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.

Progress Report: Week 3 in Rehab

– The trach came out on Saturday!! He had no trouble and the hole is healing up with only a bandaid on it.

– Wednesday and Thursday were good days in PT and OT. He’s tossing bean bags in a basket and sitting up by himself for most of the sessions.

His aim could use some work, but they were all close.

– Swallow test on Monday showed he is still not completely safe from aspirating, but he is coughing less during sessions with E-stim. Had his first taste of ice cream on Friday.

Chocolate.  The electrodes on his neck are stimulating his swallow muscles.

– Alert more and engaging others in conversation. Surprised a couple people with phone calls where he did some of the talking.

He stood in the stand-up machine for almost 10 minutes before his blood pressure tanked.

On Tuesday of week three I got a call from the social services gal assigned to Dennis. She reported that the weekly meeting of all therapists, nurses and doctors had resulted in the decision to move him out, maybe by the end of the week. His progress was too slow to warrant the acute rehab aggressive schedule. He was often too tired or unable to focus for the whole sessions in PT. There were often issues with blood pressure and bowel problems this week as well. I understand what they are dealing with, nevertheless the change from 60 days to “out by the end of the week” was a little alarming.

The next day I went around to our local facilities in Hayward and got his name on their lists. There are three of them and they are all full with long wait lists. But since we could be waiting for years yet, it was still worth it to sign up for something in town.

After social services investigated facilities that would offer the needed therapies within reasonable travel distance, I was given the short list to consider. On Thursday I decided to visit the one rehab/nursing home that had an open bed. It was in Shell Lake, 40 miles from home. True, that would cut my travel time in half on most days but still… it makes me sad to be thinking of this level of care.

The building was acceptable and clean. The staff people who gave me a tour and spent time with me were pleasant and seemed candid about the quality of care given there. I felt it was a possibility, but was a little concerned about their ability to meet the needs of someone who can’t even turn himself in bed.

Back at home I happened on a friend whose mom had been in three different facilities as an Alzheimer’s patient. Shell Lake was the worst of the three. It was back in 2014 and things could have gotten better, but it did cool my already lukewarm enthusiasm a bit more.

I am praying that his progress toward the end of the week will cause the rehab team to reconsider and give him more days at Miller Dwan. It could happen, right?