General Update #61

Libby from Aspen Park, who oversees discharge planning at the facility, contacted Dusty before noon to follow up about Joyce. She and the care giving team had their conference about Joyce today. 

Libby wanted to verify with Dusty about what kind of durable medical equipment/supplies that Joyce might need at her home for assistance in returning to her daily life. Dusty confirmed that Joyce has a wheelchair, walker, blood glucose meter, oxygen concentrator and lines. Libby said that Joyce confirmed she had a wheelchair at home but that she might want to look at getting a newer one. Libby said that if Joyce has not purchased any medical equipment using her Meidcare benefits within the last 5 years then Medicare would cover the cost of a new wheelchair (Aspen Park therapists and Joyce's primary care physician, Dr. Deborah Collins would provide the necessary documentation). 

Libby interviewed Joyce about her home situation. Joyce reported that she lives and moves about on the primary floor of her residence and would not be going to the upper or lower levels without family assistance or supervision anymore. Joyce told Libby that there was only "one step" up into the main floor of her house and so there should not be too much difficulty in gaining entry to her house when she is cleared to return home following discharge from the Aspen Park facility. Libby asked Joyce if a ramp would be needed to clear that "one step" and Joyce stated she did not think so.

Libby asked Joyce what her expectations were on the timeline for her return to her home and Joyce expressed that her desire to return home was urgent. Joyce acknowledged that her pain management and  recovery of strength needed to occur before this could happen and has been repeatedly stating she will do what it takes to get home again. At this point there is no goal date set for Joyce to return home but Libby will keep Dusty updated via email at least once per week, 

Libby confirmed that Joyce is doing well, aside from pain from injuries related to the fall down the stairs, had walked with PT yesterday and did very well, and is currently set to have occupational therapy twice per day. Occupational therapy covers how to get dressed by herself, use the bathroom, and get through the daily movements needed for return to independent life at home.

Joyce is quite independent in getting up and getting to bathroom by herself, however she experiences quite a bit of pain when attempting to rise from her chair or the toilet. For this reason the staff believes that it is still good to have someone accompany her for safety. Dusty confirmed that Joyce has a powered recliner at home which can raise her up to a near standing position. Libby was impressed with this and glad to hear that one is already owned by Joyce as that was going to be a recommendation to aid with Joyce's independence. Nursing staff emphasized that Joyce walks around fine and confidently while using her purple walker. Joyce told nursing staff that she uses the sink in her home bathroom to ease herself up and down onto her toilet. Nursing staff would prefer that the commode frame be setup around the toilet if possible as they are concerned that Joyce using the sink (at least initially) could aggravate her fractured vertebrae and ribs). Dusty confirmed that the commode frame could be setup around the home toilet for Joyce to use (at least until she is healed). 

Libby asked to confirm that the shower facilities at farm for Joyce were usable for her and Dusty confirmed a remodel of her shower to a walk in model with several hand rails several years ago. Libby commended the family on helping Joyce age in place so well. 

When Libby and staff sat down with Joyce to interview her about her overall confidence in returning to the farm in 3-4 weeks, Joyce stated that she feels confident in being able to get up into the farm house and return to living there. She confirmed that her family members check in on her often, she has the Life-alert service active thanks to her oldest son and daughter-in-law, and she does not leave the farmhouse on her own. Joyce indicated that she thought the family would be able to help her with doing her laundry and some cooking/meals initially initially if needed so no home help required. Joyce also informed Libby that family members have been good at coordinating her medical appointments pre-accident and providing transportation to/from them and it is anticipated that they could continue to do so. Libby confirmed that as long as Joyce is comfortable getting into and out of family vehicles there should be no issues in family taking Joyce to appointments.  

Libby reviewed the rough outline of the discharge process as currently in the works. For Joyce to return home, orders from Joyce's primary care provider (Dr. Collins) would need to be received by the Aspen Park facility which state that Dr. Collins has met with Joyce and that she believes that Joyce is safe to return home. Without that doctor's order from Joyce's primary care physician, then Aspen Park highly encourages people not to return home. Currently the initial follow up appointment for Joyce with Dr. Collins is still being scheduled, should be solidified before the end of this week. Aspen Park coordinator is still waiting for call back from Dr. Collins' office. Libby knows that the appointment for Joyce to see Dr. Keizur has been scheduled but did not have the information handy. Aspen Park will coordinate transportation of Joyce to and from all appointments (digitally for Dr. Collins, physically for Dr. Keizur and cancer center in Lewiston). At this time those are the only 3 appointments scheduled for Joyce expected during her stay at Aspen Park. 

Once Joyce is discharged from Aspen Park, she will be sent home with home health orders (meaning that 2 times per week an occupational therapist would arrive to continue working with Joyce on her recovery and exercises. This home health care would be covered by Medicare. The first visit would occur the day after Joyce arrives back home. The therapists would then determine how much service would be needed for Joyce and then work with Joyce until that length of time has been reached. Once home health has concluded, Joyce would be free to continue to run her therapies as outpatient service (going to a PT or gym) if so desired. More information on that can be provided.

