General Update # 90
07/16/2020
Dusty and Jess called to check in with Joyce in the evening. She reported that she was doing well, but was a little sad that she did not get to return home on the 15th. She stated that she was glad that she is being well cared for at Aspen Park and understands that the delay is really for her overall benefit and wellness. She asked if a new discharge date had been established for her yet. Dusty relayed that a new discharge date is still being worked out among the therapy team at Aspen Park.
Joyce reported that her diaper rash is still healing and barrier cream continues to be used for treatment.
07/17/2020
Rachael Kimble followed up on Dusty's request via email for notes on how Joyce's therapy is progressing. Rachael stated that she visited with Abby, who relayed: "I would maybe talk with [Joyce] about encouraging her to participate more in her own care and wanting to do more with therapy."
Current therapy work note:
Transitioning from stand by assist (SBA) to modified independence with activities of daily living (ADL). Continence therapy work is hit and miss...more miss. Joyce seems to only be taking herself to the bathroom when she has a bowel movement. Joyce was visited with about needing to initiate getting to the bathroom vs using attends [uncertain if this was meant to say attendants or if attends was slang for diapers?]. Occupational therapy is planning 2 weeks, unless physical therapy is agreeable to particle in UI program.
Dusty requested follow up on what Abby meant by "participate more in her own care and wanting to do more with therapy." Dusty requested clarification on "attends." Dusty asked for clarification on "Occupational therapy is planning 2 weeks, unless physical therapy is agreeable to particle in UI program."
Rachael also provided a .pdf of a report of Joyce's overall therapy program (Speech, Occupational and Physical therapists' reports). Summarized notes from .pdf below in italics.
7/13 Notes from Speech Therapist
Therapist provided skilled speech therapy focusing on memory and problem solving to support increased independence during ADLs. Patient recalled details of paragraph length material presented verbally to make inferences with occasional verbal cues provided by therapist. Patient answered questions regarding temporal and personal orientation with occasional verbal cues provided by therapist.
7/13 Notes from Occupational Therapist
Toileting routine with modified independence (Mod I) using 4 wheeled walker for functional mobility in room with good safety and balance during clothing management. Patient performs standing h/g at sink with Mod I to wash hands. Lower extremity (LE) dressing with Mod I to don BLT [bending, lifting, twisting] compression socks and skirt.
7/13 Notes from Physical Therapist
Patient is ambulatory today with her 4 wheeled walker, traveling 672 feet. Took rest breaks as needed (3). While patient was ambulatory she kept a constant pace working toward improving activity tolerance so she can return home safely. Transfers in her room with SBS [Dusty is assuming this was a typo, meant to be SBA]. Patient's walker was set a bit away from her and she was able to manage it and bring it closer.
---
7/14 Notes from Speech Therapist
Therapist provided skilled speech therapy focusing on memory recall and problem solving to support increased independence and safety during ADLs. Patient described items needed to complete functional tasks and steps of functional tasks with occasional verbal cues by therapist.
7/14 Notes from Occupational Therapist
Seated progressive resistance exercise (PRE) using BLT 2-pound weights (10 x 2 sets) on all planes of motion overhead movements performed AROM [active range of motion]. PRE to increase functional activity tolerance and BUE [both upper extremities] strength for ADL independence.
Self care skills training for toileting routine, patient demonstrated toilet transfer with Mod I using 4 wheeled walker for mobility into restroom. Toileting routine with Mod I and good balance/safety.
7/14 Notes from Physical Therapist
Taught patient gait training using 4 wheeled walker, with SBA, traveling 150 feet and then another 200 feet on 2-litres of oxygen with shortness of breath (SOB) noted in order to improve independence for pt to return home safely. Directed patient in sit to/from stands from wheelchair to 4 wheeled walker (10 x 2 sets) for lower extremity (LE) strengthening. Patient rates her pain at 6 out of 10 in her mid back.
---
7/15 Notes from Speech Therapist
Therapist provided skilled speech therapy focusing on memory recall to facilitate increased independence and safety during ADLs. Patient completed tasks requiring her to retain and manipulate a sequence of 3 words with approximately 50% accuracy.
7/15 Notes from Occupational Therapist
Seated and standing PRE using 3-pound weighted barin BUEs (10 x 2 sets) to increase UE strength and functional activity tolerance for ADL and IADL [instrumental activities of daily life] independence.
Standing sustained activity using 4 wheeled walker x 8 minutes with supervision and good balance/safety awareness. Self care skills training for toileting routine. Patient demos toileting routine with changing briefs (diaper) and Mod I.
