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I think the medication is a seperate concern from the aspiration pneumonia. Depokote is acheaper drug than many anti psychotics and if it is the N/H policy to medicate most of their patients to give the staff a quiet life that could be why it is possibly widely used in that particular home.
Are there other nursing homes in your area you would be more comfortable to see your mother place. As she is private pay moving her would not be difficult. I absolutely agree that with such a high cost it would be nice for the staff to have time to be extra careful. Many nursing homes ar part of large chains and are about the profits for the shareholders and not about quality care. Pay is poor and staff are overworked. Medications are prescribed by cost not effectiveness and food choices may also be based on cost per unit rather than nutritional content. It is a sad world we live in so it is very important for relatives to educate themselves and advocate for their loved ones
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Swags I appreciate how hard it is to care about your parents and to have concerns about their care and to not be the decision-maker. One person needs to have the authority to act on their behalf. Ideally, in a loving, functional family, all of the children discuss their parents' needs and their ideas are listened to. Then the POA makes the decisions and everyone respects them (even if they did not agree.) That is ideally. In the real world even loving families with shared goals can have problems with this.

Not all nursing homes are wonderful. Often there are problems that need attention. But it also happens that expectations about nursing homes are not realistic. This is not one-on-one care. Not everything that happens in a nursing home is the fault of the nursing home. My husband had aspiration pneumonia several times. This was the fault of his dementia and problems swallowing. He was at home, under loving supervision. He still wound up in the hospital a couple of times, and treated at home others.

There are care conferences held periodically (quarterly here) giving updates on all aspects of the patient's care. It might be helpful for you to attend the next conference with your brother.
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I dont have the POA, but my brother told me and has it written on his and her drug list. use aggression. My parents dont have seizures, mood disorders, are not bi polar or schizo, just old. my mother shows anger when being bathed or moved in and out of the bed, it is obvious that the anger stem from pain. She feels pain if I work with her on things like puting on the BP cuff explain to her that it will put pressure on her arm but will not hurt, she does not get angry, so slowing down and a little patience helps and I know that the nursing homes are understaffed and all their excuses but 45000 to 50000 a year paid out my parents estate should buy a little extra time. maybe I am wrong.
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Swags, Divalproex or Depakote as it is more commonly known is an anti seizure medication but it is also used to treat mood disorders. Mood disorders are not necessarily agression so knowing nothing about your father have no idea why he is taking it. Many of the anti seizure medications are used for other purposes. So that would not be unusual. Mood disorders can cover a vast range of conditions from depression to Bi Polar and schizophrenia often in combination with other drugs. It COULD be an appropriate medication for both your parents. Your parents dr will not talk to you about your parents treatment unless they give permision or you have POA for medical. You could discuss the side effects and benefits with a pharmacist. One of the side effects is drowsiness but is unlikely to be given for that purpose. There are more reliable sedatives if that is the purpose
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Thank you Veronica, long answers to difficult situations much appreciated. I have read that in Texas the drug Divalproex is given in nursing homes for aggression, because it is not regulated for aggression. so the state is not watching for how the doctor may be using it. My brother has been informed that the drug is for mom and dads (not) aggression and wont even step back and weight the benefits or non benefit of the drug. Again long is fine and understandable
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I am just concerned because they have been giving Divalproex for aggression, the same doctor gives this same drug to my father who lives at home with my sister the same drug. He is not aggressive and never has been, yes mom get upset when she is handled she is a large woman, yes she gets angry, she is being hurt, the drug is what upset me. I truley feel this drug is what put her there in the first place, but I am not over care and cannot get my brothers to even question the doctor on my dads behalf or my moms
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Swags kmonksmsn has very clearly given us the definition of palliative care. It can be a stage leading to hospice or it can be a stage that lasts many years such as when a patient is in a vegatative state. Many patient's may elect this when they feel they are not within six months of death even though others know that they are. They may choose to continue chemo or dialysis until they are just too ill to tolerate it and may or may not have a DNR. They do have the ongoing support of the palliative care team which may also be part of a hospice and in the case of a small hospice will be exactly the same personel.
Swags you mother could be in a nursing home where she has been abused but this has little to do with aspiration pneumonia. Difficulty swallowing or dysphagia is a common side effect of dementia. It can be mild or severe and can be extremely frightening and life threatening. A demented patient is often not able to follow instructions and take the necessary precautions to prevent aspiration when they eat and well meaning relatives may bring in unsuitable treats.
If your mother is not in a memorycare unit she will be difficult for the staff to control. Any medications have to be ordered by a Dr, the staff can't just decide to slip her a pill because she is being disruptive that day. The Dr may choose to order medications that will help her be calmer and more comfortable within herself. Nursing home Drs are very closely monitored by State health boards and can loose their license to practice medicine if they are seen to be over prescribing.
if you feel she is being abused in any way spend as much time visiting as possible and carefully observe how the staff treat her. also note the surroundings. are her clothes and bedding clean? Does she smell unwashed? if you help her to the bathroom do you see any bruises. If so photograph these. What do you notice about the other patients. Make friends with other visitors and learn what they think of the place. Make friends with the staff. they always appreciate a plate of cookies or a plant for the nurses station. Chat a few minutes and find out if they are extra busy or short staffed, sympathise with the Aides they love to complain.
If you genuinely feel your loved one is not being treated properly take the matter up with the nursing director to see if you can get issues resolved and failing that make a complaint to the State Health Board. Many complaints found to be justified and the nursing home will be shut down or at the very least put on probabation and not allowed to admit new patients till they are in compliance.
i know this had little to do with palliative care and my short answere is "Yes it is a good thing"
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It was a good thing for my mother. She died with her quality of life still intake and not living off a ventillator with a tracheotomy, which she would not want.
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Swags, I doubt it. If a patient has severe dementia and is uncooperative and immobile, inhaled food is going to happen somewhere down the line and then, yes, you're looking at aspiration pneumonia and inevitable hospital admission.

