General Update #127
08/29/2020
Dusty did not call Joyce due to schedule conflicts.
08/30/2020
Dusty did not call Joyce due to schedule conflicts.
08/31/2020
Dusty did not call Joyce due to schedule conflicts.
09/01/2020
~7:35 a.m. – Dusty called Joyce on his walk to work, waking her up from sleep. After apologizing and explaining that Joyce’s nurse said that she was usually awake at this hour a brief conversation was had but ended soon afterward as Joyce was struggling to gain coherency. Joyce confirmed that her oxygen line was in place but that she was just sleepy and waking herself up.
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~5:15 p.m. – Dusty called Joyce on his walk home from work. Joyce recalled that Dusty had called earlier in the morning after being reminded it occurred on the same day. They spoke briefly, mainly discussing how happy she was that she was cancer free before transitioning to questions about her location as she was uncertain where she was staying or who the people were around her. After providing Joyce an update about where she was and her relative location within Aspen Park compared to Moscow landmarks she claimed familiarity about the call ended as her dinner was delivered.
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~8:38 p.m. – Dusty attempted to call Joyce but was unable to reach Joyce via her room phone. Assuming she was away from her chair using the bathroom.
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~8:46 p.m. – Connie contacted Dusty to let him know that she had been on the phone with Joyce. Connie reported that for the first 5 minutes of her call Joyce was her old self and the last five minutes Joyce stated that she was at the farm making a list of things that she was going to put away tomorrow.
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~8:59 p.m. - Dusty attempted to call Joyce but was unable to connect. Assuming she had gotten up from her chair to use the bathroom. Will attempt to call tomorrow.
09/02/2020
Dusty called Joyce to check in with her during his walk home (~5:09 p.m). Joyce was not in a talkative mood, mostly non-responsive to questions and passive on the phone line with Dusty as he attempted to offer options for conversation which Joyce did not engage with beyond monosyllabic or truncated sentences in response. Joyce ended the call citing a desire to watch television programming.
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Dusty attempted to reach Joyce via her room phone but was unable to connect at 8:30 p.m. Assuming she was either in the bathroom or on the phone with someone else.
09/03/2020
Dusty called Joyce on his walk home from campus ~8:30 p.m. Joyce exclaimed how excited she was to be cancer free and that she probably would have trouble sleeping due to the joy she had about it. Joyce then asked if Dusty knew where she was as she wasn’t sure she was in her house. Dusty explained that Joyce as in the Aspen Park facility in Moscow. Joyce accepted this after it was explained that it was only temporary and confirmed that she was going to be returning home to her farmhouse in the near future. Joyce expressed that she did not know who everyone was but that the staff was friendly to her, “you’d hardly notice they were around at all they are so quiet and nearly invisible. They don’t act like I’m here at all. I get ignored.” Dusty asked for clarification and Joyce stated that everyone just goes on about their business with whatever they are doing and treats her like she isn’t there. Dusty inquired who Joyce was meaning, believing that Joyce may be experiencing hallucinations again, and Joyce expressed that she was referring to the nurses and the orderlies. After some effort, Joyce was able to verbalize that the staff treated her nice and that she was not being neglected, the staff was just busy and she didn’t know who anyone was. Dusty confirmed with Joyce her main nursing staff and their names and Joyce began to recall who they were. Joyce stated that she did not know who everyone was and that she thought she ought to get up and go out and ask them who they were and what they were up to. Dusty encouraged Joyce to remain in her room, as the nurses most likely had things to do and the other residents probably would not like visitors walking into their rooms so late at night. Joyce agreed that would most likely be true and Dusty managed to shift the subject. Joyce and Dusty discussed Joyce’s childhood dream of becoming a nurse and what her plans were to realize that dream. She shared that there used to be a nurse’s club for young girls in high school who wanted to become nurses and that they would read medical books and discuss how-to matters related to care of patients, assisting doctors, and so on. “A lot of dreaming,” she said. She expressed some irritation at the “city girls” of Coeur d’Alene who “thought they were better than us rural girls.” Joyce explained that there was an economic class division of sorts and the “city girls” were able to continue on with getting internships and work with hospitals while the rural girls who couldn’t get into “the big cities” easily didn’t get those opportunities. Joyce lamented the disparity of access as she thought that her and several of the rural girls would have made fine nurses if they’d had the same chances to work in hospitals or be noticed by medical staff as promising caregivers. Joyce gave the equivalent of a verbal shrug and stated that maybe some of the rural girls she lost touch with over the years did go on to become nurses or even doctors. She stated it would be interesting to know how their lives turned out. Joyce briefly lamented how her current situation was not how she thought things would turn out but quickly rebounded to confirm that she has had a great life because she got all of her family members she wouldn’t have had otherwise. Conversation ended as she stated she wanted to watch some television and bid all a goodnight.
9/4/2020
Dusty called Aspen Park to confirm coordination of the telehealth conference for Joyce, speaking with Andrea as Maggie was unavailable at 10:30 a.m.
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Maggie called Dusty from her cell phone at 10:45 a.m. to inform him that Holly will be coordinating the telehealth conference with Joyce and Moscow Medical, connecting Carol, Connie and Dusty in for the 11:40 a.m. appointment. Maggie confirmed that they would call Connie’s office conference room’s phone line.
