Care Plans

We are increasing my level of care today. Good thing. I am having a rough day, the kind where I wish I could crawl back into bed and stay there. Unfortunately I need someone around to help me with that, someone to get me up if I need to get up, especially if I need to go to the toilet. So even a day when I really want to take it easy relies on the care of others.

This new level of care includes some additions to my daily care plan, including shaving me when I ask, helping me wash in the shower, and a short visit at around 5:00 PM to help me empty my catheter bag. It's been getting overfilled some days, the back pressure causing the catheter to come loose. That's another thing they will check at 5:00 PM; making sure my catheter is well attached, re-attaching it if needed. Oh, and reminding me to take my afternoon medications. I've been forgetting them lately.

When the Health Care team at Alberta Health Services issues a new "care plan" to cover these changes and additions, they send it to CBI, the agency who provides my home care. The CBI Supervisor for my area comes over and puts the new care plans into my care log, a green folder with all the instructions and such in it. Today I took some time to review the care plan.

One of the first things I noticed is the lack of clarity in much of the instructions. An item, or several items, will be listed off on a care plan sheet, with a simple check mark beside them. Most of them on the afternoon sheet are about medications, something which is true for me also. I have been forgetting my afternoon meds. Then there is a follow up page for notes. Mine has instructions to empty my catheter bag, something which is becoming difficult for me, and to help me with toileting.

That's sort of the real agenda here. My catheter, when it comes off, tends to come off around that time of day. With someone emptying the bag and assisting with "toileting", it means that the HCA will perforce need to check whether the condom portion is still firmly attached. It also means if I leaned over to pick something up while in the confines of my chair, any surprises will be dealt with rather than being left until bed time.

It's kind of an interesting read, if you can decipher it. This plan spells out, in skeleton form, what care I am to be given. As a framework it means the HCA's can either do the minimum or seek to fulfill the greater objecticve of making it safe for me to live at home. I am fortunate that most of them do the latter. The only one who consistently works towards minimum is my night HCA. I am almost always the last on her list, so she just wants to do what must be done, then get out as quickly as possible. Yet, even with that, the care level is excellent. Excellent is not written in the plan; it must be written on the heart.