1 June 2013
Both my daughters came to stay. My mother entertained them
by taking her teeth out and doing impressions of Popeye! Taking her teeth out in public? Unheard of!.
The angry, bitter resentful woman I’ve known for most of my adult life has been
taken over by someone who is FUN! I wish I’d met her before.
2 June 2013
General wellbeing: she is very frail and is at risk of fall
(she has a history of falls).
She has low stamina and “mobilises” (this is surely an
Americanism?) slowly around the ward area and requires supervision when
“mobilising”. She has limited ability to undertake day to day activities. She
is low mood. Needs occasional encouragement to eat and drink. Has reduced right
hand use since stroke. Although eating she is losing weight, She has increasing
SOB (Shortness Of Breath?) due to CA Lung (Cancer of the Lung?) - trachea and
bronchus. Also had a temporoparietal ischaemic infarc on 24/4/2013. Has had a
CVE (?). She has had a tracheotomy since 1968 for vocal chord palsy and it has
become evident that she is now struggling to manage it. Needs regular
nebulisers for her tracheotomy to loosen secretions. She has had diabetes since
1993. Hypoglycaemia (NIDDM). She needs someone to supervise her when she uses
the commode. Has been incontinent. Needs prompting with washing and dressing.
Needs prompting re personal hygiene and personal appearance. In particular she
needs prompting to “sequence properly”. Struggles with getting dressed and
undressed. Needs assistance with bath (needs two carers).
She is also forgetful at times and needs reassurance that
all is well. Moderate difficulties in communication and consistent difficulty
in making self understood by others or understanding others. She is hard of
hearing. This affects her ability to listen and interpret conversation. She has
problems using the phone. She is not felt to be safe with using a kettle / hot
appliances. Needs someone to be present to support and supervise. She needs support and prompting with her medication.
Can become muddled. Is unable to concentrate and loses her train of thought
very easily. Becomes repetitive
Overall her health status is “Very Severe” and is suffering
from an imminently life-threatening condition.
She has a son whom she sees regularly along with other
family. She worked for many years in the tailoring industry, She understand
that her needs are such that she must consider formal care home placement to
ensure her ongoing safety and care. Son has advised the care manager that he
was advised by staff at the main hospital and Hospice that his mother would not
be returning home and has given notice to leave her present accommodation.
Son has explained that tracheotomy tubes had become mouldy
and that she had been unable to use her sucking machine. Son advised that
mother has been flushing her medication down the toilet. Son has been told by
medical staff that his mother may not survive and was transferred to the
Hospice. Mother had been “fast tracked”.
When asked about her day to day relationships that she most
values she said her immediate family. (That’s nice to know!) But when asked to
give a score out of 10 for time she spent with family she said “zero”. When
asked if she received support from family, friends or other local people she
said “No”. (Interesting, she said that she gets no support with housework and
cooking, all of which is done for her!) In spite of me taking her out at least
twice a week for coffee she told them she only gets taken out occasionally at
weekends! Although I take her to all her doctor and hospital appointments,
she’d told them she only gets about ½ the support she needs. Although I have
taken over management of all her financial affairs since my dad died, she told
them that she does it all herself and gets no support from anyone! Apparently
there is no one person in particular who provides her with high level support?
And as her “Carer”, she said that I spend my time enjoying myself. One of
“outcomes” she wishes is to spend more time with her family.
She told them that she has no leisure activities and feels
she needs to be kept occupied.
She is in pain and it is currently being managed by opiate
based analgesia. Her current medication
consists of: Glicclazide, Clopidogrel, Mirtazepine, Simvastatin, Perindopril,
Senna
Fentanyl patch Amitriptyline, Paracetamol.
She has marked and regular disturbances of mood/anxiety with
noticeable impact upon behaviour, functioning, or interaction. eg withdraws
from others and has extended bouts of anxiety, tension or worrying, negative
thoughts. She is worried about being “put into a mental hospital”. She has
marked forgetfulness; short term memory issues; repetitive speech and delirium
episodes. She was not able to recall the year nor the date WW2 started.
She has insufficient appreciation of risk / implications of
actions / decisions in some areas of a person’s life.
Mrs Napper appears to be unaware of her difficulties at home
with managing her tracheotomy, sucking machine / nebuliser. Ward staff reported
that the sucking machine was “very grubby” on admission and as a result was
increasing her risk of infection.
