General Update #88

July 10:

Rachael Kimble, Libby's counterpart, followed up with Dusty via email and telephone about Joyce's discharge plan and Aspen Park's recommendations to see if the family had reached a decision. Rachael followed up with Joyce and visited about the potential that she would remain at Aspen Park beyond the originally planned July 15 discharge date. 

Aspen Park's occupational therapy team will begin working on a bladder control program with Joyce to help with some of her incontinence and toileting since she has been having so much help with activities of daily living (ADLs) and toileting. Rachael noted that as the physical therapy team members noticed the skin breakdown on Joyce's buttocks from incontinence (which the Aspen Park wound nurse is treating) it is important for Joyce to have bladder training and wound treatment. The incontinence treatment would last 2-4 weeks according to Rachael. Rachael stated that the current projection for wound healing and incontinence treatment would likely mean the recommended time the discharge date is moved out to would be 2-3 weeks, to be determined once Rachael/Libby receive new information from Joyce's primary care physician and the Aspen Park medical team. Joyce stated that she would be fine with remaining in Aspen Park for another 2-3 weeks' time (potentially first week of August, date to be determined). Rachael talked with Joyce, expressing her concerns that Joyce might leave the facility and skilled nursing care too soon if she was discharged on July 15, which could lead to her ending up back in the hospital, which Joyce understood. 

Rachael confirmed Joyce's and family's concerns about cost of keeping Joyce in the Aspen Park facility. Joyce is covered by Medicare until 9/16, so there are plenty of days for recovery yet at no out of pocket cost to the family.

After receiving confirmation from all family members, Dusty confirmed with Rachael to initiate necessary processes to move Joyce's discharge date from July 15 to the first week of August. Rachael will begin and she or Libby will keep Dusty updated.

Rachael stated that she is available to answer questions or concerns, as is Libby, that the family may have.

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Dusty missed calling Joyce this day due to personal schedule and lateness of hour when free time came available.

July 11:

Dusty and Jess called to check in with Joyce and relay the information about the change to her discharge date. Joyce was understandably disappointed but took the news well enough, admitting that she probably wasn't ready to go home. 

Joyce did make attempts to negotiate the change to her discharge date, demanding that she at least be taken from Aspen Park for a drive in a vehicle out to the farmhouse. She stated that she would not get out of the car, she just wanted to drive past it and look at it, expressing concerns about recurring nightmares that something had happened to the farmhouse and it was no longer there. Dusty and Jess explained that leaving Aspen Park was not possible, especially due to COVID-19 safety protocols at the facility, and assured Joyce that the farmhouse was still safe and standing. Dusty confirmed that he, Craig, Carol, Connie, and Derrik go out there or are present there for several hours randomly throughout the week and that they can all verify it is in good order and safe. 

While Joyce was understanding of the change in discharge date, she expressed that she felt she could heal better at home and that the Aspen Park staff might be overprotective of her and underestimating her capabilities once she is back at the farmhouse to be independent. Dusty cited their reports again that were shared on her overall progress and witnessed capabilities under their care and Joyce backed down a bit but also stated that the staff might not know how good she actually is as they are not around her all of the time throughout the day. 

Joyce was encouraged to ask the staff about going on walks outside of the physical therapy times when she expressed in conversation that she felt she was being forgotten. Jess and Dusty suspect that she is just forgetting she had physical therapy and walks earlier in the day, having habitually forgotten events occurring from earlier in previous days. Assumption is that physical therapy is occurring regularly except possibly on weekend and Joyce lacks linear memory. Dusty will follow up with Aspen Park staff to see about obtaining a schedule of Joyce's overall therapy plan. 

Joyce visited with Jess and Dusty about various topics related to her time in skilled nursing care for around 45 minutes, the longest conversation had via telephone for some time since her admittance to Aspen Park. 

July 12:

Dusty called Joyce in the evening to check in and wish her a good night.

She ended up having gone for a walk that day. It has been more difficult to get Joyce to talk about her meals as she forgets what she has eaten. She confirms she has eaten meals throughout each day but does not make efforts to recall at times even after prompting. 

Joyce did ask for the blinds to be lowered on her room window to keep out the yard light (which she thought was causing her nightmares) and reported that she slept better.

Participant observation:
She appears to be closing back down similar to pre-accident behaviors of coping with her memory loss as she becomes more cognitively aware she has gaps in her memory. 

July 13:

Jess and Dusty called Joyce in the evening to check in and wish her a good night. Joyce was tired and somewhat confused at times during the course of the conversation, not able to fully articulate what she was meaning to say. Dusty chalked it up to the lateness of the hour of the phone call and potential Joyce didn't have her oxygen line seated correctly for use.

Joyce reported that her back is not hurting as much as it was before and she is experiencing less pain as she stands up from the chair or toilet. 

Joyce stated that her blinds were left open by the staff and Dusty reminded her that to have them closed all she needs to do is push her call button and they will come and close them for her. 

Participant observation:

Joyce appears to be getting more secretive about her short-term memory loss, most noticeable in how she talks (phrasing). 

July 14:

Dusty called Joyce on his walk home from working on campus on 7/14 around 11 a.m.

She reported that she was doing well and that the Aspen Park therapists had done some memory exercises and upper body exercises earlier in the morning with her. 

For breakfast she had a pancake, sausage patty, canned fruit, and some yogurt. As always, she stated that they give her too much food at each meal, but she eats it as best as she can. Due to placement of the monthly menu on the back of the room door she is unable to read it easily, but she said that she prefers to be surprised at what they bring her.

Dusty updated Joyce on his medical appointments, construction projects occurring around the university and some of the local happenings around Moscow. 

Joyce expressed that she needed money from her purse. Dusty inquired as to why she needed money from her purse, jokingly asking if she needed cigarettes from the commissary, but she stated it was to buy some barrettes to hold her hair back as it is getting so long. She doesn't like it long and has gone without a haircut for too long now since she last cut it herself at the farmhouse and lacks hairspray to keep it in place following showers. The length bothers her as it gets in her face and she is tired of pushing it back. Dusty reminded Joyce that the Aspen Park safety protocols would not permit him bringing in most things to her. He recommended that she ask the nursing staff if they had any in their supply cupboards that she might have, similar to the fingernail clippers she borrowed earlier in the month. Dusty also said that he would follow up with Jessica (administrator) to see if they had them for Joyce or if he could bring some by and circumvent the no outside supplies rule.

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Dusty called to check in with Joyce at 8:15 p.m.

Joyce said that the timing was good as she had just gotten off the phone with Connie. 

She stated that she was looking forward to her night of sleep. The therapists had taken her on a long walk today, one of the longer ones she has taken since being admitted to Aspen Park. It was a longer route, without just backtracking down the same hallway. It was good and interesting for her, she said. It let her see more of the facility. She enjoyed seeing out the different windows but she was not able to get her bearings. "As far as I know, I'm in Tennessee!" She lamented again that the bushes outside of her window were so high that they block any meaningful view of the landscape outside, and prevent people from coming to her window to visit. 

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Dusty reached out to Rachael to inquire about new discharge date being set for Joyce.

Also asked for a copy/example of Joyce's weekly therapy schedule to help with daily phone calls and jogging Joyce's memory.

Dusty reached out to Jennifer (administration) to see if he could drop off some hair barrettes for Joyce to use or if they had some in their supply cupboards she could have.