I Give In: Following My Heart to My New Care Home #31Days2022

Hi everyone. The optional prompt for day 2 in the 31-day writing challenge is “give”. Again, this is a bit of a freewrite as I prepare for the move to my new care home on Wednesday.

You see, when I originally moved to my current care home in 2019, it was the first place that wanted me. I also had some rather odd preconceived ideas about the kind of place I needed to be in to get my needs met. I thought that, in order to get a high staff/client ratio, you needed to be in a home for severely or profoundly intellectually disabled people. After all, places I’d known before in the psychiatric system, had a much lower staff/client ratio and so did so-called “supported housing” facilities for those with milder intellectual disabilities. (I did already know that I wanted to be in a place for people with intellectual disability rather than mental illness even though I’m not intellectually disabled, because the intellectual disability services approach is far less training-focused than that on the mentally ill.) At the back of my mind, I did know about a few homes on the care agency’s main institution grounds that catered towards those with mild or moderate intellectual disability with severe challenging behavior, but I couldn’t get the right “care profile” (on which your funding is based) for that. Not at the time, at least.

So I accepted the room at my current care home. It didn’t feel that good right from the start, but what else could I do? I was hardly getting by living with my husband. And, indeed, I don’t know what I’d have done had I had to survive lockdown while living independently. Unsuitable as this home may’ve been, it was a much-needed step on my journey.

Once I lived in my current care home, where all my fellow residents have profound intellectual disability, it became apparent pretty quickly that I needed more intensive behavior-related support than my care profile would allow for. I was first very scared when I heard that my support coordinator was applying for the highest care profile – the one I would’ve needed for the homes still at the back of my mind. After all, at first, my funding had been denied altogether. Not just the highest care profile – any long-term care funding. Were they going to re-assess me all over again? It turned out not: either I’d get the higher care profile or I’d remain in the lower category, but my funding couldn’t be taken away. Within a month, we heard the good news that my funding got upped to the highest care profile. Five months later, my additional one-on-one support got approved.

Still, I didn’t dare give in to my wish to move to one of the “intensive support” homes on main institution grounds. Not consciously, at least. When no-one was looking, I did look all over the care agency’s website to see the descriptions of their homes, all while saying I didn’t want to move.

In fact, at my care plan review last year, I said I was 95% sure I wanted to stay here and those other 5% were because of the distance to my husband. My husband said I needn’t worry, as it’s not like there are dozens of places for me to choose from. Then again, I don’t need dozens to choose from.

The home I’m moving to on Wednesday, is again the first home that wants me. However, it is also the home that stood out to me on those searches on the care agency website. It is most certainly not perfect – I know that before I’ve even moved in. However, I have my hopes up that I won’t regret having given in to following my heart.

What Will I Leave Behind?

If
Or should I say “when”
I move to the new care home,
What will I leave behind?

I’ve been pondering my legacy should I leave for the prospective new care home in less than two weeks. I’ve been thinking of gifting every staff member and a few of the residents who I’m close to and who will remember, something out of my collection of handcrafted sculptures and jewelry. The polymer clay dolphin will go to the one resident in my home I can talk with, because he always carries a stuffed dolphin with him. He may or may not fully understand what it means that I’ll leave (since I’m not sure he’s ever witnessed a fellow client move out), and in any case it’ll likely make him sad. I’ve already decided to appease him with French fries the weekend before the planned moving date. This man has his 50th birthday next year, and I’ve already told several staff I’m going to come back to celebrate it with him.

One of my regular one-on-one staff is getting a matching blue bracelet and necklace that she’s told me countless times would complete a great beach outfit. I had thought of giving it to her for her 50th birthday last March, but decided against that eventually.

Then, besides the physical gifts I’ll leave behind, there’s of course the memories. I wonder sometimes whether some clients will secretly be glad that I’ll have left, as my challenging behavior could come across quite threatening to them. I wonder whether the staff will be happy I’m gone, as then they can house a client with severe/profound intellectual disability here. Then again, we still have another empty room now too.

In all honesty, I have no idea what people will think of me if I do move. Is out of sight, actually out of mind? With my psych hospital staff, it pretty much was, as they didn’t even say goodbye when I was discharged. Then again, this staff, particularly those I’ve known from the beginning, are different. At least I hope so.


