Shopping for a care home...

Sitting nervously on a sofa to be interviewed by a care home.

Who is interviewing whom?

We are explaining our candidate...her needs and abilities.
The care home staff is explaining their services and systems.

Somehow we hope to find a match.

Yesterday we went to visit one place, and there are two more this weekend. Walking around looking at bedrooms and day lounges, dining rooms. Checking things like staff numbers, night care, recreational activities, medical services, light, TV.....my Japanese vocabulary is expanding into new areas!!

The first place was good: warm,welcoming, nice big rooms that families are encouraged to furnish with familiar things. Small communal lounge with TV and friendly feeling. 4 times a month entertainment or recreational activity event. Weekly in-home activities like singing or handicrafts.

But. But...

* no physical training room or programme
* no sunshine in most of the rooms or lounge, because it was downtown and surrounded by buildings

Most of the residents we saw were in wheelchairs and we REALLY hope Okaasan will soon (next month?) be up and moving around with at least a frame on wheels. We don't envision her going on and on and on in a wheelchair...we still hope she will be walking again...at least inside, with a walking aid.

Maybe a bigger home is better? A place where - when she IS walking - she can walk round and round? Or a place in a wheelchair that she can GO somewhere? Like now in the hospital we go to the 5th floor for a view, we go to the training room, the courtyard garden, the day room....she isn't (yet) a non-thinking human in a wheelchair.....

It was interesting. You don't know what you want, what is necessary until you start looking. So we will continue looking. We must get her into somewhere by the 3rd week of November, before DS's ski work starts and he is out of town...

The hunt is on!! And yes....I am getting giddy with the excitement of having winter of freedom...absolutely giddy.
So are the cats...I've started letting them into Okaasan's FORMER room. Now I am using the room for drying clothes and wintering houseplants. Yesterday Chi-chi claimed OKaasan's sofa....where there are some odd socks and coathangers...and he curled up for a long sleep. And I let him.
Our home life is changing....

Blogging again :-)

YES! STILL HERE!!!

Actually I wasn't. Had a 2 week holiday in the UK - ate everything I saw, drank whatever I could and talked with lots and lot of people really really fast.

Happy trip.

Came back to Japan and had jetlag. Then a headcold. And a pile of teaching work and tourism consultancy work (gonna get paid by Japanese TV to go and eat season sushi :-) someone has to do it....)

Ok.

Okaasan.
Still in hospital.

When I last bothered to write this blog she was in a bad state: with a fever and a mystery knee pain. That lasted more than 10 days. Her energy went right down and she didn't do any physical therapy. So, of course, her muscles got weak again.

While I was away she started to improve. Dear Son continued visiting the hospital and finally in the last week, she has started to do physical therapy again. Much less that before - short distances. But her speaking voice is stronger and she seems to have turned back on course.

So.

While in England many friends asked me about my life with boyfriend's mother. And what is the future.
I said - I can't see her ever being able to come home and live with us again. I hope she will go to live in a care home. But boyfriend isn't at that point yet. In Japan it is a recent idea - putting elderly family members into the care of strangers.

So. I came home and wondered how to bring this about...

I talked to him. He agrees - the likelihood that she is going to come home in the coming month is zero. We couldn't safely leave her alone in the house. From the end of November he will be ski teaching.

It's time to start looking for a place in a care home for Okaasan.

I used two arguments....which I hope will persuade him...or at least give him a feeling that it is the best thing to do for all of us....

* Best for her.
Now she is sharing a room with an even more demented, and deaf old lady. Who shouts. Okaasan's TV is usually on a bedside table that is pushed back out of reach and vision. Okaasan herself doesn't have the decision-making ability to ask someone to set it up for her. When someone asks she says "Oh, I don't watch TV", but of course she does. Hours and hours. The nurses clear it out of the way. I think in a private room in a care home we could set up the TV exactly how she can watch it easily from her bed, or a chair. She could have all her stuff around her. It would be "home", not "hospital bed". I think her hour to hour life would be happier.
When we come to see her she will get 100% of our attention, not the usual harried conversation of tired, working people.
She will be safely monitored and at far less risk of falling again.
She will have all the activities - the singing, the seasonal events, the hobby things....a community of activity. Not just us and the cats.

