How can I get Mom to calm down and work to get out of rehab?

As hard as it sounds, you stay away. She will throw a hissy fit for you and try to manipulate you. This does not work with the nurses. I stayed away for the first three days, but checked in with the nurses by phone. Once they told me she was behaving and cooperative, I went to visit.

Some people just do not like physical therapy of any type.... a little of pain and that's it, no more.... it's not easy to tell them *no pain, no gain*.

I know when my Mom was having issues with neck pain, her physical therapist was a very nice looking young man.... she was very cooperative and still talks about him a decade later, and she is still doing the exercises he requested she do that home :)

I know you are right to stay away but that's so hard to do. I need a break as well so I might take you up on that. She did response more to the guy who came in to work with her than the lady. Thanks for the info. Do you think the things she's saying and doing could be acting out becasue she doesn't want to be there?

Mp, how does your mom come to be in rehab? Did she have a stroke or TIA? You want to ask if there is any cognitive decline or dementia going on?

Has she ever seen a geriatric psychiatrist?

I'd wait til the ABs kick in and she gets a little more compos mentis. We got no sense out of mum when on strong ABs (and to be honest the phsios will struggle too, but they are used to it)
We were lucky that mum initially wanted to come home, so I'd tell her she could not come home til she could walk on her own etc.
(But she ended up loving that rehab home, think she wished she could stay there, they were wonderful and she had all her 'girls' to chat to)

Let the physios so there thing, steer a little clear til she's off the ABs.

I agree with Pam, in that family members are their best when we caregivers are out of the room, but as soon as we get there they tell us they are worse or everything else is going bad. Like you were told, this is kind of "normal" behaviors, but keep listening to her, keep telling her SHE has to do her part to get out of rehab, and you will take her home. Don't get discouraged. When people are ill, no matter who they are, they want to be taken care of like when they were a child. Just be kind, understanding, and keep your emotions in check so you don't aggravate the situation. Smile, smile, and smile some more.

The UTI is likely causing some of the problem, but I agree with Pam. You may just have to let the nurses handle this.

Normally, I'm all for visiting often and doing lots of reassuring and hand holding (literally and figuratively). But there are times, and this seems like one of them, where we have to step back and let the professionals handle the situation. Once she calms down and does what she can, then you can re-enter. keep in touch with the staff and try not to feel guilty. You are trying to do what is right and that isn't always clear-cut.

Take care of yourself. This is a long road.
Carol

Do you have a family member that she listens to that is willing to go up there. Some family member don't mind going up to help because all they have to do is to push a button. They are really scared about being in a nursing home because that is what it is in her eyes. They are waking up everyday to this place alone in a new place. Yes this this is the time to get your rest. When they get home that when you are really working with no time to yourself. Your going to have guilt if your there or not. When is her rehab time? Go up there after. I would never say don't go up there. The staff my be great but there aren't that many place that have a great staff to client ratio these days. Come in about seven in the morning in see if you smell pee or if she is wet. I know that sometimes it not the rehab but the place they are having rehab in. my dad was in a place for rehab and kept saying I want to go home and he was being abused we found out after his hip was broken. I'm just saying look at everything not just one way because everything doesn't fit in the same box. Good lucky to you

Thank you, Carol, for the "expert" answer. The timing for this question could not be better. I am dealing with this 5 weeks after 88-year-old mom had surgery for broken femur. Was in rehab 16 days, with only one rough emotional day. Now at home with very sweet home health aides. Weepy every morning. Not motivated to do PT. I am the bad guy. Told her I am going out of town next weekend and she got more depressed/upset. You have to draw boundaries at some point. She has always had a "difficult" personality and is a controller. So I know there is a lot of anger - much of it at herself - but directed to people who just want to help. Hang in there.

Unfortunately (especially for caregivers) people hurt the ones they love (that are closest to them). I should be used to the hurt/backlash I get from my mother, but I don't think I'll ever get used to it.

Why is she in Rehab?

