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My mom lives on her couch. She can’t walk or get up at all (it’s been like this for 15 months). She eats, drinks, watches tv, and yes even goes to the bathroom (on pads) on this couch. Her husband passed away 3 weeks ago. He was very ill for a long time. She just turned 76 and is of sound mind. We can’t force her to go to a facility. She has a few bed sores that we noticed when she slid off the couch and said her back hurts. The bed sores are pretty big in size - like the size of an orange.
She wants to live like this and my brothers and I have a routine to get her meals, do laundry, etc.
She refuses medical help, too. So, I would like to know at what point do we call 911 to get her to a hospital to treat the bed sores?

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Bed sores are caused by the continuous pressure in the body in people who are bedridden. If untreated, the can become life-treatening, because they can become infected and cause sepsis. Nevertheless people with bedsores can live for months and even years. You wouldn't be able to treat her bed sores unless she cooperates. Her lack of motivation to get better, could be related to depression caused by the loss of her husband recently. She needs help and you could be accused of neglect if she were to die. Speak to her doctor if she has one. Make all efforts to get her to see a health provider. Se might need to be transferred to a facility were she can be treated appropriately. Untreated bed sores can become life-threatening. At 76 she is still young and with a sound mind. She still has many years to live. Don't let her die prematurely.
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MaryKathleen May 2022
Tchamp, She is of sound mind, you can't make her do anything. I don't think it is a good idea to burden Stacey A. by saying "Don't let her die prematurely", Stacey has no control and feeling guilty doesn't do anyone any good.
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Bedsores need medical evaluation. You say MIL will not go into care of any kind. You say she is of sound mind.
Will she go to her doctor regarding the sores?
This getting sores in someone who does move about is unusual. Is your MIL diabetic?
I cannot know what you are evaluating as a "bed sore". As big as an orange? The big doesn't matter nearly as much as how deep, and in a "real" bedsore as big as an orange there would be depth that would be startling, often down to the bone.
So even as a nurse, from what you have said I can have no idea what you are evaluating as a bedsore.
Bedsores themselves do not kill. The resulting sepsis from not caring for them can kill and kill in days even for a tiny sore, so again, what is needed here is medical evaluation.
Being of sound mind means understanding that medical evaluation is needed. If she refuses this, then her condition is self limiting in that it will REQUIRE medical transport to ER at "some point" whether that is days, weeks, months or even years.
My brother died of sepsis from a tiny wound on his shin that was none healing and that he kept hidden. By the time he understood that his 3 days of illness was NOT "that flu I get every year" he was confused, and found to be in a state of no return; he had a reisistant bacteria and was dead in less than two week time from multiple system failure.
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MaryKathleen May 2022
My heart goes out to you. Makes you want to dig him up and shake him doesn't it.
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I would call in APS, Adult Protection Services. Ask if they can please try and talk her into going to ER. Bed sores are painful and need a woundcare nurse to tend them. Plus, you want to get her on their radar. They may not be able to talk her into going to the ER but you will have it on record that they tried. If you call an ambulance and she is competent and says no, they will not transport her. Maybe her PCP has a nurse practitioner that will come out and look at the sores.
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Now.

Not to get the bed sores treated in hospital, but to get professional eyes on her and professional methods of communication to her. She isn't listening to her children but she might listen to someone in uniform.

She probably doesn't need to go to a facility, seeing as she's only 76 and you don't identify any reason other than disinclination for her immobility. She needs someone competent to tackle her deep mental distress. Take that small first step - you can't possibly make her any worse off, and she can always tell them to go away.
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Going back to the immobility - in one desperately sad case you have reminded me of - and the charge wasn't neglect, it was manslaughter, and the daughter was found guilty - the mother initially refused to stand from her easy chair because she had a broken hip (and a sharp tongue). That was only the start of the story, which dragged on for years (three, as I recollect) until the mother died, the authorities at last involved themselves, and the post mortem must have been the stuff of nightmares.

So. If only to cover your own behinds, get professionals involved.
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MaryKathleen May 2022
right, document, document, document, take videos of her telling the ambulance personnel she won't go. try to get a copy of the AMA she has to sign. Take a photo if you can't get a copy. document, document. If she objects, say tough times, I am calling 911 anyway.
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Bedsores can be managed, but they can also go from being fairly small to huge and septic in a short period of time.

It's not to say the patient isn't getting good care, but the sores need to be dealt with and require 24/7 changing and care.

The first time I saw a really bad bedsore, I threw up (in the bathroom of the NH where my gma was) You literally see her spine (by her tailbone).