* Best for us.
We can get on with our lives knowing she is safe.
We - and really I - don't have to worry about being late for work etc when Okaasan suddenly refuses to go to day care...I can imagine the driver coming and me trying to get her dressed to go out...her refusing and the care unit van blocking a snowy road....lots of staff and I try to get her out.....and my work responsibilities pressing.
When we see her we will be happy to go and chat. No stressed.

So. Let's see.
I think it will be hard to start this process....Dear Son seems to think it will be easier.....just a matter of applying and then getting her to move to another place in the same, or neighboring, building.

I doubt she can get a room in the same place. It is a hospital and care home - but it IS a city wide company, and the fact that she is already a patient in the system must be good. Japanese systems take forever to unwind....it won't be easy. 

Anyway. Cross your fingers!!! It may be happening......but it won't happen at the speed I am hoping for, that is for sure. I will have to keep on his case...can this all happen by the end of November??

Watch this space...

Physical ability

Here is the physical therapy training room where we spent yesterday morning watching Okaasan being put thru her paces.

Really interesting - stretches and massages, then:

* practice in sitting upright and swinging legs over the side of the "bed".
*  Walking between those bar-rails to the chair at the end, turning by changing hand position and sitting down.
* Standing up right from the wheelchair and remaining standing for a count of 20 - holding onto bars in front.

All of this while wearing heart rate monitors.

Okaasaan enjoyed it. You could really see that she enjoyed the physical challenges and chatting to the young, cute therapist. She did well and we sat nearby and watched and gave her smiles and thumbs up.

Before the therapy session started we spent an hour with Okaasan and her wheelchair. All over the hospital, looking at views, looking at prints on the walls and two trips to the toilet with the help of nursing staff.

"Can you stand by yourself?" Dear Son asked Okaasan at one point as the three of us, plus wheelchair, were squeezed in a toilet cubical.
"Stand myself? Of course I can! I couldn't live alone if I couldn't stand on my own!"

Very true.
That is the point!!
Okaasan thinks she DOES live on her own - somehow surrounded by other elderly people in wheelchairs and nursing staff in white and pink uniforms. We know she doesn't - and are trying to judge whether she can even come and live with us again and be left alone for a few hours safely every day.

The hospital did the dementia/life assessment again last week.
Maybe a score of 9/30....two years ago it was 8/30.
It was 14/30 six years ago.
Does this mean OKaasan has improved???????!!! OMG!!!

No. I don't think that interview test is so accurate. But I am surprised if they really think she is mentally the same as 2 years ago. Anyway. That interview result is considered alongside family interview and physical ability - and then the social services decide the level of public health care we can use.

Watching the physical therapy was interesting. Okaasan is getting stronger and can stand and move from bed to chair better. Her walking (aided) is good. Turning so-so.
Turning is important, because that's what we need her to do if she goes to the toilet without us at home. We need her to be able to stand up from the bed, walk thru the kitchen, open the toilet door, go in, turn round and pull her clothing down - and then sit.
Of course we can put in more hand rails - but the basic ability needs to be there.

It isn't there yet. 
Another 2 weeks? I guess that's when we could try and stay at home and see how she is.
To see if we can work it all out.
Or not.

Tectonic shift in thinking

Okaasan's future may not be home with us.....

A shift has taken place in Dear Son's thinking. A huge shift. Tectonic plate size change in thinking.

He is now thinking and talking about a care home future for her.

I'm trying to be gently supportive, not pushing one view or another.

A few days ago we went to visit her at the physical therapy hospital. He'd visited alone a  day or two before and watched Okaasan's training - how far she could walk holding onto bars and how much her heart rate increased when she tried to use a walking frame. He came home fairly positive.

Our joint-visit on Friday. Okaasan was in her bedroom with the deaf roommate shouting annoyingly. We got her into a wheelchair an the three of us sat in the physical training room - watching other elderly people have their training regimes with balls and bars. Okaasan kept saying how being in this room was a first time for her...despite having been in the room doing the very same exercises just a few hours before.

