CONTACTS
SUBJECTS
Bob Visit Arroyo Grande Community Hospital Recover Knee Replacement
0403 -
0403 - ..
0404 - Summary/Objective
0405 -
040501 - Follow up ref SDS 13 0000. ref SDS 12 0000.
040502 -
040503 -
040504 -
040505 -
040506 -
040508 - ..
0406 -
0407 -
0408 - Progress
0409 -
040901 - Robin called this morning.
040902 -
040903 - Discuss calling Bob at Mission View and planning to visit this
040904 - afternoon.
040906 - ..
040907 - Robin asked if I am going home today, and will I come back?
040909 - ..
040910 - Explained discussions last night with Bob about staying another few
040911 - days to help workout arrangements with Cindy or Terreas to care for
040912 - Sandy the next few weeks, while Bob is at Mission View. Suggested
040913 - that Bob call his brother and say it is not necessary to come up for 3
040914 - days. Bob planned to think about this overnight, reported on 111104
040915 - 0952. ref SDS 13 4G9J
040916 -
040917 -
040919 - ..
0410 -
0411 -
0412 - 0922
0413 -
041301 - Robin called back.
041302 -
041303 - Bob wants her to get his checkbook and bring it to him at Mission
041304 - View this afternoon, so he can pay some bills.
041306 - ..
041307 - Explained working with Bob yesterday in his room at Arroyo Grande
041308 - Community Hospital. Went through his mail and he found bills that
041309 - need to be paid, reported in the record for 111104 0952. ref SDS 13
041310 - M64M
041312 - ..
041313 - At that time, Bob expected to come home within a few days, so he had
041314 - me bring the mail with the bills separated, back to the house for him
041315 - to pay later.
041317 - ..
041318 - Robin said that since Bob was told last night that he will be in the
041319 - hospital another 2 weeks, he asked her to get his checkbook today, so
041320 - the bills can be paid.
041322 - ..
041323 - Robin will be here about 1500.
041324 -
041326 - ..
0414 -
0415 -
0416 - 1038
0417 -
041701 - Bob called. He sounds very weak. Can barely hear him.
041702 -
041703 - Asked Bob if he is okay?
041705 - ..
041706 - Bob said he is highly medicated for pain.
041707 -
041708 - [...below on 111105 0853 at 1207 Bob's brother Allen
041709 - reported impression that Bob seems more down today than in
041710 - calls earlier in the week, while at Arroyo Grande Community
041711 - Hospital. ref SDS 0 VG9J
041713 - ..
041714 - [...below on 111105 0853 at 1615 visit Bob at Mission View
041715 - he is asleep and does not look well. ref SDS 0 HM6L
041717 - ..
041718 - [...below on 111105 0853 at 1620 Bob's physical therapy
041719 - nurse, Francis, checked Mission View medical chart and said
041720 - there is nothing in the medication record that accounts for
041721 - Bob's noticable loss of energy, weaker voice, sleepiness.
041722 - ref SDS 0 6S7F
041724 - ..
041725 - This condition is significantly different from Bob's condition in the
041726 - hospital the past week. His voice all week has been strong and clear.
041727 - This suggests Bob is being treated with a new protocol different from
041728 - what Doctor Fow prescribed at Community Hospital.
041730 - ..
041731 - Asked Bob what his temperature was this morning?
041733 - ..
041734 - Bob said 98 something. He was told by the nurse his temperature is
041735 - normal.
041737 - ..
041738 - This is very good news for Bob, and seems miraculous that he recovered
041739 - from temperature 103, reported last night on 111104 0952. ref SDS 13
041740 - RX8I
041742 - ..
041743 - Bob asked if his brother has arrived?
041745 - ..
041746 - Reported that Allen has not arrived.
041747 -
041748 -
041750 - ..
0418 -
0419 -
0420 - 1207
0421 -
042101 - Allen arrived. He was at the front door with the dog. They seemed
042102 - like great buddies, indicating his concerns about need help to
042103 - transition, reported on 111101 0930. ref SDS 10 NV6F
042105 - ..
042106 - He had a good drive from LA, without complications. It's about 200
042107 - miles from his home, and drive takes a little more than 3 hours.
042109 - ..
042110 - Allen said he doesn't mind the drive. He is retired and so has
042111 - plenty of time these days.
042113 - ..
