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.

Thanksgiving Dinner

Today I went in to visit dad. As always, the building is beautifully decorated. There are many Thanksgiving symbols and decorations. As I approach the front walkway I see huge bales of straw, with stuffed Wizard of Oz people made of hay, pumpkins, and bright orange ribbons. The activity staff put up cute little turkeys, too. Indoors, the floral arrangements are in tune with the theme and fall colours. It is cheery and a recognition of the changing of the seasons. I must dig out some decorations for Dad’s room.

The kitchen staff prepared a wonderful dinner. Brian doesn’t like turkey and so I am quite envious of dad’s full dinner; turkey, stuffing, hot vegetable and pumpkin pie. We will not eat so well, as there are only the two of us. We are drained with the demands of regularly feeding dad. I have found it much easier to visit Dad and feed him at dinnertime, rather trying to drum up conversation. I have the need to cry when I visit, but I can fight it if I concentrate on meeting Dad’s dietary needs. It means that Brian and I often go out to dinner after this, since I do not get home until dark and too late, with little energy to cook.
I sit there thinking of the numerous turkeys Dad had prepared. His job is to put the turkey in before church. He will quietly go about the kitchen making the stuffing; cooking and saving the giblets for whichever animals he had at the time. The cats loved them.
One of the photos I displayed for Mom’s Memorial Service visitation is one that shows them two years ago, aprons tied, Mom at the sink, Dad at the stove. He wore a bright pink vest over his dress shirt. Mom wore a white, embroidered sweater. Both dressed in black dress pants. They always take pride in their appearance. They hated it when people popped in, especially when they become so ill. Mom spent all day in her pajamas, as the tumours are painful and her colitis horrible, with emergency visits to the bathroom on an irregular and unpredictable basis.

Dad is calmer today, Monday, than he was on Sunday. He can’t figure out the hearing aid. He keeps turning up the volume, making it squeak. He reads lips a lot. He loves the ladies: cheering up every time a young caregiver pops in. He smiles and turns on the charm. He seemed to accept being fed as a gesture. It is only fitting that the person that nurtured and fed me should be, in turn, be receiving such care. I cry on the drive home, for moments lost to memory, never to be repeated. A childhood remembered with great joy. The photo shows them making the last Thanksgiving dinner they ever made. I will become an orphan. I am now the matriarch. How different it all feels.

Incontinence

Brian arrives before 8:00 a.m., in time for breakfast. Dad ate a double ration of breakfast. All seems much better. Perhaps, as the Charge Nurse says, he needs to become acclimatized to his new surroundings. When I arrive at 3:30 in the afternoon he is sleeping. I walk into the room and he is quiet and peaceful. He is now incontinent. Depending upon others to clean him up and change his adult diapers, bedclothes and clothing. When he awoke we tried to communicate. He tells me, “You don’t have to do laundry.” As always, I just nod and smile. There is a time, before Mom and Dad deigned to purchase hearing aids, that Mom will nod and smile to everything I would say. She really did not hear what I said, but does not want to admit that she could not hear us. What a weird turn of events.