Concerned with almost overnight decline in well being of my family member recently placed in NH long term care facility. Is this customary?

Probably a combination of the move (DON'T feel guilty) and simply the passing of time. A problem that would have happened whether you'd had her placed or not.

You could mention this to the staff and have her checked for a UTI or possible TIA.

And yes, people can change that rapidly.

Why would you be thinking 'sinister'? Odd word to be using if you placed your loved one in a SNF that you personally chose and checked out yourself!!

She could easily have suffered a stroke and that's why she's no longer ambulatory and you're seeing such a decline. Not to mention, dementia can progress rather quickly, even if she didn't have a stroke, so that's something else to consider, but I'd be inclined to think stroke myself.

Good luck!

I would wonder about the change too. I would talk to the DON and ask that the doctor see her. Could be dehydration. See if a new med has been introduced. Ask for labs to be done to rule out something physical. If she had a stroke, she should have been sent to the hospital. She is in LTC not on Hospice.

Agree with other posters.. UTI, dehydration etc, especially medicine change.

If no medical reason seems to explain it, I have witnessed rapid cognitive decline due to a stressful situation or illness in NHs. You might want to take her for a home visit and see if she becomes more alert. It would at least give you a clue.

Seconding @Midkid58. They can get worse or better in seemingly random increments. In addition, could also be depression/giving up hope. Or depending on time of visit "sundowning".

So in addition to the checkouts,
1) be sure to make time every few weeks to check her out - so to speak and get her a change of scenery - if not a home visit, even a McDonalds run works.
2) Check whether she is - or is supposed to be getting rehabilitative therapy.
3) Remember she's "in a new school" and still adjusting to the new people and places of the NH, or even new meds.
4) Share your concern with the NH staff so they can monitor.

Unfortunately it is common. It is mentally very taxing to someone with dementia to go to a new environment. In a familiar environment people do not have to process every single thing and can put “mental energy” toward function. In a new environment with little interpersonal interaction people tend to get very overwhelmed and shut down. The steady decline mentally, emotionally and physically is often fast and dramatic.

My first thought is dehydration, She is not familiar with her surrounds and how to access water. It is possible her walker was not near her when she wanted to get up and she just gave up. When my mom would be in rehab, she never had water or walkers within reach when I visited her. Neither when she was in bed or in a wheelchair. Can you hire an aide from outside the NH to spend a few hours with her daily. Making sure she is drinking enough and interacting. My mom lives at home, but when she had to go to inpatient rehab I always hired someone to spend 4/5 hrs with mom breakfast through lunch. Then another family member visited in the dinner/evening hours. If we were not there, no one assisted mom with her meals. Water was always in the room but out of reach.

I agree that decline can be dramatic. But I would at least ask that other reasons for her decline be investigated to see if her condition could be improved.

This is very hard. I'm sorry you are going through this.

Yes, rapid change can happen even in one day. Do as posters have said and have everything checked out, UTI, etc. My mom changed in one night, from walking to wheelchair. Took her to doc at urgent care and they gave her chest xrays. She had pneumonia and they gave antibiotics. She was walking again after 2-3 days of antibiotics. Good luck!

I would ask for a care meeting. At that meeting, ask to see the doctor's initial assessment of her condition ( see if it matches what you knew to be true upon admission) and what their assessment is of her now.

Ask to see what meds she is on and check them against previously known meds.

Find out how they are ascertaining her wants and desires since she is non-verbal. Can she point? Nod? Can she pour her own water? Find out what sorts of things they are doing to make sure she stays hydrated.

Your job is to be her advocate and her voice. Attendance at care meetings is how you do this

Any time I read of sudden onset symptoms my mind immediately runs to UTI or any other type of infection. If that gets ruled out first then I start looking into any meds changes, dehydration and yes even a change in routine or new placement.
Unfortunately, as it was for my husband, the majority of the declines were due to his Lewy body dementia and just part of his progression.
You must be gentle with yourself and realize that you're doing the best with what you have and know. You have no control over this nor did you cause it so you should not burden yourself with guilt. You're doing a great job.

