Sunday, October 15, 2006

Case Conference for Dad

The law states that there must be annual case conferences for residents in Long-Term Care (LTC). Today is the day. Aside from the intake meeting, we keep careful tabs on my father. There is little we do not know. We find that popping in at different times of the day has keeps us apprised of different issues and situations. We have met various staff members who work on the different shifts. Aside from coming in every day to feed Dad dinner, we pop in if we are in town for an appointment or an errand. I have come to know the reception staff. They are very kind. We share stories of parental issues. One woman has dealt with these very issues with which we now deal. Her mother would refuse food in her presence and eat later. Her mother agitated when she is there visiting - perhaps blaming the daughter for the frailties of old age and the insult of leaving familiar surroundings.

Today there is an accreditation meeting for the nursing home. Our case conference conflicts with this event. Dad’s doctor, who is responsible for the entire floor of patients, sees us in the hall outside the nursing station and apologizes that he cannot make the meeting. We went upstairs to see Dad before the meeting. He sees us and says, “What are you doing here this early?” It is 10:20, just before our 10:30 meeting. He must have some remaining sense of time and that we visit at dinner time on most days. He cannot really understand what I am saying – that we have a meeting, maybe. He is talking gibberish.

The case conference is in our familiar Muskoka Room. I have taken Dad down the hall to where our meeting will occur. As a teacher I always included students in our parent-teacher meetings. I think it an important thing to do. It is a small conference with the charge nurse, and another staff member, a PSW unfamiliar with dad’s case, and us. They tell me Dad has been aggressive with a caregiver. He was agitated and grabbed her arm. They tell me he is refusing a bath. He did this for two weeks at the Manor in the summer. This is not my father. As we talk Dad wheels his chair around the large, heavy pine table. He gets caught up on the table leg. He is talking out loud. “What do we deliver to?” And later, “Where can I go to a radio activity team?” I sit and write these things down as we talk. It gives me a focus and a purpose. I find it surreal, these interactions. I bought a spiral bound book to record all the information.
The PSW suggests that we get Dad involved in some activities. He cannot hear. He refuses to interact when he is embarrassed. They suggest music therapy. Dad loves music so very much. If he can only hear that might be a good bet. I ask if they can arrange to have the resident hairdresser cut his beard weekly. It grows so quickly. His hair, on the other hand, what is left of it, is straggly from the radiation treatments in the spring. It is very fine and wispy. They tell me about the massage therapist, as well. I knew she existed. I had previously contacted her and ask that she try a visit once a week. It might help his circulation and improve his well-being. I have questions about dad’s medications, but since the doctor cannot attend the meeting I will have to try and talk to him later. This proved the most difficult challenge of all: trying to talk with the busy doctor, especially at the most crucial times. He is only in the residence once a week.

Eventually, I learn that the best person to talk to is the Charge Nurse when I visit at mealtimes. She knows more of his behaviour and can speak to the doctor on our behalf. We have full power of attorney, both medical and personal, as is the case with about 90 % of the residents in this wing. I began to suspect that Dad is in pain, but cannot be sure. I had to figure out what to do with this information. They can give him Tylenol 3, but, since he has had arthritis pain in his knees for years, I think it will not have much of an effect on him.

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