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My mom suffered an ischemic stroke at the beginning of January after having heart bypass surgery.


She was fortunate enough to be able to go to acute rehab and handled it well (psychologically) for 3 weeks. They allowed 1 visitor per day and I was there almost every day for that period. Unfortunately, she did not make much progress.


She currently can drink normal liquids and eat most types of food. She can speak clearly. However, she has many serious limitations. Her left leg and arm are completely useless and she is bedridden. Transfers, posture changing, showers, etc. are all pretty much max assist or completely dependent. She suffers from extreme fatigue. She is incontinent and had a catheter, but I think she's just using diapers now. She lost the ability to tell time and will call people at 3 a.m. thinking it is dinner time. She has severe left side neglect, and will be unable to find objects right in front of her, even though she can read text with effort. She has some cognitive impairment, mostly related to problem solving/executive function and short term memory. Unrelated to the stroke, she has almost daily moderate medical issues: fluid buildup around the lungs, UTI, saline IV for fluids, about 20 different types of medications. She also has severe anxiety brought on by the stroke (no source to point to and it's been consistent since mid January).


As a family, we agreed that the next best step was to put her in a Skilled Nursing Facility. She was completely on board up until the day she was transferred. Two immediate (nuclear) family members are physicians and said we had very little other choice. After 6 hours in the SNF, she called me at close to midnight BEGGING me to come home. I've never heard her in distress like this and as the child (35) in town, I feel responsible for taking care of her. I'm freaking out a little bit as a result. She continued to plead with me all of yesterday and told the staff "she was leaving." The SNF does not allow any visitation due to COVID which makes this even more complicated.


Very recently (past couple of days) she started to develop hallucinations, including thinking she was 1000 miles away near her childhood home and could hear the ocean, and saying that the social worker told her she was going to return to the acute rehab hospital (which she most certainly didn't). She was up until this week a sweet, docile, kind woman, and has instantly become terror-stricken, agitated, and combative. She's horribly confused and is insisting to me that she is trapped in this facility even though I say that's not the case, and I want her to calm down so she can propose a solution. Most of her complaints are inattentiveness in the facility and the fact that she doesn't like the environment (not to mention the panic she's in just from the anxiety).


I'm an able-bodied man in the same city as her. Our family has money to cover any option, and I have no absolute responsibilities of my own (I was job hunting when this happened, done with school, no kids, etc.). I desperately want to do anything I can to help her but we decided to put her in the SNF for a chance at rehab, safety from COVID (family says bringing home help in might be risky), and because of how much attention she needs for essentially every function.


I know this is a lot of text but I would appreciate any perspectives you have based on what I've written here. I feel like the stress is going to kill my mom, or she's going to be a sedated zombie by the time the week is through. This decision seems like I'm condemning my mom to a terrible fate, and I don't want her life to be like this. I'm just trying to take care of her with the recommendations of my family and what I consider common sense. Please let me know if you've seen a similar situation, how it can be navigated, or if you think she really should be brought home.

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Just thinking about you and your mom - hoping she is feeling better and you are just getting settled into the new normal.
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I happen to be your moms age and had a similar problem. I was hospitalized after i had a small stroke. The week after I had some surgery. I started hallucinating as soon as I was prepped but didn't know it at the time. When I woke up I continued to hallucinate, lost track of time, started panicking, and called people to come save me. I thought the hospital was full of aliens and would not let me go. I had all kinds of crazy, night terrors,, confusion,, paranoia,, scary hallucinations that made me pull out ivs and lock myself in bathroom. I know what she is going through. I believe all the medications I was suddenly taking had caused me to go bonkers. After I stopped all the meds, blood thiners, pain pills, antipsychotics, meds for epilepsy and movement disorders, sedatives, you name it I came back to earth and was fine. Has she been taking different meds or more meds? You might look into it.
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Isthisrealyreal May 2021
Oh my, I am so sorry that you had to go through that.

