Saturday, July 12

On Thursday afternoon, the social worker, Paige, reported to me the results of the first staff assessment meeting. I had expected a positive report (i.e., "It's obvious to all staff that Mr. Long is making good progress--he is talking more, he's more awake during the day, he's making an effort in physical therapy--very good progress after having spent the first week after the stroke on his back barely able to move"). She did say that, but alas, she said more than that. This was the first time anyone had talked with me in terms of actually assigning a score to the various improvements that all agree Tommy has been making. She explained that there is a four-stage scoring system, which ranges from "dependent" (100-percent dependence on care) to "maximum-assist" (75 percent dependence) to "moderate-assist" (50 percent) to "minimum-assist (25 percent)." There are specific "functional" abilities that he must show progress in during each week; i.e., he must move from "dep" to "max-assist" in a significant number of these functions. These include the ability to sit upright at the side of the bed; the ability to "help" during "transfers" (a transfer is any move of the patient from one spot to another, such as, for example, from wheelchair to bed, where he needs to use his arms to help lift his body up from the wheelchair and he also must assume some of his own weight while the caregiver(s) pivot him onto the bed); and the abilities to respond consistently by talking or other means, to feed himself, and to take care of his own bathroom needs.
The problem is that, although Tommy showed great improvement during the previous week, he showed functional improvement only in the category of "ability to feed himself" (where he moved from "dep" to "max-assist"). In all other functions, he remained "dependent." If he can show significant functional progress by next Thursday (i.e., so that in several abilities he moves from "dep" to "max-assist"), the staff will then determine the "goals" for Tommy's therapy (although scheduled to be done at this meeting, it was postponed due to the fact that, so far, they hadn't seen enough functional progress to actually determine his goals); and they will allow him to stay in the program, at least until the following Thursday. (Medicare will cover his rehab at the center until July 29, but only if he shows "progress"; their coverage stops in its tracks if it's simply a "maintenance" situation.) If he doesn't improve significantly, the rehab center will initiate the move to a skilled nursing facility ("SNF") where, with Medicare support, Tommy can gather his strength, after which he could return to the program. I have learned that SNFs offer about half as much physical therapy, and this wouldn't be the end of the world, but I talked with Tommy on Thursday evening and we definitely want him to stay where he is. He has momentum, it's a good program, we want to keep it going.
On Friday, he worked very hard in his various therapy sessions, which I attended with him after staying overnight with him, sleeping in the chair-bed. In the morning, the speech therapist, Brie, said that their session was by far the best they have had. At all meals, he fed himself, and with increasing skill. In physical therapy, he operated a table-top set of "bike pedals" using his arms for a good ten minutes, which was really great for his arm strength; and he actually stood (assisted) at the parallel walking bars for several minutes. All day long, his transfers were accomplished not with the Hoyer lift, but rather by two staff members, who said that he was beginning to help with standing up and taking on some of his own weight. If Tommy can continue these functional improvements, he'll be in good shape to stay. He really wants to get better and come home, and he understands what he must do. So everybody keep your fingers crossed.
SPECIAL NOTE: I have learned that you have to ask, ask, ask, and keep asking until you get a satisfactory answer. In my meeting with the social worker, she initially gave me a very broad-brushed report. I was so surprised by what she was saying that I pulled out a notebook and began taking notes, and eventually, after a half-hour of increasingly specific questions, I finally was getting the overall picture of how it works. After she laid out the grading system to me, I said, "So there's actually a score card?" and she answered yes. "May I have a copy?" Again, yes. Well, duh.