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My mother is in a nursing home and can no longer feed herself. It takes her an hour to an hour and a half to eat a meal when someone has the time to sit and feed her. She lost 5 lbs this past week. Recently she told my brother she wasn’t hungry and didn’t want to go down to dining room. Not specified if it was a one time request or just that one time. She does eat when fed and will tell you when she’s had enough. They just don’t have staff to devote to feeding one patient. Now he wants to stop feeding her altogether and just let her pass away. She does have a DNR and ‘no feeding tube’ on her medical wishes. She does have some dementia. I want to hire someone to feed her meals. They haven’t even suggested or tried Ensure or Boost yet. I don’t know what she wants but brother says she isn’t capable of making her own decisions anymore. I think refusing to eat altogether would be a decision. She still eats when food is offered. Just takes too long for staff. What are other opinions on this from people who had to make such a decision?

Your mom is eating food when offered. No matter how slow or cumbersome the process is for her, she’s showing desire to eat. A day may come when she’ll no longer want food and will refuse to eat. The two are very different. Thank you for advocating for your mom and her need to be fed
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Reply to Daughterof1930
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Oatmeal55 Nov 16, 2019
Thank You!!! This is what my argument has been! Wish sibs would understand. Anyway, on my way there now. Plan is to feed her three meals a day for a week to see if she still loses weight or refuses food. Then re-evaluate. Is it her or is it nursing home staff not taking the time?
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You may need to consider that our seniors are often greatly influenced by the attitudes expressed about their weaknesses. One older lady overheard a granddaughter talking about how gross it was to see food falling from her grandmother's fork because of her shaking hands so she stopped eating in the presence of others. This became a big problem when her husband died and she lost his help and encouragement.

My mother's first cousin in NH with Parkinson eventually lost the ability to feed himself and his wife or daughters went at every meal to feed him. He would refuse food before accepting help from the nursing home staff because at some point, a staff member had expressed his/her impatience with the "lost" time spent feeding him.

It's possible your brother has expressed (not necessarily words, signs, body language) his own impatience or maybe just being uncomfortable helping or feeding your mother and she is refusing food when he's around because of it. Your mother may respond to your patience and eat well for you. If so, then it will be really important to find someone with kindness and patience to make your mother feel comfortable accepting help with her meals.
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XenaJada Nov 16, 2019
All of this makes perfect sense and is very sad too.

My grandmother ended up in a NH during the last year of her life. Thankfully it was only 5 miles from my parents. My mother was devoted to her mom and drove there for every meal for over a year to feed her mother.
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My mom is on hospice and in the final stages of Parkinsons. She too has very arthritic hands so it is not possible to feed herself anymore. Hospice aides and volunteers will not come enough to cover feeding her for every meal. The Parkinsons has affected her swallowing ability so she too is on a puréed diet and thickeners are used for all drinks. When things get too thin she coughs a lot so ice cream needs to be eaten before it gets too soft. My mom has days where she says she does not want to eat a meal and no one tries to force her to eat. Then she will eat the next meal. My mom had told us kids many years ago that she never wanted to live being dependent on others to care for her. And here she is in that situation but the problem is there is no humane way to honor her wishes because feeding someone is not violating her dnr on file.
We have private caregivers that come to her memory care facility and help with feeding some of the time. My father is still alive and he feeds her most of the time. And the staff feeds her some of the time. All of her foods are puréed and they put gravy on them which keep the food moist so dryness is never a problem that I have seen. I would suggest you ask about having them put gravy on foods that can dry out.
Maybe there is a senior in the area that would like to earn a little extra money who would be willing to come feed her? It will most likely be at least 3 different people, one for each meal, that you hire to come in for 2 hour shifts. This would give her companionship as well as help with feeding. i would check to see if the area where your mom lives has the neighborhood app "nextdoor". Then post something in there directed to the local neighbors explaining what you are looking for and you may find local seniors through that. I have had success with this in finding help for my mom.
I can tell you it does not get easier watching the decline of your loved one but you have to just accept how they are and love them unconditionally and know this is not the life they have chosen and feel good that you are doing your best to help them be comfortable and feel loved. Even though my mom can barely talk now due to the Parkinsons she will tell me many times how thankful she is is that I came to see her and she thanks me for everything I do for her. This makes it all worth it to me knowing I am helping out the person who sacrificed so much for me when I was a child.
I wish you the best. Hugs to you and let your heart guide you through this.
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I forgot to add. If she is still having trouble swallowing solid food, you can give her a small amount of some lemon Italian ice. The lemon causes the saliva and the sweet taste will induce the swallowing.

