<p>Eso- Good wishes for a smooth transition to you and your mother. Here’s to peace of mind.</p>
<p>I dont have a dog in this fight, but recent news events led me to tracking down info that might be helpful to others.
[Nursing</a> Home Inspect](<a href=“http://projects.propublica.org/nursing-homes/]Nursing”>Nursing Home Inspect - ProPublica)</p>
<p>emeraldkity4,</p>
<p>That web site is an excellent resource especially for anyone with adult parents who may be looking for a nursing home. Deficiencies are rated from A-L.</p>
<p>My mother lives in an upscale continuing care community. I checked the rating of the nursing home there. The deficiencies ranged from B-D, so I guess that’s not too bad.</p>
<p>For anyone who is interested, the states with the highest number of deficiencies are:</p>
<p>Texas
South Carolina
New Mexico
Arkansas
Louisiana
Mississippi
Alaska
Oklahoma
DC
Michigan</p>
<p>The states with the lowest number of deficiencies are:</p>
<p>Hawaii
Delaware
Pennsylvania
South Dakota
Virginia
Arizona
Massachusetts
Nebraska
Maine
Montana</p>
<p>The website “ourparents” has some useful information, though very few senior care facilities have ratings from the general public. Hopefully this will change as more computer savvy relatives are finding care for their loved ones.</p>
<p>Thank you Emerald, excellent link!</p>
<p>What do ya’ll think about getting a baseline cognitive test done. My mother has been so spacey the last day or two, I believe based on being exhausted from three days of travel. I feel like the range of ‘normal’ gets smaller and more fragile as we age. In the same way she is now cold at a warmer temperature than I am, and is hot at a cooler temperature than I am, she loses her cognitive equilibrium equally easily.</p>
<p>I don’t feel like she has dementia, not even early dementia, but I can see that since Dad died she has no interest in learning anything new, in taking on anything he did. That’s all fine, but it would be nice to know where she is now and do a test annually to have a warning for when it is beginning to go down hill, since I am too close to the situation.</p>
<p>But how does one broach that with out causing stress? Suggest to Mom that it is recommended to establish a baseline or ask the Doc to tell her he is now recommending a baseline for people over 80? I don’t want her to feel like we think she is losing it & feel badly about her silly questions (OMG, the TV remote!!)</p>
<p>I have not heard of getting a baseline cognitive test if someone is not showing any signs of dementia or mental decline. My MIL had Alzheimers and I didn’t feel that the mini-mental state examination (MMSE) was an adequate indicator of her condition. Believe me, you’ll know when she’s starting to slip. You won’t need a test to tell you that. Even if you did have a warning that she’s going downhill, there’s very little that you can do to reverse her decline. That is what is so devastating about dementia and Alzheimers. I hope and pray that scientists will discover a cure.</p>
<p>Somemom, it could be depression, and you could ask her to be tested for that as well as other issues. It did not go well when my MIL was tested for dementia. Not that she needed to be tested. It was so obvious by then, that testing really was not necessary. My MIL’s dementia is not consistent, however, and she knew she was being tested and it upset her terribly. She had been tested before, and DH put a stop to it when she was distressed It can be a sensitive issue.</p>
<p>There are meds that can help and slow down the process, or are supposed to, as well as anti depressants which help for those losing interest in things. </p>
<p>A specific test is necessary to get a incompetency diagnoses which is necessary to gain control of financial and medical decisons. We are starting that now, about 3 years at least, too late.</p>
<p>Cognition can also be challenged by physical issues, including asymptomatic UTIs. We had an active discussion of this up thread. Being tired, changing environments, stress can all play a role in cognition, as can a fall, illness, psychiatric issues or serious pain. Baseline understanding of cognitive status can be helpful, and it is also important to rule other things out. Sometimes it seems that careful observation of how info is processed, tasks are attended, instructions are remembered and decisions are made is most useful in deciding how to proceed. I found that what becomes most relevant is how successfully the demands of the day/present circumstances are navigated. </p>
<p>Esobay- hope the moving day went well.</p>
<p>travelnut,</p>
<p>“Sometimes it seems that careful observation of how info is processed, tasks are attended, instructions are remembered and decisions are made is most useful in deciding how to proceed. I found that what becomes most relevant is how successfully the demands of the day/present circumstances are navigated.”</p>
<p>I agree with you. In my opinion, a mental or cognitive evaluation administered by a doctor is not going to give you the “big picture.” Someone who is close to the person can best observe how they are functioning on a day-to-day basis.</p>
<p>Travel nut you are so right. My mother recently had two episodes of UTI and one of flu. Both times she was ravingly incoherent, slurring her speech, not knowing where she was, etc. </p>
