@rhandco: Best book ever (in my opinion) on caring for aging parents: “My Mother, Your Mother: What to Expect as Parents Age,” by Dennis McCullough. It would be worth its modest price for only this highlight: a chart that makes clear that most people die after a long and difficult decline, usually in a hospital, rather than after being healthy and functional for years and then having a heart attack at home in bed. But it contains much, much more. I’m personally and professionally interested in elder care and have read many books and this is the best.
I advise that your father prepare a health care power of attorney. At least in my state, this is the preferred document for end of life planning and likely renders a living will unnecessary.
I think it’s a good idea to talk to a lawyer who focuses on elder law as you and your family consider your father’s financial situation. Good elder law attorneys know the ins and outs of coordinating estate planning with planning for long-term care; it’s especially important to not unwittingly engage in Medicaid divestment.
Here is a resource that can be helpful “Living a Healthy Life with Chronic Conditions” - new edition 2013 also states “for ongoing physical and mental health conditions”. I have 3rd edition (2006), 4th edition (2012) - the authors are the same for these.
Talks about many areas where one can become a skilled self-manager - fulfill greatest possible physical potential and to once again derive pleasure from life. Try to help live a productive, healthy life. Lots of good information.
Book is output from the originally based 5 year study conducted at Stanford University, and then additional feedback from professionals.
I definitely will be bringing my book when we go to FIL/MIL’s - will look up issues they have, and pull out suggestions out of the book (one chapter is with a huge list of hints in different categories). A book also gives outside authority, although as a RN, they like to hear from what I see/hear/know. MIL knows I am on ‘their side’ when it comes to some of the irritating things their sons/DILs do to ‘help them’ - for example go through the basement stuff. Who cares, leave it alone. ‘Straightening up’ rooms, and then MIL can’t find stuff…and then next visit has to ask (like jewelry) - I tried to look in obvious places and couldn’t find. I would be irritated too, but they don’t want to discourage any help either.
Having a will in place for the state people are in. Then moving forward to the other things.
Can I suggest strongly that elders get their credit reports frozen? That will block other people getting credit on their social security numbers. I just got off the phone for another two attempts to get credit under Mom’s SSN.
I knew I needed to do this and just let it ride. Elders should have no need for credit checks. You can easily unfreeze it if they need a single use to enter an AL rental agreement. It will save time in the long run for lots of people.
In my case, I am pretty sure I know who sold it and initiated what is basically harassment since so far none of the credit cards have been issued. Still a mess to clean up.
Another UTI. Sigh. Just when we thought things were on the upswing - crash!
Mom had gotten over the initial paranoia/anger/confusion. She even went out twice last weekend. She was obnoxious and accusatory to one of us last night, so the care giver did a quick strip test. The dr has to fax the order for a sample and then the care provider takes it to the lab. By tomorrow afternoon she will be back on ABX. I know doctors don’t want to prescribe prophylactic ABX, but this is nuts.
We did find some new shoes for her. Very lightweight and stretchy, which helps her poor toes. Make is BZEES, found at Nordstrom.
Just went through the same issue of another UTI with my aunt. As soon as she becomes agitated and agressive or more confused than usual, I have her caregiver bring a clean catch sample in a sterile cup to the lab who, in turn gives her a new sterile specimen cup. They, (lab), will hold an order from her MD for C and S and U/A for 6 mos. in their file and they will call the MD who contacts CVS for an antibiotic. The MD at that time sends a new “on hold” order to the lab. CVS calls her caregiver who picks up the order. We have it down to a science, (it has only taken about 2 years).
Make sure that she takes probiotics with the antibiotic. The last thing you want is an elder to get C-dif. Push liquid intake as well. Hope she bounces back quickly.
Sorry, zeeba. UTIs used to hi-jack my mother, too. Always asymptotic except for the confusion. I have no urology expertise, yet understand how seeing the disruption these UTIs cause makes one wonder how the cost benefit analysis on prophylactic treatment plays out individually. It seems particularly of concern if elder is alone for any length of time as they can develop rapidly. Could make sense to get a urologist’s input.
We put my mother on a prophylactic antibiotic and she has been taking it for 2 years. No more UTI’s and no side effects from the antibiotic, she also takes pro biotics. She is having difficulty swallowing now, so we will see what happens. She has advanced dementia, does still ambulate but cannot dress, wash or toilet herself. Many times her care giver will feed her soft food and shakes.
The danger with antibiotics, especially in the elderly is the chance of C-dif. When the “good intestinal bacteria” is destroyed, this allows clostidium to multiply. The result is watery stools, (a dozen or more per day), abdominal pain, perforation of intestine, etc. You can see how this could set up a deadly situation for the frail, elderly patient.
The best thing we can do is to make sure our elders push fluid intake, (most won’t as that means more bathroom trips), and have meticulous perineal care.
