How often should I get my grandmother out of bed?


One of our home care nurses implied that we need to get her out of bed more. We feed her breakfast, lunch and dinner at the table during the day. I ask her if she wants to sit in the chair for a bit and she says "no, I want to go to bed." Should I force her to stay up or let her go back to bed? She has Alzheimer's and also had mini strokes over the years.

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Just to add one practical thing that might be worth trying. When your grandmother has finished breakfast, you could tell her that you need to change her bedlinen so would she mind sitting quietly with the newspaper or a nice view out of the window while you do that. As long as she agrees in the first place, and then seems comfortable when you check on her periodically, you might be able to spin this out for most of the morning; and it is true that maximising her mobility and changes of position and scene are good news for her wellbeing, all other things being equal.
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One of your home care nurses... What about the others?

Personally, I would say that if you are managing to get your grandmother sitting up at the table three times a day you're doing pretty well; and if you're getting her washed and dressed you're doing fine. And I would also say that if your grandmother is still able to express a preference about what she wants, on what grounds would you overrule her?

When I was quizzed on this issue by an occupational therapist who asked me to describe mother's daily routine*, the OT stood there with her pen poised above her questionnaire until she heard me say the magic word "encourage" so that she could tick that box. The point was that "asking" isn't quite enough, because if you just "ask" someone who is dog-tired if she wants to make an effort with something she is more than likely to say no thanks all the same. But if you encourage, support, assist, facilitate her to do it; and the person is still quite clear and firm about her preference; then you go with her preference. You do NOT force.

You will encounter people who have a highly structured care model in mind and are hell-bent on achieving it. In the perfect care model, your grandmother would be up at seven, washed, dressed, breakfasted by nine, ready for appointments during the morning, lunched at noon, nap for an hour, engaged in singing for the brain, handicrafts or pet visits during the afternoon, rested before supper at six, washed and changed into her nightclothes by nine and then tucked back into bed. In a tightly-run care home this would probably happen, more or less, overlooking the daily mutinies and non-compliance, whether she liked it or not. And for whose benefit, you may well ask? Well, for everybody's, really, because order and routine do tend to make for a quiet life all round. But isn't that partly why your family has chosen to keep your grandmother at home? - so that she doesn't get treated like a battery hen?

Still. The officious nurse does have your grandmother's best interests at heart as she understands them, so do your best not to tell her that she is unhelpful, annoying and falling down on respect for autonomy. There is little hope of correcting someone who's so convinced of the theory that she sees fit to guilt you instead of praising you and making constructive suggestions; but if nodding and smiling and saying "we'll do our best!" doesn't shut her up, perhaps you could ask her to demonstrate what she has in mind and let her see for herself that it doesn't work in practice. And if she really is prepared to overstep the mark and force your poor grandmother into an armchair... it probably wouldn't come to that, but if it did you'd have her kicked off the team.

*routine was a slightly grand word for it. I was just pedalling as fast as I could.
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Spot on as usual, Countrymouse!
(I particularly liked the bit about being treated  like a battery hen.. lol)
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The nurses are just worried about lack of circulation, loss of strength and skin breakdown which all occurs with too much time in any one position, bed or sitting up. Staying in bed does not allow your grandmother to engage well in her surroundings which is important for anyone especially one with dementia. Does she walk? Can she do some light exercise by watching you demonstrate? These are two things you and she could do together. If she does not have anything to look forward to after meals, why wouldn't she want to just go back to bed? Have the nurse check her for depression as well. Depression is common in people with dementia and should be ruled out or treated if needed. Good Luck to you.
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At some point leaving someone in bed, the PROPER bed, is safer.
What your Grandmother needs is to be "repositioned" at least every 2 hours and ideally moved slightly more often.
Moving can be as simple as adjusting the height of the foot or the head. You could also grab the sheet and slide her a bit up, down or over in the bed. This moves her a little.
Re positioning you should roll someone from the back to the side then over, then repeat on the other side. This relieves pressure in the areas the are in contact with the mattress. So head, shoulders, back, buttocks, calves and heels.
Doing this also is a time when you should check these areas for any redness or other skin color change.
A pressure sore can happen in a matter of an hour. It is identifying it when it is small and manageable and not wait until there is a drastic change or worse, an open wound.
If Grandma wants to stay in bed and that is where she is comfortable there should not be a problem. If you do not have a hospital bed ask that one be ordered. (If Grandma is on Hospice you would get it probably within 24 hours)

