General Update #139

Location Update: Joyce is now at the farmhouse.

Please change your default phone numbers away from previous contact information at Aspen Park facility to her farm home phone number.

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The Aspen Park team came out to wish Joyce a farewell, taking photos and sending with her their regards. They asked if Joyce would come back to visit them sometime and Joyce agreed that she would come back to visit, grinning as she said "but not to stay!" A good laugh was had by everyone.

Dusty and Joyce arrived at the farmhouse ~1:18 p.m. Joyce was elated to be returning home. She was quite overcome with joy at departing the Aspen Park care facility, taking in all the familiar sights of Moscow as Dusty drove her home providing narrative. Joyce expressed twice that she was not certain where she was or how long she had been gone. Joyce apologized to Dusty for being slow to respond and she was overcome with happiness at being out of Aspen Park and had reached a state of sublime in seeing things that she hadn't thought she would ever see again. Joyce stated that it was nice to see and touch Dusty's hand and wonderful to hear his voice in person as opposed to over the phone.

Joyce experienced difficulty in being loaded into Jess' car at Aspen Park, lacking fine motor control over her lower extremities and had a difficult time getting situated into the passenger seat. Likewise she had some difficulty in getting out of the car upon arrival at the farmhouse, requiring more assistance than previously needed pre-June 2020. 

Joyce's movement speed and steadiness were greatly reduced from pre-June 2020 baselines. Joyce had difficulty in maintaining balance and moving forward with her walker in a straight line. Dusty remained beside her and kept ready to catch her if balance was lost. Joyce struggled to lift her walker up the concrete step on the back patio unaided and could not figure out how to step up after several minutes had elapsed. Mental and physical processing of procedure to move up the step were non-existent. Dusty assisted Joyce with some difficulty in moving up the step, and moving up the threshold into the house. Dusty informed Joyce that she should not plan to go outside without someone present to aid her.

Joyce expressed thankfulness at being home and elation at having everything still standing.

Joyce stated she needed to go to the bathroom. Dusty accompanied her. Joyce continued to walk, hunched, at a slow and somewhat unsteady pace with her feet catching on the floor at times at various points during her journey from the living room to the bathroom down the hallway. Joyce had to be continually reminded to make use of the brakes on her walker from Dusty. Joyce could not find or successfully operate the light switch in the bathroom. Derrick has been using Joyce's bathroom and left towel on the floor which Dusty moved to clear the tripping hazard. Joyce had severe difficulty in moving through the bathroom and seating herself onto the toilet. Seating procedure is particularly hazardous if unaided as Joyce has no core strength and "falls" 4-6" onto the toilet as her control over her body appears to give out at that point in her lowering process. Joyce had soiled her diaper (urine and some small amounts of fecal matter most likely expelled with flatus unintentionally at some point earlier in the day) but was able to remove it and, with some difficulty, able to prep and slip into a new diaper. Joyce was unable to lift herself off of the toilet due to a lack of physical strength and coordination even after several attempts with Dusty providing verbal direction (feet would slip out of place, legs were extended too far forward from her knees, no upper body strength, etc.) before Dusty provided direct physical aid in standing Joyce upright. Joyce had only passed urine so cleanup needs were minimal for this trip. Joyce's hunched posture made it difficult for her line of sight to allow her to find toilet paper roll and wipes from where she had habitually stored them. Dusty is assuming that with more time she will become accustomed to where everything is in her home again.

It was determined by Dusty that Aspen Park's assessment was quite correct, Joyce will need assistance and care with bathroom trips and every day living (EDL) processes. Joyce is unsteady on her feet, has potential to lose her balance easily, does not utilize her walker correctly when operating it solo, and expressed that she is not 100% certain when she is seated properly on the toilet for use. Joyce expressed to Dusty that she will probably improve "as she gets used to being at the farm again" and Dusty agreed that could be a possibility. 

Dusty will coordinate purchase and installation of toilet riser and safety handles from NW Respiratory vendor later today before they close so Joyce has them over the weekend. What Dusty originally thought was at the farmhouse turned out to not be safety handles/commode but a different item entirely.

Joyce was returned to living room and was seated in her recliner. Dusty attempted to educate Joyce on the controls for her chair to aid her in rising/sitting but Joyce expressed exasperation over the two buttons. Dusty confirmed with Joyce that they'll work together in practicing its use so it becomes second nature. 

Dusty ensured Joyce was comfortable in her recliner, replaced her old cannula line from her oxygen concentrator, and then proceeded to start unloading Joyce's things from Jess' car, bringing them into the house. 