I am happy that you are recovered and found out what was the cause of your experience.
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In some cases, there comes a time when they must be placed. To me personally, the worst thing that can happen (for me) is a nursing home. Encourage her with activities and temporarily ask the doctor for some medication until she can adjust better. It takes time as it is a terrible shock to someone to be in a nursing home. But what choice to you have?
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ADM.... Your Mom is lucky to have such a caring son, I applaud your commitment to her well-being. I just lived through a very similar situation(s) with both parents. Mom is still in assisted living (4 MILES from me) Dad passed away on January 12th after almost 7 months in an SNF. Our family finally agreed to put him on hospice on Jan 4th, I was finally able to go into his room and touch him skin to skin on Jan 7th. I never stopped trying to find a better solution for his care,I we wanted to take him home to our house but the SNF had my brothers convinced that he was a fall risk and needed 24/7 care. He never even liked assisted living, never wanted to be helped, In an SNF he had no choice, he made the best of it, and they all loved him, of course, cause I know he asked for nothing, and never complained. What I learned over this :
1) You will most likely never be totally happy with her care - get her as close to you as possible and be her eyes and ears. You must be her voice.
2) Ask for her care plan to review and request a meeting if you would like to make any changes
3) buy your MOM A Grandpad! It is amazing. My dad had problems with his cellphone, either was not charging it, could not find it, had difficulty using it! I got dad his in early December, Its like a min iPad. I set up a family network with my Mom, all kids, grandkids, his two sisters and a few friends. He video called all of us through December, the aid entered our Christmas eve Zoom call number. He saw all of us and was able to say hi. anyone can post photos, you can add her favorite music, you can choose any games she likes to play, bingo, tic tack toe, word search. I edited my dads to disable everything that i knew he would not use, Check it out, if she can use it, it will help minimize her isolation.
i really cannot say enough, it brought my dad so much joy, family was everything to him.

All the best to you and your mom, may God be with you both.

https://www.grandpad.net/?gclid=Cj0KCQiAj9iBBhCJARIsAE9qRtCPF77auFKZIlP1rcfmQZGmrBp72Ptkm5yRObVOVJxg2RJD4N5IoqcaApdlEALw_wcB
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I I'm so sorry to hear of your situation. You mentioned that financially you would be able to cover whatever expense it would be to take care of her. I would highly suggest that you bring her home and have home health Care, by a nurse, or nurses aid to help care for her. It sounds as if she is in a terrible situation, not only because of her physical limitations now, but being in a strange environment with people perhaps who are not caring for her the way she was in rehab. Many times when people go into nursing homes they are given antipsychotic drugs to control their behaviors. These drugs absolutely make things worse. My husband had dementia, in and out of clear thinking and forgetfulness.His doctor recommended the hospice program, and I agreed. However the doctor was prescribing antipsychotic medications, instead of a tranquilizer for his compulsive behaviors. My husband had very negative side effect s from it, extreme agitation and anxiety. I refuse to give it to him, so the doctor gave him Ativan instead. That was a huge difference very positive. Your mom's condition of anxiety could be the result of medication she's being given, the nursing home staff are not a good fit for her, plus her medical condition of losing function of her independence. If she's begging you to bring her home, and you can afford to have home care for her, please do so. Her mental state is all she has left. I am 72, and if that was me I would want to be with my family regardless of the fear of covid-19. It's all about the quality of life. I wish you and your mom well. This is such a difficult time I know. But trust me, whatever decision you make will stay with you. I put my husband into respite care, which was supposed to be a five-day stay. When he went there they were giving him drugs and he could no longer speak, or eat, or drink. They said it was his condition. But the day he left he was fine he was eating and drinking and talking. I live with guilt every single day because after six days he passed away. That will stay with me forever.
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LoopyLoo Sep 2021
“I am 72, and if that was me I would want to be with my family regardless of the fear of covid.”

Comments like this do nothing but guilt trip. Just because the son can pay for care now does not mean he can pay for it long term. Having 24/7 care at home for years on end isn’t feasible.

