<p>Knitkneelion, sending warm wishes for you and your family during this difficult time. Each week a team meets to determine if the patient is working towards achieving the goals set for rehab, they then report this to Medicare. Once the pt. cannont meet the goals, Medicare will discontinue reimbursement. Even if there are more days left from the 100 days I cannot see how the team can justify the stay with Medicare. I would consult with hospice asap for another viewpoint. Are there any hospice beds in your area?</p>
<p>She was living in an AL prior to the hospital stay. They will not take her back due to mobility issues that will not improve. She was released by the PT at the rehab within the nursing home because of lack of progress. The nursing home is her home now. They are continuing to justify Medicare payments because of behavior issues. She was yelling out quite a bit for the first couple of weeks. Thanks for your responses. I plan to read through them carefully tonight.</p>
<p>It will get better, knitneelion. Hang in there. </p>
<p>That is helpful info. If the behavioral issues were considered as adjustments to transitions, all other variables being equal, it might be tempting to not disrupt her further. In general, the simpler it is all around, the easier it can be. You are fortunate to have seen how rehab is handling things and have that to stir into things if it is an option. </p>
<p>End of life care involves focus on comfort and addressing current dilemmas, rather than seeking answers as to why. I found it liberating at a certain point, as did the elders. I was able to just be there with them and it was everything that mattered. </p>
<p>Trust your gut, combined with feedback from trusted, seasoned caregivers. The answer will come. Thinking of you and hoping the meeting is helpful. </p>
<p>Once it was determined my FIL was not appropriate for rehab, they moved him to a nursing home and he paid full cost, even though 100 days were not up. It seems to me, if the nursing home is willing not to push your mom towards certain goals, their models of palliative care would be fine. You just need to ask what would be expected of your mom under their palliative care model. We found that by getting hospice involved, the staff was willing to stop all the things he hated such as medications, blood draws, and getting him out of bed. I’m not sure hospice did anything special, it was just a way to show the staff we were willing to let him die. </p>
<p>Well said, travelnut and GTalum #4963 and 4964. </p>
<p>GT, I think sometimes hospice does as much for the family as it does for the patient. We started orienting ourselves away from treatments and cures, stopped seeing Dad as a patient. Once that was gone, he became once more the man we loved, instead of a medical problem to be solved. I’m so so grateful that in the final days of his life, I was freed from even thinking about finding “cures” and was able to concentrate on saying goodbye. And you’re right, travelnut, it was liberating.</p>
<p>But of course the benefit of stopping the pointless treatments and fruitless searches for cures is a benefit to the person in the last stage of their life as well. No longer do they have to be annoyed and disturbed by pokes, prods, schedules, demands, medicines and foods they don’t want.</p>
<p>Isn’t that the truth…</p>
<p>My sister texted me from the doctor’s office. My mom has lost 15 lbs since June. She’s also now lost 4 inches in height. Apparently her doctor said her spine fracture came from sitting on the couch hunched over too much. Mom is very, very bad about thinking taking to her bed is the solution. The doctor told her walking will be the only way to regain any mobility. I’ve been preaching move it or lose it for years now. I’m still waiting to hear about the choking and not eating. If she eats 500 calories a day I’d be shocked. She may eat a yogurt in the morning, then just take literally one or two bites the rest of the day. They did a bone scan and are going to do some kind of iv bone strengthener. No idea why she hasn’t been on boniva or some same type medicine. </p>
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<p>Ha! If you figure out a way to make this work, let me know. Despite being continually nagged by doctors, nurses, PTs, aides, and me, Dad couldn’t be persuaded to use his walker. And my mom’s doctor put her on a low-sugar, high-protein diet, which Mom has magically transformed into “desserts, pastries and popcorn,” and cannot be convinced otherwise.</p>
<p>Does anyone have a parent with choking on food issues? My mom started choking on things like rice years ago. Now she can hardly swallow pills. Yet, she never mentioned this to the doctor until my sister took her today. She’s getting a swallowing test on Thursday. I don’t really have any idea about any of this, have any of your parents gone through this?</p>