You can purchase urine test strips at pharmacy and on line sources. It is very important to make certain the perineum is clean, wipe front to back 3 times at least with a wet wipie before you obtain the urine sample. You can buy or ask the MD office, visiting nurse, facility, etc. for sterile urine cups. I have found that the only symptom of a UTI is confusion or agitation. Don’t let an MD office shrug you off if there is not fever, pain or frequency.
For @rhandco and others, here are a few tips about end-of-life planning from a lawyer named Charles Sabatino, head of the American Bar Association’s Commission on Law and Aging.
The Durable Power of Attorney for Health Care is the more useful and versatile advance directive, because it applies to all health care decisions and empowers the person you name to make decisions for you in the way you want them made.
Meaningful discussion with your doctor and family is actually the most important step (in the end-of-life planning process).
Advanced directives are legally recognized documents and doctors must respect your known wishes, but doctors can always refuse to comply with your wishes if they have an objection of conscience or consider your wishes medically inappropriate. Then, they have an obligation to help transfer you to another health care provider who will comply.
The only reliable strategy is to discuss your values and wishes with your health care providers ahead of time, to make sure they are clear about what you want, are willing to support your wishes, and they document your wishes.
The major problems with prophylaxis for UTI’s in the elderly is resistance. The bacteria becomes resistant to the antibiotic that is being given. Once that happens, the only solution may be IV antibiotics, which usually require a hospital stay or some sort of central line for repeated IV access. An elder may culture organisms that require 2 different antibiotics. Which one do you choose?
The interesting thing about seeing a urologist might be learning what coud be causing frequent UTIs. In some cases, it may be hygiene. (If there’s a caregiver already doing strip tests or collecting samples, maybe they pay more attention to this.) Maybe dehydration (I know adding fluids poses its own problems.) Or it could be something to do with the bladder or related parts. There’s a tough decision in there, what to do/is it worth the effort, cost and risks.
Hygiene and fluids are good starting points. Urinary stasis is common, especiallly in older females due to structural changes and in men with enlarged prostate. An exam by a urologist is recommended in chronic problems of infections and retention. Broad spectrum antibiotics are used with caution, again, due to concern with C-dif.
Thanks. Mom is being seen 3x/wk for a skin ulcer, so I will ask the RN about a urine test. She does seem confused but there’s a lot going on with her and I had chalked it up to that. But she’s also now complaining of nausea, which was the only symptom when she had what turned out to be a UTI which went septic several years ago.
Thanks for all the info about chronic UTIs. I stopped by last night and mom really wants to know why she keeps getting them. I’m convinced many are due to hygiene. Bathing is hard - such a loss of dignity, and coupled with toileting issues, they are bound to reoccur. It was hard enough to get children to bathe and wipe properly, and it’s sad to take up the same subjects,with my mom. The lab results were positive, so starting a course of abx today.
ECmom, I’m going to copy what you’ve written and hand it off to my sister for the next doctor appt.
I spent a couple of hours with mom last night. She was in good spirits and was joking around and teasing the two aides on duty. They really like her, and she likes them. They are making her walk more and use the WC less. Also doing more personal/self care with less assistance. She wanted to show me her agility getting from the recliner into bed. So nice.
Mom did get irritated with another resident. It is much like school with queen bees and meanness. One of the other ladies said a few mean things about mom getting an outing. Snotty comments ensued, and mom said that she was paying to live there and didn’t have to put up with things of the sort and could “move out whenever she wanted to.” She told me that the other lady is loopy and she isn’t. In fact, “everyone tells her that she shouldn’t even be living there.” There’s no way she can live independently and don’t know that she’ll ever not be a fall risk and be able to live in real assisted living.
Times like this are when we wish there were other options.
Good info on the utis . I, too, just call for a test when Mom is more confused and tired than usual, I can diagnose over the phone.
My DH has one right now, no symptoms other than frequency, fever and then nausea. We are traveling to SILs funeral. Fine time to be sick.
And when I feel sorry for myself ( don’t very often because Mom has resources and is comfortable) I can think of our nephew, only child, mom just died, and she was the caretaker for his dad. So he had to put his dad in Memory care unit. Double room, will be Medicare spend down. He is cleaning out the house to get it on the market. DH wants to contribute to getting brother in better place. But brother is only 65, he could go on for ages and ages. Plus, his wife did work for several AL places in insurance administration so knew the better ones. She had picked out this place. It has no single memory care rooms though. I think BIL has enough coherent thoughts that he could possibly check himself out if he wanted. He thought he was just there because his wife was down the hall and he could walk to visit her. Now she is gone, I think he is going to fight to get out. We saw that a little when he wanted to leave the viewing yesterday, just got up and left. Don’t think nephew has anything more than a poa which came be revoked unless it is specially worded. Yikes!
Nephew is 35 with two young 13 & 9 year old girls. What a squeeze.