I just don't know what to do anymore. My 86-year old frail mother broke her leg 2 days after Christmas. She is a 2 person lift (with a hoyer) in and out of bed to a wheelchair. She is currently in the "rehab" section of the nursing home and is supposedly getting an hour of PT and an hour of OT daily. How that is possible is beyond me because she is non-weightbearing on her leg for at least 3 months, THEN they will try to get her on her feet. She was barely able to walk before the leg break (shuffle walking) and broke her leg by just trying to stand up from a sitting position on the sofa. So eventually getting her to use a walker will be a monumental (if impossible) task. I think they (PT/OT) will eventually give up when full Medicare payments stop.

Now she is at the nursing home/rehab and she is basically one of the "extreme" rehab cases as she is weak, frail and generally sits in a wheelchair all day, only getting put in and out of bed to get her diaper changed. My brother is there 10 hours a day (for lunch and dinner) and I am there most days, too. I have had NUMEROUS discussions with staff (Director of Nursing, RNs, LPNs, CNAs) as to her "care plan" (which THEY outlined and they are not following). She is supposed to be changed every 2 hours as she does not ring the "call button" for aid (she has some slight cognitive decline). She developed a bedsore less than 2 weeks into her admission there and it is now just finally clearing up. However, my brother and I are on their cases while we're there to change her diaper. If we are not there, she sits there sometimes for 5 or 6 hours in a wet/soiled diaper.

She is a "quiet" patient so they basically ignore her. She is supposed to be "monitored" and helped to be fed but that is not happening either. The CNAs talk amongst themselves while at the "feed table" instead of interacting with my mother and encouraging her (using verbal cues according to OT) to eat. I've seen it because I can see through the window from the outside of the facility. She has lost so much weight, the facility now wants to put her on a drug (megace) that is contraindicated for her. They also suggested Remeron. Is that safe?

Because of her leg break, she needs 24/7 care that is impossible for me to do at home. She (and we) cannot afford home health care. I wish I could change her to a place where she would get more proper attention but the place she is in now is considered "5 star" and I've checked out other facilities in the area and, unfortunately, the facility she's in IS the best one of the bunch. It's pretty much the attitude of the CNAs as they provide the majority of patient care (dressing, feeding, changing). The RNs and LPNs wouldn't touch a patient if they were on fire. They pass meds, take vitals and chart. They don't even ask my Mom, "How are you feeling today?". It's just, "I'm here to take your vitals, okay?" Then they come back moments later with their pills and leave. It's sad.

I guess I'm just venting here so thanks for listening. My Mom has always been fussy with her foods but since arriving at "rehab", she is getting more and more fussy, angry with her situation, and most likely depressed that she's there. She is taking her anger out on my brother and myself because we won't "take her home". She really has no underlying health problems; she's just getting stubborn. But she's not eating and the staff really doesn't pay attention to what she's eating or not eating. Feeding times there are about 1 hour and if you don't eat what's on your tray, oh well. It's taken away. I just don't think there's an answer because the facility staff just doesn't have the patience and time and sit with patients. Plus every day, it's "we're short staffed again".

Sorry for venting. Thank you to the poster who suggested the Teepa Snow videos. They are wonderful and I wish she could train EVERY nursing home CNA staff. I have gleaned so much information in watching her videos. However, they seem to be geared mostly for home caregivers. Sigh.....

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If your mom is not on a restricted diet, could you or your brother bring her some foods that she likes? If she has always been a bit particular about her food, she may find the nursing home offerings to be undesirable. Discomfort due to the broken leg and lack of exercise may be affecting her appetite, but a little "kick start" with some of her favorites may help.
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When my MIL started losing weight, we knew her body just was not processing the nutrients any more. She needed Hospice at that point and passed about 3 months later. Sorry, but weight loss is an end sign.
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help2day, to answer your question about losing weight.... I think that is the norm as the patient isn't walking around or exercises, thus when it comes time to eat, they just aren't that hungry.

My Mom was a fussy eater, too, thus she didn't want anything on the plate... the Aides would try to feed her but they knew it would be a losing battle... but Mom did take Boost only when it was mixed with ice.

Why is your brother spending 5 to 10 hours a day visiting Mom? Your Mom needs to start interacting with the Staff and she won't if the grown children are around. I know when I cut back on seeing my Mom [98] who was very frail and could no longer walk, eventually she was learning to do some things for herself knowing we weren't going to be there.

The Staff does appreciate when relatives come in during breakfast, lunch or dinner for those patients who will eat, it frees up the Staff to bring meals to those patients who are bedridden and to feed them.
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I think the first thing I would do would be to have a sit down with the director, the DON and the social worker and ask them why the care plan isn't being followed. And tell them that your next call is going to be to the ombudsman and to the Joint Commission on Nursing Home Accreditation. I learned those phrases here; the effect that they had on my mother's care was nothing short of remarkable.

My mom has thrived on Remeron; it's an antidepressant and can help with weight gain, so yes, I think I'd give it a go.

Find out who supervises the CNAs. Talk to that person about what you've observed about your mother's care. Write down names, dates and times, but be sweet about it. "On 2/17 at 10AM, I arrived and noted that my mother was not changed until 3 PM". that sort of record keeping. This will be useful when you talk to the Ombudsman and Joint Commission as well. Hoping others will be along with more advice!
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