Maybe you don’t care if you get or spread Covid, but all of the is residents in the NH do. They cannot risk anyone being exposed.
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hi, hang in there, these things are common, mine did too and panicked at the exam ( to check for bedsores etc) My heart goes out to you having been in that place. Moms hallucinations were brought on by a med IMO and Dr was quick to discontinue. And "seeing" a lil girl has ceased. Communication is key, talk with her Dr or Drs nurse direct about all issues. Moms Hospice care is good and the med pack mailed here at home works well for anxiety, pain etc The ocean noise may be Tinnitus which can be ringing, buzzing or roaring, tc prayers for improvements
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Adm101: I did see your update of February 21, wherein you stated that your mother is doing better, which is good. I do not advocate that you bring her home. Prayers sent.
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If your family has money to cover any option, than bring her home and hire in home caregivers from a reputable agency. I don't believe she'd have any more of a chance to catch COVID at home than at the SNF,
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Based on a couple replies to my post, I want to clarify that the money placed in the trust each month goes directly toward my mothers care (with receipts as proof). Private pay does not last long at nursing homes and Medicaid ends up paying the nursing home bills when private funds are gone. What most people do not realize is that Medicaid also offers in-home care programs and it is in many cases less expensive than nursing home care (even for Medicaid). And the person gets private care, which has worked out great for my mom. I will not get any inheritance because the money that goes into the trust is her social security/retirement benefits which will discontinue upon her death. I did not mean to offend anyone, just trying to build awareness about in-home care options. It was complicated to set up and in our case required an elder care lawyer to set up. But it is doable.
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Lymie61 Feb 2021
That’s great that you are in a state that has those programs, my mom is too at least while they are funded but not all states offer aggressive in home care programs funded by Medicaid and they aren’t all the same, Just so people don’t get excited and then disappointed or frustrated when they can’t find the set up your talking about.
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I wonder if all this she's been through hasn't brought some mental health /cognitive/dementia like issues to the service; and don't forget the impact of the institutional settings...there is a real animal called ICU psychosis and I wonder if something similar might be happening considering her environment and changes and trouble with telling time. I am far more sensitive than I used to be about negative comments in re to SNF since last fall I nearly died and had a dissected aorta. Your description of what your mom is suffering makes me realize how lucky I am to be here and to have not suffered a stroke during it or the surgery to fix it. The thought of my being dependent and not being able to take care of myself or my canine kid brings me to tears....
It will be a huge impact/burden to get her home...to her own, to yours, to a new place possibly....but I can tell you that my experience with a supposedly nice rehab, had me climbing the walls and was quite depressing. The food WAS dreadful and I will not doubt anyone who ever complains again. It also was awful to not be allowed visitors. It is probably a challenge with all the symptoms and what's happened to sort out what is really going wrong, but I would start to try and find a psychiatrist (since meds seem to be involved) experienced with elder care. And not one the facility suggests! Be aware that any drug, but especially those for psych condtions/symptoms can react differently in elder adults, and if on one, the person should be weaned off typically. I am so sorry for what you are having to deal with, apparently alone. I was just a bit more assertive with my 103 year old demanding father last night...we all live at home...with my mother who is 98 and has dementia. Instead of lightening my load of concerns (all of which contributed to high blood pressure which led to the dissection) he adds to them by expecting ME to be present for the meals on wheels delivery (which I encourage you to look into if she comes home) and to replate and reheat it. He is perfectly capable, in good health, and present, while I am working remotely upstairs...trying to hold my job until retirement! Hoping I live to see it! Good luck. I also encourage touching base with a certified elder law attorney...they will guide you through the issues whichever path you take and also probably be aware of the better agencies for at home caregiving. Sending hugs and best wishes that it goes as easy as it can for both of you.
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gdaughter Feb 2021
PS: I think in your post you mentioned something about fluid...I had the "pleural effusion" added to my list of issues and nobody was especially hysterical about that...no not the best to have, but basically the best thing would be to be up and walking, physically moving around...not sure they are giving your mom the individual time and attention she needs....
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I have had terrible experiences with these types of facilities. They often do NOT provide care and are often abusive! They love to DRUG patients in order to do less work. PLEASE LOOK INTO HOME CARE for her. It is obvious this place is NOT working out. Please don't let what happened to my sister happen to your mother! She died during the lockdown ...not from Covid. It was from dehydration. They were denying her any food and water, because they decided it was time for her to die (she was NOT dying).
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gdaughter Feb 2021
Heartbreaking. One can never be too aware. Which is why when dogooder/meddler types in the past 10 days have suggested placing one or both my parents with no consideration of the financial impact, they also don't realize me being me, that I would bear enormous stress in even investigating to find a place, and then worry about the care or lack of it, and not being able to visit due to COVID. I do hope you have reported what happened to your local long term care ombudsman's office who can also tell you where to file a complaint with the state or beyond....
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Since you have financial resources, meet with an Elder Lawyer ASAP. Our elder attorney was able to move money into a trust and get my mom on Medicaid. You can either use your moms money to pay for in/home care, or Medicaid has programs for in-home care. I’ve been doing this for 8 years and have been able to keep mom comfortably at home. a great place to find caregivers for private care or through Medicaid.
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Isthisrealyreal Feb 2021
So glad to hear that you are going to get a nice inheritance at the taxpayers expense.

