The Care Plan Meeting

Because of the apparent, sudden personality changes that the staff at "Courtland" observed in Fay, I asked them to hold an early care plan meeting which I could attend. They squeezed me in at 10:00 today, 15 minutes earlier than the normal start times for these meetings.

I arrived at the nursing home at 9:50 and was directed to conference room 1A. I assumed that if they had numbered conference rooms there would be several to choose from. In fact, there seems to be only one conference room. So 1A is a better room number than, say, 5B, or 207.

At about 10:00, the team arrived. Glenora, the social worker, conducted the meeting. She started by asking Bonita, the nurse in charge of this unit, for her observations and assessments. It seems that Fay does sometimes act abusively to staff and residents. But the behavior is transient and she usually becomes pleasant again quickly. All the staff are trained in dealing with patients with dementia, so they know not to associate this behavior with the patient, but with the disease. Bonita reported that the psychiatric nurse feels that reducing the dosage of the Alzheimer's drug (Nimenda??) may not be a good idea. I am to check with the nurse practitioner to see if she agrees.

Rachel, the activities director, said that Fay likes to go to activities, although she doesn't participate actively in those that require cognitive activity (like the daily trivia quiz). (Who is surprised by that?) Fay particularly likes the intergenerational programs (which I think means kids singing songs).

Christine, the dietitian, says that Fay's appetite is good. She eats 75% to 100% of each meal. I asked how she feeds herself since she doesn't use her right hand. That fact seemed to surprise everyone. Hmm.

All in all, it was a reassuring meeting. The team seemed to understand the situation well and was prepared to handle Fay's needs.

After the meeting I found Fay waiting with Rebecca for the trivia contest. We left the contest and went back to her room. Fay had her hair done the night before and still had the baloon on her wheel chair from the April birthday party yesterday afternoon.

Sign Of The Times

One of the things that attracted us to the Jewish Convalescent and Nursing Home was the haimish feel of the place. Kosher food, some men wearing kippot, a bima and prayer books set out in the dining room, etc. But times are changing.

Just like the Cedars in St. Louis is losing its Jewish identity (are there a dozen people using the kosher dining room?) so is the Jewish nursing home in Baltimore. We learned this weekend that the home has been renamed Courtland Gardens to reflect the fact that "the demand for long-term care services within the Baltimore-area Jewish community was not sufficient" to support a Jewish-only residency. But, says the notification letter, Jewish residents "will continue to share in the traditions of living a Jewish lifestyle." "One thing is certain," the letter goes on to say, Courtland "will continue to maintain the hightest standards" of care.

Thank goodness for that.

Closer to Her Old Self

Today Fay was finishing lunch when we arrived. On Shabbat, all the meals are cold. It looked like Fay had done a pretty good job on the white fish salad and veggies, but left the potato salad. She was drinking milk from the carton, sitting next to Rebecca.

We brought the old phone from the Cedars, programmed with my home, cell, and work phone numbers. It's one touch dialing; we'll see if it works. We were about 1 for 3 in the experiments we tried. Not too good for phone dialing, but it will get you into the Hall of Fame if you play baseball. The other advantage is the answering machine. We can check to see if anyone calls during the week and get back to callers who leave a message.

It was hot in Baltimore today. We went outside and sat in the gazebo, read the Baltimore Jewish Times and looked at some pictures. Then we went inside for the ice cream social. Some of Fay's old personality shone through the confusion today.

She asked me if she could pay for the phone.

She told us not to spend our money at the hardware store (we told her we were getting some stuff for our deck-garden).

She reminded us to say goodbye to Rebecca (after all, she has to live with her).

The Problem With Blogging

I can see that blogging has its sinister side. Once you start, you feel like you need to keep going, like a diary. Then you worry that, unlike a diary, what you post is available for anyone to read. It's like being an exhibitionist. You want to share, but somehow you worry that it's wrong.

Today the nursing home called to say that Fay was being verbally abusive to her caregivers. She has had outbreaks like this before, but I thought things were getting better. But today she hit her caregiver. The nurse practitioner will increase the medicine that is supposed to calm Fay down. I suggested that they check for a urinary tract infection, which sometimes makes her act strangely.

