General Update #157

Dusty arrived to the farmhouse ~8:02 a.m. and visited with Craig, who was on-site at the shop for a few minutes. Dusty headed inside farmhouse shortly afterward and found Joyce hunched forward in her recliner with oxygen line off. Joyce was responsive but a bit disoriented. Joyce stated that she had not gone to the bathroom and thought that she took off her oxygen line sometime earlier in the morning when she was "thinking about getting up to go to the bathroom" but stopped and fell back asleep in her recliner. 

Dusty assisted Joyce with rising up from her recliner but Joyce was able to move to the bathroom and transition onto the toilet riser without assistance. Urinary incontinence and minor fecal matter (most likely involuntarily expelled with flatus) occurred at some point after Carol's departure last night. Joyce's pull-up diaper had been augmented with a heavy-duty pad/liner insert, which had captured most of the urinary discharge and all of the fecal matter. Joyce had wanted to just replace the pad but Dusty alerted her to the urine that had made it into the diaper and convinced her a fresh diaper and pad would be good. Both were replaced post-toileting with Dusty assisting in getting the pad set into the diaper and both positioned for Joyce to step into and pull up. Joyce moved under her own power back out to kitchen area, seating herself in recliner and re-aligning her oxygen tubing while Dusty prepared her breakfast. Joyce requested slice of toast with butter and apricot jam and 1/3 of a banana for her morning meal. Dusty also refreshed Joyce's water mug and made a fresh cup of Earl Grey tea. Morning medication was also administered ~8:30 a.m. (Carvedilol, Metformin, Centrum multi-vitamin, 2 Tylenol, Potassium supplement, Iron supplement). Joyce completed breakfast ~8:50 a.m.

Dusty prepared foot soaking tub for Joyce to prep her feet for this morning's foot care appointment with Dr. Capawana. Joyce commented that she has very long toenails. Dusty assured her that Dr. Capawana would be getting them back down to normal in no time today. Went through two cycles of soaking and drying of feet in preparation for the appointment. Dusty will purchase fresh epsom salts for future use as Joyce's current supplies (if still existent) could not be located in the usual locations (garden supplies, bathroom supply cupboard, cleaning closet, or under kitchen sinks).

Joyce is in good spirits and quickly rallied after being on her oxygen again for 20 minutes and going through breathing exercises with Dusty. 

Derik arrived to use the bathroom and sat at the counter while waiting for Craig to give him directions for the day. 

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9:08 a.m. - Someone called Joyce's land line asking for Gritman Medical center. Dusty informed them this was a private residence. They asked him to verify he was not Gritman. Dusty verified and was thanked for his time.

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Dusty took Joyce to the bathroom at 10:25 a.m. Joyce had an issue with urinary incontinence which required change of skirt and replacement of disposable pad on recliner. Departed for appointment with Dr. Capawana ~10:50 a.m. after getting Joyce cleaned up and loaded into the Subaru.

Appointment slot for 10:50 a.m. was missed but they were able to reschedule Joyce to be seen with Dr. Capawana at 11:30 a.m. Joyce and Dusty sat outside in the hallway due to COVID-19 safety protocols. Dr. Capawana was glad to see Joyce, noting tenderness just shy of bleeding on her left big toe following nail trimming but stated it should clear up now that the nail pressure is off. Joked as main nail was cut away from Joyce's right big toe, "Did you hear that one? It sounded like a quarter hitting the floor when it fell!" Dr. Capawana noted that the nails on Joyce were long and should feel better in her shoes now that they've been trimmed up. Follow-up appointment scheduled for December 1 at 11 a.m. by Dusty with their clerk.

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Returned to farmhouse ~12:45 p.m. to find occupational therapist (Deandra) present in her vehicle about to depart. Apparently there had been a paperwork error somewhere and Joyce's cell phone (which is usually off and only powered on when Joyce goes outside or out on her own pre-June 2020) was set as the default number for her and the physical therapist to call. Deandra suggested that though Dusty had set his cell phone number up with Tracy (Kindred Home Health nurse) yesterday that the information might not have filtered out through to everyone else yet from the computer servers. Deandra noted that the physical therapist, Marshall, had apparently been out to the farm while Dusty and Joyce were at Dr. Capawana's office as he had left a note on the door. Deandra had been in the process of adding her information to Marshall's note and was about to replace it on the door when Dusty and Joyce returned to the farm.

Deandra asked if today was all right for her to come in and check on Joyce. Dusty confirmed, stating he was going to just get Joyce into the bathroom and then feed her lunch he'd bought in town. Deandra went in through the main door as Dusty brought Joyce in from the back. Joyce still struggling with getting her walker up onto the concrete landing on the back patio. Joyce lost her balance and fell backward but Dusty caught her. Joyce expressed confusion as to what happened, Dusty informed her she mis-stepped in trying to move up onto the step of the patio. Joyce said that it was good Dusty was behind her to catch her and that she didn't want to do that again. Joyce was able to make it the rest of the way into the farmhouse across the threshold and into the bathroom without assistance. 

