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My mother fell in Nov- fractured sacrum, sacroplasty- then to rehab. In rehab she was delerious and within a week UTI- back to hospital. We have been on antibiotics for almost 4 weeks and in the rehab again since Dec 27. She is not making any progress in regaining mobility. In fact she is showing signs of dementia or possible stroke. They checked in hospital for bleeds- nothing showed. Even my mother in her current state has said there is something neurologically wrong. Her boyfriend wants her to go home- he is currently in trial for AML and possibly going for transplant in a few weeks. He cannot afford the 24 hour care nor can he care for her. I have DPOA and the nomination of guardianship from my attorney. The rehab has told me that due to her non mobility Nursing Home is only option. I feel like I am blowing up everything my Mom can identify as her life. We do have neurologist appt in Feb and the Psych that visits put Mom on Remeron and gave her a 21 on the dementia test (but she doesn't diagnose) Can anyone relate?

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Coop, welcome!

Here's the thing. RIGHT NOW, the situation is that your mom needs full time care and that means a nursing home.

If something is able to be improved, reversed, down the road and her needs change, you get her what she needs THEN.

Perhaps it is grief you are feeling. Guilt implies you've done something wrong. You haven't.
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CoopHeath Jan 2022
Thank you Barb.
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Well I guess you are blowing up her life .... but her heath problems and lack of ability are causing you to have to make that decision. Even if he would afford 24 hour care...that doesn't mean it would be the best or most consistent. What happens if somebody flakes out on a shift? He has his own significant health problems right now that need serious attention and focus.

True story. Back in the day, my MIL needed assisted living and the husband picked a very nice religious private pay facility for her. Somehow she ended up with a Foley catheter which resulted in several UTIs. It would take them a lot of time to get a doctor to order a urine sample to get the results back to getting her a prescription. After a hospitalization of a UTI, the facility decided that she needed to go into the skilled side and did not qualify for assisted living any longer. We moved her to a very small basic facility that did accept medicaid etc, And they did an absolutely WONDERFUL job. They would check the bag and would do a quick dip test if it looked suspicious...and she would be on antibiotics within a couple of hours.

Moral of the story....an expensive private pay facility may not be as good as a rate one.

Regardless....your mother and her boyfriend each need time to get well and placing her in skilled nursing of some sort until she can regain her strength will be best for her and them as a couple.
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CoopHeath Jan 2022
Those concerns you mention, were part of my thought process too. With Covid the staffing has been really sparse. Even aides he is supposed to get are missing due to it. I really appreciate your reply.
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Is it absolutely necessary that your mom be on Remeron? I've seen that drug given to many elderly people both in facility and in the homecare setting. Every one of the elders I saw who were on it lost whatever mobility they had and were permanently confined to wheelchairs.
I truly think that you should eliminate the Psych from your mother's care. If they aren't allowed to diagnose dementia they really shouldn't be doing the testing for it. I've known way too many elders that psych was brought in for. Of course they were put on unnecessary "meds" by these people. It totally destroyed them and any independence they still possessed. Then there is no choice but a nursing home because the elder cannot improve or even get back to what they were before they were given psychiatric meds.
Please tell psych to go pound sand and deal with neurology only. If your mother is still sound enough to know there's something wrong with her physically, then her mind isn't so far gone yet.
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bundleofjoy Jan 2022
i agree with all of it!!
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Fractures in elders can cause delerium. Fractures in elderly can often also seem to move any cognitive decline (if present) a few steps worse. UTI can cause delerium. Unfamiliar surrounds can cause falls.

Sorry to be such a downer.

Was any reason found for the initial fall?

It can take much time to see if the delerium lifts, or this is indeed the new normal. Wait & hope.

The rock & a hard place: Yes, I see just the one option available to you. The one you are doing.

Fractures can be game-changers. All I can add is stay hopeful, but be realistic. You have not 'blown up' your Mom's life. Old age did.
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CoopHeath Jan 2022
The fall was outside pulling a weed in the yard.. or so she told us. Doing the look back on other things it may be that she was having some early signs of D but we missed because its also been 2 years of stress with the boyfriend disease.. and caring for him.
Thank you for the support.
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It doesn't have to be permanent. We couldn't take advantage of the Medicaid-at-Home program for my dad because home dialysis was in its early stages back then. Maybe it will work for you as a long-term solution while the nursing home serves as a short-term solution.