We drank canned coffee and chatted.
Okaasan smelled bad...I knew a diaper change would be necessary.
Then she asked to go to the toilet.
We wheeled her to the toilet and the three of us went inside.

Dear Son was advising/helping Okaasan to stand and move from wheelchair to toilet seat.
Advising her how to move her legs so her body changed direction. She had no idea....
I was pulling down her pants and reaching back and between her legs to catch the heavily soiled diaper as her bum swayed near the toilet seat...managing to catch and lift out the diaper before she sat - and into a handy trash bag nearby.
Then I went to get a nurse to help with cleaning and re-diapering....

We stayed for an hour or so. Wheeled around the hospital looking at pictures. Left Okaasan joining others for dinner time near the TV.
We came away.....for our dinner and life.

Hmm...

I wondered. Could Okaasan come home at all soon, like this? Come home ever, like this?
She has been in diapers for 4 months now, mentally and physically she is used to that. This will be beyond "toilet accidents", to regular diaper changes....even if she decides and activates a toilet visit on her own....I am guessing there will be more diaper use. Much more.
Could she turn in the toilet? Our toilet at home? Would she understand HOW to walk in, turn round, take down her pants and then sit? Could she DO a toilet visit alone?
Could we leave her for more than an hour alone...?

These thoughts were in my mind. I talked to friends about my worries...and said to Dear Son that I still thought Okaasn's permanent return to life with us was only a 50% possibility.

And he agrees...thinks the percentage is larger - in the negative.
He doubts we and she can manage together at home. Even with day service 5 days a week.

I guess this IS the hoped for/expected result of putting her in this kind of hospital/home environment - thinking by the social worker to get the family and the aged person accustomed to the reality of care outside the home.

Dear Son said he is going to talk to the social worker this week.
He is starting to believe that Okaasan may be generally happier and safer in a care home....

If you've read this blog for a while, you'll understand what a change in thinking this is for him. From not wanting any outside help - to accepting and coming to the realization that the time for us being able to care for his mother alone is coming to a close.

A new chapter is ahead.
I am relieved. I think so. 
I can't see how it would be here...specially how it would be for me in winter alone with her. Impossible.

Walking. Together.

So. New normal.

I took Okaasan for a walk.

She needed a little persuading to go out, but I reassured her that I knew which roads were icy and so she got herself together and we set out together on Sunday afternoon for a stroll round the local streets.

Awful balance problems. She seems to teeter along - like she is on tip toe all the time - almost ready to go off balance and into trouble. Her whole body appears to be forward all the time.

I grasped her hand and guided her firmly up the street and to the main road.

We walked/teetered. She grabbed onto walls and street lights, shop windows and signs. Kept stopping and looking up and down the street.

"Are you tired? Shall we take a break?"

"No, not a break. I am just looking and thinking where to go. ...."

Constantly.

And often really holding onto something, like a street pole, with both arms. Looked very odd.

But we walled. And stopped. And sat on walls and benches. 

No way could she walk to the Seiyu supermarket where she always used to go and I was wondering what to do when we got to the crossroads. We could come back by taxi, but I doubted she had the energy to GET there in the first place. 
At the corner she hesitated. Looked around. I made vague comments about the Japanese sweets shop and a cup of coffee in the other direction....and after a few minutes she came with me...almost willingly.

At the sweets shop almost fell INTO a basket of sweets on a rickety table outside the shop. Then bought some rice cakes. Back to the station, into the convenience store, toilet, magazine and finally.....agreed to let me lead her home.

Obviously exhausted.

She enjoyed telling me "this is what I always do, sit here, buy my magazine here, go to the toilet here, walk here"...and I let her instruct me. But I managed to make it a short enough walk an get her home again.

But. shocked really.

She used to walk so far alone, miles actually. For hours. Not now.

Magazine buying..and buying...

This is not a good sign: multiple magazines...

Until now Okaasan always clearly knew which magazines she had already bought, and which she HAD to buy right now.

