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Riverdale Posted September 2021

Serious event at Skilled Nursing

Last week my nearly 91 year old mother was dropped by a CNA during a transfer from the bed to wheelchair. This was strictly against protocol as she was only supposed to be lifted with a Hoyer lift. Both her femur bones were fractured.


The worker was let go that day. My mother had surgery on the leg that did not have an existing knee replacement. She was released from the hospital today. I will go to the facility tomorrow. She will require PT which she generally likes if she has energy for it.


It has been so hard to process this happening. She was not mobile with her legs but she had learned to navigate the wheelchair in the facility. Now I wonder if she will regain that. The femur in one leg will have to heal on its own if possible..I am just putting this out there for any thoughts on the healing of fractured femurs or any other thoughts. Prior to this unfortunate incident I have felt her care in this facility was decent. I am at least comforted with the taking of responsibility and stating the truth on their part which they probably would have had to do. I imagine the hospital wanted exact facts.

Isthisrealyreal Dec 2021
RD, good news!

Continued prayers for her and you.

BarbBrooklyn Dec 2021
Riverdale, I'm so glad for this good news!! I hope that your mom's healing continues apace. (((((hugs))))))

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Riverdale Dec 2021
Thanks so much for such heartfelt messages. Some positive news at least for now: my mother had her 3 month follow up with the orthopedic surgeon and her femurs are fully healed. Secondly the SN facility has started using a wound vac on the bedsore. It was my understanding that there had to be some evidence of improvement before they could. Her nurse told me a few days ago that the more serious sore had grown smaller. Just taking their word. We must have seen the most negative infectious disease doctor. There were business cards for around 8 at the office so that was our misfortune. I don't know that it will necessarily fully heal but at least some steps forward rather than spiraling downwards.

Ricky6 Dec 2021
Dear Riverdale. I pray that Mom is still ok. I hope you had a good Thanksgiving Day, and I wish you Happy Holidays. God Bless you and your family.

gladimhere Nov 2021
Riverdale, I am so sorry.

Daughterof1930 Nov 2021
I’m so sorry for all the negative news and your mom’s struggles. I hope her doctors will talk with her in a better moment and help her understand. I wish you both peace

Isthisrealyreal Nov 2021
Oh Riverdale, I am so sorry.

May The Lord be merciful.

BarbBrooklyn Nov 2021
Riverdale, I'm so sorry about this sad turn of events.

Do you think the doctor should explain this to mom, not you?

I don't think I could do this.

lealonnie1 Nov 2021
Riverdale, my heart hurts for you and for your dear mom to hear this awful news. I think you have no other choice now but to tell mom the truth and then tell her that hospice is the best course of action to take now, that they will keep her comfortable since she does not want to go back to the hospital. The human spirit, I think, has a tremendous desire to live, but not in pain and suffering, is the bottom line.

When I took my father to the ER back in 2015, they told me his brain tumor had grown and they could do nothing for him at that point; no drugs, no surgery; that hospice was the only 'answer' for him. It was up to me to talk to him. I took a deep breath and went into the room; he knew he had a brain tumor; same as your mom knows she has a very bad infection going on in her body. I told dad his tumor grew & worsened, and that there wasn't any medication or surgery that could help him at his advanced age. He said "Nothing at all?" I said no and my eyes welled up. His did too. I told him that we could call hospice in to help him stay comfortable, but that it did NOT mean he'd pass away immediately; that he could easily live another year or MORE under their care. He was pretty stoic about the whole thing, and agreed to hospice care at the ALF. But I felt that he gave up then, after fighting very hard for 11 months prior (after breaking his hip and having a lot of PT/OT etc). He got a UTI a short while later, got into his bed and passed away 19 days later, which I felt was God being very merciful to all of us.

I did the best I could telling him the truth of what was happening with his health; what else could I do? I think you are in the same position, and I'm sorry you are faced with this RD. After I broke the news to dad, he thanked me for all I'd done for him, and told me I was a good daughter, which was the first & only time I'd heard such words in 58 years of life.

Sending you a big hug and many prayers for you and your mom that you can find acceptance for the unfortunate turn of events.

Riverdale Nov 2021
My mother was finally seen by an infectious disease doctor. The news was all bad. He cannot treat the wound. It is too massive. I saw it and nearly fainted.

Tomorrow I will go to SN and do my best to explain what I can. My mother has this tremendous desire to live no matter the physical circumstances. However she does not want to be hospitalized again and the doctor discussed how futile this will be. She does not like the catheter. If she goes off it the wound will grow worse. If she stays on it she will encounter UTI's.

I guess I am asking if anyone has advice for me. She has been put on palliative care twice in the past year only to be removed from it as she was doing well. However that was before she had this serious a bedsore. I don't know how to tell her she is close to dying. I appreciate any advice.

BarbBrooklyn Oct 2021
Riverdale, I sure hope the IV antibiotics do the trick. ((((((((Hugs)))))) to you all.

