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My mom is almost 92 and in the final stage of Alz. She is completely bed bound, cannot move on her own, incontinent and non-verbal. She has started developing bedsores, the worst is on her butt, but now has one on her hip and starting to get them on her heels. We try to change her position as much as possible but she is in pain on her side and always falls back to lying on her back. We are using patches, med.ointment, position changing and keeping her clean and dry. She also seems to have trouble breathing on her side as she winds up getting face down on the mattress or pillow - we use props to keep her in place but again she still winds up face down. We are using an air pillow to relieve the stress on her butt, but now she is developing sores on her hips (lying on her side) and on her heels. She cannot move her arms or legs so we do that for but her joints are freezing up. Any ideas of what we can do to help her? Her nutrition is poor as she no longer wants to eat, so we keep her hydrated with home-made smoothies (yogurt, fruit, juice and her meds) as this is something she will take. Does anyone have any ideas of what else we can do for her? She is at home under hospice care.

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Based on what you describe, I don't know what else there could be to do for her. I think all you can do is keep doing what you are. It is so difficult to watch a loved one decline, but it sounds like you are doing all the right things. Sending thoughts for mercy and comfort to you & your mother.
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Lindaz, what do the hospice nurses say about this? They are the professionals, and I'm sure they deal with this all the time.
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At the end of life there is often little you can do to prevent bedsores so don't feel you have been neglectful if your loved one does develop some despite your best efforts.
The circulation begins to slow and does not reach areas where there is pressure, and deprived of a good blood supply the tissue begins to die. I have seen sores even on noses and ears! Your hospice nurse should be on top of this so follow her advice.
Real sheepskin is wonderful but unfortunately can't be cleaned. The synthetic stuff is pretty worthless you need the natural oils from the sheepskin.
I have seen lawyers looking for business state that bedsores are always a sign of neglect. Not true they can happen with the best of care. As someone mentioned they do take a long time to heal. Make sure the patient is not suffering pain from the sores or other causes. I would rather be pain free and sleepy than suffering. So if hospice offers medication use what ever you feel comfortable with for your loved one.
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Dont ever put anything on a pressure wound (bedsore) that is not specifically prescribed by a doctor or nurse. Bed sores happen when the body stays in a certain position for long periods of time. Blood pools in those areas (particularly with the elderly who have poorer circulation) eventually causing tissue breakdown. There are several things that can be done. The first, if possible, help her change position every hour or two throughout the day. If she is not incontinent, or is kept quite clean throughout the day, sometimes a sheepskin pad helps. The last possibility is a hospital bed with a special mattress. Hopefully, you have some kind of visiting nurse coming, if not, request one through her PCP. A nurse practitioner sent from her PCP office, is your best friend. if you get a good one, they can advocate for you to get the necessary medical equipment to keep your loved one comfortable.
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Do not give IV fluids. not that hospice will do this anyway. Giving IV to the dying just puts an extra load on the heart and kidneys and does not make the patient more comfortable. Dehydration is thought to release natural endorphins which are thought to be comforting.
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Hi this is Lindaz, and I wanted to thank ALL of you for your good suggestions, prayers and helpful talks here on agingcare. You will probably not know how much you have helped my Dad and I with all of your comments. Maybe even you have helped others with the same problems we are having. I cannot thank you all enough. Please know that I will pray for all of you and for the loved ones that you are taking care of. There are too many people who will critize us for what we do and what we do not do, but they will not realize this until they too are caretakers for an invalid. My Dad and I love my Mom so much...and at 85 he is one of the best care-takers I have ever had the honor to know. They have been married for 64 years and he is in it for the long run. Not many people can say that. He wanted to keep Mama home as he felt we could give her the best care. I signed up with him because he is my hero....may you all be blessed for all that you do for the ones you love. You are the unspoken heros in this world and I hope that God blesses you, I certainly do! Thank you ! Thank all of you for what you do! Linda
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An air mattress that blows air up & deflates every couple of minutes is helpful. Once bedsores develop, they are very difficult to heal & it takes quite some time for them to heal. The goal is to prevent them from occurring. The sheepskin heel cups that others have mentioned are helpful. They also make sheepskin pads for under the sacrum. I suspect since her food/fluid intake is not good, that she is thin---when the bones of the sacrum & hips protrude, bedsores are far more likely to occur & more difficult to heal because the tissue is being poked by the bones all the time.

It sounds like your mom is nearing the end of life. It also sounds like you are doing everything you can for her, and that's all you can do. Keep her comfortable. Give her fluids. Sing to her. Hold her hand. Touch her. Rub her gently. Kiss her. Hug her. She can't talk, but she can still feel.
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What Veronica91 said.

Bless you.
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I concur with Veronica91. From what you're describing, it sounds like the time is near to start preparing yourself for the final stages of her life. As a culture we have become quite unaccustomed to observing what is 'normal' for a person who is dying. And it's also 'normal' not to want to let go. Things that are done in hospitals often reflect an unrealistic expectation that 'life' can be prolonged for an indefinite period of time, but when we observe that, it appears so unnatural and even (to some minds) cruel. Since your mother is home (as mine is) we have the ability to prevent them from being stuck with needles and tubes, we can let them slip away peacefully. On their time, not some arbitrary schedule. I'm trying to prepare myself (and my 2 brothers) for this eventuality. Many times I've gone into her room and had to really look, to make sure she is breathing. Mentally, I brace myself for finding her 'still' but that hasn't happened, yet. I'm trying not to expect that we will all be lined up by her side, holding her hands. It might happen, but we might not get the chance to do that, and it will be okay if she ultimately breathes her last breath in the night when we are asleep. This is what I'm telling myself. We don't know how or when 'it' will happen, we only know that it will happen, if we don't interfere too much. Meanwhile, we let her know with our voices and hugs and touches, that she is loved. I've been working on funeral preparations for several months to avoid having to make those decisions all at once, and that's been a relief. It's not a happy process, but it can be a comforting one, to know you're going to see her through to the end of her life.
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Having just been through this.....talk to her...tell her how much you love her..which I am sure you have been......play some of her favorite music....

If she stops eating and then drinking as my mom did...make sure hospice uses those stick sponges to help clean out her mouth and make it more comfortable for her...
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And with hospice I had them make sure they called me when I was resting when the signs of her breathing were starting to indicate the end was near...this way I could be by her side as she passed. It was truly an amazing experience. You truly feel the love...and almost have your life with them go before your eyes as it happens. Hugs...she will be okay......concentrate on your being okay and the rest of your family...
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