Jim's Visits Today

Jim's GP was relatively happy with his condition. Somehow, after feeling so bad the last couple of days, Jim rallied and used his walker to get around today (not the wheelchair) and he seemed more mentally "there." However, my slight increase in the lactulose has pushed Jim's sodium back down a bit by dehydrating him, so the DR recommended no lactulose for 2 days. I told him I already had withheld for 1.5 days because I had seen the increased and looser bowel movements. I think the DR was impressed that I was knowledgeable enough about the meds to adjust to symptoms.

The DR wants to know Jim's BP tomorrow and if it's still as low as it "normally is (like 100/60), hold his 2 diuretics for the day. The DR wants to get the systolic up to 110. That usually only happens when Jim exercises extensively.

The DR also wants the PICC line pulled. He said that Jim's need for blood draws is diminishing and the risk/reward of the PICC line has changed. He does not want Jim to end up with an infection. We couldn't change his mind. The DR is going to call the Home Health Care Agency to remove the PICC line. After that, Jim will surely be discharged from HHC.

Then we stopped at Eden Rock, the Assisted Living Facility that does Adult Day Care. Jim was impressed, I think. It is a small place--24 residents and 3 day care clients. It has two levels for activities, and an elevator to get between the two. It's on a 4.5 acre lot, so there's lots of outdoor spaces and they grow alot of their own food in a huge garden that the residents help to tend. The place has no problem if Jim is on Hospice; a couple of their residents are on the same Hospice we will be joining.

I was amazed at the reduced level of ambulation of most of the residents at the facility. Alot of wheelchairs. I don't want Jim in a wheelchair; the walker is going to give him more exercise. However, we didn't see folks in wheelchairs parked in the hall staring at their hands. The residents are fairly alert, and they mostly went back to their rooms/suites after lunch. There were 3 in the front lobby folding cloth napkins for the dining room as we left; the head nurse said they gather there to try to overhear what's going on at the nurse's station.

I also was concerned that the facility doesn't seem to have "aides" roaming the common areas. I am really concerned about Jim being a fall risk. More and more he is abandoning his walker and trying to get from Point A to Point B by holding onto stable and sometimes not stable items.

There also weren't "quiet" spots where Jim could recline or lay down for his afternoon naps. But maybe that's a good thing. If he's awake more during the day, he may sleep better at night.

I was told there is one day care client (in a wheelchair) who comes to the facility by Paratransit, which Jim already is signed up for. The Paratransit driver wheels the client up into the facility. That amazed me, because I had been told it was a curb to curb service. Jim seemed to think that would work for him, once he got used to the place. I told him I would take him or pick him up the first few times.

Jim and I are going to sit down and check out when we want him to go during the month of January. We have the facility's activity schedule, and our own calendar with DR appointment for him and me, so we should be able to mark all of this out tonight. I hope to get him started there at least by Thursday, because I will be out of the house for 3 hours for an appointment with my breast surgeon.

And they will take him on weekend days as well as weekdays. So there may be times we do a Saturday or Sunday so that I can do chores outside the home more easily. This could be a Godsend, provided he likes it as much when he's staying there as he did on today's visit.

I even see the possibility of releasing/reducing Patrick if Jim likes this place and wants to increase his time there (I'm presently planning only 3 weekdays a week). If Jim comes home ready to sleep a full night, with only a couple of toileting times, I might be able to take over more of the night care.

We also were told that if they have a space (which they don't right now), they also can do overnight respite care. I didn't ask the price for that. But, if they had the space, that might have been a great alternative for when I am in and recovering from my final surgery (if I didn't already have my brother on the hook).

Gotta go. Jim is watching the "bonus footage" on a DVD, and I have to change the choice around every 5 minutes. (Even in his mentally clear days, Jim couldn't figure out the DVD remote. Heck, I screw it up myself every one in a while.)

Bye Ya!