042114 - Allen asked how long Bob wants him to stay, and if I am returning to
042115 - Nipomo to help with Bob's care?
042117 - ..
042118 - Explained discussion with Bob that Allen would be here 3 days. Bob
042119 - is working with others on arranging to care for Sandy and the house
042120 - during his stay at Mission View.
042122 - ..
042123 - Allen said he talked to Bob this morning, and Bob advised that he
042124 - needs Allen to come up and stay at the house with Sandy for only
042125 - today, so he would go home tomorrow.
042127 - ..
042128 - Allen also noted that Bob seemed very discousaged and "down" (voice
042129 - was weaker than prior calls), when he spoke with him this morning,
042130 - citing disclosure by the Mission View team, that Bob will need
042131 - rehabilitation for the next 2 weeks.
042133 - ..
042134 - Allen's impression that Bob sounded weaker in their call today than in
042135 - calls prior today, aligns with the record of similar impression,
042136 - reported above. ref SDS 0 RJ5O
042138 - ..
042139 - Explained that Bob has had a temperature and is heavily medicated. He
042140 - is also very disappointed about being told he will be in rehab at
042141 - Mission View for 2 weeks. He expected to come home yesterday, and
042142 - then when told he needs special support in a rehabilitation facility
042143 - that this would only take 3 days. Learning that he will be away from
042144 - home and from Sandy another 2 weeks may account for Bob not having a
042145 - clear understanding of requirements for support, and possibly making
042146 - conflicting requests. His understanding of medical requirements is
042147 - unfolding gradually.
042149 - ..
042150 - None-the-less, have also noticed that today, Bob's voice his calls
042151 - have been noticably weaker than anytime this past week.
042153 - ..
042154 - Allen said he brought clothing and things to last 2 weeks, so he is
042155 - prepared to help Bob for at least a week or 2. Then, he has to return
042156 - home in the LA area for personal business, pay bills etc.
042158 - ..
042159 - Allen further suggested that he can take Sandy home with him and care
042160 - for him there, while Bob recuperates from surgery and gets back on his
042161 - feet.
042163 - ..
042164 - Allen feels Bob will need someone to pickup his mail and get important
042165 - papers to Bob through is recovery at Mission View. He asked if Robin
042166 - could be every few days and do this?
042168 - ..
042169 - Explained recent discussions with Cindy a backyard neighbor, and with
042170 - Shari a prior neighbor. Cindy wants Bob to hire her to care for
042171 - Sandy, and she could check Bob's mail. As well, Shari has offered
042172 - services of her cousin, Terreas, who helped Bob clean the house 2
042173 - weeks ago.
042175 - ..
042176 - Additionally, I offered to adjust my schedule and stay over or return
042177 - to Nipomo in a few days, if that would helpful.
042179 - ..
042180 - Bob is meeting with Shari and Terreas tomorrow afternoon at Mission
042181 - View. He will then have a better idea of how much it would cost for
042182 - Terreas to care for Sandy and house, and whether he needs for from
042183 - Allen, or whether to put Sandy in a kennel.
042185 - ..
042186 - Allen said he knows that Bob does not want Sandy in a kennel.
042188 - ..
042189 - Decided to discuss these options with Bob at Mission View later
042190 - today.
042192 - ..
042193 - Gave Allen the keys to Bob's house. Showed which keys open the front
042194 - and back doors.
042196 - ..
042197 - Allen asked which key opens the front screen door?
042199 - ..
042200 - Explained that Bob does not lock the front screen door, just the door
042201 - knob and deadbolt on the front and back doors, and that both keys work
042202 - the same for front and back doors.
042204 - ..
042205 - Gave Allen the list of instructions, which Bob reviewed yesterday on
042206 - performing household tasks, including feeding Sandy, reported on
042207 - 111104 0952. ref SDS 13 RT6L
042209 - ..
042210 - Allen folded the paper and put it in a shirt pocket for reference.
042212 - ..
042213 - Showed Allen Bob's walut and change purse in the top drawer left of
042214 - the stove, so if Bob needs them later, Allen can find them.
042220 - ..
042221 - Showed him Bob's cell phone number in the walut visible on top of
042222 - Bob's driver's license.
042224 - ..
042225 - Showed Allen Bob's mail on the counter left of the stove.
042227 - ..
042228 - Mail is separated between what Bob has seen and identified as
042229 - important, like bills that need to be paid, as reported yesterday on
042230 - 111104 0952. ref SDS 13 M64M
042232 - ..
