I’m still here! Talking about Care Facilities and that F-699 thing

Another challenge that relates to last week’s blog is polypharmacy, when someone is on lots of different medications prescribed by several different providers who may not talk with each other.

Alice in 310 was on a tear. Since she’d fallen and wasn’t as mobile as she used to be? Anytime anyone came in her room? She was screaming and yelling at everyone! Especially at night, when she began to throw things at them.

They couldn’t tell if she was having flashbacks about something, hallucinating from dementia, experiencing adverse effects of medication interactions, or had simply become psychotic. In the moment, Alice could have as easily been triggered by something. It certainly slowed down night rounds. And as much as she kept it up? The repetition had to be somewhat retraumatizing for her if not for the staff.

A chart review yielded no clues: Alice had no known history of events that could cause her night terrors. People were stumped. Then the DON was walking by two CNAs who were talking. She couldn’t help but hear “… my mama and her mama didn’t talk about nothing! I wonder if something happened to Miss Alice…” one voice said. “Yeah, if it had, she wouldn’t have said anything either,” another voice chimed in, “but it’s like her body’s trying to tell us something. It’s the same way my niece acted after somebody got hold of her.”

“Known” was the key. The CNAs were thinking symbolically. No matter how they said it, the DON “got it” the generational differences in what people were comfortable talking about, and the level of relationship people needed to disclose difficult events. It certainly isn’t when they’re admitted or to a stranger.

She was surprised to hear the CNAs talk so easily about traumatic events in their family’s lives. It occurred to her that helping staff increase their resilience might be a good thing to do. It hadn’t quite dawned on her that every day staff are exposed to the longing and sorrow of the grief many residents feel, and to behavior to things no one might be able to talk about.

What do you think?