Communication styles

I had one of the nicest home visits today that I've had thus far...a 91-year-old woman who lives in what they call warden-controlled flats over here. Basically this means that there is a warden who supposedly is on site 24 hours although I believe in many of these buildings some wardens are only on duty 9-5, and in other hours the various alarm pull cords that residents have in each room of their flat go through to an answering service or something.

Anywho, this woman's flat was very nice, and almost an OT dream in terms of safety and risk management in the home. The reason we'd gone out for the home visit though, is because during last week's falls education group on mobility and transfers (bed transfers being something we demonstrate and practice), this woman said to me that she has been unable to get into bed, and therefore has been sleeping in her armchair for six months. I was horrified, because her medical agenda at the day hospital mainly revolves around bilateral leg edema, and if she had missed this particular for some reason, she may never have brought up the trouble with her bed. She was initially assessed by the Head OT, who only did a Folstein (MMSE) because that was what was specifically requested. An initial interview was never done, a functional assessment was never done, so the bed issue had never come up. So essentially, every day this woman is sitting or walking around with fluid moving down into her legs, and every night she sleeps upright in a chair with her feet on a small footstool about 6 inches off the floor, with fluid moving down into her legs.

When we went out to her flat, we measured the bed and found it to be 24" with the woman sitting on it, far too high for her to manage. It's what they call a divan over here, essentially a cupboard on its side, with drawers that pull out of the frame for extra storage, and a mattress on top (no one uses box springs over here). The mattress is fairly thick at 9" and the divan has wheels which add an extra 1.5" Basically this woman needs to be getting into a bed at a height of 19", maybe 20" max to be able to manage her bed transfers independently. But she's very attached to her divan, with the drawers...we talked with her about the possibility that she might need a new bed ("I have to have the drawers for space, you see"), we talked about a chest of drawers to go along with a new lower bed ("Do they make lower divans? I have to have the drawers for my pictures and other things"), we talked about taking the casters, sorry, wheels, off the bed and purchasing a new thinner, perhaps softer mattress ("Well that bed is brand new, but I've slept in it twice, so I don't think I can sell it, you see").

And Annette took over the conversation at this point insisting 4 or 5 times that this woman must understand that she needs to sleep in bed, there is no way her legs will get better unless she's sleeping in bed, and her health is much more important than drawers. Could she please stop talking about drawers, there would always be something that could be done about drawers afterward, but the most important thing is health, and the bed must be lowered no matter what. In the end, you have to look at what's most important, and the legs will never get better if you're not able to sleep in bed, etc etc etc.

Now I do appreciate what Annette was trying to do, but it made me reflect on how different people adopt different communication styles. Thankfully, this woman wasn't put off too much by Annette's direct, commanding sort of style, but I was just thinking on the car ride back to the hospital that we could have saved that speech for once everything else had been tried. Such as taking off the casters and getting a thinner mattress, or searching for a divan much lower in height...if it just wasn't possible for her to have a divan, then we could have had the conversation about her health needing to come first. As it turns out, we will end up going through those stages anyway, because back at the hospital, I called her son-in-law to discuss what needed to be done about the bed. And while he did state he will do what needs to be done, he wants to start by taking off the casters himself, and having us go back next week with a bed rail to see if she can manage the transfers with the bed rail and bed being just an inch and a half lower. I did take a firmer stand with him at that point to say, we could do that, but it's our recommendation given your mother-in-law's medical condition and functional status, that the bed be no higher than 20" which also means she will need a thinner mattress. And I even told him we'd looked up very reasonably priced mattresses of the right height in an Argos catalog. But in the end, we can't force anyone to take our recommendations, so I agreed to reassess next week with the casters off and a bed rail (I already know it won't be enough, but have to jump through the hoops I guess). I wonder if Annette hadn't left for the day and had gotten on the phone herself, would the son-in-law have agreed to purchase a thinner mattress ASAP?!