Visit

Went to visit Dad today...lately have only been able to squeeze in brief visits, but today I had a little more time. I showed him the postcard that Cathy sent him, and he was able to read some of it on his own. I asked him if he wanted to go for a walk, so we did. We walked inside the house as he said he didn't want to go outside. He is slow, but methodical. Took a break to sit in the wheelchair then chatted some more. After awhile, took another walk back to the recliner, where he seemed happy to rest for awhile. All reports from the caregivers are good. His appetite is still good...when I'm there during a meal he won't even look up from the plate to respond! Overall wasn't very talkative today, but looked good and when I asked how he was doing he said "i'm doing fine!" They are expecting a new roommate next week...a gentleman!

Doctor's Appt

Today I took Dad to a physical check-up with Dr. Gee. Anna was working, so she traveled with us to assist with the transfers. Dad had to skip breakfast for the blood work so he was a bit lethargic. He complained when he got "stuck" for the blood test, but after I gave him the snack I brought for him, and he had some juice, he seemed to be happier and woke up a bit. He did well getting in the car for the ride home, and after we got back, he walked from the driveway into the house. He doesn't seem to be experiencing any leg pain when walking.

Dr. Gee said Dad looks good. We made an attempt, but were unable to get Dad up onto the table, so the doctor did his checkup with Dad in the wheelchair. His BP was 122/66, right ear a little waxy, no wheezing. These are his current meds:

Aspirin 81mg, 1x day
Amlodopine 5mg, 1x day (blood pressure med)
Metoprolol 50mg, 1x day
Aricept 10mg 1x day
Namenda 10mg 2x day
Prozac 10mg 2x day
Lisinopril 5mg 1x day (bp and heart med. Prescribed by Dr. Lai in hospital)
Senna Tablet 2x day
Colace 1x day

Anna told me that Dad is usually taking walks a couple of times a day now, making several "loops" through the halls in the house. She also said that for the past few days, except this morning, he was initiating getting out of bed in the morning, without them having to prompt him. In general, it sounds like there is still occasionally some complaining with this morning get up routine, but nothing unmanageable. Apparently he has been sleeping well, and has made no attempts to get up in the middle of the night, except once when they heard him, and he needed to have a bowel movement. Anna also said they still use the Hoyer Lift to get Dad into his bed at night, to get him placed properly and that he no longer complains about it.

Anna also said that Dad is very talkative, and talks to some of his housemates quite a bit. When I visited this past Sunday, they were celebrating one of the ladies' 101st birthdays! Perhaps there's something special in the water at that house....Dad is almost the baby. 105, 103, 101, 95, 94, 93.

Friday

On Friday I stopped by for a visit with Dad. Reports for the week were good. They mentioned that he's actually been walking faster.

Dad seemed happy to see me and was responsive. Asked him if he wanted to go for a walk with me and he said yes and that he'd like to get the exercise. We got up and walked down the hall, out the front door, and then all the way around the side and to the back! We made one stop to sit and rest in the wheelchair. Once inside, it was time for dinner so we moved to sit at the table with the others. Seemed happy to be seated at that point and too tired to say goodbye!

At this point, I have cut one day for Anna---she is now working 3 mornings (M-W) instead of 4. Haydee is still scheduled for Tuesday afternoons (2.5 hours) and Thursday and Saturday mornings, though she has missed the past two Saturdays (sick one day, family conflict the other.)

Talked with Dad

I finally called Dad. He seemed upbeat. He didn't talk much but he said he was okay. It was nice to talk with him after such a long time. I hope to call more often in the future.

Yesterday and Today

I stopped by briefly to see Dad yesterday and drop off a check for Anna. Reports were all positive that Dad had been doing well, getting daily walks, etc. Dad smiled and said Hello but seemed comfortable and a bit dozy on the couch.

This afternoon I stopped by again to see if Dad might want to go for a ride in my car and possibly come to my house. He was on the couch and we talked for awhile. I was asking about whether he wanted to get up, go for a ride, etc. He was talking a little bit soft spoken...was first saying, "I'm not sure if I like you or not, but you seem nice" then I said, "I'm your daughter, do you remember me" and he said "I'm starting to". Later asked him if he remembered my name and he said "Suzie". I said no I'm Barbara, and he kept saying "Barbrack". Eventually seemed willing to get up...when prompted, he started to reach for walker and did fairly well to adjust himself with just a little assistance pushing on his back...good news being that he showed no signs of resistance either, considering he was kind of slumped in the couch. He stood up and seemed to need to balance a little, but then eventually we walked into the hallway. During the walk he seemed to be saying a lot of "ohs" with his steps, but then I'd ask him if he felt OK and he said "yes" and wanted to continue. Eventually he asked to switch to the wheelchair and we took him outside beside my car.