042233 - Allen asked how the microwave works?
042235 - ..
042236 - Wasn't sure how the unit above the stove works. Showed Allen how the
042237 - 2nd microwave works that is on the kitchen counter next to the
042238 - refrigerator.
042240 - ..
042241 - Allen asked if Bob has any canned goods for dinner.
042243 - ..
042244 - Showed where canned good are stored under the breakfast counter.
042246 - ..
042247 - Showed Allen Sandy's dry food in the garage.
042249 - ..
042250 - Explained the procedure to give Sandy 33% of a can mixed with dry food
042251 - for dinner, and only dry food for breakfast, although occassionally
042252 - Bob mixes a couple eggs in Sandy's breakfast meal.
042254 - ..
042255 - Showed Allen the garage door control buttons inside the door to the
042256 - garage from the house.
042258 - ..
042259 - Allen tried each and was satisfied on understanding this issue.
042261 - ..
042262 - Explained Bob's practice to keep the garage door open during the day,
042263 - so Sandy has access to the front and back yards.
042265 - ..
042266 - Allen asked about Sandy running off, chasing cars or pedistrians.
042268 - ..
042269 - Related experience that Sandy has not left the property while I have
042270 - been here. Bob has indicated it is safe for Sandy to be in the front
042271 - yard during the day.
042273 - ..
042274 - Typically close the garage door when it gets dark, now about 1800.
042276 - ..
042277 - Explaned Bob has a procedure of wiping mud from the dog's paws with
042278 - rags in the garage before letting Sandy in the house on rainy days,
042279 - like we had yesterday.
042281 - ..
042282 - Showed Allen Sandy's water bowl outside. Advised of moving the bowel
042283 - from next to Sandy's food dish in the breezeway between the kitchen
042284 - and the garage, so the bowl is now near the faucet and underneath the
042285 - protruding sill of the new gargen widow in the kitchen. This makes
042286 - maintenance easier since the bowl is heavy and difficult to manage
042287 - when full. This way the bowl need not be moved, but simply tipped
042288 - over to rinse and fill.
042290 - ..
042291 - Showed Allen how to manipulate the several levers for turning the
042292 - water on to rinse and fill the bowl so Sandy has fresh water everyday.
042294 - ..
042295 - Explained Bob's practice for Sandy to sleep in the house, as shown on
042296 - the instructions, per above. ref SDS 0 NR6O
042298 - ..
042299 - Allen asked about closing the door from the breezeway into the garage.
042301 - ..
042302 - Advised that Bob never seems to close that door. This gives Sandy
042303 - continual access to the garage to lay down if he sleeps outside or
042304 - simply to get out of the weather.
042306 - ..
042307 - Allen asked what time Sandy comes into the house?
042309 - ..
042310 - Said I have been bringing Sandy in anywhere from 1900 - 2100 after he
042311 - has the evening meal.
042313 - ..
042314 - Allen asked if the back door is left open at night so the dog can get
042315 - out if nature calls?
042317 - ..
042318 - Said I have left the back door open until I go to sleep, but close it
042319 - then usually between 2300 - 1300. So far there has not been a
042320 - problem with Sandy in the house. One morning he woke me up at 0630
042321 - and seemed to want out. That has worked.
042323 - ..
042324 - Allen will discuss further with Bob.
042326 - ..
042327 - Allen likes Bob's new Samsung television.
042329 - ..
042330 - He asked what happened to the old Entertainment Center furniture? He
042331 - related Bob's report to him months ago that installers for the new
042332 - Samsung TV dismantled and moved the furniture 30 feet into the kitchen
042333 - to make room for the new television in the living room, but refused to
042334 - move it another 20 feet into the garage on grounds they are not
042335 - "furniture movers."
042337 - ..
042338 - Explained the former Entertainment furniture was moved into the garage
042339 - to give Bob easier access in the house while recovering mobility after
042340 - knee surgery, reported on 111031 0800. ref SDS 9 VB9G
042342 - ..
042343 - Allen asked how the televison works. He has not been here since Bob
042344 - got the new television.
042346 - ..
042347 - Showed Allen the television remote control. He mostly figured out
042348 - how to use it himself, since he also has Direct TV service from AT&T.
042350 - ..
042351 - Allen watched Stanford v Oregon football game.
042352 -
042354 - ..
