November in a Nursing Home

Freezing rain, snow showers, car covered with dirt and salt spray, gray skies, darkness before we are ready for it. It’s definitely November in Wisconsin. My daily trips to Spooner seem short by comparison but they still are challenged with this weather.

I am learning how different a nursing home is from a rehab hospital – something I knew in my head but experience emphasizes it. Some days I am dismayed with the care the husband is given. Some days I feel much better about it. Several days I have had to wake him up and get his care started without help. The weekend was actually frightening with the staff being stretched thin and several incidents happening. I wasn’t sure Dennis was getting his meds or his feedings on time or at all.

Today I arrived late in the morning and all was peaceful and calm, the room was straightened and my husband was dressed and sleeping in his recliner. But let me tell you about yesterday…

Somewhere between his speech therapy session, which I was told went well, and his PT session something happened to Dennis. He was much different, being unable to participate in his PT transfers, unable to keep himself upright, and not being responsive to questions and general talk. He stiffened and was hard to move and slept for hours without his usual requests for position change or the urinal. I wondered if he was having a second stroke. After a couple hours without improvement, it was decided to pack him up and go to the hospital ER for evaluation. The ambulance came and got him.

I will mention here that he didn’t want to go and had to be talked into it. He saw nothing wrong with the way he was feeling. I knew something wasn’t right but didn’t know what. I’m the one who has to think about him needing emergency care. Emergency care in the nursing home amounts to an LPN doing chest compressions while waiting for a phone request for a doctor to show up – no monitoring, medications or personnel familiar with running a code. I pretty much scared him into going by telling him to get evaluated or risk dying in his bed.

At the ER we got so much information over the next five hours. He had a urinary tract infection but the good news was that he didn’t have Covid, didn’t have pneumonia, didn’t have a second stroke or heart problems. He got a dose of antibiotic in his feeding tube and another ride back to Maple Ridge in the ambulance.

I went home and was settling down to sleep when the nursing home called to say Dennis was on the way back to the ER because his feeding tube had come out. I had heard a popping sound while watching the ER nurse give the antibiotic but I assumed she was familiar with the ports on his feeding tube. I asked her if one of them was the inflation port for the balloon that kept the tube in place in the stomach. She said yes, but didn’t seem concerned. The balloon had broken but the tube didn’t slip out until back at the nursing home when they moved him about.

Dennis got a new tube put in and two more rides in the ambulance. What a night. And, as I said, he is pretty hard to wake up again today, but with reason.

I find it hard to sit and watch him sleep. He is unable to wake up long enough to focus on anything or communicate more than a word at a time. I hope that as the urinary tract infection clears up, he will revive, be himself again and resume therapy.

Our setback matches perfectly with the gray, wet, coldness outside. It’s November.

He has a window. The view is not very impressive.

On the Move Again

Dennis is missing lots of beautiful sunsets, but the sun is setting on one more of his stroke recovery experiences.

It’s been 23 days in “swing bed” status at St. Mary’s in Superior. The husband has become accustomed to the people, the environment, the routine. So, naturally, it is time to change things up again.

Thursday, November 3: Care conference with the case manager, therapists, in Dennis’s room and with me on the phone was concerning. The physical and occupational therapists have noticed that he has trouble remembering steps and sequences for moving. He doesn’t seem to be able to build to a greater skill level because of that. He heard this report and later when I questioned him he agreed with their assessment.

The goal with these physical therapies has been to make transfers possible without mechanical help and multiple people. Dennis has muscular strength but he doesn’t know how to direct it when it comes to complicated (yes, complicated!) movements like standing up, or sliding over. He has reached a plateau. They feel he should transfer to another long term facility. His only remark was that it should be as close to home as possible. However there are no beds available in Hayward.

Friday, November 4: By the time I reached the hospital parking lot my plan for the day got scrapped. I got a call that there was a bed available in a town 30 miles from home. I had not visited this facility but decided to say yes to it, pending approval after I had seen it. Dennis and I discussed the move. He’s already dreading leaving this batch of new friends…

It is so confusing to navigate the rules of Medicare. If it were not for the social workers and case managers that we have encountered I would not know what to expect. They are very good at keeping track of how many days are left at different levels of care, and how to keep Dennis getting some more time with the therapies he needs most.

One of the most improved areas lately has been his work on swallowing. He has steadily increased the time on the E-Stim device and the number of swallows he takes. I am glad that the speech therapist made sure he got one more evaluation with the fiber optic camera and it did show improvement. He was given the choice of having some soft foods like pudding if he was okay with the slight risk involved. But there is still more work to be done before he can consider having the feeding tube removed.

Tuesday, November 8: I visited the new facility in Spooner yesterday after my time in Superior with Dennis. It was neither greatly good or greatly bad. It’s hard to be specific about what makes some places clearly “nursing homes” and other places “hospitals”. Sometimes it’s the fact that many nursing homes are in older buildings, abandoned for their original purpose or dated in some other way.

Maple Ridge Care Center is a former hospital with several wings off a central nurses’ station. There are parts of the building that are completely unused. One section has been made into a daycare for the employees children. The outside of the building and the grounds are neglected, sidewalks and curbs cracked and crumbling, the foyer sports a rumpled rug at the entry and leaves and debris have blown in from outside. Doors in the hall are open showing offices with varying degrees of mess and disorganization.

The better aspects of the facility were the people working there. Many of them were young and appeared competent. The patients were mostly sitting around in wheelchairs watching birds in the small aviary or playing bingo in the dining room. Therapists were wheeling people back and forth after their sessions. It looked busy and fairly happy.

The room where Dennis is most likely to end up was large and empty. Some painting or repair had taken place and it hadn’t been refurbished yet. I could see it being a nice room, although it was in the long term wing instead of short term rehab. I’m not sure if there is a message in that, probably not. I hope they are getting it ready today since he is scheduled to leave Superior at 9 a.m. tomorrow.

I will try to be there to meet him when he arrives – they have open visitor hours 24/7. They also have some Covid patients that they keep in quarantine. They evidently aren’t having too hard a time with the virus. One other concern about Maple Ridge is that I’ve noticed it’s hard to get anyone to return a phone call. I will have to train Dennis to pick up his own phone when he gets there.

For anyone wishing to send a card or letter to welcome Dennis to his new place, the address: Maple Ridge Care Center, 510 First Street, Spooner WI 54801

510 First