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Holly with Aspen Park connected Connie, Carol and Dusty at 11:41 a.m. into the telehealth call with Moscow Medical for Joyce. Dr. Collins reviewed Joyce’s information with the family last appointment at Moscow Medical (in-person meeting) 8/13. Confirmed that Joyce was to have been discharged from Aspen Park ~3 weeks ago but due to concerns about her hallucinations and potential UTI that was delayed. CT scans were ordered and have been reviewed. Oncologist reviewed the CT scans (on 8/27) and found no cancer existing within Joyce at this time. No further recommendations for additional scans.
Dr. Collins and Aspen Park’s primary concerns are that Joyce will have care and help at home. Joyce’s family intending to take on 24/7 care for Joyce. Joyce will need help with her everyday living skills (EDLS): bathroom use and bathroom hygiene, meal preparation, etc. More specific instructions on her care will be provided to the family upon her discharge from Aspen Park via social worker Rachael.
Joyce was asked by Dr. Collins if she felt ready to return home and Joyce indicated that she was ready to return home. Joyce was asked by Dr. Collins if she felt dizzy, had body pains, or if she was still experiencing hallucinations to which Joyce indicated that she was not.
Maggie’s reports from Aspen Park were relayed via Holly, stating that Joyce was much improved from where she had been. Joyce was cleared to leave Aspen Park as soon as all the needed paperwork and coordination of her discharge plan can be arranged. Estimating sometime next week.
Joyce appears to be okay from her fall in June. No persistent aches or pains reported. Joyce has no bowel movement issues reported.
No tests are needed for Joyce to do before discharge from Aspen Park. Joyce should have a follow up appointment with Dr. Collins at Moscow Medical in ~ 6 weeks.
Joyce’s family requested information on a baseline for Joyce’s memory loss. Holly confirmed that Aspen Park has the speech/cognitive therapists’ reports and could ensure those are provided in the exit packet to Dusty.
Dr. Collins confirmed that insulin injections at home will be stopped for now for Joyce. At the 6 week follow up appointment for Joyce it will be determined if it needs to be restarted or see what other changes could be made (example – adjustment to the slow dose oral medication for blood sugar control).
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Rachael (Aspen Park social worker) contacted Dusty via email confirming that Holly had participated in Joyce’s telehealth conference and provided her an update. Rachael confirmed that discharge orders had been received from Dr. Collins’ office and that was great news. Rachael inquired if the family still wanted a portable O2 for Joyce and to look at dates for discharge and if the family was wanting Home Health for Joyce which Rachael would have Dr. Collins sign paperwork.
Dusty followed up with Rachael via email to confirm associated costs and timelines for Aspen Park.
09/05/2020
Dusty did not call Joyce due to schedule conflicts.
09/06/2020
Dusty and Jess called Joyce ~8:46 p.m. to visit and wish her a goodnight. Joyce was slightly lethargic in conversation, most likely due to time of phone call. Joyce confirmed that she was looking forward to getting home to the farm. Dusty and Jess shared information on their weekend so far and explored plans for what Joyce wanted to do when she returned home.
Dusty called Joyce to wish her a goodnight. Joyce uncertain as to her location – informed her she was in Aspen Park. Joyce confirmed she was watching television and winding down for the night and so a brief phone call was welcome.
09/08/2020
Dusty called Aspen Park at 9:50 a.m. for a general update on Joyce, reaching Jennifer. Jennifer transferred Dusty to Joyce's day nurse (Kim). Kim reported that Joyce had a good breakfast today. Joyce's blood sugar levels have been good, no reports yet from physical therapy on their work with her as it is still too early in the day for the reports to be posted to Joyce's file at the nurse's station. Joyce had a good weekend, no hallucinations, and is reported to be in good spirits.
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Dusty called Rachael (Aspen Park social worker) to follow up on 9/4 email ~9:57 a.m. Jennifer, who arranged transfer of the call to Rachel's office, stated that Rachael was in a morning meeting and would most likely return Dusty's call later today. Dusty left voicemail message for Rachel.
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Rachael returned Dusty's call at 10:02 a.m.
Rachael will call Lincare to check on the cost of adding portable oxygen to Joyce's account she already has with them for her at-home oxygen concentrator and will follow up with Dusty before submitting paperwork for it. Portable oxygen was previously recommended for Joyce for occasions where she needs to be transported to/from medical appointments as there is documented need for her to use it.
Rachael confirmed that the Home Health therapy visits for Joyce have medicare covering for them in full as is common for transition work from skilled nursing care to back home. Rachael estimates that they will most likely last for a month or two in duration with therapists briefly visiting Joyce 1-2 times per week where they will check Joyce's vitals, blood sugars, etc. and if Joyce does not appear to be doing well they'll suggest Joyce be taken for a visit to her primary care doctor. They will also work with Joyce on physical therapy to help prevent her from returning to skilled nursing care or the hospital.
Joyce's primary care physician needs to sign off for both of those orders (portable oxygen order; Home Health order) and it is easiest to try to get those orders before Joyce leaves Aspen Park.
Rachael will be sending off both orders to Dr. Collins to sign this morning (after confirming cost of portable oxygen for Joyce and confirming with Dusty the added monthly cost is acceptable to the family), and Rachael will also call Dr. Collins to confirm receipt and signatures for both orders are done. Rachael estimates that Joyce should be discharged from Aspen Park by the end of the week.
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