Asked him if he wanted to go for a ride and he responded "let's just be quiet for a while," so instead we just sat outside...nice sunny day. Dylan was in the car and I pointed that out and I saw Dad looking in at Dylan. I told him "There's your grandson." After several times asking him if he wanted to go in the car, he never seemed interested enough, so we said "Good-bye"

May try again to see if he wants to go for a ride tomorrow, and perhaps come over to my house for the 4th holiday.

No news is good news?

Got no calls while on my trip regarding Dad. Had texted Haydee and she reported that Dad has been walking and doing well. Have only been able to check in with him briefly the past couple of days since my return. On Monday he gave me a big smile and hello when I saw him. He was a bit reluctant to move from the couch and started very slightly to do the "push backwards" and "hand grabbing" when we were prompting him to lean forward, but eventually did do so and then walked with me about halfway down the hall. Yesterday I was delivering some lotion and only had a minute....they had just started dinner and he was digging into a nice looking plate of roasted chicken and a broiled potato/carrot vegetable dish. Al and Juana reported that he had been quite awake and talkative during the day.

Dad's bed alarm mat arrived while I was gone and I gave that to them as well.

PT today

Dad was a bit grumpy at PT this morning. He was walking, but seemed to need a little more help getting up and was not very talkative. We thought we "smelled" something, so we realized we should take him to the bathroom. The trip was quite successful and afterwards he said he was feeling "much better." We wanted to see if he would get in the car again, and when we asked if he wanted to go for a ride he said Yes. We went outside and got him to the point where he was sitting on the seat but with his legs still hanging to the side...then he protested about getting in further asking "Why were we doing this?" Told him we thought that was what he wanted, but if he didn't want to, then fine....he easily lowered himself off the seat and that was it for the day.

After lunch, Haydee arrived, but she phoned me to say Dad was very sleepy. She left and returned later in the afternoon. She got him to walk down the hall, but again he was quite sleepy. It's been a gloomy, misty day here today...perhaps that contributed to his sleepiness.

THursday is Dad's last PT day with Lucinda...Haydee will be there so she will get a good set of instructions for follow through. Anna is doing great as well. Reminder that I'm leaving Thursday until the 20th, and extra caregivers will continue at least until my return. Lucinda said not to hesitate to call and request more PT if we see any downturn.

Car and doctor's appt

Wednesday during PT we had a bit more success getting Dad into my car in the 2nd row. THe rest of the session went fine as well. Lucinda commented that it "gives her chills" to think about the progress Dad has made.

I arranged for Anna to be able to come with me to Dad's doctor's appt today to help getting Dad in/out of car. It worked out! He seems to get better each time. He still goes into a little bit of the "fear mode" when being asked to come forward (leaning forward to get out of seat) but handled it better with each successive attempt. Note that getting Dad into the car does require someone (in our case Anna) pulling up on his pants from behind to help lift him onto the seat. Once on the seat, Dad participates in adjusting his feet, body to sit in the seat.

At appointment, doctor had requested x-rays, but I asked him if they were needed---mentioned how difficult it was to get him on x-ray table on prior visit. After checking the prior xrays and examining him (he picked up Dad's leg in a flexed position and rotated it in a circular motion, during which Dad chuckled), as well as being told that Dad is walking several times a day, he agreed it was not necessary and to keep up the good work. He recommended that PT continue, but I will probably have to contact insurance if I want to push it to continue beyond next week (anyone interested in researching this?) . I'm sort of feeling he probably is getting enough exercise each day at this point, so perhaps not worth it. Lucinda also mentioned that should Dad's situation changed, they can always try to "re-activate" it.

Anna also reported that Dad is getting more and more talkative.

Bed Alarm mat has been ordered, but is on back-order. Only cost $75.

Last Friday and Monday

Dad had a pretty good therapy session last Friday. Since he was doing so well, we decided we would try and see if he could get into my van (hoping that perhaps I could take him for a ride on the weekend, and also to prepare for going to the doctor.) Dad seemed motivated to get in, but couldn't seem to get his butt up high enough on the seat, and then he started leaning back (but he was leaning towards the driver's side, not against the back of the seat.) He then seemed to be a little afraid and as we tried to assist him to come forward, he resisted, and leaned back (pattern we've seen in bed and before in hospital.) With Al's help, we eventually got him out, and Dad seemed a bit unhappy with us. He did do another walk in the house, and a brief set of exercises.

