Thursday 23 May 2013
The Dementia Diary: An Onion Sandwich
The Dementia Diary: An Onion Sandwich: I haven't been writing a lot on the blog lately because it has been a very difficult 3 weeks. There have been a couple deaths on my mom...
An Onion Sandwich
I haven't been writing a lot on the blog lately because it has been a very difficult 3 weeks. There have been a couple deaths on my mom's wing that saddened me more than I thought they would. I've struggled with my own mid-life thoughts and mom, well mom has been helped along to a 'I hate Lisa mode'. Although it isn't unfamiliar territory for me, it hurts and it's depressing to read about so I won't go into detail. It's not what she says that hurts because they are things I have heard before at many times through out my life. They are nasty, hurtful words that in the past could be attributed to mental illness but now not so much. Mom still has some sort of dementia, nobody can really pin point what and mom still has mental illness and what label she is now can't really be defined either. What is for sure is that she isn't firing on all cylinders and it is obvious to everyone. What is for sure is that she isn't at a normal functioning level of thought and that too is obvious to everyone. What is also for sure that her thoughts are being manipulated by a close family member and that is what I find most hurtful and disturbing.
We go through life really believing that we know our family members, that we really know them and trust them. That is until a family crisis hits and often the true colours of the person are revealed. That is the present situation. Two months ago dad and I started bringing mom home on the weekends. Not all the visits were good because mom can't remember things that have always been in the house and insisted they were another woman's. They she couldn't remember that she once weighed almost 200 lbs and the clothes in the closet weren't another 'fat' woman's rather they were hers. To alleviate the possibility of mom getting agitated dad and I would often give the phone and her address book to her. Mom really can't use the phone that well and most calls would not get through but the occasional call would connect and mom would talk away about whatever was in her mind at the time. Regardless, it would occupy a good hour of mom's time and often tire her out to the point of needed an afternoon nap. I guess the phone was a pacifier for mom as it allowed her to feel some connection with the outside world. Some of the conversations were innocuous and I had no concern. But, some required damage control like when she called the husband of her deceased friend and demanded to speak with her or when she laughed at another friend after he told that his wife (who mom really didn't like) has terminal cancer. Many times mom would hit the speaker phone button and from the basement I could monitor the conversations and intervene to do any damage control when needed. It was during these speaker phone calls that I heard my mom's conversations with the family member I speak of.
The first hint of dissidence was in January of this year and it wasn't in a phone call rather it was in person and this family member said things, with lawyers present that were disturbing and confusing. At the time mom was was getting better and had been taken out of the Broda chair and into a regular wheelchair. I thought this family member would pleased with mom's progression but they seemed not notice, let alone care. This person then told lawyers that my mom put herself into the extended care facility that she is in to get away from the abuse of my father. Of course no one present took it seriously because all of us present knew that people don't admit themselves to an extended care home. We all know that any senior or person with disability must be assessed and then they are put on a waiting list and when a bed becomes available then they are placed in a facility. Depending on the level of need is how people are placed in Alberta and because, at the time, mom's need was great, she was placed in an available facility almost immediately. This person knows that mom was in two other extended care facilities before a bed became available where she presently resides. The statement confused everyone and one of the lawyers actually asked me if there were skeletons in the closet. I was confused and began to think that maybe I didn't notice things or I had blocked things out or that perhaps things had happened before I was born. I was shocked and couldn't believe that this person would say such things and to alleviate my own confusion I spoke with other family members. They all reassured me that my father was never abusive to my mother and that I'm not blocking anything out of my memory. We all agreed that this family member has their own mental health issues that aren't being addressed and this is how they perceive things from the past and things now present. So, I just left it at that as no one was taking the statement seriously and we all knew it to be untrue.
Months later when I first overheard a conversation between this person and my mom I still wasn't that concerned. This person has issues not only with the family but with me in particular and the statements they made about me to my mom were hurtful, untrue and uncalled for. I was angered not by what was said about me but that this person, knowing that mom is often confused, would say things to add more confusion to her mind. I thought it very irresponsible and inconsiderate of this person to do so because that is exactly what happened. Mom became more confused and began to question the reasoning as to why I, of all people, returned home to help care for her. I explained to her that at the time we all felt that she would not survive to Christmas and I came home to be with her during that time and to be there for my father. Nothing more became of it and after a nap, mom was fine.
