had multiple spinal surgery to relieve her pain from fall.
sent her to transitional ROOM at a nursing home. She continues to get UTI hosp. 3 times for that. They have her in a body wast that needs to be adjusted. She's way over medicated,so consequently she acts nutsy. She said her speech therapist is picking at her head. Would she be better off in her home with a one on one caregiver?

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I've noticed a tendency for hospitals/etc to try to "dump" patients on family, even if they can't care for them, the assumtion being that somehow, family will manage. You may need to push back a lot in order to avoid getting put on the hook for her care. You are likely to be of more use to her as "extra" help while she is at a facility than if you are "not nearly enough help" as a sole caregiver in the work/work scenario where you work all day then come home and care for your sis in all of the rest of your waking hours.

Just for what it is worth, in our area 6 person board & care facilities tend to be about $3000/mos --$3500, depending on care needed. That is half of what agencies charge for caregivers, and similar to what the least expensive english--barely caregivers charge per month (12 hr day & live-in are often the same amount). They have 2 people at a time (helpful for moving with a cast). Downside is they seldom do rehab like Skilled Nursing.
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If she is now in a TCU (transitional care unit), that is intended to be temporary, and at some point she (you?) will have to decide whether she will return home or go to a more permanent care center, such as an assisted living place.

Being in constant pain can make one "nutsy," and medications to try to relieve the pain can also cause "nutsy" symptoms. Is the TCU trying different approaches to managing the pain, to try to get the maximum relief with the minimum side effects? Pain can be a very difficult thing to manage! I hope they come up with an effective treatment plan before they release her.

How long is she expected to be in a body cast? Can that be managed by one person?

The TCU should be having periodic meetings with the family, to give updates on her condition. All of her care providers -- OT, PT, Nurse, etc. -- should be there to share their perspective. Have you attended such a meeting. What to they feel would be best for your sister when she is ready to be released? Not that you have to follow their advice, but hearing their opinions and especially their reasons can be informative.

She MIGHT be better off in her home, or she might be better off where a number of different specialists are readily available to her, especially until the pain is under control.

Twenty-four-hour care is expensive, no matter where it is provided. Does she have insurance that will help pay for it? Is she on or would she be eligible for Medicaid?
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