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Tracy, thanks so much for coming back and telling us the outcome. You sound like an extraordinary caregiver!
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Thank you Lorraine2, I love my clients.
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Tracy 3;I am so very happy for you to have been able to help your patient. I know this must make you feel so much better ,liveing proof of how caregivers need to go above and beyond at times.You are an angel !Good luck,with your caregiver family....You speaking to her daughter was a great thing to do ...sometimes people need to hear TRUTH it's the best ..after all this is REAL LIFE !!Good Job ! I would hire you to help caregive for my loved ones ......
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Good news Tracey3. I hope this eases your mind! I know in our state home deaths are looked into as well.. always good to have the DR on board!
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I am not young or untrained. I asked if it was legal. I thought or assumed that most if not all of you were probably your loved ones health POA and might know the answer. I have talked to the daughter and her family and suggested pallitive care or hospice. I'm not trying to take over nor am I condemning their feelings or wishes. My client is in a state that investigates any deaths in the home where the person hasn't been seen by a physician within 36hrs prior to death. Hospice and or pallitive care would qualify. I have license to protect. The daughter was not aware of that and doesn't want to have to deal with that at a time when she will be grieving. She has taken her mother to the Dr. And hospice is scheduled to meet with them. Thank you to all for the help it was much appreciated.
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My mother had several TIAs 3 years ago when they first moved in with me. She was over them in 15 minutes (sort of like passing out with some confusion for a bit afterwards ) and she refused to allow us to call EMS, she is a retired RN, I work in a neurology ICU. She is complete DNR. The biggest risk is an increased risk for a full blown brain attack ( stoke) in the future. Mom smokes and drinks and hardly eats.. so we see this coming anyway. The trip to the ER would have been as bad as the TIA, and lasted a lot longer. Her DR and Cardiologist are both aware of this.. If she has a total brain attack of course we will call EMS,, but otherwise all are in agreement that as long as she bounces back in good time,, we will let her be. I'm not saying it's easy,, but it is her wishes. She has no dementia at this time, and I am her medical POA.
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I will admit to not having read all the replies to this post. TIAs present the same way as a stroke but the symptoms resolve in less than 24 hours. The danger for any one is that they can evolve into major life threatening stroke. This lady is 90 and is going to die of something in the near future so heroic measures would not really achieve anything. From the description Tracy gives of the episodes I would also consider that she might be having seizures but once again so what.
I would assume the daughter is acting on her mother's previously expressed wishes which is very reasonable.
Tracy may not be a very experienced or untrained caregiver and feels everything possible should be done for her patient which is a very laudible sentiment.
Having hospice come in would be a good idea and provide extra help and support but if the lady is being adequately cared for and does not need things like aggressive pain control it is not really necessary. Nice but not vital.
Those who are not familiar with end of life care can find it hard to just let things be which seems to be what the daughter has decided and not put Mom through distressing tests like MRIs. I don't think Medicare would not approve the tests but I could be wrong. She certainly would meet the requirements. The amount of stuff they have approved for me is mind boggling and I am ten years younger and able to tolerate these procedures.
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When my Mom was having mini-strokes....the situation was quite clear.....without any followup medical remediation, there is no point to doing the tests to find out.

Yeah...you can go ahead and do I...but, insurance won't pay and Medicare won't pay. With no treatment options, no point to doing expensive tests.

Mom was already on the medication to do the best they could to control it. That is that
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Tracy 3, The reason I say go to pallitive care Hospice is because the mom and daughter probly do not want aggressive hospital visits .Visits to the hospital are Very stressful to the elderly .Mostly hospital will just run thousands of dollars in tests to say "we can Not do anything to help because shes tooo old and weak .SO daughter & mom just want to maintain any level of comfort that's available,90 years old is amazeing and delicate...but it's a definite HOSPICE situation..
Also I read another post that says there is NOTHING they can do for TIA & THAT'S THE TRUTH nothing can be done for A 90 year old haveing a TIA just wait it out ...SAD I KNOW....
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I agree with Nomad. A hired CG can’t override the wishes of the Medical POA.

If Tracy felt the woman was being abused or otherwise yes but it doesn’t appear to be the case.

As for diagnosing Tracy - no disrespect meant - that is not your scope of practice. I’m an RN & I don’t diagnose either. I am not a physician.

