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My aunt lives to go to church every week and has someone that picks her up. When she gets there, they get her out and she immediately is put in a wheelchair where they push her around the whole time. The nursing home told me that she is getting weaker and they do not think that she should be going out. After a few days of thinking it over, I decided that her quality of life is more important then her quantity of life. A fall can happen anytime - even at the nursing home and I feel that the people that pick her up are able to help her. She also does not go if she is not feeling well that week. When I told the nursing home how I felt, they immediately told me that they are now using a lift to transfer so they will not allow her to go out. Are they allowed to do that? As her POA, I am trying to do everything in her best interest but I feel that they are overriding her/ my wishes. Can someone please let me know if they are able to do this? If not, what can I do?

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I can't imagine the facility would have the "right" to deny her, especially if she doesn't have dementia. They are not her POA. They would bear no responsibility for her once she left the facility. If she fell at church, they would not be liable.

A not so nice thought; Maybe they want to keep her there as a patient, receiving the income from her. If she falls, she would go to the hospital, then to a rehab facility for a long while. If she's not there, they don't make money. You don't want to think that way but I can't figure out why they are laying down the law. Contact an elder law attorney to get this set straight.
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I would call an attorney about that. Both the places my mom has been allowed it as long as she wasn't going by herself. Sometimes the churches will help with transportation.
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Ruth, are you in the area that aunt is? When did you last see her and her condition? Could it be that aunt is too weak to go? Maybe people taking her to church have decided it has become too difficult. Nursing home may have stepped in to help transporters so they are the bad guy. There does come a point where it is too hard for everyone involved to take the elderly out.
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gladimhere - I live about 15 minutes from my aunt and I just saw her 3 days ago. Three days ago, they told me that they use a lift sometimes if she is too tired. When I told them that I still wanted her to be able to go to church, they then said they switched her over to using the lift all the time so she is not allowed to leave with anyone.
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I wonder if Aunt is difficult to deal with once she has been out?

A fellow-member of my local caregiving group took her late-stage dementia husband to church frequently. She hired special transportation to take him in his geri-chair and to return him to the facility. He had a special jacket/lap robe for wheelchair users. The facility did not object because all of his needs were being met and the risks were being mitigated. And she could be the Caregiver From Hell when she needed to be. :P She also arranged for communion to be brought to him in the NH between his church visits.

Having kind volunteers to pick Aunt up may no longer meet her increasing weakness.

Once my mother was a two-person transfer with a sit-to-stand device, she seldom left the facility. Once a month they transported residents to Walmart. She did not get out of her wheelchair for that ride. My sister met her there and wheeled her around shopping. She rode back in the special van. The challenge was, what if she had to go to the bathroom? Well, that could not have happened. She'd simply have to wait to be changed when she got back. Other residents were in the same situation, and the trips were kept short. The only other trip she made was to her sister's 100th birthday celebration. We hired a van so she didn't have to get out of her wheelchair, and limited her visit to about an hour (which was enough for her energy level anyway).

If Aunt really wants to go to church, ask the facility what would make that possible. Could you hire a medi-van and take her in a wheelchair? What would make this safe, in their view? Could you sign a waiver, taking full responsibility for the period she was gone?

I agree that quality of life is way more important than quantity at this point. But if Aunt falls or is dropped or bumps into something, the quality of her remaining life could be miserable. Getting her from the wheelchair to the car and back again is an increased risk period.

My mom's nursing home had several church services per week, of different denominations. Residents could attend easily, without getting dressed for outdoors and without leaving their wheelchairs if they used them. Aides came and got them and brought them to the chapel. There were also a couple of Bible study sessions, and rosary sessions, and hymn sings each week. My mother was not religious at all, but she sometimes went to the religious music events.

I wonder if participating in what is available at the nursing home might be a good practice now for Aunt. It would be another way to connect with the residents she sees often. And maybe those kind people who pick her up for church could instead occasionally visit her where she is, perhaps even going to a church event with her there. Ask her pastor if there is a visiting committee who could come and see her occasionally so she doesn't completely lose touch with her church buddies.

