Sleep and Chairs
Rosemarie is still sleeping a lot. They keep telling me.
The fluid intake chart still shows her as being awake enough to have up to 100 ml of thickened water or juice during the night at least a couple of times a week, usually about 2 a.m. and again at about 5 - 6 a.m. I suspect she is awake at night more often, and this accounts for a lot of her tiredness as I have written before, but I have been looking at the charts and talking to others and doing some thinking.
All of this assumes the intake chart is accurately reflecting what is happening when I am not there.
Usually she is awake enough to eat all her breakfast at about 9 a.m., and drink some Ames and thickened fluid. Even when she is recorded as awake during the night she seems alert enough for breakfast - maybe she is hungry.
Sometimes she is marked as sleepy during the morning and sometimes not. They don't complete a sleep chart during the day and I think they are sometimes recording her as sleeping on the intake chart when they come to give her fluid and she is asleep. As with so many things there is no standard procedure for writing things down so an empty chart doesn't actually mean anything.
She is usually awake enough to have some or all of her lunch, but she almost always falls asleep afterwards (we have witnessed this) and will sleep on and off most of the afternoon. When she does wake up she seems instantly wide awake, and if stimulated will usually stay awake for a while. Often she will go back to sleep almost immediately, but she is almost always awake by the time supper arrives at about 5. She shows no signs of wanting to sleep afterwards, and is often at her most alert when I need to leave at about 7.
At one stage I assumed the 'sleepiness' was an excuse to leave her in bed (which is less work) and I think that is still true to an extent, but I have argued that is she is up and in her chair then when she wakes from her doze (which is what I think it is, often) at least there is a chance of her being stimulated.
I had an interaction with the Care Home Manager and she agreed that by default Rosemarie should be dressed and up by mid morning. From last Monday (13th) this started happening and I am mostly happy with the result. She is either awake or less deeply asleep when I arrive, and on warm days it is possible to take her into the garden, and on wet days we can go to the downstairs lounge and look at the wet garden through the rain-streaked windows.
My only concern is there is a marked disinclination to move her from the chair except to put her back to bed ("too tired" has happened a couple of times in the last week), and this can mean she goes for seven hours or more without having her pad checked (supposed to happen every four hours). I will have to work on this because we do not want a resurgence of the UTI.
The staff also have to be trained and reminded about adjusting the chair every hour or so to prevent sores forming.
Ah yes. There is a new reclining chair for her, delivered yesterday.
We have been agitating for some time for a proper padded reclining chair and the one loaned by Croydon Social Services has done a sterling job. It was on loan for 4-6 weeks while the Home organised purchasing a chair matching the OT's specifications. They are legally obliged to do this, but it comes as no surprise they are reluctant to pay the £3800 asking price. They kept dragging their feet (and there was the legitimate hiatus when Rosemarie was a Death's Door) and the loan stretched to 15 weeks and Croydon understandably started getting impatient and threatened to start charging rent on the chair.
Suddenly things started to move.
I was treated to some fairly blatant and amateurish expectation manipulation: shown a proposal for a totally unsuitable chair that was understandably dirt cheap and left to stew and boil for a day or two, then the Care Home Manager sought me out to tell me that she didn't really like that chair and had identified a much better mid range chair that she thought was suitable. She had a sample delivered when I was not there and took lots of pictures of Rosemarie sitting in it apparently happily. Here was the Sales Brochure. Would I like to proceed?
No I would not. I want to see it for myself, sit in it myself, see Rosemarie sit in it with my own eyes. Agreed.
These things happened and I have to say I found very little to complain about, and in some aspects it was better than the specified chair. The Croydon OT does not have the final say, the Home does (and they have a tame OT they can bring in if things get sticky), and I could not come up with a reason not to proceed. All I could do was state a couple of minor concerns that I can refer back to should in be necessary (absence of foot box and shaped back support).
But Rosemarie seems comfortable in it and that is the most important thing.
