Maddie’s Recovery

 

 I phoned the assisted living facility where my client Maddie* resided to discuss the level of care she was receiving.   Three weeks prior she had had a stroke which dramatically changed her life.  Though she was left with few residual physical limitations, her memory and cognitive abilities had changed.   After a week in the hospital and another week in inpatient rehabilitation, she was discharged to the assisted living rather than returning to her independent lifestyle in her apartment in a retirement community.  Though she continued to show some improvement for the first weeks there, she still had not resumed many of the activities that she had been doing six months before.  She was not able to write letters or play the piano again.  She had some difficulty placing people when they called even when she had known them for a long time.   She settled into the routine at the assisted living, but her new deficits remained obvious as she did not recognize items such as books, jewelry, etc. that had been part of her life for many years.  There were lots of gaps in her memories.  She functioned fairly well in the setting and seemed at least “comfortable” both physically and psychologically but I had really hoped for more for her.  I wanted her to have a higher quality of life.

Her hospitalization had been quite grim but I had seen her go through other similar hospitalizations and come out remarkably well.  Throughout the week at inpatient rehab she had regained most of her physical status and speech.  According to the rehab standards, she was doing well.  Coming home from the hospital was the first time I really felt doubtful that she would make her usual remarkable recovery.  She recognized so little on the ride home and was even unsure what city we were in.  Her new apartment was carefully filled with familiar things but she did not realize it.  She fell into the new routine with guidance from the nursing assistants but was still a fish out of water swimming through someone else’s life.

Unexpectedly, several weeks later, there was a remarkable change in her status.  She suddenly began to write letters again.  She started knitting which she had not done in months.  Conversation began to flow more smoothly with fewer stumbles over unavailable words.  Memories began to slowly emerge.  She was able to find her way to the dining room on her own with simple reminders.  Clearly to me, she no longer needed the level of care she had been assigned when she was first admitted to the facility so I phoned to discuss the change with staff.  I was finally able to reach the designated staff person to discuss Maddie’s improvement.  Though ultimately it is a nurse who is responsible for a care plan for assisted living residents, it is not always a nurse who is involved with the day to day management of care.  Such was the case at this facility.  A non-clinical staff person was the one who supervised the nursing assistants.  When I reached her, I began to explain the changes that I had noted and why I thought Maddie needed to be re-evaluated for a change in her level of care.  While the nursing assistants had been doing an adequate job, there was inconsistency of care and some were overly attentive while others were much less so.  The supervisor mentioned concern because one of the nursing assistants had made an observation that she believed indicated Maddie was not doing well.   “She wears the same clothes every day”, the aide reported to her supervisor.  The nursing assistant had done a good job observing and passing on the information but that is where the information became skewed.  From that information assumptions were made by the aide and then her supervisor.   If the resident is not changing clothes, she must not have improved, the supervisor assumed.  She questioned her appropriateness for a change in level of care.

Do not assume!  That is my mantra and here was yet another example.    There were assumptions made and they were not validated.  The nursing assistant had done her job of observing her patient (though if she had observed without assumptions of her own, she would have noticed a drying rack in the bathroom with clothes hanging from it.)  She would have also observed that though the patient was wearing the same clothes each day, her hygiene was always good and her clothes clean and neat.  If the supervisor  had looked further or stopped to consult the resident, she would have found that Maddie was washing her clothes each evening and putting them on in the morning as had been her routine  for many years.  She was actually performing at a much higher level than the staff was aware. 

Eventually, the assistive living staff re-evaluated Maddie’s status and agreed that she qualified for a lower level of care.  This proved to be better for her from the standpoint of her independence as well as financially a considerable savings.  Where did the assistive living staff go wrong?  I believe it was with assuming.    We must view situations without a predetermined idea but open to the evidence and verifying and validating as we go.  There are so many lessons here for all of us.  Maddie continued to improve and with support is now living a life filled with activity, independence and purpose.  It was a remarkable recovery!  I am still preaching “DO NOT ASSUME!”

*Maddie is a fictitious name but the story is based on a real incident.

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356 Responses to “Maddie’s Recovery”

  1. Francis says:

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    ñïñ çà èíôó….

  2. angelo says:

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    ñýíêñ çà èíôó!!…

  3. herman says:

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    áëàãîäàðåí!!…

  4. Enrique says:

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    áëàãîäàðåí!!…

  5. henry says:

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    áëàãîäàðåí!…

  6. salvador says:

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    ñïàñèáî çà èíôó….

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