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BArb, this sounds like the final weeks. What is happening with your Mom sounds a great deal like what happened with mine..except mine was home in my care the whole time.

Now you and family must find the strength to accept the end and help your Mom with that strength. I know only too well what this will cost you emotionally.....be sure that you are not alone, have a shoulder to lean on.

After all these years, you might think this will not be any harder than what you have already come through....but, all this history really doesn't prepare us.

Hugs to you!
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Barb, my dad was bedridden and had pneumonia twice. The first one, he had problem breathing and it was very, very painful for him to try to inhale. Definitely, if your mom is in pain - I say do the treatment for her comfort.... My dad's 2nd bout with pneumonia, he did Not get the painful-to-breathe symptoms. Instead, left untreated, it went septic. The infection spread out from his lung. That morning before I called 911, he was sitting up and aware. By the time I got home at 6:30pm, he was unconscious, high fever and vitals signs failing (not that I knew this - only after it all happened.) The sepsis was causing his organs to fail.

Throughout dad's stay in the ER Trauma, they aggressively sought medical treatments. It was very difficult for us to just stand by and watch this. Dad was tired. His body was failing. And the medical doctors were doing their best to get him better - despite his history of aversion to seek medical help.

I was torn emotionally - should I do it? Should I not? Should I? Or not? And every single time I had doubts, I would ask myself, "What would dad want?" vs. "In reality, what would Dad really DO?" ... Yes, dad would want to live (afraid of death). In reality, he would never ever faithfully do the dialysis... And in the end, I had to keep convincing all his different doctors, surgeon, internists, etc.. that in the end - Dad would NOT do dialysis if he survived and was released from the hospital. In the end, the doctors acknowledged this. They discussed it and then presented it to us as a family that based on dad's current condition and his past history of Not seeking medical help, they recommend taking him off life support. We agreed.

I KNOW what you're going through inside, the indecision of what's good for mom vs what is the right thing to do. All I can say is - do what is Best for mom and for Her Comfort. (Unlike my niece who wanted to go all out for grandpa. With lots of questions from me, I realized she wanted grandpa to be alive For The Family. NOT for him!) If treating the pneumonia means alleviating any pain/discomfort your mom's experiencing - so be it - do the treatment. Go with what's happening with your mom now and always discuss this as a family (so that no one does the blame game after it's all said and done.) {{{{{ HUGS }}}}}
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H Barb
Such difficult decisions

Pneumonia is often what takes them but then your mom has had it before too

I'm not sure what decision I will make if faced the same, as mom's memory care cannot administer IV antibiotics - it wasn't easy to get through the 10 days of oral she just finished
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Barb - (((((((hugs))))) It certainly looks like your mother is declining. Mother is on comfort care and they said they would treat any infection with antibiotics. I am good with that. There does come a point, with decline, that the body's immune system is so compromised that even antibiotics do not help.

You may want to refer to this question on AC to which you gave the first answer - https://www.agingcare.com/questions/treat-infections-on-comfort-care-197298.htm

This article discusses the pros and cons -
"Antibiotics may carry more cost than benefit for patients at end of life
By Kathy Holliman" (ACP Hospitalist)

Antibiotics can provide symptom relief (as well as having curative value) which would come under comfort care. However, they can also prolong a life with lesser quality. It is a hard decision.

Each case is individual and sometimes there are no good answers, just better or worse ones, but you may need a crystal ball to know which is which.  I know whatever decisions are made for your mum's care will be made with deep consideration and knowledge of her and the various factors, and with much love.
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Still not getting out of bed, is taking ice cream when offered, eyes mostly closed but smiled hugely when told a funny story about one of the Ggkids.

Interestingly, in listening to old messages from, brother, there is one from last Friday that I never got the info from. Mom's o2 sat had dropped into 80s, she wasnt eating, they were going to do a metabolic panel to see if anything was going on. I saw her on Monday8.14 and she was happy to see go baby, but tired. She fell later that week.

I think we are seeing a slow downward slope.

If she gets pneumonia, will we treat it. Good question. I don't know.

What do you all Think? I'm terrified of either the chf, gasping for breath, and I really want to not get to the point where she's incontinent of bowel. My mother has a lifelong horror of all things fecal. Long story.

Tell me what you think about pneumonia, please!
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Barb - How is your mum this morning and how are you?
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My goodness Barb, two black eyes ?

Will nH also use suction to clear some of the mucus? Oxygen, the inhaler, mucinex and suctioning helped my mom recently when she was discharged from a short hospital stay and was having trouble breathing

Hope she, you and family can get some rest
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Barbara, thinking of you and mom.
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Barb, if she has pneumonia, will she be treated for that?

