Falling in Memory Care

This morning, Monday, a bit before 9:00 I saw Margaret fall backwards; this time onto the daybed. She may have tripped over her own feet. She may have been a bit dizzy from bending over and picking up a magazine. She may have . . ..

I pulled the call button at 9:00 and returned to reading the morning newspaper. No response by 9:15; some 5 minutes after the system repeats the call. No response by 9:35. I go looking for a reason the system is not working. There were three caregivers on duty in the dining/activity area.

What went wrong this time? First, I was an hour late going to breakfast; I was not  a backup for the 8:00 getup. Second, no one came at 8:00 to get Margaret up, dressed, and out of the apartment, in about five minutes, for a light breakfast. This plan has worked perfectly for over the past two weeks.

There is no explanation of why it works, but getting up late today recreates the performances of the past.

[10:05 I hear the laundry cart rattle. Margaret is pushing it in the bathroom. I wait. I take her left hand at that magic moment when her attention is changing. “Time for breakfast. Let’s go.” Pause. “Let’s go. Let’s go.” And to the apartment door. “Let’s go, let’s go” in a soft chant. And out into the hall.

R____ jumped to one side of the hall near his door. A grin spread across Margaret’s face. They both laughed. She greeted everyone in the activity area with a smile, a head nod, and her I’m OK grin. I return to writing.]

Dressing late is a struggle for all concerned. She is not a happy camper when the eyebrows arch and the vertical lines show between. After being ready for the day, the caregivers know to give her time to outlive the “worries”. 

This time the call system failed because one person did not have a pager but did hear the call in the office. Another said that memory care residents don’t use the system. Their calls are accidental trips.

[What is wrong with this picture? When the cord was not tied up it was near a towel and the handle on the commode. Margaret was pulling the chord more than once a day, at times. The correction was to tie up the cord and keep towels off the towel bar.]

All agreed that the 8:00 getup time was needed to be continued every day. Memory care rooms are visually checked periodically all day and all night.

[A pizza party was held, last week, to celebrate reducing the average call button response time in assisted living to less than four minutes. When problems are identified, they get fixed.]

1:30 and back from church streamed into the 3^rd floor theater. Margaret came to our apartment door at 11:05. I asked her if she wanted to go to church. “I don’t know if I do,” as clear as can be!! We walked into the service, 10 minutes late, to a roaring community church rendition of How Great Thou Art. She was attentive all through the service and lunch.

Response Time in Room 133

(Written some time ago but I forgot to post it until it showed up this morning when I opened Word! My 2008 copy of Word selects old pages at random on opening.)

Margaret slowly slid to the floor in front of the windowed bookcase. The dining room table leaf rattled a bit. Her hand, sliding down the edge, may have controlled her soft landing on the floor in a seated position.

I pulled the bedroom call button: 9:17. Margaret seemed totally unflustered by being on the floor. This was a different behavior. I went back to writing while watching her. She went back to playing

I pulled the bathroom call button: 9:29. Margaret remained fully intent on her keepsakes on the bottom two bookcase shelves.

I walked to the office: 9:45. Three people were there. I again inquired, as I have done several times before, “Did you hear the bell?”

“Yes”. “Why did you not come to our room?”

“A--- responded to the call.”

“But no one came.”

“Here. See what the pager shows.”  Room 133.

S--- visits with me as other matters are cared for. Maggie is busy with her keepsakes. I learn that the personal call buttons show the person’s name rather than the room number.

I learn that A--- went to the apartment across the hall from ours: Room 134.

I remember B--- racing into our room twice in the last month to find our call buttons not pulled. She then going across the hall: Room 134.

“I remember to go to Maggie for 134 and to C--- for 133. I don’t know the room numbers.” A new person on the floor did not (rightly) associate call numbers with room numbers in this case.

“It seems the wiring has been corrected in the building but no one informed the caregivers.” The building is now over two years old.

This explains the false calls to our apartment over the past several months.

At the last residents council meeting, the call response time was severely questioned. It became clear that the system is not an emergency response system. An acceptable time was given as four minutes, on average. This makes sense as an, “I need some routine assistance,” system.

Also reported was a delay in responding to our call in memory care one, that was confused with a call, at about the same time, with a call made in memory care two.

The personal call buttons that show the person calling is a step up from the room call buttons. Experienced caregivers know what each resident needs at each time of day.

This works with experienced caregivers. One of our calls last month was not received because the pager was not turned on. Another because only one pager was functioning, so it was left in the office. At other times pagers were either missing or the batteries were dead.  Or people were not familiar with a new pager system.

The building does have an emergency call system. Call 401 on a room phone. Ours is under one of the Sleep Number beds where Maggie leaves it alone. The concierge can rouse who ever is needed, if you know this, and if you have access to a room phone. Also set your cell phone for the concierge (of course memory care residents normally do not have cell phones or room phones.)

11:15 Margaret just got up, flashed a big smile, and left the apartment. An hour’s nap made a complete personality change. The “worries” are gone and she is happy again. She could speak in one and two word sentences all afternoon!

The resident’s council meeting pointed out that a true emergency response system must include a real person and a means of communication (two way conversation). That is 911, for example. In house, such a system confirms the call (if no need for anyone to respond it saves manpower) or distributes the call to the appropriate person to respond in an appropriate time. In an emergency the line of communication would remain open until the responder checks in.

In San Antonio, three years ago, we found two separate systems for routine and emergency calls at one place, and a pendent with two buttons for routine and emergency calls. Maggie is now out in the activity/dining areas most of the day with about a five-minute check if she is not visible.

[The past two days, Margaret has refused to get up at 8:00! This leaves her in the room when no one is at hand. She has again slid onto the floor. We switched chairs (no arms and no wheels) to see what happens.]