They’re allowed to restrain in your state? In CA, only hospitals can do that.
Momofjandl,
Its great that he can keep up with current events, but that doesn’t mean he has safe judgement or problem solving skills. There was a classic case we used to tall about in grad school about a retired astrophysics professor who didnt understand why he was being evaluated: He was intelligent and oriented and could talk about his career and current events. But he was on a fixed income, so, in his mind, it was fine to rummage through the dumpster outside his apt building in the summer when it rotted quickly to find half eaten food in the trash to have for his supper, and to go to the sand ashtray outside his supermarket to get half smoked cigarettes.
Just an example.
MomofJandL - My mother could feed herself up until very recently. At first, she missed having foods like steak and pizza, but she adjusted to the pureed diet and doesn’t have complaints about the food she can have. Not everyone may adjust as well as she did.
We’re having an issue I hope someone can advise. My mom has been high strung and anxious her entire life. Her dr’s offered medicine and she always says no. An example of how bad it is, when her cell phone rings she nearly jumps out of her skin.
She has an appointment Monday with the cardiologist in NYC. She called my sister today in a tizzy wanting to cancel the appointment for Monday. Sister says it’s anxiety, of course she’s nervous and calls the nurse (mom is on the rehab floor ) and tells them mom is having a panic attack can someone please see about anxiety meds. The nurse goes to see mom, who is stubborn but would listen if someone would talk to her and the nurse tells her she’d get her an anxiety meds if she had to but she’d rather not because she’s already a fall risk… sigh
So with sister in a tizzy I call my mom and she’s furious with my sister and adamant that the medical staff doesn’t think she’s anxious either and not a good idea. I just suggested trying it and planning on hanging in bed with her feet up, watch tv and reading the paper. She absolutely won’t do it.
I calmed her down, told her not to make any decisions until she hears what the doctor has to say. I then got her chatting about other stuff and by the end she was much better. Literally doing this walking through the airport.
My sister is sick of it. She’s mom’s crutch when she’s anxious. Which you can understand but at the same time if mom won’t do the things to help herself it puts an unfair burden on my sister to be getting these calls and pleas for visiting. Sister goes there nearly every day.
Sister is making an appointment with the manager of the facility that we can’t have the nurses doing this.
What would you suggest on how to handle someone being resistant to antidepressants and anxiety meds?
@eyeamom, so sorry for your sister and you, too. Your Mom can’t really help it, but I get how tired one can be. My advice to both you and your sister is to draw some boundaries. Talk every day, but stop after a shorter time. Stop some topics dead in the water.
I’d also let a few of the chips fall where they may. If your Mom doesn’t want anti-anxiety pill, let her get anxious enough to really really be obvious that she needs one. The nurse was wrong, no question. If she was already a fall risk, then they are to monitor closely and adding the pill is not more risk really. I just got my mom some anti-anxiety pills. She is not saying anything very anxious, but is fussy, and not still and does ask (when she gets a little tired) about every little thing. Is this the right fork? What do I do with the (used) TP? I shouldn’t put it in the toilet! (She’d been putting the large wet wipe bath things in there).
It is sad, Mom gets very much more calm when a family person is with her. But neither my brother nor I can be there every minute of every day. I pop in once a month or so and shake up the staff and order anxiety meds (this trip) and etc etc etc.
Moms (and dads) with dementia are like tending your kids, and all of us parent a little differently. But we ALL heard the message that you can not live your life for your kids. Same is true for the demented parent.
eyemamom, would it work to ask your mom to humor you and your on-site sister and give the meds a try?
My dad resisted taking antidepressants. When he started taking them he said he was only doing it for me and my brothers, that it made us less depressed but that he didn’t need them (he did!).
LasMa- he is still in the hospital. He can’t move to rehab until he can swallow on his own, at least enough to stay fed and take medicines that need to go through his stomach. Either that, or he’ll need an abdominal feeding tube to move out, which the living will he just signed says he won’t accept. For now, he has the nasal feeding tube, and is restrained to keep him from pulling it out (again).
jym626 we understand very well the phenomena of a patient that can keep up with current events and pay his bills, but who makes appallingly bad decisions. We’ve been watching in horror for years. But most of us are, as a poster very much earlier on this thread said, entitled to our own folly. I’m just not sure a what point we can intervene without his consent, but don’t think we’re there yet. I also don’t know how much the current brain injury will affect his thinking. As of yesterday, he seemed about the same as he’s been lately, except for the speech issues and weakness on the left side. He just doesn’t understand that that weakness will affect his ability to go back home and live there alone without assistance. The rehab team will have their work cut out for them. Once he and the family understand his current state and prognosis better we can start making plans.
SIL is ready to move him to AL, give the grandkids any keepsakes they want from the house, clean out the rest, and get the house on the market. She and I fantasize about doing all of that the way people talk about what they would do with lottery winnings. Then we go back to the life we actually live.
eyeamom- our parents’ generation can be particularly self-conscious and resistant to any psychiatric meds. It might not help with your mother, but for some, how the medication is explained can impact willingness to try it. Help you rest, increase comfort, take the edge off, smooth out your recovery, etc. may apply. The more it can be “medicalized”, the better for some. Often, “sometimes your heart seems a little racy and this might help” is less threatening than hearing they are anxious.
Truth is truth. Taking care of a balky, cognitively challenged elder without de-escalating, re-grouping and finessing at times seems almost impossible. Many benefit from kid gloves and just enough info to suit their circumstances.
