Care Conference

Gregory’s current situation actually consists of two parts: 1) Responsive Behaviors and 2) Permanent RCA (Resident Care Associate)

Everyone seems to be reporting that Gregory has been experiencing an increased agitation in his responsive behavior as well as his every day “at rest” behaviors. This includes RCAs, Nurses, Manny, Hospice, Dr. Barris - Neuroligist, and me. Perhaps it is time to increase as minimally as possible his Risperdal.

According to Dr. Barris, who made it clearer to me, Gregory without language is not able to process or monitor his daily emotions. In many situations he does not know if he is safe or if he is in danger. The purpose of the Risperdal is to help keep him even so he doesn't feel he has to process or monitor, so that he just knows that all is good.

While the initial administration of the drug caused Gregory to be very sleepy, lethargic, and unengaged; he did slowly regain those energies and for quite a few months did very well; both even of mood and alert in demeanor. It looks like Gregory is needing more support either because his condition is advancing or perhaps the drug is loosing its effectiveness.

Lieberman, as it always does, sought my permission for the increase will carefully monitor any changes for better or worse and act accordingly. I believe that the increase is to help Gregory be more comfortable inside himself, not to make anyone's job easier!

A permanent RCA is one who gets to really know Gregory and his needs. They know when Gregory usually needs to be changed. Gregory gets used to that person being by his side more often then the others who support in changing him.

Recently his daytime RCA left to begin nursing school. I am very happy for her but sad for me and for Gregory. Yet again time for adjustments. This issue, however, troubles me a little more. There has been some issues with getting another RCA to take Gregory.

His leaving RCA and his evening RCA report that they do not see Gregory acting much differently than usual and that they feel they are used to working with him. He has the tendency to stiffen when rolled and calls out loudly when uncomfortable, unhappy, and/or frightened.

He does not like his “privates” to be cleaned especially when he has had a bowel movement. But usually Gregory does not physically “fight,” he just resists and gives loud verbal complaint! Because his regular RCAs know him so well, they are able to handle working with Gregory. They are able to anticipate when Gregory needs to be changed and also Manny keeps an eye on this.

Assigning a new daytime RCA is currently under consideration and prospective candidates are worried about how hard it is to change Gregory. They are assisted by one other person so that should not be an issue. Manny will be in the picture assisting so there will always be three people to help change Gregory. Difficult, back pain, and health issues should not be a problem. 

Also, I cannot believe that Gregory is the only “difficult” resident. What causes me concern in that with the attitude that “Gregory is a difficult resident,” the love and human care that needs to go into working with Gregory seems will be missing? 

Which RCA will go out of their way to make sure his needs are being met? Who will make sure the necessary supplies are stocked in his room? Who will really get to know Gregory and support him? Who will be there for him especially on the days Manny and I cannot be there?

In addition, a continuing ”pet peeve” of mine is that I am providing Manny who, not only is a great help to Gregory as well as so many other residents, he takes on many of the responsibilities usually assigned by the RCAs including feeding, shaving, brushing teeth, transporting, hydrating, applying and lotion. He attends him in supervision, etc. Hospice now is giving Gregory his baths which gives back more to the RCAs. I am with Gregory almost very day which makes the RCAs job easier again. Periodically, including this time, I bring up "What 'pay back' is Gregory getting?"

I expressed these concerns at the quarterly Care Conference and believe my concerns were heard. Already the Nurse Director has been working on the situation and she will continue to do so and get back to me as soon as a decision is made as to who Gregory's new RCA will be during the day.