My mom was also very emotional and prone to outbursts when she was in a rehab facility. She picked it based on its location close to me (!) and I knew it was not a great facility for her. She was resistant and angry with everyone there, and with family too. Honestly, they did try to make her "happy" but she wasn't at Club Med and people weren't jumping up to fulfill her every wish. She had a TON of visitors (her friends, mostly) but she finally got to us w/constant complaints and refusal to cooperate. We told her she could not go home in a wheelchair-she had to be able to walk (as per dr's orders, not ours) yet she continued to try to manipulate the system behind our backs. Finally wealthy older sis gave up and had her moved to a facility about 5-6 miles away. Much more posh, but almost no visitors--so she traded a place she hated for a lonely, quiet one. Eventually she quit trying to manipulate everyone and gave in to the therapy--it did take her 10 weeks instead of 4 to get ready to go home. Hard to watch a loved one turn on you--when you are really trying to do your best by them. Mom swears to this day that the 1st place was "robbing her blind" but she would forget from day to day she'd given ME her wallet, keys, watch, etc and all they could have stolen from her were housecoats and word puzzles. And it's VERY likely the UTI is making her worse. Try not to take it personally.....I know that's hard to do. I'm one of 5 sibs who care for her and she's often just horrible to me. The ones who never visit are the "good ones"..the 2 of us who take care of her--oh well. This too shall pass.

I'll go against the grain here. I strongly advise you to have someone you trust be there with your Mom as much as possible to monitor her care while in Skilled nursing/rehab. Bear with me while I tell you why.
My sweet father was recently in hospital for a fall, but he was recovering well. I live out of state and didn't fly in because I was assured by him, his caregivers and his niece who is a nurse in that hospital, that he was healing up and I didn't need to come in. At 94 my Dad's mind was sharp as a tack. But he did have chronic congestive heart trouble and got easily upset. But accounts even from Doctors said he was healing from the fall, but it was recommended to get him rehab for strenght so he could return home with caregivers of course. I agreed with the recommendation and he was moved to Rehab/SNF floor in hospital. That night he and caregiver said the nurses were not nice there. And his roommate was loud and yelling. My Dad was upset but I knew a caregiver would be there. But she got sick and didn't show. Dad had a panic attack, they gave him Ativan and he had a bad reaction to it. They called me, I flew out and 48 hours later he was dead. I don't blame Skilled Nursing/Rehab but I will tell you there is a particular culture and attitude to the people who work on these nursing units that is vastly different from the Cardiac or other floors. Even the Social Worker agreed with me on this. My fatal mistake was not being there and not having got a replacement for the caregiver who didn't show. Listen to your Mom's complaints closely and make SURE an advocate is there for her while she is in that unit.

55cagirl--
I'm very sorry for this terrible experience and the loss of your father, that is so sad!
I know in my mother's case--it would have been impossible (and I think many others will agree with me) to have had someone with their loved ones "watching" them to make sure their care was the best. This is why they are in rehab facilities or AL. Because we CAN'T be there. We really tried to give mother a ton of attention and time, but it was to the point that the therapists said our constant presence was just making her less likely to be cooperative and to adjust to the rehab facility. (If she didn't like the food, she'd call one of us and have us bring her something she liked). She really had a chance to socialize and do a lot during the days,, but all she wanted to do was lie in bed and "receive" visitors. I think there is a fine line between keeping an eye on the situation and practically living in. Most people don't have enough family, friends, etc in their lives to DO a 4-6 hr stint for weeks, months...again, I am very sorry for how things went with your father. That is sad, and no one should have to deal with that. Please don't beat yourself up over not being there.

I think she just isn't feeling well, alibi tale confused and frustrated at not getting her own way and being hospitalized, so she is lashing out and says hurtful things but truly doesn't mean to be hurtful to you...but just feels too darn bad to take them back.

Don't take it personally, but for your sake, just remind her you love her and wish she didn't have to go through this, but each day will get better and she'll be home befor she knows it...stay positive.

Take a break and keep conversations and visits short. Give her a few days to adjust and let the care team know you are available but you are stepping away a few days while they get mom on board.

Tell mom, you can't wait to get her home when she can walk on her own, feed and toilet herself, whatever and request care team reinforce that message everyday in rehab.

Do your best to understand why your mother is angry. Was she worried because you came home past your curfew? Acknowledge and empathize with her feelings. Help your mother identify the feelings causing her anger by naming them. Use statements such as "I understand that you were worried because I didn't spend some time with you nd other stuff..good luck

Apologize to your mother for making her upset. Often, the angry person just needs to hear that the other person is taking responsibility for her actions. Ask what you can do to make reparations or fix the situation.

