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1. Mom was successfully placed in a great Nursing Home on Long Island this April. Well run, friendly staff, beautiful grounds...
2. Took some acclimation. Doing great now with help from Aricept. Not Alzheimers. 87 y.o, plus MBI from repeated falls & head injuries. Does not remember the past 10 years. Knows family members and her new environment.
3. Brother lives 5 minutes away and sees her almost on a daily basis. Good guy.
4. PROBLEM: -They delayed getting her ambulatory after arm fracture healed bec. she lacks balance even with a walker and could topple backwards. She can walk.
SO she spends way too much time in a wheelchair, to the point that she requests that they pull her from the great "community space" room and let her lie down in her bed because her back hurts her from so much sitting. My brother walks her at every opportunity.

Can he demand a written plan from staff to guarantee a daily quota of individual attention for her involving say 30 minutes of assisted walking down the halls? Must this be couched as a therapy order?

Second, she is a naysayer, meaning, even before all this she would turn down requests to go out to eat with is or favors be done for her. Case in point, they have nice courtyard - garden areas with raised boxes and she is growing tomato and pepper plant with my brother's help. They do not get watered by anyone but him.

How do we get the staff to be more proactive with her needs and take her out daily to visit with her garden - she was an avid gardener........

Brother is a charmer and has a great relationship with staff but not enough is being done for her anyway.....

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Danica: She definitely needs PT. I hope she is getting it. Maybe she is requesting to go back to bed because it hurts too much. Great idea on the garden, but get her healed first and foremost!
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I agree with many of the responses here, however i am wondering if her back really does hurt: can you make adaptations to the wheelchair? Is it tge correct size? My SIL needs a child size Are the foot rests attached for support or do her feet dangle? Does she have a cushion to sit on or support her back? Maybe its an excuse to gi back to bed?

The staff will not take care of the garden--its not realistic, in my opinion. They are--and should be-- focused on patient care. They just dont have time for one on one activities.

Finally, no matter how great or good the establishment is or what great care they provide --it's likely you willbe let down and disappointed. It is super hard work and the turnover is VERY high. Finally, no matter h9w great the place you must let them know you are very involved and know what is happening with your mom's care.

It also helps to bring flowers and cookies!☺
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Well, Danica, at least you have a better understanding now of what to expect as "normal" or "usual" in a US nursing home. And since that is where your mother is, that is probably useful information.
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Danica, I'm sorry if i offended you! I just meant to point out that Aricept is not a deug that is going to help elevate your mom's mood and possible relieve her distress. She CAN take both. Many people do.

My mother is in a NH in Connecticut, and it is VERY assistive. But they are simply not allowed to make people do what they decline to do. That's all anyone was trying to say. I hope you'll reconsider and stay.
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Aloha. AND Aloha which also means good bye. I read postings on this site in a cursory manner. Until this discussion I did not realize that you act as police.
My mother's current problem is that in the US nursing home stuff is assigned only nursing and custodial functions (food & pill dispensing) but not assistive, like in Europe. Sorry I erred on Aricept. This site is not very helpful.
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No, aricept is an acetocholine inhibitor. Not serotonin. Antidepressants are SSRIs Or Ssnris. Differenent neurotransmi\rts
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Is your brother the Healthcare Power of Attorney for your mom?
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Oh, BTW, Aricept did smooth out my moods initially. I was upset at cognitive loss & decline but with cognitive and behavioral therapy regained most of it back early on - within 6 months.

I think it's your standard serotonin uptake assist mechanism in
Aricept. Since then, I have stayed on it because my husband says I am too volatile emotionally without it. Before the injury, I was very laid back. So, it keeps me in check. Would I rather get off it: yes!
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If your brother is reporting that he sees your mom distressed, then I would definitely see what medications that might bring her relief. To me, mental anguish should be treated no less seriously than physical pain. If she felt better, she might be more inclined to participate in activities as well.
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To jeannegibbs: No, they have not officially discussed depression or diagnosed depression. They ascribed her early symptoms to a "settling in" phase that lasts 2-3 months. Her English is marginal, anyway, so communication sometimes falters.

Really, the impetus was that my brother was extremely pained by seeing her so distressed initially, and since I have always been honest about my using Aricept he thought he would ask the psychiatrist for it. BTW, I have found that such honesty often backfires. People that I have told about my MBI symptoms and "mild" dementia - not intellectual BTW (more losing focus at times), soon adopt the concept & run off with it and start treating you differently with condescension. In retrospect, I wish I had not told so many people.

The funny thing is that in the last year I have become the most lucid & acute & creative than I have ever been incl. college days. Rather than Aricept, which I've been on for almost a decade, I ascribe it to the healing properties of the Island Life -- the Aloha Spirit prevalent here and finally de-stressing to the max.....
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My mom' s willingness to go to activities is very much governed by when sne thinks she'll need to use the bathrom next!

When my mom was in rehab, before we discovered she had developed Vascular Dementia, she misinterpreted a lot of things. She felt abandoned in a dining room of others, she thought people were demanding money from her, she was convinced that she was "in charge" of her own meds. And oh yes, that the male CNA was having sex in her bathroom, as the bins filled with dead bodies was being trundled by her room.

