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Hi,


My mom is 92, has later stage dementia, but physically pretty healthy. Being treated right now by a home health nurse for a bedsore, which is healing nicely. I have not met the nurse, but I have phone conversations and, frankly, don't like her. I don't think I'm hypersensitive, but she just sounds like an overbearing busybody trying to interject her agency into providing all sorts of other services just to get her claws into us, aka, make money. Sorry if this sounds unhinged, but I believe in less medical intervention than more. I'm not in denial regarding my mom's situation, but I know her and what works best for her. I feel the nurse is looking for ways to point out things we aren't doing so she can interject why we need hospice and her agency's services. I get the "ideal," but she doesn't seem to get we are working with a person with dementia and that all bets are off. Again, not looking for specific suggestions, maybe just feedback. Have you ever felt you were in a battle of wills with someone involved in the care of your loved one?

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I'm going to answer in a way you might find less confrontational (or not) - I don't get your assertion that this nurse is only offering advice so she can somehow get her claws into your family's business and sell a lot of unneeded services, unless she owns the agency it wouldn't matter to her personally whether you hire 10 hours of help or 100, and (where I live at least) most agencies have a backlog of people waiting for help so it's not as though they are needing to trick people into buying their services. Our home care nurse often asked whether I needed more help and I know she did it out of concern for me as a caregiver, not because she was a shill for her agency. That said, I had a homecare aide I never quite trusted that I had replaced and things ran much more smoothly after she was gone, so you needn't put up with having someone in your home who rubs you the wrong way.
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Reply to cwillie
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Just to play devil's advocate - if you know what is best for your mom and are providing an adequate level of care how did she end up needing to be being treated for a pressure ulcer?
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dmasty Nov 15, 2018
I’m not a nurse but in many cases no one is at fault for a pressure ulcer. Skin breakdown can be part of the decline when an elder starts eating less. Protein status is compromised. Some people with more reserves never develop them. Others, no matter how often they are repositioned will I believe.
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I'd have more sympathy for your point of view if this nurse hadn't been called in to deal with a pressure sore.

This will sound a bit brutal. But I suspect that if you continue this battle of wills as you are doing you will soon find APS knocking on your door. Consider the possibility that she is trying to prevent what she perceives as possible neglect. Nurses, I believe, are mandated reporters.

You'd do better to have more respect for her experience. If you're not happy with what her agency charges, you can always shop around.
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Reply to Countrymouse
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Later stages of dementia, along with pressure sores would qualify your mother for hospice. Giving your mother more care and support would only serve to help her. Hospice care is covered by Medicare, so there’s no additional cost. In fact, all of the care, treatment and services related to the terminal illness would be covered, so it would likely be a savings. I think this nurse is probably offering good suggestions for a more appropriate level of care.
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Reply to Tboosrn
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Your Mom is in later stage of Dementia? Besides this HC nurse coming in, who cares for your Mom daily? Your profile says she is at home. Hopefully, she is not left on her own. At late stage Dementia she should not be left alone at all.
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Reply to JoAnn29
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Here is my 2 cents!

Have you thought about the possibility that the nurse sees somethings that you don't? Drs and nurse are trained to see the human body as one system made up with many systems. What looks like just a bed sore to you, the nurse sees infections, muscle breaking down, tissue (skin) breaking down, circulation problems and etc.

I am with CM, I wouldn't put up to much of a resist you could lose that battle very quickly. The nurse has medical acknowledge and you don't therefore, APS or a judge will believe her over you.

Try to hire a different nurse or use a different agency. You might have the right to fire her; however, make sure you have someone to take her place.

You could be right that she is over stepping the line...but even if your right; what good is going to come out of it?

This is about your mom's health, not about who's will is stronger!

Something to think about!
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Reply to Shell38314
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Sometimes people simply don't care for a particular nurse so you always have the option of requesting a change. I did exactly that when an older nurse tired of working did a sloppy job and next visit was someone I really liked. Try and meet this lady and see what she is like in person before you flip out if she is doing a good job with Mom's bedsore. Some but not all nurses have special training in wound care which can be a big plus.
She may also feel that the family contributed to the bed sore by not moving Mom around enough.
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Reply to Veronica91
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From a caregivers perspective it is more likely your mother's caregiver just wants consistently good and proper care for someone she has taken some responsibility for. Caregivers that are hired and not family members more often than not have their clients best interests at heart. We may try to inform family members of services and care they may not know are avilable. We know families are in new territory when they have to make decisions for a parent or other family member. I will do research to find services my clients may need and inform the family. More than once it has been ignored, but in most cases it is appreciated for what it is ; a caregiver trying to do the best thing for those they care for.
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Reply to Icareforcp
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I'm curious on exactly What she is trying to push.  Hospice? WHY is she recommending this?  Did you ask her? The same applies for all her other recommendations. Did you ask her why she thinks your mom needs it?

To answer your question, I rarely battle with someone over differences of opinions/advice. I tend to go with the flow. However, anything major - like going to the clinic or the ER, or for medications, I tend to ask a lot of questions. But I'm never confrontational. All of my parents' home caregivers and visiting home nurses in the past 25 years - were used to my constant questions. Why you're doing it that way? I do it this way.... What do you think I should take mom to the clinic? Ohhhhh…. If their reasoning sounds reasonable, logical, I follow them. If I disagree, I tell them so and why. Usually, they will give me more time to eventually see that they were right. Or wrong.
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Reply to bookluvr
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If you are located in the U.S., then a nurse that provides wound care is hired by a Medicare-certified agency and ordered by the physician. Medicare pays. And if Mom requires a level of care to involve Hospice, Medicare pays. So that nurse is not looking to have you pay. Hospice is not a bad thing; it's a very good thing and able to provide all sorts of additional services, equipment and supplies, paid for by Medicare, not your mom and not you.

The question is, does your mother like the nurse? The nurse is there for your mother; if the nurse's personality truly does clash, of course another nurse can be requested. But the nurse is looking out for your mother's best interests.

What the others on here have said about the source of the wound being questionable, nurses being mandated reporters (all in the health field are mandated reporters), and the possibility of APS being called if your mother is left alone with dementia, all of that is true.
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Reply to Myownlife
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anonymous806474 Nov 15, 2018
thankyou, all true, if I had known to call MEDICARE before my brother died with Dad, being burned out, maybe a lot would have been different...…..my Brother needed help ASAP...….with Dad and his dementia..we did not ask
he was only on Aid and Attendance money which was first level 900.00
for only three years Dad was 96 when I applied for this WW2 vet...……….
and frankly the GP doesn't help....looks like they want all old people in a Nursing Home...…………...I mean you can barely get Dad to his Doctors office...….
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