So here we go. My friends tell me what a good idea it was to move my mom to Maryland. "Now you won't have to feel guilty every time something happens and you can't be there," they say. So now I feel guilty that I have moved her from one situation, where she was apparently comfortable with her surroundings (albeit lonely for me and Margie and our kids) to one where she must feel threatened by her caregivers (and still lonely).

Go figure. Things will work out.

Spring Has Sprung

The weather in Baltimore is 72F with a few high, whispy clouds, and hardly a breeze. We took Fay out into the courtyard this afternoon for her sugar-free ice cream snack and manicure. Margie only wounded Fay once during the manicure, but Fay didn't seem to mind. Basecoat, polish and topcoat. Ready for another week.

You can see that the beauty shop has become a little more adept at styling Fay's hair. It has grown out some and the new set looks good. Not as much hairspray as Fay has used for the past, oh, 60 years, but attractive nonetheless.


Fay seemed a little confused today. She talked on the phone with Wendy and then with Sarah, but at times the conversations seemed to take strange twists. I think her ability to articulate her thoughts is lagging the thoughts themselves. Sometimes by the time she thinks of how to say what she had on her mind she has forgotten why she wanted to say it. The nurse practitioner and doctor are of the opinion that the memory and Alzheimer's drugs are not doing anything (and their efficacy is controversial anyway) so we have started to wean her off them. Maybe we need to re-think that strategy.

Birthday Cards, Etc

Today (Saturday during Pesach) only Denny came for a visit. Margie was with Fay yesterday when she brought Wendy and Simon for a visit.

Fay was all dressed up in a velvet skirt. I'm not sure if it was because of Shabbat or the staff just find the skirt easy to put on. Anyway, another visitor or volunteer said that he saw Fay at services this morning. That's a fine activity for a rainy Saturday morning.

I signed Fay up for a special Medicare program that provides an LPN and drug coverage (like Plan D) for nursing home residents. The LPN had given Fay an examination earlier in the week and gave me a report on what she observed, some things she was going to adjust, etc. I mentioned the visit to Fay and she said she was looking forward to meeting this lady. (Events an hour or two in the past or often lost to her now, much less something that happened three days ago.)

I also found birthday cards from my good friend Mike Goldfinger (see post below about A Friend in Need) and Fay's sisters-in-law Lydia and Rosie. Fay wants me to tell everyone how happy she is to get the cards.

Visit from the Grinbergs

Here are a few pictures from Wendy, Misha and Simon's visit over Passover. They were excited to wish Fay a happy 89th birthday. The great grandson and his great grandmother thought one another were, well, great!





Simon wasn't too interested in the birds or the fish, but he had lots of fun throwing the camera case and then picking it up.



He also appreciated the toddler-level microwave that reminded him of the play kitchen.


Everyone liked listening to stories.





Grandma Fay especially liked Simon's shoes.


A favorite comment overheard in the sun room--
Clue for "giant" crossword: I think, therefore...
Best guess: I think they're five!

Well, we think you're swell, Grandma!

Settling Into A Routine

Saturday afternoons are starting to take on a comfortable routine. After Denny has his workout and Margie does her morning activities, we go to the nursing home for a visit with Fay. By the time we get the home it's about 1:30, which is just in time to do a little schmoozing in the room before we go to the dining room for the start of the ice-cream lady's program. We discovered that she has sugar fee ice cream, which apparently was better for Fay than the two scoops of chocolate that sent her blood sugar through the roof last week.

We don't stay for the trivia contest and story telling. We go next door to the solarium and read stories. Fay gets a free copy of the Baltimore Jewish Times, so we read some of the more interesting features, like the resumption of a kosher food stand at Orioles' games. (A favorite of Evan, when he lived in Baltimore, were the gigantic knishes that they served.) Margie has become quite a manicurist. It's a nice touch to have someone fix your nails and Margie has gotten very good at this skill.

You can see Fay displaying her manicure above.

Another fun touch is that we have met a young Orthodox woman and her two little girls who walk to the home every week to visit the residents. Fay gets a kick out of chatting with this family (plus a young friend who usually comes too). An interesting note is that this woman's grandmother lived in St. Louis and owned the Evergreen Nursing Home, which I think is where my Aunt Beckie lived for a while. The other link to Aunt Beckie is that Fay's room mate's name is Rebecca Wolfe, which was this same Aunt Beckie's name. I've tried to explain this several times, but I don't think there is any comprehension.