Oh @compmom that is the worst. It’s a very serious issue. An NG tube is hard for anyone so I can imagine how hard it would be for your mom. She shouldn’t be encouraged to eat since she has a blockage. When it’s that bad surgery is the best approach. If it were me I would try equal parts of Milk of Magnesia and prune juice warmed up in the microwave. I know it might be hard to get her to drink that, but that sometimes works. Best to you
I’m surprised the AL hasn’t suggested the hospital. They are very painful and often an emergency situation.
My head is spinning with information right now. For those of you who playing along at home . . .Last week my folks’ ALF told me they wanted to move them into their Memory Care unit. The agency OT and speech therapist told me they did not think that MC was a good fit for my folks, as they are still very high functioning and many of the MC residents are immobile etc.
So I visited 5 units in three days. And, pro tip, it’s like college tours. Don’t do three in one day, people!! They really blend together.
All the sales people did a great job of assuring me that they could tailor care to mom and dad’s needs. “If dad wants to sit and talk baseball, we can have a care manager do that with him while mom goes to flower arranging.” “We’d create a separate activity schedule for each person” etc etc. But is that reality?
I have also been reaching out to my own contacts and hearing conflicting information. Like, in the OT’s experience XYZ facility has fewer care aides than their current place and they would get less attention.
Some places have said they would still keep them in PC not MC.
Some places have an attractive calendar with a more varied schedule - horticulture person, art therapist, etc while some are more typical of balloon volleyball, coloring etc.
Bottom line is, it’s going to be impossible to make them both happy. They are both very high functioning when it comes to activities. Dad can still discuss sports and politics like he did 20 years ago. Mom is still social and extroverted although she is not oriented to time. But they need direction to initiate activities, and mom needs help with self care and toileting. So they have a real mix of needs. I cannot picture them in with the memory patients I saw anywhere, who were mostly in wheelchairs, not very attentive etc.
I have gone round and round with spreadsheets and talking to sales people and personal contacts and the private duty aides I have hired. There seems to be no consensus at all about anything. Everyone says things like Oh they need MC because mom has tried to leave the building; but she would be bored without the name that tune games. Or they need the constant one hourly checks and engagement, but dad will hate having so many people in his business.
I am tempted to ask for advice here but I don’t think I can handle any more information unless it is a crystal ball that tells me which way to go! 
Oh my, @surfcity! Wow. No wonder your head is spinning.
No advice, but I do have a thought. When our parents are declining, I think it’s tempting to try to find the “right” place. It may not apply to you, but I think that there can be an almost magical belief that there is a “right” choice. And maybe an underlying magical belief that the right choice can kind of fix things for them, to some degree. And these underlying beliefs can add a lot of pressure.
I don’t think there is any place that can really fix the problem. Declining parents are moving targets. Just when we find a good fit, things change.
I guess what I’m trying to say is, take some pressure off yourself. And YOU are a factor in this whole equation. Is there a place closer to you? More affordable? One where you like the staff better? Your parents are on a downward slope, and it’s okay to make a choice that seems reasonable but that isn’t overly nitpicked. It’s okay to just make a choice and go with it.
Hugs to you in this decision.
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No advice @surfcity, just relaying my similar experience 1 1/2 years ago. I eventually picked the place easiest for me; the one closest to my house so I could visit and swing by for emergencies or concerns. I love the care home where my dad is and mom was. But, there were some negatives when I moved them. For example, they could walk for up to a mile while other residents struggled with 50 feet. They tried to bring them on regular walks, but often unable to spare someone to walk with them. I missed regular activities of different kinds so that them could pick something they would be interested in doing. But, where dad is, they get/got individualized and attentive care, good food, all in one pricing, and the opportunity to see me and my husband more. But, I didn’t find the “perfect” place but the situation is imperfect and therefore, no perfect solution. I also found, as @calla1 says well, they have been moving targets and I am thrilled that their care has been able to move with them.
surfcity I have wondered how much these memory unit vary, in terms of the level of functioning of residents, activities offered, and relative freedom. I hope you can find a good one amidst all those tours.
To clarify, my mother has been in the hospital since Sunday after ER Sat. and Sun. It is becoming clear that without surgery, this may be a terminal situation, and she may not be able to have surgery due to heart, and due to Coumadin. She had a stroke off Coumadin a few years ago so it is risky to take her off, so bridging is a possibility.
Her bowels are entirely blocked, low down in the sigmoid colon, probably due to diverticulitis inflammation. Nothing gets through and her tummy is distended like late pregnancy.
They got the nasogastric tube in which is a relief because when she needs to vomit, they can suck out the bile instead. It is remarkable how much comes out, literally enough to fill a pitcher.
They did a series of x-rays after putting some dye through the tube so they can locate the blockage. It is pretty far down, sigmoid colon level,and everything above that is blocked AND full of air.
She hasn’t eaten or had anything to drink since Friday.
I called the surgeon at the bigger teaching hospital and talked with hospitalist where she is, who suggested morphine and letting her go. The GI doctor was more hopeful and at my request connected with the surgeon at the teaching hospital. I called the PCP, talked with Palliative Care, and reached out to the surgeon at the better hospital. Net result is they will transfer her when there is a bed. The better hospital can do stents, the one where she is now can’t.
I have a feeling this is indeed a hospice situation but won’t feel right about it until she is on the service of the surgeon at the better hospital whom we trust. Her interest is in the “intersection of palliative care and surgery.” She is gentle and caring.
The original radiologist in the ER on Sat. read the CT scan as “constipation” which has caused delays in involvement of GI and, finally, yesterday, a surgeon. The surgeon is the one tracing the blockage. The radiologist who read x-rays reread the original CT as blockage due to “stricture” which is a whole different picture. That reading got others involved beyond general hospitalist. So we had a three day delay due to that bad CT reading.