I overheard other conversations between my mom and this person and each one became more and more disturbing. There is a very fine line between being positive and encouraging with mom and encouraging the delusions. When mom gets angry at the walker and says how she hates it dad or I or the workers tell her that the walker is for her safety until she gets her balance back and that there is no shame in using a walker as almost all the people around her use them. We remind her that only a few months ago she couldn't walk at all and we try to encourage her to be grateful. Those are words of reassurance and encouragement and they are positive and they alleviate her anxiety. Mom is nothing short of a small miracle and it is possible that someday she will not need the walker but the reality is that she for now, she needs it and chances are that she will need it for the rest of her life. However this person made statements that if mom could walk without the walker she could move out of the care facility she is in and live on her own. What has happened is mom at times thinks that she should walk more without the walker and then she can leave the extended facility. The fact is that mom does not have good balance without the walker. She can walk without from a chair to a nearby table to keep her balance but no further. She has argued with the caregivers at the facility insisting that she does not need the walker. These beliefs put mom at risk. Mom could easily fall and break a hip or hit or head or anything. But the person who made these statements, the statements that enhance her delusions gave no consideration to the risk that it creates for mom or the facility or for the worry it creates for the rest of family, especially my dad. That I find very disturbing.
For a couple months now mom has worried about money and the power of attorney and how to pay for the facility. She worries that her grand-children's educational funds will be spent up paying for the facility. She worries that dad will sell the house and keep all the money. She is angry that she no longer has credit cards. Others in the facility worry and complain about the exact same things and many families and caregivers deal with these issues regularly. We tell mom that her pensions cover the expenses of the facility and they do. We remind her that she doesn't need money as everything she needs is at the facility and when she needs anything, and I mean anything from ice cream to support hose, dad runs out and gets it for it. When she wants to go shopping, dad takes her. Still the worries of money sit in her mind and some days that is all she can think about and it agitates her. In some of the conversations that mom had with this family member, they too mentioned the power of attorney and how it was there opinion that mom was capable to handle her finances and that they would help her with that but first she had to get the power of attorney revoked. On two occasions after conversations with this family member mom became so agitated that dad and I had to end the home visit and return her to the facility where the workers could calm her down and medicate her if necessary. One of these occasions I got so angry that I called other family members and asked them to speak with this other family member because perhaps they don't realize how it agitates mom and how their words effect her well being. I didn't think it was intentional, I thought they just aren't aware of how to communicate with a person who has an addled mind and how you have to choose your words wisely. I left to the rest of family to deal with and I hoped that this family member would understand and start talking about the weather instead, they didn't.
The other reoccurring delusion that mom has is that there is another woman living with dad during the week who leaves on the weekend. In the past she had a name, Mary but that morphed to a fat woman wearing size 18 clothes who was using the closet and then mom deciding that she was leaving dad as soon as she could. Most people at the facility simply laughed at the delusions, not in front of mom, but rather with me when I came to help out or to visit. Although very hurtful to hear and hurtful to see how it hurts my dad, we have to laugh at them because it's funny to imagine my father with another woman or someone like my dad carrying on with another woman. For myself, my dad, my daughter and the workers there really was no way to put a positive spin on her delusions so we would attempt to refute them with common sense. That doesn't work either as you can't reason with a person who's mind isn't working properly. More often than not we would all choose just to listen as she would natter on and after a few minutes, because her mind isn't all there, mom would think about something else and the conversation would change. In another conversation that I overhead between my mother and the family member it became very evident that the family member I write about has little concern for the well being of my mother. Rather than refute the delusions that mom spoke off, like other members of the family and friends who she had spoken with on the matter and on that day, this person said that they hire a moving van and in July come and collect mom, her things and help her to resettle in another city, in another province and that all my mom had to do was get the power of attorney back. I couldn't believe what I was hearing and the level of agitation that it created in mom was off the scale. I cried out of anger and I cried out of the realization that this family member is not in denial about mom's mental capability, they are not unaware of how to communicate with mom, they are not trying to help mom, rather they are trying to use mom's weak mind to manipulate the situation. If mom were actually to move and leave dad, live on her own and take care of her money (all of which she can't physically, mentally or competently do) then this person would have access to what money and investments mom has and with the state of mind that mom is in, they could easily manipulative mom for their own financial and personal gain. I can't even comprehend such behaviour by anyone let alone a member of our family and by definition it's a form of elder abuse. I was sickened by the obvious and struggled to find answers as to why this person, this family person would behave in such a way. Is this person so greedy that they will say and do things with the intention of gaining access to mom's finances? Do they hate me and dad so much that they say and do things that will upset mom and in turn make things difficult for dad and myself? Are they delusional or mentally ill themselves and really aren't aware of what they are doing? I simply do not know the reasoning and I never really will but what I do know it that their actions and behaviors are harmful to my mother and her well being but I can't stop it and I feel helpless.
