Monday, April 07, 2008

The return of the Blogger

January 30 - oh my - what a long time - and especially after that heartfelt resolution to blog as often as I could during this year. My devoted readers will be happy to know that I have kept up with my 366/2008 resolution. Some where in the memory banks of my digital camera I have at least one picture for every day of this year. Perhaps as the semester ends I will find the time to post them on my Flurl account.

So why haven't I been here for such a long time?

I am going to post a letter that I sent which may explain a bit

February 4, 2008

Delivered by hand to the office of Restorative and Continuing Care, Wascana Rehabilitation Centre

Dr. Cyril Kesten
219 Rogers Road
Regina, SK, S4S 7C5

xxxxxxx xxxxxxx, Chair
Program Access Committee
Regina Qu’Appelle Health Region
Regina, SK,

Dear Ms. xxxxxxxx and Ms. xxx

I am writing on behalf of my mother, Velma Kesten. On August 9, 2007 my mother granted me a General Power of Attorney (attached). My mother is asking that when she is discharged from hospital (as determined to be medically appropriate by her physicians) that she be allowed to access a convalescence/rehabilitation program in Regina (Wascana Rehabilitation Centre or William Booth Special Care Home) that will assist her to regain mobility and as much independence as possible. Given the progress my mother has achieved in the short time since her accident I believe that this convalescent period will be greatly shortened through the support and active participation given by her family and friends here in Regina.

Although I understand my mother’s request was heard by the Program Access Committee on Thursday, January 31, 2008 I am concerned that the Committee did not receive sufficient information concerning my mother’s situation. I understand that the Committee will re-hear my mother’s case on February 5, 2008 and I have been told that I may not meet directly with the Committee at tomorrow’s meeting. To provide the Committee with more information I am submitting this letter.

My mother, Velma Kesten, is a 94 year old woman who lives a vital and active life. Until August of 2007 she lived at 513 Rupertsland in Winnipeg, the home she had lived in with her own parents, her husband and her two children since 1954. She has lived alone in that house since my father died in 1992. Until August of 2007 she did all of her own housekeeping, cooking and general household activities, including mowing her front and back lawn and shoveling the snow.

In August, 2007 Mrs. Kesten moved into the Portsmouth Retirement Residence at 125 Portsmouth Blvd. in Winnipeg. In the Portsmouth my mother lives in her own apartment and is provided housekeeping services once a week and daily lunch and dinner. She participates in social activities, socializes with her friends both in person and by phone and continues her active lifestyle. My mother is a walker. At the Portsmouth she regularly walks around the property, weather permitting, as part of her self-described ‘exercise’ routine. When the weather is not appropriate she does her walking inside the building.

My mother’s short term memory is slowly deteriorating. This has not really interfered with her lifestyle although it does cause her some confusion occasionally. To ensure she takes her medications regularly and on time we have arranged to have Home Care supervise her daily intake of medications. She has no other outside assistance.

My mother is also hesitant to use elevators, especially when she is alone. Her apartment is on the second floor so she normally uses the steps to go to her meals and programming and to return to her apartment.

On January 18, 2008 my sister Roberta Calderone, who lives in Montreal, and I were in Winnipeg to celebrate our mother’s 94th birthday. We celebrated by taking my mother and her brother (who turned 86 on the same day) to dinner at a restaurant in Winnipeg.

On January 20, 2008 my mother and I flew to Regina. My mother intended to spend a week visiting us and her friends here. As part of her visit my mother hosted a birthday party for herself at the Hotel Saskatchewan on Friday, January 25, 2008.

After the birthday lunch my mother and my daughter walked from the restaurant to the spa inside the Hotel Saskatchewan. My mother fell down the spiral staircase inside the spa and as a result broke her hip. She was transported by ambulance to the Pasqua Hospital where she was operated on by Dr. Mahmoud the morning of Saturday, January 26, 2008. She has been recuperating and undergoing physio-therapy at the Pasqua to date.

On the morning of January 31, 2008 a social worker at the Pasqua Hospital, informed my wife, Helene Kesten, that my mother’s case would be presented to the Program Access Committee that afternoon and that she, the social worker, would be my mother’s advocate. My wife had a brief discussion with the social worker at that time and later in the morning I was able to find the social worker and also had a brief discussion with her concerning our desire to continue being actively involved in my mother’s recuperation and convalescence. It was not clear at that time whether the social worker had interviewed my mother, her physiotherapist, the nurses on the ward or the physician responsible for my mother’s care. Around 5:00 p.m. that afternoon I received a voice message indicating that my mother’s case had been declined. After some discussion with the social worker I received an email and fax (attached) from her on Feb. 1, 2008. I quote a portion of that email below.

Your mother, Velma Kesten, was presented to the Program Access Committee
on Jan. 31st for discussion for a convelsecent [sic] bed.

The committee declined this request as your mother is from Winnepeg [sic] (out
of the Regina Qu'appelle Health District) and there are programs and
facilities she could access in her own health region. Also, there are
demands on these convelsecent [sic] beds from people residing in this health
district. The program Access committee also declined this request as
the goal and hope for your mother is to return back to Winnepeg [sic] to her

If you want to appeal the committee's decision, you can put forth a
letter in writing. In this letter you should state your

mother's condition, medically, and mobility of how she was funcitiong [sic]
prior to the hospital admission
the circumstances of why your mother is in hospital
your mother's current situation of mobility ( to the best of your
your rational [sic] for why you would like your mother to remain in Regina
ie- her support system in Regina. Also discuss
how you and your wife have been actively involved in caring for
your mother while in hosptial [sic] (atttending [sic] Physio with her
the goal for your mother once she would be discharged from a
convelescent [sic] bed.

