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Togore101

Caregiver appt

Question

My wife recently applied to be my caregiver. The process was easy once the form was completed and sent off that call us up, and schedule the evaul. Overall the evaul seem to go well, but this is new territory for me and would like input on the notes that the MD put in eben. Below are the notes. Any one with any insight on this program are welcome to comment and let me know your thoughts.

 

Household makeup: Veteran, wife and three minor children aged 4 and 3
month old twins
Employment:
Veteran: WOrks in Federal Department of State in passport
division
Caregiver: Not working at this time
Education:
Veteran: Masters in Organizational Management
Caregiver: Computer towards a Masters in business
Hobbies:
Veteran: None
Caregiver: None

Substance Use:
Veteran: Denies
Caregiver: Denies
ADL Screen - Katz Index of Independence in Activities of Daily Living
Record INDEX of ADL.
Score = 15
1. Bathing: either sponge bath, tub bath or shower.
Receives assistance in bathing only one part of body (such as back
or leg).
2. Dressing: gets clothes from closets and drawers, including
under-clothes, outer garments and using fasteners (including braces
if worn).
Receives assistance in getting clothes, or dressing, or stays partly
or completely undressed.
3. Toileting: going to the "toilet room" for bowel and urine
elimination; cleaning self after elimination and arranging clothes.
(May use cane, walker, or wheelchair, and manage bedpan or commode,
emptying same next morning).
No assistance needed.
4. Transfer:
Moves in and out of bed, or chair, without assistance (may use
support object like cane or walker).
5. Continence:
Controls urination and bowel movement completely by self.
6. Feeding:
Feeds self without assistance.

SUPERVISION/PROTECTION SCORING:
Delusions/Hallucinations:
Is there the presence of delusions/hallucinations?
Has there been reckless, impulsive or otherwise potentially harmful
behavior that poses a risk to Veteran in the presence of
hallucinations/delusions? E.g. hearing voices that tell Veteran to
harm him/herself or others; driving in unsafe conditions to escape
belief that that Veteran is being watched in his/her home; jumping off
roof of building due to beliefs that flight is possible, etc.
1 Mild behavorial risk Auditory hallucinations interferes with
veteran's sleep and he sometimes leaves house to investigate

Affective/Behavioral Dysregulation (Self-regulation):
Is the Veteran able to regulate behaviors without exhibiting any of
the following behaviors:
* Aggressive/combative with self or others * Verbally
disruptive including yelling, threatening and excessive
profanity
* Disruptive behavior
* Infantile behavior
* Socially inappropriate behavior
3 Veteran displays one or more of the behaviors (described
above) SEVERAL TIMES A WEEK requiring caregiver
supervision/intervention: Veteran gets into vebal confrontations
with co-workers which need intervention from supervisor.
Impairment of Recent Memory:
Is the Veteran able to remember recent events and learn new
information? Assessed by:
* "How is your memory?" * Provide me with some examples
of
recent troubles you've had/the
Veteran has had with your/his/her memory." (Common responses
include: difficulty remembering appointment dates/time,
difficulty remembering recent conversations, difficulty
remembering driving directions, misplacing common objects,
difficulty remembering what he/she just read, walking into a
room
and forgetting why he/she entered, etc.)
* "What measure do you take to assist you with your memory
troubles?" (E.g. writing down things, using electronic
devices,
having caregiver remind of tasks, etc.)
* "How much of the time is your memory a problem for you?"
AND/OR
"In a typical day how often do your or your caregiver notice
trouble with your memory?"
3 Veteran is able to recall 25-49% of recent information and
requires the supervision/assistance of the Caregiver to remember
to perform necessary day-to-day activities: Veteran needs
assistance with medications, appointments

Sleep:
Is the Veteran able to regulate sleep?
Assessed by:
* Do you (does the Veteran) require support from your caregiver
in
order to sleep well?
*If yes, "How so?" (e.g. reminds Veteran to go to bed at a
regular time, reminds VEteran not to use caffeine before bed,
reminds Veteran to use relaxation techniques, sits with
Veteran
Until they fall asleep, etc.)
* "How often are you able to sleep through the night?"
* "Are you having nightmares?"
*If yes, "How often? Do you (does the Veteran) require
support
from your caregiver in order to calm down following a
nightmare?"
4 Veteran is unable to sleep at night, prone to wandering and
requires overnight safety precautions such as locked doors and
constant overnight supervision by caregiver: Veteran unable to
sleep through the night, has left home to investigate noises but
does not wander.
Safety:
Is the Veteran able to maintain safety with self and others (i.e.
Veteran poses no risk to self or other and/or is without risk of
falling or wandering, crosses street safely and safely uses electrical
appliances, stove top or oven)?
Assessed by:
* "Are you/is the Veteran able to leave the home
independently/safely ?"
*If No, "How often are you having troubles of this kind?"
* "Are you/is the Veteran able to utilize household appliances
independently/safely?"
*If No, "How often are you having troubles of this kind?"
3 Veteran is able to leave the home independently 25-49% OF THE
TIME or use electrical or cooking appliances with direct
supervision: Veteran does not leave home independently apparently
by choice.