I brought my concerns to other family members. Really nothing can be done and no one wanted to pursue it further because the rest of the family is well aware of mom's limitations, so nothing was said or done. I was left with a very saddened and broken heart and not because I felt no one was listening but because this was another family member who I had trusted and who I had once loved. It breaks my heart to see the confusion this person's statements had for mom and how it bothered her to the point of where my mom is once again a victim of the terrors that are in her own mind. For a few months mom was normal and our relationship was normal and enjoyable. If I left the room she would ask, where's Lisa-Maire and would ask the workers when my dad and I were coming and we would have normal conversations do things together. Life was good, well as good as it gets and this family member has awakened the demons that had been sleeping in mom and they have done that intentionally. When the family member decided to come for what is now an extended visit I simply had to put everything in God's hands, and as difficult as that is for me to do, that's what I've done. So for over a week now mom won't speak to me because this family member told her not too. That hurts, that hurts a lot. Other caregivers and workers on the wing that mom lives on have also over heard what this person says to mom and how they communicate with her and they have concerns too as they see how it agitates and creates anxiety for mom. The other caregivers and workers have noticed how it is affecting my father and his anguish is showing in his health. The other caregivers and workers have noticed how it hurts me because my smile isn't as big as it was. But I tell them not to worry because this person will eventually leave and mom will have a different delusion and that the dust will settle. I said this just yesterday though inside, my heart was throbbing because it is painful.
As I was speaking with another caregiver and explaining to her not to worry one of the residents called me.
"Lisa-Marie," she said. "I can hear you, come over here." This resident is very blind and knows me by the sound of my voice. So I went over to her to see what she wanted.
"Did you make Joan an onion sandwich,' she asked abruptly.
I answered that I had and I was confused by the question and thinking that maybe the smell of sandwich or smell of Joan's breath was disturbing to this resident. Instead she asked how I made the sandwich and I told her with whole wheat bread, butter, mayo, salt, pepper and white vidalia onions.
She smiled at me and said "White onions, right".
"Yes," I responded.
"Perfect," she said. "Can you make me one for supper tomorrow only I like lots of mayo on mine." I smiled and said I would and gave her a hug.
In that moment all the the worry, the fear, the anger and the hurt was gone. It was gone because I realized that people know what is in our souls and that the residents, the staff, the rest of my family and even my mother know that my soul is good. So does God and God really knows what is in our souls so now I fear for this family member because I'm pretty sure that they are digging themselves to hell.
We go through life really believing that we know our family members, that we really know them and trust them. That is until a family crisis hits and often the true colours of the person are revealed. That is the present situation. Two months ago dad and I started bringing mom home on the weekends. Not all the visits were good because mom can't remember things that have always been in the house and insisted they were another woman's. They she couldn't remember that she once weighed almost 200 lbs and the clothes in the closet weren't another 'fat' woman's rather they were hers. To alleviate the possibility of mom getting agitated dad and I would often give the phone and her address book to her. Mom really can't use the phone that well and most calls would not get through but the occasional call would connect and mom would talk away about whatever was in her mind at the time. Regardless, it would occupy a good hour of mom's time and often tire her out to the point of needed an afternoon nap. I guess the phone was a pacifier for mom as it allowed her to feel some connection with the outside world. Some of the conversations were innocuous and I had no concern. But, some required damage control like when she called the husband of her deceased friend and demanded to speak with her or when she laughed at another friend after he told that his wife (who mom really didn't like) has terminal cancer. Many times mom would hit the speaker phone button and from the basement I could monitor the conversations and intervene to do any damage control when needed. It was during these speaker phone calls that I heard my mom's conversations with the family member I speak of.
The first hint of dissidence was in January of this year and it wasn't in a phone call rather it was in person and this family member said things, with lawyers present that were disturbing and confusing. At the time mom was was getting better and had been taken out of the Broda chair and into a regular wheelchair. I thought this family member would pleased with mom's progression but they seemed not notice, let alone care. This person then told lawyers that my mom put herself into the extended care facility that she is in to get away from the abuse of my father. Of course no one present took it seriously because all of us present knew that people don't admit themselves to an extended care home. We all know that any senior or person with disability must be assessed and then they are put on a waiting list and when a bed becomes available then they are placed in a facility. Depending on the level of need is how people are placed in Alberta and because, at the time, mom's need was great, she was placed in an available facility almost immediately. This person knows that mom was in two other extended care facilities before a bed became available where she presently resides. The statement confused everyone and one of the lawyers actually asked me if there were skeletons in the closet. I was confused and began to think that maybe I didn't notice things or I had blocked things out or that perhaps things had happened before I was born. I was shocked and couldn't believe that this person would say such things and to alleviate my own confusion I spoke with other family members. They all reassured me that my father was never abusive to my mother and that I'm not blocking anything out of my memory. We all agreed that this family member has their own mental health issues that aren't being addressed and this is how they perceive things from the past and things now present. So, I just left it at that as no one was taking the statement seriously and we all knew it to be untrue.