The next step, once the patient recovers from the pneumonia, would be PEG feeding. That bypasses the faulty swallowing reflex so no more food gets inhaled. If the patient is receiving palliative care, whether or not to go down that route would be open to debate; it would depend on other decisions about her quality of life, prognosis and so on. PEG feeding COULD, just about, be considered palliative care if it would enable the patient to continue an otherwise bearable state of being; but you could equally argue that it is artificially prolonging her natural life and causing her needless suffering. It's very much a judgement call.

But what is your main concern about how your mother is being looked after? Are you worried that somebody has fallen down on the job, or are you anxious about things will go from here, or what? Is there something you want to change about how she's being managed?
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what if the patient has severe dimentia and a difficult patient to deal with, have you ever heard of abuse in dealing with difficult patients whom are imobile and need help in all aspects off living. She was recently hospitalised for aspirated pneaumonia, inhaled food in the lungs. sound to me like a nursing home looking for an excuse to medicate my mother so they dont have to deal with her
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Palliative care is always a good thing. I just recently did a blog about it.
Palliative care is a multidiscipline (medical, nursing, therapy, etc.) approach to control of symptoms of a disease, including symptoms resulting from its treatment. One does not need to be dying to receive palliative care. The term palliative means to make less intense or less severe. The symptoms may include physical, emotional, psychosocial, and spiritual. Frankly, I think that palliative care should always be a part of health treatment.
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I think it is a good choice at the end of life. We are taught to fight death throughout our lives. When it comes to our loved ones, we can tackle any ailment that comes up. We are so accustomed to fixing things that we even bring people back from death, knowing there may be significant brain damage. Palliative care to me is giving all of us permission to let go and let Nature take its course. We just make sure the person is comfortable as possible in their remaining time.I don't know why anyone would think it is a bad thing. We all know there comes a time to stop trying to cure someone of old age.
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It is a personal choice. The care is good if you like your personal physician. It's merely a stepping stone on a rather short journey. It usually converts to Hospice in a short time, as the patient accepts their situation.
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