accountablity

The new social worker called me today to set up a "care" meeting for my brother.  I took the opportunity to voice my concern that it shouldn't have been me to note that my brother had put on 15 pounds in 3 weeks.  Also, I told her that he had experienced plummeting blood pressure before and that they needed to keep an eye on it.  I let her know that I thought there was a problem  with accountability, that everyone replies that some kind of incident doesn't happen on their shift, therefore they are not accountable.  I mentioned that all his clothes are missing for a second time, and that I had to hound them to shave him, but that seemed to be fixed for the time being.  And I mentioned the need to remember to clean his hearing.

I told her these were items I wanted to put on the agenda to discuss.  She is knew on the job.  I think she was taken aback, and was a little distant.  I think at these meetings you are supposed to be compliant and that they hold them just to satisfy some kind of regulation.

so far so good

I went to visit my brother tonight with some trepidation.  I wasn't sure what I was going to find, although I think I mentioned in my last blog that his blood pressure seemed to be coming down, which was good.  Well, he was ok today.  He wasn't great.  He looked a little raggedy.  He was able to walk very briskly with his walker, but seemed to be having a hard time getting up from a sitting position.  His blood pressure was pretty good, 128/70 or so.  I guess I am going to wait and see what happens to his blood pressure  as he starts losing more fluid.

He mentioned that his girlfriend, Veronica, had to spend a few nights in the hospital for "arthritis".  I wonder what is going on there, I hope he has some time with her, it seems to be so happy about having a girlfriend.

still worried

I am spending many moments a day wondering how my brother is doing. If I call him, he is just going to say "fine".  Pinning down the nurses is about the same.

just trying to stay on top of my brothers care

I called the director of nursing today to make sure she was on top of my brother's medical condition.  Of course, she didn't answer the phone.  I got a wierd voice mail of what I think is the company she works for.  I called back the nursing home to make sure they had transferred me to the right number and they assured me they did.  I left her a message, telling her that they had doubled the amount of Lasex (sp?) and that I was concerned that my brother's blood pressure could drop precipitously, which it has done before.  I asked her to call me back, and she has yet to do so.  Neither has the patient advocate.

Then I called his nurse on his floor.  His blood pressure isn't too bad, in the 140s, something like that.  But when he was living on his own, it rarely got above 120/80.  My brother had told me earlier in the week his blood pressure (before the medication was changed) was in the 170s. That's so high, I didn't know whether I should believe him or not because he does get this kind of thing messed up.  But maybe he was right.  It makes me so angry that I'm the one that has to alert the staff that he was putting on fluid. 

I hate to take up the nurses' time, I know they work so hard, but if I don't look out for him, no one will.

a little bit of action today

My brother finally saw a doctor today.  My brother took some blood tests and the doctor ordered a chest xray.  When I was on the phone with the nurse trying to find out what happened, I found out that the doctor order weekly weighings.  This b others me, I am pretty sure he ordered daily weigh-ins earlier in my brother's stay, I am pretty sure they have been very haphazard in weighing him.  I also asked the nurse to make sure that they shaved him.  She started asking, what, were they supposed to shave off his moustache.  I told her that his previous CNA had been pretty good about keeping him relatively well shaved and since she was assigned to do something else, the only time he got a shave was when I came to visit and requested it.  She told me she would write into his orders for a daily shave.  I will believe it when I see it.

 I went out tonight to visit my brother.  He was pretty chipper.  He was sitting at a table eating dinner with his girlfriend, who was more alert than usual.  They were pretty cute, they looked quite comfortable with each other.  I talked her with her a bit for the first time.  She didn't know I was my brother's sister.  She told me she had just come back from the hospital because her legs hurt.  After discussing this with my brother later, it wasn't clear to me when she had gone to the hospital, whether this was an old memory or not.  When I got there my brother immediately wanted to get up from the dinner table and go to one of the sitting rooms and he didn't want Veronica, his girlfriend, to join us.

Later, I asked him why.  He said it was because "she is here all day, I am here all day, I don't get to have quality time with you, it's precious to me."  Sometimes, he sounds just like a regular person and I treasure those moments.

He sounded pretty good.  But later in our visit he started a really nasty cough.  When I got home, I had a message from the doctor on my answering machine from the morning, suggesting that I call him.  Since he hasn't done that in the past, I am a little worried.

concern

I'm concerned today.  The doctor never showed up to see my brother, even though he told the nurse on Sunday he would.  I anticipated something like this because I can never get a straight story about when he is going to show up.  So this morning, I spoke to my brother's nurse.  She knew nothing about my brother's weight, she had only two weights for the last two months.  I told her that it was in the doctors orders that he was supposed to be weighed daily, and I got a song and dance about how she wasn't there yesterday.  Nobody there every wants to be held accountable for anything.  The nurse said she would tell her supervisor what was going on, and that she couldn't order the doctor to come, it was up to him.