I give you gold stars for advocating for your dear Aunt! She is lucky to have you. What is best for Aunt may change over time. Stay flexible, while continuing to work in her best interests.
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If Auntie is a true two person assist and needs to use a lift then unless she is transported in her wheelchair in a spcially adapted vehicle then she could not be allowed to go out sad as that might be. Can you be there when she needs to be transferred to see exactly how that is managed and decide if they are blowing smoke for some reason as yet not known to you.
Many church goers tend to be elderly to and it may be that the nursing home feels those who transport her are not now up to the job. Would they allow you to transport her? There seem to be a lot of unknowns here. it might just be a case of "Mother knows best"when you challenged it.
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Get a doctor's order.
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I wonder about the way this was presented by the nursing home. Your mother "can't" go to church anymore - she physically can't because she can no longer transfer from wheelchair to car. Perhaps the message really was We can't allow her to go to church unless you find suitable transportation that doesn't involve transfers. In my opinion they have a duty to bring this to your attention and insist on a safe solution , and sometimes friends and family do need to be told bluntly when something isn't working anymore.
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I have often stated to the nursing home that my brother is in, that my goal is to keep him active as long as we can, including what community involvement he can do.

I don't know your aunt's condition, but I would object to them using the lift all the time! Muscles and ability decline rapidly when use is stopped: "use it or lose it".

Working with many patients with major mobility risks (clear for me after helping my brother for so many years), I know that with patience, gentle direction and supports they can hold onto, position legs and use leg strength to lift - it is possible to help most people up - sounds as if someone in the nursing home is using the lift use as a way to follow some medical equipment idea - that may not be what your aunt needs. I took care of a woman who would tell all her aides, when she was 106, "Don't help me, damn it! If I let you help me this time, soon I won't be able to get myself up anymore"." She was walking - with more difficulty yes but she was not bed-ridden until the last 6 months of her life, she died at 106.

I find the nursing home relate to my wish to focus on keeping my brother active at his level, so he walks to the bathroom with his rollator, despite some falls when he recently got sick. He gets up and dresses and is picked up 4 days a week for a day program. He walks with his rollator outside on flat streets, including to church, and I support the services in avoiding any gaps in these routines unless clear reasons, for I know that when he stops, he will sit and not get up. They already let him gain 50 lbs in there.

I would suggest maybe a Physical Therapy consult. You should ask the church helpers also, do they find your aunt able enough and alert enough so the routine is safe?

When I have difficulties with one person at the nursing home, I call and express my concerns with others there, including the Director. And of course, check with your aunt's wishes, that's another card in your deck. Use the cards you have to find some people there who agree that the goal is not to have 100% non risk by letting a patient lose what remaining abilities they have to help themselves - but to be as kind and resourceful as you can, and get the staff's help to help her maintain the quality of life she has developed and loved in every way possible. I've found that there are people there who understand - and at every level, there are always some who use rules to take over - but I think you are right, keep talking, with many, asking again: what is the goal here?
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If your aunt can’t go to church, why not bring the church to your aunt? Maybe a few folks (even 2 or 3) would be willing to visit her once a week. They could discuss a sermon, a passage from the Bible, or stories from life reflecting the fruits of the spirit (love, joy, peace, patience, kindness, gentleness, self control).
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I would go with your Aunt one time and witness the whole process from start to finish. Several things to consider; how competent is the church's pickup service? How are they transporting her? If left in her wheelchair, is it being anchored in place for the trip? If transferred from the wheelchair to the vehicle, do they have someone who can transfer dead weight? Once she is there how do they deal with it when she needs to go to the bathroom? I am a church goer myself and I understand her wanting to attend but sometimes it just becomes too difficult. It is obvious you love your Aunt and care about her wishes. Keep us posted on how this progresses.
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Does the nursing home have a chaplain? My husband was confined to bed in a nursing home where a chaplain visited him on a schedule.
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If you go with her I don't think they can stop you. I would tell them you appreciate their suggestion but you will be accompanying her each week and will be responsible for her during her time traveling to and from church.
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I too had the question of who it is picking up your Aunt. Is it an aide, church member, etc.? I'm not passing any judgement, but there does come a point when friends, family, workers simply don't want to be responsible for someone with mobility issues. Sometimes, it's for legal reasons and sometimes when the resident returns back to the facility/own home, the outing has left them even more debilitated. In the case of the woman I take care of, she is so weak after an outing, she can barely move and the trip induces unbelievable sundowning. Unfortunately, the NH employees may be less interested in her ability to worship, and more interested in the extra work and stress of getting her there and her condition when she returns. If possible, I probably would watch the process, beginning to end, including the church service and return to NH.
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They are covering their butts!!! Someone wants to be in complete control. Do you live nearby? Sounds like someone in charge of her legal affairs needs to step in.
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The NH doesn't have a chapel? Even hospitals have a chapel.

And yes, if they are using a lift - they can "suggest" you not take her out of the NH and would most likely make you sign a waiver in case she falls.