Riverdale Oct 2021
A PICC line has been put in and are starting antibiotics for it today. This is for the osteomyelitis in bone of bedsore.In 2 weeks they will do cultures again to determine what road to take. Very different from my experience 2 years ago. I had the line in for 6 weeks and drug was erdeptem(not sure of spelling) and blood was drawn weekly to be sent to lab to be sure infection levels were improving. They have removed the catheter(UTI) so I hope urine from protective underwear will not further endanger the bedsore area. Her frame of mind changes drastically daily. Upbeat one day and seeming on her last legs other days. Definitely alot of cognitive decline since this all happened now 2 months ago.

BarbBrooklyn Oct 2021
So glad her pain is under control! (((((Hugs)))))))

lealonnie1 Oct 2021
LA LA land is a good place for her to be when the pain is under control and there's not too much thinking to do. Not being mean or aggressive is also a good thing, meaning mom is not in pain and lashing out. Thank God for this good news in the face of mostly bad news, RD. Continuing to keep you in my thoughts and prayers.

I laughed out loud @ your DH using accents when reading to your mom! How fun is that? :)

cxmoody Oct 2021
Good news about the pain getting under control, Riverdale.

Thanks for the update!

Riverdale Oct 2021
I think the pain medication is under control a bit. They have done both with giving medication as needed and requested as well as keeping her on a schedule for it. She now has a UTI. Was put on a strong course of antibiotics. Yesterday she was in total LA LA land. Told me whan I came in that a long time friend who is somewhat on her last legs was there at the facility and was clearing out her house which was there at the facility. At least her UTI is not making her mean and or aggressive. My daughter from Utah has flown in to see her. They are having a long visit today. My husband has been a saint. He reads to her from a book and as he is an actor he does the various accents involved.

BarbBrooklyn Oct 2021
Oh, Riverdale, I'm so sorry that your mom is in distress.

Clarify with the DON how mom's pain meds are ordered by the Doctor.

Are they scheduled (like every 3 hours) OR PRN (at patient's request.

After many, many, MANY months of going round and round with both my mom's pain and anxiety meds, I discovered they were both "PRN". Meaning that the nurse would come in and ask my mom "Flo, are you in pain/anxious?". Being a good girl, my mom would say "no, I'm fine".

My poor SIL would show up 15 minutes later and find mom writhing in pain or wringing her hands in panic.

It took a LOT of time to figure this out. So ask to talk to the DON and look at the orders.

We got mom on scheduled pain AND anxity meds with PRN extras if she had breakthough of either.

Don't take anyone's word for it. Ask to see the orders. I got shined on a lot at the beginning

NH's live in fear of getting accused of over-medicating their patients.

Isthisrealyreal Oct 2021
RD, I am so sorry.

One thing that I would verify, are they giving her pain meds as needed or on a schedule? Because it takes time for oral meds to work, sometimes as long as an hour, so perhaps she is in pain.

My granny was in tremendous pain near the end and she was unconscious but, we could tell by her face and body movement that she was hurting. It took getting upset with the doctor to get enough prescribed so she could be comfortable.

Prayers for God's will to be done.

Riverdale Oct 2021
For the last few visits my mother seems in an altered mental state. Complains of alot of pain yet all her pain medications were just given to her. She just is different and it feels more permanent. She still has some appetite. She will claim she can't breathe yet they bring in everything and all her vitals are stable. As I know so many of you know it is incredibly hard to witness. I just don't know what to think. Conversations go in circles as my mental state grasps for reality.

Isthisrealyreal Oct 2021
Rd, If she is not ready, then you keep doing the aggressive treatment.

Is palliative care keeping her relative pain free? If not, ask them what can be done so she is not suffering.

My sister believed that she would utilize hospice to help her get better, so no thought of it being the end. Unfortunately, she had breast cancer that had metastasized to the bone and she would get spontaneous breaks in her spine when she moved. It took 5 of them before she sought medical treatment and at that point, it was too late. Treatment only offered an 8 week survival. She actually lived 10 more weeks without anything but hospice care.

Right to the end she believed she would walk out of that room completely healthy. She did, just not in the way she thought.

I pray that they can heal your mom and restore her to better health.

Warm hug! This is such a challenging time for your family. May The Lord strengthen you all.

Riverdale Oct 2021
Thank you Geaton. ITRR, it is not clear to me if she has to agree to hospice although I believe the facility only offers palliative care. She continues to have that aspect to her personality of not dealing with reality and add her current state. She claims she wants to get better. She does not express a desire to be freed from all she is enduring.

Geaton777 Oct 2021
Riverdale, just reading about your mom...oh my I'm so so sorry for what your mom (and you) are going through. I pray you are comforted by the very wise insights and support from the seasoned caregivers of the forum. ((hugs to you))

BarbBrooklyn Oct 2021
Riverdale, big (((((hugs))). The hardest thing for me was making these decisions when in the back of my head was "do you remember when you told me to stop making mountains out of molehills?". Remembering when, in a fit of anger, she threw my favorite doll out in the trash.