Sounds like this is another one of "those kind" of weeks for you and your family. I hope you're each finding a way to relax at night to keep some level of balance in your life.

Are the trees turning color yet in your area? There are perhaps half a dozen or so here, and they provide such a bright and vivid splash of color.
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Oh Barb. Glad you are on the same page as your bro. That helps. At her age and stage, as you know, anything can happen. Comfort care is just that. Mother is on comfort care when and I heard about her being in pain from sitting in one position too long I was not happy. She has vascular dementia too and no ability to shift herself around for comfort. Even when she is in bed she is uncomfortable, though not in pain. I told them to give her more painkillers if necessary. The other thing is to let her stay in bed more. I know it is good for them to be up, but not if they are in pain, The concept of comfort care is pretty simple, I thought. Like your mother, it is all that can be done for her.

Hope the nebulizer treatment helps your mum.
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Talked to mom's nurse today. She ate breakfast, but is refusing to get out of bed. Talked to brother and sil tonight; mom apparently didn't eat lunch or dinner and choked when taking a sip of water. Coughed up a lot of mucus. They will start her on nebulizer treatments tonight.
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You don't have to be a hands on caregiver to experience extreme levels of stress and frustration.

Being the troubleshooter with the NH is enough to send one screaming into the night!

Take care of yourself.
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Thank you Lizzie. Just got off phone with brother, we are on same page.

Hey, I'm not a hands on caregiver. My mom is getting decent care in a NH. She's docile and only occasionally agitated. She saw her third greatgrandbaby for the first time on Monday!

She's 94 and has had a good and long life. I don't want to subject her to any more poking and twisting than we have to.
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Barb,
I was following this thread when you were Babalou but lost track of this thread. I had no idea your journey is so challenging and ongoing. I found it after you mentioned it on the Whine Thread.

I just don't know what to say...

I hope you and your Mom find peace soon.

Those words just don't seem to cover it.  I just don't what else to say.
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Just got off the phone with POA brother and SIL who is mom's most frequent visitor. 

SIL upset at mom's facial bruising, discharge from two black eyes. Wants an xray of mom's face. Said mom does seem to want to talk or think.

(INSERT SILENT SCREAM HERE).

Okay, so if we do an xray of her face and there is a broken bone, are we going to rush her into surgery? (no).

Why should mom talk or think? She's got Vascular dementia and aphasia. She's not in pain.

Why do I keep having thus conversation?
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I posted the other day in the "whine" thread that mom fell and broke her wrist. (These things ALWAYS happen in August, it's uncanny!)

Went up to see her yesterday. Naturally, this was the two days that I'd arranged to have a rare overnight with my 5 yo grandson, but I took him with me and We stopped in twice.

Mom was out both times. Doesn't look like she's in pain.

Talked to NH doc today who confirmed that we don't need to do followup with an ortho (the ER said to my brother " of course you'll followup with an orthopedist". Yeah, right.

Doctor is concerned because she is getting congested from being in bed so PT will attempt to get her up today.

Doctor (NH director, who is lovely) emphasized that the aim is comfort.

Thanks for listening. Dating this 8/2017
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Seems like "nurses" would want to know all their patients "backgrounds" they are taking care of. I don't get it. My moms AL had her med chart sheet dosages wrong at doc visit yesterday. 10 phone calls later by me and it's still not figured out. Hard enough watching parents decline slowly in front of our eyes let alone making sure they're getting what they need at NH or AL and demanding it after being "nice" about it after 100xs. The communication is rediculous where my mom is
Thinking of you BB
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So, a couple of developments. Had a chat with the nurse manager on Mom's unit after we sent an email, alerting her to changes we were seeing in mom's behavior (staying in bed, eating V E R Y slowly). The conversation started out somewhat contentiously (I can't be held responsible if your mom doesn't tell us that she's in pain!).

I explained that we all are trying to be team players here and are trying to provide useful information to the facility to further mom's care. NOT trying to play a game of "gotcha".

I got a very thougthful email from her yesterday; they've been keeping track of mom's input/output and are finding that she should be drinking more; and that when she stays in bed, she hardly drinks anything. She asked if I thought this was a true decline or simply infection/dehydration.