Most people think that the money they have should be used for their care, not hidden, legally or otherwise, so that they can go on welfare so their offspring can benefit from their lifetime of hard work.
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Forgot to mention. Watch for UTI's! Especially if incontinent, UTI frequently causes hallucinations. And if has not had COVID vaccine would wait until her symptoms settle down so as to not have so much going on to know what may be causing what.
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These decisions are terribly difficult. You obviously care deeply and have given this much thought! From my experience, I can absolutely say, nursing home is last resort and any amount effort to have mom at home will likely be worth it in the end. Especially if you can handle it financially. Maybe a TRUSTED live in caregiver could be an option. However, family input is important, they are close to the situation. It will be extremely difficult, most likely, to care for mom at home. Not sure how old she is; I guess weighing giving it your all now for 5-10 years or continue to wonder if nursing home is right choice. Depending on if there is any dementia or not, moves are very challenging for the elderly, so good you are thinking through. You are a very good son!!! So from my experience, I would say have mom home if you can find a caregiver. In a nursing home people have almost no say in anything which takes away from feelings of self worth. I am sure you will make the right decision, I can tell you that knowing you did everything you could for as long as you can will be a huge blessing when the time comes for mom to fall asleep. May your strength see you through!
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You expressed yourself well. This may be the time for at least a couple of harmless lies.
First, ask the staff to hide her phone after 8 pm until morning.
second, tell her the doctor says she has to stay another “few” weeks before he can decide if it will be ok for her to go home.
I used the second suggestion with my wife years ago and soon enough she would nod her head yes when I asked her if she liked her room and the staff. (She was in the same “condition” as your mom but she could not speak at all.)

Also I routinely asked her a couple of times per month if she would like to take a trip to Florida/California/ Grand Canyon/etc when she “gets better.”
Such strategies served us well for the ten years she was in the skilled nursing facility.

Grace + Peace,
Old Bob
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Please have her medical doctor and a neurologist exam her. Anxiety related to change and moving to a new place is expected and can be managed medically. Hallucinations are something else all together. There can be multiple causes for hallucinations: infection, poor oxygenation, blood chemistry imbalances, new stroke... Only a thorough examination can determine the cause and the proper treatment.