She could not move, she was actively dying and these moron CG's kept telling her they'd have her 'up and dancing' in 2 days. She wasn't stupid. She had me roll her over and look at the bedsore and made me tell her what it looked like.

OMG.

She didn't last a week in this NH, not from lack of care, b/c that was 'fine', but because she was dying. Giving her false hope and being all perky and cheerful just made her feel like she wasn't trying hard enough. Good grief. I spent my time with her just talking and singing and 'remembering when'. Either mom or I was there most of the last days of her life.

Gma's bedsores were not painful. She actually couldn't feel anything on her body, as the ciculation in her extremities got worse and worse. I guess that's a blessing, she was able to be coherent and chatty to the day she died.
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You need to get your mother to the ER for evaluation of her bedsores immediately. Also, it sounds to me that your mother is also suffering from depression perhaps because of the loss of her husband. You should also have her evaluated at the ER for depression. Tell the doctors at the ER about her habit of sleeping on the couch, etc. Your mother has a lot of years left in her life so try your best to help her overcome these problems that she has right now.
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Pressure wounds like this are from continuous pressure from lying in a position for too long. It would help if your loved one would stay off the wounds and move every 2 hours. Since her wounds are large, please get her to an emergency room for initial treatment. She may need to be admitted as a patient and send to rehab for a time until the wounds heal.

How long she can live like this isn't a hard and fast timeline. Some geriatric patients can live years with minor pressure injuries. Other patients' wound can become infected and the infection can move into the bloodstream (sepsis) which is known to cause death.
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Bed sores if unattended can easily become sepsis. She needs to be seen asap by a wound specialist as this could turn deadly. The fact that she has been on the sofa for 15 months is a cause for major concern as well. Is there a physical cause for her immobility that has rendered her couch bound? I really don't think she is of "sound mind" and should be evaluated for depression and possible dementia. The fact that she is just 76 and allowing herself to physically deteriorate is just too sad to be ignored. Please find her the help she desperately needs.
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If you and your brother “have a routine to get her meals” etc, then you are enabling her to live this way and are responsible for her condition. No one of sound mind would want to live like that. Don’t hesitate, call APS now! Tell your mother that you can no longer provide any help if she refuses medical treatment. If you wait until she is dying from sepsis and then call 911, you will be charged with negligence. This is serious
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Lisa Fleming. My 600LB Life
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So if mom is laying on the couch and even going to the bathroom on pads beneath her - who is changing those pads? Who is cleaning her up after urinating and bowel movements? First - clean up should always include inspection for wounds, so finding these wounds only after she slid off the couch is questionable to me. Who is bathing her while she lays on the couch? Again, all of the backside should be inspected for wounds during each bath.

Mom may want to live like this, but the children doing routine meals and laundry are getting into a very gray area of possible neglect: possibly not enough bathing, appropriate cleaning her after using the bathroom. There is also a huge risk of injury to caregiver by leaning over so low when trying to change the pads, cleaning her, bathing her etc. She needs to be in a hospital bed where it can be raised to avoid caregiver back injury - adjustable to get her in other positions - and some positional cushions (look like triangles) to adjust the pressure on all parts of her backside during the day.


Tell mom you HAVE to notify the doctor so none of y'all get in to trouble for neglect, Tell dr that you noticed the problem when she slid off couch and ask - bring her to his office or have an ambulance take her to ER for treatment?? ER route may be best because they can get treatment started and then mom can be released to rehab for possible strength work. Does she just not want to walk or there is something physically wrong with her legs making it impossible to walk?

During rehab, you and sibs can decide if you can manage her care, with hospital bed....absolutely NO to the couch thing anymore....and other equipment. Caretaking is going to require adjusting her body throughout the day to avoid wound issues to arise - bathing - appropriate clean up after going to the bathroom - body inspections every day. If none of you can manage this - does mom have financial means to hire appropriate hours of in-home care?

Whatever is decided, she needs to be seen immediately for the bed sores. Those wounds can go directly to open-to-the-bone wounds very quickly.
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My last care client was bedridden and had a pressure ulcer on her tailbone. She had it for five years and it is not what she actually dies of. It was very painful even though she was kept immaculately clean and her wound was properly cared for.
The "sores" you're seeing that are the size of an orange are in their earliest stages and can still be treated and healed. If they weren't she would be crying in agony.
You say your mother is of sound mind. She is not. No one in their right mind lives like she does.
No, you cannot force her into care but the state can. Please call APS and explain what's going on with her before her become to serious to treat.
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"Once a bedsore develops, it can take days, months, or even years to heal. It can also become infected, causing fever and chills. An infected bedsore can take a long time to clear up. As the infection spreads through your body, it can also cause mental confusion, a fast heartbeat, and generalized weakness."