Months later when I first overheard a conversation between this person and my mom I still wasn't that concerned. This person has issues not only with the family but with me in particular and the statements they made about me to my mom were hurtful, untrue and uncalled for. I was angered not by what was said about me but that this person, knowing that mom is often confused, would say things to add more confusion to her mind. I thought it very irresponsible and inconsiderate of this person to do so because that is exactly what happened. Mom became more confused and began to question the reasoning as to why I, of all people, returned home to help care for her. I explained to her that at the time we all felt that she would not survive to Christmas and I came home to be with her during that time and to be there for my father. Nothing more became of it and after a nap, mom was fine.
I overheard other conversations between my mom and this person and each one became more and more disturbing. There is a very fine line between being positive and encouraging with mom and encouraging the delusions. When mom gets angry at the walker and says how she hates it dad or I or the workers tell her that the walker is for her safety until she gets her balance back and that there is no shame in using a walker as almost all the people around her use them. We remind her that only a few months ago she couldn't walk at all and we try to encourage her to be grateful. Those are words of reassurance and encouragement and they are positive and they alleviate her anxiety. Mom is nothing short of a small miracle and it is possible that someday she will not need the walker but the reality is that she for now, she needs it and chances are that she will need it for the rest of her life. However this person made statements that if mom could walk without the walker she could move out of the care facility she is in and live on her own. What has happened is mom at times thinks that she should walk more without the walker and then she can leave the extended facility. The fact is that mom does not have good balance without the walker. She can walk without from a chair to a nearby table to keep her balance but no further. She has argued with the caregivers at the facility insisting that she does not need the walker. These beliefs put mom at risk. Mom could easily fall and break a hip or hit or head or anything. But the person who made these statements, the statements that enhance her delusions gave no consideration to the risk that it creates for mom or the facility or for the worry it creates for the rest of family, especially my dad. That I find very disturbing.
For a couple months now mom has worried about money and the power of attorney and how to pay for the facility. She worries that her grand-children's educational funds will be spent up paying for the facility. She worries that dad will sell the house and keep all the money. She is angry that she no longer has credit cards. Others in the facility worry and complain about the exact same things and many families and caregivers deal with these issues regularly. We tell mom that her pensions cover the expenses of the facility and they do. We remind her that she doesn't need money as everything she needs is at the facility and when she needs anything, and I mean anything from ice cream to support hose, dad runs out and gets it for it. When she wants to go shopping, dad takes her. Still the worries of money sit in her mind and some days that is all she can think about and it agitates her. In some of the conversations that mom had with this family member, they too mentioned the power of attorney and how it was there opinion that mom was capable to handle her finances and that they would help her with that but first she had to get the power of attorney revoked. On two occasions after conversations with this family member mom became so agitated that dad and I had to end the home visit and return her to the facility where the workers could calm her down and medicate her if necessary. One of these occasions I got so angry that I called other family members and asked them to speak with this other family member because perhaps they don't realize how it agitates mom and how their words effect her well being. I didn't think it was intentional, I thought they just aren't aware of how to communicate with a person who has an addled mind and how you have to choose your words wisely. I left to the rest of family to deal with and I hoped that this family member would understand and start talking about the weather instead, they didn't.
The other reoccurring delusion that mom has is that there is another woman living with dad during the week who leaves on the weekend. In the past she had a name, Mary but that morphed to a fat woman wearing size 18 clothes who was using the closet and then mom deciding that she was leaving dad as soon as she could. Most people at the facility simply laughed at the delusions, not in front of mom, but rather with me when I came to help out or to visit. Although very hurtful to hear and hurtful to see how it hurts my dad, we have to laugh at them because it's funny to imagine my father with another woman or someone like my dad carrying on with another woman. For myself, my dad, my daughter and the workers there really was no way to put a positive spin on her delusions so we would attempt to refute them with common sense. That doesn't work either as you can't reason with a person who's mind isn't working properly. More often than not we would all choose just to listen as she would natter on and after a few minutes, because her mind isn't all there, mom would think about something else and the conversation would change. In another conversation that I overhead between my mother and the family member it became very evident that the family member I write about has little concern for the well being of my mother. Rather than refute the delusions that mom spoke off, like other members of the family and friends who she had spoken with on the matter and on that day, this person said that they hire a moving van and in July come and collect mom, her things and help her to resettle in another city, in another province and that all my mom had to do was get the power of attorney back. I couldn't believe what I was hearing and the level of agitation that it created in mom was off the scale. I cried out of anger and I cried out of the realization that this family member is not in denial about mom's mental capability, they are not unaware of how to communicate with mom, they are not trying to help mom, rather they are trying to use mom's weak mind to manipulate the situation. If mom were actually to move and leave dad, live on her own and take care of her money (all of which she can't physically, mentally or competently do) then this person would have access to what money and investments mom has and with the state of mind that mom is in, they could easily manipulative mom for their own financial and personal gain. I can't even comprehend such behaviour by anyone let alone a member of our family and by definition it's a form of elder abuse. I was sickened by the obvious and struggled to find answers as to why this person, this family person would behave in such a way. Is this person so greedy that they will say and do things with the intention of gaining access to mom's finances? Do they hate me and dad so much that they say and do things that will upset mom and in turn make things difficult for dad and myself? Are they delusional or mentally ill themselves and really aren't aware of what they are doing? I simply do not know the reasoning and I never really will but what I do know it that their actions and behaviors are harmful to my mother and her well being but I can't stop it and I feel helpless.