Magazines are one of her passions. These young women fashion magazines. Always. She never buys middle aged or older person magazines. Fashion magazines with free bag offers.

When I moved/tidied away her magazines a few years ago she got really angry with me and accused me of stealing etc etc. It ended up as a huge family row...was that the time DS hit her and I left home for 4 days? I can't remember now. but maybe. All over her precious magazines.

So, I was surprised a little sad to find all these multiple magazines in her room this week. Not a good sign: she is beginning to lose the memory on something very important to her.

Next morning I asked her politely if she needed all these magazines and whether I could take some to give my students. Okaasan was as surprised as me to see multiples: did I buy these? All these? Why? I must be losing my mind! 

But she gave them up willingly and my Friday students were happy with the windfall. Funny though: my 50-70 years old students all said: Oh, I don't read this magazine myself. My daughter/daughter-in-law would like it though!!

But 85 years old Okaasan loves these magazines :-)

Meanwhile. Family trip to the local festival this morning. Walk in the local area. Sit in the festival. Eat some food. Say hello to a few familiar faces. Okaasan enjoyed it. Maybe. Sat looking at it all. Responded if we talked about something. Ate her way through a curry, some Chinese dumplings, some soy bean snacks and half a sausage. Came home hand in hand with her son.

Family outing. Makes me realize always how frail she is really. Watching her walk. Get off balance easily in a dip in the tarmac. Clutching onto walls and fences.

We are lucky that she doesn't go so far alone now. Downtown by subway is maybe twice a month now. Most of her daily walks are very local.

I'm off away tonight to stay at a friend's home and then early tomorrow driving a few hours east into the mountains to do another day of kayak training. Yippeeeeee!!!

A little scary. But yippppeeeee!

Out...and down :-(

And. Another fall.
How many times can an old lady fall down without seriously injuring herself? We are finding out.
Not sure MY nerves can stand the stress, though.

It was a beautiful day - getting warm, sunshine and springy.
I called Okaasan from the office at 2 pm. Told her the weather was great and that now was the time to go for a walk. I'd given her some money at breakfast time.

So. A little surprised, and worried that I got home at 6.10 pm and she was out. Now the spring day had turned dark and cold.
Tracked her on the GPS and saw that she was near the local MacDonald s. I called her and told her to come home soon for dinner. I asked about her legs and she claimed she was fine and didn't need a ride in the car.

THEN I realised her winter coat was still hanging in her room. She'd gone out wearing a blouse and a cardigan?
So I jumped in the car and went looking for her, in the evening rush hour. Couldn't find her and had left my phone on the kitchen table.

So, back home. Started cooking dinner...waited. Checked the GPS again....finally near 7 pm could see her on the GPS in the next street.
Waited. 10 minutes, she didn't return.

I walked outside to look: found her sitting in the dark, cold street - with legs nearly drawn up in front of her...like a prim girl sitting at a picnic.
84 years old and sitting in the street at 7 pm on a March night in 5 C.

She seemed ok though. Kept saying it was too soon to stand up,  getting testy with me for worrying. I brought a chair out of the house  so she could get to her feet. Then took her hand firmly and walked her inside.
Gave her dinner - and watched her do the whole tea/water/powder/cold water/hot water dance while the food got cold on the table.

Finally I escaped.

Luckily, luckily she seems ok. I haven't seen her body - I am sure there will be bruises/cuts from falling on the road surface. But no broken bones. Amazing, really.

What could I have done differently?
Is it too soon for her to walk alone outside?

I should have hunted for her more in the car and brought her home. That's for sure. Despite her refusal of a lift. My decision making about her ability is better than her own ability.
I should have called her again at 2.30 pm to make sure she really WAS going out for a walk in daylight?

We shouldn't be letting her walk out alone yet?

aghhh..........have to talk to DS (who is away at a ski resort for 4 days)....

Mean thought of the Day: I wish she WOULD injure herself and end up in hospital. Life would be easier.

Can't say that anywhere else....but here.....

Downtown Okaasan

Life is getting better for Okaasan - freedom to get out and about.