Once her medical issues are addressed, she should settle down. It may take a few weeks for her to get used to the new routine. Once she is acclimated, her anxiety should calm down. As you have noted, she really needs to be in a skilled nursing facility. "Coming home" does not mean living with family but a home she lived in from her history (not an option).
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My suggestion (based on experience with my mother) is to have her examined by a neurologist. And Google “ICU delirium.” Good luck. You are in a terrible situation and there are no easy (or right) answers.
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sorry for all her issues. I don't have any good answers but some of it might be due to the stroke and the changing of where she was to someplace different. Is there any way they can put her on a small dosage of anxiety meds? none of us want our loved ones to be zombies and believe me I don't think neither do the nursing homes, but it could be just all the change, she is upset because she can't do things she normally did. Even if you don't have a job, how do you plan on paying bills, etc. everything that is done for your mom should come out of her money, but at some point you will need things yourself and if you don't have a job and/or your unemployment runs out, then what? Also, as time progresses she is going to require plenty more assistance than you might be able to handle. speak with her doctor to see if and what happens with the kind of stroke(s) she has had. i wish you luck.
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My father suffered an exact same stroke as your mother. Left sided totally parylysis. Covid has been unyielding! I am a seasoned nurse who could not protect my father from the acute and subacute rehabs, and the "unskilled, understaffed SNFs" he endured while trying to recover. He lost 100lbs, his will to live was gone , he was depressed, isolated, anxious and had reorientation issues similar to your mother. Ie phone calls in the middle of night, it was harrowing to be on the other end of the phone wandering where the staff were and why no one cared. His body became further injuried by the inattentive staff no range of motion was performed therefore leading to stiff muscle contractures. You are greatly fortunate that you have the finances to pay for homecare support. I took my father out of the facilitys prayed that home would be better. I have a live in caregiver via an agency that is marginal at best but still risk it because my dad improved immediately.
If you have family help and MDs to advise you please check medications first! My father was on overlapping meds that hindered his ability to rehab and exercise well. I got him a antidepressant medication which took affect and made his depression much better and brought back his motivation and incentive. I also got him on a wake sleep program that involved meds for insomnia and he can sleep 8hrs without issues. He increased fluids which decreased UTIs.
My plans were to have him in a adult day care for 8hrs, then homecare at night. However daycares are still closed in PA so we are waiting it out. My father gained 50lbs and is a healthy weight now. His skin and muscle tone improved greatly , his mental status and attitude improved, and remarkably he regained a small amount of movement in his left leg. There is alot left to do, he hasn't been able to seek medical follow up because of covid and transportation issues but its better than before.
Please try whatever it takes to bring your mother home and at least give it a shot. Get with a social worker to advise you on your insurance options, veterans benefits, local community resources, and homecare choices. Find a support group (which I know sounds funny because your thinking when the flip do I have time to attend a support group)? But remember good resources are key! Bad ones waste time and energy...
It is all consuming, mentally and physically but if you dont try your mom could suffer further.
If you can't handle it at least you know you tired your best! Thanks for listening and please reach out if you need anything.
Namaste
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Lymie61 Feb 2021
I have to point out that you are “a seasoned nurse” who is still using full time help to care for your dad and knows how to provide the personal stroke rehab treatment. You are still recognizing the difficulty and toll, I imagine it could be far greater on a 35 year old untrained son caring for mom and without the training and experience you have results might not be similar. I’m not saying he shouldn’t bring her home if that’s what he really thinks is best just that you aren’t comparing apples to apples even if your loved ones afflictions are so similar.
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HI there! I am an RN, caring at home for my disabled family member in my home.

First, I would like for you to explore the idea that your mom may have a uti. Frequently these cause confusion, agitation, and dementia symptoms. A test to diagnose or rule out is simple, and treatment is easy. Yet without treatment, sepsis is a possibility.

Second, I am a caregiver of a disabled family member who, through a series of unfortunate events, was taken out of a facility and then basically abandoned by his adult daughter, who proceeded to spend almost all of his disability funds on herself. (She is currently charged, and out of jail on bond pending trial.) As a result, we took him into my home, at the request of APS. Due to covid, the legal process of obtaining guardianship and conservatorship was long and drawn out. To summarize my living environment I will simply say that you should NOT bring mom home in her current state. It will cause you mental and physical hardship, and you will not be able to leave your home. You are not in a relationship now, but if you meet someone, want a career, or decide that you want children through adoption, you will not be able to. We hired a full time caregiver, but she does not stay on nights or weekends. Reliable help is almost impossible to find, no matter how much you are willing to spend. The behaviors of my family member who has brain damage and several medical issues, along with the frequent medications and toieting issues, and the verbal outbursts (he called my son with high functioning autism a "retard" at the dinner table last night) are horrific. We are currently seeking placement. I do not know if my marriage and my family is going to survive the fallout from this if it goes on much longer, we are told the wait for a bed is 2 months to 2 years. Our family member has been with us for a year.