We've been doing this for four years. Another thing I would add is that drinks have to be kept cool or she won't be able to swallow. The staff is letting food sit and deteriorate into a condition that can't be handled by your mom. Food dries up breaks apart, which can't be held together in the mouth. Drinks warm up and the throat muscles will not move to allow her to swallow. I have a neighbor who has Parkinson's without a sign of mental decline. She uses the same techniques.

The problem is that the medical staff doesn't have the time since staffing is kept to a minimum. I would also be very wary of non-medical opinions such as she refuses to eat or has forgotten to eat. It may very simply be that she is refusing food or liquid because they served it to her in a condition that is difficult to hold in her mouth and wait for the swallow. In a word, she is afraid that they will give it to her in a form that cause her to choke. When you work with her, always ask her if the food was okay for her to eat, whether it's too dried out or too thin to hold together, and whether a drink is too warm. You may have to go back to the kitchen and bring back something else in better condition to be eaten.
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Oatmeal55 Nov 16, 2019
Thank you for this advice on the lemon ice! I will try this today once I arrive. Awaiting my plane now.

all of what you say is true: understaffed, dried out pureed food, long feeding time etc.

question between sibs is does she want to stop eating, is she really hungry or just can’t stand to eat that food anymore or does it take too long. Mom will never tell us the truth. She doesn’t want to be a burden. We can afford to hire someone to feed her but is that what she would want, is the burning question here. I guess I’m the only hold out among my sibs right now on that. I think we should. That’s why I’m going early to see for myself.
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I agree with your point of view.

If your mother were not capable of eating or did not want food, it would be different. But all that stops her is that she needs prompting and support; then she eats normally-for-her. I don't see this as being any different from a person who needs help because her hands are in plaster or she can't see her plate, for example: there is no extraordinary or heroic intervention required, here, no artificial prolonging of life past the point where it has any quality.

So it is, as you say, purely a matter of one person's taking the time to be with her. Is hiring an assistant at meal times your decision?

Encourage, support, assist, but don't force. Your mother's appetite may go and she may lose all interest in eating, but as long as she enjoys as much as she wants that's good; and food should be offered in any case.
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Oatmeal55 Nov 16, 2019
I’m pretty sure at this point I would be outvoted on hiring someone. I always lose the vote when it comes to my moms care. I even wanted to move her close to me but was outvoted before I could even present the info on the nursing homes. I do not have the POA.
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I would go myself and see what the situation is.

If mom eats when fed, I think that it is cruel to withhold food and just not feed her.
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Reply to Isthisrealyreal
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Oatmeal55 Nov 14, 2019
Yes I’ve rearranged my schedule to go now instead of Thanksgiving. I was there on October and she ate just fine.
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Oatmeal55 - I completely understand your situation as it sounds identical to mine except that my mother lives with me - she has Parkinson’s, rheumatoid arthritis along with the related dementia and Alzheimer’s.

Honestly, I usually end up feeding her a bit. I try to give her an opportunity to feed herself, and if she can’t due to the tremors and/or forgetfulness, I will step in and feed her. She gets about halfway through though and doesn’t want to eat anymore and I respect that. Patients do seem to know when it’s time to stop eating and though your mom’s precious mind may be impaired, she will let you know when it is time for her to quit eating altogether and at that point, perhaps the best decision would be to respect her decision.