Libby asked if Joyce was able to self-administer medications to herself. Dusty informed Libby that the family has been noticing Joyce has been missing medication doses on occasion. Joyce has recently started tracking her blood sugar levels again with the help of Connie. Dusty stated that Joyce has stated she cannot recall how to administer her insulin. Libby stated that if the family can continue to assist Joyce with taking her medications and checking her blood sugar levels then that should be fine. Libby shared that if it would be helpful for the family to have Joyce's medications pre-sorted into easy to administer packs (example - morning, noon, evening, bed time) then some pharmacies, such as at Rosauers, offer that service.

Libby will update Dusty once per week via email on Joyce's progress and any pertinent information about her recovery, or to pass on information from Aspen Park's medical staff. Libby is onsite at Aspen Park on Mondays, Wednesdays, and Fridays. Libby will send next Joyce update on Monday via email to Dusty. 

Dusty was transferred to Jennifer to discuss COVID-19 quarantine rules and potential planned family visit to Joyce on her birthday. Jennifer said she needed to discuss with the facility director about where Aspen Park would be at that time as the next stage of reopening from lock down would be occurring. Aspen Park is still working on their own policies and protocols for the next phase of reopening with an eye on the safety of their community as primary concern. More information to be discussed at the administration level and with the director. Jennifer let Dusty know she would call him back once she had more information about what (if anything) had changed for Aspen Park's visitation rules for this weekend.

Jennifer called Dusty back and informed him that the current rules remain in effect.

Aspen Park acknowledges that Joyce's birthday is a special occasion and that the family would like to mark it appropriately as best as possible given current safety protocols in place. 

Current rules through the weekend in effect limit in-person outdoor visits with residents to four (4) people maximum (no large groups). This also ties up one of the facility staff members who oversees interactions to ensure social distancing guidelines and safety procedures are in place (prevent physical contact, no items given to Joyce which could be contaminated, masks are worn at all times, etc.) 

The recommendation is that Joyce's family should plan to gather outside her window at a certain time (example, 4 p.m.) and share a phone call with Joyce. Family members would be free to use outdoor patio furniture or bring their own and setup outside Joyce's room. If family members want to bring snacks to enjoy as they sit outside, they are free to do so. 

When Jennifer asked about rough timeline family might come to visit Joyce, Dusty indicated late afternoon on Saturday, actual time to meet up is still being determined. Jennifer said she would ask the grounds team to see about setting up some of the patio furniture cushions before that time so it is available. 

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Visitation Information

Aspen Park is still following recommended federal and state quarantine procedures for the COVID-19 pandemic to protect its community members and staff. At present, visitation with residents of Aspen Park is limited. Their processes and protocols will be updated as the quarantine stages continue to ease. For visitation options below, please keep in mind that Aspen Park meal times are at 8:30 a.m., 12:30 p.m., and 6 p.m. Pacific time. Please do not plan to contact residents during these time periods.

At this time, a daily schedule for Joyce is not available yet.

PHONE

Due to computer difficulties in the administration office, Jennifer was not able to provide Dusty with the direct line to Joyce's room at this time. Jennifer will provide the direct number for Joyce's room when computer access is restored in the main office. In the meantime, family may call the main office phone number at 208.882.4576 and Jennifer (or manager on duty) will assist in getting connection to Joyce's room.

MAIL

Letters are always welcome and are delivered each day to residents as they are received. Letters may be sent to Joyce using this address format:

Joyce Fleener

c/o Aspen Park of Cascadia

420 Rowe St

Moscow, ID 83843

IN-PERSON (VIA ROOM EXTERIOR WINDOW)

Joyce's room has a window which faces out toward the exterior of the building. Friends and family can arrive at the Aspen Park facility and visit with Joyce by using cellular phones to call Joyce's room and see Joyce through the window during the conversation. When planning to visit Joyce in this fashion, it is recommended that Jennifer (or other staff member stationed at the front desk) is consulted to ensure Joyce is present and not scheduled to be out of her room at time of visit. Please be sure to take the above listed meal times into account as well. If visiting for the first time using this method it is recommended that visitor(s) check in with front desk so staff can lead them to the correct room window as well as ensure blinds in room are up so Joyce can see outside. For subsequent visits made to Aspen Park, visitors may walk up to Joyce's room window and look in. If Joyce is present, they can call her room phone and visit. If Joyce is not present, they may return to try their luck again later on. Joyce's room window must remain closed at all times during visit.

IN-PERSON (FACILITY'S OUTDOOR AREA)

Time may be scheduled to visit Joyce in person. The Aspen Park facility has an outdoor area where residents can be brought outside to visit with friends and family face to face. These scheduled visits are on a time limit and monitored by Aspen Park staff. Social distancing protocols and face mask use for all visitors must be strictly maintained. These visits are scheduled by calling Jennifer (or manager on duty) at the Aspen Park front desk at least 24 hours in advance of requested day and time. This allows Jennifer to ensure that the outdoor area is not in use by other families or for PT work or community activities. Maximum group size for such visits are limited to four (4) at one time.