I brought my concerns to other family members. Really nothing can be done and no one wanted to pursue it further because the rest of the family is well aware of mom's limitations, so nothing was said or done. I was left with a very saddened and broken heart and not because I felt no one was listening but because this was another family member who I had trusted and who I had once loved. It breaks my heart to see the confusion this person's statements had for mom and how it bothered her to the point of where my mom is once again a victim of the terrors that are in her own mind. For a few months mom was normal and our relationship was normal and enjoyable. If I left the room she would ask, where's Lisa-Maire and would ask the workers when my dad and I were coming and we would have normal conversations do things together. Life was good, well as good as it gets and this family member has awakened the demons that had been sleeping in mom and they have done that intentionally. When the family member decided to come for what is now an extended visit I simply had to put everything in God's hands, and as difficult as that is for me to do, that's what I've done. So for over a week now mom won't speak to me because this family member told her not too. That hurts, that hurts a lot. Other caregivers and workers on the wing that mom lives on have also over heard what this person says to mom and how they communicate with her and they have concerns too as they see how it agitates and creates anxiety for mom. The other caregivers and workers have noticed how it is affecting my father and his anguish is showing in his health. The other caregivers and workers have noticed how it hurts me because my smile isn't as big as it was. But I tell them not to worry because this person will eventually leave and mom will have a different delusion and that the dust will settle. I said this just yesterday though inside, my heart was throbbing because it is painful.
As I was speaking with another caregiver and explaining to her not to worry one of the residents called me.
"Lisa-Marie," she said. "I can hear you, come over here." This resident is very blind and knows me by the sound of my voice. So I went over to her to see what she wanted.
"Did you make Joan an onion sandwich,' she asked abruptly.
I answered that I had and I was confused by the question and thinking that maybe the smell of sandwich or smell of Joan's breath was disturbing to this resident. Instead she asked how I made the sandwich and I told her with whole wheat bread, butter, mayo, salt, pepper and white vidalia onions.
She smiled at me and said "White onions, right".
"Yes," I responded.
"Perfect," she said. "Can you make me one for supper tomorrow only I like lots of mayo on mine." I smiled and said I would and gave her a hug.
In that moment all the the worry, the fear, the anger and the hurt was gone. It was gone because I realized that people know what is in our souls and that the residents, the staff, the rest of my family and even my mother know that my soul is good. So does God and God really knows what is in our souls so now I fear for this family member because I'm pretty sure that they are digging themselves to hell.
Monday 6 May 2013
The Dementia Diary: The Dementia Diary: Stupid is as stupid does.
The Dementia Diary: The Dementia Diary: Stupid is as stupid does.: The Dementia Diary: Stupid is as stupid does. : Government has never made sense to me. I think it's a lot like Wal-mart, stupidity is a...
Sunday 5 May 2013
The Dementia Diary: Stupid is as stupid does.
The Dementia Diary: Stupid is as stupid does.: Government has never made sense to me. I think it's a lot like Wal-mart, stupidity is a requirement for employment. The new model of a...
Stupid is as stupid does.
Government has never made sense to me. I think it's a lot like Wal-mart, stupidity is a requirement for employment. The new model of activity based funding for Alberta Heath Services is no different. Stupid, that's the only word to describe it, stupid.
The new model will be beneficial to some areas of health care in this province. It has the potential to speed up treatment time in hospital wait rooms and decrease surgery wait times and even simple procedures like ultra sound. It provides incentives for health care providers to ensure quality care. Pay for performance is another name for this payment model as it rewards physicians, hospitals, medical groups, and other health care providers for meeting certain performance measures for quality and efficiency. The quality and efficiency are rated on turn over and turn over times. The idea is that doctors and health service providers will see more patients because the more they see and the more they treat than more funding is available to them.
This funding model works well for long-term facilities that operate to rehabilitate an individual. 70% of the long-term facilities in Alberta are for the care of our senior citizens. Roughly 40,000 of those seniors have dementia. Dementia is a progressive disease, with no cure. Dementia is a loss of mental ability severe enough to interfere with normal activities of daily living and lasts more than 6 months. Dementia is a terminal illness. Allison Redford, our premiere, knows what dementia is. Ron Casey, our local MLA, knows what dementia is. Fred Horne, the minister of health in Alberta, surely must know what dementia is and I'm sure, George VanderBurg, the associate minister for seniors, knows what dementia is. Yet, I have to wonder if they do, because they have applied this new funding model to long care facilities across the province knowing that 70% of those facilities are for seniors and knowing that 40,000 tax-paying Albertans have some form of dementia. Long-term care facilities and especially those that cater to seniors with dementia, don't have turn over, so the funding that they have been receiving in the past is now gone and they can't possibly qualify for additional funding with the new model. The name long-term care says it all. Long-term is self explanatory it means a patient is at the facility for a long term.