Along these lines, my father’s memory care unit uses the phrase “therapeutic fiblet”. Of course, by definition there are significant competency issues for all there and the point was, keep them comfortable, listen to their thoughts, be reassuring and if they need to hear the house they once owned is in great shape, tell them that, too. This presumes no malfeasance on the part of family members. I haven’t had to do much of that as my father is not anxious and will take my word for things. For others, the visits went from constant tensions to pleasant when they no longer felt that all inaccuracies their parents presented must be worked through.
Oh, my.
http://www.wsj.com/articles/abuse-plagues-system-of-legal-guardians-for-adults-1446225524
One day in March 2012, 71-year-old Linda McDowell received a knock at the door of her small Vancouver, Wash., home. Ms. McDowell needed court-appointed help, the visitor told her.
It turned out that Ms. McDowell’s former housemate and companion had pushed for a court petition claiming Ms. McDowell was unable to take care of herself. The petition said Ms. McDowell had recently made an unsafe driving maneuver, had been disruptive in a doctor’s office and, in a recent phone call, had seemed confused over the whereabouts of some personal papers.
Based on the motion, a judge ordered an attorney to act as a temporary guardian with control over Ms. McDowell’s money and medical care. Ms. McDowell was also to pay for these services.
That’s not how it works in most states, momofj&l.
As someone who has had their share of medical interventions, and friends with even more, it saddens me that so many people are afraid of medicine. It used to be that people would die from a broken leg. But we don’t any more. But that’s also why we are working on finalizing my dad’s advanced directive.
And if he is pulling out his feeding tube, there is no way to prove he can’t take care of himself? That seems really harsh. The risk from aspiration pneumonia is great when a feeding tube is removed forcefully. Is he de facto saying he doesn’t want a feeding tube (is he in immediate danger without a feeding tube?)? Is someone else making his decisions for him?
This is some guidance on feeding tubes:
http://www.gosh.nhs.uk/health-professionals/clinical-guidelines/nasogastric-and-orogastric-tube-management
Pulling out the nasal feeding tube was accidental. He won’t leave the hospital until he can swallow, or will agree to a surgically inserted abdominal tube. The living will he just signed said that he didn’t want to be kept alive if he couldn’t feed himself. So…the language in the living will did not anticipate a mild stroke that left him (we think for now) little changed cognitively but unable to take food by mouth. No one is sending him home while hooked up to IVs, and no one is going to pull the plug if he can’t learn to swallow in the next week. But they are telling us that the nasal tube can only be used for a short period of time, not sure how long until the next decision has to be made.
As someone else said “can swallow” is a whole range of “can’t swallow at all” through “can swallow with difficulty, or making sure to take care”. If this just happened recently, I agree there is no rush. The piece of paper which is the living will is ONLY for the case where he cannot actively make the decision.
And unless I missed something, is this not the same case where he would be declared competent and is still living alone? Then the living will is moot, he is competent and can say “yes” or “no”. Why would the family be involved unless he is declared incompetent and the one person who has his medical power of attorney would make decisions?
(I am not trying to accuse, I am trying to understand)
“Competent” is also a whole range. There may be a definition for medical or oversight purposes, but the examples throughout this thread show how tricky it is. Many of the concerns on this thread are about behaviors which can lead to worse problems down the road. Driving, refusing assistance, spending, not managing meds, then the volatility, falling prey to sales reps or scams, etc. In that sense, competent is more than knowing the president or recounting events.
It’s one thing when a parent can actually function well independently, and safely. And/or allows outside help and understands the family cannot fill in all blanks, all the time. Another when they are uber dependent, the family runs in circles, but the elders refuse to acknowledge or cooperate. Or are unable to.
No one (yet) is going to be making decisions for him. Just an observation that he just signed a living will that pretty much ruled out use of a feeding tube, and we’re now talking about the possibility of surgically inserting a feeding tube. Really just an example of how you can write a living will, but you’ll never cover every possibility. Some things that patients and families agree to do because they think it will be temporary become permanent.
I don’t know how long a nasal tube can be left in place, or whether he will consent to an abdominal tube, or whether he will be eating salsa and chips next week.
It’s been 3 days. We have no idea how much recovery is possible or how long it will take. His full expectation, though is that he’ll be back home on his own within the week. Which is nuts, but that’s how he is. And maybe believing that for as long as possible is the best thing for him.
Holding my breath!
The caregiver contract has been cancelled. The caregiver is taking a vacation. The caregiver told FIL should would not stay and care for him alone if MIL stays in SNF. All huge steps, theoretically FIL thinks he could hire the caregiver back after vacation.
Just today FIL agreed to move to the independent living wing of the facility where MIL is in rehab, she would then go to SNF. This is huge for us.
Next step renting their house, estate sale, jewelry! What do ya’ll do with nice jewelry when they move to SNF? I was thinking about having some CZ replicas made so she still feels good about having it, but it’s not a big loss if stolen.
CZ sounds like a great idea. If she’s a bit hazy about what the pieces look like, maybe you can buy ready-made pieces that look similar instead of having replicas made. I’d suspect that would be the cheaper way to go.
It might be expensive to have replicas made, so i agree about finding other good looking costume pieces. Most thrift shops have them and it’s usually easy to find older styles that appeal to elders, rather than obviously modern pieces.
One should investigate in your own state “Durable power of health care” versus a living will. You can list agent, first and second alternative - which are your relatives/friends that know your desires with end of life issues. You have a card in your wallet with your ID.
Some states, it may come down to an ethics board at a hospital if you don’t have something in place.