You have received a lot of good advice here and I know that you will make the best decision for your dear mother.

This is a very difficult time in our lives, hang in there, as I tell myself...this will pass soon enough and our dear mother’s’ journeys will be done after a courageous battle with the terrible disease.
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Reply to Shay1990
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Short answer - do not stop feeding her. It does not sound like she’s at that point yet. You’ll know when. Trust your instincts so that down the road you will have peace with your decision. (I had a different experience which I still cry over.) If she’s accepting food, she wants to eat. I can understand her decision not to go to the dining room: limited time to eat, public setting, little assistance . . . Hire someone for as long as she needs them. Keeping you and your mom in my prayers.
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Reply to Barsenault60
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My husband takes a long time to eat. I found that he really enjoys the Bolthouse Farms and Naked smoothies. Some of the Boldthouse smoothies have 30 grams of protein and about 400 calories. They taste much better than the Ensure/Boost drinks. I give him one or two of those every day. He also likes lots of the toddler and baby foods. He wears full dentures. The baby foods don’t take him as long to eat. I try to use adult words for everything concerning his care. He likes the baby food. It can be put into a bowl so it’s not obviously baby food. He loves ice cream so I let him have as much as he wants. Another thing he enjoys are the sport drinks like Body Armour. A frozen meal he enjoys is the Gramma’s Chicken and Rice Bake. I cook it and run it through the food processor. He can eat that for two meals. Lentil soup and many other soups appeal to him and taste good. Very easy to consume. My husband is home with me, and I have a caregiver for him four hours a day. I try to make sure the CG feeds him a meal during that time to relieve me. For dinner, I pull up a chair to his bed and feed him while we watch TV. I use those straws that are made of some kind of bendable plastic. I found some Contigo drink mugs that don’t allow spills. You can also drill a hole in a few lids that fit the bolthouse and Body Armour drinks and put a straw in those. All these things have taken a lot of the stress out of feeding him and keeping him satisfied. It has helped avoid some of the weight loss.
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sanhoro12 Nov 16, 2019
If you're having difficulty getting up to speed with preparing meals for puree, there are some Stouffer's meals that lend themselves to puree if you add several tablespoons of water,

Lasagna with Meat and Sauce
Tuna Casserole
Grandma's Chicken Rice Bake

There are mashed cauliflower by one of the companies that you microwave and put in the blender with bread to make it hold together.

Broccoli or cauliflower can boiled with butter and salt. They can then be put in a blender with steamed rice to become mashed vegetables.

If she gets stuck with food in her mouth that she has trouble swallowing, you can offer ice cream or lemon ice as a chaser.
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I work as a front desk receptionist in a Memory Care community which houses dementia residents, Alzheimer's and Parkinson's sufferers as well. We have a woman who's in the advanced stages of the disease, and 3 of her children alternate coming in to help feed her lunch & dinner every day, as she's forgotten how to eat. Like your mom, she will eat if fed, but not otherwise. If you're unable to go in to the SNF physically to help your mom eat every day, you can consider hiring someone for that express purpose. I think with Ensure or Boost, again, she'd have to be helped and/or encouraged to drink it, right? Unless she's okay drinking on her own.........and then you can certainly bring in a case or two of those products.

Have you had a hospice evaluation yet? If not, you may want to do that so you can get their opinion on how to proceed down this difficult path.

I'm sorry you are facing such a tough situation; my heart hurts for you. All the best to you.
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Reply to lealonnie1
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Oatmeal55 Nov 14, 2019
She hasn’t forgotten how to eat. Her dementia is not that bad! She can still track her favorite sports team and most of the time knows who we are. She just can’t hold the utensils and bring anything to her mouth because of the Parkinson’s. Plus swallowing is slow. So small mouthfuls are needed. but I guess she is saying she’s not hungry sometimes but eats when it’s offered. Will tell you when she’s had enough.
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