Mom fell again.
Mom fell last Sunday (tried to walk without help again - she can't be trusted for a minute - even with her chair and bed alarmed) The first x-ray didn't show anything, and she did not complain of pain for four days. I visited the next day and she never said a word about hurting anywhere. I'm convinced she has such a high threshhold for pain that she simply doesn't recognize it. She also has cellulitis and claimed that it didn't hurt either. Yesterday she finally complained her arm hurt and another x-ray showed a break in her ulna and a fractured pelvis so she was sent to the hospital for two days. I don't know how severe the pelvic fracture is, but she was discharged and sent back to the NH today.
At 101, they can't do much for her except give her pain meds and will evaluate on Monday but I can't see how PT will be of benefit at this point.
I'll visit her tomorrow, but it doesn't sound like this can go on much longer if she is now bedridden and can't even sit in a wheel chair.
We knew this would eventually happen because she has fallen at least 10 times this year. If only she had used the walker last year, and now, if only she would not insist she doesn't need help in the NH. They tell me she is so stubborn that once she gets something in her head they can't do anything with her.
It makes me sad to see Mom be the cause of her own downfall but there is nothing we can do.
Might it be appropriaye to call hospice for an eval? ( don't shoot, just thinking out loud). Can they give her sedation to keep her from trying to get up? How sad.
My ex-mom-in-law, who is 90, had broken her pelvis and her shoulder. She fell in her backyard on a cold rainy day, a neighbor found her after a couple of hours. She was taken to the hospital, then to rehab. Once the bones healed, she had a lot of physical therapy as the arm where the shoulder was broken had frozen up being in a sling for 6 weeks [I had that, too]. After months of physical therapy she came back to her home. Now uses her walker and also wears a life alert pendant. It's been almost a year now and she's doing ok.
So you never know. Seems like your Mom goes in spurts, so it will be interesting to see how this all plays out.
The doctor is going to examine Mom on Monday. When I go tomorrow I will insist he call me and give me some answers. She has been there 4 months and I have never received any contact from him although he has prescribed for her several times. I plan to ask specifics of where and what type of pelvic fracture she has, what is the prognosis, what can we expect based on his examination of her over four months, and also whether she would benefit from hospice.
Truthfully, I don't understand what hospice's role would be, meaning what would be different than the care she is getting now? Can anyone enlighten me? Does it mean they will move her to a different wing, or will she have an additional person assigned just to her, etc. Being 40 miles from the NH, I'm still trying to navigate the system and its hard to find the right person to give me information. Thank the good Lord there is one aide who has taken her under her wing and looks after her, treats her wonderfully. (they all think Mom is cute because she is so frail and tiny - alas, also stubborn) My sister is going for major surgery next week, so I will be doubling trips and taking all the responsibility again for the next couple of months.
If they think the patient would be more comfortable on the different kind of mattress. presto chango, the mattress appears, not in 6 days but in 6 hours. If an unanticipated drug is needed it is delivered the same day.
They are very anti-pain and very pro-whatever-it-takes to relieve the pain. They have more authority in this regard than the nursing home on its own.
They provide volunteers. Yes, my mom was being adequately looked after in the nursing home. But here was some extra one-on-one fussing about her. They did her nails. They pushed her in her wheelchair all around the building. They talked to her, and put lotion on her. She had her daughters coming daily, but no one can get too much attention when they are in such dire conditions.
The additional benefit to the family is that they can usually explain what is going on and what to expect. This was more important with at-home hospice in my experience.
I would definitely order hospice again, for either at-home or in-facility help. It might help and it can't hurt. My mother is still with us, after "graduating" from hospice care after a few months. If it isn't your loved one's time, hospice isn't going to change that.
Of course the "sitters" couldn't figure out why they needed to be there as I was there, I caught them whispering in a corner about me when they thought I was sleeping. I called them on it and told them that as volunteers, it was THEIR job and not mine to watch my dad, and if I chose to be there, that was my choice. If I needed to leave to use the bathroom or go get something to eat, whatever..it was THEIR job as volunteers to watch my dad and mine to be there as loving support for him.
