Mom has had a rough time lately. Dementia that is progressing, at least partially due to a fall giving her a broken foot bone, a bout with ischemic colitis (which has resolved), and another fall which was unremarkable (besides the 7 hours in the ED getting checked out).
After broken foot, had rehab to get her stronger and was able to return to AL.
After colitis attack, she's still in rehab. I've been arguing with the staff about getting her back to her room sooner rather than later. Mentally and cognitively she does much better in her room than in rehab. As of last week (before most recent fall), she was making the goals of being able to walk far enough to get to the dining room and to descend a set of stairs in the event of an emergency. They are reluctant to let her go because they could still work on things like her poor balance. That is very subjective and I feel like they are mostly just double dipping since we're paying for AL AND for rehab (Medicare paying for that).
She fell in her rehab bathroom because her memory is swiss cheese due to her dementia and she is not able to remember the constant reminders for her to call for help when she wants to get up to go to the bathroom. They, pretty understandably, don't want her to fall on their watch. You can only imagine how many times she gets up alone and does her thing. And surprisingly it took a few weeks before she fell, on the cusp of moving back to AL. I'm sure they're going to push to extend her again.
Now she is saying she just wants to give up. Not for the first time. Last time I told her that she could do that if she wanted and that would mean that she'd have to go to a nursing home and would get more care and wouldn't be expected to do as much for herself as she is in AL. She didn't really jump on that idea so I let it pass. Now I guess I'll give her the same info and see if it at all appealing to her.
Not sure what I should push her towards. Or as POA, I can work with the staff to decide if her AL days should just be over.
Or thirdly, she might even be ready for memory care. She's not a flight risk at all and is still pretty social. So I kind of feel like being with people that are REALLY far gone in their dementia journey might not be the best fit for her.
Thanks for reading and perhaps having any insight or kind words of encouragement. I'm pretty burnt out on all this! Of course her last two episodes have happened while I was trying to have some time away. One trip got truncated because I thought she was dying and this weekend away just got a nice dose of stress added to a relaxing time. Oh well.
My 100+yr old Aunt with advanced dementia and mobility issues (and cared for in her own home by family) shimmied past her bed boundaries one random night and fell and broke her hip. Due to her advanced age and uncooperativeness, we waved surgery. We were trying to get her to at least pivot in rehab so she could be more easily assisted, but she was already still trying to get out of bed by herself in rehab. I was 1 day away from having her assessed for placement before she thankfully passed away in her sleep. The dilemma was that she needed LTC but was still "mobile" and was absolutely going to fall again. I had no real solutions, except to expect her to keep falling in MC until she could no longer physically get up. The good Lord solved my problem for me. But I totally understand your dilemma. I think one answer would be MC and realistic expectations about her risk of falling again.
May you receive clarity, wisdom and peace in your heart as you make decisions.
I would talk to her, but don't forget she has dementia, so she will most likely keep changing her mind. Probably according to her pain, if she is having a clear moment she may have a different view than when she isn't and her pain is more pronounced. Your mom is aging and it sounds like your mom is having one issue after another, she may get a break for a month or 2 then I suspect it will be something else.
I would definitely talk to the staff, ultimately this is your decision,
I would say follow your gut , your instincts, I'm feeling are thinking NH.
Also, you need a life , you need to go on a vacation, and enjoy yourself.
As for MC verses NH . Im not educated enough to have an opinion for that
Best of luck. Let us know what you decide
I think you know your Mom and her comfort and wishes best. I am comfortable with your making this decision with her input and the input of the care team.
Talk to the AL director and see what they think about bringing Mom back to the AL and having PT, OT brought there. If they feel she would be better served in an SNF then thats what it need to be. Mom can get therapy there. But this broken bone has probably changed things. They are good until they aren't and anything like this usually changes things.
Be aware that after 20 days Medicare only pays 50%, the other 50% is Moms responsibility if her secondary does not pay. That can mount up.
