Too Young to be Called Grandma

This is a dilemma many woman have to face. It is a wonderful thing to become a grandparent, but what should the child call the grandparents. When I was a child in the Midwest, everyone grandparent was called Grandma and Grandpa. Times have changed.

I am a fairly new grandmother with my granddaughter, Gracie, being just under 2. She is living with our family while her daddy serves in the Middle East. Gracie is talking and she is calling me Mom because everyone else in the house calls me Mom. This is confusing that her Mom and I are both being called Mom. Obviously her Mom is going to stay Mom. What to do?

Now I have to be called something else besides Mom. I searched the internet for grandma names. I don't think I am old enough to be called Grannie or Grams or any other name that makes me sound old. I am not into cute name for Grandma either like NaNa or YeYe. After much discussion, we all decided I would be called Oma which is German for Grandma. After 29 years of being Mom, I am now Oma.

I have attached a link about choosing a name for yourself when you become a grandparent.

Client Centered Care for Dementia Patients

The past few weeks we’ve been talking about dementia and learning a lot about techniques to use while working with individuals with the disease. And I am getting some good experience while working with my particular patient on FW. This week I was so frustrated for my patient. He is on 24 hour assistance which means he is encouraged (forced) into either the activities room or therapy where a staff member can watch him all the times. He is extremely tired throughout the morning and hardly can keep his eyes open during therapy. This week was tough for him and myself because he was adamant on getting in that bed after I was finished with him – not listening to any reasoning. There was no changing topics, talking him down or compromising… he was just plain exhausted. (And that is really hard to forget about!) I was really thankful my instructor stepped and saw the state he was in and overruled the “not allowed to take a nap until after lunch” rule. We helped him back to bed and I think he was asleep before we left the room.

This protocol really bothers me!!! My grandmother went through the same type of situation a few years ago. She was in an ALF which didn’t have an alzheimer’s/dementia unit but was falling quite constantly when out of watch. They were making her go to activities all morning and afternoon so they could watch her. When we would come to visit she would be so tired that she couldn’t hold a conversation and she would cry to us and tell us how much she wanted to go to bed. It was so hard seeing her so frustrated and unhappy. I know what a situation she put the staff members in as well…if she did what she wanted to do and she fell it would be on their watch. ARGH! This is such a hard situation!

I saw another scenario play out at work this weekend. A patient just had hip replacement surgery and had a secondary diagnosis of dementia. I went to get her for therapy and found her trying to take the alarm off her chair as she was standing up. She presented very confused and absent minded. After getting her to the therapy gym, she started to cross her leg! I immediately jumped in and talked to her about her hip precautions. She said she never heard anyone talk to her about them. (They were posted in her room where she could see them). This is some serious stuff! If she isn’t about to follow precautions, then someone does really need to be with her 24/7. BUT…who is taking the responsibility for this? The facility? Do they hire more CNAs? Sitters? Should they even be accepting these patients if they don’t have the staff to watch them all day? And should these patients be subjected to hanging out at the nurses station, or attending activities in which they have no interest just so they can be watched?

I am fired up about these situations and I think that it is only going to get worse with the growing cases of dementia in the US. In 2010, North Carolina alone there are around 170,000 cases of dementia and that number is projected to increase to 210,000 by 2025!!! Those numbers are very intimidating. I think there not only needs to be more education on the disease, but increased funding for specialized facilities and rehab facilities to increase dementia care staff.

Click on the title of this post for more NC Alzheimer’s stats.

A penny saved is a penny earned ...

The patient that I had this past Thursday at fieldwork is completing her 21-day stint of OT this coming Tuesday.  She has been very independent in all ADLs since I met her 2 weeks ago, having completed the STGs and LTGs set by the OTR.  The OT staff is "working" on IADLs including simple meal prep and this was the subject of the tx session that I did with her.  She prepared a blueberry cobbler.  As she worked, I couldn't help but think "she doesn't need any help from me."  She washed the blueberries, mixed the ingredients and poured them over the prepared blueberries.  I pre-heated the oven and put the cobbler in the oven for her, because her leg is fixated in the extended position it is impossible for her to do these things safely.  Everything, that did not require her to stand (she is NWB) or reach above her extended reach height, she did.

This lady is a great, strong-willed, capable lady and I enjoyed talking to her and was inspired by her determination to stay healthy and go home.  Saying that, though, I think for the last week, at least, she has been getting OT, when really there are many who need it so much more.  She is capable of doing UE exercises on her own and has done them at home for many months.  It seems like a wasted expense for OT to see her every day.  She would do just as well to be seen every other day or 2 times each week, letting her exercise independently on the "off" days.  There are so many people who need more minutes, more days than medicare allows.  Wouldn't it go far to take days from patients that don't really need them and transfer them to the patients who need them most?