This post was written for Reena’s Xploration Challenge. It is a one-word prompt this week: “legacy”.

#WeekendCoffeeShare (July 2, 2022)

Hi everyone on this first Saturday of July. Wow, can you believe the first half of the year is over with already? I certainly can’t. I’m joining #WeekendCoffeeShare today. I just had my afternoon coffee, but the other residents are probably still having theirs. Let’s have a coffee and let’s catch up.

If we were having coffee, I’d start out by asking how you are. How’s your weather? Ours has been mixed. Right now, it’s about 23°C and partly cloudy, but we’ve had daytime temps as high as 29°C and as low as 19°C and a mix of sun and rain and thunderstorms.

If we were having coffee, I would share that this week was a mixed bag. I’ve been struggling quite a bit with all the new staff being introduced to me over the week. Now I hear you say what my staff have been saying too: isn’t that better than temp workers? Yes, it is and, thankfully, I didn’t have any temping staff all week. However, on some days, I had two staff introduced to me in a day and this generally meant at least one of them was orienting to my one-on-one shift. This means they’re with me literally all the time and this means I have two staff with me all the time, who are sometimes chatting among themselves about their kids or whatever (sometimes under the guise of the new staff telling me about themself). That cost me a lot of energy. By the middle of the week, I had thankfully been able to get it through to the staff that I don’t like this.

If we were having coffee, I would tell you that I’ve been struggling a bit with the discrepancy between my emotional development and my intelligence again. I have been reading up on emotional development as it relates to people with developmental disabilities and, though the theory makes perfect sense to me, this does actually create intense turmoil inside of me. This specifically relates to the situation in which staff confront me with my challenging behavior, trying to let me know it’s unacceptable. I am not even always rationally able to see their point, for example when it relates to the temp workers and new staff, but even when I am, it is sheer impossible for me to grasp it emotionally.

If we were having coffee, I would share that, on Monday, some evangelicals were handing out flowers near my neighborhood supermarket. As a progressive Christian, I agreed with a lot but not all of what the woman doing the evangelizing to me said, but I didn’t feel like challenging her. After she started challenging my staff’s Catholic beliefs and all of us noticed the conversation became awkward, I accepted the flowers and moved on. I do feel that this, odd as it may seem, came at the right time, being that it was my birthday and I’d just had a really hard appt with my nurse practitioner. At least yesterday, the flowers still looked quite good.

If we were having coffee, lastly I would tell you I’ve been very crafty lately. The creations I shared yesterday, I had finished late last week. This week, I’ve been experimenting with the plunger cutters I got from the new student staff on Wednesday, as well as with my extruder. I didn’t actually create anything using the extruder yet and I might’ve broken it already after all. Today, I did create a sort of Earth charm. I originally wanted to do the continents much like they are on the real planet, but that didn’t work out.

How have you been?

Autism and Aggression: An Autistic Adult’s Perspective

April was Autism Awareness Month. In previous years, I have dedicated my #AtoZChallenge to autism, but this year, I chose a different topic. For a while, I had it in mind to focus on developmental disabilities in general, but, as you can see, I chose another topic entirely. However, the topic of autism is still on my mind. In the coming weeks, I want to offer more of an insider’s perspective on autism and its characteristics. After all, I am autistic and I feel that the blog coverage on autism is heavily divided between parents of autistic children sharing their stories and adult autistics sharing advocacy. Now there’s nothing wrong with advocacy – I feel passionate about it too -, but there is also nothing wrong with personal experience stories. What is wrong is when these are mostly one-sidedly coming from neurotypical (non-autistic) parents of autistic children. Hence, my insider’s perspective.

For my first post, I am choosing a rather controversial topic: aggression. When parents talk about their child with autism, one of the first things they will usually mention is the child’s aggressive behavior. And in fact, this was the first thing my parents would say when asked to describe my problem behaviors too. It was also what got me to be referred to the mental health agency for an evaluation at age 20, which ultimately led to my autism diagnosis.

I don’t know about statistics of aggression in general, but it is highly stereotypical to equate autism with violent behavior. Autistics are not more likely to be deliberately violent than neurotypicals and they are, in fact, more likely to fall victim to violent crimes.

