Forward, ho!

Ok, you all now know that I am an optimist. But today as I leave BridgePark, I am again hopeful that progress can be made.

Today, I met with the Certified Nursing Assistant, Rolina “Ro” Fleurina, who will be helping Alison M/W/F/Sa from 1-5pm.
• Ro is mid 20’s, is very pleasant, and speaks very good English
• Ro does what Alsion asks plus has her hands on Alison, frequently massaging limbs or holding hands.
• Ro is very attentive to Alison's needs but also sets limits.
• I told Alsion HOW lucky she was to have Ro and how much I liked Ro.
I gave Ro Alison’s family info and then the July forward (and previous) medical, cognitive, and physical history. We shared the ups and downs of the last year so she could get a sense for the “water marks”. I also shared Alison’s personality, use of drugs, and tendency to avoid hard work. All is understood.

Ro started last week and, after two visits, Alison is beginning to move all her limbs. Only a bit but it is a start! I do not think I have since any controlled movement of three of the limbs since December. We tested Alison's physical control. She is now able to slowly raise her right hand, slowly blow her nose, slowly wipe her mouth, and hold a spoon on her own. She can now raise her left arm a foot off the bed as well as her right and left legs. She is strong enough to push her legs downward against hands held against the bottoms of her feet (the first step in learning how to pivot off a bed into a chair). I have also asked Laxshmi from PT come up on Wednesday or Friday to train Rolina on range of motion massage and movement so we can loosen her joints and muscles. With more progress, we can ask PT to re-evaluate when to restart physical, occupational and speech therapy.

We also went over how to feed Alison (sitting up, 1/2 spoonfuls, double reminders to swallow, honey consistency, NO unthickened water, NO straw). I showed her how to get ginger ale/condiments/butter from the facility’s basement kitchen, the bisque/cheese spreads/yogurts from the nurses’ frig, thickener/ice from the nurses desk, and S&P/cups/spoons from the drawer. We talked about Alison’s pleasure foods. The nursing staff reminded us to when possible have Alison serve herself using a spoon. Alison then fed herself both mashed potatoes and spreadable cheese – slowly and with difficulty and some tears, but she did it!! Ro did a great job assisting Alison with parts of the process, without doing it for her. But Ro is going to feed her soup and thickened drinks for the time being...

In front of Alison, I asked Ro to get Alison in the Geri chair each day for 3-4 hours during each visit. This of course made Alison cry. She petulantly then told me she did not love me and to go away. When asked why, Alison said she was scared she would be in pain or be left in the chair. We then talked to Alison:
• The chair is NOT punishment but pleasure, as a way to get out of her room!!
• Alison needs to spend time in the chair to get stronger
• While we are there to help Alison, Alison needs to take more responsibility to get herself strong
• Ro reminded Alison that, during the last time in the chair, Alison had never gotten into pain because Ro had listen to Alison’s needs and kept adjusting her position in the chair.
Ro and I discussed putting a pillow under Alsion's butt on the chair seat as well as asking for a Tylenol before starting a session in the chair.

Alison just got a piece of mail from Joann and Ted! It's another card about dogs.

REENIE - It may be time to directly call Yolanda who runs nursing. I am still concerned with the BridgePark's consistency of care and communications.
• The staff has been putting Alison in a normal wheelchair (as seen by Ro on Fri and Sat) counter to instructions from PT that she be put in a Geri chair. I told Nursing and then asked PT to have Laxshmi follow up with nursing to get this corrected. This is the second time as I had to do this last visit as well.
• Does the facility have enough Geri chairs? When we asked today for a Geri chair for Alison, they said that all the shared Geri chairs were “being cleaned on the first floor”. BUT PT told me each floor had their own chairs and knew for example that the two Geri chairs on the second floor were broken. And that the chairs were seldom/never cleaned….
• I think that there is still a problem with 4th floor staff not feeding Alison regularly. As I do not yet trust the regularity of any of the stomach peg or pleasure feeding, can we get nursing to tell us the program.
- When I arrived, Alison’s lunch had not been delivered although everyone else was already eating and they were picking up trays. I had to ask to get Alison’s tray delivered off the rolling container on the floor.
- While I was talking to the 4th floor staff, they and I learned that Speech Therapy has stopped. The staff on the 4th floor was surprised that Speech as part of their mid-day treatment was not longer feeding Alison her pleasure lunch.
- Separately, staff had planned to give Alison a peg feeding at 2pm but postponed it since Ro and I were there.
• I have not yet gotten a clear idea if Alison is still crying out at night. I do find out that they give her an evening dose of anti-anxiety meds. Alison’s roommate said it had been quiet at night (but she was sleeping) but Alison said she was still crying out. I asked Alison why she cries out and she said it was either because of pain or that the room was too hot. I have asked the nursing staff to share instructions with night staff to always offer Alison the option of pain meds at 9 o'clock when they give her evening meds. As well they'll see if they can get her roommate to not turn the heat on high. Can we share this with Yolanda too?