I know this is a difficult issue on many levels, and I'm sure her family would say she should get all the time that is allowed by Medicare, but it does make me think that there need to be some changes in the way that some think about insurance, Medicare and the need to be flexible.  Not everyone needs 21 days of OT.  Some need much more, some need less.

This seems to be an ethical delimma that has been observed by many.  This is a good article on such issues.
http://www.aota.org/Practitioners/Ethics/Advisory/Social-Justice.aspx

More than normal cognitive aging

I had a new pt last week at FW, & because I didn't know anything about the pt & there were timing issues, my teacher instructed me to do an assessment & get to know what the pt was expecting from rehab & what he needed to be able to go home. I thought I did well & I thought I had a good understanding of the pt. After the session, I talked with my teacher about the pt & his status. I thought he was a very alert & intelligent man (he's a retired high school teacher), & he seemed younger than his age of 81. But the teacher saw something I didn't.... cognitive issues. She brought up his slowness in answering, & loss of train of thoughts. I saw it as a normal part of the aging process, but she saw more. In my previous FW, I also saw several older pts that I thought their cognition levels were normal for their age, but I was wrong there too.

When is it just normal aging process & when is it something more? I think to know if it's normal & when it's something more takes experience, along with an exam & several tests. The Mayo Clinic's website has great information about mild cognitive impairment (MCI). The website defines MCI as "an intermediate stage between the expected cognitive decline of normal aging and the more pronounced decline of dementia". It also states that it increases a persons risk of developing dementia, including Alzheimer's disease. I don't think my patient is at risk for these because of his age.

I look forward to working with this pt to see if I can recognize any of the other symptoms from the website, such as: you forget important events; you feel increasingly overwhelmed when making decisions or planning steps to accomplish a task or interpreting instructions; you have trouble finding your way around familiar environments. Click on the title to get more information about MCI.

Ready to go!!

Last week we learned about car transfers and how to educate seniors in how to transfers into a car using proper technique. Well, when I got to FW this week, the PT was working with my patient on .... car transfer. I walked outside with the patient and the therapist to see first hand what we had learned last week. The PT open the passenger door and explain about moving the car seat back to give the client enough room to manuever. PT continue to show how to sit down and then swing your legs into the car. PT then position the wheelchair and the patient near the door and had her stand. Just as PT was helping and positioning the patient correctly, the patient swung her legs into the car and sat down, just like you normally get in the car. LOL!! that took both PT and I by surprise. She was ready to go. Told us to get the keys, let's go!
Sometimes patients move and know more than we think. So after we stopped laughing, we took the patient back in the facility and continued with therapy.

This site had pictures of car transfer for seniors and wheelchair bound persons: http://www.ricability.org.uk/consumer_reports/mobility_reports/getting_in_and_out_of_a_car/techniques/

Memory Books and a Helpful Note...

I work on the weekends as a Therapy Aide at a short term rehab and nursing care center. Some of my major duties are to get patients ready for therapy, transport patients to the gym, and just basically be another set of hands during treatment. One of the patients I saw this week was a lady suffering from Primary Progressive Aphasia (PPA). PPA is a form of dementia that can occur in individuals under the age of 65 (and sometimes as early as in the 40’s), and involves a decline in one or more language functions. She had a recent fall and was in therapy to improve her physical functioning to the point where she could go home to live with her daughter and not be quite as much a physical burden. I worked with the PT throughout her session and tried any way to motivate her to walk with the rolling walker. We spent what seemed to be 20 minutes standing with her walker and the PT trying every way to get her to take a few steps. (She was physically able to walk around the whole gym but was refusing and wasn’t about to express why).

Barely getting anything accomplished, the PT and the patient finished the session frustrated. As I pushed her back to her room I was thinking…there must be a way to reach her! My brain spinning, I pulled her back in the room. The poor lady looked like she was going to cry. I started reading the white board over her bed and in the bottom corner it said “Likes baseball, golf and soap operas”. So grateful for the tip, I turned on the television, found a baseball game and asked if she would like to watch baseball. She smiled and me and said yes. Those were the first words I heard out of her mouth in the 30 minute session. She seemed relieved to look at something familiar and comforting. I felt better leaving her in the room in a good place, and kept thinking how important that little note was! If that wasn’t there, there would have been no way I would have turned on baseball for the little sweet 78 year old lady!