He is not the same person he was before his brain damage. He is in his early 50's.
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Chickie1 Feb 2021
Praying for you and your loved one.
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Is she on any new medications? This happened to my Mom...very similar situation as yours....hallucinations, personality change, confusion, agitation. My Mom even believed that they were trying to kill her in the SNF and called 911. Thankfully I was there when the police came. Turns out that they had put her on steroids when she entered the SNF (she had metastatic cancer that was spreading quickly) and as soon as they took her off the steroids she returned to normal. It was bizarre. But don't rule out a possible medication or physical cause (like a UTI).
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Hi everyone - I just wanted to post an update. I'm positively overwhelmed with the support, empathy, and insight that you have all provided -- I didn't expect to find such a great resource and I am very grateful that you all took the time to respond. It's helped me understand the resources available, general approaches to dealing with this kind of problem, and it has helped keep the stress from being overwhelming.

Mom is doing a bit better, fortunately. The hallucinations seem to be absent and her generalized anxiety/panic attacks have greatly subsided. I'm not sure exactly what the cause is; I can imagine it being either treating the infection, adjusting to her new environment, or may simply be the subsidence of a cyclical issue, but there is some relative calm. The remainder of her psychological concerns have been reduced, at least for now, to general confusion (this morning she kept punching buttons on the TV remote thinking it would summon a nurse, apparently forgetting about the dedicated call button remote in the process). She even brought up the idea of looking at facilities to settle in for the longer term, mentioning in the process that she had a former neighbor who lived in one and she (my mom) liked it when she visited.

The family and I are all in agreement that the SNF is the best option for her. The posts here have made me realize that pulling her out of the facility in an act of desperate compassion would likely do much more harm than good, both to my mom and myself. It has been difficult to process my thoughts under duress which is why I reached out for some thoughts, and I feel much better equipped with information and clarity.

Thank you, sincerely, for your generosity here.
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Adm, one more thing; at some point, someone may recommend transfer to a psychiatric hospital or "senior behavioral unit". Say "yes, thank you, or suggest it yourself if her anxiety and combativeness continues to be out of control.

As horrifying as the thought is to ALL of us, these places are mostly very skilled at getting the meds "right". My mom never needed to go this route, but one of my colleagues, younger than your mom, spiralled into an unremitting depressive episode a couple of years ago. (This is a mental health professional--her thought process was unrecognizable to me while she was in this state).

The specialty hospital found the right combo of treatments and she is back in practice.

Several posters here have also had positive experiences with their parents. Solving the psych issues is actually more fundamental, because the rehab won't go well without it.
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Adm101 Feb 2021
Thank you for the heads-up about advanced psychiatric care, which hasn't even been on my radar. I will add another post here as an update, but I am keeping my fingers crossed that we will not have to pursue that. In any case, just knowing there are resources to deal with these mental health problems in the event she does continue to suffer is reassuring.
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Adm101, I am so sorry that your mom is going through all of this so young.

Is it possible that she is having mini strokes and that is why she is getting worse?

When you have the conditions that your mom has it is very common for sudden and sharp declines. So prepare yourself for a rollercoaster ride.

My grandmother had a series of strokes that took her from fine on Friday to full blown dementia on Monday and she never recovered.

Strokes cause brain damage, unmanaged diabetes is a common in dementia patients and top all of that off with heart conditions. Which it is very common for mental health issues to come up after a cardiac incident. We were warned that we would see this as time went by with my dad, it could be part of what your mom is experiencing.

Be her advocate and loving son, please do not bring her home and try to care for her. She will not get the best care possible, because of everything going on with her and you will feel wrecked in no time by the constant worry and struggle of trying to care for her.

You are fortunate that you can afford options, perhaps hiring a companion that will be allowed in the facility as a caregiver to give your mom some reassurance that she is being taken care of and that she will be okay.

Great big warm hug! This is so very difficult. My dad was only 69 when his decline started and it was heart breaking to see such a young person lose so much.
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Adm101 Feb 2021
I do believe it is possible she may be having mini strokes, but to some extent it would be very difficult to tell unless she developed new and obvious symptoms. She's in such an altered state right now that I think many symptoms might be confused with drugs, so figuring out what the exact cause is could be challenging, short of repeated trips to the neurologist.