Definitely do due diligence, very good suggestions here. If there is no reason for her decline, then as my Moms doctor said, it is her moment. He explained to us that each person who reaches old age has that moment when their decline becomes more rapid. Everyone’s moment is different; often depending upon how well they took care of themself throughout life, but often just because it is their moment. He also explained that even before the rapid decline, when a person is seen by family in a familiar environment often the family does not realize how much decline they have already experienced because much of their long term memory is used to function in familiar environments. In a new place they must rely on short term memory which is not working properly.

What does the medical staff say at the nursing home?

Two things: are drugs being administered and are any drugs new? If there is a new drugs in her regimen, it could have an adverse effect, and because she hasn't been in the SNF long, there's no understandable baseline for medical staff to draw from. I hate to say #2, but perhaps she is very depressed. She recognizes that she is in a care facility and she knows that her life has changed (likely forever).

I am so sorry.

Besides depression from boredom, They probably have her on new meds.

Iit's easier to keep them like that then hearing them asking for help, ect.

I have Caregivers 24 7 stay with my 95 yr old Dad.

I had cameras installed so I can see how he's being treated.

You should deffiently direct your concerns and see what new meds were given and ask them not to be given.

A lot if times when the old person is uprooted from their home or wherever they were use to living and no longer familure with their surroundings, it can cause them to regress.

Check her medication has something changed with what she was taking at home. was there more added what are the side effects...when she was home was she able to walk around..If so when did that stop. It is easier for them when a patient is sitting in a chair instead of walking around especially with Dementia..Does she have a UTI.Does she have a catheter/ lots of questions.. Yes they do decline when moved some more the others. I always check medications first that is usually the beginning..Good Luck

I would have the NH physician assess her. It's possible that she had some kind of "event" with brain or heart or even a urinary tract infection

Check to see if she has a UTI. My mother’s personality and mental state went haywire.

Whenever my LO who has dementia is hospitalized, after a minimal amount of time, he develops what staff calls "hospital delirium" you can transfer that to any environment that is not their own, NH delirium, rehab delirium, etc.... for the very reason stated in Momlanni's last paragraph: remove them from their familiar zone and down they go. My LO would go into hospital hall looking for "refrigerator to get a drink", "going to the porch, I am cold and want to sit in the sun" etc. In less than 24 Hrs they had to put him in restraints because you couldn't keep him from removing IV and catheter. Made visits difficult because he insisted that I'd put him in this place and he wanted to go home, wanted restraints off. It was critical that he receive the meds he needed through IV because his condition was acute. Those 5 days were a nightmare.

Even on returning home, it takes a few days to get back to their pre-hospitalization "normal" though never quite fully. I am FT caregiver, have been for 9 years, and dearly pray that I never am faced with the decision to have him in a nursing home.

I do recommend testing for UTI as well, as previously mentioned, as that definitely has a very negative impact overall. When my LO started talking nonsense I told doctor I thought he had a UTI though he'd never had one before. To which came the snot reply "are you in the medical field?" No I am not. "So do you have experience with this?" No I don't.... yet. "Well, he has dementia so....." I insisted that his urine be tested, and Dr. pushed back because it was tested on admission 48 hr. prior. I pushed back, demanded. Guess who called me that night with an apology and a much better attitude???? Caregivers know their LO. Yeah he has dementia and he can be cantankerous. But he has yet to talk nonsense albeit sometimes uses wrong word. But when he said he wanted me to take him to local police department and I enquired to reason... "so we could buy more room" huh, what?

Dementia and ALZ patients go through plateau periods, then step down. Sometimes the plateau is short lived, or longer than previous ones, that step down is barely perceptible, sometimes steep. Environment is key to both in many cases as are meds. All the best to you and please do not blame yourself. You have done the best you could, and can be pro-active in following some of suggestions posted here. God bless you.