As I thought about that brilliant little note left from what looked to be a family member I thought about our memory book project. I started seeing and how important those are not only for the patient/resident/client, but for the caregivers and healthcare professionals too! In the case of the lady with PPA, she wasn’t able to voice their likes and dislikes and what she needs. I remember when my grandma went into a dementia care facility 2 years ago, my mother filled out a very long questionnaire about all my grandma’s likes, dislikes, habits, patterns, and daily routines down to the small details. I LOVED hearing this! I know she adapted so much more quickly because of the detailed and personalized care they gave her. Even if this kind of care isn’t required or given at a facility a loved one is in, I would encourage family members or friends to do it anyway! It can’t hurt to leave notes about what they need, like and dislike. Who knows, the patients daughter was able to give a key word or phrase to the PT that would make her mother take a few steps, then it is worth it!

It was very interesting reading about Primary Progressive Aphasia on the Mayo Clinic’s website…I’ve put the link to the website in the title of my post if you want to read more detail about this form of dementia.

Memory Life Books

This past week at FW I observed an OT therapy session with a low functioning client. The therapist was trying to connect with the client. However, the therapist was having a very difficult time engaging the client very well no matter what she tried. The therapist played some calming music but it was not music familiar to the client. Also the client was shouting a man's name, but the client could not communicate who the man was and the therapist did not know either.

This lead me to think about our assignment to make a "Life Book". I think a book of the client's life and favorite song might have helped the therapist make a better connection to the client. In the very least, the therapist would have known who the man was in the client's life.

Life Books are therapeutic for the client, but also provide a way for caregivers to connect with the clients. The University of Michigan did a research study on creating families creating memory books with family members experiencing chronic, life limiting illnesses. The study confirmed that clients with memory books were less stressed at the end of their life than clients that did not have memory books. Click on the title for the link to the study for more information.

The elderly in jail

I was watching the news the other night and saw a story about an older man who couldn't afford his health bills so he went to a bank, stole $1 and then waited for the cops to get there to arrest him. His reasoning was if he was in jail then he could get the health care he needed because the jail is obligated to take care of him while he was there and robbing the bank, even though it was for only 1 dollar would keep him there for a while.

This got me thinking, what exactly does the jail do with the elderly inmates? When they are there for a life sentence, what happens when they develop dementia, or Alzheimer's? Are the jails equipped to take care of them? Do they keep them there? Do the prisoners even know what they are there for anymore? Do they understand that they are being punished?

I found an article about the elderly that are in jail and they presented some good points. The elderly inmates cost 3x more than a younger inmate. They get all of the health care that they need, paid for by the local tax payers. Some jails have added hospital type units to the jail that can take care of long term inmates with chronic illnesses. Some provide transportation to doctor appointments. Others hire a physician that will come to the jail and see the elderly inmates.

But with the elderly with dementia or Alzheimer's, is it fair to keep them in jail? If they are confused and disorientated, why keep them there? If they don't realize that they are there for punishment anymore, it's time to move them on. Either send them home to family or take them to a facility that is trained to take care of them. The jail is not the right place.

The article also states that the elderly population in the jail system has double between 1995 and 2003. Now that the baby boomer generation is reaching the elderly point, are there going to be more like the man on the news that don't have enough money for health care so they do stupid stuff to get put in prison for health care?

Stan and Denise

In class this week the topic of Alzheimer's Disease came up. The discussion took me back to my past experience working at a SNF and the people I encountered on the Alzheimer's Unit. I don't think you can get a real understanding or perception of how this disease affects people unless you have either a relative/friend with the disease or have worked with the people. Of all the people living in the SNF, I remember most of the Alzheimer's clients the most. Something special stands out for me and I can't quite put my finger on what it is. Maybe it's the smiles of these people. There are so many different kinds of smiles. I see now that the smiles can be a from habit of normal social interactions, pure happiness, or just a simple reaction. The loss in their eyes is unforgettable. Sometimes I can remember having conversations with them that felt so real and special only to find out from family members that the stories were made up or false. The family members also touch my heart. I can only imagine how one might feel to witness their mother or father turn into a completely different person, slowly losing their brain and memories. I found this very interesting video on-line. Please take the time watch it. It is brief and tells the story of Denise and Stan. Denise takes care of her husband Stan who is in the late stages of Alzheimer's. She says some things that really stands out for me. For example, she says well we are lucky because Stan in pretty healthy right now. You can see from the video that Stan in not mobile, he has lost his ability to speak, and all his food must be in liquid form, yet she says they are "lucky". She also mentions that almost over night he lost his ability to speak and walk after a fall. He basically forgot how to walk. I never thought about how it might be if these things seem to happen over night. You can see her love for her husband, but I can't help wonder how hard this must be on her, the wife. The husband is blessed in a way because he no longer has a memory. He is not really aware of what is happening, or is there somewhere in his soul or heart that understand what is happening. I can only pray the answer is no. I feel stronger than ever to help support finding a cure to Alzheimer's Disease. Hope you all enjoy the video.