I had planned to check in at the end of Lucinda's therapy session yesterday (had Dylan with me, Paul/Ryland out of town), but I just missed her by the time I arrived. Lucinda told me that Dad did well with the walking and such. She tried getting in/out of bed...in was OK, but getting out was difficult again.

Lucinda mentioned that she wants to try the car again, so I will be there tomorrow and we will attempt it. We had the idea to try the 2nd row seat of my van (instead of passenger), which should actually be easier since the door won't be in the way, and also, allows easier assistance from someone who can sit in the 2nd row.

Lucinda also said that she has requested two more therapy sessions next week, but then he reaches his max on therapy. As it turns out, Dad has an appointment this Friday with the ortho surgeon, and I will talk to him about the possibility of more therapy. Depending upon how getting in the car goes tomorrow, i'll see if I need to arrange for a taxi to the doctor's appt again.

Fri/Wednesday

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.

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."

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!!!

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.

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.

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.)

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.

Better day today

Dad was doing much better today. First I stopped by around 10:30 to say Hi, offer him a banana and also to give him an Advil prior to the physical therapy scheduled for 11am. (Dr. Park, ortho doc, had said the Advil would be fine and worth a try in addition to the Tylenol he gets each day.) He went right for the banana, and took the pill with a cup of water. The caregivers reported that Dad had stood for several minutes earlier in the day during his morning hygiene.

I went on a brief errand to deposit Dad's homestead hills check in his account (Wells Fargo now, not Wachovia) and then returned to meet the new physical therapist. Her name is Lucinda. Dad seems to like her. She developed a fairly good rapport with Dad (she asked him about NC...when she asked him what city, he responded "Winston-Salem". Lucinda had done some work at Baptist Hospital and commented on how big that hospital is.)

She proceeded to start with some leg exercises while seated in the chair and Dad participated, even counting. He required some prompting, including physical help with the leg lifts, and also to keep his eyes open, but a definite improvement from Tuesday. We then proceeded to working on standing, which we did utilizing the electric chair to raise him up significantly. He did it 3 times total, but he was leaning a great deal on his right side (onto Lucinda...I was helping him on his left.) He didn't seem to want to stand up straight. After the last stand, we sat him in his wheelchair and again he went right for his lunch at the table with the others. Note that the therapist doesn't think Dad is feeling a lot of pain, and her initial assessment of his reactions when attempting to move him is more fear-based, which she said is quite common.

I returned around 2pm to meet with Haydee with whom I have arranged a schedule of 2 hours (1:30-3:30) Tues/Thurs in the afternoon (she works close by from 8 to 1pm so this works well for her.). When I arrived, she had Dad playing cards on a lap-style table in the recliner and he seemed quite engaged with the activity. I proceeded to show her the same leg exercises the therapist had shown me in the morning. We asked Dad if he wanted to stand, and he said yes. I used the chair, but didn't raise it to it's max. When starting, Dad again expressed concern, but it was more like "Do you think I can do this" as opposed to "I can't do it!" --- with Haydee's reassurance, he did it. This time he stood much straighter than he had in the morning, and even wanted to initiate some steps. He moved a couple of steps forward, and then we had to prompt him backwards to get back to the chair. We did it a 2nd time, and this time he was standing quite well---I went to get the wheelchair (replacing it for the recliner), so he could sit there for awhile. About that time, the home health nurse arrived to do some basic follow ups (BP, oxygen, etc. ) BP was good and his O2 was 99%. She said she will probably come one more time next week and then discharge him. Before I left, I asked Haydee if she would take Dad outside for some fresh air, so that was her plan. I had also brought him some choc chip cookies to hopefully enjoy.

During the leg exercises, by the way, I watched Dad watching Haydee, with a grin on his face. I feel optimistic that her visits will be the right "medicine" for Dad. Also, I heard back from Dr. Gee who agrees with the increase in his prozac from 10mg to 20mg. I also like the new PT. I will try and be there to assist for all the therapy sessions. She is coming back tomorrow, and then we have MWF scheduled for next week.

I have posted an ad on sittercity.com to see if I can find someone to help with the morning shift as discussed in the previous blog.

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.

Dad this week

Overall, it appears that Dad has regressed a bit in this 2nd week back from the rehab unit...he is wanting to participate less and less in therapy and helping with transfers and such, thus the caregivers are needing to use the hoyer lift. This then becomes a bit of a vicious cycle in my opinion because I believe Dad is uncomfortable with that as well as when he needs to be lifted by the caregivers (sensitive and sometimes crying out with even the slightest touches), and thus he resists even more, making it all the more difficult to move him.