I am sorry to hear that this happened to your dad, too. It's absolutely tragic, but if nothing else it has made me reflect on how much I cherished my parents in good health, and how fortunate I am not to have suffered a medical setback. Thank you for this advice - I'm sending a big (albeit virtual) hug right back at you!
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Adm, I'm so glad you understand what we're all saying!

So, after subacute rehab, we were hoping that mom could go to a nice AL (the one at the rehab would not take her with a dx of dementia). We found a fabulous one near where my brother lives with several levels of care available--regular AL, basic memory care and advanced memory care.

The AL assessed mom and though she might be a better for basic MC but had no bed available. So we moved her into the AL section with some extra oversight by staff. Within 15 minutes of us all leaving, mom fell and just lay on the floor until someone came by to check (they had said they would check every 10 minutes and they did; we got the call as we were driving away. (Mom could no longer process the idea of pushing her wrist call button to summon help).

We moved her immediately to the available bed in "Advanced" memory care. Mom seemed dazed and very confused from the moves. She declined before our eyes.

We hired a 24/7 aide to keep her company, feed her, make sure she was hydrated and getting where she needed to go. On the 3rd or 4 th night (this whole time has a nightmarish quality in my memory), mom got up to use the restroom; there were 2 aides in the room--her roomate also had a 24/7 aide-- and mom fell before either of them could get to her (spacious rooms have their drawbacks). Mom SEEMED okay after this fall but she was taken to the ER and everything was xrayed (hips, pelvis) but mom stopped wanting to get out of bed and was very resistant to PT. The very alert PT noticed that she wasnt bearing weight on one leg (she looked kind of like a racehorse that has gone lame) and he insisted on a new xray. Mom had a broken hip.

Hip surgery repair was done, thankfully under a spinal anethetic, because general anethesia is VERY hard on the elder brain, something to keep in mind if your mother's surgery was recent. One month's recovery for every hour under is the rule of thumb.

Anyway, it was clear after the surgery that mom needed a much higher level of care than AL or MC. We had a GREAT discharge planner at the hospital who pointed out to me that often it's not the fall that causes the break, it is the break that causes the fall. I had told her that my mom fell with 2 aides in the room; she replied that her mom had fallen with 3 RNs in the room, and one if them was her, the daughter.

We got great advice about placing mom in a NH that would accept her as a Medicare rehab patient, but that would allow her to stay (after a certain number of years as a private pay patient) if she needed to go on Medicaid.

I recall thinking as they wheeled mom into the NH that she would probably decline and die quickly... she lived for 4 1/2 happy years. Thanks to good psychiatry, she was on the above mentioned cocktail of meds that kept her happy, alert and calm. She had CHF which was treated conservatively, had a pacemaker put in (we left that decision up to her) and eventually we asked for palliative care--no more hospital trips as they terrified her and left here more depleted and never got back to her baseline. She passed away after 3 days on hospice after a fall at the age of 94.

I hope this is helpful. Please feel free to ask any questions.
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Adm101 Feb 2021
This certainly does help and I appreciate you taking the time to provide some more details on what is a very difficult series of events. Hearing about how other people have navigated these challenges and what their advice is helps keep me focused on what's important, and I feel much less overwhelmed than trying to figure it all out by Google or trial & error.

I had not even considered the effects and burden of the surgery itself, which may be compounding everything else that's going on. It may make us cautious in the future about pursuing somewhat optional interventions (the doctors had originally planned to have her come back for additional stents, for example).

Despite all of her issues, it is inspiring to hear that your mom beat the odds and managed to survive for a few more years. No matter how exhausted or stressed I am, I cherish every minute I get to spend/communicate with my mom because I know that she's in a very precarious position.
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https://www.alzheimers.org.uk/get-support/daily-living/delirium

She's had multiple traumas in a short time -- stroke and loss of abilities, hospitalization, a rehab hospitalization, and now a skilled nursing facility. It's a lot to handle for a younger, healthy person, let alone an older person.