Older drivers+road constuction=confusion

There is a lot of road work going on around where I live. I'm not sure why they wait until the summer to do ALL of the needed road work but it is what it is. I pass through 2 sections of road work on my way to FW, my pool and my child's favorite park. Road work always gives me a little bit of road rage just b/c I'm really inpatient and usually just trying to get to where ever I need to be ASAP. I get even more frustrated when the car in front of me doesn't go when the man changes the sign from "STOP" to "SLOW," pull up next to him to ask him questions or don't understand that the light may be red but the man with the sign is waving to you to come on so it is ok to put your foot on the accelerator. Well today I was on my way to the pool and I came up to the roadwork b/c I forgot to go around it. Anyways, there is a car in front of me with an older driver. I knew this one b/c she had the old lady helmet hair, she had a box of Kleenex in the back of her car up by the back window and I could see her reflection in her side mirror. When we got to the man with the sign he was standing in the middle of the intersection pointing that you had to go left or go right. Obviously this woman needed to go straight b/c she kept creeping towards this man like she thought if maybe she got close enough to him he would move. Well, he didn't. So then she starts honking and I'm thinking in my head (and partially out loud) "will one of the men that are sitting on the curb smoking please go tell this woman that she can't go straight?" Does anyone tell her? nope. The man just keeps pointing. I swear I sat behind this woman for 5 min before she finally just went left. This isn't the first time I've had this issue, not only with older drivers though. I found statics on the CDC website on older drivers who tend to avoid driving under specific conditions. I'm not sure what road construction would fall under, possibility heavy traffic. Personally, I would make it, it's own but I guess it is hard to avoid road work because sometimes it just pops out of nowhere!

You say the early bird get the worm?..Well I say the night owl gets fun times & a night cap!

During FW today I heard a staff member say that a dilemma of the facility was providing fun & new activities for the residents to do, especially the ones that stay up past dusk! The staff member made a good point when she said not every person is in the bed by 7pm. Night time activities are not really scheduled because when most people think of activities they think of daytime stuff, but I bet some of the residents would not mind a little night time action going on!! Maybe even happy hour a couple nights a week?! I read a very informative & interesting article about a nursing facility in Missouri that has lots of activities (that are not the norm...they refer to BINGO as the "B word") for their residents to do. Today there was a live band at the FW site and the lady I was working with said she enjoyed it very much. She was smiling when I entered the room and the first thing she spoke about (which was the first of many) was how she enjoyed the band. She said they were good enough to play in Vegas! I think she is one that would enjoy happy hour. Today, Audra and I noticed the residents were pumped (thanks to nothing but a little morning java probably...get a little "juice" in them and that place will be comedy central!!) so I think they can handle a little weekly excitement. I felt really bad when I heard that they were lacking in the activities in the evening department, but after reading this article I think there is hope. Let me know what you all think. http://www.columbiamissourian.com/stories/2008/06/20/adult-entertainment-nursing-homes-undergo-makeover/

Just In Case You Don't Know About Kyphoplasty

Even though my session did not go as planned, it was so refreshing to work with a client who wanted to get better. I went from one end of the continuum to the other. First, I had a client who didn't want to do anything, and now I have a client who wants to independently do everything. I wasn't expecting a client so independent because there is a woman in my neighborhood who had kyphoplasty surgery 2 months ago and is still wearing a brace. I'm starting to thing she just wants some sympathy! I didn't know much about this type of surgery so, of course, I looked it up, and I hope the chart provides some insight into the procedure.

The website I provided is very informative concerning the rehabilitation techniques and adaptive equipment used, but what's extremely sad and frustrating is how small the section concerning OT and recreation therapy is. As usual, PT steals the limelight! If you click on the Next Section in the bottom right corner, there's lots of great information. one important factor to remember is that usually these clients have comorbid medical issues and the bed rest needed to heal from the kyphoplasty can worsen those conditions.

After reading the article and finding out that kyphosis is caused from osteoporosis, I made sure to go get some more vitamins! I had been putting it off because I only like the ones at Whole Foods but I most certainly don't want to have a compression fx one day just because I didn't feel like driving a few extra miles to get my calcium.