Bedsores | Johns Hopkins Medicine

You mentioned that she is "of sound mind." Hmmmmm...It sure sounds like she isn't. Your willingness to serve her and care for her is admirable, but it is the reason she can continue to live on the couch in such a deplorable existence. Please call 911 and get her transported to the hospital. Refuse to pick her up until they have the results of a 72 hour psych eval stay. A Hospital Social Worker can make it all happen and start the process for a state placement.
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Can you get someone to help you or get someone to help you at home with her sores if they are too advanced. I did this with my mother whom I lost to the virus in February 2021 and to the negligence of the medical staff at the hospital. She had stage one bed sores, only one or two small ones. They were slightly reddish and I told her not to sit on that area. They gave me a plastic patch to put on it . I put a little bit of vaseline and the skin healed, but if you ignore it then it will get worse. First tell your mother not to sit on her bed sores because she will make them worse and get help right now !!!!!!!!!!!!! a nurse will come it and help you. Try to buy one of those plastic donuts that you sit one so that she will not sit on the sores. Then get a home attendant to stay with her. Some life insurance companies offer what they call long term care ( I did not know this ). They give you someone to help your loved one 24/7. If you have the means you can help pay for this which is better, because this is important. If you have Medicaid then they will help you too, but only for a short period of time. Do your homework. Read about her care and condition. Do not rely on others too much to help you. . Love her and hug her tightly because when they go it hurts like hell !!!!!!!!!!!! ok? I did the impossible for my mother who was recovering from colon cancer surgery and radiation. I was very sure she was going to go into remission, until she got the virus at the same hospital. Then I got it from her. It was devastating and crushing. I had all the symptoms. I thought I was going to go. I was scared, but I recovered at home. She did not. I would have preferred to die, not her. That is how much you should love your parents. My grandmother as you can see in my posts here lived past age 102 and she did not die from old age. My grandmom died because of the negligence of a bunch of people in a nursing home assigned to her care which was not doing anything for her. This is why you cannot always hope that someone else will come in and help you. You can read about this on the internet. It is called elderly abuse. Take care,
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To be blunt, you are way past "when should we call 911." Is her Primary Care Physician aware? If not, why not? Have your reached out to your local Dept of Social Services for guidance? You give the impression she can not walk. Is that correct? Who is taking care of her during the day? Do you help change her? This needs to be addresssed immediately. As another poster noted, you and your siblings could face neglect charges.

As my Mom's son and caregiver, I was big on making sure she did not get a pressure ulcer under my care. Every two hours, I assisted her as she walked (with her walker) to a different chair. At least three times a day, I helped her change her pull-ups. At least twice a day, I put Calmoseptine on her behind to form a barrier. The only time she experienced an ulcer was when she was in the nursing home after her hip surgery (So much for "rehab"). When she came home, my daily routine with her started, and it worked well.
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KaleyBug May 2022
Rehab and hospitals where the only time my mom got them too
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Contact her doctor and get a virtual appointment. The doctor can then order a nurse to come in to take care of the sores and order you a hospital bed for her, move the couch and replace it with the bed when you get it. They can also order PT to get her moving or a hoyer lift. I treat bed sores as soon as I see any sign with Desitine. Once healed I continue to use it in those areas. Your mom needs to be in depends or diapers. Maybe its time for hospice if she has given up.
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StaceyA2021: Be very careful that these pressure sores don't turn septic. For starters, she should visit her PCP, EVEN if she refuses; you will have to step in and override her poor choices.
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Can she really be of “sound mind “ if she is living like that .. Does she live alone ? Who cleans the mess and disposes of the pads ? I have been a caretaker for my significant other for 5 years now. First thing I learned was I could not MAKE him do anything he didn’t want to do ..I took it very personally. It took me 2 years to get to a caretakers meeting , it has been a life saver for me .. AS HE IS GETTING WORSE, I am getting better . I am tired because he can no longer do much of anything. But the atmosphere at home is so much better . His brain is broken .. I do the best I can to keep him safe . I have learned so very much . I tell fiblets as not to end up getting into arguments. I also have learned to take care of my self. Now , not when you think you need 911, make some calls. You might want to contact your local Council on Aging. They can share a wealth of information. Someone might need to talk to a lawyer. Someone needs to know if there is enough insurance and finances to pay to get help in for her. Then there is the need for a Durable Power Of Attorney to make health decisions. Something’s just might have to be done without asking her. She needs medical attention and you need some outside help . Prayers are you and your mom.
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Stacey, my heart goes out to you. You are in a hard place. Why is she couch bound? Could she get up if you and your brother stopped helping her?

