The Codger Whisperer

Just got home from my shift with the combative ex-alcoholic that lives at the CrapDorable facility that I used to work at and hated. Whew!

Let me tell you, walking into a place, saying "I'm here to pick up Mr. Codger for his doctor's appointment" and hearing "Ohhh, yeah, he's in a really bad mood. He was out here in the lobby but they took him back to his room to use the bathroom because he can't use the main one." (??) That's not how you want to greet any outside providers that come into your facility. If I hadn't known what I was getting into, I'd have been tempted to walk right back out.

The receptionist remembered me from my brief and hellish stint there months ago, and gave me her key so I could go find Mr. C myself. Which I did. Sitting in his wheelchair in his room with 2 aides trying to pee in a urinal & yelling at us all to get the hell out. I grabbed the paperwork I needed from his room and did so, waiting out in the hallway to work on it there. After his urination, Mr. C seemed in a better mood, and he and I sat in the lobby of the CrapDorable facility chatting while we waited for Dial-A-Lift to come pick us up (you know, those bus system buses that will take you door-to-door if you're disabled and have a wheelchair lift on them). Bus came, we went, he crabbed the whole way there. Arrived, read to him from a travel magazine in the lobby (his favorite topic) and got him all cheerful and pleasant for his appointment.

Then the doctor, who looked to be my age or younger, walked in. And told Mr. C he was there to consult on whether or not to remove his toe. OMG. They pulled out the offending toe, and I'm no expert but it looked like a good candidate for removal to me; lots of necrotic black flesh, and ooze, and bleeding. Yuck. Apparently Mr. C didn't have any pain from it though. Then came the awesome part, in which the doc said we needed to transfer Mr. C to the exam bench, Mr. C refused, the doc seemed completely unaware that his patient had dementia, and I pulled the MA and the MD out into the hall.

"Look, I just met this guy today, but I picked him up from a dementia care facility. He has dementia. He also gets physically and verbally combative. He is a 2-person transfer and can't walk or really bear weight. So we can transfer him if it's absolutely necessary, but he may not like it."

They came back in, we tried, Mr. C grabbed on to his wheelchair, refused, and started swearing at us all. At this point, I figured we were just going to have to do it anyway, but the MD backed down and said never mind, even though he was supposed to be examining the codger in other areas for cancer. Some people might consider follow up to a biopsy a little bit IMPORTANT.

Instead, he chickened out and said "Uh... well, we won't make any decisions about that surgery, and I'll have you come back in 3 weeks so we can take another look at that toe." and he and the MA rushed us out of there as fast as possible.

Sheesh. So the codger just spent a bunch of money for this appt. plus someone to shepherd him there and back, and all he got was a clean dressing for his horrible toe. Great.

We then had a half hour to kill before our ride back to the CrapDorable, so I chatted and read to the codger until then. He freaking loved me. Just not anyone or anything else, today, unfortunately.

I brought him into the facility with an admonishment to behave ("I find it difficult when you aren't here, dear") and watch his language, and then set about coordinating his follow up appt. I told the homecare agency CareCo that I'm happy to take him BUT
1. He needs to be premedicated, because clearly dermatologists are afraid of pissy old men who swear at them. If he gets premedicated, he probably won't do that.
2. I want CareCo to call ahead to the doctor's appt. and make sure the physician understands what's happening and what needs to be done.

Jeez, people. How scary can one wheelchair bound old man be?

Phoned it in, in a positive sense

Yep, that's right, I called Child Protective Services about my ex-coworker Calliope. They do prefer that you be able to give them your name and number, and the names/ages of the children you're calling about, as well as the parents' names and address. Luckily for me (as an abuse reporter, not as a taxpayer) Calliope's family is on "medical assistance" (ie her husband's on disability) so the person I spoke with was able to pull up her address easily. Since I haven't witnessed any direct child abuse, all I could report is that she is clearly a meth addict, and I know for 100% certain that she drives while intoxicated, both with and without her kids in the car.

As the case worker I talked to said, that's not enough for them to go and investigate the family. However, when something else inevitably happens, this will go a long way toward building a case for intervention. No one can be an adequate parent and a meth addict at the same time. I'm just so sorry for those kids that they have to wait for someone else to call it in again. I hope their teachers are being alert for signs of abuse and neglect.

As a reminder, if you have any reason to suspect child abuse or neglect in any kids you encounter, a national number is 1-800-4-A-Child and you can easily find the local numbers with google. If you're wrong, nothing bad will happen. No one goes and snatches kids away for no reason; they don't have the resources for that, for one thing. At worst, they'll do a check-in and find that everything's okay, and the family will be puzzled. At best, they'll do a check-in, find that things are not okay, and those kids will get the help they need.

The current trend with child welfare services is toward "family preservation". The goal is to give malfunctioning families support services (counseling, food stamps, respite care, medical care, etc.) in order to rehabilitate them and get them to be a decent place for their children to live. Even the agency I used to work at (theraputic group home for teen boys with multiple failed foster care placements) provides preservation counseling/coaching. It's pretty cool. Especially with the lack of people who want to foster parent. It's hopefully easier to fix the parents that already exist than to find new ones.

I guess we'll know in a few more years after the next batch of longitudinal studies come out.

In the meantime, screw you, Calliope. I hope your kids have other caring adults in their lives.