Dusty paused work to participate in a Zoom meeting for work, during which time Carol stopped by the farmhouse to visit with Joyce. Dusty and Carol reviewed Joyce's time at the farmhouse briefly once Dusty's meeting had concluded before Carol departed. Carol also pointed out a package that had been left for Joyce sometime during the week by Allen and Diane. Dusty will aid Joyce in calling Allen and Diane later on to say thank you.

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2:50 p.m. - Joyce took herself for a short walk from her chair to the patio doorway and back. Dusty reinforced proper use of the walker and its brakes with Joyce, as well as the controls for the recliner after Joyce stated that she could not rise up from it. Joyce marveled at the recliner's ability to help stand her upright and stated that she didn't know it could do that. Joyce retrieved her cane from by the patio door frame, assuring Dusty that she was not going to use it for walking around the house (she was still intending to use the walker) but the cane acts as a reaching tool for her should she accidentally move her walker out of reach when sitting down in her recliner. Dusty recommended that Joyce use proper methods of walker use (setting her hand brakes) to help prevent the walker from being moved out of reach or from shooting out from under her.

Dusty prepared Joyce a lunch of low sodium cream of chicken soup and no salt green beans (much of the food in the farm's pantry is not compliant with Joyce's low-sodium diet plan directive). Joyce informed Dusty that the low sodium diet plan does not need to be followed. Dusty informed Joyce that if she wanted to keep living at the farmhouse she needs to do what the doctors prescribe to keep her healthy and un-hospitalized. Joyce concurred that made sense. Joyce had difficulty in eating the soup from a bowl so Dusty transferred it to a mug to facilitate consumption. 

Joyce consumed her 3/4 mug of soup and 1/2 bowl of green beans along with a mug of water.

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3:50 p.m. Joyce got up on her own from her recliner, using the remote, to go to the bathroom. Dusty accompanied her.

Accidental incontinence issue necessitated change of skirt and diaper. 

Dusty removed the bathroom door from its hinges to create more room for assisting Joyce and to remove hazard of Joyce attempting to use door as a brace for stability. 

Joyce was able to find and operate light switch and had a more controlled "fall" onto the toilet seat this trip.

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4:09 p.m. - Dusty paused bathroom assistance as Mary (Kindred Home Health) called Dusty's cell, previously having called Craig and confirmed him as POA on file. Craig confirmed he is okay with care and that Dusty can coordinate with Mary. All covered with insurance. Will come out as long as needed. Nurse can come out, Physical and Occupational therapist. OT will survey house. Will work with Dr. Collins. 

Confirm Dr. Collins follow up appt

Dr. Collins will be the one that signs on the orders for home health. 

Confirmed address with Mary and that Dusty is the defacto hub for scheduling at the moment.

Provided info on COVID safety procedures

Monday 14th will be first arrival, nurse will check in first (Tracy) - will coordinate time with Dusty day before

First visit will cover goals and overview - Joyce will run the show, if Joyce not feeling up to PT/OT they'll work around her schedule

Any questions, contact Mary

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Dusty returned to assisting Joyce with bathroom trip. Joyce was unable to rise up unaided from her seated position on the toilet. Joyce was able to self-clean and re-don a fresh diaper. Joyce was able to remove her soiled skirt by herself but was unable to slip new skirt on in bathroom.

Joyce relocated herself to her recliner to facilitate donning of fresh skirt, citing that it was just the two of them in the farmhouse at the moment. 

Joyce had urine output and some Type 6-7 bowel movement (Bristol Stool Chart) this trip.  

Joyce became frustrated in attempting to use recliner controls while keeping herself perched in pose conducive to donning skirt, sitting down, and keeping balanced in lifting her feet while maintaining hold of skirt. Dusty calmed Joyce who was becoming frustrated by the multi-tasking efforts. Dusty helped Joyce process and accomplish steps verbally. Joyce swapped her slippers for her regular everyday slip-on shoes with some difficulty, working at the task solo for sake of attempt at independence. Dusty suggested that their traction might help Joyce with gaining purchase in the bathroom to prevent her legs from slipping out from under her as she attempts to stand. Joyce concurred that might be valid. 

Participant observation: Joyce has difficulty multi-tasking (processing conversation, focusing on steps of task she is working on, processing audio or visual stimulus occurring simultaneously around her while she is attempting to accomplish a task, etc.). 

Participant observation: Joyce pulls her skirt up around herself in a manner similar to a belly band when using the bathroom, so if it is soiled and she is unaware, the contaminated cloth comes into contact with the back of her upper garments.