Sending good thoughts your way, jym626. These anniversary times can be tough. I find that while time helps, there are always moments…
And the 5 pm Friday rehab discharge happened twice to my 1,500 miles away MIL. Once the receiving AL (part of same complex where she lived pre-rehab) thought they would “probably” be able to have her necessary anti-coagulant by Monday. Uh, no. The second time she was so weak that her husband called in a panic and DH arranged for round the clock care for her safety at 9 pm on a Friday. All despite good family efforts.
It applies anytime a Medicare patient is using services under Part A, which covers hospitalization and (at least in my experience) Rehabilitation Hospitals.
We had to use this once with MIL when the attempt was made to do a discharge without a satisfactory (from our perspective) discharge plan in place. The nursing home not having the prescribed drugs on hand and not being able to get them for a day was cause enough. It stopped it immediately. Every state has a Medicare Quality Improvement Organization, and one of the (many) papers you get upon hospital admission is how to contact them. Keep it handy.
One thing on Medicare and being kept for observation. Have the regular medications from home, as the charges for this may be astronomical and medicare will not pay for medication during a hospital observation time. Others can perhaps chime in on this, but a friend was charged over $2000; they had a supplement, but if medicare doesn’t pay their supplement won’t pay. Because of strong ties with a physician group, was able to get the hospital to ‘write off’ the charges.
Apparently this kind of break is not uncommon several years after a hip replacement. I gather my mom’s upper femur (so technically not actually a broken hip) is shattered and the stem from the implant is not connected to anything. They’re going to have to replace the stem with a much longer one (going into existing bone) and presumably build new bone at the top somehow. Surgery is tomorrow morning; takes about three hours.
Not sure if this book was mentioned on this thread but ‘How Doctors Think’ by Jerome Groopman MD (2007) is a very interesting read. By understanding some of these insights, can perhaps help with your own judgment in various medical situations. I got the book cheap through Amazon used.
I know my cancer misdiagnosis is a very good trump card for me to get extra testing and very close scrutiny from my medical providers because they don’t want to make another mistake (my fired doctor did not follow medical protocol, and my very good doctors in this community are embarrassed by how devastating the mistake was for me and could have cost me my life).
My 91 year old m-i-l, who had been living in an independent living facility and doing ok for the past 4 months, has deteriorated tremendously in the past 2 weeks. It presents somewhat like a stroke, but she has been hospitalized for a week and the CT scans and MRI have ruled out stroke, tumor, etc. She is generally very confused. Sometimes agitated. Sometimes delusional. Other times reasonably ok. She needs help dressing, eating, bathing, etc. - all tasks she did alone up until 2 weeks ago. The doctirs have no explanation for her sudden decilne - main focus has been to control her very high blood pressure.
She is being released from the hospital and going to rehab for 10-14 days - during which time we have to find the next location for her. She cannot return to her independent living apartment.
Question has to do with the type of facility. She needs memory care and assisted living. We are going to see a Sunrise facility next week, but b-i-l also wants to look at a small group home facility. I get that the group home is homier and less institutionalized, but I can’t imagine it would have the resources of a large facility. Does anyone have experience with placing a relative in either type of memory care facility and what are the pros and cons of each?
Yes - that was one of the first theories and has been ruled out. The only hint of explanation is her very high blood pressure and/or her reaction to the 5 bp meds they are giving her in the hospital to bring bp down.
Basically - we have been told that there is no explanation for how she deteriorated so quickly. Hard to believe she was living in her own condo and still driving back in September.
Our main concern now is the need to find a memory care facility for her in 2 weeks or less. Just wondering if large Sunrise facility with more amenities is better than small group home. I have never heard of the small group home concept for someone in her situation.
We’ve seen before in this thread that very old people can deteriorate quickly. It’s by no means unprecedented when that happens, though of course it’s a sad shock if it’s one’s own loved ones.
Yes - very sad shock. I wonder, in retrospect, if relocating her from her familiar condo in Florida where she had lived for 20 years and bringing her to Dallas to live near my b-i-l in an independent living community was too much of a change for her? But at 91 - we could not see her remaining on her own in Florida. I think the change in climate was tough, giving up her car was hard, moving away from her few remaining friends, etc.
My main concern now is all of the next moves. Now she has ben in the hospital for a week - then to rehab - then to some type of memory care facility. That would be a lot for anyone to handle. B-i-l has already given notice on her apartment in the independent living facility. I am concerned about choosing a memory care facility for her on such a short timeframe.
Marylin, s sorry for your moms hip. Hope surgery is successful.