That doesn’t mean aggression doesn’t occur and, when it does, that it isn’t related to the autistic person’s autism. To say that it’s a “comorbidity” is, in my opinion, doing the autistic a disservice. It is, however, an issue that arises in the interaction between the autistic person and a highly autism-unfriendly world. After all, at least I have often gotten aggressive when my needs for autism-supportive care are not met.

For instance, one day in the psych hospital, a nurse, whom I will call Sara, had said one evening that she’d get back to me the following day after morning report to talk about getting me unsupervised off-ward privileges. The next day, I went up to Sara, but wasn’t able to communicate clearly what I wanted. “I’m not your assigned nurse today,” Sara said. “Go to Daisy if you want something.” Now the nurse I’ll call Daisy was a temp worker, so clueless about my needs or what I’d talked to Sara about the previous day. I got very irritable, because Sara had promised me she’d get back to me and now she was referring me to Daisy. I screamed, walked around the ward restlessly and constantly nagged the staff in an irritable voice. By handover, a third nurse, whom I’ll call Robert, came on and said that he’d put me in seclusion if I didn’t calm down right away. “Go on then, stupid,” I shouted. So he did.

This was not my worst incident of aggression ever. As a teen, my mother reports, I would hit her. I currently still occasionally slap or push staff. Usually, this again results from staff not following through on something or not following my daily routine.

I feel strongly that, though not all incidents of aggression can be prevented by parents or carers providing autism-sensitive support, a lot of them can. If an autistic is aggressive anyway, there are much better ways of handling it than solitary confinement.

loopyloulaura

Also linking up with #PoCoLo.

No Unwholesome Talk

“Do not let any unwholesome talk come out of your mouths, but only what is helpful for building others up according to their needs, that it may benefit those who listen.” (Ephesians 4:29 NIV)

I had a very bad anger outburst this afternoon. For a very minor reason, I yelled at and insulted a staff member quite majorly. I told her to leave, which she did, but not just because I told her to. In fact, I’d caused her to get a little teary.

Obviously, I regret my outburst, though initially I didn’t fully see that it was all my responsibility. I mean, I did feel as though this staff member had triggered me. I see now that my anger was extreme and way out of proportion to the situation.

Then, in a collection of journaling prompts, I was pointed to this Bible verse. I didn’t know what it said, so went and looked it up because I find that Paul’s letter to the Ephesians usually appeals to me. There it was. Do not let any unwholesome talk come out of your mouths. Wow!

This does not refer just to no swear words. If it had, I could’ve said I don’t use those. Instead, looking at the second part of the verse, we’re supposed to only use words that build others up. In other words, calling someone names is the exact opposite of what Paul asks us to do here.

I did eventually apologize. Initially, this was a kind of half-hearted apology. Not because I had meant my insult, but because I struggle to prevent this happening again and because, at the time, I didn’t fully see that I alone was responsible for my behavior. I see now. I am praying that, with God’s help, I will learn better anger management strategies.

God, I want to confess that I am a very sinful person. You know this already, but I need to realize that my behavior is wrong. I had a horrible anger outburst and I didn’t even fully acknowledge that it was my fault. Please help me take responsibility for my anger. Please also help me come to You in future situations where I get triggered rather than react in anger. I pray for forgiveness and hope that You will still accept me even though I am not living up to even human expectations, let alone Yours. In Jesus’ name, Amen.

This Is “Profound Autism”?: Reframing the Discussion Around Complex Care Needs

A few days ago, there was a discussion on the Autism Science Foundation’s Facebook page in which parents of autistic adults with complex care needs were describing their children with the hasthag #ThisIsProfoundAutism. I asked to reframe the discussion to include people with multiple disabilities including autism in general, because it is rarely (but not never!) autism, no matter how severe, alone that causes a person to be completely dependent on caretakers. I then explained that due to the combination of my disabilities, I need 24-hour care, including one-on-one for most of the day.

Not surprisingly, I was quickly met with the question whether I was saying I needed 24-hour help with basic tasks such as eating, bathing, dressing myself, etc. Well, the Autism Science Foundation page is a public Facebook page and I didn’t want the people on my friends list (including immediate family) who don’t know this, to judge me for it, but the short answer is yes. While I, like presumably most “profoundly autistic” people who don’t have physical disabilities, am physically capable of eating and dressing myself for the most part with some difficulty, my executive dysfunction means I still need help with them. As for bathing, well, I basically need someone to wash me, because, while I can physically hold a washcloth in my hand, I don’t have the organizational skills to actually work out the ritual without a ton of supervision and even then it’d lead to a lot of meltdowns.