Um, what??

First, my favorite thing a resident said to me today:

I was at my cart getting meds out for the dinnertime pass when Wendy sidled up to me and quietly asked "So, have they reserved a rope and a tree for me yet?" I immediately burst out laughing and asked her where that question came from, to which she replied "I don't know, I just thought it up." and laughed as well.

Secondly, this is a note to myself:

Before accepting home care shifts, ASK A FEW QUESTIONS! I agreed to chaperon some dude to his doctor's appt via the local bus system's Dial-a-Lift on Monday. Then I got home and read the plan of care and ...
a) he lives at the CrapDorable place I used to work at briefly! Oh no. I hate that place. And the staff there, if they haven't all turned over by now, know it. So that's awkward.
b) his plan of care makes him sound like a freaking nightmare. Recovering alcoholic, combative toward staff at the crapdorable facility he lives at, multiple divorces ("DO NOT DISCUSS SPOUSES WITH CLIENT") and has threatened to kill his adult child and said child's spouse ("if this comes up, caregiver to redirect"). Oh my lord, this is going to be the longest few hours of my life.
c) he's wheelchair bound (hence the dial-a-lift) and apparently continent but is a 2 person transfer. So should he get the urge to go to the bathroom during the 4 or so hours I have him, I have to tell him ... what? "I hope you just have to pee, here's a big gulp cup you can use for a urinal." "Go ahead! All wheelchairs are destined to be pooped in anyway." "Let's see if I can get the nice receptionist to help me transfer you." Plus, given the quality of care at the crapdorable facility, chances that he'll be recently toileted and ready to go when I arrive are slim to none.

So, yeah. Polly, in the future, ask questions, you dumbass!

but yeah, I'm too broke right now to cancel this shift, so I'll just be crossing my fingers and counting my money in my head while I'm doing this terrible job

Paternalism

I've written here before about dignity being a hot topic among those in the eldercare field. This month, I've been thinking a lot about rights and paternalism. We're working with adults, and they generally retain the rights all adults have: to vote, to make financial decisions, where to live, etc. A few of our residents have court-appointed guardians (family members) because they weren't able to handle those rights anymore. But for the most part, you can't really tell your parents or grandparents what to do unless they're so confused they don't notice you're doing it. We use words like "encourage" and "persuade" and "offer" a lot when talking about getting our residents to bathe, eat, take their meds, etc. Because that's all we really can do. It's easy to think of old people as overgrown children (especially because bald, toothless, and diapered describes babies just as well as very old people). But they're not children, and don't want to be talked to like they are. Usually that makes sense to me, and there aren't many rights that I want to take from the people I care for. The "right" that I have the most difficulty with at my facility, though, is the right to get drunk.

The idea of an elderly alcoholic is a little weird and off putting, probably because you either had one in your family, or because you think old people are unintelligible and clumsy enough sober. I wonder if we know fewer elderly alcoholics because the WWII generation tends to hide it more, or because alcoholics usually die younger?

At any rate, the fancy-shmancy AL facility I work at has a bar, and has a handful of alcoholic residents. This adds up to a lot of falls and a lot of belligerence for staff to handle. We're constantly speculating as to why the bartenders serve as many drinks per resident as they do, but my instinct tells me that they probably want to avoid the ugly scene that happens when you cut a drunk off, so they cave.

This weekend, I had a run-in with one of my drunken "frequent fliers/fallers". While he was still sober before dinner, I took him outside to smoke. Residents who smoke have to turn over their matches, lighters and cigarettes to nursing staff, and we store them where we keep the meds. If they want to go out to smoke, a lucky aide (sarcasm here - I'm a nonsmoker) gets their things and escorts them out, then takes the person inside again and puts their things away. This is because not only is it state law that you cannot smoke in a public building (including bars, even) but we've got a lot of oxygen tanks throughout the building for people who need them to breathe, and those are combustible.

Smoking and drinking go hand in hand, and the last thing we want is our drunk residents trying to smoke in their apartments, setting themselves on fire, and having their oxygen tanks fuel that fire. A lot of people could die that way.

So despite my general non-paternalistic approach, you can probably see why, when Mr.Perma-Rugburn (from drunken falls) whipped out his own lighter, I reached over and snatched it out of his hand. I've learned from past experience that he won't hand them over when asked or told. He was pissed. I was pissed. I labeled it with his name and room number, and stuck it in my supply bag to store with the rest of his smoking paraphernalia in the nurse's station.

And then another employee from a different department spoke up, "But I'm the one that bought it for him". Picture Pollyanna with steam coming out of her ears and red as a tomato. This jackass, also an adult, went and bought lighters for someone who could easily incinerate this building and all the people in it?!?!? I glared and shook my head at this employee, wishing desperately that there weren't uninvolved residents around who don't need to hear me chewing out someone they know and trust.

So what to do now? The next day I put out an APB for that employee, hoping to catch him as he went off shift, but he was too fast for me. Bah.

Later that evening, I was thinking maybe I was overreacting and should pull the stick out and calm down. Until I got a page and went in to see Mr. Rugburn sprawled on his floor once again, drunk as could be, furniture scattered everywhere, insisting that a very pregnant employee should be helping him up and slurring all the while.

This dude, plus the one who is buying lighters and cigarettes for him?

They need a little paternalism. Or a LOT.