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It's Beginning to Feel Real

Posted Jan 06 2010 2:26pm
Skip's discharge and arrival home, that is. It really is beginning to feel real and I can't wait for it to happen. It's only eight days from now, and I do believe she'll be coming home that day.

I had a long talk with Skip's case manager at the rehab hospital on Monday to talk about lots of transition things such as the special bed, the wound vac rental, any barriers to a possible discharge, visiting nurse, home health aide and PT/OT services at home and so on. We both walked away with various follow-up tasks, and based on the phone calls I've been getting, she's taking care of her end of the bargain.

I got a call yesterday from the company that manufactures and rents the Clinitron bed. Apparently, Medicare doesn't pay for these for home use unless the patient has used a different kind of bed for 30 days and can demonstrate inadequate progress using the other bed. So, they'll deliver a low air loss mattress and hospital bed frame, likely the day before Skip comes home, for her immediate use. Then, they'll keep in touch with the visiting nurse agency to get data that might support the upgrade to the Clinitron. Just that call really made it feel real to me. If we're talking bed options and delivery dates ... it's really gonna happen.

Skip is staying at the rehab hospital until the 14th in order to complete her course of IV antibiotics before returning home. I figured the only thing that would hold up the release was a determination that a longer period of IV administration was required. I hadn't heard anything about a follow-up visit with the infectious disease MD who worked with Skip in the hospital, so I gave his office a call on Monday. Turns out it's not too easy to determine if the infection is gone from the bone. His recommendation was to have the plastic surgeon evaluate the situation on Skip's next visit (tomorrow) and, from that, suggest likely next steps. I suspect what will happen is that Skip will come home with a prescription for oral antibiotics to keep the treatment going and then other diagnostic work will follow to evaluate the situation. I'd imagine this would include tests like another MRI to take a look at the hip bone.

We've already got a relationship with a local agency that has visiting nurses, home health aides and physical therapists. The hospital will write the orders for the care Skip needs and they can be the providers, which is good since we already know a bunch of the nurses. I think we're going to have a conversation about MRSA, though, before anyone gets their hands on my Skip.

I got a call today from a physical therapist who had evaluated Skip's wheelchair to see what pressure-relieving cushion should replace the existing foam cushion. They're looking at the mother of all Roho cushions, which is 4" thick with air bladders and will work with a local agency to get it. The PT pointed out to me something I hadn't been aware of. Now that Skip has had a pressure sore, she is at greater risk for recurrence because the healed skin never returns entirely to its original state. This makes extra care with her seating and pressure management a definite must.

I've also purchased a number of things we're going to need when Skip's here. Since she's going to be in bed 22+ hours a day, I've ordered hospital johnnies, bedpans and absorbing bed pads. I found a good cheap source for twin sheets on eBay and bought them this morning. I got special mugs and foam tubing to build up silverware handles to make it easier to eat in bed. This weekend, I'll be heading out to buy myself a twin bed to use while Skip's in the hospital bed. Then, I'll have to figure out what furniture needs to temporarily be removed from the bedroom to hold all the new stuff. I'm thinking, with the removal of our platform bed, this is also the perfect time to turn the rug, which is long overdue.

Yep, it's definitely feeling real.
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