I suggest you sit with the person’s daughter and discuss your concerns. If the POA stated to you that no heroic measures were to be taken, then you have to trust that the POA is carrying out the wishes of her mother.
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TRACY 3 ,sounds like your friends mom needs to be on HOSPICE ! Call a representative for hospice and have them meet your friend.Vitas hospice has a absolutely wonderful system they go right to the house nurse ,CNA,DR ,social worker,Chaplin ,massage therapy,music therapy...they even helped me to preform my fathers memorial service...people hear hospice and they think death but that's not true people are taken care of and made comfortable ,and help to counceling the family in their time of mourning and Medicare pays for it ...I know people who were on hospice for 3 & 4 years the people are wonderful and Good..
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I don't know enough about the situation (how can any of us claim to?) to judge the daughter or her reasons for her decisions. I can't judge whether the caregiver is acting out of a sense of duty and compassion or high-and-mighty righteousness. I tend to assume that everyone is acting out of genuine concern unless there is evidence to the contrary. "Genuine concern" doesn't always translate into "doing the right thing," of course, but the right thing can be very difficult to judge and nearly impossible to judge by outsiders who don't know the full picture.

Tracey3, if you feel that what you are being asked to do -- ignore symptoms that you think should have medical attention -- goes against your principles and is unethical, then I wonder if you would be better able to live up to your own standards in a different caregiving position. You have reported the situation to the visiting nurse. You have explained your concerns to the medical POA (the daughter). Perhaps it is time to move on, having done what you can do.

I can relate hypothetically to the daughter's situation (without knowing the background) and to what NomadSE says. It can extremely difficult to make decisions for a loved one when other people don't approve of those decisions, even when you firmly believe your decisions are in the best interest of the loved one.

I knew that my husband had VERY strong feelings against prolonging his life after he developed dementia. If he were having a heart attack I think I could abide by his DNR wishes. But he had a different kind of medical emergency altogether. Do I ignore the symptoms and hope he dies? He was conscious. I was holding him. I said, "I'm going to lay you down and call 911." He said, "OK." Turned out he had a bleeding ulcer. I don't think anyone at all would have the right to judge me, whichever way I made that terribly painful decision.

Client has appointed Daughter to make medical decisions. Daughter is doing that. Caregiver is disturbed by those decisions. None of this seems worthy of name-calling, in my opinion.
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GardenArtist, if the home health nurse felt the mother needed to go to the hospital, then she would have called the ambulance there and then. What probably happened is that the nurse agreed that it would be appropriate to take the mom to the hospital. Which, if the mom wanted, would be fine. But apparently the mom isn't saying, "take me to the hospital".

What we have here is a caregiver who wants to take over the role of healthcare POA and wants us to validate her concerns about the daughter's decisions. I'm just calling it like I see it. And I don't see it is any of our place to second guess the healthcare POA's decisions for her mother.
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Nomad, I think there are other issues besides allegedly being "high and mighty." Tracey also wrote:

"She is seen by a home health nurse periodically and the nurse had also told the daughter to take her to the hospital." I wouldn't think that 2 people would be "high and mighty" on the same issue, especially a home care nurse.

As to blood thinners, sure, they can cause hematomas, but they can also perform a vital function in keeping the blood within a therapeutic range for patients who need that kind of control. My father took Coumadin for years; if I needed it, I wouldn't hesitate to take it and I'm generally anti-medicine. But I'd rather have bruising than a stroke.

And I also saw the scary and unsettling repercussions when his blood was out of therapeutic range and he began hemorrhaging.
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Tracy, if the daughter is the healthcare POA she specifically can make these medical decisions for her mother. That's what the healthcare POA is all about. Whether you agree with those decisions is another matter entirely. Now if the mother is of sound mind and really wants to go to the hospital she will tell you. If you just THINK she should go then that's your OPINION and just that. She may have told her daughter previously that she doesn't want to go on and be treated for this and that. You can't know what they have discussed, can you?

I can tell you right now that there is nothing they can do for a TIA. Nothing, other than start the patient on blood thinners which are a whole nother can of worms with bruising and bleeding. So if the daughter doesn't want to go that route and the mother has given her daughter the right to make healthcare decisions, then pardon me, but who the blankety blank do you think you are to fuss about it?