0424 -
0425 -
0426 - 1227
0427 -
042701 - Bob is out of canned dog food. Explained going to the store to get
042702 - dog food, and asked Allen if there is anything he needs?
042704 - ..
042705 - Allen said he cannot think of anything.
042707 - ..
042708 - Drove to Von's on Tefft and bought 3 cans of Alpo dog food, which Bob
042709 - has been using for Sandy.
042710 -
042711 - Paid............................. $4.15
042713 - ..
042714 - Post expense ledger...
042718 - ..
042719 - On returning showed Allen where Sandy's canned dog food is stored in
042720 - the revolving counter beneath the kitchen counter in the corner
042721 - between the stove and refrigerator.
042723 - ..
042724 - Allen asked where Bob stores coffee in the house.
042726 - ..
042727 - We looked through the cabinets and could not find coffee.
042729 - ..
042730 - There are several empgy coffee containers in the garage on the table
042731 - next to the car. Possibly Bob is out of coffee.
042733 - ..
042734 - Offered to go back to the store an get coffee for Allen.
042736 - ..
042737 - Allen said he will take care of it later.
042739 - ..
042740 - Showed Allen where Bob's cloths are stored which he wore going to the
042741 - hospital for surgery on reported on 111031 0800. ref SDS 9 YJ80
042743 - ..
042744 - These can be returned for Bob when he is released to come home in a
042745 - few weeks after rehabing his knee.
042746 -
042748 - ..
0428 -
0429 -
0430 - 1305
0431 -
043101 - Moved furniture from dining area. Swept entryway from front door,
043102 - dining area and kitchen, and the mopped the tile flooring.
043104 - ..
043105 - Put the furnither back in place.
043107 - ..
043108 - Allen commented that everything looks pretty good.
043109 -
043111 - ..
0432 -
0433 -
0434 - 1438
0435 -
043501 - Bob called and asked to bring his walut when we come to see him at
043502 - Mission View later today.
043503 -
043504 - [...below Bob needed his medicare card from his walut; this
043505 - was copied by Mission View staff and returned to his walut,
043506 - and his walut was returned to the house. ref SDS 0 H77I
043508 - ..
043509 - He initially sounded stronger than his call this morning, per above.
043510 - ref SDS 0 RJ5O
043512 - ..
043513 - Asked about bringing invoices for him to pay.
043515 - ..
043516 - Bob said to bring the invoice from Bank of America.
043518 - ..
043519 - Found it and put in a stack for the trip to Mission View, that
043520 - includes his cell phone charger and address book, requested yesterday
043521 - on
043522 -
043523 -
043525 - ..
0436 -
0437 -
0438 - 1502
0439 -
043901 - Robin arrived to find Bob's checkbook, and for the trip to see him at
043902 - Mission View in San Luis Obispo.
043904 - ..
043905 - She could not find the checkbook applying Bob's instructions.
043907 - ..
043908 - Robin asked for help. She said Bob's checkbook is in one of the 3
043909 - filing cabinets in the laundry room. She looked through the filing
043910 - cabinets and cannot find anything like checkbooks. One of the
043911 - cabinets is locked. Robin cannot find a key.
043913 - ..
043914 - We tried several keys from among the 10 - 15 keys that Bob provided on
043915 - 111031 0800. ref SDS 9 458K They looked like the right size, but did
043916 - not fit.
043918 - ..
043919 - Robin called Bob to ask for further assistance.
043921 - ..
043922 - Bob gave further verbal instructions which were not clear nor
043923 - understandable under the circumstance sufficient for Robin to find
043924 - the key to the file cabinet.
043926 - ..
043927 - Bob got emotional and frustrated about not being able to get his
043928 - checkbook, and difficulty with communications.
043930 - ..
043931 - Robin asked me to take the call.
043933 - ..
043934 - Bob continued with loud, angry shouts that occur from frustration of
043935 - helplessness being in a hospital and depending on others for doing
043936 - routine personal tasks.
043938 - ..
043939 - After a few moments, understood better Bob's guidance and luckily
043940 - found a key in overhead cabinets in the laundry room.
043942 - ..
043943 - The key worked to unlock and open the 2 drawer filing cabinet located
043944 - between the 2 four-drawer cabinets in the laundry room.
043950 - ..
043951 - Robin opened the top drawer and found Bob's checkbooks in the back of
043952 - the file drawer.
043954 - ..