Someone used the bathroom while Dusty and Joyce were out of the house, removing the toilet riser from the toilet bowl and didn't replace it, which stopped Joyce (who had traveled into the room with Deandra as Dusty had returned to the Subaru to get his new box of disposable gloves) in going to the bathroom. Deandra alerted Dusty and Dusty got the toilet riser back into place. Joyce lowered herself down onto the secured toilet riser and went through her toileting routine with Dusty as Deandra observed. Dusty assisted with removal of soiled pad and diaper (urinary incontinence had occurred at some point) and Joyce passed urine. Joyce cleaned herself and rose up for Dusty to aid in getting fresh barrier cream applied and new diaper and pad put into position. Joyce completed toileting process. Deandra's main note was that she thought it would be good for Joyce to get the diaper prepped (stepped into and pulled up to her knees/thighs while she was seated on the toilet) but understood that the barrier cream application caused Joyce to shift and shuffle which the diaper in such a place might restrict.

As Deandra had previously been out she was familiar with Joyce and her home. Deandra reviewed equipment, medications, and health history with Dusty and Joyce. Reviewed the layout of the house and what the family was doing for Joyce's care (meal prep, bathroom assistance, laundry, being present when Joyce went out of doors, etc.). 

Deandra went through recommended range of motion activities involving the pulley system still in place on Joyce's cleaning cupboard door with Dusty. Also reviewed were weight exercises. Joyce found her 2 lb. weights that had previously been purchased for her when Deandra was out for Joyce's last OT session work, surprising Dusty and Deandra. Dusty to train family members on range of motion exercises and weight training exercises for Joyce at a future date. Range of motion exercises should be done every day for 5 minutes. Weight training exercises should be done on alternating days of the exercises that PT will give to Dusty once they are able to arrange a time to come out.

Deandra reviewed Joyce's sleeping arrangements and stated that Joyce is all right to continue sleeping in her chair if she desires and is also okay to attempt to transition to sleeping in bed if she desires. If she moves to sleeping in the bed it is recommended that she keep the bed rail in place that Dusty and Jess setup previously for her and that family checks in on Joyce if she is sleeping in her bed to ensure she doesn't get tangled in sheets, oxygen lines, has assistance in getting up when she wants it, etc. Deandra checked with Dusty on Joyce's sleeping arrangements and overnight care or observers. 

Deandra took Joyce's vitals while she was out.

Joyce's blood pressure was 140/81 with pulse of 77.

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Dusty fed Joyce her lunch ~1:45 p.m. after Deandra departed the farmhouse.

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Jennifer at Aspen Park called to check in and see how Joyce was doing at 1:49 p.m. and also to let Dusty know that Joyce had some laundry that was missed in getting reconnected to her before departure. Dusty stated he would swing by and pick it up today on his way back through. Jennifer asked if Joyce needed any yard work done (as they go out to help former residents with things like that as part of their team building/community work). Dusty thanked Jennifer for the offer, joking that taking care of Joyce's yard would be a full day's work and noted that he and the rest of Joyce's kids looked after property upkeep. Jennifer and Dusty talked with Joyce and thought maybe they could do a drive-by wave to Joyce as they went around helping other former residents and Joyce said that would be nice. Jennifer said that they'd call next week to check in with Dusty about Joyce, too.

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Joyce finished her lunch ~2 p.m., eating all of her fries and entire sandwich.

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Carol called Dusty ~2:13 p.m. to check in on Joyce. Dusty will setup a log book for Joyce's care and leave it on the counter to provide succinct information for family caregivers. 

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At 2:23 p.m. Joyce asked if she could be alone this evening. Dusty informed her that Connie would be coming by to take care of her. Joyce wondered if she could keep taking herself to the bathroom then the family could just leave her alone and she would not be a burden. Dusty let Joyce know that she isn't a burden and that there were a few more requirements than Joyce just being able to take herself to the bathroom that necessitated she have the planned family care for her.

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Dusty attempted to call Marshall (Kindred physical therapist) ~2:27 p.m. to apologize for missing him and to reschedule appointment for Joyce's initial PT session. Marshall did not answer so Dusty left a voicemail. Dusty discovered that Marshall had also attempted to contact Dusty's cellphone while he was driving out to the farmhouse (but had not seen the missed call notification or voicemail alert for them as Deandra was present and held his attention until her departure).

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Joyce reporting that she feels perkier today. She thinks she will take a nap later on, though, as today was very active for her. Dusty thought that might be a good idea. Joyce asked if Carol and Connie knew that they could just bring things for themselves to work on while they were here as "they did not need to entertain the baby." Dusty told Joyce he thinks they know they can just let her sleep, or read, etc. and just work on their own things they bring along when they are present.

Dusty took Joyce to the bathroom ~2:45 p.m.

Dusty got Joyce settled into her recliner and removed Joyce's lidocaine patch before departing the farm for the day ~3 p.m.