I did, incidentally, point out that I recognize intellectual disability as a valid additional disability that needs to be taken into account when I asked to reframe the discussion. After all, that’s most likely what’s causing these autistic adults to be unable to understand instruction and to be completely dependent. For me, it’s a combination of executive dysfunction, which is a direct autism symptom, blindness, mild cerebral palsy, and other things.

I also do recognize that the need for support with severe challenging behavior is not the same as the need for help with basic personal care. One does not exclude or necessarily include the other and one is not more valid than the other. I, for one, am somewhat more independent in terms of eating, dressing and bathing than my severely intellectually disabled fellow clients. I am a lot more dependent where it comes to the effects of my challenging behavior.

I also do not mean to say that autism on its own cannot possibly cause a person to need a lot of care. It can. I am reminded of a girl I read about on Dutch social media many years ago, who indeed had hardly any functional communication skills but did have an IQ above 85. She, unlike me, didn’t have any additional disabilities. She was completely left behind in the care system: she was too severely disabled for traditional child and adolescent mental health services, but her IQ was too high for intellectual disability services. Really, I should not have called for reframing the discussion to include those with multiple disabilities, but those with complex care needs in general.

That being said, I strongly disagree with those people who say that just because I can write, means I should have ignored the conversation, since it clearly wasn’t meant for me. The fact that I can write, does not make me not dependent on care providers and does not mean policy or lack thereof won’t affect me. I am autistic and that, along with my blindness and other disabilities, causes me to need the extensive care I get now.

Time-Out Rooms, Comfort Rooms, Snoezelen® Rooms: Special Care Rooms in Mental Health and Disability Services #31Days2021 #Blogtober21

Today, I’m not feeling too inspired. The optional word prompt for the 31-day writing challenge is “Comfort”. For some reason, probably the fact that I’ve been experiencing a lot of flashbacks to my time in the mental hospital lately, I was immediately reminded of comfort rooms. Then I thought, maybe I could use this post to raise some awareness of the different kinds of special care rooms used in mental health and disability services.

Back in my early days in the mental hospital in 2007, seclusion or isolation was pretty commonly the only intervention used, maybe in combination with forced medication, on disruptive patients. I was initially admitted to the locked ward only because the open ward had no available beds. During my first night in the hospital, I heard a lot of screaming and was later told that the staff “handled it appropriately”. Another patient told me that the screaming patient pretty much lived in the seclusion room. I was pretty scared out of my mind.

Once moved from my parents’ city hospital to my own city’s locked ward, I again experienced seclusion as a witness repeatedly. The ward I stayed on, was the less restrictive locked ward, so it didn’t have isolation rooms. Rather, ours were called time-out rooms, but that didn’t make them any better to be honest.

I experienced one hour forced time-out once, three months into my mental hospital stay. After that though, it was used as a threat repeatedly. This, for clarity’s sake, is illegal: seclusion can only be used to avert danger, not as punishment.

About three years into my mental hospital stay, some wards, particularly locked wards, started deconstructing their seclusion rooms and repurposing them as “comfort rooms”. A comfort room in theory looked nicer, as it had soft toys in it and maybe some special lighting. However, them being repurposed seclusion rooms did mean they still had the vibe of isolation about them. Indeed, the few times I was sent to the locked ward for a time-out once at the open resocialization ward, I spent my time in the “comfort room”. This did not feel comforting at all.

My last psych ward, which I spent four years on between 2013 and 2017, had both a comfort room and a time-out room. This comfort room was indeed actually comforting. There was an essential oil diffuser, a CD player, comfy couch and a few other things. What made it different though was the fact that you couldn’t be locked up into it. If you were to be locked up, it’d have to be in the time-out room.

At the end of my psych hospital stay, I first learned about snoezelen®. This, like I’ve explained before, is a method of helping people with significant intellectual or developmental disabilities by modulating their entire sensory environment. I wanted to experience what a snoezelen® room would be like. My psych hospital had an intellectual disability unit with a room like this, but my psychologist refused to let me visit it, claiming I’m far too capable for this type of activity. I stood my ground and got a place at my first day center with my current agency, which did have a snoezelen® room.