043955 - There were 4 or 5 different of check books. Bob said he needs only 2
043956 - of them. The way he described names of the vendor did not match well
043957 - with names written on the checks. Eventually put what Bob seemed to
043958 - want into a plastic bag and left for the hospital in San Luis Obispo.
043960 - ..
043961 - Robin put Bob's check book in a plastic shopping bag, and put the
043962 - other things in the bag, which Bob has requested...
043963 -
043964 - cell phone charger
043965 - address book
043966 - walut
043967 - bills to pay
043969 - ..
043970 - [...below on 111105 0853 1640 after getting and copying his
043971 - medicare card needed by Mission View, Bob asked that the
043972 - walut be returned to the house for storage in the drawer
043973 - next to the stove. ref SDS 0 M98J
043974 -
043975 -
043977 - ..
0440 -
0441 -
0442 - 1531
0443 -
044301 - Drove to Mission View in San Luis Obispo. Allen drove with me. We
044302 - followed Robin who knows area well from being a long time resident,
044303 - and she works for a medical company in San Luis Obispo. She was at
044304 - Mission View previously, when mother was there in 2007.
044305 -
044307 - ..
0444 -
0445 -
0446 - 1615
0447 -
044701 - Arrive at Mission View.
044702 -
044703 - Mission View
044704 - 1425 Woodside Drive
044705 - San Luis Obispo, CA 93401
044706 - 805 543 0210
044708 - ..
044709 - Bob is in room 202.
044711 - ..
044712 - Bob is sleeping and does not look well.
044714 - ..
044715 - This aligns with impressions in the call from Bob this morning that
044716 - his voice was noticably weaker, per above. ref SDS 0 RJ5O Bob's
044717 - brother, Allen, reported similar finding, also, above. ref SDS 0 JO88
044718 -
044719 - [...below on 111105 0853 at 1620 Bob's physical therapy
044720 - nurse, Francis, checked Mission View medical chart and said
044721 - there is nothing in the medication record that accounts for
044722 - Bob's noticable loss of energy, weaker voice, sleepiness.
044723 - ref SDS 0 6S7F
044725 - ..
044726 - He has his own room while recovering from infection, diagnosed at
044727 - Arroyo Grande Community Hospital, reported on 111031 0800. ref SDS 9
044728 - CS8H
044730 - ..
044731 - Robin rustled Bob's hand, and he opened his eyes.
044733 - ..
044734 - Exchanging greetings and talking with Bob, he seems very weak. More
044735 - so than anytime the past 6 days after surgery at Community Hospital.
044736 -
044737 -
044739 - ..
0448 -
0449 -
0450 - 1620
0451 -
045101 - Walked down the hall and found the Control Center.
045103 - ..
045104 - Talked to Francis, a male nurse who indicated he is charge of Bob's
045105 - care on the day shift.
045107 - ..
045108 - Good news...
045110 - ..
045111 - Mission View medical records show...
045112 -
045113 - Temperature
045114 -
045115 - 111104 1740............. 100.3
045116 - 111105 0330............. 98.5
045117 - 111105 0900............. 98.1
045118 -
045119 -
045120 - WBC
045121 -
045122 - 111103.................. 9.7
045123 - 111102.................. 12.9
045124 - 111101.................. 10.6
045126 - ..
045127 - It is good news that Bob's temperature is only 100.3, rather than 103,
045128 - which Bob reported yesterday on 111104 0952. ref SDS 13 RX8I
045130 - ..
045131 - However, Mission View's report today that Bob's temperature was 100.3
045132 - on arrival from Arroyo Grande Community Hospital conflicts with Doctor
045133 - Fow's report that Bob could not be discharged from the hospital until
045134 - his temperature and blood counts that required a transfusion on
045135 - 111103, have normalized, reported on 111103 0709. ref SDS 12 6T56
045137 - ..
045138 - Need to see discharge documentation that Arroyo Grande Community
045139 - Hospital prepared to justify transfer to Mission View Health Center,
045140 - and instructions for Bob's care to recover from complications.
045142 - ..
045143 - Francis looked quickly through Mission View records at Station #2. He
045144 - could not find the discharge document, cited by Tony yesterday on
045145 - 111104 0952. ref SDS 13 TG63 Francis said he will look more carefully
045146 - and make inquiries to find Bob's discharge instructions from Doctor
045147 - Fow and Arroyo Grande Community Hospital.
