Thank you everyone, yet again, for the words of support - they do make such a difference xxxxx
I went to see Mil yesterday, walked into chaos tbh, as the admittance of 3 new residents, all with quite a high degree of challenging behaviour had the staff with their hands full. They had managed to get Mil washed and dressed, and into the lounge, but the TD symptoms were starting to build, jaw and tongue tics very evident, starting to impact on her speech and (at that time) quite mild spasms and writhing through the rest of her body. It slowly but surely was worsening, so I would guess that before the end of the day Mil would have had to have been placed on the bean bags again, as the only means of keeping her safe from falls and injury. Usually, they would have taken her to her room as soon as these symptoms started showing, but with no 1-1 till 12pm, and no way staff could be spared to try and cover it, keeping her in the lounge so she could be watched was the only option. She was in a pretty good mood, but her frustration at not being able to speak clearly and at the uncontrolable movements, was starting to show, and the noise and behaviour of the new residents was also getting to her. One gentleman kept banging on the table and shouting - 4 or 5 times Mil screamed at him to 'Shut up'. In the meantime, the two new ladies had the staff running round like the proverbial blue bottomed flies - one is very aggressive, I saw her hit out 3 or 4 times at staff. Another gets up and walks a few paces, before dropping to the floor - with staff runing from all directions to try and break the fall - or she will head to a staff who may be givng another resident a drink, and try and collapse on top of them. It was as close to bedlam as I have seen there, and a stark reminder of what the staff may have to deal with if there are several agitated residents at the same time. Fair play to them all, they kept - when they could - coming over to Mil and checking on her, but they were really struggling to give her the needed attention and as two of them actually said to me, it was a case of them being very glad I was there as the much needed extra pair of hands and eyes for Mil.
Senior carer, the lovely N was there, and I spoke briefly to her about the notes I needed - she asked, very apologetically could she phone the manager S (the assistant manager is now the actual manager) and arrange a time for me to go in on Monday to get what I need and talk with S. Given what they were all dealing with, of course, I agreed. In the meantime, N told me that the HBM had, it turns out, brought the threatened OT with her, and that they had discussed, in front of N, providing Mil with a bucket-style recliner and a waist restraint. The bucket style recliners are rarely used anymore, I'm pretty sure they are regarded as contributing hugely to the likelyhood of pressure sores these days - and I'd already spoken at length about the pros and cons of using any form of restraint with Mil with Dr J, SW and nurse L at the last meeting, with all advising that the use of restraints was absolutely not appropriate for Mil. Because, they agreed, the TD symptoms would cause her to become extremely distressed unless she was able to respond to the complusive need to move and writhe, because she was likely to pull at and try and get the restraint off, and there was a high risk of the strap and her attempts to pull at it causing skin tears, bruising, possibly deep wounds and because the writhing and compulsove movements are strong enough that she could still manage to slip down in the chair and therefore, the risk of any restraint catching round her throat and choking her was extremely high. I've also read several articles where the use of restraint in the elderly has been researched, and there are so many negative aspects to it, that I am hopeful that I can argue successfully against using it when (and it will be 'when', not 'if') the HBM tries to impose it as an alternative to 1-1.
N was also really upset at something else. The HBM had turned up shortly after Mil had woken. She had been very agitated the day before, a lot of TD symptoms, and had finally fallen into one of her very deep sleeps. Staff just let Mil sleep as long as she needs when this happens, they are aware that the TD symptoms are exhausting for Mil, they have spoken to me several times about letting Mil sleep till she wakes naturally on these occasions, and I agree that its better not to disturb her. When the HBM arrived, N had been giving Mi her first drink of the day, N explained that Mil was reluctant and it had taken her quite a while to get Mil to drink just half of the 400 mls of squash that N was trying to get her to take. When the HBM arrived, N obviously had to stop, and at one point she left the room to help another member of staff. The HBM then reported to S that she had checked Mils fluid chart during this time, and that Mil hadn't had a drink for 14 hours - N hadn't filled in the fluids chart at this point, simply because she intended to continue giving Mil the drink once the HBM had left. The HBM - despite the fact that N was giving Mil a drink when she arrived, and despite the fact that the half finished drink was there, insisted that as it wasn't charted, Mil can't have had anything. I presume her intention there is to blame Mils behaviour on dehydration and try and claim the staff are responsible or negligent. I was fuming at the upset this had caused N, and at the HBM's blatent attempt to twist facts to suit her need to find anything at all to remove the 1-1. This evil *$%&^ will stoop to just about anything in order to have her way - and I think 2jays, Red, Lemony and the rest of you are right, she is determined to 'win' as she see's it, its a personal challenge for her, and in her arrogance, Mils actual needs and well being clearly don't feature at all.
Lemony, I have also been wondering if Mil being in some sort of hospital unit would be more cost effective and if that's what this creature is aiming for - that would tie in with her wanting Dr R involved - because he had, prior to him leaving, suggested that could be an appropriate 'next step' in Mil's care.
I stayed as long as I could, but had to leave 30 mins before the 1-1 kicked in, because youngest was in a show at Theatre Clwyd last night, and I was on car pool to drive her and 3 fellow show mates to the venue. I'm going in today at 10, and staying till 12 when the 1-1 can start again. I wish I could do that every day, because yesterday showed me how impossible it is for the staff at the moment, but obviously, with work, I can't. I'm taking a very early 'lunch break' tomorrow, to go in and get the copies of the paperwork I need, will have the email to the mister ready today, and just attached the paperwork and send it as soon as I get back from the CH tomorrow.
As a side note, daus show last night was amazing - the 13 to 18 year olds from 4 theatre school branches in the area were in a production called 'Life' where they performed songs to reflect the '7 ages of man'. They treated us to everything from 'The circle of life', to 'smells like teen spirit', to 'when I'm 64'. Fom start to finish, it was fantastic - there is some serious young talent between the 4 branches. The show stopper was a wee girl of about 16, who sang the Carpenters 'Goodbye to Love' and pretty much reduced everyone to tears. As always, I was the volunteer photographer for the performance, so today, I have a lot of editing to get through.
2jays, I am glad you are on the mend - supervision rather than doing stuff yourself is definitely the way to go
Much love to all of you, will update you when I can - and again - thank you xxxxxx