The fluid intake chart still shows her as being awake enough to have up to 100 ml of thickened water or juice during the night at least a couple of times a week, usually about 2 a.m. and again at about 5 - 6 a.m. I suspect she is awake at night more often, and this accounts for a lot of her tiredness as I have written before, but I have been looking at the charts and talking to others and doing some thinking.
All of this assumes the intake chart is accurately reflecting what is happening when I am not there.
Usually she is awake enough to eat all her breakfast at about 9 a.m., and drink some Ames and thickened fluid. Even when she is recorded as awake during the night she seems alert enough for breakfast - maybe she is hungry.
Sometimes she is marked as sleepy during the morning and sometimes not. They don't complete a sleep chart during the day and I think they are sometimes recording her as sleeping on the intake chart when they come to give her fluid and she is asleep. As with so many things there is no standard procedure for writing things down so an empty chart doesn't actually mean anything.
She is usually awake enough to have some or all of her lunch, but she almost always falls asleep afterwards (we have witnessed this) and will sleep on and off most of the afternoon. When she does wake up she seems instantly wide awake, and if stimulated will usually stay awake for a while. Often she will go back to sleep almost immediately, but she is almost always awake by the time supper arrives at about 5. She shows no signs of wanting to sleep afterwards, and is often at her most alert when I need to leave at about 7.
At one stage I assumed the 'sleepiness' was an excuse to leave her in bed (which is less work) and I think that is still true to an extent, but I have argued that is she is up and in her chair then when she wakes from her doze (which is what I think it is, often) at least there is a chance of her being stimulated.
I had an interaction with the Care Home Manager and she agreed that by default Rosemarie should be dressed and up by mid morning. From last Monday (13th) this started happening and I am mostly happy with the result. She is either awake or less deeply asleep when I arrive, and on warm days it is possible to take her into the garden, and on wet days we can go to the downstairs lounge and look at the wet garden through the rain-streaked windows.
My only concern is there is a marked disinclination to move her from the chair except to put her back to bed ("too tired" has happened a couple of times in the last week), and this can mean she goes for seven hours or more without having her pad checked (supposed to happen every four hours). I will have to work on this because we do not want a resurgence of the UTI.
The staff also have to be trained and reminded about adjusting the chair every hour or so to prevent sores forming.
Ah yes. There is a new reclining chair for her, delivered yesterday.
We have been agitating for some time for a proper padded reclining chair and the one loaned by Croydon Social Services has done a sterling job. It was on loan for 4-6 weeks while the Home organised purchasing a chair matching the OT's specifications. They are legally obliged to do this, but it comes as no surprise they are reluctant to pay the £3800 asking price. They kept dragging their feet (and there was the legitimate hiatus when Rosemarie was a Death's Door) and the loan stretched to 15 weeks and Croydon understandably started getting impatient and threatened to start charging rent on the chair.
Suddenly things started to move.
I was treated to some fairly blatant and amateurish expectation manipulation: shown a proposal for a totally unsuitable chair that was understandably dirt cheap and left to stew and boil for a day or two, then the Care Home Manager sought me out to tell me that she didn't really like that chair and had identified a much better mid range chair that she thought was suitable. She had a sample delivered when I was not there and took lots of pictures of Rosemarie sitting in it apparently happily. Here was the Sales Brochure. Would I like to proceed?
No I would not. I want to see it for myself, sit in it myself, see Rosemarie sit in it with my own eyes. Agreed.
These things happened and I have to say I found very little to complain about, and in some aspects it was better than the specified chair. The Croydon OT does not have the final say, the Home does (and they have a tame OT they can bring in if things get sticky), and I could not come up with a reason not to proceed. All I could do was state a couple of minor concerns that I can refer back to should in be necessary (absence of foot box and shaped back support).
But Rosemarie seems comfortable in it and that is the most important thing.
posted by Other Kosh at 8:09 pm
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