I think folks who have great relationships with their parents have one kind of terrible time letting go. Those of us with ambiguous relationships are always second guessing ourselves (at least I was).

Be at peace with getting your mom good pain relief.

Riverdale Oct 2021
That is a good point BarbBrooklyn. I know they do have end of life medication
I don't know how effective it might be. In my thoughts., Cancer patients need the very strong stuff but maybe the simple elderly might be fine with the basics. Of course if a hospital is necessary that would happen. I had a first cousin who planned for home for her end but the multiple cancers she had were so strong and required much pain relief so she had to go to a hospital and died there. Her pain required only what allowed by hospital.

.

Isthisrealyreal Oct 2021
RD, I am so sorry that your mom is having such a brutal time.

I have to agree with Barb about hospice. To many people bring them in to late and lose so many of the benefits.

Remember, you don't have to allow the amount of meds prescribed be administered. My sister had wound care, on hospice and she decided what she would or wouldn't take. (Until she couldn't and then her mom decided, whole drama)

It is definitely worth speaking to them, at least.

Big hugs for all of you.

BarbBrooklyn Oct 2021
Riverdale; please try to get past the "hospice is just a way to finish her off". My dear brother had the same feeling; I truly regret not pushing to get hospice in earlier to get my mom more day to day assistance.

The NH promised me that at the end, even without hospice, they would be able to relieve her pain. They weren't . There were apparently limits beyond which they couldn't prescibe.

Have you spoken to the Medical Director of the NH? That's who helped me out, and who was abke to talk to my brother, sensibly, about relieving mom's pain.

lealonnie1 Oct 2021
YW RD. My father was exactly the same way. He was FINE one minute, then all of a sudden, he started leaning to the left. My mother was screaming SIT UP STRAIGHT SIT UP STRAIGHT but he couldn't! The AL nurse thought he'd had a stroke, so off to the ER we went. It wasn't a stroke; the brain tumor had grown, as a CT Scan revealed, which was at the root of his leaning to the left. Hospice got involved, and dad immediately developed a UTI, got into bed, and never got out! He passed away 19 days later. He was 91, same age as your mom. I think at such an advanced age, something hits them and BOOM, they start that slide downhill they can't recover from. For dad, it was blessedly fast and for that I'm very grateful. Hospice was wonderful; they kept him very comfortable the entire time, thank God.

Riverdale Oct 2021
Thank you Lealonnie. You always have such thorough replies that make so much sense. One daughter is coming here this weekend. She is in the Healthcare field. I will inquire about hospice is she stays the same. A few days ago she was alert and hungry. This up and downs make it hard to know what to do.

lealonnie1 Oct 2021
RD, now is not the time to be beating yourself up about 'not feeling more joy being around mom' when she was in AL! You can't go back and fix things from the past, or else you'd go way way back & fix the fact that your mom wasn't a person anyone would feel much joy TO be around in the first place. You've been nothing but a wonderful daughter to her all along, and what's happened now is through no fault of your own, so don't be blaming yourself for invented 'sins'. Just stay on top of her care, as you have been, and treat yourself with kindness & grace; this whole matter has been very hard for YOU, too, not just her.

Is she not on hospice now? If not, why not? You say, "I am not trying to finish her off." Of course you aren't, but by the same token, continuing to administer harsh drug treatments now, like IV antibiotics for osteomyelitis, is taking drastic measures to prolong her life AND her pain when she's declining further all the time. Doesn't it seem that way to you? It may be wiser to stop medical treatments at this point and allow hospice to give her comfort meds to keep her pain free and relaxed. This is the course I would take with my mother, should she find herself in a similar situation.

I know this is very difficult for you, but the signs are pointing towards hospice being the right next step, especially since you have to transport the woman to the infectious disease doc who can't even see her till early November!! You just want peace and no pain for her now, that's the only goal. When the ailments just keep piling up and UP, the treatments become too much to manage and that's how you know that hospice is likely the right decision. When my dad's brain tumor grew, the only meds were steroids which would make him very sick and wouldn't really DO anything to get rid of the tumor, so that's when we knew hospice was the best call. A bone infection can be a very hard situation to get rid of. My sister in law had one for months & months and it would not clear up, so her foot had to be amputated up to the knee. And she's only 64.

Sending you a big hug and a prayer that God will guide you to the right path w/o punishing yourself in the process.

Riverdale Oct 2021
An infectious disease doctor cannot see my mother until early November. I have sent the facility the contact I had for myself. I have also asked if she should be on another antibiotic until then.

Today she seemed faded. Very little appetite and mainly wanted to sleep. I am my own worst enemy because I ask myself why I didn't feel more joy around her when she was in AL. I have mentioned how our relationship was not ideal but I know I tried to meet all her needs once she was in a facility. Now I have to search out staff for her pain medication etc. I guess I am wondering what untreated osteomyelitis might lead to. It is located where her bedsore is. I literally don't have any friend to reach out to. Am so grateful for this site and those who help me here.

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