Rockville mom. Sorry for your mil sudden drop down too. I think the small foster are environment can be great depending on the person. When my dads wife got demented, her daughter put her in two AL places, then moved her home with live in help who helped herself… Then to what we called foster care. For dads wife the foster care was the best place, she was not social much and preferred the quiet . There were 3 people there so there were people to sit and eat with. We think maybe for mom when she goes further down, it might’ve e an option, but right now she enjoys the activities.mshe is very much a social person.
I looked into small group homes for my grandmother in AZ. But they had (state-mandated, I believe) minimum requirements for how well the client could function. They were not appropriate for my grandmother’s end of life condition. Some were very minimally staffed. (But all were nice.) I’d think a call to the local community’s elder care resources could offer some insight. I think the hospital social worker gave me a list of some.
Rockvillemom, I think the best thing to do is visit as many facilities as possible. Try not to rely on web sites or brochures for information, as these are put together by marketing departments and can be deceptive. So much depends on the individual staff members and other residents. My mom is in a large assisted living building, but her memory care group is only 10 people. The facility brings in lots of activities and entertainment for them, something that might not be as available in a smaller group. However a small group home with dedicated staff probably offers much better individual care and attention. It is upsetting when a decline comes on so suddenly. I’ve just come across some cards my mom sent only a year ago, and now she can’t even write. I’ve learned that the older the patient the less compelled the doctors seem to be to find an explanation for problems. They do the obligatory scans and blood work and if those are normal that’s the end of the investigation.
rockville - it seems like every time I visit my mom there is a new low. She was okay until August, then a really fast spiral down.
I agree with others, go visit in person. Much like you can tell a lot about a school by a drop in visit, the same can be said for elder care facilities.
If she’s going into memory care does she need amenities? What are the most important things for her care and focus on that. I think places make and break on staff. Check turnover, check qualifications and ask about the daily schedule. Also ask how meds are determined and given out, access to a doctors visit. For me there is something to be said for bigger places so there is less dependency on one particular caregiver. To me the more eyes the better. It’s like daycare - a home daycare can be cozier, more trust to the individual, whereas a daycare center will be more structured, less chance of any funny business with an individual. It just really depends on the particular place.
Thank you. I very much like the daycare analogy! These situations always bring complicated family dynamics to the forefront as well. My m-i-l lives in Dallas near her younger son - and he is in charge. We are flying in this week. I know we won’t have much of a say in anything - and b-i-l has handled her financial affairs and health issues for years - and done a great job - no complaints. I just want to be an informed participant rather than a useless bystander.
rockvile–if your MIL is going downhill that fast maybe you also need to talk to the local hospice, either at the hospital or rehab facility. At 91, palliative or comfort care could be best and they could help you find the appropriate facility/home for what you actually want.
When your MIL is “with it”, what are her desires? What are her health care goals and how can you help her get there? I know she probably wants to go back home, but that can’t happen. Best wishes because this isn’t easy on any level.
dentmom - if I was managing the situation and this was my mother - I would completely agree with you. But I am not managing this - just a helpless bystander. My m-i-l emphatically told me she wanted no extraordinary measures taken. But we never got into specifics. Now she has been hospitalized for 8 days and while she does have reasonably lucid hours here and there - she is mostly very confused and helpless. Her blood pressure was dangerously high all week - now it is too low. She is experiencing terrible head pain. Second CT scan showed nothing - now the hospital is proposing a spinal tap. I just feel like she is being tortured at this point.
I’m so sorry for your MIL’s pain and circumstance. Is she dehydrated? Was the urine culture a “clean catch” or a catheterization? Has it been repeated? It sounds like her medication has now lowered her blood pressure to a point that she may also be an increased fall risk. It also seems like they are trying to rule out any central nervous system disorders including viral, bacterial, fungal. A spinal tap would be the next step after exam, blood, and radiological studies. It may uncover something that is easily treatable. Since she was doing well previously, this is something that I would consider for my elderly family members. Sending good thoughts and hugs.
Thank you. It’hard being in Maryland and all this going on in Dallas. We are dependent on DH’s brother for updates. I don’t know any details about the UTI testing - just that it was eliminated. She has an IV - so I assume she is being kept hydrated. Thank you for your reassurance that doing the spinal tap is not crazy. The funny thing - if there is a funny thing in this whole situation - is that I generally don’t even LIKE my m-i-l - and yet this had been so upsetting. For those of you dealing with this type of situation for your parent or other close family member - you have my utmost sympathy. This is hard.