In addition, I was ALSO there to keep an eye on staff. Whether a parent is in the hospital or not, you wouldn't believe how lax nursing staff can get and I wasn't going to let that happen. You'd be surprised how often my dad would pull out his catheter or try to get out of bed on his own. One time it took not only the "sitter", but myself to hold him down from getting out of bed on his own...the reason WHY they had sitters come and watch him 24 hours round the clock. Even with his light on, it took staff forever to get to his room, even when pushing the RED light for immediate care. I finally got him calmed down long enough to go out in the hall and call for a nurse to help us. There was NO way the elderly ladies that were "sitters" would have been able to handle him on their own!!
They had rehab come in and work with him in his bed and eventually had him up and walking as his levels straighted out and he got more in his right mind; so one day I thought it was safe for me to leave for an hour to go home a few blocks away, take a shower, and get more clothing.
I was gone for less than an hour, came back and since my dad was hallucinating and reaching for things that weren't there (something that he's done after every seizure he's had as he's recuperated from it), they took him down for an MRI without calling me and telling me what was going on. When I got back my dad was hollering, "Where's my daughter" and staff came in and told me what he'd been doing. Not once had they called me about this while I was away for an hour and when I got back I was absolutely livid!! Their excuse was that all staff that was available was busy at the time...and apologized profusely. To make matters worse, when physical therapy came by to give my dad in bed physical therapy (and as the therapist told me; my dad's muscles needed to be moved on a daily basis to keep them from weakening; as just a day laying in bed could not only cause that, but could cause blood clots to form in his legs.); and I caught the nurse that was making notes on the computer look out of the corner of her eye and shake her head no..sending the therapist away.
Again, I was livid and told her that she had NO right to send the therapist away as my dad was completely capable of receiving therapy at that time..and SHOULD have received therapy that day. In addition, it was I who had medical Power of Attorney and up to ME whether he receive that therapy or not.
THESE are the sorts of things that happen in hospitals behind our backs and sometimes reasons why our loved ones develop additional health issues. I wasn't going to let that happen and from that time on they were Johnny on the Spot because they knew if they weren't..they'd hear from me.
After speaking to the hospitalist about this, she told me that I was indeed correct regarding that PT happening and that it should not have been put off, for the exact reasons I was concerned about.
I have been extremely proactive in my dad's care from the very beginning of his health issues. At one point when he was hospitalized for what they thought were heart issues, he had an MD come into his room and tell him that he needed to have a stint put in his heart. My not being in the room at the time, my dad told him that it was up to his daughter if this was going to be necessary or not and refused having the stint put in. The physician told my dad, "Do you want to die???!"
When I finally got back to his room after only going down to the hospital cafeteria to grab something to eat, I got a call from the MD and I told him that no..my dad was NOT going to have any stints put in his heart until we got a second opinion and asked if he'd refer him to a good cardiologist and NOT one that only had half my dad's medical records sitting in front of him.
Going on my own instincts, they released my dad and I took him up to one of the best hospitals in the area and had one of THEIR cardiologists take a look at my dad and go through every single page of his medical records with us. HER opinion was that my dad didn't need a stint at all, and had they put one in, it may have killed him.
Well that was that and being that I'm not an MD by any means, I DO know everything about my dad's medical history. After his stroke, his neurology team had told me that EVERYTHING that was done with my dad needed to go directly through them and putting him under any general anesthesia could put him into another possible stroke.
We visited several other cardiologists and they did nothing but throw out diagnosis after diagnosis which were all wrong. Finally between myself and his regular PCP, he ordered an electrocardiology study; along with referring him to one of the best Electrocardiologist in the area. He too ordered another electrocardiology study and diagnosed my dad with what's called Sick Sinus Symdrome: Sick sinus syndrome is a group of heart rhythm disorders that include: Sinus bradycardia: This occurs when the natural pacemaker of the heart does not send out a signal telling the heart to beat often enough. The heart beat rate is slow.
FINALLY we had a diagnosis, and the reason why my dad was having these episodes where he would have periods of garbled talking, etc. It was due to the fact that his heart rate would drop, his brain wasn't getting enough oxygen..and he would have again, have what we called episodes. They put in a pacemaker and he went several years after his stroke where he had absolutely no issues.
With a complicated history such as my dad has, I need to be on board every time he has a health issue as I need to educate his health professionals on everything. The few pages of his health history does them no good (as most of the time it's all they have). I have apologized several times to health professionals as they're the physician and not me, but they have all told me that a patient's family being proactive in their loved one's health is the key to them being able to treat my dad correctly..and to be honest..I was more the MD than they as I know my dad's health background like the back of my hand..and thus, they can give him the medical care they need.
