Attended Dad's Care Conference this morning over the phone, with Mom in attendance. They confirmed our do not resuscitate orders in case Dad would need CPR, but he would get oxygen if he needed it.
We determined since Dad is on Hospice now, some medications are not paid by Hospice and some services. Dad has needed dental work, but Medicare/Medi-Cal prefers to pull the teeth than fill them. Having worked for dentists in the past, I know that is not a preventative practice. If teeth are pulled, the space has to be filled or the teeth shift and throw off the bite, not to mention making it more difficult for a person to chew food. That said, Dad would not allow any dental work to be done...he would not allow them to do x-rays!
Dad needs about 15 teeth filled now. He needed dental work before he went into the nursing home, but would not go because he was getting more and more fearful and paranoid of treatment, making excuses about x-rays, not liking the dentist and how overly priced the dental work was...
Dad has a hearing aid, but rarely uses it because he forgets he has it at the nursing station, and family usually manages without it when we visit... If Dad had it, he would lose it like he loses his glasses. He does have glasses and the nurses are really good about taking them off Dad and putting them away in his bedside drawer. The staff also remind or ask if he wants to wear them.
We will continue Dad having his eye exams as it is especially important to keep an ongoing examination of his right eye with the skin cancer on the lower eye lid.
We may discontinue his hearing tests but he will continue to see the Podiatrist, especially with the skin cancer on his left pinkie toe.
There was a question and brief discussion about Dad not being able to see the Psychiatrist since Dad is on Hospice, because the Psychiatrist would not be paid....It is important Dad continues to see the Psychiatrist to keep Dad on the Lexapro. Dad's primary physician can continue the Aracept, but not the Lexapro.
I determined if that was an issue, we would discontinue Hospice. Mom agreed. The Hospice nurse said she would have an answer for us by this afternoon....but before the meeting was over, the Hospice Director showed up at the Care Conference and confirmed the Psychiatrist would continue to get paid, he would make sure he was paid and explain how to bill....so that was resolved.
I am not thrilled with Hospice so far. I am not getting regular reports from the LVN as she promised. She promised again to call me every Wednesday, because I had to contact her through the Hospice Rep last Thursday to find out what happened last Wednesday.
Also the RN has been to see Dad twice and has not contacted me about her visits. She was in the Care Conference meeting, so I took the opportunity to ask if she would be contacting me and she said she would.
I have been playing phone tag with the Social Worker and still not spoken with her. I had to ask at the Care Conference if the nursing home would continue to update me on new orders for Dad or would Hospice let me know. They told me the nursing home should be calling me. I explained they had not let me know about new orders for more drops for Dad's eye and for antibiotic topical cream for Dad's left toe. I found out from the LVN visiting on Wednesdays.
The Director of Nursing apologized to me and assured me, they would notify me. I realize how busy they are and the level of care they provide the patients and attention to the visiting families, I could understand if they were side tracked occasionally.
Dad gained a pound and now weighs 149. He is eating 85 to 95% of his meals and doing excellent in attending daily activities. Dad attends 3-5 times per week and especially loves any music, singing and dancing.
I had concerns with Dad's new Hospice diagnosis of Failure to Thrive and wondered if Dad would be taken off some of the many medications he takes for his blood pressure, heart, thyroid, gout, etc...and happily, they plan to continue those medications. There were a few duplications with his meds such as Colace and Phena S which are stool softeners....and he is not constipated, so I had wondered why he had to be on two. They will discontinue the Colace and keep Dad on the other...
In addition, he is on aspirin and Clavix, which are both blood thinners. The nursing home had been treating Dad's blood pressure and heart condition aggressively by making sure his blood stayed free of clots, but often taking the double dose causes more hematomas and bruising....so we decided to discontinue the Clavix and see how Dad does.
Hospice questioned the Vitamin D Dad takes, but when they were told Dad does walk and move around and is not wheel chair bound or bed bound, they agreed Dad should stay on it.
All and all it was a good report...
Mom called me after the Conference so I could talk with Dad. Dad and Mom were in the dining room I think, waiting for Dad's lunch. It was very noisy and I could hardly hear him, so I know it had to be difficult for him as well...
Dad responds when I call him my pet name for him, Papa Doots, and when I tell him I love him...but when I ask how he is, he launches into lengthy, run-together-abstract thoughts which don't make any sense. I attempt to pick out a word or two and say something relating to that, which he responds to and in my mind, is my attempt to keep him thinking he is being understood and carrying on a conversation.
He commented on not being able to hear, how noisy it was...and he is waiting for his lunch. So I told him I loved him, blessed him and extended my husband Jerry's love to him. He was happy to hear about my husband as he thinks the world of him. He laughed when I told him Izzy our dog sends her love too.
I told him to have a nice visit with Mom and to enjoy his lunch....it was so good to just hear his voice.