Sunday, January 22, 2017

Memory Care vs. Skilled Nursing

The past few days have made evident there is a marked difference in the structure, staffing, and training between memory care and skilled nursing. You can even hear it in the halls:

. . . Mrs. Hart . . .

. . . Maggie . . .

A knock on the door, “Have you seen two discs about this size?” “How thick are they?” “About so.”

“The envelope is like for a card rather than a regular letter.”

“She packed this stuff up in the room across the way and I can’t get her to turn it lose (without running the risk of being socked)”, easily being communicated in body language. “Let her keep it and I will return it shortly.” (In about five minutes.)

We search the room for contraband. Really search the room (Twice). Look in every pocket of clothes on hangers. After three weeks we still find clothes that are not marked. We find nothing that is not ours. We still fail to find missing clothes sent to the laundry.

Skilled nursing has twice the patients per square feet of space than Provision Living at Columbia in memory care. There are no locks on the doors to keep wanderers out. “Wrong room.” There are over 80 patients here. I find, when I walk with my wife, many of them know her by name and most greet her as a friend.

Memory care at Provision Living manages wandering, and other behaviors, by the design of the building (22 in one locked unit and only 12 in another) and staff interventions (at all levels). In skilled nursing, the deviation from “normal” that calls for special responses seems to be narrower than in memory care.

Also my wife does not have her two shelves of keepsakes to play with. She retains her wastebasket packing learned in two nights of motel experience.

Three days ago she appeared very tired and unresponsive. As time passed all parties became concerned. A change in “calming” medication was being used to manage wandering, in skilled-nursing, but what is a normal behavior in memory care.

Other refugees have been sent to the hospital for evaluations that would again be within control of memory care practice. If those behaviors repeat here, I am of the opinion that a hospital evaluation may not be called for; the skilled-nursing staff has learned what the memory care staff learned many months ago. Both must learn by experience with each patient or resident. Each can only respond within the structural and licensing limits of the facility.

My wife needs memory care. The day she qualifies for skilled-nursing (and our long-term health insurance kicks in) we will have some idea what that life will be for her if calming drugs will be a leading part of managing her behavior.

We are now walking on an increasingly narrow path; a world after the heart fibrillation event in December (that could have been fatal). On one side is “let nature take its course” and on the other side, that flips from a mischievous free ranging early teenager, to a belligerent scowling sleepy existence suspended in time and space.

The compassionate care from both staffs help keep my wife in a positive frame of mind. Maintaining the family atmosphere in the activity and the classroom spaces here at South Hampton Place has been critical for her and the other refugees: the common dining room table, games, exercises, and other. By letting me duck out when things are going well, I can find time to write, and nap.

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