045148 -
045149 - [On 111111 0802 Mission View reported they did not receive
045150 - a copy of Bob's discharge documentation from Arroyo Grande
045151 - Community hospital disclosing Bob has infection after
045152 - surgery on 111031, that he required a blood transfusion due
045153 - to low HGB blood counts, nor that Bob had temperature of
045154 - 100.3; as a result, Mission View called and requested a
045155 - copy of discharge documentation prepared by Arroyo Grande
045156 - Community Hospital that notifies Mission View on scope of
045157 - work to provide health care services required by Bob's
045158 - patient history. ref SDS 14 TC6J
045160 - ..
045161 - [On 111114 0715 Kimbeny in Medical Records Department
045162 - reported that there is Discharge form on file at Arroyo
045163 - Grande Community Hospital for Bob's release from care on
045164 - 111104, and transfer first to Arroyo Grande Care Center,
045165 - and ultimately to Mission View. ref SDS 15 MI6N
045166 -
045167 -
045169 - ..
045170 - Asked Francis about Bob's medication. Has there been a change on
045171 - arriving at Mission View that might be causing noticable increased
045172 - weakness in Bob's voice and energy. For example he was sleeping and
045173 - does not look well, when we arrived a few minutes ago, per above.
045174 - ref SDS 0 HM6L His voice seems much weaker than it has been the
045175 - entire week after surgery on Monday, reported earlier this morning,
045176 - and Bob attributed this to being medicated for pain, per above.
045177 - ref SDS 0 RJ5O
045179 - ..
045180 - Francis looked at Bob's medical chart maintained at Mission View. He
045181 - gave the name of Bob's medications and said nothing jumps out that
045182 - might be causing a big change in patient energy, voice, groggy, etc.
045184 - ..
045185 - Asked if there is any record of increasing the dose of medication?
045187 - ..
045188 - Francis seemed to say no.
045190 - ..
045191 - Could there have been a mistake in the amount of medication Bob is
045192 - getting? In other words, the chart shows no change, but somehow it
045193 - has been increased and not reported?
045195 - ..
045196 - Francis will check with the staff on this.
045198 - ..
045199 - Asked for the list of Bob's currently assigned doctors?
045201 - ..
045202 - Francis said that Doctor Fow is listed in Mission View records as
045203 - Bob's physician responsible for knee surgery and any complications.
045205 - ..
045206 - Another doctor is now assigned for treating Bob's infection...
045207 -
045208 - Doctor D'Ambruoso
045210 - ..
045211 - Francis seemed to say that Doctor D'Ambruoso is working under or with
045212 - Doctor Ritter who provided Infectious Disease care at Arroyo Grande
045213 - Community Hospital, and according to Doctor Fow made the deicsion to
045214 - release Bob with an infection, reported on 111103 0709. ref SDS 12
045215 - 6T56, cited as well by Jeff at Arroyo Grande Community Hospital, shwon
045216 - on 111104 0952. ref SDS 13 05HB
045218 - ..
045219 - Francis explained that Bob is currently very discouraged about needing
045220 - 2 weeks of rehab at Mission View rather than going home in 3 days,
045221 - which Bob has been counting on since his meeting with Doctor Fow on
045222 - 111103 0709. ref SDS 12 LP5O Francis noticed immediately that Bob was
045223 - deeply dissappointment, when Francis disclosed to Bob on arrival at
045224 - Mission View last in the afternoon that Bob would need 2 weeks of
045225 - physical therapy at Mission View Care Center.
045227 - ..
045228 - Explained Bob's original understanding that he could go home 3 - 5
045229 - days after knee surgery, reported on 110919 0911. ref SDS 5 HH7O
045231 - ..
045232 - Francis further explained that knee replacement surgeries are among
045233 - the most difficult for patients to recover because of risk patients
045234 - will fall and get injured, requiring additional surgery to repair
045235 - their knee again, or worse break and arm, shoulder, or suffer head
045236 - trauma, even death.
045237 -
045238 - [On 111111 0802 at 0852 Laurie, Mission View Medicare
045239 - Manager, explains Medicare requirements for higher standard
045240 - of care to rehabilitate very elderly patients who live
045241 - alone in order reduce risks of falling and causing injuries
045242 - that increase medical costs. ref SDS 14 574F
045244 - ..