She has occasional behavioural problems that are out of the
ordinary causing concern to others. May be socially unacceptable or mildly
self-harming. Her doctor reports volatile behaviour and reports that she
accused him of forcing her into an asylum.
She has worsening physical condition. Diagnosis of life limiting illness
and in need of palliative care.
Son is frustrated as he has been informed that Mrs Napper
was being assessed for “fast track” continuing healthcare because of her
rapidly failing health but nothing has happened.
She feels her memory is going and worries about that. Has
accepted son’s worry for her and has agreed to residential home. She is very
worried about going into a “mental hospital”. She is worried about moving into
an environment where there are people with mental health issues. She describes
these places as “mental home”, “nut house” and “asylum” Reassurance given and
son is happy to support the process.
3 June 2013
Good News! Mum has been transferred from the General
Hospital in Exeter to the small cottage hospital in town. Bad news: the cottage hospital doesn’t have a coffee
shop. However, I am still able to take in supplies of brandy and coke for her.
4 June 2013
More Good News. Mum has been awarded funding for her to live
in a Nursing Home! There are trained nurses on hand who can deal with her
tracheotomy. I am taking mum to look around next week.
5 June 2013
I have at last finished clearing out mum’s room from the
Home she lived in. I have arranged for a second-hand furniture man to come on
Saturday to take away the furniture she won’t be needing, including her bed.
The deadline to clear her room is Sunday!
11 June 2013
Collected mum from the hospital to take her to see the
Nursing Home where she is going to live. Mum was overwhelmed by its splendour:
this is nothing less than a minor stately home. We entered through the
magnificent entrance into the oak panelled Hall with its grand oak staircase
sweeping down, We were entertained to afternoon tea by the Matron in the music
room with its grand piano, elegant chandeliers, oil paintings and comfortable
armchairs. The Matron couldn’t have been nicer or more reassuring. We then took
the lift up to the 3rd floor to see mum’s en suite room, with its view of the
gardens and beyond to the open sea. To
say that mum was over the moon is an understatement. I thought back to my great-grandmothers, Fat
Granny and Skinning Granny, who had spent time in the Workhouse. It was
strangely satisfying to know that my mother would spend her final days in such
a beautiful place.
12 June 2013
My sister has come to stay and spends the afternoons
pampering mother with various lotions, creams and nail varnish: which of course
mother loves. Vanity does not diminish even with dementia!
21 June 2013
My mother had moved for the 47th time since she
married my father. She has settled in very nicely and is enjoying living in The
Nursing Home. She loves the staff, the food, the people, her room, the view.
She sits with her new friend, Nora, during the day and has her meals with two
new friends both called Margaret. Although still very muddily, she has improved
a lot physically. She has not needed to use her sucking machine since she's
been there, and she is pain free. The staff are making sure she takes the
medication! However, mum has forgotten how to put her tracheotomy tubes in, and
needs help to do it.
She is generally lucid, but we tend to have the same 2
minute conversation over and over again. But I am enjoying spending time with
the “new” mum. She is happy and contented and dare I say, fun?
23 June 2013
The staff report that there are still traces of the old mum
there. A member of staff overheard mum telling someone that she hadn't had a
bath since she'd been there. The senior nurse and manager, gently asked mum if
she needed any help with a bath. What mum heard was, "You are a dirty of
old woman in need of a good scrub".
The manager tried to explain to mum that everyone has to have assistance
because they are special baths with a hoist and not to take it personally.
The manager took me to one side as I left to express her
concern that mum's personality seemed to flip and she easily takes offence.
"Yes, welcome to Maggie world!" I said. Apparently, the manager
eventually hoisted mum into the bath. She tried to placate mum by making a
comment about how nice her skin is and how it glowed. "Yes" said mum,
"It's because I scrub it clean every day having a strip wash."!
25 June 2013
Mum is hankering to have her sewing machine back. I spoke to
the Care Manager and said that I felt that mum didn't have the physical agility
in her hands, or the mental capacity in her brain, to take up sewing again. The
manager agreed but said maybe we should put the sewing machine in her room, but
keep it in its box, so that mum can see the it. I suggested that mum should
only use the machine under supervision, down in the lounge. (It took mum over
an hour to thread a needle to sew on a button when she was in hospital.)
27 June 2013
The Nursing Home has made an appointment for mum at the Head
and Neck clinic at the Hospital. They have arranged transport and one of their
nurses to accompany her. What a relief to know that mum is being so well cared
for.
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