Things Fall Apart in New York, and Nursing Home 4

The situation in New York is coming apart quickly now.  My father reportedly had a bad few days over the weekend and at the beginning of the week.  On Monday, for some reason (or none), he threw his meds at one of the attendants.  Tuesday morning he was due at Dr. B's.  E and M had a hell of a time getting him there.  Dr. B immediately doubled his Seroquel dose (to 100 mg this time?  I'm losing track).  Yesterday night, during our one-hour-plus phone call, he was intensely paranoid but relaxed and dreamy at the same time - strange, but that's usually how the Seroquel plays out.  In a quiet, drawn-out, languorous way, he went on about the horrible people in his apartment - "the women" (he also called them "niggers" at one point, totally uncharacteristic but character really doesn't apply here anymore).  He told me that on Tuesday morning, one of them had made him so angry that he grabbed her, pushed her backward over his knee and threw her to the ground.  Of course nothing like that happened.  His fighting delusions (often elaborate, involving eight or 10 people) typically happen during his hospital stays.  This is one of the first at home.  Seroquel again.

E and M wound up at loggerheads during and after the doctor visit.  M wants E to be more interventionist - get my father outdoors more often, for example.  I agree in principle but had to remind M that even when he was whole, my father was the most stubborn man in creation.  Getting him to do anything he doesn't want to do is nearly impossible, and the usual techniques (distraction and redirection and such) often don't work.  Flexibility is key.  Case in point - E was getting him ready to go downstairs and get into a cab, and my father didn't want to put on his street shoes.  E took him to see Dr. B in his bedroom slippers.  M objected.  I understand, but I have to side with E - what difference does it make, as long as he's not barefoot?  Opting for slippers is the kind of improvisation that they talked about at Nursing Home 3 - a necessity, I think, and the main reason why, right now, they're at the top of my list.

As far as the nursing home list is concerned - I'm getting to the end of the first round of the search.  Tuesday afternoon, in between trips to a regional vet to deal with a Bombay cat with MRSA (life is complex), I was able to visit Nursing Home 4, which was nearby.  It's owned in common with Nursing Home 3, through some arrangement that I don't understand.  I liked it.  Very nice physical space - grounds with sitting areas and nature trails that the patients get to use, a small aviary in the lobby.  Good atmosphere - more visitors than I'd seen at the others, though that could be accidental.  The tour was less satisfying - given by an admissions person in a uniform of the kind you'd see on hotel staff.  She was fast and glib and had me in and out in half an hour.  I suppose I shouldn't put too much stock in admissions people - how much contact with patients are they going to have?  On the other hand, the depth of the discussion at Nursing Home 3 continues to impress me - it was a whole different quality of interaction, and that has to count, too.  So for the moment, Nursing Home 4 stays in play, but Nursing Home 3 is still at the top of the list.

On reflection, I've decided to rule out Assisted Living Facility 2 - the fact that they don't take Medicaid is a problem.  I could gamble on his dying before he'd need Medicaid coverage, or on being able to transfer him later to a Medicaid facility, but neither seems like a good option.  As for Assisted Living Facility 3 (note to self - they're really group homes, and I should start calling them that)... I spoke to someone who told me that I'd have a better chance of reaching the admissions director if I called him on my cell phone.  I haven't tried him yet.  There's nothing wrong with being given a cell phone number, but there's something about it that reminds me that the group homes are small, quirky establishment, mostly run by founder-owners.  I'm not sure that that's going to give me what I need.  I suspect at the end of the day I'm going to opt for one of the nursing homes, but the question is open for now.

Today I sent an e-mail to D, the Maryland care manager, giving her a quick rundown of my initial impressions, and asking whether she'd be willing to meet with me and give me a reality check before I start follow-up visits.  I don't know if she'll bite, but my sense is that an objective conversation with an outsider would be helpful at this stage.  Elsewhere on the research front, Dr. C, the friend of a friend who's an emergency physician, tells me that Nursing Home 1 has a terrible reputation.  I didn't like it much, either, and it's good to have a gut impression confirmed.  Unfortunately, it turns out that Dr. C is based in the Baltimore area, and doesn't know the facilities in the DC suburbs that well (Nursing Home 1 is run by a chain, so it's a different animal).  He promised to check, but I don't know what he'll be able to find out.  Still, every insight helps.

I didn't visit New York this week.  Multiple reasons - cat care requirements (I have to administer meds five or six times a day, including at oh-dark-hundred), the fact that I've got to push through the nursing home search, and also the fact that I needed a break.  The New York scene is getting to be too much, which is one more reason why I've got to get the search concluded, start an application, and do the transfer.  It's all overwhelming, but as long as I'm getting overwhelmed, I might as well be overwhelmed in the right place for the right reasons.  I could say something cheap about my father going south, but I'll let that go... for now, at least.  But I'm sure the thought will surface again soon.

Comments

[Shu]

Hugs, just loads and loads of hugs for all the fronts you're warring on. Hang on. Sending you many positive beams of thought, and to your dad and your kitty as well, both being those beings so dear to my heart.

huggingly,
Shu

[Alan G. Ampolsk]

Thanks, and sorry I haven't been around much lately to pick up on comments. Have been pinned down with the nursing home search, the legal and financial end of things, and so on. Am hoping you'll understand. Hope you're doing well - I know things have been tough at the small world lately. Is Guardian Ad Litem something employment-related? Hope so.