Does your mom have dementia? Something like Alzheimers? Because my mom went through the same thing with therapy after breaking her knee in a fall. She was really hard on the staff and her family, acting out and at times actively trying to hurt me. Let the staff handle her and just be there as moral support. If she's not too bad and still can be reasoned with tell her she can't hurt others and if she does that you will have to go for awhile. A uti or any other infection really does seem to change their personalities. So that will get better. My mom did complete her therapy and we did take her home. But while she was there at the rehab facility we brought her some personal things from her bedroom to make her more comfortable. I never thought I would miss her crankiness but she is in the final stage now and can do nothing for herself. She sleeps most of the time and is slowly just fading away!

She has a UTI which is not pleasant and she has been out of her normal routine in institutional settings (the hospital and the rehab) during the holiday season, that's all part of the change in attitude toward you. I would continue to visit, yes she will say hurtful things but just refuse to feed into that conversation. Ask her about how she thinks she is doing with the rehab and if she is feeling a bit better in general. Tell her if they can finish the treatment for the UTI she will feel better and that the sooner she is stable on her feet from rehab or PT she can leave the rehab. Stress everyone wants this to be a temporary placement. If she senses an end to this dark tunnel she feels she is in --she will slowly come around. Leaving her alone will only make her feel abandoned and make her effort at rehab become worse. Often I had to "sell" a visit to rehab or treatment to my father. Use words like "we will get through this today" etc. Avoid you must do whatever, as it leads to lots of problems with the elderly above 85 years old.

I would observe the staff doing her PT also. Some of them are not very good at handling the elderly and really unrealistic regarding their stamina. They tend to be 20 somethings with little life experience and poor social skills. They can not relate to the elderly. If you have one who shows genuine interest in your mother , you and your mother will really be so fortunate.

Good luck.

"Dad had a panic attack, they gave him Ativan and he had a bad reaction to it. They called me, I flew out and 48 hours later he was dead. I don't blame Skilled Nursing/Rehab but I will tell you there is a particular culture and attitude to the people who work on these nursing units that is vastly different from the Cardiac or other floors. Even the Social Worker agreed with me on this. My fatal mistake was not being there and not having got a replacement for the caregiver who didn't show. Listen to your Mom's complaints closely and make SURE an advocate is there for her while she is in that unit."

My sweet mom also had a very bad reaction to Ativan. She seemed fine at first, but then had severe delusions - yelling and screaming and completely not herself - which stopped as soon as the Ativan was stopped. I looked it up and found that this reaction is fairly common. Ativan is very strong, and should only be given to certain geriatric patients, and in very small doses, to see how they react. I strongly agree that an advocate is extremely necessary to be sure that the proper meds and treatment are given at SNFs. Although some of the caregivers were wonderful and took great care of my mom, the communication between RNs, LVNs, CNAs, Therapists and Doctors is poor - pretty much across the board. And Doctors are rarely seeing patients - if at all (my mom was seen by the doctor only once in 5 weeks). It is very important to make sure that patients get the proper medication, as I know they gave her contraindicated medicines for her condition. In addition to the Ativan, they gave her too much Morphine, and she OD'd and died. Had I been there, I would have asked them to stop giving it to her, as she was not in pain, just uncomfortable.

I found this article interesting: http://www.mdanderson.org/transcripts/delirium-palliative-care.html

la55cagirl, excellent answer.

My mother was given Levoquin and it made her crazy. The UTIs also made her crazy and angry. Any antibiotic seems to agitate my mother. Give her cranberry juice, the real kind Knudson makes one. It must be mixed with water because it's bitter and strong. I mix one "Sweet & Low" in a glass of mostly water and about 1/4 cranberry juice. It seems to do the trick. Some people also recommend D-Mannos for prevention of UTIs. The UTI is like some devil has taken over my mother and she completely changes personality, so give it a week while the infection clears up and remember to keep her hydrated and drinking cranberry juice.