<p>Stroke, diabetes, Alzheimers and other diseases affect the ability to swallow. Food has to be modified. There are thinckening agents that can be added to liquid and soft foods. My aunt who eats very little now exist mostly on Ensure Plus shakes. It is high protein and seems to keep her going.</p>
<p>Sometimes candida thrush fungal infections can also reduce the ability to swallow. It can be treated via Rx lozenges once it’s diagnosed. Definitely something to talk with the doc about and have him or ENT (ear nose throat specialist) check it out.</p>
<p>My mother has had swallowing problems for years and is on a puréed diet and thickened liquids. The swallowing test will show what consistency of food and drink your mother needs to be on.</p>
<p>My FIL had Parkinson’s, which is associated with many swallowing disorders. There was a swallowing therapist at the rehabilitation hospital (not a nursing home) who was quite helpful. I was surprised to learn that thin liquids were among the most dangerous. </p>
<p>Such a big loss in height is the result of ‘compression fractures’ in the spine. </p>
<p>Signs in mother means checking for osteopenia on you and other sisters - my mom had osteoporosis and my older sis has osteopenia (and is responding to TX, she is 61). Younger sis and I are fine - I inherited dad’s bone structure, and younger sis is in great shape.</p>
<p>Smokers, or people who have had prolonged use of steroids (for medical conditions like arthritis) often have affected bones resulting in osteopenia or osteoporosis.</p>
<p>My MIL is back in the hospital. Third time in a year - she has congestive heart failure and pulmonary fibrosis. isn’t like to take her meds because they make her have to go to the bathroom or sometimes she just doesn’t feel like taking them. Hence fluid builds up and her heart works overtime and she needs intervention to drain all the edema. Which is 2 weeks in the hospital. </p>
<p>Last week her Dr told her she must be admitted and she refused until the weekend. Then she talked to her Dr and admitted that her O2 level was in the 40s (!!!) but did not call 911 or go to ER until later that night “when it was more convenient.” </p>
<p>Now they are telling us that he heart has been so damaged they are not sure she will recover. My H and his siblings are feeling so many emotions, chief of which is frustration with their mom. This is her pattern, of not listening to them or making small changes and we all see it as extremely selfish. </p>
<p>I just had to come here and vent to people who would understand. We know she is older and this condition was going to catch up with her sooner or later, but it is so sad that she would let her stubborn I’m-not-going-to-let-my-kids-tell-me-what-to-do posturing shorten her life. 
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<p>So sad, surfcity . The thing I remind myself of is that all these physical problems may well impact cognition. People with inadequate oxygen don’t think straight. My MIL had a similar experience - became acutely short of breath on Sunday morning and just let it be until Wednesday. She had a pulmonary embolism- Drs told her another half hour and she would have been gone. </p>
<p>I hope that the family can rally together for her to be in the best setting possible. Sometimes ongoing personality issues mask symptoms related to aging. MIL was always hyper-critical. During one visit she repeatedly made requests that I put needed items in her bathroom. They were all there in usual places. Found out she had several mini strokes, not yet diagnosed. Our elders are now 90 and impaired. I found it helpful to give them a free pass on most things; more may beyond their control than it seems. That said, they are in a level of care appropriate to their limitations, which makes all the difference. Best to the entire family. Lots of us here do get it. </p>
<p>When we get frustrated with our parents, sometimes it’s helpful to look at it from their point of view. From your mother’s point of view, if she takes the diuretics, right away she’s going to have to need to pee frequently, and for someone with congestive heart failure, even getting up to go to the bathroom is an effort, and she might not feel up to making that effort. She might be feeling, I need some peace for a while, without getting up all the time. It’s not wise in the scheme of things, but don’t all of us make these stupid short-term decisions? (Ahem, about that leftover Halloween candy that I shouldn’t have eaten…)</p>
<p>Surfcity, I’m glad you can come here to vent. Most of us have been there. We know. We know how frustrating it is, and how you love your mother but you think she’s doing such stupid things. Hugs. It’s a tough time-- not for sissies, for sure.</p>
<p>My MIL did the same thing with the diuretics, for the same reasons. It is tough. For a lot of people who are in bad shape, the struggle to get up is so much that they can’t make it to the toilet quickly enough anyway. </p>
<p>Glad you’re here, Surfcity. You do what you can. Take care of yourself and your family.</p>