Getting her seen by a good geriatric psychiatrist and getting her on two antidepressants and a low dose of antianxiety meds, with extra available as needed has proved a Godsend in evening out my mom's mood, agitation, willingness to "roll with the punches" a bit.
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You got me interested enough to look up off label uses for aricept, they have been using it in children for ADHD, to treat behavioural symptoms in other forms of dementia, and to treat memory problems and improve executive functioning in traumatic brain injuries. I expect that improving brain function in brain injuries would help with the stress from having uncontrolled symptoms and make someone feel more themselves, but as Jeanne says, it is not the same as an antidepressant.
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"It is not only for depression." Um, Aricept is not for depression at all. That your doctor and mom's doctor were willing to prescribe it off-label is swell. I'm glad it is helping. But it is not an antidepressant and does not take the place of one.

So once again I'll ask, has the possibility of an antidepressant or an anti-anxiety pill ever been discussed for your mother?
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To Babalou: I take Aricept ( 9 years) myself for "off color" use resulting from MBI injuries (re: impulse control & easy to provoke). It is not only for depression. It does not hurt me in any way and my husband swears I am a much nicer person (my "old" self) on it. I myself cannot tell the difference.....I am not that self aware.

My mother does not have Alzheimers, but this second concussion (Feb. 2016) in 2 years has had a permanent & tragic effect. The mental decline & fog followed immediately. She does not remember the fall (bathroom) or the apartment she loved so much for 10 years. Aside from this amnesia, and irascibility she was acting extremely stressed and agitated in the new environment. Questions: How did I get here? When did I get here? IS this my furniture? What happened? This is all so unbelievable! I don't understand!

She is still sharp & and her long term memory is pretty good. Her recent short term memory seems functional. So, my brother figured that since we are genetically close and I do well on Aricept, he should have them try it out on her... She still does not approve of some of the staff and the more confrontational residents but the agitation is gone and she is behaviorally miles from 2 months ago. The problem now is to get her ambulatory.

Thanks to all for suggesting I conference call in to the plan meetings! Will definitely try for that..... Hard with a 6 hour time difference!

My brother and I have very different "parenting" styles. I would "abduct" her regularly and take her with my car to lovely places like the beach, the boardwalk etc. etc. And, she WOULD LET ME. And she would thoroughly enjoy every hour, minute and second... Maybe it's that I am the oldest child (by 10 years) and the only one that remembers the old country.

He is also afraid to bring her for a visit on a weekend afternoon to his beautiful home 5 minutes away, where his wife has a beautiful vegetable garden. He never took her to restaurants either, through the years. I really do not know why or understand the difference. I do not need to. But he is doing the Lion's share of the work and has through the years for both parents (while Dad was alive) while I am basking in our new life in Hawaii.
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Danica, I think there are limited things you can do from 5,000 miles away. Do stay as involved as you can be, but also be realistic about your role.

A family member always attends my mother's quarterly care conferences. I live 30 miles away and visit once a week, but couldn't attend the most recent conference. They offered to include me by speaker phone, and that worked great. So perhaps you and your brother could both attend the conferences for your mother, if you can do it by phone.

Aricept is for dementia -- memory and confusion. It is quite useful for some patients and less useful for others. It is approved only for Alzheimer's, but is frequently prescribed for other kinds of dementia. Do you know what kind of dementia your mother is thought to have?

Has the possibility of other medications been discussed, such as antidepressants and/or anti-anxiety drugs?

Your intentions are awesome. Your view of what to expect from the facility is perhaps not quite realistic.
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I was reading over the various posts on this thread and have a question for Danika. Your first post with this question says that your mother takes Aricept and NO Alzheimers. Do you know know what type of dementia she has?

Is her reason for being in the Nursing Home mobility issues?
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Danica, wheeling her out to water her tomato plants *when she has repeatedly and consistently said that she doesn't want to be wheeled anywhere* would constitute abuse, yes.

I arranged PT for my by this time 97 year old great aunt, who was still able to mobilise with assistance. All I wanted the hired PT to do was toddle her up and down the passage outside her room, and on nice sunny days sweet-talk her into sitting outside. I used to get irritated, too, at the number of times "Miss S declined" was logged in the resident's record. Came the day, perfect sunshine, light breeze, balmy afternoon, and me there to help; and darling Auntie L smiled at me charmingly and said 'another time, perhaps.' We kept up the regular PT appointment to make sure the offer was there if L chose to take it up; but I abruptly stopped feeling annoyed with the staff.