When I was at my first day center with my current care agency, the snoezelen® room was sometimes used as a time-out room for me, in that I was forced to go in there when I was irritable and not allowed to come out. Though the door couldn’t be locked, it did feel intensely triggering to me. It is one reason I still struggle to be in my current day center’s snoezelen® room if no staff is present.

Of course, I must say here that an old-fashioned time-out room has hardly any furniture: just a bed and a stool, both attached to the floor, as well as a toilet made of metal. The seclusion room the screaming patient from my first night in the hospital was locked into, was likely even worse. Comfort and snoezelen® or other sensory rooms are much better. Still, the idea that someone can be put into solitary confinement against their will, is rather disturbing if you ask me.

Why Do I Need One-on-One Support? #31Days2021 #Blogtober21

Yay, it’s October and this means it’s time for Blogtober 2021. Last year, the prompts were based on song titles. This year, there are no prompts. However, Kate Motaung of Five Minute Friday also relaunched the 31-day writing challenge after a break last year and there are prompts for this year. The first prompt is “need”. We can do a five-minute freewrite, but I’m no good at sticking to five minutes or at not editing my writing.

Yesterday I had my care plan review. I was really concerned about my need for one-on-one support being reassessed later this year. Not that the care plan review would really matter for this or so I’m told, but now that we were all together (my home and day center staff, the behavior specialist and my mother-in-law), I wanted to raise the issue. It’s the behavior specialist’s job to write the reapplication paperwork and I questioned whether it sufficiently documented my need for one-on-one. To get things clear in my mind, I am going to write out why I need the support I need.

Firstly, I am blind and have a mild mobility impairment due to cerebral palsy. This, combined with my psychiatric illnesses, means I cannot move about outside the care home, or even outside of my room, independently much at all. This means that the staff need to be alerted when I leave my room looking for them, so that they can come out looking for me.

I am autistic. In my case, I get severely overloaded having to function in a group setting, such as at the day center. Even with noise-canceling headphones on, I still get distracted from trying to do things on my phone while there. Besides, if I do have functioning headphones, they will block out so much noise that I’m essentially cut off from my surroundings and can’t be alerted should something happen. This creates intense anxiety.

This anxiety also leads me to be unable to function on my own for long periods of time. I can, if I’m doing well, be left on my own in my room for up to about 30 minutes at a time. It doesn’t help that I know rationally that someone might be in the next room, because emotionally, if they’re out of earshot, they might as well be on the North Pole.

Autism also means I tend to fixate on routines. In my case, I tend to hyperfocus on the times my staff are going to leave me alone and this creates even more anxiety even when they’re still present. For this reason, staff need not stick to rigid rules of what time exactly they’re going to leave me, but rather to the order of activities.

If I’m left alone for prolonged periods of time, I can often feel incredibly unsafe and start to ruminate, which can easily escalate into self-destructive thoughts and actions. I may also run off in a fight-or-flight response.

I have complex PTSD, as well as dissociative symptoms. This means I can experience apparent age regressions. I get triggered very easily. Flashbacks, too, can lead to a fight-or-flight response.

Thankfully, now that I’m on the right medication, I don’t get as many flashbacks as before. However, I still do experience many serious behavioral issues that can be prevented or averted by the fact that I have one-on-one support most of the time.

I’m pretty sure a critical assessor would be countering that my one-on-one would not help me learn to cope with my anxiety. Thankfully, the goal of my long-term care plan is stabilization, not development. In other words, the original assessors for my long-term care funding did not feel I am trainable anymore. Otherwise, I would not have gotten approved for what is essentially lifelong care at all. The only thing is that my one-on-one care exceeds the care normally paid for by my long-term care profile. Oh well, let’s hope the assessor sees my need for it for at least another year.

Misunderstood

I am currently reading Forty Days on Being a Four, a book of reflections by Christine Yi Suh, who identifies as an enneagram type Four. In the day one reflection, she discusses the story in Luke 7:36-50 in which an unnamed, sinful woman enters the house in which Jesus is eating with a Pharisee. The woman’s dramatic display of emotion makes Christine Yi Suh think she’s a Four. Indeed, she is greatly misunderstood by the Pharisees, who see just her sinful lifestyle and don’t understand that she is in fact displaying her faith, love and devotion towards Jesus.