045245 - [On 111111 0802 at 1810 Mission View has no records showing
045246 - Bob has taken 1 step. ref SDS 14 5Q4N
045248 - ..
045249 - [On 111111 0802 at 1822 Laura physicial therapyst reported
045250 - Bob walked 150 steps with walker and physical therapyst;
045251 - still has long way to go to walk 150 steps that demonstrate
045252 - rehabilitation to function indepently; patients usually
045253 - require 4 weeks, and some take months to be ready for
045254 - discharge. ref SDS 14 FH5W
045256 - ..
045257 - [On 111111 0802 at 1903 Bob still very discouraged about
045258 - slow progress recovering from knee surgery; feels he was
045259 - misled into agreeing to knee surgery with false promises of
045260 - walking out of the hospital and going home 3 - 5 days after
045261 - surgery. ref SDS 14 668O
045263 - ..
045264 - [On 111114 0715 Ken, Manager Mission View Physical Therapy
045265 - Department reported Bob's rehabilitation is delayed by
045266 - infection; the past few days, he has begun making better
045267 - progress. ref SDS 15 SA31
045269 - ..
045270 - We reviewed Doctor Fow's report that standard protocol for releasing
045271 - patients to go home after knee surgery is when the patient can walk
045272 - 150 feet, shown in the record on 111103 0709. ref SDS 12 QU3I Not
045273 - sure if this is 150 feet in a walker or unaided.
045275 - ..
045276 - Francis said walking 150 feet is the criteria Mission View uses to
045277 - determine a patient is ready to go home.
045279 - ..
045280 - Francis said that some patients take months (think he said 2 - 6
045281 - months) to rehabilitate at Mission View sufficiently to go home. He
045282 - noted that age is major factor that prolongs recovery. Francis
045283 - credited Bob for being in excellent physical shape, so his advanced
045284 - age of 84 may not hinder him as much as other 80 year olds.
045285 -
045286 -
045288 - ..
0453 -
0454 -
0455 - 1643
0456 -
045601 - Thanked Francis and walked back to Bob's room.
045602 -
045603 - Bob was talking to his brother, Allen, asking if he feels settled into
045604 - Bob's home to stay for at least a few days, while Bob decides what to
045605 - do about his dog, Sandy, and makes plans with Medicare for post-rehab
045606 - support at home.
045608 - ..
045609 - Allen said he feels things are under control now at Bob's home, based
045610 - on orientation earlier this afternoon, per above. ref SDS 0 OY5M
045612 - ..
045613 - Bob asked if Allen is comfortable handling Sandy, feeding and
045614 - watering, etc.
045616 - ..
045617 - Allen said everything will be fine.
045619 - ..
045620 - Robin was helping Bob write checks to pay 1 or 2 bills.
045622 - ..
045623 - Bob asked if we brought his cell phone charger?
045625 - ..
045626 - Turned out the cord is too short for putting the cell phone in a
045627 - convenient position that Bob can reach from his hospital bed.
045629 - ..
045630 - Walked outside into the hallway and hailed Nurse Jennie. Explained
045631 - problem to configure Bob's electrical outlets and cords so his cell
045632 - phone charger can be plugged into a wall outlet close enough to the
045633 - bed that Bob can reach it.
045635 - ..
045636 - In a few minutes, a Nurse Angelica came with an extension cord and
045637 - fixed this.
045639 - ..
045640 - Put Bob's address book on his bed table so it is within reach. He
045641 - seemed to indicate that he can use the Mission View room telephone
045642 - system to make long distance calls at no cost. This a better
045643 - communication solution than using his cell phone. Bob likes his cell
045644 - phone, because it has numbers that can be dialed by pressing buttons,
045645 - however, this cell phone service charges for each call, so using the
045646 - Mission View system seems better.
045648 - ..
045649 - Bob pulled his medicare card from his billfold, which is why he asked
045650 - to have it brought back to Mission View, during his call earlier
045651 - today, per above. ref SDS 0 WY6L
045653 - ..
045654 - Bob said to return his walut to the house and store back in the top
045655 - left drawer next to the stove, per above. ref SDS 0 O79J
045657 - ..
045658 - Robin suggesting having the Mission View team copy his medicare card,
045659 - rather than leave at Mission View where it might get lost in the
045660 - shuffle.
045662 - ..
045663 - Bob agreed.
045665 - ..