Nurses are great aren’t they? I am continually grateful for the nurses and wary of the doctors!!! That hospitalist seemed prejudiced against the old. He said that we should understand that this is a result of my mother’s overall health but she was pretty healthy a week ago. What he meant was let’s let her go because she is old!
We WILL let her go to spare her suffering unnecessarily, and bring her home. We’ll know in a few days.
We spend years caring for our parents and it is hard to believe this is actually happening. I guess somewhere in there we don’t really believe our parents can die.
@compmom, my dad was in the hospital for an unrelated matter, and then he had a hemorrhagic stroke. The neurologist went from “wait and see” right afterward to “no chance” when he looked at the second-day MRI. I was fortunate that I knew my dad’s wishes which he had made very clear in his living will, and he was gone in less than a week. It was such a lonely, heartbreaking thing to say, ok, keep him comfortable, this is what he would have wanted if someone had asked him last week.
There was no way to bring him home, and I was fortunate that the hospital kept him for hospice care until the end. It took several months after he passed before I could look at the downward spiral of his final two years of life.
(((((HUGS))))) to you, and hoping for the best possible outcome for your mom, and for you too.
@calla1 wow, you’re comments are really, really helpful. And a bit of a relief for me to read, as I struggle to find the “perfect” place. There is no one perfect place, as @GTalum echos. Thank you.
@compmom I feel for you. What a difficult situation. I understand what you say about “hard to believe this is happening.” I find that I can have all sorts of pragmatic conversations about my parents dying, when I am choosing a care facility or completing a living will, but when I do get an unexpected call from the nurse or someone lands in the hospital, it all becomes too “real” and harder to accept.
@surfcity - There is definitely no perfect place. I toured so many facilities and always felt like my mom was much higher functioning than most residents. However, she would wander and get lost, and needed assistance with ADLs. We were fortunate to find a facility that would group high functioning residents together for meals and activities. That helped a lot. I will also say that while my mom was physically higher functioning, she was middle of the road mentally and it ended up being the right decision for her to go to memory care over AL. It took her a solid month to adjust which was tough on everyone but we kept reminding ourselves that the primary goal was her safety.
Good luck. It sucks 
I think the system needs something between AL and memory care?
@compmom you are such at attentive daughter who leaves no stone unturned. I hope your family appreciates your endless research and open-mindedness to finding options for your mom with few of the medical professionals are helping. I’m so glad the nurses are providing comfort for you both.
I have had feedback from friends on Hospitalist comments that are beyond outrageous (from two different Hospitals). One friend (who had a long chronic condition) was told by a Hospitalist that she would die THAT DAY! Of course she didn’t but she died within about 6 weeks. The other was pushing H to take his wife off the respiratory machine, talking to him IN THE ROOM where she could potentially hear!
So relieved to be at the teaching hospital where they are already trying new things. My mother has a nasogastric tube and is not allowed to drink. Her dementia is so much worse. She can’t understand why she can’t drink and asks everyone every 10 seconds for water. I have tried every strategy and take quick walks in the hall to stay patient! Thanks for the stories about hospitalist and the death panel!!
The hospital has assigned a one on one sitter 24 hours a day due to my mothers dementia .??. She’s safe and I got some sleep?
@compmom Perfect! I’m sure you really appreciated that. Any progress with the blockage?
@compmom I’m so glad you got some sleep! It’s so hard to function when you’re running on empty.
I had no idea a hospital could do that. Glad you are getting some rest, it is surprisingly wearying to stay by someone’s hospital bed all day (and night).
They have to keep the nasogastric tube in to drain the extremely distended tummy. Literally pitchers of bile. The blockage is not total, and is not a result of new diverticulitis or mass, but from the original attack which caused a stricture. The diagnostic enema means massive watery stool so the hope is she can clean out without a procedure, but surgery is schedule for Tuesday or Thursday
. I never though we would go to that length but the surgeon, who is so good with palliative approaches, says that NOT doing anything is not an option because the result would be so unpleasant It’s just a small incision above the blockage and a bag to let the stool out. We’ll see what happens.
Another day of my mother saying, every minute of the day “I need some water, please give me water, I am thirsty,” and having to say no, and explain or not explain because she cannot understand or remember. Even with the slightest liquid, she chokes horribly since the tube interferes with swallowing.
The palliative nurse came in and got her some fake saliva spray. I promised this every hour or two and my mother was able to sleep. Her discomfort is so real, but there is nothing we can do. The huge tummy reflects the entire intestine is distended with air and bile.
We’ll see what the weekend brings. Decision will be Monday. They can hold the Coumadin and bridge her with Heparin. When Coumadin was held 5 days she had a stroke so was happy they could manage that risk.
Hope this helps someone in the future. If we had kept her at the local hospital, which is cozy and we know it so well, I don’t know what would have happened. The hospitalist just wrote her off as on the way out. The GI doc said there wasn’t anything they could do. But there is plenty to try. Very hopeful.
I stayed in the room and the aide hired one on one for her, helped out on the floor until I left. They made it very clear that they would come right in and relieve me as soon as I wanted to leave, so I left at 6:30, amazing.
At one point she wanted to go to the bathroom and she lunged at the sink on the way, trying to get water. Hard to watch her desperation.
@compmom That’s an extremely difficult situation, but you sound hopeful. So glad that you have an excellent hospital. They seem to really be giving you lots of hope and lots of help with a very sensible, compassionate plan in place.
I’m glad you’re getting some relief too.