I have sent emails to all of those involved in the changes to the funding model. They have a standard answer written by the communications officer. It states 'the service provider at the facility where your mother resides, was made aware of the forthcoming changes in 2009. They have had 3 years in which to adjust their budgeting, costing and expense requirements accordingly. Therefore your concerns should be addressed to them'. Passing the buck, the one thing all politicians are good at. It isn't the service providers fault that the government is applying such a funding model to facilities that can't possibly rehabilitate those that reside there.
To manage the loss in funding, the society that runs my mom's facility did lay-offs from the top to the bottom. The loss of an executive position has no relevance in the care of my mother but the loss of a nurse or an LPN or a health care worker certainly does and everyone has noticed the difference. The staff that still have jobs are already tired and burning out. There are two workers and one nurse on a wing with 26 residents. The nurse is usually very busy giving medications and checking everything from minor to major complaints. In addition, the government, in their infinite wisdom now requires a tracking system for each individual patient that must be recorded daily and then input into a government database. It can take almost an hour to record and input the data required for 1 PATIENT, yes for 1 patient. The nurses work 8 hour shifts, there are 24 hours in a day there are 26 patients so everyday they are already behind. Then they fall further behind because there is only 1 nurse on the midnight shift for 3 wings that have 78 long-term care patients and she must input every report that hasn't been entered and make adjustments if there is any incident that happens in any of the three wings overnight. If you think that people with dementia actually sleep at night then you are wrong. The reports are sent to the government every two weeks and if any report is late or missing then there is no money given to the facility for that period. If a computer glitches up and the reports are not submitted then there is no money given to the facility for that period.. If a resident is rehabilitated and moves out of the facility during that period, then the government does give money to the facility and even more money. But in a 'dementia' wing, the only way out is by death and death doesn't meet the funding criteria so if a resident dies during that reporting period, then no money is given to the facility.
The nurses are busy but the government expects them to properly adhere to the medication requirements in a timely manner and do the residents reports and help with the basic day to day care of the facility residents. They don't have the time so the onus for the basic care of course falls on the tired shoulders of the health care workers. It takes anywhere from 20 to 45 minutes to wake, wash and dress a dementia resident. That is providing that the resident is agreeable, aware and in good spirits. The health care workers start waking residents up at 7:00 am. People with dementia sometimes get aggressive and it's near impossible to wash or dress them if they don't want to. They are like toddlers but in adult bodies and one person can't do it alone. People with dementia are confused and scared and don't remember faces and don't want someone that they view as a stranger touching them or helping them. Dementia patients are often very weak and feeble and can't help in any way. Needless to say, by noon some of the residents are having breakfast while others are getting lunch.
Most people with dementia either require to be fed or they are a choking risk and must be watched. Some will put too much food into their mouths because they have lost the ability to eat normally. Others won't eat and need encouragement and others might pocket the food in their mouths and could aspirate on it later and cause aspiration pneumonia. Again, there are 26 residents and 2 workers at breakfast, lunch and dinner. Any family or volunteer that comes during meal times to assist their loved one is so greatly appreciated. Some of residents that do require feeding are unfortunately getting cold food or have fallen asleep by the time a worker is able to get to them and they won't wake up. I know from experience that it takes a minimal of 30 minutes to feed a person who requires meal assistance.
In addition, most people with dementia are incontinent and require toileting. An adult diaper is changed in the same way that a babies diaper is. They are laid down, the dirty diaper is removed, they are cleaned, a fresh diaper is put on and they are redressed. With a baby it is actually quite easy, but not so easy with an adult. It is time consuming and often requires two workers and a mechanical lift to get the resident safely from their chair, to the bed and back again. Many dementia patients do use the toilet but they still require assistance and often it requires two workers to get them safely to, on and back from the toilet and change the adult pull-up if needed.
Then, again with their infinite wisdom the government has assured, under an act no less, that all residents of long-term care facilities will receive two assisted bathes or showers per week. To accommodate this there is a floater. The floater is assigned to do all the bathing or showering AND help with meals, toileting, lifting, portering AND covers breaks. There is one floater who works an 8 hour day/7 days a week. That is 56 hours and there are 78 residents that require bathing and as they are to get two bathes or showers a week, that is 156 bathes and showers. I take hour long bathes on a regular basis and even in a rush, I'll take a 20 minute shower and that's just my wet time and not including getting naked, towelling dry and getting dressed again. It takes close to an hour to properly bathe or shower a person with dementia. Again, not enough hours in the day or days in the week.
