Monday, October 17, 2011

Same Old

Back to dealing with the same old business, picking up where we left off when decided that man, screw it.  She's moving out, why deal with this stuff?

To the residential director of the current house:
As I believe my Dad told you, Amy is unable to move to the [New] house. He told her this afternoon.

I'm actually emailing at Amy's request about the take-as-needed meds and scheduling a counselor appointment.

After Amy got the news, we talked and we agreed she should take one of her white pills, as Dr. [Psychologist] had told us she should in such circumstances, rather than letting herself get wound up. She told me the staff had to call the nurse to administer the medication even though they were medtrained. Last I talked to Amy at 8:40 the nurse hadn't made it there yet and she was headed to sleep. She was ok -- I am AMAZED by her resilience, but can we try to deal with this and figure it out so she can take her meds when she needs them? What if she wasn't ok? These meds aren't recreational -- when Amy is overcome with panic it affects her tightness, increases likelihood of seizure (still highly unlikely, but Amy worries when she's stressed that she could give herself a seizure -- a horrible spiral), and it makes it harder for her to be cared for. Being able to take these pills quickly when she needs them is important.

The other thing which Amy asked me to email you about is that she needs to start seeing a counselor again. Do you know if there are other counselors and Amy could try out a different one? My sense is that her and [Shouting Counselor] didn't really click and that their time together was not was constructive. Of course, Amy can see  [Shouting Counselor] in the interim till someone else is identified.

Both of these things are pretty important as Amy continues to deal with losing our mom, and now in the disappointment of losing her opportunity at the [New] house.

Thanks, [Residential Director].   

I tried softening up.   Less knife-wielding, no?

I have read what you have said and know that this is a difficult time for Amy.

Regarding the “white pill” which is a PRN medication. The agency has procedures regarding administering medications that staff must follow.

The staff are not able to just give the medication regardless if they are med trained or not, Once a client begin to show signs of what the medication was prescribed for, the staff must contact the program nurse or the nurse on call.

Also you have stated in previous e-mails that Amy is “terrified” of [House Head]. I am concerned about this statement as [House Head] is the QSP for Amy and responsible for her care, including finding another counselor.

So I am wondering how to resolve this issue if [House Head] “terrifies” Amy and has to work with the counselor, talk with Amy about her concerns and address them.

I have copied by supervisor Wendy Swims in this e-mail, because as Amy is continuing to receive services from [Organization],   [House Head] will have contact with her and as Amy’s family you will need to have communication with [House Head] .

Look forward to hearing from you. 

And reply:
Hi, [Residential Director],

On the PRN, medication issue: Can Amy be screened on the Self Administration of Medication Assessment tool, so she'd be able to self administer (my mom was working with [so and so]and [so and so] on this so she could self medicate at [Sheltered Workplace]). This would fall under rule 116 that if Amy has the cognitive ability to understand the medication and her needs that she be allowed to self-administer even if she needs physical assistance to access the medication, and under rule 119, that allow staff to supervise her in self-administration, even if she needs physical assistance. Should I contact Sue to see if this was worked out at [Sheltered Workplace] , and if so, can this be applied at the house as well? Not getting the meds when she needs them is not a solution -- both the antacid and the white pill are things she needs to take quickly after the onset of symptoms to provide relief and prevent worsening symptoms. The nurse route is ok, provided the nurse can administer the meds to her within half an hour, but that hasn't been the case to date. These meds are not optional, and need to be delivered swiftly after they are requested.

 I agree that Amy seeing a counselor with [house head] is a good idea, provided that Amy have the opportunity to work with the counselor prior to meeting with [House Head] , as Amy has a hard time speaking up in front of [House Head] , and provided that this isn't a one off. They would need to have ongoing joint visits with the counselor.

I think another thing that will help is if Amy starts being more in charge of issue resolution. Right now, when Amy has a problem, she tells me, I email you and [House Head], and then we hope for result. This is for one, ineffective, and two, totally inappropriate and awkward. Amy is in charge, Amy tells me what issues need to be dealt with, and Amy hears all these email, but they are all addressed to me. Amy and I will start composing all communications together and writing them in the first person -- from Amy, and when Amy gets her computer she can start composing them herself. Also, Amy needs a phone number to contact [house head] directly when she is having a problem or wants an update on an issue in progress. 

And another reply:
Apologies, forgot to include this in the last note. Amy tells me she would like to start seeing [Screaming Counselor] again on a weekly basis, as soon as possible.

Aaaaand, what I wanted to say:
 Amy is terrified of [House Head], and I don't blame her. In the past, [House Head] called Amy a liar, and it tainted the waters. Plus, in my experience dealing with [House Head] , she seems really inconvenienced by providing care for Amy -- such as at her neurologist appointment when [House Head] was scheduling her next visit and sounding irritated and saying none of the appointment times would work, and then acted irritated when Amy decided to eat lunch before heading home, which was totally reasonable. I'm concerned about this, too. Numerous meetings with my mom tried to resolve this, and it's still a problem. Our hope was she could just move on to a new house, but that isn't in the cards right now.

I get this sense from Amy that she has started to think that [House Head] is the boss or in charge or has power of her to doll out punishment/disciple, and that is the number one thing we need to resolve. Amy lives at [house address], and [House Head] , as QSP, is employed to facilitate her life there. [House Head]  works for Amy, not the other way around, and the same applies to staff relationship with Amy. They aren't doing Amy a favor when they care for her -- it's their job. The staff, and [House Head] , are effectively employed by the residents of the house. I think we need a major paradigm shift wit the whole household.  

I talked to Amy today about all this stuff.  Said, hey, maybe they aren't so bad as we think.  Let's throw them a bone, let's assume the best about them.  I think they DO care about you (I'm trying to spread goodwill!).

"Try living here", says Amy.  "That's all I have to say.   They do like me, but its still hard with mom being gone... Stuff will get better.  I know. I understand it's not snap crackle and pop."


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