Last year, after moving my dad to a nursing facility, nursing staff found that he had really low blood pressure. He felt fine and no chest pain, etc. They gave him fluids at our local hospital with no results and my feeling was that he may have a Urinary Tract Infection (UTI), as we'd again, been down this road before with his blood pressure being low and at that time, that was the issue.
Thankfully, the ER at our local hospital call Frodert (the great hospital that has done everything RIGHT with my dad, begged them to take him as they were out of ideas on how to treat him). Being that my dad had suffered a fall in his apartment trying to self ambulate several months before that; and ended up having a subdural hematoma where they had to rush him to this same great hospital and do brain surgery to allieve the blood on his brain, at 87, my dad came through with flying colors after months of therapy at the wonderful nursing care facility he is now at.
I apologize for being all over the place here at this point, but knowing my dad's history everytime he has to go to the ER, physician, etc...it was again, a lifesaver to know that the current ER's knowledge of all this was over their heads and they took by ambulance again to Froedert.
They have a team of specialists there that concentrate on one patient for each team and after giving him Dilantin and several other IV's, their conclusion was that he was merely dehydrated, and that was making his blood pressure so low.
I was good with that.
I guess my purpose for making this really long post is that I beg all of you with elderly parents (or even with loved ones with health issues), is to stay proactive and keep an eye on their medical care. Know it like a book if you must and don't be afraid to ask questions; ask their physician to explain their findings, etc. Don't ever be afraid to ask for a second opinion at the best hospital that will treat them; making sure that they're in their insurance health network.
This post started in the right place, and I apologize if I got a little off track from the original post. Thanks for reading.
This means that he is no longer improving, so they gave us a THREE day notice that I needed to find a place for him. This is what happens with Medicare as a patient is allowed 120 days in a rehab facility..however..once Medicare feels that the patient is no longer improving, they will no longer pay.
The rehab facility my dad was at gave us few choices except for putting him in the horrible upstairs of their facility. I toured it and it was like looking at a rerun of "One Flew Over the Cuckoo's Nest" as the rooms were all small..and shared...one bed one way against a wall..and the other bed placed the other way against the other wall.
In addition, all the resident mostly congregated in the middle of this so called County Facility, most seeming barely coherant.
It horrible that when a person finally reaches the end of their stay somewhere that Social Workers are of little help and can become very cold and uncaring...and thus, I called the Assisted Living Facility where my dad was living and asked them to please come and do an analysis to see if he was alright to go back there.
Once I got the okay, I took Dad back to where he called home, as that's where he wanted to be anyway.
He was soo glad to be back there and able to sleep in his own bed!! Of course again, I slept on his couch every night not only to keep an eye on him, but to also make sure that staff came in and checked on him since I added med assistance to make sure he got his meds (and holy expensive..for someone to simply come in and give him his meds twice a day..his rent went from $2400 to over $3600!!
The staff that came in twice a day gave him his meds, but the rest of the staff that came in to help him to the bathroom when he pushed the call button he wore on his wrist were absolutely terrible!!
As often as I told my dad that he COULD NOT take himself to the bathroom without supervision from staff, I found him doing it anyway, as I would spend every night sleeping on his couch, not only to keep an eye on HIM, but to keep an eye on staff.
I can't tell you how many times when I was there that I'd find my dad coming out of his bedroom after getting himself into his transport chair; coming out of his bedroom and into the bathroom!! It was maddening and I can't tell you the amount of lectures I gave him that if he should fall, I wouldn't be the one choosing where he lived anymore as it would be out of my hands. I asked him often if he'd rather be where he was then or in a nursing home.
Of course his reply was that he didn't want to go to a nursing facility, but he kept doing what he wanted to do. I had Homecare come in three times a week to check his vitals, do a little PT (which he hated..but I told him was needed); and to teach him how to get in and out of the shower (as he insisted on doing it himself..)
Well all that went in one ear and out the other. We finally came to the agreement that if he was so insistent on taking a shower by himself, he should call me when he was going to take his shower and leave the phone off the hook so that I could hear if he fell or needed help.
