My mom is 82. She has congestive heart failure, copd, low kidney function, extreme anemia , mild dementia and has had several major strokes , left side of body(90% regained) and speed and memory (about 85% regained.) She had to move to assisted living in March 2011, but was in the hospital every six weeks because they could not provide appropriate level of care for CHF. She went in the hospital in May 2012 and then to a nursing home where she is now. She has been going from one day unable to do anything but sleep and not eat, the next day agitated and aggressive to the next day somewhat normal. Last week I reviewed her medicene list. In April her dr. had given mom vicodin am and pm for pain she was having in arm and leg. it was to be for two weeks, but in the meantime mom went in hospital then to nursing home and this was never changed. She was getting a Xanax at 8 am, then vicodin at 10 am and same at night. I asked for medicene changes to see if this was causing some of behavior. We changed the Xanax to another anxiety medication given only every twelve hours and stopped all the vicodin. This week my my is alert, dressing herself and happier. she still has some confusion talking about the preacher setting people on fire, but much better. I am now concerned that maybe the medicene was causing the problems that were seen that led to the belief she needs to be in nursing home. she wants more physical therapy to get her strength back but medicare and medicaid will not pay for any more. i told her she will just have to get up and walk around more with her walker. I spoke with the doctor who said even if the behavior was caused by the medicene, she needs nursing home care to take care of her other physical problems and the dementia is slowy progressing. i tried explaining to mom that she is healthier because we can control her issues there, but she wants to leave. the problem is she is a medicaid patient and our assisted living facilities have gone private pay. I cannot bring her home with me because I have to work. I am the only caretaker as all my siblings live in other states out west. I am glad she feels better, but now I have a different set of problems in her anger at me not taking her out. It is making things even more stressful. On top of that my daughter who is a single mom with three kids just had to move back in with us. I am really overwhelmed and tires.

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Your mom is where she needs to be. She has congestive heart failure, copd, low kidney function, extreme anemia , mild dementia and has had several major strokes. I am soooo glad you insisted on drug review and that med changes helped her. She is doing well where she is and with her current drug program. That does not mean she would do equally well in a different setting or with different drugs.

You have way too much on your plate to bring her into your home and assume full responsibility for her. She cannot afford care centers that Medicaid does not cover. Her options are limited, so it is fortunate the present situation is working.

You were an excellent advocate on the medication issue. Continue in that role for her. What would have to happen for PT to be covered again, for example? Did it stop because she was not showing progress? Can you convince someone she is now improved enough so that she could make progress? Has she used up the maximum this year and could have more starting in a few months? Meanwhile, could you walk with her and perhaps do simple exercises with her?

What improvements can you arrange right where she is? Would taking her out to lunch once a week help? Are there activities at the NH she might enjoy if she were encouraged to try them?

You've done an excellent job! Continue in your role as advocate and in making her life as fulfilling as it can be right where she is.
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