You're doing what you can with the resources available. That's good caregiving.
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Sohenc Jan 2022
Check out how long the Medicaid-at-home aide wait list is where you are. We were told they only come 2 or 3 times per week for only an hour or two, no night or weekend help but worse there is a huge demand and few if any availability. Where we are, we were told the wait list is several years long before one is actually in line to have a Medicaid-cover aide show up. The private nursing agency we check with, would have charged $150 per hour including travel time or about $525 a day for about 3 hours (including travel time) x 5 days or $1.6K per week just for a few hours of help - not possible.
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I'm so sorry that you're in this distressing situation. My MIL is in a wonderful LTC facility on Medicaid (she even has a private room, which is unusual). She is not mobile. She was getting many UTIs even though she had no catheter and her hygiene care there was very good. Sometimes UTIs are caused by changes in a woman's physiology and so her bladder can no longer empty completely. When she was clear of her infection we started her on a maintenance supplement called D-Mannose. You can look that up here on this forum or online to see if this is something that may help your mom. It greatly reduced the number of UTIs my MIL was getting.

Regarding her cognitive/memory issue... did she have anesthesia for her sacroplasty? You don't mention your mom's age but some anesthesias are not good for seniors and cause a fog afterward that takes a while to go away, and sometimes never goes away (my friend's dad had permanent impairment after shoulder surgery and he was in his mid 70s).

There are other health issues that can cause dementia-like symptoms, including thyroid problems, diabetes, cardiac problems, etc. Please make sure these are all discounted as causes. Wishing you peace in your heart as you work to help your mom!
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Moxy234 Jan 2022
I have heard such a good things about d mannose and explored it with dad. I wished we could use it but urologist said it’s not beneficial with an enlarged prostate but he does prescribe it for his female patients which was great to hear xx
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hey coop
youre not blowing up your mums life - this situ has. I’ve been in a similar situ re UTIs delirium and a long stay in rehab with my lovely dad
we can do our best but we’re not professionals and hearing your mums needs give it a go. If your mum boyfriend has his own stuff going on and a carer even being there all the time you can’t guarantee needs will be met.
its hard I know. If our loved ones are in hospital getting the care they need we’re ok with it, the minute we say the words “home” or “care” it feels different but it is still about giving our loved ones the best care they can have to bring them to the best place for them.
My dad came home for hospital after 10 weeks 7 days ago; he’s slept the last 3 days 20 hours a day; has already been in A&E for a fall and I feel like shite about the whole situ, our social worker has said he needs respite now because she’s not happy with the situ and my 82 year old mum is falling apart with the care she needs to give him. I’ve been staying now till we can get him in respite, We have carers in 4 times a day. If you are being offered a nursing home take it, it’s best for your mums care and further rehab. I am wondering if my dad has dementia or has had a stroke and it’s been missed
good luck with it xxxx
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If your mom still has an infection, that will need to be cleared before thinking about a nursing home. Work with her medical doctor to make sure her UTI is treated with the right antibiotic and she gets that cleared up. Infections can cause a lot of the symptoms of dementia. Also have her tested for COVID too.

If she truly does have neurological decline, then help her to get the care that she can afford. Her boyfriend may be a candidate to join her at her new facility.
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I'm glad to see the supplement D-Mannose has been mentioned in prior comments. It works both as a UTI prevention and can even eliminate an infection in some cases. You can get it on Amazon, and give it to your Mom regularly. Make sure she drinks plenty of water, something the elderly doesn't like to do but is crucial.
It's very disorienting to be in a hospital, then rehab. The elderly do not take to these environments well. Your Mom has been through a lot so don't give up - it can take months before she gets back to herself. My 93 year old MIL suffered a stroke, then Covid, lost mobility and couldn't eat - was put on hospice - fast forward - she is now back to herself in a nursing home. The important thing is that you advocate for her, get 2nd opinions, make sure she is getting the proper rehab, and keep her mood up.
When all is said and done, if she must be in a NH, find the best one you can, one that values the patient and their families. You must be able to visit frequently so that you can assess her care and be her advocate. The most important thing is that she feels cared for, safe and comfortable, wherever she is.
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I can’t comment on the drugs, but can remind you that many of our elders die following something unexpected going wrong. My sister right now is (thank heavens) recovering from viral pneumonia that took 8 weeks to diagnose, and took her to the only local hospital that currently accepts lung issues because of Covid, no visitors etc etc. Her problems were totally unexpected, and could easily have been fatal. No-one was guilty of anything!

Make the best choices you can for her care, and for her partner’s care (if that is your business). Set them up with Zoom technology if it’s possible. Give BF a stack of cards with stamped addressed envelopes so that she can get the pleasure of opening something from him every day or two – and cards for her to send as well. If they can add a kiss, the staff will post them. It will give M and BF something to talk about in phone calls, whether it’s pretties or funnies or outrageous jokes. Don’t worry about the future or the past, just make the present as pleasant as you can, for yourself as well as M and BF. Love, Margaret
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CoopHeath Jan 2022
That is a lovely suggestion. Thank you!
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