Dental Care at Lieberman

Based on a technique that the dentist used with Gregory yesterday, we have started a new tooth brushing routine. It is important to keep Gregory's teeth and mouth in good condition as a cavity or gum problem for people with dementia can be a major catastrophe including the need to go to a dental surgical location in an ambulance, putting the patient asleep, and filling the cavity.

We tried our Sonicare toothbrush but to no avail as Gregory hated and fought the hight pitched vibration and the intrusion into his mouth. As suggested by the dentist, I purchased a more reasonably priced rotating toothbrush head by Colgate. The head spins and provides multifold bushing with ease and with less vibration.

Wearing rubber gloves, I stuck my thumb into Gregory's mouth - being careful to not be in a position to be bit. I talked through and assured him about the whole experience as it was taking place. With thumb in place, one at a time I gently pulled his lips and cheeks out and away from the teeth as I glided the rotating bush head, gently and slowly against his teeth. First top, then bottom, then repeat inside.

Gregory was not happy, shouted through the mouth full of toothpaste, equipment and fingers ... but did not fight me. I continued to talk through the process with assurances that it was almost over. The turning point came towards the end, when I told Gregory that his mother IS so proud of him that he doesn't have any cavities. He calmed down and smiled.

I let him hold the toothbrush while it was on so he could feel it and helped him to use the brush to brush my teeth. He seemed to enjoy that.

Care Conference

Gregory has been at Lieberman a little over three months and I have attended six Care Conferences to discuss his progress and needs. That is a meeting twice a month! Every time I take a long list of questions, concerns, and quandaries. 

Every time I come away from the meetings feeling listened to and content with the results. The meetings are always attended by the Head Nurse, the Social Worker, and depending on what we need to discuss, others. 

This time we were joined by the Nutritionist and the Restorative Nurse Supervisor.

• • •

BOLDFACE WAS ON CHECK LIST WHICH I BROUGHT TO MEETING.
Italics is what was discussed at meeting.

• • •

CHECK and CHANGE: How going? Records/regularity? (Being kept by RCAs) Hover over chair or in bed? (Depends on need)  When changed how cleaned? (Warm cloth and special soap) Is special soap used so rinsing doesn't affect his skin? (Yes) Is “tushie cream” used every time? (Yes)

The Restorative Nurse reported that Check and Change is going well.

Use of Urinal Training has not been successful as physically it is difficult to accomplish in time before he "messes" and Gregory is not able to help.

I reported that I am NOT confident that the Check and Change every two hours is going as well as I would like. When Gregory is discovered to be wet there usually is not enough time and/or staff available to get him changed so he ends up "sitting in it" for 3 or 4 hours until they can get to him. Often he sits in his urine and/or feces during meals. Also, from my observations, human nature causes the “check” part to not take place as often as necessary. 

I know that Resident Care Assistants (RCAs) are doing their best, that there are times when changing him is not possible because it takes four people to do so; the nature of scheduling, moving patients, floor needs, etc are getting in the way of Gregory’s care.

I proposed that staff should check for "messes" every hour NOT every two hours. That would not take more time or cause Gregory to "mess" more often but rather might bring his being changed closer to a manageable time through out the day. 

It was agreed that this will be done.

I proposed a way to resume Urinal Training. I purchased specialty pants which zip down both sides to the knee? Sometimes G does give signals that he needs to go and if one can get into his "area" quickly perhaps we can "save the day." 

I also purchased a woman's urinal box which seems to be angled more appropriately thus allowing Gregory to urinate while sitting. Also, we can try  a "penis friendly" urinal which I created using a collapsible, flexible silicone funnel attached to a water bottle. 

Staff will be trained to use the new idea as will Manny, Gregory's private care help.

A change in Gregory’s permanent RCA's for Days and Afternoons was made. Previously I had insisted that the RCA be in Gregory's wing and therefore closer to his needs. "Floating" RCA's have fewer people to take care of. Now that Gregory is not in as much need as he was the first month at Lieberman, proximity of RCA is not as important.

I think the new people will be better suited to meet Gregory's needs.

What kind of Active Assisted Movement will be given now that Gregory is no longer in OT/PT? By whom? When? 

Stand now and then? Sit now and then? Walk now and then?

Active Assisted Movement takes place every morning. Each resident works with a RCA for 15 minutes doing exercises like tossing a ball or leg and arm movement. Also, Manny will be trained so he can provide more activity and exercise throughout the day besides the regularly scheduled times in the morning.

We went back and forth on "standing, sitting, walking" regarding safety for Gregory as well as the staff. I fought for not "giving up" on him yet even though PT/OT thinks he must always be in the wheel chair and moved with the Hoyer lift. We compromised in that there will be a new screening and review by PT/OT. Also a new kind of wheel chair without foot pedals will be tried which might allow Gregory to "walk" himself around the unit.