045666 - We hailed another attendant. Someone came and took Bob's Medicare
045667 - card, and another card that shows his account for extended health care
045668 - insurance. These were copied and given to Mission View. The
045669 - originals were returned to Bob's walut.
045671 - ..
045672 - Robin put Bob's walut in the plastic bag along with the check books
045673 - for Allen to take back to Bob's house.
045675 - ..
045676 - Allen explained his thought about taking Sandy to his home in the LA
045677 - area until Bob gets out of rehab and can take care of Sandy at home
045678 - in Nipomo.
045680 - ..
045681 - Bob doesn't want to do that.
045683 - ..
045684 - Bob explained he is meeting with Terreas tomorrow. He feels she can
045685 - do a good job. He is meeting with her tomorrow and if he can afford
045686 - to hire Terreas that will be a better solution for him.
045687 -
045689 - ..
0457 -
0458 -
0459 - 1714
0460 -
046001 - Bob said he wants to remove the leg bending physical therapy
046002 - equipment, because it is huring his knee.
046004 - ..
046005 - Hailed an attendant to help Bob remove his leg from the equipment.
046006 -
046008 - ..
0461 -
0462 -
0463 - 1722
0464 -
046401 - A team of 3 or 4 people arrived at Bob's room.
046402 -
046403 - The explained Bob's protocol requires continual exercise in the
046404 - machine to expedite his recovery.
046406 - ..
046407 - The lead team member said they can disconnect it now, since Bob has
046408 - elevated pain. He said they will put it back later after Bob has
046409 - taken pain medication and it become effective in Bob's system. The
046410 - attendant seemed to say the machine runs while Bob is sleeping at
046411 - night.
046413 - ..
046414 - This may account for why Bob seems to be talking so much softer and
046415 - seemingly less engaged (excpet for the checkbook incicent earlier
046416 - today, per above. ref SDS 0 7A5L
046418 - ..
046419 - Bob may be on a new protocol to expedite rehabilitation from left knee
046420 - replacement surgery. This may entail increased use of the bending
046421 - machine, which in turn requires more pain medication. Increasing
046422 - Bob's pain medication possibly in combination with other agents for
046423 - sleep, may make him sleepy, as he was when we arrived, per above.
046424 - ref SDS 0 OX7N
046426 - ..
046427 - Allen had commented on Bob seeming to have a weaker voice in his call
046428 - this morning, per above. ref SDS 0 YG8I
046430 - ..
046431 - While we talked in the hallway outside Bob's room. a nurse removed
046432 - the leg bending equipment from Bob's leg. Bob gave out a loud cry of
046433 - agony, indicating he still has great pain in his leg, and so a long
046434 - way to go in order to restore mobility.
046436 - ..
046437 - After Bob was comfortable again we all chatted again for another 10
046438 - minutes or so, and then said goodby.
046440 - ..
046441 - Bob took the plastic bag with Bob's checkbooks, walut, and documents
046442 - for storage at the house.
046443 -
046445 - ..
0465 -
0466 -
0467 - 1740
0468 -
046801 - Left Mission View in San Luis Obispo, followed Robin to get back to
046802 - the freeway, and then she went home to Arroyo Grande and I drove
046803 - Allen back to Bob's place.
046804 -
046806 - ..
0469 -
0470 -
0471 - 1818
0472 -
047201 - Arrived at Bob's home.
047202 -
047203 - Showed Allen again where Bob keeps the key to the filing cabinet.
047204 - Opened it for Allen to put the checkbooks away.
047206 - ..
047207 - Unlocked the filing cabinet and put the key back.
047209 - ..
047210 - Allen decided to put the entire plastic bag and all contents in the
047211 - filing cabinet, rather than remove Bob's walut and put it back in the
047212 - top drawer left of the stove, and also put the documents from the
047213 - mail back on the kitchen counter top left of the stove.
047215 - ..
047216 - Allen said keeping everthing together will make it easier for him to
047217 - find what Bob needs, if he calls again.
047219 - ..
047220 - Helped Allen feed Sandy opening a can of Alpo and mixing 33% with
047221 - Sandy's dry food.
047223 - ..
047224 - Thanked Allen for help with Sandy, and appreciated meeting him.
047225 -
047226 -
047228 - ..
0473 -
0474 -
0475 - 1832
0476 -
047601 - Left the house for home.
047602 -
047603 -
047604 -
047605 -
047606 -
047607 -
047608 -
0477 -