My FIL is now more chairbound in his wheelchair. More so in the afternoon. If he does not ask to go to the toilet or does not ask to go to bed for a nap, he would stay in the chair all afternoon in the activity room sleeping.
It is good that he is quiet and sleeping...
I am wondering how you guys cope with this? Do we have to move him every 4 hours? The nurses said that he walks some when he got up and so it is OK and does not need the cushion. We got the cushion they recommended anyway.
He got pink color on the bottom but it is Ok - not pressure sores.
He only uses the walker in his room when he gets up.
I don't quite like the residential care director/nurses director. He seems to just manage and does not actively help out unless I complain to the family director who acts like a middle person.
When the wheelchair came last late Oct., the height was too high for his lap. Well, the nurse director happened to walk by before he left from work: He said, oh, only with therapy, one can customize and so it is Ok this way... Do nothing is what he meant. Well, I wrote to the family director about the height, she went and checked the chair the next week. Indeed there was a way to adjust its height and they called the service people again and charged it. At least the height is perfect now.
Should I trust this nurse/residential care director?
It is hard to know, without actually seeing the situation, exactly what is right.
I will tell you what I told the care staff when Dad reached that point.... Let Dad do what Dad wants to do! You can try to get him up but if he doesn't want to get up then let him sit. You can try to put him down for a nap but if he wants to stay in the chair then let him. Just asking... do you want a nap doesn't work. But Dad was still communicative at that point and they they started moving him he would let them know his wishes. Mostly it was "Let me stay in bed".
With your Dad's limited ability to communicate they still need to follow his lead. When he is up and walking he is a fall risk. If he is happy sitting the let him sit. There is no right time to get a chair cushion. I say the sooner the better because it does make the chair more comfortable. You don't wait until the skin integrity is diminished to do preventative action. Keeping him clean and dry is much more important than the cushion.
Because he is happy sitting all day the care staff does need a schedule for changing him and a daily routine that gives him position changes. He should NOT be left in a chair for hours and hours. Rule of thumb is that he should have a position change every 4 hours.... more often if the skin integrity is compromised. They can move him to a regular chair or recliner for a while, put him down for a nap, or even get him up and walk... but he needs to be off his bottom occasionally. If he can't ask for a nap but naps in his chair, you might want to request that they put him to bed for a few hours in the afternoon.
Wheel chair height is critical for those that are getting up and down out of a wheel chair. Improper chair height can actually be used to hamper them from standing up on their own. Just be sure the feed are on the floor or they are using the leg rest. You don't want the feet dangling because that hampers leg circulation.
You don't have a choice but to trust, while investigating, observing, and being aware of FIL's condition. Continue being proactive and question what you don't understand or approve of. Don't ask just once, ask several people. There are times when a staff member will be overwhelmed and you may bet a flip answer but then asking another staff member who is more focused will get you a better answer. It just is what it is in the world of facility care but keep after it until you are satisfied... as you did with the wheel chair height. The nurse director was on his way home! Does he really want to get stuck in a 20 minute solution? Probably not. Next time it may be this very person that gives you the answer you need because he's in FIL's room anyway and has time to process. Eventually, over time, with repeated incidents, you learn who is more responsive and who is not.
But I would request that FIL have a schedule of movement and changing.
I talked to the family director. Basically it is kind of tricky. Many nurses said it helps stimulating him if he stays in the activity room even if he is sleeping. Sometimes he likes to be with people to feel secure (he is used to them now.)
The other thing is one cannot push him to be moved. Probably they will ask him if he likes to be moved around a little bit.
They cannot really go with every 4 hours schedule in terms of moving him in the activity rooom. (They do check residents every 2 hour or even 15 minutes if needed overnight or in the day.) I didn't really push that far. One cannot just push/force him to move around every 4 hours and annoy him if he is content in the chair sleeping.
At least we have the understanding that this is going on and they are aware of it.
My FIL can still use the walker to go to his bathroom in the morning. He still responds to the computer person with the musical video and he still responds to listening to the music. So overall, we will see how it goes. The cushion is on its way.
Yes, they do need the stimulation of the activity room but on the flip side they also need to get off that bottom as well. Constantly sitting is not good for circulation or skin integrity on the pressure points. So yes there is a balance between the two. Many of our residents that are wheel chair bound are up in the morning for breakfast and early morning activities, then down for a nap before lunch, then up for lunch and early afternoon activities, then back down for a short nap. It's the best of both worlds. It is just that circulation which affects the lower extremities and skin integrity issues that have to be addressed before they become a problem.
I do have a problem with "asking" the demented patient what is best for them. Giving them choices to a point is necessary but when it comes to something that is health related, sometimes common sense has to prevail. Then you have the fact that they may or may not understand the question and may or may not give an informed answer that truly reflects their desires. We have one that you can ask if she wants to eat, ask her if she is hungry, ask her if she would like to come to lunch and the answer is ALWAYS an emphatic NO. Yet if you bring her to the table and sit a plate in front of her she will eat everything on it. You guessed it... if you ask her if she wants to stay in her room and miss lunch she also says no In order to determine if they are giving you cognitive answers you have to ask the question in several ways that require both yes and no answers.
It is good that he is still using the walker first thing in the morning and that he does respond to the music. Music is amazing with cognitive decline. Many times that is the last thing they will respond to. It is the nature of music. Rather than using one brain center as we do in speech or other cognitive abilities Music uses every part of the brain and even if only one part responds.. you get a response. It's great therapy!... and I am glad they are using it
Just be sure they are watching the skin integrity on the bottom and for indication of lower extremity circulation problems such as ankle swelling
From what I saw in the log from one-on-one caregiver, he did at times asked the lady to take him to the bed room to take a nap.
He did also tell the regular caregivers that he wanted to take a nap. So now they depend on him telling them he wants to take a nap. Otherwise he stays put in the activity room. I assume this works so far since we are not there all the time.
I believe they are saying overall he has been able to tell them what he wants and so he is not really sitting there literally 8 hours all day.
But I will make sure they don't keep him there too long.