I called back in the later afternoon and of course no one had seen him.  The doctor is not supposedly coming tomorrow.  They did weigh him again and it sounded like he had gained around 13 pounds in the last few weeks.    I left a voice mail for the patient advocate.  Of course this was one of her days off.  It really ticks me off that I have to work at this to get him the proper medical care.  I am very concerned that if they don't deal with this condition soon, it is going to get into a crisis with him in the hospital, or worse.  I plan on driving out to the nursing home tomorrow evening to see how he is and get him some attention.  The problem is by the time I will get there, a lot of the people will have gone home.  I will also try and do this by phone during the day.

And this is one of the better nursing homes he has stayed at.  It is very discouraging.

Bloating

When I took out my brother this morning for breakfast, on the way out he asked our favorite nurse, Stephanie, to button his pants.  She made a remark that he was putting on weight, so I mentioned that I thought he looked a little bloated and voiced my concern that his congestive heart failure might be acting up.  She mentioned she had been working 2 16 hour shifts (she doesn't get along with the new nursing director), and that she wouldn't be around during the week to follow up.  Actually, she wasn't even his nurse today anyhow.  So we left for breakfast.  I noticed he had a gurgle in his throat and was breathing somewhat heavily, so when we got back, I started looking through his chart to see what his weight was.  I couldn't find it, it turns out it gets entered into the computer, not his "book", and they hadn't done it for several days.  One of the CNTs overheard us (another better one who has been taken off of helping my brother to "walk" patients (she doesn't like doing that), who weighed him.  It turns out e has gained about 15 lbs in about 2-3 weeks!  When Stephanie found out she called the doctor who comes into the nursing home.  He told her he would see my brother tomorrow morning, but that he had just seen him 2-3 days ago and that he had appeared fine.

This does not give me confidence in the medical care at the home, to say the least.  If I can tell there's something wrong just by looking at him. why can't the medical staff who works there?  I had a strong feeling that the doctor was just covering himself.  My expectations of the nursing staff is somewhat low; for the last 2 weeks, they have stopped shaving him unless I make a fuss.  Some of this is from the frequent turn over in staff, I expect it to just get worse because of the crisis in public aid in our State and the lack of timely payments to the nursing homes.

Meanwhile, Stephanie mentioned to me that she thinks the new girlfriend is not good for my brother.  She says she berates him because he doesn't pay enough attention to him.  She thinks the beratement makes my brother depressed.  Apparently the girlfriend is often quite depressed.  So the nurse separated them for the evening Saturday night, and she said my brother was singing and laughing with other patients.

When I asked my brother if the girlfriend was making him depressed, he started laughing.  He said the nurses have nothing else to talk about!  So I am thinking about all this and trying to take it in.  I will call the head  nurse in the morning and request again that my brother see a doctor.  The way things work at the home, it's my guess he won't see anyone for several days.

bloated?

I went to see my brother last night, because I knew I had physical therapy for myself late this afternoon and that I wouldn't get out to see him in time.  It turns out that the nursing home starts shutting down for the night after around 7 pm.   So, I went.  My brother was ok, not real energetic and with a phelgmy cough.  Plus I think he may be putting on water again.  They hadn't shaved him for several days, so I stopped by the head nurses office and asked to have him shaved.

Since I moved, I have to drive to the train station and park in a garage.  I left for the nursing home as soon as I got off the train, so I was able to cut down on my driving time by about 15 minutes.  It still took me half an hour, but that's better.  I got home about 7:00 pm, which still gave me some time for the rest of my family, which was good.

the girlfriend

Well, I would have never believed it, but my brother has a genuine girlfriend, the first time in his life.  Granted. she is pretty deranged.  She is 74, he is almost 63.  Actually, she is probably the person in the nursing home who is in the best shape, it's just that her mind is gone.  I hear that they kiss, hold hands, and he puts his arm around her when they watch tv.  And that he goes into her room to watch tv, too.  When I took him out for breakfast this Sunday, she scowled at me when I came back, I think she is jealous!

He is really happy and I am so happy for him.  I sit and think about how hard I worked for several years to keep him out of a nursing home so he could be independent, but he really is so much happier now. He told me he has always wanted a woman to be interested in him and now he has it!!