Having more fun with LTC

The past few days at Rex's rehab/LTC facility have been much more interesting.

I've gotten a lot more patient contact, including rounds. (And I don't mean rounds like in the hospital, where care providers get together and run through a list of patients. I mean actually going to every room in two halls and talking with every patient about their concerns and needs.) A surprising number of people really liked the food, so we really just made small changes and answered questions. One woman, though, is the grandmother of a chef at the main hospital, and she said everything tastes awful. She couldn't be more specific about what she didn't like - it was everything. "Is it just different from what you're used to?" I ventured. "No, I like all sorts of different foods...as long as they're good." So now she's getting VIP treatment, including food off of the more gourmet hospital menu. Fortunately her roommate is verging on comatose, so we don't have to worry too much about other residents asking for similar perks.

On Wednesday, I got to observe the PT's working with several patients, many of whom I had already seen. It was great to see them in a different setting, being more active and pushing themselves. I realized why nutrition support is so important - we have to provide the energy and nutrients allow patients to walk again after a stroke or hip replacement. I particularly love a 95 yo woman who chugged away at her hand wheel exercises, and a sweet-tempered woman who suffered a hemorrhagic stroke that left her severely aphasic. (The latter has refused tube feeds and is making remarkable progress on eating.)

Today, I sat in on patient care meetings, where patients and families can talk to the social worker, nursing administrator, activities coordinator and RD all together. The family dynamics and interpersonal issues were particularly interesting. It was great to see the RD play a more collaborative role, working on overall quality of life rather than focusing on just nutrition. One case involved a 93 yo woman who is too exhausted to eat or go to the bathroom, much less engage in activities, because she refuses to take a nap. More specifically, she refuses to get into bed in the middle of the day because she thinks that means she'll die. We all worked together with her son to brainstorm strategies to meet her needs without forcing her to do something that scares her.

Oh, and I've also been told twice, both times by women who weigh less than 90 lbs, that I need to eat more and gain weight. What are you supposed to say to that?