Wednesday, January 6, 2010

It's Beginning to Feel Real

Skip's discharge and arrival home, that is. It really is beginning to feel real and I can't wait for it to happen. It's only eight days from now, and I do believe she'll be coming home that day.

I had a long talk with Skip's case manager at the rehab hospital on Monday to talk about lots of transition things such as the special bed, the wound vac rental, any barriers to a possible discharge, visiting nurse, home health aide and PT/OT services at home and so on. We both walked away with various follow-up tasks, and based on the phone calls I've been getting, she's taking care of her end of the bargain.

I got a call yesterday from the company that manufactures and rents the Clinitron bed. Apparently, Medicare doesn't pay for these for home use unless the patient has used a different kind of bed for 30 days and can demonstrate inadequate progress using the other bed. So, they'll deliver a low air loss mattress and hospital bed frame, likely the day before Skip comes home, for her immediate use. Then, they'll keep in touch with the visiting nurse agency to get data that might support the upgrade to the Clinitron. Just that call really made it feel real to me. If we're talking bed options and delivery dates ... it's really gonna happen.

Skip is staying at the rehab hospital until the 14th in order to complete her course of IV antibiotics before returning home. I figured the only thing that would hold up the release was a determination that a longer period of IV administration was required. I hadn't heard anything about a follow-up visit with the infectious disease MD who worked with Skip in the hospital, so I gave his office a call on Monday. Turns out it's not too easy to determine if the infection is gone from the bone. His recommendation was to have the plastic surgeon evaluate the situation on Skip's next visit (tomorrow) and, from that, suggest likely next steps. I suspect what will happen is that Skip will come home with a prescription for oral antibiotics to keep the treatment going and then other diagnostic work will follow to evaluate the situation. I'd imagine this would include tests like another MRI to take a look at the hip bone.

We've already got a relationship with a local agency that has visiting nurses, home health aides and physical therapists. The hospital will write the orders for the care Skip needs and they can be the providers, which is good since we already know a bunch of the nurses. I think we're going to have a conversation about MRSA, though, before anyone gets their hands on my Skip.

I got a call today from a physical therapist who had evaluated Skip's wheelchair to see what pressure-relieving cushion should replace the existing foam cushion. They're looking at the mother of all Roho cushions, which is 4" thick with air bladders and will work with a local agency to get it. The PT pointed out to me something I hadn't been aware of. Now that Skip has had a pressure sore, she is at greater risk for recurrence because the healed skin never returns entirely to its original state. This makes extra care with her seating and pressure management a definite must.

I've also purchased a number of things we're going to need when Skip's here. Since she's going to be in bed 22+ hours a day, I've ordered hospital johnnies, bedpans and absorbing bed pads. I found a good cheap source for twin sheets on eBay and bought them this morning. I got special mugs and foam tubing to build up silverware handles to make it easier to eat in bed. This weekend, I'll be heading out to buy myself a twin bed to use while Skip's in the hospital bed. Then, I'll have to figure out what furniture needs to temporarily be removed from the bedroom to hold all the new stuff. I'm thinking, with the removal of our platform bed, this is also the perfect time to turn the rug, which is long overdue.

Yep, it's definitely feeling real.


Herrad said...

Hi Cranky,
It sure sounds real now.
Thinking of you and counting the days with the two of you.
Keep warm.

steve said...

I can feel your excitement! Sounds like you got your bases covered. Just a couple details you might want to consider:

Hospital bed mattresses are longer than standard twin mattresses. I found sheets sized "Twin XL" at Macy's that fit well. Otherwise, compensate with an extra deep pocket size for any fitted sheet or mattress pad.

Depending on Skip's strength, you might also need bed rails, draw sheets, and/or a trapeze to make it as easy as possible for Skip to shift around in bed, with or without your help.

Also, absorbent underpads with polyester top layers can end up trapping a lot of body heat next to the skin. Look for cotton or cotton/poly blend top layers.

Happy King's Day! Mardi Gras season has officially begun.


Cranky said...

Herrad - yep, definitely real. It is pretty nippy here; you stay warm too.

Steve - thanks for the insight on some other items to have. Good idea on the absorbent pads. I'll check what they're made of and get some cotton or cotton/poly blend ones if these are totally polyester. For the sheets, I wasn't too worried about their fitting perfectly because I envision them getting washed with great frequency, based on what I've seen in the rehab hospital. With Skip in bed all the time, I figured I'd need to change them pretty much ever day to help her feel as clean as possible.

I have been wondering how we'd handle in-bed adjustments, especially as I see she regularly needs to be pulled up on the mattress in rehab. A trapeze won't help as she doesn't have enough hand/arm strength. Is a draw sheet a device that could help with positioning on the mattress?

steve said...

Since her arms are weak, you will definitely want a draw sheet. We take a queen or king sized flat sheet and fold it into quarters, then lay it across the bed (over the underpad) so that it is positioned under her shoulders and bottom. When she slips down the bed, you can lay the bed flat, stand behind the headboard, grab the draw sheet under Skip's shoulders, and pull her up with relative ease. It works similarly to roll from side to side, pulling the sheet in the opposite direction of the roll.

And definitely get side rails. Even with only a little arm strength, Skip will appreciate having them for small movements. BR likes half rails better than full rails, because they stay better positioned when the head is raised.

Cranky said...

Steve - thanks so much for your explanation of the draw sheet. And, I'll call the rep from Hill-Rom and speak with her about bed rails.

steve said...

Hill-Rom? Sweet! I'll need to hide your comment from BR, or he'll get bed envy. He's in a pretty basic Invacare semi-electric bed that squeaks a lot.

Cranky said...

Steve - LOL!

Peace Be With You said...

In honor of caregivers like you, I have posted the following poem on my blog today:

Caregivers are great.
We are lucky to have them.
A devoted love.

They must have had wings
before they landed on earth.
It sure seems that way.

Selfless and giving,
they smooth the bumpy pathways.
They soothe our hurts.

Thank you for what you do.

Diane J Standiford said...

Sounds like an electric hoist is needed? Oh, right, you know about those. You know, I cry out of anger when I read these posts...that gay couples are not to be considered "married" that we are "less" and we can't begin to understand what a real marriage entails. I will put your and my situation against any str8 couple and I DARE them to last as long as we have. #$%^&*() I can't wait till she gets home.

Cranky said...

Judy - that's lovely. Thanks! I hope I can live up to it!

Diane - I can't wait either. Thanks!

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Cranky said...

Alena/sarah - thanks for stopping by and your note. Glad you've enjoyed reading, it's been great for me to have this blog.