The Law Of Four

After a few uneventful weeks it has been a busy few days.

There have been problems using the new wheelchair. Not the chair itself, which is excellent, but the procedures around using it. 

It is not as comfortable as her reclining chair and the engineer who fitted it for her said that three hours was the maximum time for her to be in it, and in practice she starts to get restless after about two hours.

Its main purpose is to give easier access to the parts of the garden served by paths with a significant camber, and allow her to take up less room at the afternoon activity sessions (the reclining chair is a bit of a monster).

It takes six minutes (I have timed it) to get the hoist, transfer her from one chair to the other (which Rosemarie finds quite unstressful) and return the hoist. Hardly a huge chunk of time, and only one care worker is required because a visitor is always there to help. But somehow this has become a Major Event for the staff and the idea that it can be done more than three or four times a day seems to violate some care worker's ethos. One care worker in particular is adamant that if Rosemarie is moved from the wheelchair it must be to bed for the rest of the day. 

It all came to a head this week. I have been trying to establish for some time that Rosemarie has actually been having her pad checked about every four hours and changed if necessary. I have never observed this any time I have been there throughout the day but I have been shrilly assured that it does happen, usually just before I got there. No other visitors have seen it either. Conversations with the Particular Care Worker about the options for moving her were very enlightening. Rosemarie could not be moved from bed to reclining chair, reclining chair to wheelchair, wheelchair to reclining chair and reclining chair to bed at the end of the day because FOUR MOVES WAS TOO MANY.

But wait. If they were checking her pad during the day that means bed to chair, chair to bed (for checking), bed to chair and chair to bed at the end of the day and that is four moves which is apparently TOO MANY. I raised this mathematical conundrum with New Nurse on Monday and after a lot of defensive body language he said that he would not talk about the past but going forward she would be checked every four hours. 

I also established that I wanted Rosemarie to go to Physiotherapy on Tuesday afternoon in the wheelchair. We agree that she would be moved from the reclining chair to the wheelchair after lunch, and I would take her down. When I brought her up she would be moved to the bed so her pad could be checked then moved to the reclining chair. 

Tuesday I was there nice and early. One of the new intake of care workers (sweet and helpful) had been assigned to Rosemarie. I checked with her and the New Nurse that the plan was still on and they agreed. I helped with getting Rosemarie into the wheelchair and took her downstairs. 

An hour or so later I brought her back up and found her assigned care worker doing some notes. New Nurse was on a break. I said I was ready to help her check Rosemarie's pad and move her to the reclining chair. She said she would be along in a couple of minutes. I took Rosemarie to her room and got things ready. 

After ten minutes I went in search of the care worker and found her still doing her notes but looking very uncomfortable. I asked her to come and help me but she sheepishly said she had been told that we had to put Rosemarie to bed. No, I said, we are moving her to the reclining chair, as agreed with New Nurse. We couldn't do that, she said. Rosemarie had to be put to bed. I enquired who had told her this. Particular Care Worker had vetoed the plan.

I did not take this well. I rather loudly enquired if she was now in charge of the floor and did New Nurse know. Apparently he was expected back imminently. I said I would wait in the room and would she ask him to come and see me as soon as he got back. If he was not back soon I would go downstairs and take the matter up with the Care Home Manager.

This had the desired effect and within ten minutes he was in the room, conciliatory and uncomfortable. He had got the message and already spoken with the Care Home Manager and had a Deal. No mention of Particular Care Worker and an almost desperate disinclination to discuss the events of the day so far. 

What I agreed to try was a plan where on days where she was going to use the wheelchair she would stay in bed until just before or just after lunch and moved to the reclining chair after had pad has been checked on her return from wherever she went. This would preserve the sanctity of the Law Of Four. 

I agreed to try this but I can't see it working in the long term. The activities in the afternoon start at about 2.30 and last for about an hour. The chances are that the care workers will, over the course of time, get Rosemarie out of bed earlier and earlier to avoid conflicts with lunch (which is a moveable feast) which will mean she will be tired of the chair before the activities have properly started. 

I am going to have to let things calm down slightly then speak with the Care Home Manager about this mysterious Law. If Rosemarie is tired or distressed then of course we should consider putting her to bed, but if she is alert and in a good mood why not let her stay up and move her to one of the lounges or the patio?

I have not seen Particular Care Worker since. She is probably avoiding me. This is sad because I actually quite like her. She has Rosemarie's interests and heart and most of the time she is kind and supportive. 

I am sure that she thinks she is doing the best for Rosemarie but in this particular case she doesn't have a veto.