I understand and agree with most of what you say what you are saying about the advantages of the home (AL, in this case) environment over being in an unfamiliar, institutional environment. However, Medicare would here have to agree to cover in-home therapy without the goals of rehab having been met. Rehab has the goal (among others) of getting you to the point where you can function with in-home PT/OT. That goal so far isn't being met, and it sounds as if the OP's mother is going to have difficulty inmeetin it.
What stood out to me was that your Mom would need to navigate steps in an emergency like a fire . This may be the deciding factor as to whether or not Mom can go back to her original room . Do you know exactly what AL requires for your Mom to be accepted back ?
When my FIL was in rehab , AL said in order to go back , he had to walk 150 feet with his walker unassisted . He did it .
The last time he was in rehab , AL said the same thing . He would not have made 150 feet . We got them to reduce it to 100 feet because his room was right near an emergency exit and the dining room . No stairs though.
I suggest you stop pushing your poor mom to do anything now. She suffers from dementia and should not be expected to climb or descend stairs to evacuate a building in an emergency! In reality, she needs Memory Care Assisted Living and that may be exactly what you're told when an evaluation is done on mom after rehab. There is only SO far she'll progress in rehab because of her limitations and inability to remember instructions.
Memory Care shrinks down her world FOR her and removes expectations OF her while still offering activities and interactions with others. She's likely to stop feeling like "giving up" then because nobody will be making unrealistic demands on her anymore.
In any event, the nurse at AL is definitely going to evaluate your mom before she's released from rehab anyway, so all this is likely a moot point.
Best of luck to you.
You're wearing yourself out, so it might be time to accept the inevitable.
Also, there is no perfect solution - you could get your mum to the point where she can go back to AL only for her to fall again, or not remember things she knew just a short while ago, such as how to find her way around or how things work.
So, go with how your mum is right now, which is someone who needs more care than an AL can provide.
My FIL was in an AL for about 3 years. No stairs in his AL facility, but their rule was you had to be able to get to the dining room on your own whichever way (Walker, wheelchair, etc). The last year, he had 3 major falls, each followed by rehab. During the third rehab the AL told us they could no longer keep him safe and he would have to go to NH which was actually connected to the rehab place. He had argued against it previously, but when it happened he adapted quite quickly. He died two years later from a heart attack while eating tira misu in bed.
Thanks for responding.
OK - you need to go on vacation. Mom is being taken care of and they can call you. I was a 7 hours drive away when she was in the hospital for the colitis issue and then 2 hours away the next time she ended up in the ED. I am going to keep going away. They call me and if I feel like I need to go home, I do. I give it some time to see what's really going on. I did come home from the 7 hour away place but that's because it sounded like she had only a few days left. But we are lucky it resolved itself without the major surgery the surgeon wanted to do.
Best of luck to you.
Perhaps she can go back to her AL apartment for a time, but they will not be able to meet her needs for much longer.
Start looking at Nursing homes Now! Meet with admission directors, take tours, with or without mom. You seem to know her well and what would suit her best,
and ultimately, this is a decision you may have to make without her input.
Better to be prepared now.
Does the Rehab facility offer long term skilled nursing care? Many SNF's offer some form of physical therapy, and if they offer multiple levels of care, they can transfer her to another room when the time is right.
This rehab does not have LTC. I know the place I want her in does have PT, etc.
My sugestion: Do what is easliest for you. As if you do not keep yourself as healthy as possible, you won't be there for her. I do not see her age.
I do not believe - or understand - when you say "not sure what I should push her towards." You can encourage perhaps. With dementia, it is best you do what is in your best interest. There isn't an easy solution to these situations. You do the best you can and that is all you can do. At times, it is a month, week, day at a time.
If I was in this situation, I would do what will keep her as calm as possible (considering dementia brings up confusion and fears) and weigh w what is easier or best for you. Easier doesn't mean being 'mean' to her - she needs you to be as whole and healthy as you can be to support her needs / well-being.
Gena / Touch Matters
I guess I really won't be pushing her towards anything as she will not be deciding. I will. I'll just have to "sell" it to her and explain it to her. I'll be deciding with input from the facility she's in.