I would explain to your mother that bed sores are dangerous and you were going to call 911 and get an ambulance. If she says "don't do it". I would say, I am going to do it anyway, then do it. I have done this with my husband at least 4 times. She might sign an AMA (Against Medical Advice) slip and not go (husband did this last time). OK, the paperwork is started that show the world that you tried. I got a copy of the AMA, if you can't get a copy, take a picture and record the time and date. If she does go, when she can come home, tell them there is no one to care for her and it would be a "unsafe discharge" (hopefully these are magic words, so use them). document, document, take videos and photos.

So she gets mad, she can't get off the couch and hit you can she LOL.
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BurntCaregiver May 2022
You're right, MaryKathleen. The OP is going to have to just have to call an ambulance for the mother and have her taken to the hospital.
She isn't in her right mind and cannot be reasoned with, so it will have to be done against her will for her own good.
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My mother has had a serious bedsore since last September. She is on round the clock pain medication. The bedsore has been treated at various periods of time once to twice a day. I am told that it is improving but I don't believe it will ever be gone.

An infectious disease doctor told me it would never fully go away. I believe it is smaller than at its worse. I simply can't bear to see it after nearly fainting when I saw it at the infectious disease doctors office. She doesn't complain about it. At various times different medications have been used to treat it. At times she is catheterized to help keep it dry.

A wound specialist nurse sees it once a week. At some point a biopsy indicated osteomyelitis there and she was put on antibiotics. She is not on them now.

It is a very serious ailment that can worsen very quickly. With all I know I can't imagine leaving it untreated but I also know that it really requires constant monitoring. I don't believe a hospital is the right place because it takes a long time if ever to heal. I have heard of it proving to be fatal. Sorry to be so negative but I have learned a great deal about this in the past 9 months.
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BurntCaregiver May 2022
Riverdale,

The OP's mother refuses to go to any doctor. She refuses to even get up to use the bathroom and would rather crap and pee on her couch.
This is not a person in their right mind. She needs paramedics to forcibly remove her from the couch and bring her to the hospital. The paramedics are not going to bring her to a wound care doctor or clinic. They're going to bring her to a hospital. That's a step in the right direction at least.
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Bedsores can be deadly. They are easily infected if care is not immaculate. The infection is slow to heal. And eventually there can be enough tissue damage to blunt the sensation of pain (which may partially account for your mother's lack of concern) and infection may reach the bone. At that point antibiotics, possibly by IV, are the most effective treatment. A doctor should evaluate her before she reaches this point.

Sorry to paint such a catastrophic picture, but I have seen this problem minimized even in so-called "good" nursing homes. Position her any way you can to keep her weight off the area. You can pad her with pillows or pieces of foam wrapped in pillow cases. You may have to be really creative! And she will have to work with you to find what's comfortable.
Turn her side to side, or even on her abdomen, if the sore is on her bottom. If she needs diapers, gently clean the area with every diaper change, and apply them loosely enough so some air can circulate.
Have her seen by a doctor (and/or home health nurse...you may need one) to determine what medication to apply or give by mouth.

Perhaps your biggest difficulty will be convincing mom that all this is necessary. Possibly a physician can convince her that "bed sores" (decubitus ulcers) can be truly life threatening if not treated. No one, including you, can make her co-operate if she doesn't want to. But give it your best shot and you won't have to send yourself on a guilt trip.
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Call now.
I know it's difficult. My SO fell 3 times before I went against his wishes and called 911 & the EMTs got him off the floor and because of an undiagnosed heart issue, to the ER.
That pang of emotional embarrassment: "Call 911?! This doesn't seem like an emergency! She's conscious. She's not bleeding to death," or whatever rationalization you come up with to justify not calling 911 doesn't hold a candle to the fact that this is a dangerous situation.
Please call.
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She is a vulnerable adult. Call your local department of human services and ask for their help.

She must be in terrific pain, both emotionally and physically. So very sad.
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Just an observation: It seems as if the concept of ' in their right mind' is a mighty broad one.

To me, and and maybe I'm being picky--someone who lays in a bed/couch and has deep pressure sores and uses the couch/bed as an open toilet--that is far from being of sound mind. Just b/c they may be able to string together a coherent sentence is just one skill they'd need to have to be considered "sound".

How sad to accept that as 'ok' or normal.
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If your mother is under a doctor's care, the physician might consider requesting hospice care. Hospice workers keep a close eye on any sore that pops up - and they develop very quickly. On the positive side they also heal rather quickly if they are not too advanced and you can manage to position her so the air can start the healing process. Hospice workers also train you in the many skills family will need to care for an elderly patient including administering medicines and checking vital signs.
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