Saturday I took her downtown in the car. Released her in the city center in a familiar place. Let her roam free. Checked on her a few hours later and found she'd already safely made her way home by subway. Successful outing.

Getting her ready was the usual run-around-of-confusion...

Couldn't find her purse at all. Hunted for about 30 minutes among piles of clothes, multiple bags, newspapers and stuff. Couldn't locate it.
Finally I gave her shopping money in a different little plastic pouch. But - of course - she wasn't able to remember from minute to minute that today her money was IN this pouch...so lots of confusion.

On the drive downtown I stopped at the bank to use the ATM.
"Shall I walk from here?".
Stopped at a convenience store to buy something and get change.
"Why am I here? Shall I walk from here? Do I have any money? What did I buy here? Shall I walk from here?"
Endless...endless little checking questions. It makes me realize that increasingly Okaasan needs reassurance about the immediate world around her and what her place is in it.

At home too...the little questions we notice more and more....
"Is this tomorrow's rice?"
"Why?"
"Because we are going to eat ramen? That is the ramen bowl?"
....it was actually a ramen bowl, but being used to mix salad in on the table.....

...oh...and the Japanese tea....expensive Japanese tea that we can only buy in one shop in Sapporo. 
Okaasan is having a harder and harder time making the tea for herself. Almost every day now there are cups of water/cups of tea powder/cold water/forgotten tea around the kitchen.
She probably drinks only 50% of the tea we buy for her. The rest is wasted and thrown away.

The correct tea making order: heat water/put powder in cup/wait/put hot water on powder/whisk with bamboo whisk/wait/drink - all of that is getting more and more confusing for Okaasan.
It's a basic series of actions she has seen/done all her life. Now, getting it done in the correct order is getting harder.

But!
Spring is a-coming and today will be the last day helper visit day for this winter season (must leave note about the missing/substitute purse). From now on we hope Okaasan can go out and walk on her own. Have freeeeeeedom. And get more mentally alert.

SPRING!!!!

Weekend outings

Okaasan had a great weekend.
Thanks to me :-)
And, I managed to squeeze in a bit of joy for myself here and there too.

Yesterday took her downtown for walking and lunch.
Luckily managed to find a parking space just in the city center. Okaasan willingly grabbed my hand and off we started. Down the escalator into the underground shopping areas around the main subway station in Sapporo.
Okaasan's walking is bad for sure.
She kind of totters forwards all the time. Walking along the walls, so she can put out her hand to steady herself, and holding onto shop display areas to get along.
Downtown was busy with pre-Christmas shoppers, so it was a bit of a battle to move along. I'd hate to think of her alone in all of that. I agree with Dear Son - she can't do downtown trips unsupervised. Her balance and walking style just isn't great.

Lots of Christmas stuff to look at together, shops and displays. People dressed as Santa handing out paper butterflies, kids and families and music. All very stimulating.
I got Okaasan half way down the shopping arcade and then into an old fashioned restaurant where they had sets of fried oysters, with rice, soup and salad. Packed with families. But fast service. 
Okaasan ate mainly in silence and we chatted a little about the menu, the families and oysters. It was a good noisy place with many things for her to watch.
Then I managed to steer her BACK along the underground shopping street, via a few knickknack shops and a magazine purchase. Thankfully, when we got to the station she suggested herself that we should go home - having forgotten of course that we'd come by car.
I got her back thru the crowds, back to the car and drove home.
Successful. Enough walking for sure for her. After a week of sitting in front of the TV with her muscles doing zero.

Did dinner with her in the evening. Her conversation was very repetitive. I guess the outing was tiring.

Today?
I went skiing at 8 am!

Glorious weather. Great first skiing. This is 1 hour from home. Yes, I live in paradise!

Left Okaasan's lunch on the table and stove. Told her I'd be home by 2 pm.

Home at 2 for the next round of duties.

Today is Election Day in Japan. Nobody knows WHY Japan has an election now. The government decided to call one at the worst possible time - winter and end of year rush for everyone - to get a majority for 3 more years of awfulness.

Okaasan wanted to vote. She thinks it is important.