I gave her a brief hx: graduated summa cum laude from college at 82, suddenly at 88 presenting with terrible anxiety which led us to cognitive testing, which revealed a stroke and dx of Mild Cog Decline BEFORE her "big" stroke in 2013. She seemed grateful for the background and I also pointed out that these declines (which always herald "the new normal" always seem to occur at this time of year, when the weather turns warm. Allergy related? Dehydration?

No clue. Just feeling happy that I was able to give someone information who appeared to be listening.

Head of rehab emailed today; they evaluated mom for self feeding today and will be applying to Medicare for some sessions to improve mom's utensil use.

Good news all around.
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Huh! That's a very comforting thought, CM, which actually makes me feel SO much better. I appreciate it!
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No, it isn't.

She's not really self-aware now, BB, it won't horrify her as the thought of it would have done years ago. Doesn't make it any less awful for you though. Hugs x
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Thanks to you all. The facility has , at least in the past, picked up Infections before we'd seen any signs at all.

Mom does seem to decline in the summer. I'm not sure if it's the heat ( she's in an air conditioned environment, but allergens, etc) or what, but there always seems to be a decline at this time of year. They are going to review her meds, monitor i/O and have the aprn check her again tomorrow. They say they are seeing significant cognitive decline.

This is so NOT what my mom wanted.
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Sorry to hear about these changes, BB. It must be a bit like that feeling of a turn in the weather, and you're not sure if it's going to settle back down or blow up a storm. Hope there is either an explanation or even better a return to normal.
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barb - it is a change, which is concerning. My mother with vascular dementia went from using a walker to being bedridden and sleeping half the day in a couple of months. It was due to the dementia, They get her up and dressed in the mornings and she sits in a wheel chair and nods off in front of a tv. She sleeps in bed in the afternoons. Mother still has a appetite and her vitals are good. She can feed herself pureed food, but if anyone offers to feed her she is happy to be fed. Mother can still articulate her concerns which is a blessing. Hope you find out what is going on. ((((((hugs)))))
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Have they checked her for UTI or pneumonia or lymph node infection? When my mother was in the NH I noticed she was not aware when she had an infection or that something hurt. Dementia seemed to protect her from discomfort and ease her passage. It took them a few days to realize she had pneumonia because she had no symptoms.
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Have they checked her for UTI or pneumonia or lymph node infection? When my mother was in the NH I noticed she was not aware when she had an infection or that something hurt. Dementia seemed to protect her from discomfort and ease her passage. It took them a few days to realize she had pneumonia because she had no symptoms and she would fall asleep a lot, which they attributed to her age rather than illness.
Mom was a very bad eater for 20 years but toward the end she stopped eating entirely.  It sounds like your mother still has an appetite which maybe is a good sign she is not giving up.
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Send; she is always up and dressed when I visit on weekends; talked to my SIL and she's been abed several times this week. Mom was never an early to rise type, so the facility respects the fact that she likes to sleep late and stay up late. But that usually means they get her dressed around 10 AM.

Somethings up; I sent an email to the RN director on the unit and the SW; she was apparently weepy earlier in the week as well. There is something that troubles her, we don't know what it is. If she can get a few words out, she'll say to us "you know, you KNOW what it is!" Once, when I told her that I truly did NOT she said "don't put me through this!" She sometimes thinks she has MRSA or leprosy and wont' let us bring the great grandbabies to see her.

Ms. Madge, they hand fed her breakfast. She had eaten a good deal of her lunch when I got there, but in slo-mo. Very strange.
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Can it be, that people sleep in on Sundays, and elderly in NH carry on this tradition unwittingly? (Staff's choice?).
It seems so good that she ate and drank what you brought her. Keep watching out Barb. Tonight I started reading what you wrote 3 years ago, not knowing it was not today.
And I felt so bad about your Mom's troubles. But it was not the end 3 years ago. I encourage your journal here, keep it up!
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Ah Barb
Bless you for bringing her a latte - do you suspect they let her sleep through breakfast and lunch ?
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Again, just an update as to my mom's condition.

Went to visit today; she was still in bed at 1.30PM, very sleepy, eating in slow motion. Drank the latte I brought her and ate most of the chocolate muffin. Her vitals have been checked and they are fine. Sent an email to the DON to ask for a UTI check and to let them know that we are concerned.
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CM, you made me laugh, which is a very good thing.

I'm trying to navigate my way into a "let go, let God" state of mind. Which I could probably do, left to my own devices. However....

My sister in law, who is our eyes and ears, as she visits mom several times a week, in the evening, notices the little things. Then I call up the facility, find out what is going on and what I find out is that, while they are taking good care of mom, they are not telling us about stuff.

sigh.......
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