I did much the same when my nephew tried to take my dad out of state. I let him know that for the time he was away from home, total responsibility was on the nephew.
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One thing we all must understand is that an Assisted Living or a Nursing Home has been on hundreds, if not thousands of rodeos so they know what is safe for a resident, and what is not. For us, the relative, this is usually our first rodeo and we are learning as we go along.

There are legal aspects of allowing a resident to leave the building when it has become not feasible. Even if a waiver is signed, the family can still try to sue, if something happens, saying that the Assisted Living or Nursing Home knew about this but still allowed the resident to leave the complex.

It is not unusual for the resident to return back to the complex and become a hand full for the Staff, not cooperating, wanting to leave again, etc. That takes time away from other residents who need hand-on care. Since the relative isn't there to see this happening they think their Mom, Dad, or other love one had a good outing.
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To me it has nothing to do with attending church...If the house physician orders she not leave the facility, "case closed." If other than the house doc said she can't leave, then that is another matter...

I don't have a dog in the fight.

Grace + Peace,

Bob
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I am surprised that the nursing home does not have church services weekly. my parents were in the nursing home and they had service once a week for whom ever wanted to attend. if the home doesn't have church services I would call the local church and request that a Decan or a Priest be able to visit my family member for
she is unable to travel due to her health. I am sure you would be able to get help from them, or someone that they could connect you with. my mom once she came home had hospice till she recently passed and they had a Decan come in and chat with mom and give her communion once a week. it cant hurt to try....good luck.....
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I think the nursing home can suggest but they can't "make" her do or not anything. This is her home not a prison. Are the people transporting her having problems. My Church streams and tapes the service putting it on the internet. For those with no computer they have DVDs. My Mom got overwhelmed in church so this was a great alternative.
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You are using the 'going to church' thing as a last-ditch-effort in your belief your aunt will still be able to go to church, participate, get something out of it, and go back all aglow with the holy spirit, etc etc. Even though she is coming to the END OF THE ROAD, you still persist. Why, all she needs is a little help! .... If it is so important she goes to church, every nursing home, assisted living, and senior center has some kind of religious service, some kind of chapel, some kind of service. Priests and such can come in and give communion. Videotapes and tv shows - 'Mass For Shut-Ins' are all over. Stop making life harder for those trying to care for her.  If you want to drag her out because, church, - ok, it is all on YOU.  But she is never going to 'get better', church or not.
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Church smurch - if she was a true godfearing person then she done her bit by now - but most church attendance is go to church then a gathering afterwards - that is what she wants not some service but some interaction with others afterwards be it coffee & cookies or other - tv won't give it to her but getting in place a wheelchair capable van is what is now needed - if you need to transfer then you need to stay put but if vehicle doesn't need to transfer then go with it
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If your mother cannot make the trip to the house of worship, there are a variety of ways for her to receive religion-
#1 Pastor coming to the facility
#2 Live streaming sermons on computer assuming she can get to one and be able to see it
#3 Bible study
#4 Bible scripture reading by volunteers who are looking for this type of work
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Nursing homes have church folks come in on Sunday mornings and read scripture, give Holy Communion and talk to residents. I do this on a weekly basis. It is much easier on the residents to be indoor and within their own environment especially in cold and inclement weather. If a person is too weak or frail to go to church, I have found family members are most grateful and appreciative for the concern others give to a loved one for their health and well being. Do you take your aunt go to the doctor, the dentist, out to dinner or family outings? Is she easily transportable? If the answer is "yes" to these questions then, perhaps your aunt can be transported to church if you assure the nursing home (and sign a waiver) you will take full responsibility for her health while away. Since a lift was mentioned, I assume your aunt may be heavy. Please know I do not say this to be cruel. We have 2 residents at the nursing home that weight over 300 pound. The aides simply cannot manually lift them! To try could result in serious back injuries, plus the patient could be dropped! Is your aunt heavily medicated, is she susceptible to colds and/or viruses? Please understand...perhaps realism is not be applied here. If transporting her to church causes chaos and stress, talk to her about attending church services at the home. Doing so, will probably be easier on everyone concerned.
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Our parish has a great program for those who cannot get to church, much like what GrammyM described: Volunteers bring Holy Communion, Scripture readings, and the latest parish bulletin. Typically the volunteer visits anywhere from half an hour to an hour, depending on the patient's energy and preference. My mom loves these visits and has never once complained of not being able to get to church. In fact, I think she feels more secure because she can receive Communion at home, rather than enduring the effort and stress of going out. To GrammyM and others who give of their time in programs like this: THANK YOU!! You are a blessing to my mom and others like her!
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Many assisted living facilities or skilled nursing facility is have several church services per week, depending on the residents faith. It is new for the resident but so is their living situation and it will be hard for them but I think better for them to go to services with the people they live with. They can make friends and people with friends live longer than those who spend most of their time isolated. People from the church can visit your mom. I wouldn't choose to fight the battle you are considering because it will make it difficult for your mom to adjust to her need home if you are put out with the facility. I'd actually look at it as a blessing; friends, believers, and activities right in the community where they live. Priests, elders, deacons, and pastor's can all I think) administer communion when they visit the resident. Blessings on your decisions in this matter. I work in hospice and see that most of the residents can adjust;. Just like us, it takes time.
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A person is quite vulnerable to falling while being transferred between a wheelchair and a car. The person doing the transfer needs to be strong enough to support, alert enough to sense problems and trained enough to know how to properly assist. Optimally, a gait belt should be used. And even with all that, if the person being transferred has weak legs, it's still iffy. I send up prayers every time I transfer my mom and have gone to a 2 person assist. At that, I would never leave her transfer to a stranger who may not take precautions or know how to do it safely. In time, her leg will weaken to where she will need a lift, not because of her weight, but because she will be unable to support her weight and I can't lift her.

