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What were the key factors in deciding to move your LO from AL to skilled nursing? Did they want to go?


My mother is 85, end stage copd and chf. She has been in assisted living for 6.5 years and after another Hospital stay due to a small heart attack and pneumonia last month she is now back at rehab. She has been in the verge of death so many times over the past 7 years - it is a miracle she is still on this earth.


She has been in rehab about a month and has made very little progress this time. She says she wants to ‘get better’ and likes to do the pt and ot with their therapists but when the aids try to get her to to walk; use the bathroom etc she refuses. She says she is tired and just can’t do it. She says she is unable to walk or get up on her own and prefers to release her bladder in bed vs trying to use the toilet or commode. She makes no effort to dress herself and only does her nighttime routine if the set everything up for her and hand it to her. It’s like she’s lost all her motivation to take care of herself yet is so pleased for everyone else to do it.


While she IS very sick and would meet the criteria for hospice for a few different things she has been in this state for years. The nurse director says mom can do more but is choosing not to and while she did improve the first 2 weeks she has actually declined the past 5 days. This is not surprising - mom is not one to push herself and is very happy to sit in bed and watch tv day after day But I’m just struggling to understand if she really CAN’T do more if if she just doesn’t WANT to.


My brother insists it doesn’t matter - the end result is still the same.


We had a care zoom call today and the rehab said they can justify 2 more weeks to evaluate but at that point Medicare will no longer cover her stay.


She loves her assisted living place and had friends and things to do and it makes me so sad to think of her sitting in a bed in a nursing home for the rest of her life. She seems content to stay so I’m not sure why it bothers me so much.


she has the resources and will private pay so that is not the issue. I think it’s how much do you push and encourage vs step back?


She does not want to die at all -I think she is just tired and doesn’t want to put any effort.

My mother was in AL for almost a year. She became a two person assist, which isn’t to be in AL. She was sent to the PT floor, and she asked how much stronger did they expect her to get? PT and SW said that if she wanted to go back to AL apartment she had to get stronger. Mom told them she was over the apartment.

They moved her up stairs to SNF and she blossomed. She was always busy at activities, she had a “job” folding towels for the hair dresser. She went to church services, and all the programs that went on.

Nobody was left in bed, unless they wanted to be. Not until the last few months of her life she started spending more time in bed.
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Reply to LisaNJ
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Is your only NH choice the one that will allow her to be “....sitting in a bed........”? I ask because MY mother’s life bloomed in her NH placement. She participated in activities, toddled around in her wheel chair, got in everyone else’s business (in a charming way), and was loved by most of the staff.

If she “does not want to die” then perhaps one of her therapists will be willing to perform a “come to Jesus- BUT YOU NEED TO SHOW HIM YOU WANT TO STAY A LITTLE LONGER HERE” moment, to encourage her to get her act together for her own good, and do her therapy routines for just a few minutes. If somebody can pull that off, she may be able to get herself a little more in gear.
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Reply to AnnReid
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Does her doctor know about this "tiredness"? Did it manifest itself in the hospital?

I'm wondering if her oxygen saturation is good, if damage to the heart muscle more extensive. CHF and COPD can make you VERY tired.

My mom was getting extremely fatigued: alert NH sent her to the hospital and it transpired she needed a pacemaker.

I would look for the physiological factors involved before you decide that mom has given up.
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Reply to BarbBrooklyn
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Sorry you post seems to have gotten lost - The AL will likely have a lot to say about whether they will accept her back and from what you describe she needs more care than most can offer. The crux may be whether or not she actually can walk and toilet, if she has the physical ability but lacks the will has anyone suggested an antidepressant?

If a nursing home is the ultimate answer it doesn't mean she has to just waste away in bed, at my mom's NH nobody was in bed but those who had an acute illness or were dying, everyone else was up in their wheelchairs. (If money is no issue she should get a good custom tilt in place chair as that's where she would be spending most of her day, and ask about a ROHO cushion). It is painful to accept the decline in someone we love and in my experience NH living was truly a culture shock but a good NH still works hard to provide quality of life opportunities for their residents.
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Reply to cwillie
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