If the Shoe Fits........

An 84 year old client of mine live in an assisted living facility. She has dementia, but is in many ways alert. She is physically healthy, and can be quite active, with the restlessness that people with dementia often have.

Her family bought her some new running shoes. She wouldn't wear them. The facility tried, but said she just takes them off. The family is upset when they came in to see her and she isn't wearing them.

When I went to see her last week, I looked at her footwear. Again, her slippers. The ankles are wobbly, and she could fall.

I asked her why she wasn't wearing her new running shoes.

"Because they're too tight," She told me.

I have done many things in my life, but I have never been a shoe salesman. Nonetheless, I went with her to her room, and asked if I could see how they fit. She sat on the bed, and I put on her shoes, and did up the laces.

I pressed down, the way shoe salespeople do, on the front of the shoe, to see where her toe came to.

Guess what? The shoe didn't fit.

Now, I don't know how she ended up with those shoes exactly. But I know that anyone in the facility, when putting them on, along the way, could have asked her about them., if they couldn't figure it out when putting them on her.

This is one of the reasons you might hire a Geriatric Care Manager.

Or a shoe salesman.

On the Use of Medications I

The other day I was at an assisted living/ licensed nursing facility with some clients, a couple in their nineties. It is a high end facility that prides itself on its care and approaches.

My clients had just had an assessment done through the health department. Neither of them really understood it, but the wife was quite upset. She kep asking over and over what it had been about. Her husband, patiently continued to try to explain to her.

She would ask the same question; he would give the same answer. This stresses out most caregivers; for one who is also impaired, it is even worse. He has never hit her, but he has lost his temper with her.

So I went to the nursing station and explained what had happened, and what the present situation was. I asked if they could monitor them, meaning go in from time to time. In her care conferrence we had discussed getting him out of there when he needs a break.

The response was, "I think we will give her something." This meant they would give her some of the medication that is ordered for her, to be given at the facility's disgression when she is agitated.

I thought to myself, "You people have a choice, you can intervene with a relationship and personal intervention, or you can intervene with medication. You are making the wrong choice here."

It was a very telling moment for how they deal with their clients.

Tracking Your Loved One in Care

A client of mine broke a hip about six weeks ago, and was in hospital for several weeks. On discharge, I talked to the hospital team, and arranged for him to go to the hospital out patient clinic for rehab on a weekly basis. I told the facility where he lives that that would be happening.

After he had been back a week or so, I got wind of his having had a visit from a physiotherapist. Then I heard about it again. When I confronted the manager of the home, she confirmed that he had been getting physio from the private person who comes into their building. I asked her who had authorized that. She didn't know. She told me she would ask the nurse. Then she started telling me that there were too many people involved in making decisions for this person.

Aas far as I can tell there are three people making decisions: a stepdaughter, myself, and the bank/trustee. The daughter has told them numerous times to call me. I have told them to do the same, or at least call the trustee.

So we will get this straightened out. This was not a money grab by the facility, I think they just kind of forgot about it. But again, it just shows that you need to monitor what is going on if your loved one is cognitively impaired or otherwise fragile. This gentleman is in an assisted living/licensed care facility. But it can be any kind, public or private.

The second thing this illustrates is that facilities need to know very clearly who is the decision maker, and they need to learn to develop communication lines that reflect that. Often, with a geriatric care manager, especially in Canada, this is more difficult because they are not used to dealing with us. It is a new role for them, and it takes time for them to become comfortable with it.

Important Ratios

It seems to me that, in Eldercare, there are certain ratios which are important. And a couple that are completetly meaningless, but interesting.

Important Ratio:

People ask about choosing care facilities, how do you know which Seniors Housing is good, what do you have to do to get good care,etc. Besides reading my book (Nurisng Homes: The Family's Journey --www.nursinghomesbook.com), one thing has stood out for me.

The greater the dementia, the more monitoring the family needs to do.

Simply, the less people can speak for themselves, makes problems known, etc., the more their caregivers are going to have to be watching out for them.


Important Ratio:

I often see in guides to nursing homes say that, when you are figuring out which is good and which isn't, you need to ask about the ratio of staff to resident. I think that is true, but--

You need to ask
--the number of nurses to residents
--the number of care aides to residents

But as important, it seems to me, and this is not what is highlighted, you need to ask about the number of recreation staff to residents. If you don't have a good ratio, and a home is not guided on principles of all staff doing many roles ( for instance care aides also being recreation workers), then the amount of stimulation available is going to be impacted.

Unimportant Ratio:

Weight to Age

Often I will hear in a care conference that a person is a certain age, and a certain weight. It seems to me that when their weight goes lower than their age, we're in trouble. Like, if you are 90 years old , but only weigh 88 pounds, that doesn't seem good. 85 years old, but weight 80 pounds, even worse.

Totally unscientific. Not useful for measuring anything valid. But still something to think about, if you have nothing better to do today.