Archive for December 21st, 2009|Daily archive page

Care conference 2

I met last Wednesday with a nurse, the social worker and the chief dietitian at the Alz center for my second care conference about Mom. These will be quarterly for as long as Mom lives there, as I understand it. I just appreciate the chance to hear reports about Mom from people who see her every day. And I also see it as yet another brief therapeutic activity – a chance to bounce some thoughts off of staff to see if my head is in the right place about what I think and feel concerning Mom.

The activities director couldn’t be there, but she left behind a report saying that Mom participates quite a bit in activities and can self-initiate during the activities rather than requiring coaching from staff the whole time. In fact, she can still get a little grumpy when someone tells her what to do. The dietitian reported that Mom has gained about five pounds in the last quarter. Mom has a great appetite and typically finishes her meals. Sometimes, she plays a little with her food. She sometimes can cut meat herself, but sometimes asks for help. I told the staff members that I always cut her meat if I am there when her food arrives. And I wondered if that would somehow lead to more helplessness on Mom’s part. But that’s not really how Alzheimer’s works, necessarily. She won’t remember that I cut her meat recently. So if she needs help some days but not others, that is just part of the disease process.

The nurse said Mom seems to be a patient whose disease fluctuates. She has good days and bad – not so much in terms of mood, but in how much she is impaired by the illness. Her mood generally is good. In fact, the medical staff weaned Mom off of Wellbutrin, one of two antidepressants she was taking. She had been taking that mood cocktail for at least five years. The nurse said Mom had no ill effects from the gradual omission of the drug. I was pleased to hear this. I told them that my main concern is that Mom maintain a decent mood. Now, if her mood slips, we can add that medication back in. But if she doesn’t need it – well, something about that just makes me feel good.

The social worker, a new staff member, said she still didn’t know much about Mom, but definitely recognized her by her Crocs. Mom has been wearing the blue ones lately, but she apparently does emerge from her room on some days with one blue and one pink Croc, and she will not change them to make a matching pair. This reminded me that I had been wondering about how Mom gets dressed each day. She apparently still likes to pick out her own clothes. She probably needs help getting into them. She might reject an outfit picked out by a staff member. And I asked if there was any laundry confusion left over, because there were some clothes in a box on the floor of her closet. That box had held disposable underwear at one point and I wondered if aides were mistaking it for a hamper. But the nurse said there’s a good chance it is Mom who is tossing clothes into the box. Why, I wonder, hadn’t I considered that possibility? At any rate, I said I had rearranged some of the shirts in Mom’s closet so they were front and center. Mom has some nice clothes, I said, and there is no reason she shouldn’t wear them. Unless she doesn’t want to, of course…

Mom apparently is in a group that some staff members call the “clucking chickens.” They are ladies who sit together in the program area and occasionally make comments about others. They can be a little catty in their remarks. Only staff members really hear what they say, or understand at whom the remarks are directed. I don’t know how much Mom participates in the clucking. She does occasionally make observations about others to me, but they aren’t usually mean-spirited. The nurse also said Mom likes to be helpful to other residents. And on this day, in fact, during our conference, Mom was keeping residents organized during a visit from an eye doctor, the nurse said. Mom might be a little bit bossy sometimes, but the residents respond to her instruction. I think this is interesting. I think the old Mom would have been more inclined to just keep to herself under similar circumstances. Or might have disliked being told what to do. Maybe this is a defense mechanism – a way to be the boss rather than to be told what to do. After the conference I was going to go back to the program area and observe this behavior in action, but I thought I might just mess up the flow. And I had to go back to work. So I turned around midstream and left the building instead.

During the conference, though, I also asked about how families tend to handle Christmas. The staff members said families do what works best for them, and that could be just about anything. “Every day is Christmas,” the nurse said. So if I don’t see Mom on Christmas day, it’s really OK. She won’t know the difference or feel abandoned by me. When I brought Mom to my house last year to open gifts on Christmas morning, she seemed confused. She didn’t take her coat off. The decorations didn’t seem meaningful to her. Frankly, it bummed me out. So I am thinking of taking gifts to Mom at the Alz center and then taking her out to lunch. Or maybe dinner, depending on what day I do it – but it won’t be Christmas day. Patrick and I will be visiting his family that day. I asked if taking gifts to the center would make other residents jealous. “They don’t have those feelings anymore,” the dietitian noted. I asked if staff members think family members who don’t see residents on Christmas are terrible. They don’t give off that sort of vibe, but I am insecure that way, unfortunately. “We don’t judge anyone,” the nurse said. And I believe her.

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