Forrest Gump said it best "Stupid is as stupid does". The new funding model is just about as stupid as stupid can get. I always took that line to mean that your character is defined by your actions, so our government representatives have very questionable characters. I am not impressed, in fact I am pissed off, really fucking pissed off. Those that know me, know I must be pissed off because I used the f-bomb. And I am really fucking pissed off. I'm pissed off because our seniors deserve better. I'm pissed off because a simple bladder infection can mean the end for a dementia patient and because they no longer can get toileted or changed regularly they are going to get infections. I'm pissed off because my mom needs assistance to get to the toilet and if she can't get a worker to help her she will go on her own and she might fall and break a hip or get a concussion, or something. I'm pissed off because our seniors might choke on a boiled egg. I'm pissed off because sometimes all a dementia patient needs is someone to hold their hand and no one has the time to hold their hand anymore. I'm pissed off because my mom has dementia. I'm pissed off because my dad is a senior. I'm pissed off because I too will be a senior someday. I'm really pissed off because right now, in some ER in the city, some bimbo is getting top notch medical care because she has a little infection from a botched manicure and my mom is anxiously awaiting for a worker to help her get dressed and into bed because she's tired. I'm pissed off because my mom has paid more taxes in her life time then the bimbo with a bad hang nail at the Foothills emergency room right now. Yep, I'm just pissed off.
That's why we organized the rally against cutbacks. I hope that you reading this will do the same where ever you live. The pay for performance funding system is prevalent in the US, the UK and Europe. More and more countries are moving towards this model of health care funding. That means more and more seniors will not get the quality of care that they not only deserve but that they earned. We have to do something and if we don't then we are stupider than the politicians. I'm not stupid, my mother didn't raise a fool.
The new model will be beneficial to some areas of health care in this province. It has the potential to speed up treatment time in hospital wait rooms and decrease surgery wait times and even simple procedures like ultra sound. It provides incentives for health care providers to ensure quality care. Pay for performance is another name for this payment model as it rewards physicians, hospitals, medical groups, and other health care providers for meeting certain performance measures for quality and efficiency. The quality and efficiency are rated on turn over and turn over times. The idea is that doctors and health service providers will see more patients because the more they see and the more they treat than more funding is available to them.
This funding model works well for long-term facilities that operate to rehabilitate an individual. 70% of the long-term facilities in Alberta are for the care of our senior citizens. Roughly 40,000 of those seniors have dementia. Dementia is a progressive disease, with no cure. Dementia is a loss of mental ability severe enough to interfere with normal activities of daily living and lasts more than 6 months. Dementia is a terminal illness. Allison Redford, our premiere, knows what dementia is. Ron Casey, our local MLA, knows what dementia is. Fred Horne, the minister of health in Alberta, surely must know what dementia is and I'm sure, George VanderBurg, the associate minister for seniors, knows what dementia is. Yet, I have to wonder if they do, because they have applied this new funding model to long care facilities across the province knowing that 70% of those facilities are for seniors and knowing that 40,000 tax-paying Albertans have some form of dementia. Long-term care facilities and especially those that cater to seniors with dementia, don't have turn over, so the funding that they have been receiving in the past is now gone and they can't possibly qualify for additional funding with the new model. The name long-term care says it all. Long-term is self explanatory it means a patient is at the facility for a long term.
I have sent emails to all of those involved in the changes to the funding model. They have a standard answer written by the communications officer. It states 'the service provider at the facility where your mother resides, was made aware of the forthcoming changes in 2009. They have had 3 years in which to adjust their budgeting, costing and expense requirements accordingly. Therefore your concerns should be addressed to them'. Passing the buck, the one thing all politicians are good at. It isn't the service providers fault that the government is applying such a funding model to facilities that can't possibly rehabilitate those that reside there.
To manage the loss in funding, the society that runs my mom's facility did lay-offs from the top to the bottom. The loss of an executive position has no relevance in the care of my mother but the loss of a nurse or an LPN or a health care worker certainly does and everyone has noticed the difference. The staff that still have jobs are already tired and burning out. There are two workers and one nurse on a wing with 26 residents. The nurse is usually very busy giving medications and checking everything from minor to major complaints. In addition, the government, in their infinite wisdom now requires a tracking system for each individual patient that must be recorded daily and then input into a government database. It can take almost an hour to record and input the data required for 1 PATIENT, yes for 1 patient. The nurses work 8 hour shifts, there are 24 hours in a day there are 26 patients so everyday they are already behind. Then they fall further behind because there is only 1 nurse on the midnight shift for 3 wings that have 78 long-term care patients and she must input every report that hasn't been entered and make adjustments if there is any incident that happens in any of the three wings overnight. If you think that people with dementia actually sleep at night then you are wrong. The reports are sent to the government every two weeks and if any report is late or missing then there is no money given to the facility for that period. If a computer glitches up and the reports are not submitted then there is no money given to the facility for that period.. If a resident is rehabilitated and moves out of the facility during that period, then the government does give money to the facility and even more money. But in a 'dementia' wing, the only way out is by death and death doesn't meet the funding criteria so if a resident dies during that reporting period, then no money is given to the facility.