Planning and Organizing:
Is the Veteran able to plan and organize as manifested by the
following tasks:
* Food preparation
* Grocery shopping
* Laundry
* Managing medications
* Arranging transportation
* scheduling and keeping appointments
* Organizing and manifesting important papers
Assessed by:
* "How often do you independently _____________?"
4 Veteran is unable to initiate and complete tasks. Veteran
requires caregiver assistance to motivate to initiate a task and
requires assistance and cueing throughout a task to structure and
complete it: Veteran does not perform any tasks, caregiver does
not seem to motivate him. He does not drive due to physical
problems, won't ride in a taxi, etc.
Physical Exam
GENERAL: Alert, no distress
HEENT: TM's clear, eyes photophobic, throat clear
Lungs:
clear
CV: RRR
Abd: Soft, non-tender
Back:
Appearance: Normal
Palpation: tender
ROM: only to 45 degrees flexion
Extremities:
Appearance: Normal
Palpation: Normal
ROM: Diminished for hips and knees
Neuro: Strenght normal, reflexes symmetric
Pertinent Imaging: Lumbar spine, knees, wrists, hands
Current Medications: See Below
Active Outpatient Medications (excluding Supplies):
Active Outpatient Medications Status
======================================================================
===
1) ARIPIPRAZOLE 20MG TAB TAKE ONE TABLET BY MOUTH AT ACTIVE (S)
BEDTIME
2) DOXAZOSIN MESYLATE 4MG TAB TAKE TWO AND ONE-HALF ACTIVE (S)
TABLETS BY MOUTH AT BEDTIME FOR SLEEP AND
NIGHTMARES
3) MELATONIN 3MG CAP/TAB TAKE 2 CAPSULES OR TABLETS BY ACTIVE
MOUTH AT BEDTIME IF NEEDED FOR SLEEP. MAY TAKE UP
TO 3 CAPSULES NIGHTLY ONE HOUR BEFORE BEDTIME
4) VARENICLINE 1MG TAB TAKE ONE TABLET BY MOUTH TWICE A ACTIVE
DAY AFTER MEALS THEREAFTER FOR 12 WEEKS. TAKE WITH
A FULL GLASS OF WATER. REPORT MOOD AND BEHAVIOR
CHANGES TO MD. (FOR SMOKING CESSATION)
5) VENLAFAXINE HCL 150MG 24HR SA CAP TAKE ONE CAPSULE BY ACTIVE (S)
MOUTH EVERY DAY WITH BREAKFAST FOR MOOD. DO NOT
STOP TAKING ABRUPTLY WITHOUT THE ADVICE OF
PROVIDER. SWALLOW CAPSULE WHOLE. DO NOT DIVIDE,
CRUSH, CHEW, OR DISSOLVE IN WATER.
6) VENLAFAXINE HCL 75MG 24HR SA CAP TAKE ONE CAPSULE BY ACTIVE
MOUTH EVERY DAY WITH BREAKFAST FOR MOOD. DO NOT
STOP TAKING ABRUPTLY WITHOUT THE ADVICE OF
PROVIDER. SWALLOW CAPSULE WHOLE. DO NOT DIVIDE,
CRUSH, CHEW, OR DISSOLVE IN WATER. TAKE WITH 150
MG CAPSULE FOR TOTAL DOSE OF 225 MG EVERY DAY
Pending Outpatient Medications Status
======================================================================
===
1) CHOLECALCIFEROL (VIT D3) 1,000UNIT TAB TAKE TWO PENDING
TABLETS BY MOUTH ONCE A DAY FOR VITAMIN-D
SUPPLEMENT
2) THIAMINE HCL 100MG TAB TAKE ONE TABLET BY MOUTH ONCE PENDING
A DAY FOR THIAMINE SUPPLEMENTATION
8 Total Medications
Veterans Interview: In regards to your service connections, Why do you
need caregiver support? Caregiver drives him to work, appointments,
pays the bills, cooks, manages medications, physically he can't
accomplish certain tasks, CG keeps an eye on his drinking.
Caregiver Interview: As pertains to ADL's CG says about 3 or 4 times
a month she has to help him shower washing back,legs, feet.
Concommitantly she will have to help him get dressed, get out of bed

and help him off comode. She has noticed some soiled undergarments
believes it is due to difficulty wiping. As per the IADL's She has
noticed veteran's auditory hallucinations, co-wokers help calm him at
work, he forgets more than half of recent information, Nightmares
disrupt sleep 2 or 3 times a week. Veteran does not leave home alone.
Does not let him cook even with supervision. In regards to Veteran's
service connections, Why do you feel Veteran needs caregiver support?
Veteran is mentally unable to respond to things appropriately,angers
easily, difficulty communicating, reckless spending would put assets
at risk, physically unable to care for himself at times, needs to
have medications managed, unable to drive as a result of road rage.
Additional Comments: Appears veteran is able to hold down this job
with reasonable accommodations.
 

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You got this from Ebenefits or Myhealthevet?  The caregiver program is done by the VHA (hospital) vs VBA (claims).  Did your wife already do the training and did you have your home visit from the VA nurse?

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