7/15 Notes from Physical Therapist
Directed patient in gait training using 4 wheeled walker for 200 feet (x2) on 2 litres of oxygen with therapist managing supplemental oxygen. Patient continues to use walker unsafely despite cues, forgetting to lock her brakes and pushing walker off to the side during transfers. Patient sitting in a very saturated brief [diaper] again this morning. Taught patient to sit to/from stand transfer training with SBA including toilet transfer training. Patient has had difficulty putting on clean briefs for the past few times with this therapist and patient was instructed on how to use a reacher. Patient continues to have memory deficits requiring repeated cues for tasks along with cues for task initiation.
---
7/16 Notes from Speech Therapist
Patient described solutions to mock functional problems presented with minimal verbal cues provided by therapist. Patient described items needed and steps to complete functional tasks with minimal verbal cues provided by therapist.
7/16 Notes from Occupational Therapist
Patient provided with determination of home barriers and education on overcoming home barriers. Patient verbalizes 1 step to enter home from back porch but is inaccessible in winter. 5 steps with railings required for secondary entrance during winter. Family provides assistance with IADL tasks including grocery shopping and light housekeeping. Patient performs laundry and meal prep tasks.
7/16 Notes from Physical Therapist
Standing LE exercises to improve functional strength for better stability with mobility.
Gait training 200 feet (x2) with emphasis on improving functional distances and activity tolerance. Patient uses 4 wheeled walker and SBA with therapist managing oxygen tubing.
---
7/17 Notes from Speech Therapist
Therapist provided skilled speech therapy focusing on memory recall and problem solving to facilitate improved safety and independence during ADLs. Therapist trained patient to rules of some of simple card game. Patient recalled rules of game and solved problems with moderate visual and verbal prompts provided by therapist.
No notes from Occupational Therapist or Physical Therapist at time of this report being generated for Dusty.
---
Dusty requested clarification on acronyms/jargon utilized in therapists' report.
07/18/2020
Dusty dropped off a bag of assorted hair barrettes for Joyce at the Aspen Park front desk following instructions received from Jennifer Trout. They will be disinfected and transferred to Joyce for use either over the weekend or on Monday when Jennifer arrives to check in mail and freight that arrived to Aspen Park's front entrance vestibule.
Dusty called Joyce to check in with her about her day. Joyce stated that she was doing well and enjoying her Saturday. No therapists visit her on the weekend, she said, so she was just relaxing in her room. Meals were good (but she could not recall what they served).
Dusty called Joyce back in the evening to visit and wish her a goodnight. For dinner Joyce reported that she had some kind of chicken entree, potato salad, and watermelon for dessert. Joyce and Dusty reviewed their list of foods they intend to make and eat once she was back at the farmhouse as celebration. Dusty updated Joyce that he had emptied the refrigerator at the farmhouse of expired food and begun to deep clean the refrigerator shelving and drawers so it is ready for use upon her return. He confirmed that he did not throw out her sour dough starter and it was safe in the green melamine bowl she had left it in prior to her fall down the basement stairs. Dusty confirmed that Zac and Connie have been keeping the yard work up at the farm and Craig, Derrick, and Dusty have been at the farm around the clock so everything is being watched. This news set Joyce at ease.
07/19/2020
Dusty and Jess called Joyce to check in and wish her a good night. Joyce reported that she had a good Sunday and that she was looking forward to sleeping through the night, even if it was not at the farmhouse. Dusty told Joyce that Tim had stopped by the farmhouse earlier in the day and picked up his tomato plants she had sprouted for him. She was happy he got them.
Libby Sheffler (Social Service Assistant at Aspen Park) contacted Dusty via email. She had been brought up to speed with Joyce's change of discharge date (first week of August, exact date still to be determined) with the goal of increasing Joyce's independence and therapy work. She inquired if the family thought that Joyce would need anything once she returns to the farmhouse. She reminded Dusty that she is available to answer any questions that the family might have.
Dusty responded to Libby's email, confirming equipment already on hand and home modifications previously performed to move the majority of Joyce's daily activity to the main floor of the farmhouse. Dusty requested review of previously cataloged items (walker, powered recliner, commode, wheelchair, etc.) to confirm that there is not anything new that physical therapy requests or doctor recommends for Joyce's return to the farmhouse.
Libby followed up with Dusty's response. She confirms that all the equipment already on hand at the farmhouse for Joyce to use is what was recommended by the physical therapy team. Libby believes that Aspen Park has all the documentation together and ready to submit to Joyce's insurance to cover a new wheelchair as well.
Comments
Post a Comment