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My stepfather had to be admitted into a rehab facility one week ago because of a large diabetic foot ulcer wound which has MRSA. He needs IV antibiotics administered. He did OK for the first few days, a little decline but that’s to be expected. Over the last few days though he has made a rapid decline in that he hardly speaks and has trouble understanding what’s being said. Today he ate only a few bites of breakfast and no lunch, and he wants to sleep all the time. Is this something to be concerned about or is this normal behavior for someone entering a new facility?

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He could be developing osteomyelitis from the diabetic ulcer. That is a bone infection which takes a long time to resolve & usually requires IV abx.
& can progress to amputation. He may be developing sepsis (system wide infection),or he could be having low or high blood sugar swings which is harder to control as when a diabetic gets an infection it can affect blood sugars.
These are a life threatening illnesses & your dad is very sick.
Does he have Advanced Directives or a Living Will? It may be a good time to make sure his final wishes are known re resuscitation & when to stop treatment.
I hope he improves.
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Reply to Shane1124
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Insist that a urine test be done. UTI is common reason for people to act incoherent and kind of 'crazy'. Happens all the time at facilities. I don't have a medical reason for it to happen, but my own opinion for some of it is putting a person in diapers when they didn't use them before. You are expecting someone to just pee/poop in a diaper while their mind tells them it is not normal so they hold it longer than they would have.
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cindybirk Jun 5, 2019
I agree. I had a friend whose catheter got blocked tell me all about the people who were in the room with her. When that was fixed she was back to normal. I know there are several problems going on but he should be showing improvement.
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Thank you all for your responses. We signed him up for Hospice today. The good thing is if he does make a miraculous recovery he can come out of hospice and be put back on the rehab track. Since he would not/could not participate in rehab he didn’t qualify to stay at the facility any longer. They discontinued the antibiotics because it was too hard on his one remaining kidney. I think the coming days and weeks will be very telling as to how his condition will progress. The doctor said his dementia will interfere quite a bit with his recovery. I so appreciate everyone’s input, so helpful to have the wealth of knowledge and experience.
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Reply to ABoston
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I don't think so unless his dementia is pretty severe. I am not trying to freak you out but I had a friend that ended up in the hospital with the same issue and she ended up passing away.

Try to get protein in him, engage him as much as possible and have as many visitors as possible.

I believe my friend had given up because I was the only one that would visit because everyone was frightened of the MRSA. Her family stood at the door one time talking at her. I have never seen anything so sad, her reaching out to them and they were not willing to suit up and touch her. I suited up and gave her as much physical contact as possible, the nurses said she was only peaceful when I was with her. They didn't even go see her in the hospice facility.

So give him a reason to recover if at all possible.
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ABoston Jun 3, 2019
MRSA is pretty frightening for an elderly person (he’s 89), and It has gotten into his bone, though not his blood yet (fingers crossed). I am the kind of person that would like to hear all of the possibilities, even if they are bad, so thank you for your realistic response.
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My mother has been in rehab for 2 weeks now; she's 92 and had hospital delirium (which is very real) while in the hospital for 6 days, and hasn't had much improvement now while in Rehab, either, unfortunately. She is babbling and making NO sense most of the time, yet other times she's fairly lucid. It's a horrible thing to witness, I know. Definitely insist your stepdad be checked for a UTI, and if it's clear, look into a hospice evaluation. What does the rehab doctor have to say? The whole thing is really a nightmare with these old folks going thru these illnesses, isn't it? My mother had double pneumonia, which she's recovered from, but I'm really not sure if she'll wind up recovering from the REST of it.

Wishing you all the best, my friend, and sending you a big hug
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Reply to lealonnie1
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You might want to see exactly what medications they gave him when he started the decline. My mom was in rehab for broken hip and she could not stay awake to do physical therapy. When I checked the nurse had given her not one but 3 pain pills in one day. Of course she could not wake up. I had to request they only give her Advil and nothing stronger.
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my2cents Jun 6, 2019
Yes, yes, yes. We had to request the ibuprofen only SEVERAL times and finally had to get ugly about it to stop it. It was a rehab, and I use the word loosely, because they put her in a diaper, gave too many pain pills, and she was losing ground. Records said she was in therapy like 2-3 hrs everyday, but really she was sitting in a wheel chair waiting on her turn to try something. She went in walking and released in a wheelchair when she was deemed 'at a plateau' in her rehab. (She was released immediately after I reported the cna giving her the wrong meds...for the second time)
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Normal? For some it may be. For some it may not be.

Where was he living before?

MRSA is very difficult to treat. Boston, how was his behavior and appetite before?

Stepdad developed MRSA. He ended up in the hospital for two weeks.
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ABoston Jun 3, 2019
He was living at home with caregivers coming morning and evening, and family members coming in the afternoon. When I first went into the facility his appetite was good. He was a little off with his behavior I think simply from having the surgery on his foot while in the hospital. Just a couple of hours ago he began actually feeling nauseous. It’s so sad to see him this way.
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It does sound as though everything is going downhill quite fast. Perhaps the best thing is just to go with it. Even 'bounce back' may not be the best thing if he continues to be so ill. Have courage. He is in the right place for care, so what you can give him yourself is some love.
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Reply to MargaretMcKen
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I’m so sorry about this! If he’s not eating & he’s sleeping most of the time, I hate to alarm you, but I’d be very concerned, at least if he had normal appetite before & was aware of environment. We went through something very similar last year with my 89 year old father in law.

Are they keeping a good check on his sugar levels? I’m guessing you can’t get blood work done more frequently to determine if infection is worse/sepsis developing/kidney failure is occurring?

Sending you a big hug!!!
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Reply to mollymoose
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With every illness the "recovery" will not be as complete or as quick as the previous.
His body is battling an infection, pretty serious one at that. So it is understandable that he is tired and wants to sleep.
Try encouraging the eating but do not force it. If he is entering EOL (End of Life) his body will not require food and it would do more harm than good to feed him.
Keep an eye on this. If you fee up to it call in Hospice. They will help you as well as him. They will answer your questions and make him comfortable. It is never to early to contact Hospice he may not be ready but they will let you know that.
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