So I drove her down to the local elementary school and took hand again to take her inside. Took her up to the first sign-in counter, then pointed her on the next step round the voting area.

I can't vote in Japan. Lived here more than 20 years. Pay all my taxes etc. Own my own business. Can't vote.

I stood back at the entrance area and watched Okaasan go round the voting booths and boxes. There were two areas - maybe one is for the city and one is for national? When Okaasan got to the second area she seemed stuck in the booth for a looong time.

I didn't want to cause a voting center crisis by crossing the floor to enter the important area. Foreigners are probably banned from coming within 3 meters of a voting box - so I waved at one of the staff to go and help her. He presumably knows how much help he is legally allowed to give a confused voter....

Not sure what her confusion was. But she emerged a  few minutes later all smiley. Hope she didn't vote for 3 more years of the awfulness. 

She complained that she has a sore on her foot...I'll have to check that later.

Back in the car I casually asked if she needed any shopping. She asked to go to Macdonalds for coffee time. I delivered her there, then made an excuse and rushed home to clean her room.

BIG side effect of our new regime is that if Okaasan is always out WITH me, I can't get into her room to clean. So it was a chance. Otherwise I have to rush in while she is in the toilet...

Dirty clothes, old lunchboxes, newspapers, peanut shells...

45 minutes later I picked Okaasan back up from Macdonalds and politely turned down her offer of something to drink...cos back home at the end of all of this was a student's home made brandy plum wine.

As I backed the car out of the car park Okaasan said: "Oh...there is XX Supermarket. I could go there for a while, couldn't I?"

Nooooooooooooooooooooooooooooooooooo.

You can't.

I gave you 3 hours of my time yesterday. Now 90 minutes more. Plus two dinners. You are not going to wander round the supermarket too.

Of course I didn't say it like that. Just mentioned her painful foot and how it was best to rest it etc How the helper on Wednesday will take her to the supermarket etc.

Brought her home.

In the hallway was some election paper. Okaasan looked at it. "Oh, the election. I should vote today?"

You did. Already. You did. You did.

Time to break open the brandy plum wine.

And relaaaax.

A subtle change...

There's been a change in Okaasan.

Her walking power/ability/confidence has diminished. She is happier to be taken out and led by the hand round streets or a shopping center. With a kind of mask face....

And Dear Son is right in it.

This week he has taken his mum out several times, walking round local streets and on trips in the car to supermarkets (including Costco again). It's good. He is spending time with her and getting to judge her mental and physical ability more.

He is worried about the walking. He says she is really precarious when she walks, tripping over small rough surfaces or slight slopes. Threatening to teeter and topple at any moment. Holding his hand - and she takes his hand very willingly - gives her confidence to walk.
She is still walking a long way. They walked from home to my classroom one evening for a family trip out to a restaurant, and  she's walked all over Costco.

So, she isn't so weak and incapable.
But somehow her balance? Her confidence? Her coping with a change in surface - all has declined since summer.

So he has taken her out almost every day this week.

One more week of him being at home. Maybe. Then the ski season starts. And she is my responsibility.

I can take her out at weekends, in the car to a safe walking place. And on Wednesdays the day service helper will be in charge. DS doesn't think she should go out alone....and Okaasan's attitude to using a stick is...hmmm....not great.

So. A new stage we've reached.
I see other families doing this a lot. The aged member being led by the hand, or steered by the elbow by a middle aged family member. Sometimes the aged one is marching with determination, but usually they are passively being lead and not really connecting with stuff happening around them.

Tonight we went to a local store and while I whizzed around grabbing our dinner and cat food, DS walked his mum around two floors...she gripped his hand and walked willingly with him.

Will she walk with me like that? She takes my hand if she is getting in and out of the car, and on steps. I wonder if she'll walk with me hand in hand.

When we moved to this house 5 years ago Okaasan took long, daily walks all over this area and regularly went downtown by train.
That narrowed to fixed routes locally and downtown. A few falls. Less and less going downtown. Over ambitious distances locally. Then the past few months less and less actually going out herself....

A new stage of all of this....