Why did you place her in the nursing home? Not a judgement, but if there was a medical reason, then the decline might be related.

Is she in a nursing home or an assisted living facility? My mom enjoyed more activities at the assisted living but she is a high level of care from brain surgery in 2011.

I think you should feel free to challenge the NH about this. I can't, of course, guess what might be going on with your relative, but I'll share an experience I had.

My great aunt, aged 96, in full possession of her mental faculties but physically too frail to live alone, was admitted "temporarily" to a nursing home. A few weeks later, she was not at all herself. Sleepy, not engaging when we visited her, no appetite, not much interest in her usual favourite drinks (Canada Dry ginger ale, e.g., had always been well-received before).

I tracked down the general practitioner who oversaw residents' medical care, and tentatively but in terms asked her whether my great aunt was being given any kind of sedation or similar to "help her settle in to the home's routine, perhaps," I think I said.

The GP was indignant. She would *never* countenance any such thing. She was appalled that I could even think it.

Well, I can't be sure and I never was sure, maybe auntie just perked up of her own accord and had been going through a rough patch for entirely different reasons; but following that conversation the next time we saw her and thereafter for two or more years she was back to normal.

So if I were you I would put the question to them. It will help if you are your family member's health proxy or at least have HIPAA authorisation, but you don't need either to express your concerns. Be as clear as you have been in your post about the Before and After picture, and ask if they can explain.

So many of Our Elders when placed in a Care Facility loose thir will to live nd give up.

Sometimes when a person is put in a facility they will become depressed until they adjust .

You can call the local ombudsman for long term care. They are knowledgeable volunteers that monitor and intervene if necessary.
Call your local elder care center

Have them do blood work and also urine test to check for UTI, Then get a list of meds and compare to what she took prior to going to facility. Very possible you have an infection going on or change in meds.

Bbefore reaching a conclusion, I would review her medications as well as her care plan with the director of nursing of the facility. I would discuss the changes you've seen as well. If necessary, I would contact the physician responsible for her care there too. I feel medical causes should be eliminated prior to attributing this to the normal progression of her dementia.

You should speak to the Ombudsman about her and your concerns about her.

Common. Many elderly seniors have a terrible time adjusting to the shock of an entirely new life situation, and may rapidly decline.

This could be infection. UTI. Get tested and treatment before it gets into kidneys. Could be dehydration. Check numbers. Check deficiencies. Electrolytes. Nursing homes don’t keep up with fluids and to keep patients moving. Which keeps body working. I worry about all defenseless elderly in these facilities. Horrible place. To be alone. At home there is someone. I believe home health care should be instead of facilities. This slump condition and what you described is not depression. It is medical. If they don’t test. Or Dr. will be in next month, take her out and to Hospital. Get her tested NOW. I took my mother out & into Hospital. Saved her life. Hide nanny camera in something. AND Do NOT SIGN ARBITRATION PAPERS! They hide it in with the admission papers. You would be signing away rights. They will get away with any harm. Take care. And right now go get your mother and get her to hospital now. And did you know that she could also with the sodium levels have a stroke.? Why was your family member put into NH???

This is normal. Placement is very disorienting, especially in moderate to later stages of dementia. It sounds like this is true of your mom since she has been nonverbal for years. You can help by nonverbal interaction with her like a hand massage, or showing her enlarged pictures on an i-pad. She may respond to music or singing familiar songs to her, especially repetitive songs like "Row Your Boat. Some nonverbal people can still sing; it's a different part of the brain that is activated.

I would also suggest a geropsychiatrist. Or the doctor serving the facility could try a low-dose antidepressant. Depression is common in recently placed people and can look like a drastic decline in function. I'm sure you did everything possible before placing her and had no alternative. Home care is actually not safe in most cases of late stage dementia.
Dr. Gross