My mother is only 78, but she has dementia and doesn't know me sometimes and it's only going to get worse. It will NEVER get better for her. I did take her to the ER for a TIA and it helped me in that she's in rehab now and I have a bit of a break, but in the future I won't be doing that. I won't be doing any lifesaving procedures on her anymore because she doesn't need her suffering prolonged. And while I won't hasten her end, I'm not going to drag it out needlessly either.

So your post kind of strikes a nerve for me, because if I ever found out that a caregiver was having a case of the high and mightys over my decisions for my mother that would be the last day that caregiver was at my home.
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There's another risk from syncopatic episodes: fractures. My father's leg fractures both resulted from a syncopatic episode.
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Tracy, there's another option. Do you know the name of the agency for which the visiting nurse works? If so, you might want to consider contacting the nurse and asking her for advice, including whether or not the agency is a mandated reporter and will be contacting any agency.

You could also ask if a supervisor could send her out to double check the mother, with the goal of doing as much of a cardiac workup as a visiting nurse can. She should be able to tell from the heart beat if something is amiss.

You can also try to take her pulse and monitor that, keeping track of it in your records or the chart (if any) at the house.
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Thank all of you. I agree with what y'all are saying. And boot shop girl that is exactly what she is doing. I just want the daughter to have her checked and see what the problem is and then go from there. I don't understand just ignoring it.
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Yes syncope was what my mom kept doing. Passed out cold. She did it 3 times and then we put in a pacemaker after they determined she also has Bradycardia (spelling) too. If we had know how bad the dementia was going to get...I would probably not had mom get the pacemaker. But they can't just keep passing out and not responding either. Sigh. Those episodes are what led to the C.A.T scan that showed all my mom's shrinking of the brain all over. My mom's blood pressure dropped very low during the passing out and she was bery confused afterwards and usually remembered nothing. E.r. said could be T.I.A.'s also.
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Traci you are also describing cardiac syncope which is treatable. When she passes out, what is happening with her pulse
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If daughter won't take her, I would call an ambulance the next time this happens.without telling daughter. With TIA's there is not anything that can be done. But it might be something else.

My mom exhibited stroke symptoms, I called an ambulance, EMT's thought it was a stroke, so did doc's in ER. It wasn't it was a UTI. The first of seven over the next year.
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They could also be disoriented. Sometimes there is no recognizable signs with a mini-stroke
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It's hard to notice as a onlooker until afterwards and you see the drooping on one side of the body. I'm going by what she tells me she is experiencing. But signs are drooping on one side of the body. Slurred speech or unintelligible speech. Weakness on one side of the body
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Tracey3 if you don't mind me asking I am curious on how to recognize a mini stroke can you share? what kind of symptoms or behavior should we look out for?
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My client takes medication for other things but she has never been treated for this. The daughter has no clue what's going on with her mom she just doesn't want to do any life saving measures
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What I think should happen is I feel the daughter should take her to the hospital when she has these episodes (she says she feels shake and then it's like she passes out eyes open non-responsive for a few minutes then when she comes to she says she doesn't feel good). I feel they should find out what is going on and then make the decision on what they want to do. Instead she says we are not doing any life saving measures. Shouldn't there be legal ways to go about that instead of just not doing anything?
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Tracey, is this lady already receiving medication?

If the TIA's or related diseases have never been assessed by the lady's doctor, then I agree it's high time they were - there are things that can reduce her risk of something more serious. But if she's already being treated, then I can see the daughter's point of view that there's not a lot of point in going to the ER about a TIA - by the time anyone does a CT scan it will likely have vanished without trace.

But in any case, if the lady is of sound mind you don't need the daughter's permission to seek medical attention, the lady can agree to that herself. Have you tried asking her if she would like to see a doctor?
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I work privately, I have asked about hospice, the daughter says she's not ready for that.
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The mother is almost 90yrs old. Is of sound mind just had difficult with mobility. She has had episodes of confusion but each time it has come back as a UTI, once that is cleared up the confusion goes away. She is seen by a home health nurse periodically and the nurse had also told the daughter to take her to the hospital.
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Do you work through an agency or privately?

If you work through an agency, I would talk to the supervisor.

Have you asked the daughter if she has considered Hospice or Palliative care for her mom?
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