<p>Once the illnesses were cured, she returned to normal. But unlike Alzheimer’s these episodes came on relatively quickly. They looked like a possible stroke though, which was ruled out be CT scan.</p>
<p>Hi all, posted back in January about my mom having a small intestine blockage. She has been back home since late January and under hospice care. At first she seemed to be improving but has not been eating for several days, sleeping and in bed most of the time. I keep pushing ensures and oatmeal with fruit puree. Hospice nurses have told me to stop pushing. So very hard.</p>
<p>My thoughts are with you and your mother.</p>
<p>Bonnie - Sorry for what you are going through now. It is hard. Good that you have hospice support. I’ll keep a good thought for you and your family.</p>
<p>I have stumbled on this thread several times over the past three months as the situation with my mother’s health has gone from bad to worse. From her complete independence to staying at my house with support to congestive heart failure and exhaustion to progressive weakness in her legs and loss of urinary continence over the past 2 weeks and now in skilled nursing with a vague diagnosis of a spinal tumor. From the day she first came to my house she expressed how she wished euthenasia was legal and how she wanted to die. We had continued hopes of recovery as we went through several lapses of improvement followed by decline. She is totally cognitively aware and her pain is my pain. She always cherished her independence. For now there are some bright moments but mostly profound saddness. I am working to be there for her and here for the rest of the family but that weight never leaves me. How do you get through this sort of thing. I don’t know whether to encourage her rehab or a move to hospice. And even if we do start hospice there is nothing about that decision that will make her final peace any closer. This is so difficult. As the primary support system an cheerleader how do you keep the joy in your life? Today was only the second of two days since December that I didn’t see her and the worry and saddness has been relentless. How do you do it?</p>
<p>Spectrum2, I don’t have any answers but your post hit close to home. My mom has said several times that she wishes there was a pill she could take to “go to sleep”. She was a brilliant woman once, and now can’t calculate the tip on a bill. It’s as though the person she was is being slowly erased, and she is aware it is happening. I don’t know how to be a cheerleader anymore.</p>
<p>Spectrum- Sorry for this rapid, distressing decline and all the angst that inevitably accompanies it. I helped my mother through her terminal illness and have a lot of empathy for your situation. </p>
<p>While every situation is different, here is what helped me:</p>
<ul>
<li>I viewed honoring my mother’s wishes as a sacred trust between us and used what I knew about her preferences and beliefs to guide me. Easier, because she had been direct.</li>
<li> Once it was clear that all was winding down, I didn’t second guess myself. I borrowed her confidence. </li>
<li> I spent a lot of time with her, spoke with her whether she was responsive or not, told her anything I wanted to say to her, including that we would always miss her, but always be okay. </li>
<li> I asked her team questions about her care, comfort and state. It helped me to understand the process.</li>
<li> When hospice said that food, and ultimately water were a challenge, not a help, I let go of that form of caregiving. </li>
<li> I slept at home so I could actually get a bit rest and see my family. I leaned on my husband and cried at times. </li>
<li> I accepted offers of help from my inner circle during the “vigil time”.</li>
<li> I did the best I could, knowing my mom appreciated it all and it was enough. </li>
</ul>
<p>What I didn’t know was how much that experience would enrich and inform my life going forward. She has been gone for 7 years now. </p>
<p>Sometimes, you don’t know how you can go through one more day. I would just show up and see what happened. That was enough. </p>
<p>Best to you and your mother.</p>
<p>Momsquad- I know that feeling. When my mother’s illness turned the corner, if I was a cheerleader at all, it was to say to her directly, “Mom, there isn’t anything we can’t do together, is there?”. And there wasn’t. Just bearing witness and hearing their thoughts or fears and abiding is everything.</p>
<p>Bonnie… I am so very sorry. That is so terribly hard. From what I have observed of hospice people, they usually are telling you the right thing and I hope they are supporting you.</p>
<p>Spectrum, euthanasia is legal in Oregon where we are, but there are so many catches… One being that you have to have two drs agree you are six months from natural death. So for Alzheimer’s and some dementias, they take longer than six months… And by the time the drs are sure it is less than six months, the person is too demented to talk and ask for and self administer the pill. My mom always said she,d want one, too. Especially after she lived with grandma for ten years and by the end grandma couldn’t even speak… But she ate and lived another two years due to my moms excellent care.