At some point, when your mother says she doesn't want to join in, you are going to have to take her word for it, you know. Even if it does feel like the beginning of the end.
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Danica - Babalou is right in saying if the resident says "no" then acting to the contrary is considered abuse - it might seem silly but respecting the residents rights not to be forced to do anything they don't want to, should be taken seriously- from a walk to a shower - even if it's in their best interest in the long run. A good nursing home will find a way around the "no" and get "yes" eventually. That said - find out the staff to resident ratio, you'll probably see why walking your mother out to tend to her tomatoes can be a problem. My mothers nursing home has a staff -to -resident ratio that is considered to be above average - yet everytime I visit I can hear the call buttons going off all over the place non-stop. I think the best thing to do is ask your brother what he thinks of the request for staff to walk with your mom. Since he is there almost daily he'll probably have a good idea as to how do-able this is. You may find out that like many of us have - that in spite of paying a hefty monthly payment, to get the little extras you'll need to hire an outside "companion". That's what I ended up doing.
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Aricept is not for depression or anxiety.

If they ask your mom if she wants to do something and she says "no" and they make her do it anything, yes, that's abuse.
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Yes, she was put on ARICEPT and it is helping, but she "animates" lately only for my brother (or my visits).

Your advice is well taken, but really? Wheeling her out to water her tomato plant - which will otherwise die - would constitute abuse?
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Danica, where YOU as her daughter can ignore her "no" aand insist and cajole, that might be interpreted as abuse if done by staff.

Is mom on anti-anxiety and antidepressant meds? They've made a difference in my mom's life.
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"Out of her apartment", means for short walks, to a restaurant or for a drive to the shore or even IKEA. She gives up really easily if you persist and greatly benefits form getting active.....
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Thank you all for your replies. Yes, she stayed in rehab part of the institution first.
Had official PT, never enforced well - she bristled at being "dumped" after the session in the GREAT room for hours on end.

I know the personnel is busy. I was asking whether they are supposed to help impacted people ambulate when they can steal a minute. And, unsaid, I visit 2 times a year bec. I live, 5,000 miles away. As to my mom having changed, yes and not. The point about disregarding her negativity, is that I never would have gotten her out of her apartment if I had accepted the first 2 or 3 "NO"s out of her mouth. These people are professionals, they should know all this stuff...

Will look into volunteers for 2 or 3 days a week to supplement what my brother does, but frankly, given your response "live with it", am not
optimistic
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My mom's NH is great about getting her to activities. An aide comes in and says, "The singing is about to start in the fireside room. Do you want to take a sweater with you?" And off she goes! She cannot bear weight at all so she is wheel-chair bound. We take her outside in good weather when we visit and sometimes the staff takes her, too. But there aren't enough hours in the day and staff in the facility to expect one-on-one time on a regular basis. And, frankly, when staff has time for that I wouldn't blame them if they mostly attend to the folks who have few or no visitors, rather than my mother who gets4 or 5 visits each week.

At the ALF where my daughter works, there is individual attention for walking with residents by a trained person. Residents can sign up for daily or a few times a week walking. There is a significant charge for this service.

If mom is in a great nursing home, work with them to see how to resolve this without unrealistic expectations on their staff. Attend the care conferences. Bring this up as a concern and ask for suggestions about how to achieve your goals for mom. (And also listen to their input about what goals are realistic.)
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Fractures take a long time to heal in the elderly. You cannot use a walker with a fractured arm or poor balance. PT requires a doctor's order, not just a request from family. The MD can also write an order for a reclining wheelchair to relieve the back pain.
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I think it is unrealistic to expect staff to spend extra time with your mother taking her for "30 minutes of assisted walking down the halls" and "out daily to visit with her garden". It may seem like very little, but there are many others there with their own special needs and desires as well as the routine tasks they must get through. You might ask if there are volunteers who can give your mother special attention, or hire an aide to help her for an hour a day.
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Babalou is right about how our parent(s) are unable to engage in things that they use to enjoy. They just don't have the energy any more. Plus they are afraid of falling.

My Dad will walk but only if his regular caregiver insists he get his behind up and out of that recliner away from his TV, and walk down to the sunroom or to sit outside for awhile. I honestly think if recliners weren't invented, my Dad wouldn't want to sit for so long :P
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Danica, something else that you need to take into consideration...this is NOT the mom you knew who was an avid gardener. This is someone else, with diminished mental capacity.


My dear SIL wants mom involved in all sorts of activities, taken to the dining room...mom just wants to sit in her room and watch Fox news. There's a balance of course. But don't expect the old mom back. It's very much a grieving process.
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Danica, the older one gets the longer it takes to heal a broken bone, believe me I know. Then months of physical therapy which can be extremely painful especially if one was in a sling/cast more than 2-3 weeks... longer the sling, the more the muscles will break down....

Thus the reason for the delay in getting your Mom up to walk... your Mom probably couldn't hang onto the walker as it takes months to get an arm to straighten out. And a lot of strength is gone from that arm.

I still can't lift what I use to and my injury was over a year ago. When my Dad wants me to help him get up out of a chair by me pulling on this arms, I can't do it anymore :(
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When you write "nursing home", do you mean a rehab facility? If so, a therapy plan is typically developed the first or second day of admission, and a care plan is discussed with the family sometimes in the first, sometimes the second week.

Has any of this occurred? If she's specifically there for therapy, something's amiss, because she should be getting PT regularly.

Babalou makes a good point about compression fractures. You might have to ask for spinal x-rays.
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