Here is a brief summary of my experiences for the week with Dad since last Friday when I was there with the therapist and we had fairly reasonable success doing exercises with Dad (while sitting) and getting him to stand up with walker in front of him (using electric chair that lifts him.) At that point, the caregivers may have used the lift once or twice during that 1st week.

Sunday---brief visit to deliver medication. Caregivers reporting that Dad would not stand for transfers so needed to use lift.

Monday--therapy with PT...PT reports that Dad seemed to have more difficulty with the standing and less willing to participate.

Tuesday--PT called me in the morning to say she had to cancel with Dad for the day to personal health issues. She mentions that perhaps Dad needs stronger pain meds. I was contacted in the morning by administrator Chris who is concerned that Dad is not participating because he is in pain and that's why he's not participating. She's suspicious of problems with surgery site and is anxious for Dad to follow up with ortho doctor and have an xray. He has a scheduled appt for Friday but I put a call into the doctor I went to the house around 1pm and was there with other administrator, Janice. Dad is more receptive to me and Janice at this visit and we were able to get him to participate in some leg exercises while in the chair, as well as coming up to stand at the walker 3 times. When he is standing, he is only bearing weight on right leg...he has difficulty shifting to put any weight on left leg and wants to sit back down.

Later after I got him, the doctor returns my call and is doubtful there is a problem with the surgery site. He mentions that it doesn't seem too unreasonable that Dad is still experiencing some pain just a little more than 3 weeks since surgery, particularly since he was not that active before. Says it's not necessary to push him too much with therapy at this point, though obviously good to get him using his muscles as much as possible. We also talk about the trade-off between going with stronger pain meds vs the narcotic effect. Suggests tylenol should be adequate (note tylenol with codeine is prescribed and available as needed...caregivers have given it once or twice and no noticeable differences were noted.)

Friday--I went to meet the wheelchair accessible taxi at Dad's house around 9:15 for his ortho appointment. At the appt he required 2 big guys to help lift him onto the xray table. On the table they were trying to put a wedge on one side of him and we were trying to ask Dad to roll a little to his side---when he didn't do it himself, as the technician (and I) tried to help move him, Dad went into his "resistance" routine...He pushes back in the direction of what you're trying to do. Also his face clenches and he sticks his tongue out in an odd way from his mouth. Everyone was doing their best to calm him---it appears to be a very defensive maneuver as if he's dreadfully afraid of something. It's very disheartening to see it. Xrays showed everything was fine. When doctor came to see him, Dad was pleasant, but for the most part would open his eyes to speak to the doctor and/or respond to his questions or to me when I talked to him, but then he would just close his eyes, fold his hands and rest. Doctor and I discussed that we obviously want to continue with as much therapy as possible, but understands the difficulty for Dad to participate with his dementia. He still thinks tylenol is adequate (and better than narcotic if not needed) but also said we could Advil in between if desired.

Upon the return to the house, Anna the caregiver was mentioning how difficult it has been for the transfers and that the morning routine is quite difficult, particularly on Thursdays when it's Al's day off. She said they really don't have the time to do the leg exercises that the therapist had left papers on to be done daily, particularly when it's difficult to get him to participate.

After our discussion, I spent some time with Dad again trying to do exercises, focusing first on just trying to get him to lean forward. His pattern is that he sits in the chair, often leaning to his right side and just digs his back into the chair. Any touches to his arms or back to encourage the leaning forward invokes an "ow" or facial clench described above. With a LOT of verbal encouragement, I was finally able to get him to come a little forward and then finally he was successful coming to a stand at the walker.

Saturday--I went to visit Dad this afternoon and try to do a little therapy again. It was a struggle...my approach as always is to verbally try to get him to be willing to participate in the therapy. He often will agree, but as the attempt is made to move to a stand, he resists and then pushes back. Note that I NEVER force him to do anything, but am offering a lot of verbal encouragement. Today he would start and then say "I can't do it" several times. I respond that I know he can, he is strong, he did it yesterday, etc. At one point I asked him if he was giving up and he said yes. Eventually he did stand up, which was helpful as Al then brought the wheelchair behind him so he could eat his dinner.

I clearly have concerns and questions about the best way to move forward and am fearful about Dad's future and the best way to care for him. I do fear that Dad is giving up and if that's the case, how do we care for him?