One Sunday morning, I went home to shower myself, etc. and upon calling him, I couldn't get an answer. Rushed over there and he was sitting in front of the bathroom mirror with a towel around his neck shaving; happy as ever.
I was soo angry with him, but couldn't help but laugh a bit when he told me he'd just gotten out of the shower..by himself.
Another lecture from me proved useless, and it got to the point where I was afraid to leave him alone at ANY time. Lecture after lecture regarding him taking himself to the bathroom without supervision turned into nothing but an arguement, as there were many.
I can't tell you how many times I heard, "Don't tell me what to do..I'm old enough to know what I can and can't do, etc." I think it's something we all go through when all of a sudden we become the parent and our aging parents become the child.
There was one time when the facility he was at had an Elvis Impersonator come in. Dad really enjoyed going to see him. Along with all that, they offered cocktails and Dad wanted a beer. I felt horrible telling him that he could have a small half glass, but after calling his physician to see if he could have a beer or two, he told me that half a glass was all and being on Dilantin..alcohol might lessen the effects of it.
Dad was angrier than angry and told me that he was old enough to make his own decisions and if he wanted a beer..he was going to have one. He's always loved his shot and a beer now and then..and I had to be the one to tell him that he could no longer have that.
We argued about that one for over a week. Good lord he was angry with me taking that away too.
We had soo many arguements over what he could and couldn't do in his own apartment and there were times he'd act like a child and retreat to his bedroom telling me to just leave him alone.
That I couldn't do and he'd get soo angry with me at times sleeping on his couch telling me to leave him alone; yet there were other times we'd have slumber parties talking all night long..him in his bed..and me laying at the foot of his bed talking all night long. We'd sing old songs and laugh our hearts out over silly things until the nurse would come in with his meds in the mornings. Dad would sing to his favorite nurse when he had her, making up his own words, "You are my sunshine; the sun is shining; you making me happy; all the time; you don't know how much, I really like you; every morning; all the time".
After all my lectures telling Dad NOT to take himself to use the bathroom on his own and that one day it wouldn't be up to me that he gets to stay in the apartment he so loves..if he didn't listen, it would no longer be up to me...
One day he decided to again take himself to the bathroom with no supervision, lost his balance standing up from his transport chair; and hit his head on the top of the toilet; hard enough to make it askew. I noticed it when I was there one day and he told me he lost his balance and hit his ear on the top. He said he was fine, his ear was just a bit sore.
Looking at it, it was purple and sore, but it got better over time. I'd even taken him to see his PCP and he told my dad that he was lucky it wasn't worse.
Over the next few weeks, I noticed that Dad was having hard time eating..it was like he couldn't find the end of his plate and thus, there was food all over the place. Finding that really odd, I called his PCP's nurse and she told me that sometimes when people have brain injuries like my dad had, they may have times where their depth perception isn't always what it should be and suggested I try putting his plate on a darker surface and see if he improves..
This is where it makes me angry that his physician didn't immediatly order an MRI since any head injury almost always should be checked out for possible brain injury.
He didn't and thankfully one day one of the better staff at Dad's Assisted Living Facility called me and told me that my dad told her he forgot how to use his legs.
I should have also noticed this earlier as, along with Dad's not being able to distiguish the end of his plate; he was also laughing hysterically over funny things, yet his laughter continued much longer than it should have.
Long story short, I drove him to the ER, they did an MRI, and found that he had a subdural hematoma. I will never forget those words as it seemed like it would be nothing. Dad was sitting there laughing with me while we waited for the results and the only thing he complained about was a small headache.
They rushed him by ambulance to Froedert (best hospital EVER!!) and as I met Dad there in ICU, he seemed fine. Talked to me and joked around like we always did..the neurology team came in and told me they had to do immediate surgery consisting of drilling a hole in my dad's skull and just numbing the area while he was still awake;putting a stint in and thus releasing the blood off his brain since it was so bad that it was pushing one side of his brain into the other.
Extremey risky surgery, but I told Dad that either he goes to Mom..or decides to stay here with me. Funny, Dad sang to me and told me that he had new tennis shoes to wear out..Mom could wait a bit...
I never prayed so hard in my life, but when the surgeorn came out and told me that Dad had come through with flying colors...I actually hugged him!!
This whole thing put Dad in nursing care for the rest of his life..he wouldn't listen..just wouldn't..but he's still here with us and I thank God for that everyday.