Yep, smart smart woman, now can’t remember why she called the dentist.</p>
<p>If Mom isn’t being argumentative, she can be talked into almost anything, so it went better than I expected for talking her into moving. So I think she will sign the papers and move tomorrow. I hope so. It will be a big relief to have her where she has better care. And she is still pretty good, but if she did get a UTI and get loopy, no one would pick up on it very fast over on the independent living side… And she is prone to UTI s.
She is actually very happy being around people. She always was social so I am at ease with " locking her up"</p>
<p>spectrum, I’m so sorry. This is so hard on you. We haven’t quite reached the stage where you are yet, but I know it’s coming. I think travelnut has some really good suggestions, and from everything I’ve ever heard about hospice, you can trust and rely on them to be telling you what’s best. Lean on them.</p>
<p>I’m concerned about you. It is so, so hard for caregivers to take care of themselves, but it’s absolutely essential. You’re going to need your physical, mental and emotional strength in the days ahead. You will be helping your mother by taking a little time for yourself.</p>
<p>Talk to your nearest and dearest, your closest friends, and your clergy if any. Tell them that while you care for your mother, you’re asking them to care for you. Tell them that sometimes you’ll need to just talk, and sometimes they need to kidnap you for lunch or a bike ride or a good romantic comedy. And take care of yourself – try to eat well, sleep, and exercise. Be nice to yourself – read a good book, do a jigsaw puzzle, watch an old movie, take a bubble bath – whatever spells pampering to you.</p>
<p>I’ve been reading this thread as my brother and I have seen my mother through her second broken, hip, rehab stay and then move into assisted living. This was the tipping point as she was still living alone independently and driving. It was already clear that memory issues were becoming a problem and it doesn’t look like she will ever live independently or drive again. We have not taken her back to her house even though it is only a few miles away from her AL place - straight there from rehab as advised. She was told in rehab that she couldn’t drive, but I don’t think it sunk in as a permanent situation. We have not brought up the issue of never driving again or living at her house again and she hasn’t either. Although she is having trouble with words and conversations and some confusion, she is perfectly aware of her present situation and needing to recover from her injury. We are taking her to a neurologist soon. Question for you guys - how do you broach these 2 issues (not driving or going home) in the kindest way possible and when? Also, how do you get LTC insurance to pay off when your parent clearly has to have AL but doesn’t qualify completely for the ADL’s. There is a cognitive impairment clause, but it is vague. Any experiences?</p>
<p>Preironic,</p>
<p>I will share my experience with you. When it became obvious that my MIL should no longer be driving (due to Alzheimers), my H and his sisters requested that her doctor tell her this. Since I was the one who took her to this doctor’s appt, I was the one who she “blamed.” In her eyes, I was the one who took away the keys. She was miserable about this for at least a year. I’m not sure how it could have been handled differently.</p>