I had left a message with Janice, the administrator who called me back a little while ago. We both agree that the ideal minimum goal is just to have Dad willing again to at least stand and support his transfers to make his care easier, and also to avoid the vicious cycle I mentioned above. She did not mention that assistance was necessarily needed, and also wants to talk to the caregivers about doing more with the exercises so Dad will get stronger and at least stand. But she said if he doesn't do that, they will have to use the lift and seemed to be taking full responsibility for caring for Dad no matter what. It eased my mind a little bit because based on some of my prior conversations with the other administrator Chris, I had concerns that perhaps Dad was too hard to handle. I did mention to Janice that I am willing to pursue hiring additional help that could be an extra set of hands that are dedicated to Dad to hopefully give us a better chance of having Dad meet this minimum goal. In my opinion, it does require the right personality, particularly someone with patience as again I think motivation is the key here and it's more important to take the time to get Dad to agree to help himself than just another set of hands to help lift him from point a to point b. Anyway, Janice and I agreed to meet on Tuesday at the house, talk to the caregivers about what they are seeing and the difficulties they are having and try to develop some strategies for moving forward.

Note that It has been a little confusing with me as far as which administrator is responsible for what (Chris vs. Janice) but Janice let me know today that she is the main point of contact for the residents, so she is the one I'll be dealing with (which I'm happy about.)

i'm sorry to be reporting these difficult circumstances. Perhaps Dad just needs more time and things will look better next week...I certainly hope so, but am not that optimistic. Everyone's input and/or suggestions welcome and appreciated.

Dad's Recovery at Emerald Isle

I have been to see Dad every day this week since his discharge from the rehab, all the while coordinating with the doctors and Emerald Isle administrators, filling prescriptions, and working with the physical therapists and caregivers on Dad's rehab and hopeful return to pre-fall abilities.

As Justine reported for me, Dad is looking so much better since returning to EI. I'm usually seeing him in mid to late morning, after he has received his morning shower and breakfast. He just seems so much more comfortable and relaxed and has been much more alert and responsive than how he was in the rehab. I really like the physical therapist (Lauri Malloy) ... from the 1st day of therapy (Tuesday), we identified the need to ensure Dad's "buy-in" so to speak in participating in the therapy. I believe that in the rehab, despite the best efforts of the PT Kristen, Dad just was not comfortable with all the shifting, adjusting, poking, prodding that typically goes along with 3 shifts of workers a day, and he developed a fear of moving (understandably due to pain that he had experienced) and truly resisted most efforts to get him up and around (in fact would push back any attempts to even lean forward for example). Furthermore, he seemed to want to sleep all the time, or at least keep his eyes closed (shutting out the world in my view).

Anyway, he is now participating in the PT, thus far standing up from a chair (they have an electric one like Mom's, so they are using that to boost him quite a bit) up to his walker (with arm support on either side helping him up), standing for a period of time, and taking some small steps. The caregivers are reporting that he is usually assisting similarly when going through his various transfers during the day, including shower time, though sometimes he is doing the "ow ow" thing and is getting more of a lift from the caregivers. When I saw him yesterday with the PT, he clearly was showing difficulty or at least not wanting to put much weight on his left leg (same side as broken hip). We are trying to sort out the use of medications to ensure minimal pain, while at the same time not wanting to knock him out. For the most part, he is on a regimen of Two 500mg regular Tylenol, every 6 hours. He was also prescribed Tylenol Codeine as needed for pain, so we (therapist, EI administrator, myself) have been talking about using that 1st thing in the morning to help with the morning hygiene routine and subsequent therapy session to see if it makes a difference, Note that the caregivers (Al, Juana) are fully engaged while the PT is there as well and Lauri has been instructing them on exercises to do with Dad, as well as reinforcing the idea of being patient with Dad, communicating with him what they want/need him to do, and getting him to participate, which seems to be going well.

Also when I was there yesterday I tossed the ball with Dad....therapist was trying to get Dad to raise his arms over his head and he wasn't quite getting it so I showed her this activity which we've been doing with him for the last year. She was pleased to see how engaged Dad was in that activity and encouraged it. We also tried putting it at his feet and asking him to kick it, which he did very slightly with his right foot. He also participated in raising/lowering both legs, both with knees bent and legs extended. We witnessed evidence of more pain in his left leg, particularly when trying to raise the bent knee.

In addition to the PT, who will be seeing Dad 3x/week, the doctor prescribed a home health nurse to come out to administer an injection called Zestril. This is a precaution against clotting which can be common in post-surgical patients. Dad is on a fairly small dose, 2.5 mg, and he will receive it for 7 days.

Thought I'd post a separate note describing Dad's remaining meds to serve as an easily searchable as needed source of info in case needed for the future for whatever reason.

Dad has a follow-up appointment with the orthopaedic surgeon next Friday which I will take him to.

Finally, got Dad's taxes submitted (after having to recreate since having my computer stolen...much easier though as I had documented quite a bit and had some printouts done as well.)