The nurses are busy but the government expects them to properly adhere to the medication requirements in a timely manner and do the residents reports and help with the basic day to day care of the facility residents. They don't have the time so the onus for the basic care of course falls on the tired shoulders of the health care workers. It takes anywhere from 20 to 45 minutes to wake, wash and dress a dementia resident. That is providing that the resident is agreeable, aware and in good spirits. The health care workers start waking residents up at 7:00 am. People with dementia sometimes get aggressive and it's near impossible to wash or dress them if they don't want to. They are like toddlers but in adult bodies and one person can't do it alone. People with dementia are confused and scared and don't remember faces and don't want someone that they view as a stranger touching them or helping them. Dementia patients are often very weak and feeble and can't help in any way. Needless to say, by noon some of the residents are having breakfast while others are getting lunch.
Most people with dementia either require to be fed or they are a choking risk and must be watched. Some will put too much food into their mouths because they have lost the ability to eat normally. Others won't eat and need encouragement and others might pocket the food in their mouths and could aspirate on it later and cause aspiration pneumonia. Again, there are 26 residents and 2 workers at breakfast, lunch and dinner. Any family or volunteer that comes during meal times to assist their loved one is so greatly appreciated. Some of residents that do require feeding are unfortunately getting cold food or have fallen asleep by the time a worker is able to get to them and they won't wake up. I know from experience that it takes a minimal of 30 minutes to feed a person who requires meal assistance.
In addition, most people with dementia are incontinent and require toileting. An adult diaper is changed in the same way that a babies diaper is. They are laid down, the dirty diaper is removed, they are cleaned, a fresh diaper is put on and they are redressed. With a baby it is actually quite easy, but not so easy with an adult. It is time consuming and often requires two workers and a mechanical lift to get the resident safely from their chair, to the bed and back again. Many dementia patients do use the toilet but they still require assistance and often it requires two workers to get them safely to, on and back from the toilet and change the adult pull-up if needed.
Then, again with their infinite wisdom the government has assured, under an act no less, that all residents of long-term care facilities will receive two assisted bathes or showers per week. To accommodate this there is a floater. The floater is assigned to do all the bathing or showering AND help with meals, toileting, lifting, portering AND covers breaks. There is one floater who works an 8 hour day/7 days a week. That is 56 hours and there are 78 residents that require bathing and as they are to get two bathes or showers a week, that is 156 bathes and showers. I take hour long bathes on a regular basis and even in a rush, I'll take a 20 minute shower and that's just my wet time and not including getting naked, towelling dry and getting dressed again. It takes close to an hour to properly bathe or shower a person with dementia. Again, not enough hours in the day or days in the week.
Forrest Gump said it best "Stupid is as stupid does". The new funding model is just about as stupid as stupid can get. I always took that line to mean that your character is defined by your actions, so our government representatives have very questionable characters. I am not impressed, in fact I am pissed off, really fucking pissed off. Those that know me, know I must be pissed off because I used the f-bomb. And I am really fucking pissed off. I'm pissed off because our seniors deserve better. I'm pissed off because a simple bladder infection can mean the end for a dementia patient and because they no longer can get toileted or changed regularly they are going to get infections. I'm pissed off because my mom needs assistance to get to the toilet and if she can't get a worker to help her she will go on her own and she might fall and break a hip or get a concussion, or something. I'm pissed off because our seniors might choke on a boiled egg. I'm pissed off because sometimes all a dementia patient needs is someone to hold their hand and no one has the time to hold their hand anymore. I'm pissed off because my mom has dementia. I'm pissed off because my dad is a senior. I'm pissed off because I too will be a senior someday. I'm really pissed off because right now, in some ER in the city, some bimbo is getting top notch medical care because she has a little infection from a botched manicure and my mom is anxiously awaiting for a worker to help her get dressed and into bed because she's tired. I'm pissed off because my mom has paid more taxes in her life time then the bimbo with a bad hang nail at the Foothills emergency room right now. Yep, I'm just pissed off.
That's why we organized the rally against cutbacks. I hope that you reading this will do the same where ever you live. The pay for performance funding system is prevalent in the US, the UK and Europe. More and more countries are moving towards this model of health care funding. That means more and more seniors will not get the quality of care that they not only deserve but that they earned. We have to do something and if we don't then we are stupider than the politicians. I'm not stupid, my mother didn't raise a fool.
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