Is this the time to look into placement in a nursing home for my Mom?

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My 87 year old mom who lives with us has moderate dementia, afib, decreased kidney function, and compression fractures. She has been in the hospital 28 days (in and out) since March 5th, 2015. The first time she went in for anemia, but also twice because the hospital doctors could NOT get her afib meds right. This last time she went to a different hospital with hospital-acquired pneumonia and is coming home today with a different dosage for her afib. Let's hope the meds are right this time - at least for longer than a week.

She is already depressed from the multiple hospital stays (who wouldn't be) and the pain she suffers from the compression fractures, so my fear is that if we placed her in a NH for medical management, she would just give up. A hospital psychiatrist is going to see her today to try and get a read on her as well since she keeps saying she wants to die. At her age and with the afib issues over the last 45 days, I can understand. But I hate to see her in this mental state of despair and discouragement. Am I doing her a disservice keeping her home with us? We do have caretakers every weekday since my husband and I work full time. I'm now beginning to feel that maybe her medical conditions are becoming more than I can manage. I hate the idea of placing her in a NH, but at what point is it more appropriate for her?

Should we give it the "ol college try" with the caregivers and the new dosages and go from there? Any insights would be appreciated.

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Turns out my mom does qualify for rehab because her releases from the hospital were less than 30 days ago. I have contacted a local nursing home with skilled nursing and am waiting for them to review her records and let me know if they can accept her as a skilled nursing patient. For some reason the hospital never asked US if we thought she should go to rehab while she was still inpatient, even though she would have benefited tremendously. Heck, I had to ask for home PT. When I was speaking to her hospital case manager the other day and questioned the decision to send her home with us each of the three times she was there, I was told they usually abide by the patient's wishes. Apparently they asked HER, and she told then she wanted to go home. Well, of course she would say that - what else would she say? They never told us in detail about her medical/physical limitations or asked if we were able to manage them. And the last hospitalization really sapped her strength. She's can stand but has difficulty walking now, even with a walker. And forget about getting to the bathroom on her own, day OR night. Lessons learned the hard way. My poor mom.
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Thank you all for sharing your experiences. She did fairly well until recently, all things considered. We want to try to keep her home with caregivers, PT, and nursing support for as long as practical. In the meantime I have contacted our local nursing homes for information as well. Trying to keep all options open and be prepared for when the next hospitalization occurs. I agree, it's not a matter of "if", but "when". Just makes me sad to lose my mom like this.
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Rascal with the hospitalizations recently, my guess would be another will be coming. As soon as we as caregivers begin to question whether proper care can be done in the home, it is time for a nursing home. It is difficult when they reach the stage of constant medical issues. Nursing homes would monitor her closely and recognize even subtle changes that we as family carers would not. While she is home, I think rehab can only be done at time of release from hospital, shop the different facilities in your area that will be convenient for you to visit as often as you like. Look up the facility ratings on Medicaire's website, be prepared before the next hospitalization. Then have her moved on discharge to the nursing home you have chosen (have a list of several since your first choice may not have availability). And social workers at hospitals may recommend homes that are not the best because of the time and effort involved to find one with a bed available.
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Dementia patients have tremendous difficulties indicating when they are in pain. Is mom's pop a geriatric doc? That made all the difference for my mom. Her regular pop was a nice guy, good doc, but didn't see the cognitive decline or the depression.
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Mom came home from the hospital yesterday evening after two full days, so this time she didn't qualify for rehab. Would she qualify for rehab now if she has been in a hospital 28 of the last 35 days? During the most recent hospital stay she told the nurses she just wants to die, so she was interviewed by a psychiatric resident who felt she has significant cognitive deficits and wants to do a neuro-psych evaluation. FINALLY!!! We know she has dementia - you don't need an evaluation to see it, but it would help us get her on the right meds, taking the afib into consideration. Her PCP hasn't really wanted to address the depression because my mom was "smiling and engaged" in her last appt. This is even after I told the PCP about her constant crying, wanting to die, etc. It feels the PCP just wants to work around the depression using Celexa because of my mom's age and doesn't want to prescribe meds because Mom is a fall risk.

We do have lidocaine patches and a TENS unit for the pain, so it feels we are getting our arms around the compression fractures a bit. It's still challenging because Mom doesn't always let us know she is getting the pain until it's in full swing.

If we can manage the depression and the pain, I think we'll see what the next phase brings and go from there!
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Placement in a nursing home is a personal choice. What would mom say? find what else can be done to ease her pain from the compression fractures, this could improve her quality of life. Ask her physician about her prognosis. she has moderate dementia-if she has a lot of alert times, then for me-I'd keep her at home, especially is she is able to enjoy some things. If she has more confused times than alert, then it's a toss. If she has in home caregivers and she can be managed at home, then it's just a personal choice. A nursing home can be beneficial, she would have the chance to socialize and attend activities. You still must consider the depression that a nursing home admission can bring. maybe she can do a rehab stay after a hospitalization (a 3 day qualifying hospital stay) medicare should pick up and pay for the first 20 days. She can receive physical and occupational therapy, socialize and participate in facility activities. She may decide she enjoys being there.
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My mom's compression fractures are now pain free due to local pain patches (recommended by the nh nursing staff).
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Do you think that the psychiatrist could/would prescribe an antidepressant that would help her with her desire to die? After a few months of that, she may have a turnaround that would help her a lot. Is there no relief for the pain of the compression fractures? If everyone feels that being in your home is the best case scenario for right now, then maybe these changes would help to keep her there. Good luck!
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This is just what I was wondering. We're keeping my mom home with us because this is what she, we, and even her PCP think is best for her. Individual attention by the caregivers and us, but we aren't nurses and don't always know what is going on. It's so hard to know when it's time to go down that road.
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My own 96yo mother, would not be alive today, if it wasn't for the NH. My sister died, trying to take care of her.

She is now, clean, safe, fed and there is an RN on duty. She had a stroke 2 months ago and the staff was right there. I know that Mother likes the attention.
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