The reflection ends with the question in which ways I, being a Four, have been misunderstood. Well, for one thing, I’m often not even seen as a Four. Others would most likely describe me as a Five, because I’m such a thinker.

In fact, one of the main ways in which I feel misunderstood, is that my intellect is overrated and my emotional life underrated. As a child, I was described as self-centered, selfish even. I often got the feeling that I was seen as unfeeling. I am not and never was unemotional at all.

Indeed, I do feel that the depth of my emotional life is often misunderstood. I used to joke that I should give my parents the table of contents of the DSM-IV (we were still in IV era at the time), so that they could pick a random disorder to label me with when I wasn’t being my desirable, intellectual self. I mean, they often labeled me as dramatic, psychotic even. I wasn’t.

People who really know me, know that deep down, I’m definitely sensitive. I may not show it on the outside as much as the unnamed woman in the story does.

Another way in which I am often misunderstood, is in terms of my behavior. Too often, my challenging behavior has been seen as a willful act of defiance. In this sense, I do relate to the woman in the story, who lived a sinful lifestyle up till the point she met Jesus. Like Jesus saw beyond her acts, so He hopefully sees beyond mine. Like this woman was saved by her faith, so hopefully am I.

I also see that other people who know me, look beyond my distant, intellectual façade and also beyond my dramatic emotionality. They don’t see my intellectual and distant appearance as a sign of lack of emotion. They also don’t see my dramatic displays of emotion as mere manipulativeness, like my family used to. They, in fact, see me as a sensitive but also caring woman.

Like the woman in the story, I am sinful. I mean, my challenging behavior was there when I was a child and in some ways still is there. However, I recognize that I am not just my behavior. Like Bobby Schuller says, I am not what I have, I am not what I do, I am not what people say about me. I am the beloved of God.

Just Rambling

IWSG

I really should be posting my Insecure Writer’s Support group post today, but I’m not fussed. I didn’t write as much over the past month as I’d liked to and the optional question doesn’t appeal to me. For this reason, I’m just going to ramble. I will post the #IWSG link and image on this post, but I won’t really be sharing much writing-related news.

I mean, the optional question is how long you let drafts sit there before redrafting. The short answer is that I don’t really do drafts. I write my pieces in one go usually and publish them onto my blog right away. Of course, I do have freewrites and some works-in-progress that I haven’t published anywhere, but even my one published piece that I wrote back in 2014, I wrote in one sitting.

Okay, now that we have this out of the way, let me ramble about other stuff. Today, like most of the past month, has been mixed. I was okay for most of the morning and afternoon, but in the evening, I’ve really been struggling. My feelings that, if I drop my mask (figuratively speaking), everyone will run from me and no-one will want to care for me anymore, are intense. For those who might be visiting from the IWSG: I live in a care facility due to my multiple disabilities, including challenging behavior. Lately, I’m spiraling more and more out of control and this seems to create a vicious cycle of anger, shame, self-hatred and more anger.

Yesterday, I had an appointment with my psychiatric nurse practitioner. We decided there that I won’t go the diagnosis route for dissociative disorders, but that off the record at least we agree that I have dissociative identity disorder (DID). We won’t do a whole lot of system mapping. Not only have I done this already, but it seems counterproductive to the idea of needing to practice being present.

Speaking of which, I looked up the learning to be present exercise in the first chapter of Coping with Trauma-Related Dissociation and had my staff write it down. The book is in English (at least, my edition is) and my native language is Dutch, so I translated the exercises and where appropriate, adapted them to suit my needs. After all, one of the exercises is naming three things you can see around you. As I am blind, this won’t work. I do find that other exercises do help me. One in particular is the butterfly hug.

Tomorrow, my GP will get back to me about my medication. I would’ve gotten topiramate prescribed to me for my PTSD symptoms, but found out last week that it’d block my birth control pill from working. My nurse practitioner would originally have prescribed the topiramate, but now I need to work something out about getting on a different contraceptive first. This will hopefully be sorted tomorrow or at least then I’ll know when I can come in to see my GP about it. I really hope this medication (the topiramate) will help, since I’m on quite an emotional rollercoaster.