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June' Berg's Care Conference 11 June 2008

June’s quarterly “Care Conference” at the Benedictine Health Center at Innsbruck was held on June 11th, 2008 in the Villa Family Conference Room. 

In attendance was the staff Social Worker, the Villa Coordinator, the Villa Duty Nurse, the Staff Dietician and myself. 

The Dietician reported that June’s most recent weight on June 4th was 130.5 lbs. This was down a little less than 2 lbs (132.2) since the Care Conference on February 27th, 2008. June was reported as eating between 60-75% of the normal meal provided to the residents. June eats pureed foods and thickened liquids because June has a swallowing problem related to the Alzheimer’s.

I discussed June’s eating. I personally feed June some of the noon time meals. June is difficult to feed in that she does not always open her mouth to accept food. Each person feeding June has their own techniques for prompting June to open her mouth to accept food. The skill, ability and patience of the staff varies I feed June when I am equally as capable or more capable than the staff Nursing Assistant that is on duty for feeding June at that particular time. If a more capable staff person is available to feed June, I would request that person do the feeding. There has been a gradual increase in feeding difficulty over the last several months. It usually takes me almost 1-1/2 hours to accomplish the feeding. This change in feeding difficulty is normal with the progress of Alzheimer’s.

 I expressed my concerns to the Nursing Staff about some areas of June’s care.

 I had requested many months ago that whenever June was placed in bed for a nap or placed in bed for the evening, that the head of the bed be inclined upward approximately 30 degrees. This request was made in view of June having to occasionally cough during the nap or bed time periods. I was concerned that any liquids that June might cough up could cause her to choke. The inclined angle would facilitate expelling the liquids. I also wanted June to be able to see the walls (pictures, cross etc.) so that she would not become afraid if she should wake up and be staring at a blank ceiling. Because of the Alzheimer’s she would not understand where she was. I felt that her seeing objects on the wall such as a picture, her Cross and other items would have a comforting effect. This procedure was being done for the most part as requested. However, the Nursing Assistants all seemed to be a little reluctant to place the bed fully upward at the requested angle or did not understand what that angle was. I discussed the ways that this could easily be determined. (June is not able to move herself to different positions and for the most part will lay helpless on her back.) We also discussed placing her in an initially comfortable position in the bed. 

June tends to bruise very easily. I was concerned that on occasions, June is seated in her Geri Chair in a manner that would facilitate bruising. Some times her arms are in positions that they could be bruised between the side of her body and the side of the chair frame. I discussed means of arranging June’s seating in a manner that would avoid such a problem. I have suggested that the Nursing Assistants step back after June is seated in her Geri Chair and look June over. They should then ask themselves – “Doe’s she look comfortable.” I emphasized that June is totally helpless and would remain in what ever position she was placed until the next time she was moved for a bathroom break. While many residents have the strength or ability to move themselves and adjust themselves in their chairs, June cannot do so. Her comfort is completely dependent on their care in placing her in the chair properly. Because June is no longer able to speak, she cannot voice any complaints of discomfort or ask for help. 

The staff at the Benedictine are all very caring persons and as usual have pledged their cooperation in providing June with the best of care to insure her comfort. 

Stan Berg – 6/11/2008 

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