6 November 2024
This afternoon I met with Deb the Rehab Coordinator, Joseph the Nutritionist and Aaron the Nurse to discuss Joyce's care at Golden Heights.
Deb said that whenever a physical or occupational therapist has gone in to work with Joyce, she has been uncooperative. Deb told her if she continues to refuse to work with them, they will cease her care there.
That didn't bother Joyce. She told them she'd just go home and I'd take care of her. Not an option, I told Deb, who agreed she'd need 24-hour nursing.
I mentioned she had been sitting on the side of the bed and transferring to a chair at the hospital but there was no walker or chair in the room. Deb said they have to see her transition to the side of the bed before assigning equipment.
So I arranged an appointment for Friday's session at which I'll be present to encourage her to get out of bed.
I asked what occupational therapy tasks she had refused to do. Basic things, Deb said like hand exercises, brushing her teeth and combing her hair. And some mobility exercises like sitting up.
Next, Joseph discussed her nutrition issues. We'd actually met when he came into Joyce's room before the meeting. I had just gotten her a Boost. I told him I was giving her one when I saw she didn't eat her meal.x
She isn't eating, he confirmed. He offered to bring her six a day but she cut it back to three. Which isn't enough protein but better than my occasional approach.
I told him she complains that everything tastes bad but she says that about everything. I wondered if it might be caused by the Zoloft. Aron said he ask the doctor about it. She's been on it long enough, though, that it shouldn't bother her.
At the meeting, Joseph said he could also give her a special protein syrup once a day.
He encouraged me to bring her favorite foods in. I told him even they "make me gag," as she put it. I did wonder why she was restricted to small bites of soft foods. They thought it was something recommended by the hospital. I thought it might have something to do with her arthritis and handling cutlery.
Aaron discussed her medications. They're giving her two doses of Tylenol depending on her pain level but the Tramadol prescribed three times a day at the hospital has been on demand only. So I suggested we return to three times a day and give her Tylenol half an hour before physical therapy.
They're giving her a multivitamin and vitamin B as well, which they had discontinued at the hospital. I wondered if she needed it because she had scored normal levels at Kaiser. She had a blood test yesterday, which didn't look at that buy showed everything was normal.
At night she gets Zoloft and Remeron.
We also discussed wound care. I described the dressing and why we do what we do. They have two wound care nurses who cover for each other. I met and coached Yanne but I haven't talked to Benita. Aaron said they share notes.
I offered to answer any questions and bring another wide Ace bandage if they don't have any. They used the one I brought but discarded the one they took off.
I asked who arranges transport to Kaiser for her debridement appointment next week. Kaiser usually handles that, Aaron said.
After the meeting, I went back to the room to tell Joyce she can't go home until she can get out of bed and walk. If she keeps refusing to work with the therapists, they'll stop treatment but she can't come home. I told her I'd be there tomorrow to help them work with her.
But then it was time for me to catch the shuttle.
As I walked down the street, Christina called. "Where are you?" She offered me a ride home.
I told her on the way that I was planning to call her about a ride there tomorrow to make the 1 p.m. session. She promised to do that too. I'd tried to take SamTrans out of the city to Daly City today but got the wrong bus and had to walk halfway there. So I haven't figured out how to go south yet.