February 17, 2008
It looked as though it were rain glittering on the black tarred parking lot floor. Carefully I stepped down from the step off my front porch, sliding each foot slowly. At the halfway point, I could see the car is glazed with inches of clear ice! Chances for opening the drivers side door is null. It's good, paywise, that I worked a double yesterday. Psychologically, it probably is best that I have called off, from another day of working with The Patient From Hell. Her meds have been upped to 2mg xanax q 8hr, MS Contin 15mg q 12 hr and dilaudid 4 mg q 4hr prn. Forget about the prn as her verbal demands outweigh her body language. Admittedly, this 500lb Plus babe is taking 20 minute cat naps, but, her expectations upon each awakening is stealing thought for caring of any of the other 44 patients I am responsable for. The 200 mg seroquel at night does allow for her to sleep at a six to eight hour interval.
Leaving the facility, last night I again read the business sign. It still says N. Nursing Home, and not N. Mental Institution. Having been assessed by two psychiatrists during this past month long stay, her 3877 has not been changed to read Alzheimer with Delusions nor Dementia with Psychotic Behavior. It continues to read, "Mental Illness". The psychiatrist on Friday explained to me that she is so attention starving that her groping of male attendants and the also inappropriate behavior of flashing her breasts to female attendants is a means to try to manipulate them into not leaving her bedside.
As per Nursing Home rules and regulations, she is seen by the physician minimally, once a month. She is being followed by psychiatrists also. Each physician visits her no more than twenty minutes, unlike the routine 10 minutes as with the other patients. This means that they can not appreciate any of her antics, unlike the eight hour plus, Nurse and CENA's. She continues to receive care as per Nursing Home Guidelines, but, does not receive the care which would include Time Outs and Setting Limits and guidelines as to what is acceptable and not acceptable behavior. I am of the opinion that a Mental Institution befits her present outrageous, manipulative, rude behavior more so than a Nursing Home. Especially because she continues to refuse to leave her bariatric bed to sit upon a three foot wide bariatric wheel chair which the Nursing Home has also provided. The Administration will not provide a 24hr sitter, nor will her, just as obnoxious 7 daughters. She and her family's, and the Nursing Home Administration's world revolves around the telephone. Sure, the Big Wigs have made a short visit or two, away from their computers, but, again as with the physicians, they do not appreciate the wear and tear from 99.9% total thought, while trying to deliver hands on care to others such as the three who require suctioning every thirty minutes many times. After a month of these dealings, I no longer believe that "Love is just a phone call away!" A phone call means The Patient From Hell is lonely and will say and do anything to have someone at her bedside around the clock.
During Friday's Followup visit, from the state...it was her MDS meeting day. Administration, for the first time held the meeting at her bedside. They had never left the MDS office for this Federally required meet, outside of this one resident in their history. Yes, this is a good thing, but comical in the sense that the only reason this was done was to prevent the resident or daughter from knowing that The State was in the building! "Mums the word" was what was anticipated. The Facility Heads are therefore somewhat aware that whatever that patient or daughter may care to report will lead to the opening of her chart-where the Form 3877 is housed, and Nurses' Notes which had not yet been removed. (Yes, that does mysteriously happen.)
During the meet, as did the Nurse From Hell, the resident laughingly apologized for having 'flashed' stating "I was only playing! I didn't think you would think anything more." All I could think to say was "Well, I have never played that way, and well, I just don't play that way and found that antic to be inappropriate as you were so angry because it was not time for another narcotic." Normally, the MDS Meet lasts 15-20 minutes, but, this one went on for two hours. It was nice not having to respond to her call light and/or phone calls as her attention seeking was finally appeased. Yesterday, the following day, and since the meet come to think of it, she is behaving with renewed empowerment. Apparently, The Heads did not read the psychiatrists notes.
Near the end of the shift Friday, a state regulator inquired from me as to why The Patient's From Hell roommates bed was up against the wall with one of the privacy curtains tucked against the wall with the bed. OMG! I could not explain that it was to make room for the bariatric to be wheeled from her bed, as that would have also encouraged her to go beyond the (second) pulled privacy curtain and see the behind of the Patient From Hell as the facility does not have a gown large enough for her, that should the patient ever be pain free enough to be lifted by the hoyer lift onto the wheelchair that the lift is inadequate for a person weighing more than 250lbs, and she no doubt would have captivated the Surveyors attention thereby risking the Facility's existence. OMG!
But, then again, what a wonderful diversion! The surveyor wrote, as I spoke. "Yes, this is awkward for the caregivers as it causes them to have to lean extensively to deliver care, but normally they move the bed out from the wall to make reaching easier and to save their backs from injury. I have mentioned to the higher ups that this is also an infection control issue having the curtain touching the bed and/or patient and to the CENA's, but, their ears are deaf and they still consider me a 'New Employee' who is trying to 'change the place' and say The State has never complained about it. Just look in the other rooms...this condition is widespread!"
Within half an hour, when the 2 Surveyors made their next Rounds, they found the entire facility to be 'within compliance', and that is what the official record proclaims. But, my God...will life be easier working at another facility which may not consume my every thought off the clock too, or, will the Patient From Hell soon be discharged from this Nursing Home to be admitted to the next Extended Care Facility (ECF) I run off to?????? Now that the 2008 State Survey has found this facility to be within compliance, my personal goal has been met. If this facility does not soon make amends with the actual needs for The Patient From Hell and her family, they may find their new celebration for 'Having Passed', shortlived.