Consult with the doctors at the SNF to see what they recommend. She'll get settled in eventually, but she probably won't be the same. Every trauma is a little harder to recover from, so expect the bounce back to be a little less each time.
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Adm101 Feb 2021
These setbacks do seem to build on each other. I will take a look at this resource and learn a bit more about delirium and how to manage it. Thank you for your perspective on this.
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That you already have two physicians in the family is a comfort to me, because I do believe that they would caution you against bringing your mother to live with you, or supposing that 24/7 care is affordable over a long period of time, to live in her own home with caregivers. I think that from my own experience recovery from stroke occurs within the first two weeks, or--sadly--seldom at all without tremendous determination and hard work as well as full cognition. That is my personal experience of it. Many physicians are now so highly specialized that even your family members may hesitate to tell you this, but if they consult with friends in neuro/psyc, I think many would agree with me.
The UTI will be addressed; it will be of interest to see if there is any improvement after that; there may be in terms of agitation. I hope there will be.
That you feel so dreadful hearing what you are hearing is indeed more painful than any of us who have not heard this desperation can even begin to imagine. But the truth is that not everything can be fixed, and your Mom may not be appreciably better. There may also be continued heart and brain incidents.
I know you don't want to hear this, but placement is the only--and the very saddest--option I can imagine right now, and hospice when it is possible.
I am so sorry this happened to your Mom. 68 today is still young enough to have so much of life left, but when this occurs all choices are really removed from us.
You say that finances are in place to let there be options, and there is nothing to say that you cannot try options, but my suspicion is that it will only prolong what may be inevitable. I am so sorry this happened to your Mom, to your entire family.
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Adm101 Feb 2021
Thank you for this advice and the sympathy. I agree that while the decision is less than desirable, it may be the only sensible option on the table for us. My dad echoed the same sentiment that most stroke recovery tends to happen upfront but that we should not give up hope (or let mom give up hope). It's certainly one of these "hope for the best, prepare for the worst" scenarios.
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Adm, my mother-in-law (MIL) went to emergency room with a UTI. She is late stage parkinsons with a Supra pubic catheter. She tried to pull it out, telling us she had been shot with an arrow while camping. Change from her SNF to ER caused delirium. We got her treated and back to her facility. Now? She calls us at random times, no one ever comes when she pushes button, they don’t feed her...and she wants to come home. No one wants to leave home and live in medical facility. Please tell her medical professionals that she needs to be evaluated for anxiety and may need antibiotics. My husband said it helped when he recognized that the home she wants to return to is one where she is healthy and no medical issues. He can’t move the clock backward and she cannot afford hundreds of thousands of $$ for 2 persons 24/7 care. You can’t be a nursing home, but you can be her advocate for care. She would want you to have a life separate from her needs, and you won’t as her full time caregiver.
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Adm101 Feb 2021
Thank you for this response. "You can't be a nursing home" is pretty much why we made the decision in the first place.

She is on antibiotics for the UTI. If she were at home when this developed (along with the myriad of other problems), I'd be Hoyer lifting her to the hospital daily. She's also on two antidepressants and has seen a clinical psychologist in the rehab facility who helped manage her anxiety on a day by day basis, but she's only been in the SNF for two days (and it's the weekend) so I think the only thing they may do is try to triage with Xanax. I will talk to the social worker and the nurses and see if we can get a psychiatric consult ASAP.
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Adm101 Feb 2021
I previously came across this article in a frantic Google search, but totally lost track of it in the frenzy of trying to deal with all of my mom's issues and didn't take the time to properly read it. I appreciate you sharing this resource as it will be a good reference as we navigate these challenges.
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Agree with Barb, obtain a Geriatric Pschiatrist asap.

Your Mother has had a major health crises. The right meds can be a rope to reach people in crises before they spiral down further.

Once things are more stable, you have time to start the long process of adjusting. Time for further tests, PT, counselling etc.

I think for now, aim for medical stability. She will get used to the regular staff & routine.

I have personal stories re ischemic stroke I will post later, regarding what home care could look like. But if not stable, results in bouncing back into an ER - which is distressing to say the least.
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Adm101 Feb 2021
Thank you for your perspective on this. Your description of meds as a figurative rope has helped me realize how time-sensitive treating these issues are. I'm also trying to remain optimistic that she will adjust to the new environment, at least enough to not treat it like the actual end of the world.
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