. Gee in establishing the need/level/dosage of these pain meds.

I also heard from the PT today...the previous gal is still on a medical leave, so I have an appt with her/Dad for PT on Thursday.

Today in my conversations with Dad, I did ask him if he would like to see a priest a couple of times. I didn't get a response, but will continue to ask him that in the future. One of the cards, from Bobby Telesca I believe, had some prayers in it that I read aloud to him.