It may be that the nursing home staff is concerned about those from church being able to transfer her safely or that she is no longer able to safely support her weight.
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I'd encourage you to rethink this a bit. Assisted living facilities and skilled nursing facilities all have various in- house spiritual services where residents who share similar beliefs can get to know one another. Participating in the any of the facility activities actually helps people to adjust to their new home. And, your aunt's friends from her former church can visit, likely more easily than your dear Aunt could go out. People live longer with friends and her world will, ultimately, get smaller as she continues to age. It will be healthy for her to make friends. The spiritual leader of her church can visit often and provide communion. I'd encourage you to help your aunt adjust to the community that can keep her safe.
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I think that you need to reevaluate the situation. Have you recently watched or assisted in transferring your aunt into and out of a car? If you haven't, then you need to and you need to ask yourself some questions during the transfer: How well can your aunt stand on her own two legs? Do the people assisting her just stand beside her and guide her into the car while she stands up, walks the 2-4 steps to get closer to the car, turns around and sits down on the car seat, and puts her legs into the car? Or do they need to put their arms around her and bear some of her weight on their bodies to help her stand up, turn, and sit down in the car? How much does your aunt lean on those assisting her during the transfer? How easy or difficult is it for your aunt to transfer from the wheelchair to the car and back again?
If your aunt needs to put more than 25% of her weight on those assisting her during the transfer and they have to do more than 25% of the repositioning of your aunt's body during the transfer, then, I'm sorry, it is in your aunt's best interest and "QUALITY OF LIFE" that she NOT be taken to church in a car. She needs to be taken in a wheelchair equipped van so that she does not have to get out of the wheelchair at all while attending church. Most facilities do not operate their vans on the weekends nor do they use them to take people to church services.
In regards to you labeling the use of a mechanical lift device as a "quantity of life" item instead of a "quality of life" item, the use of mechanical lifts is one way to maintain a person's current "quality of life" because it decreases the possibility of that person falling and breaking a bone or injuring themselves in other ways. More than 50% of the elderly who break a bone experience a rapid decline in overall health and/or DIE within 6 months of breaking a bone.
Please, please reconsider your decision!! Sit down with the nursing staff and talk with the nursing supervisor about how much help your aunt really needs. You may find that NOT taking her to church will be the BEST choice to maintain her "Quality of Life."
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     When mobility and transferring from chair to car are issues, you can get the help of any physical therapy department to teach you how to use a 'gait belt'. The belt wraps around the waist of the patient. It gives the assisting person a better way to stabilize and safeguard the patient by holding on to the belt in back as the patient transfers. You could start by googling 'gait belt'. Also check with the facility to see if they have a procedure on that topic. Be in mind that safely ambulating and transferring weak patients takes coaching and experience. You can expect a facility to provide a person to teach you the skills you need to best take care your loved one.

     Another technique I use when getting the patient to go from sitting to standing I call 'count of three'. Number one and two the patient rocks his body while seated. On number three, patient rocks but then stands with assist. Before starting, I tell the patient we're going to stand on number three.

      As a caregiver, I love to see family involved in hands on care for their loved one. It takes a special sort of person to do this. Mary RN
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