In discussion with the social worker she indicated that my mother’s request would be re-heard by the Committee on the afternoon of February 5, 2008. As per the social workers instructions I am writing this document to contribute to the deliberations of the Program Access Committee on that date.

I have portrayed my mother’s condition and mobility prior to hospital admission in the paragraphs at the beginning of this document.

In regard to my mother’s medical condition prior to this hospital admission I can only say the following. My mother is under the care of Dr. David K. She sees Dr. K. regularly. Dr. K. has prescribed a number of medications for my mother including medication for hypertension. I am sure Dr. K. can provide you with more specific information concerning my mother’s medical condition. Aside from these minor considerations, my mother is in extraordinary physical condition for a 94 year-old.

I have described ‘the circumstances of why your mother is in hospital’ in the introductory paragraphs to this document.

When I visit my mother in hospital she is either lying or sitting up in bed or sitting in a wheel chair. I have been told by the nurses that she is not to get out of bed or the wheelchair without calling a nurse and I have watched as the nurses help my mother transition from the bed to the chair and vice versa. I have also watched the nurses assist my mother in getting to and using the bathroom.

I do know that my mother is participating in physio-therapy on a regular basis. I am sure her physiotherapist can provide you with more pertinent and technical information regarding my mother’s mobility and her rate of progress. My wife, who has accompanied my mother to a number of her physio-therapy sessions, reports that in her (non-expert) opinion it seems that my mother is progressing very quickly. My mother has walked, with assistance, using both the parallel bars and a walker.

Since my mother was brought to the Pasqua Emergency Department my wife, my daughter or I have been with her for between 5 to 7 hours each day. We have engaged her in conversation, encouraged her to recover, assisted with her care and advocated for her when she was incapable of speaking coherently for herself. My mother was very confused for a number of days after the operation and some of that confusion still persists. Similarly, when my mother started physio-therapy either my daughter or my wife accompanied her, working with the physiotherapist in getting my mother mobile.

My mother is comforted by familiar faces, responds well to encouragement from her family and ‘brightens up’ whenever one of us or her many Regina friends visit with her. It is my firm belief that my mother’s rapid recovery thus far is due, in large part, to the fact that she has been surrounded by a strong and active support network in Regina since the time of her accident. I also believe strongly that allowing my mother to remain in Regina – with her family and friends – will facilitate her continued progress and recovery. Put simply, my mother will be out of the hospital/recovery system faster if she is allowed to remain in Regina.

On the other hand, the situation is very different in Winnipeg. Many of my mother’s friends in Winnipeg are around her age and are not usually able to regularly visit her. Her only brother is 86 years old and is limited in his ability to support, comfort and advocate for my mother. Her closest cousin is 104 years old. In contrast to the vibrant and constant companionship and support that she would receive in Regina, my mother would be more or less alone if she is forced to return to Winnipeg at this stage.

In thinking about a “goal for your mother once she would be discharged from a convelescent bed” the best I can say is that this is indeterminate at this point. There are many considerations including my mother’s capabilities after her convalescent period, available support, her wishes, etc. As with all families, we want each of the members of our family to be safe, happy and well cared for. As I live in Regina, my sister lives in Montreal and my mother’s ‘home’ is in Winnipeg all of the alternatives will need to be considered as we come closer to the end of my mother’s recuperation, convalescence and rehabilitation. I would hope that the Committee’s decision is guided by where my mother will be best able to recuperate quickly and safely, and also where she has the strongest likelihood of regaining substantially the same level of independence that she enjoyed prior to her recent accident. From my perspective, this can only occur in Regina.

It is our hope that for the time being my mother is able to stay in Regina with her family, engage in appropriate physiotherapy under the supervision of a professional physiotherapist experienced in working with women like my mother and that my mother regain as much of her mobility and independence as is possible and reasonable. It is our observation (the opinion of the physiotherapist should be sought here) that as a result of her previous physical condition, her strength and determination my mother’s physical progress has been very encouraging if not remarkable. We feel that my mother will respond well, quickly and in a determined way to further physiotherapy.

We hope the decision of the Program Access Committee will allow my mother to be discharged from the hospital as soon as her physicians feel it is appropriate, that she be placed in a situation that provides support such as assistance in getting in and out of bed and wheelchair and accessing washroom facilities and that provides her with access to physio-therapy that we believe will bring her to some degree of mobility and independence.

As you will understand, my mother's strongest and most effective family support is in Regina. Considering my mother's advanced years and personal circumstances the only way to ensure treatment will be both successful and humane is to have her remain in Regina where she will have the physical and emotional support of her family.

Yours truly,

The reader will be happy to know that my mother was approved to stay in Regina during her convalescence. She spent around 5 weeks at the William Booth Special Care Home where she received excellent care and attention.

My mother is back at home in Winnipeg now and happy to be there. Short term memory loss is still something of an issue but she is doing remarkably well for someone that is 94 years old. She is always on time for breakfast, lunch and supper and rarely misses movie night.

Her physio-therapist has indicated that very shortly she will be able to get rid of her walker and will only have to use a cane. She is a wonder.

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