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My mother is 85 years old & is:
Mid stage / dementia --
She Recognizes family / responds to questions / can converse ( very slow response & processing but comprehensible ) .. Is very even tempered Emotional /flat like/ & very compliant / loves her home & pets / has her humor/ Is able to perform basic grooming practices/ uses bathroom/ Has extreme osteoarthritis in eight knee (knee replacement in other knee) because of pain requires assistance in ambulatory areas (wheel chair) -Is able to stand from sitting position--& sit from standing /.
**Needs assistance in getting in & out of bed....
-- osteoarthritis -compression fractures in her back --led to Xtreme pain & inabilty to move --hospitalization. (Kyphoplasty procedure completed to treat back pain!) but nothing can do about severe knee-
Her stay in hospital lead to: 8 days
And Now on:
antibiotic (aspiration pneumonia)
Heart /beta blocker & blood thinner...
Tramadol pain med --.
She was sent from hospital to skill nurse rehab--
But? Her osteoporosis is so advanced at this point that - can only complete minimal level (exercise)... W/O fracture or increased swelling /Joint -back pain...
She wants to go home-- AND? She does have 2 CNA s hired for in-home service along with me coming In for couple days /wk too....
I feel her wishes need to be honored! And if she wants to go home and there is full time assistance in her home setting --- then? She should spend at least another year peacefully living in her own home! ( lived In for 45 years) ..
I don't know ? What kind of "forces" I am up against tho?
Brother & sister - believe not a good idea for her to go home--- And that her dementia mental degeneration could go on on on and also leave her penniless (paying for in-home care) ...... She has been left with savings enough to def cover at minimum a year with lots left
Over --. Doesn't the dignity of her -- and how she wants to spend some of the last days of her life Count? ..
Some family ? Fear she may go on on on and drain all the family trust .... And say ? She would be cared about and for If she stays in rehab & moves into full nursing home (part of facility that she is already now in..)!
She IS declining. But?
So much better and more content inner own just home ?
Can I insist her wishes be honored ?
Docs ? Listen ? Or siblings?
Try to/-? Get a medical POA from he now?
My sister is POA finances ?
I dunno ???

Severe osteoarthritis (knee & back scoliosis).

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This is so tough. I don't know what type of dementia she has, but depending on the progression, she may not be able to enjoy being in her own home in the future.. My loved one had a sharp decline while living alone and now about a year later, she is in Secure Memory Care and doesn't know she has a house, a car, a cat. Her memory went fast and she's now in the final stage. She is receiving good care where she is and that's a relief.

If your mom has the funds, I would try to find a place for her to go that is pleasant and that will provide her with care. You might incur the services of a professional who can properly access your mom's needs. It sounds like she can't really take care of herself. Have you actually observed her in her daily care routine? I know my loved one would tell me she had bathed, eaten, etc., but she had not.

Are there any family members who could move in with her? It's one option, but I can't imagine doing it. It's an overwhelming job, even with lots of backup and support.
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It is the wish of most people to die in their own homes. Can the 24 hour nursing care she requires be adequately provided. If she is heavy two people will soon be needed to provide satisfactory care. Someone must be with her overnight. her decline will continue and probably escalate usually at a faster rate.
Rationally having her complete the rehab and then transfer to a skilled nursing facility is the sensible way to go. But that is not what she wants to do. her care could be better or worse in a nursing home. Your sisters have POA so you really have no say and the likelyhood of changing that is slim to none at this stage. In the end it is always about the money and what will be left for the sibs. It does not matter which is the cheaper alternative she will run out eventually if she lives long enough. It is her money so it should be used to follow her wishes. if it runs out or she needs more care than she can get at home then cross that bridge when you get to it.
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Who has mom's healthcare power of attorney? That person has the authority to make the decision. If that person is you or the sibling who agrees with you, I would suggest you be careful what you wish for. If mom doesn't have a HCPOA, then she has decided to leave her fate in the hands of the doctors by default. "Against Medical Advice" can be tough. If a sibling has HCPOA who doesn't agree with you, I doubt it's going to happen.
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This is a tough question. From your description of all her medical needs my instinct is to place in assited living or skilled nursing facility, but it is possible to use in home care. It's my understanding that in home care at the level she would require is much more expensive than placement in a facility. And, is her home set up for all her medical and mobility needs?

As to the issue of money, I've always felt that my parents funds should be first be used for their care. The issue of exhausting the family's inheritance should not be a consideration. Would you want to scrimp on her care to save money?
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