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My Mum has late stages Alzheimers. I haven’t been to see her for a month as one of the staff contracted COVID-19 and visiting was stopped. However, it has restarted and I have a visit scheduled for tomorrow morning.
I was telephoned by a nurse today to say that she had been sleeping all the time and was unresponsive. Her heart rate, pulse, blood pressure etc were all normal and fine but she was very pale and clammy. A call later in the day and the nurse updated me by saying there was no change but that because she was sleeping for hours and hours she hadn’t had any food or hydration.
They said that she had deteriorated over the last few weeks and what was my view? Do we send her to accident & emergency at the hospital or do we leave her be at the Nursing Home? What do I do for the best? I am unsure and don’t want to do the wrong thing by my 88 yr old mum.

My 92 year old Mom was in a nursing home and declining with dementia. I was called one day and told that her hemoglobin was dangerously low and they wanted to send her to the hospital for a blood transfusion. If she went she would be but back into 14 day isolation again which would probably send her deeper into dementia. She had had a couple of falls with bruising which could have caused some blood loss

We chose not to allow it. Her mental state is declining and I did not want to put her through that trauma. She has always had a horror of ending up on life support for no good reason. I talked to the nurse and they agreed to give her iron supplements and wait to see. A week later she was fine.

IMO SNF don’t want the death of a resident on their record, at the same time nor do hospitals. So these poor elderly people are shuttled back and forth between facilities, each hoping they don’t get stuck with the hot potato.
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Reply to Frances73
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Ask for hospice. Make her comfortable. Focus on her quality of life. The doctors at the hospital will keep her body alive. It's a horrible thing to see someone treated like that and to know she will have no idea what is happening to her or why. Most people do not want to die in hospital.
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Reply to NYDaughterInLaw
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Go see you Mum. If somebody is pale and clammy, something is going on inside of her: infection, circulation problems, neurological problem... Then talk to her doctor about what you experience. If she has a treatable cause, you will feel better having seen her and gotten her help. If these are her last weeks, you'll feel better having seen her and expressing your love.
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Reply to Taarna
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You need to ask yourself what you expect a trip to the hospital to accomplish. Is it to make her more comfortable? They can do that at the nursing home through hospice. Is it to cure her? That won't happen.

Sometimes when you think about any treatment in terms of realistic expectations of what you want to accomplish, it makes decisions easier to make.
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Reply to MJ1929
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Wishing you peace during this difficult time.

You are making the right decision.
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Reply to NeedHelpWithMom
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I'm very glad you decided against A&E!

Do let us know how the visit went?
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Reply to Countrymouse
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Thank you @worriedinCali. You have really given me direction in your answer. I think nature taking its course is probably the kindest thing for my Mum.
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Reply to Els1eL
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There is so much here that I can't know and that the doctor surely does. What underlying conditions does your Mom have. The nurse describes her as cold and clammy. I don't understand that nothing has been done at all; could this simply be a diabetic coma and reversible in seconds with treatment? Is it Covid?
What preparations have you made in your own mind. Is Mum on Hospice Care now? Have you decided on palliative care and no further hospital treatment?
I don't know what to tell you. If your Mom passes peacefully and you have honestly been expecting that this has been the trajectory she has been on it is something completely different than just saying "Well, we don't know what's going on and this sure is unusual, but should we check temp, blood sugar, Urine, all those things that can be done in just seconds?
I am uncomfortable in guiding you. I don't know the background or expectations and the last thing in the world I want for you is to think you could have done something to reverse this.
In my Aunts case we knew her kidneys were done, and got the call should she be transported; even her aids in facility knew she would not want that.
I am so sorry. Just tell me this isn't a sudden change in an otherwise generally healthy woman. A desire for "no heroic measures" doesn't mean not trying to find out what is going on.
Are your hospitals currently overwhelmed with covid cases? Is this why there is no MD advising here? I guess I would tell them you want the advice of an MD, however that is got, but again, saying that without knowing the history here.
I wish you good luck. I hope you will update us.
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Reply to AlvaDeer
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Els, I was so fortunate in having doctors who were very straightforward with me. When mom needed her lung tapped for a second time in a week, the pulmonologist said to me "stopped doing this. Let your mom be and let nature take its course".

I asked another doctor who was proposing some God-awful procedure if he would put HIS 90 year old mother through it. "Hell no" was the response.

There comes a times when the time for intervention is in the past and the time for comfort is the right thing to do. I know that you'll find the right answer.
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Reply to BarbBrooklyn
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Els1eL Dec 1, 2020
Thank you again Barb. You are so right.
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It sounds like it might be time to get hospice involved. They will be able to asses her and give you their recommendations. They will do their best to keep her comfortable and pain free right where she is at. Putting her through more tests, and the stress of the hospital, doesn't really seem necessary at this point in her journey. Just be with her(as much as they will let you), and let her know how much you love her and that it's ok for her to go, and that you will be ok. Praying for God's peace to be with you in the days ahead.
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Reply to funkygrandma59
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I'm so sorry that your mom is declining.

Does she have a DNR?

Is she on Hospice?

Are you clear about what her end of life wishes are?

As my mother's Vascular Dementia advanced, it became QUITE clear that trips to the ER (A and E by you) were doing more harm than good. We talked to the NH and they agreed to handle all issues like pneumonia and UTIs "in house" and would consult with us before sending mom to the hospital.
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Reply to BarbBrooklyn
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Els1eL Nov 29, 2020
Thank you@BarbBrooklyn. My mother would never discuss end of life wishes with me unlike my father. My father made it clear that he didn’t want to die in hospital. I just want to do what’s best for her. I have PoA for health and welfare as well as financial and have said to the nursing home that I just want what’s best for my mum and not to put her in distress. It’s such a difficult decision to have to make.
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