Level V – Confused, Inappropriate Non-Agitated: Maximal Assistance

• Alert, not agitated but may wander randomly or with a vague intention of going home.
• May become agitated in reponse to external stimulation, and/or lack of environmental structure.
• Not oriented to person, place or time.
• Frequent brief periods, non-purposeful sustained attention
• Severely impaired recent memory, with confusion of past and present in reaction to ongoing activity
• Absent goal directed, problem solving, self-monitoring behavior
• Often demonstrates inappropriate use of objects without external direction
• May be able to perform previously learned tasks when structured and cues provided
• Unable to learn new information
• Able to respond appropriately to simple commands fairly consistently with external structures and cues
• Responses to simple commands without external structure are random and non-purposeful in relation to command
• Able to converse on a social, automatic level for brief periods of time when provided external structure and cues
• Verbalizations about present events become inappropriate and confabulatory when external structure and cues are not provided

I think Vernon falls into most of those pretty squarely. Let’s take a look at Level 6:

Level VI – Confused, Appropriate: Moderate Assistance

• Inconsistently oriented to person, time and place
• Able to attend to highly familiar tasks in non-distracting environment for 30 minutes with moderate redirection
• Remote memory has more depth and detail than recent memory
• Vague recognition of some staff
• Able to use assistive memory aide with maximum assistance
• Emerging awareness of appropriate response to self, family and basic needs
• Moderate assist to problem solve barriers to task completion
• Supervised for old learning (e.g. self care)
• Shows carry over for relearned familiar tasks (e.g. self care)
• Maximum assistance for new learning with little or nor carry over
• Unaware of impairments, disabilities and safety risks
• Consistently follows simple directions
• Verbal expressions are appropriate in highly familiar and structured situations

Typically, he is showing some of those behaviors too. There is a vague recognition of some staff, for example. But those are one the ones who care for him intimately. And I believe he is able to follow simple directions more consistently.

But though these stages are fluid, and a person could move in an out of different levels of behavior at the same time, I think he’s pretty squarely in Level 5. Now I’ve read these charts many different times over the past 18 months, and the funny thing is, about a year ago, I thought he was between a 5 and a 6.  I don’t know if he’s in about the same state he was in then or if I just interpret the descriptions differently than I used to. I feel like I’m a very different person every three months or so, so it’s hard for me to gauge.

Yesterday, the doctor called to ask if I would approve a trial of Xanax for Vernon as he has been particularly agitated at night. He knows I have strong thoughts about the heavy anti-anxiety medications. I told him we could try it for a few days, as its causing unrest to Joe, his room-mate. This is hard for me to allow as  the last time we used benzodiazepines, I think they were making things worse (and possibly killing him.)  I just cannot get there regularly enough to administer alternative medicine and therapy. This is the kind of problem we have by Vernon living in a home. I can not have him home yet because he needs constant nursing care, but at the care home, healing options are very limited. I am taking a few big breaths and saying: “Ok, we’ll try it!”  But the truth is, it makes my stomach drop.  Joe and the others need their sleep too, and they don’t get any if Vernon is being loud and agitated through the night.

While I’m at it , I’m going to put out another call for dialysis help again too. The next two Saturday mornings, I will be unavailable, and my parents will be out of town.  I am  looking for someone who is willing to sit with him in Costa Mesa from 10-12.  I hate to keep asking. But sometimes people want to do it! I’d appreciate it very much…so would the dialysis technicians (its easiest when people go in twos.)  He loves to be read to…especially fantasy fiction.  Click on this link if you find it in your heart and schedule to sign up. We have many opportunities (he goes 5 times a week and always requires a sitter.)

Here is a picture sent from my friend Susan and her daughter Belle, who sat with him yesterday.  You can see how much he loves “The Magician’s Nephew.”  Now if only he could have books and music administered to him all the time instead of sketchy pills.

PS I don’t entirely have problems with medications in general…but I think people with neurological problems have a different reaction than others.  I shouldn’t generalize, but this is what I’ve seen to be true in Vernon, and I’m researching whether its true in others with TBI, etc. However, I’d like to be pleasantly dissuaded.

“Mental health is not a destination but a process. It’s about how you drive, not where you’re going.” Noam Shpancer

Update: Since posting this, someone has signed up for Friday the 5th.  Thank you, Barbara!  I have posted dates through January on the new Sign Up Genius Calendar.