CONCERN: There are many things that the Private Care Aid I have hired provides for Gregory between 11:30 and 5:30 and which relieves the RCAs of some responsibilities and allows them more time to be with their other duties. Some examples: Need to be shaved, to be transported from place to place, to be fed, to "entertain," calm, or otherwise occupy Gregory's time, Need to be supervised.

I need to feel that some of that time is being given back to helping Gregory. Right now his most important need is with bath rooming and being kept clean since he mostly has to "mess his pants." My concerns were heard and recognized as valid. With the above changes I feel this will be accomplished.

Current doctor reports? podiatrist? eye doctor? 

Any changes are reported, if no change assume everything is OK.

Adhesive on neck has really helped keep Gregory's neck strong.

No need for that now but muscle power in neck will be under observation.

Has he been showered in shower chair? Belly Button is full!
Teeth brushed. When? How often? By whom? Doesn't seem to be happening.

While shower chair discussed previously, not yet acted on. Will begin now. Teeth should be brushed twice a day. With new RCAs should happen now. I made myself available to "help calm" by being available for first few shower times.

More sir! Lunch and dinner, please. Sometimes a "regular" portion is enough for residents but not enough for Gregory. At times Manny or I ask for seconds if there are any left. Also, can he have more fresh fruit and vegetables. When does he get evening snack?

Evening snack consists of apple sauce or ice cream. 

Even before my mention, it was noticed that Gregory has lost some weight and has been put on mealtime "double portion." If Gregory is ever still hungry, Manny should ask for seconds. If none at station on floor, worker will go down to the main kitchen. There is ALWAYS more food available!

We talked about adult life time usual 155lb weight, his recent developing a "little belly" 180lb weight, and his current 167lb weight. Will keep an eye on what his NEW optimum weight might be. 

Will add more fresh fruit and veggies. 

In touch with Psychiatrist who has been following Gregory? Psychiatrist who chatted with Hannah about what to expect in general with Young Onset Alzheimer's patients.

Done.

• • •

It continues to amaze me how wonderful the care and concern for Gregory is. Often the staff is "ahead" of me when a concern develops. They are open and willing to try my suggestions but also know when they need to "educate" me on the realities of Gregory's situation. I cannot say enough about how wonderful each individual person is.

Meanwhile, I Die

Most nights I don't just go to sleep. I die.

There are so many things that can go wrong at bedtime and being tired myself I don't always handle them as well as I should. Although I am getting better.

The hallway from the front door to the living room runs parallel to our master bathroom. So it is sometimes difficult for Gregory to know where he needs to go to brush his teeth. This evening he was hanging out in the hallway and I asked, "What are you doing?"

As usual he couldn't really explain so I followed up with, "There isn't anything out there that you need to worry about now."

He disagreed.

I suggested, "Do you want to brush your teeth?" as he reentered the bedroom.

"Yes. That is what I was going to do."

So I pointed to the bathroom and said, "That is where you brush your teeth."

He proceeded to go into the bathroom and brush his teeth.

Meanwhile, I died.

This is a new behavior that I have just identified at bedtime, although at other times, when I tell him to go into the bathroom, or the guest bathroom, or the TV room, or the bedroom; he is not sure where I want him to go.

Brushing his teeth is also confusing. He can find the toothbrush and toothpaste (although never puts them back where they came from, I do that for him.)

Figuring out how to take off the cap on the toothpaste, squeeze a nurdle of paste onto the brush, wet the brush, and then brush and rinse works most of the time.

But every third, or seventh, or nineteenth time he get frozen at one or another of the steps so I have to unravel the mystery for him. The hard part for me is the coming and going of his intermittant ability and that clouds how I react.

Sometimes I can "swallow" my reaction, other times I comment on the absurdity of his behavior if only because after the fourteenth or fifteenth time I forget that he gets confused while brushing his teeth. I treat him like his "normal" was my "normal" and then apologize.

What I cannot do for sure is explain to him where he went wrong or why, for example, explaining to him that filling the cap with paste after taking it off the tube of tooth paste is not part of the process.

Meanwhile, I die.

Taking his daytime clothes off and putting them on the bench for me to put them in the closet doesn't always work. He stops short of his underpants and undershirt and if I say something like, "Take off the rest." That makes no sense to him. If I point, it doesn't always help. If I yank on the articles of clothing in question, that doesn't always work either.

Sometimes before I can get to him, he puts his sleep bottoms over his underwear, or puts tops or bottoms on backwards, or inside out. Sometimes he will recognize the problem but not know how to fix it. When he doesn't realize the problem, maybe I should just keep my mouth shut and accept his "normal" and not care how many layers he is wearing or in what direction they are facing. I am working at getting better at this but instead I try to help.

Meanwhile, I die.

In the next BLOG I will talk about reading at bedtime. This hasn't been working well for a while, I have tried many different approaches, sometimes they work, other times they do not. What I do know is that with all I have to do to get the house and Gregory put to bed, I no longer have time to read. I miss it ... and I die.