Hilary65,
I am so very sorry for your loss of your mother due to the OD and morphine. Sounds like we have both learned the very hard way- us both having lost our parents due to medication mistakes - that advocating for the elderly, especially when they are in a Skilled Nursing or Therapy Rehab situation, is vital. As you pointed out, they medical system does not always excel in communication among them selves and horrible mistakes happen often. And , the rehab PTs are often young and not empathetic to the elderly. How ironic and sad I find this to be. I wonder how you have found to deal with not being there when the incident with your Mother happened? I am very hard on myself because I was not there with my Father when the mistake with the Ativan occurred.

Morphine almost killed my mother a few years ago when she has a dislocated shoulder. It's a shame that we have to be watch dogs and forbid medications be given, but that is what I've been doing for over 5 years now.

You might try Valerian root as well. It is a mild sedative. I give it to my mother at night to help her sleep. Also L-Trypthaphane (sp?) helps to produce seratonin which is a natural calming agent.

My mom did that. She was in hosp for 3 months and never cooperated. They then moved her to nursing rehab outside of the hosp. Mo
Was uncooperative there as well. And Medicare won't pay if you don't make progress. Fast forward a year. Mom is now 100% confined to a wheelchair as she lost all her leg muscles. Now she cries cus she is stuck in a chair and she is in a residential care home, waiting 6 years for me to retire. She thinks I will bring her home then to live w me. What she doesn't know is Im not.

My mom went through the same agitation problems while in rehab. I think one of the best pieces of advice is not to visit too often. It is difficult, but gives you a break. Mom has hemocromatosis, which is iron overload, but it causes anemia. I constantly have to educate healthcare professionals about not giving her iron pills, because it could be dangerous. I find that caregivers must be aggressive about medications. Don't be afraid to speak up. My mom's anxiety is due to fear of actually having to do for herself, which she can do. So I try to pick the issues. She is in independent living and has to do some things for herself. If its not really important, I accommodate her. Otherwise , I push. Try to save your energy by getting the staff to help you. If I say something, I am a b*tch and a dope. If the staff says it, they get more cooperation.

Just let her go you don't need to be a guardian anymore

I loved my mom more than anything in the world, so the idea of not visiting "too often" because a parent is agitated is unfathomable to me. But I know everyone's situation is different.

la55cagirl, thanks for the comment and question. I am having an extremely difficult time dealing with the death of my mom -- especially because I wasn't there. I am very depressed and having a hard time dealing with life. I had been with her at the SNF every day for over a month. Luckily we found a SNF only a mile from our home, and I was not working, so I went for lunch and dinner every day and we had four weeks to talk and be together, and although she really worked hard in PT, she was losing weight rapidly and the Ativan and Morphine made her worse, but she also had many signs that her body was shutting down. The last few days were extremely tough on her. She could not get comfortable and we wanted to bring her home on hospice, but because she still had over 50 days left on SNF, and needed constant care, my husband and the hospice worker recommended keeping her at SNF. Because she was vomiting (due to the morphine, or just to her body shutting down - not sure), the hospice worker also recommended changing her from morphine in a 1ml dose to a sublingual .5 ml dose of 10mg, ever hour as needed, and a Fentanyl patch (both can cause respiratory failure, which is what she died of). After 2 10mg. doses of Morphine over 2 hours, she was still uncomfortable and moaning, so I told the med nurse to give her the morphine every hour -- she really couldn't request it herself. I was so exhausted, after an incredibly physically and emotionally painful day, so I left at 10:30pm, and made the mistake of not requesting a student or someone to stay with her. I know the nurses observed her, but no one was sitting with her, or closely monitoring her. The ONLY thing I can think of to relieve my guilt for not staying with her is that she really was close to end of life. Her liver was shutting down and she was miserable - and she was DNR, at her request. If I had stayed, I would have stopped the morphine and she would have continued to suffer for another few days, or weeks. I know my mom wanted the pain to end and she was not going to get better, but one more day would have allowed us to say goodbye, and that is just something I will have to live with.

My aunt broke her hip and was transferred to a lovely NH rehab next day after surgery. Most people stay in the hospital 3 days after surgery, but she had already spent 3 days in the hospital beforehand. (Medicare 3 day hospital stay rule). She was 91 at the time. She lived alone and didn't like to be around people. So the first fee days she ate in her room. Then after she started eating in the dining room, she enjoyed it and made friends. She didn't even want to come home til after Christmas. She wanted to be there for Christmas not just with me at her place because there were more people around. So she'll get used to it.