Monday, October 6, 2008

Planning Ahead

I was encouraged last night but when I woke up this morning...all the concerns about my mother hit me like a ton of bricks. I was so happy to see her sitting up in bed and doing all the things she can for herself that I was hoping it meant she'd get out of bed soon. But the reality is that she is still weak. I really am floored that this happened like this. I guess that's life...especially in the elderly population. Truth is... anything can happen to anyone at anytime. Ii knew she was slowing down, but I guess because of the good physical and labs... it takes me by surprise.

And I am just sad about all of this... and wasted time between us. I so much want her to come home and I think she understands that she does have to let us, especially me assist her.

I spoke with the social worker today who informed me that Mom had her PT this morning. She is unable to sit up without assistance ...nor can she transition from the bed to a chair. She tired easily.

I was encouraged though that she is able to ring the bell for assistance and is mentally alert.

The social worker did bring up rehab to build her strength. She asked my mother how the rehab went for her and she deferred to the PT therapist for the answer. Hmmm.

I stated that I will not even mention rehab because if it comes out of my mouth it will be jaded for her. She thinks Dr is God and so they should not let her know she can refuse (and really-given her physical condition she can't) and should approach it with her as a way to facilitate healing so she can come back home. When she brings it up to me...I will assure her we are loving and caring for her cats... which I do anyway. Also I will faithfully go over to see her. I will mix my visits up for different times of the day so staff never knows when I am showing up. I have heard that if there is a possibility of patient neglect...it helps for family to keep an alternate visiting schedule so they can't assume they show up 2pm everyday and so have things ship shape at that time.

Then the decision was where? She gave me 3...which I think are the top 3 but then her doc only has privileges at place #4. One place has a brand new wing and is close to another hospital. I think the sub-acute place he has privileges at is alright but if she needs long term care...I have not heard good things.

So She gave me the obligatory 3 recommendations and said they place patients in all of them including #4. She said there is a waiting list for longterm care facilities but not #4. Of course what does that say?

If indeed she is only there for 3 weeks and can come home after that...then I would rather she have the continuity of care with her doctor that she trusts and knows. He also knows her very well and if anything has to be tweaked with her meds or whatever... he knows her the best... for maybe 15 years... or so..not sure. Also, if she had to be readmitted into the hospital...she would be transported back and he would be her physician.

I think it is key to have continuity of care, particularly when the physician is familiar with the patient and knows how to work things both physically and psychologically... and I think it is an emotional safetynet for the patient as well as physical. It's bad enough when all these new and often unpleasant situations are thrust at a patient and I think the continuity can have a calming effect and be a catylist for a sense of security in a difficult situation. Physicians may not be family... but in some ways they can know more about the patient then family and what they as a patient need at that time. Hopefully the physcician and family are coordinating their efforts and that is what I am trying to do now. I do appreciate that he listened too me a couple of weeks ago and that he listened last night. In the end...of course he knows what is best for her... but at least I know he took what I said to heart.

So... what would you do? Would you try to keep continuity of care with the physician who knows all about her and she very much likes... or go for the better facility? And are they really better? I don't know.

I am praying she can come home again. I shouldn't project ahead negatively...but it is difficult not to because I have to plan too. It all breaks my heart. And I have to try to not let emotion cloud my knowledge of what is best for her.

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