One of the issues I faced with caregiving was "keeping on top of things". The initial aides treated me like a mushroom. That is, they kept me in the dark and fed me bull___. There was "na na" and "Sha-Sha", and "Sweetpea". Oh, and there was a girl allegedly named "bling-bling". All with streetnames. And gussied up falsified certificates that made them aides. Falsified? Yup. The norm in my area. Whenever I provided "constructive criticism" I got either of two replies (a) "I know that" or (b) "I've been doing this for years." Obtaining information about my sweet little camper became a task best suited to a CIA interogator at Guantanamo. I obtained a closed circuit television camera (just to view a small area of the room) and they complained hard and rigorously, and I unfortunately caved. Then there was the "chain of command issue". They reported to Nancy Nurse, who carried band-aides in her purse. Some said she was slow, some said she was fast, but all agreed Nancy was a pain-in-the-____. In an attempt to "get a handle on things". I fired "bling-bling" after showing up and finding sweety-pie tied to the bed in her own feces, and the aide missing for four hours. Of course they didn't expect me to show up at six A.M. on a sunday. This was a "chain-of command" issue. I solved it by firing four nurses in succession and them simply ending nursing visits. The straw that broke the camal's back was to show up one morning and find the house deserted. The visiting nurse arrived and decided to go out for breakfast with the aide. They left my sweety-pie belted into her wheelchair. She was crying and trying to undo-the seat-belt when I arrived. Not to be undone, the nurse and aide locked themselves out and didn't have the telephone number to the home. Since the home is huge and the bell doesn't work I didn't hear them banging. It wasn't until the fire department arrived that I discovered where the missing persons had been. Every day I ausculate sweety-pies lung fields anterior and posterior, four quadrants, check blood pressure and dorsalis pedis pulse, and rely on the aides to keep track of the private parts. And I have a fingernail oxygen sensor to keep track of P02. All data recorded daily. In any event I then instituted a daily logbook system. The log is a children's permanently bound marble-cover school notebook. Every single day the lopg is kept. There are no erasures allowed. If a mistake is made a single line is drawn through the entry. The log reflects every visitor in and out of the room. With a printed name. The times meals start and finish. All phone calls. The time in bed and time in the chair. An exact menu of every meal (I make the meals anyway). Every bowel movement is documented with a comment as to the consistency. Did she strain? Were the stools hard or soft? Urine color is noted each day. A morning and evening comment is made regarding (1) alertness (2) mobility (3) Is the little camper in any pain or discomfort (4) Any physical problems such as a sore or a rash or a cut (5) happiness (was she sad or bubbly?). At the beginning the aides refused to keep a calorie and hydration count. There were a hundred interesting excuses. After firing thirty three aides they began to catch on. Every day I expect a precise hydration tally. She is served exclusively in little two ounce or two and a half ounce cups. The cups are stacked and tallied at the end of the day. And a precise calorie count. Not what was served, but what was actually eaten. And I want the "work shown" just like in the second grade. One square of chocolate equals 15 calories. Put it down. One banana is 100 calories. I want "one banana - 100 calories 1215 HRS (national guard time)" logged in. Etc., etc. And the log is inspected by me every single day without exception. Inspection is VERY critical. And when one book is completed they are stored neatly. Thus I have a precise daily record of my sweety-pies activities for the last three years. And there are notes on foods she likes and foods she dislikes. Of course the book initially contained information on every word she spoke. For months she didn't say a word. She had a stroke and could not talk for almost a year. I took her outside in a wheelchair every single day for four or five hours (weather permitting). I wanted her to experience life. To participate in the on-going process. I took her to fancy stores. To concerts. And for hours took her along the pathways of a beautiful park. And mostly to watch little children play. Did the nurses complain! ("She's a hundred years old - you're going to kill her!" and there was the famous quote "She's a hundred years old. She can't possibly benefit from visual stimulation") Now sweety-pie can talk a bit, feed herself, and we no longer log such things. The aide is not permitted to leave the premises without permission and having a replacement to stay in the room and all time out of the house is logged. They are paid for this time. At the end of every day we review the log and try to set goals for the week. We review the need for supplies and my sweety-pies appetite. The log gives the aides something meaninful to do. And I made clear falsification of a log entry is a dismissable offense. On the last page of the log are emergency telephone numbers and instructions and in the back of the book is an envelope containing insurance cards. I suppose you could use a computer log, but my aides are not internet conscious. A sinple dollar children's school book seems to work well enough.
I'm not a big fan of commercial nutritional supplements, such as "ensure", but I've used them ocasionally. My chief complaint is the soy content. My little 103 year old has swallowing difficulties and must eat pureed food. One of her favorites is mashed potatoes. I use organic mashed, supplemented with lots of butter, lactose-free milk, and various gravies. I supplement every portion with 70 calories of whey protein (from a health food store) mixed with the mashed potatos. I always add supplemental whey protein. I use a calorie chart to figure out what this provides for her. One tablespoon of butter is 100 calories. She loves butter. One quarter cup of cream of chicken gravy is about thirty calories. Turkey gravy, thirty calories. One quarter cup spaghetti sauce, seventy calories. I use a half dozen different gravies and sprinkle on a tiny bit of fresh ground pepper. The different flavored gravies provide variety to the meals. The mashed potatoes are easy to prepare and she enjoys eating them by herself. The potato sticks to the spoon, which helps with spills. She can't always hold the spoon parallel with the ground. I like the fact one can adjust the consistency of the mashed potatoes Sometimes I mix the mashed potatoes with some very finely minced ham.