If the reason Grandma does not want to sit in a chair is because she is afraid of the transfer or if it hurts her that is another thing that can easily be addressed. A Sit-to-Stand or a Hoyer Lift would easily help with that and again they can be ordered.
Sit to stand is for someone that can support their own weight and can follow instruction and hold onto the machine.
Hoyer would be a full sling that you would have to place under her then hook the sling to the lift and she can easily and comfortably be lifted from the bed to a chair.
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In a NH, the patient is taken out of bed and sat in a chair all day. The reason for this is probably to clean the room and change the linens.

This doesn't mean it is better for the patient - it is better for the NH staff.

I agree, if your GM sits at the table 3X daily to have meals - you're doing a fine job! It is typical for up to 20 hours of sleeping daily as they age. My DH is in the 16-20 hour range and I just let him sleep. His preferred position is prone but I get him to sit in his recliner a little every day so I can change the sheets and straighten them. Invariably he reclines to a sleep position. Would you force a baby to sit up all day? Well, as they age, our elderly revert to being like bigger babies and they want to sleep. It's nature and natural.

Don't let "one of the nurses" upset you - you're doing a fine job!

Besides, sitting in the wrong position will make "pressure sores" and you really don't want to mess with them if you can avoid them.  My DH only gets them in his Lift-Sleep Chair so I don't make him sit there very long.
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I loved reading all these answers. Caring for an aging loved one is definitely a balance of encouraging, helping and listening to what grandma/grandpa wants to do as well. When I was in college, I worked as a CNA in a nursing home (dementia wing). I learned so much in that job. I was responsible for the daily care of 9 people each day from breakfast to just before dinner. It was very challenging, but ultimately rewarding. Anyway, we got every single resident up, dressed, washed, and fed each morning, and most of them in their wheelchairs and parked in the common room or hallway. Some were ambulatory, but many just leaned back and slept in their uncomfortable wheelchairs. I asked why they couldn't just go back to bed for a nap, and I remember another staff member telling me that if the family came to visit, and grandma was still in bed, they would be very angry. That really stuck with me. I remember thinking, "if this was my mom, I'd let her sleep in a bit". SO, now that I AM caring for my mom, I do listen to her. I let her sleep in, but I also strongly encourage her to get up at a certain point because it is good for her and she can interact with the family. I don't have a certain time of day that I force her to get up. As long as she is comfortable, has eaten, etc. and she wants to sleep in a bit, then I say she has earned the right to do that! God bless all the caregivers out is not an easy job.
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You can fit quite a lot of salt into a cinnamon capsule.

Are you doing this on medical advice?

If you've had one of the really vicious stomach bugs that are doing the rounds this year, I think I'd give it a little bit longer before you bring your mother home. Just to be on the safe side. Hope you're feeling better but I bet you could do with a few more days to get really over it.
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My mom is 90 and has moderate Alzheimer's. I let her stay in bed until she feels like getting up. I do think that if it were up to her, she'd be in bed all day, but she still has a feeling that she needs to get up and dressed. That being said, she spends all day on the sofa and has no interest in walking around at all. She was living in assisted living, and we moved her in with us for a variety of reasons. She's very happy here, but she has lost considerable muscle since moving in with us because she doesn't need to walk to her mailbox or to the dining room. I agree that if you can get her into a recliner, that might satisfy your nurses and get your grandmother out of bed. A nice recliner is sometimes more comfortable than a bed!
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If you have a comfortable chair, such as a recliner type or a big upholstered chair, set grandma up there for a couple hours. Elevate her feet and legs and have a window she can look outside or if you must, a TV but that’s not the greatest because Alzheimer’s patient can be frightened by TV.
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