Question for all you LTC Providers

  1. I have a bit of a problem. My Grandmother, age 96 was just placed in a LTC/Rehab center. She has lived at home with her son up until 3 weeks ago when she had to be hospitalised.
    She is very stubborn, depressed and angry. While I understand her wanting to go home, if we took her to my Mother's house, (she and my Dad are thinking about it) I feel it would not be a good idea.
    Gram has Diabetes, and all the health problems related to it. She isn't able to ambulate without assistance and refuses a wheelchair. Needless to say, falls are a major concern. She is incontinant and must wear a breif which she fights. Her hospital stay was for CHF and UTI. She had been cheeking her Lasix because she didn't want to have to pee so much.
    She is a bit paranoid and has started hallucinating a bit. Every time we try to get her to take a PRN Ativan, she refuses saying she's not having anxiety. When the nurse leaves she is crying and begging us to take her home. She won't admit to any pain, ( she has a fx wrist from a fall) because she thinks they will keep her longer.
    My real concern is that my Mom or Uncle will take her home. They are both in their upper 70's and not in great health. I know Grandma will never "adjust" to life anywhere but home. I don't think she qualifies for hospice and I'm looking for any advise you can give. This is really tearing the family up. My Mom goes to the center at least 3 times per day, as does my uncle. I try to go every day.
    We all want her to be as comfortable as possible, but I'm at a loss as to how to help her.
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  2. 9 Comments

  3. by   mizzou_ivy
    I understand your frustration and heartache. At least you are one step ahead of the rest of your family in seeing that Grams is not appropriate for home care any longer. She will adjust to wherever she is placed as long as it is done with compassion and sense of well-being. She will be provided with the kind of care that your elderly mother and uncle will not be able to provide. A third party is often more helpful in getting a "Stubborn" person to help themselves (i.e. wear depends, take Lasix, etc.). Do what is best for grandma and either get home health care, 24-hour nursing care or a LTC. Whatever your choice try not to feel guilty for your decision.
  4. by   CapeCodMermaid
    [FONT="Comic Sans MS"]Can you get the social worker involved? No wonder she's depressed if she's in a home after being on her own for 96 years. Maybe just someone to talk to or an antidepressant short term. Then...can the time of her lasix be changed to earlier in the day so she doesn't have to get up at night to pee? Or, really...at 96 does she even need all those meds? Can the staff set up a toileting program so she stays dry? So many suggestions, so little time. Good luck and let us know how she does.
  5. by   MadRedneckRN
    Thanks for the replies. We have a Social Worker involved, just no suggestions yet except "everyone has to tell her the same thing, she can't go home right now". The Lasix is early in the morning but noc bed wetting has also been an issue. She will wear the brief at night without too much trouble. She is on Lexapro, and Elivil. She has had Home Health in the past, but she doesn't like them to do anything. She just will smile and say, "Well, Lynn can do that for me." (Lynn is my uncle, who needs a cane to walk) He won't say a word to her, but will tell the family, he can't do it. He just doesn't want to be the bad guy
  6. by   Dixiecup
    Some will probably disagree with me but if you're comfortable with the facility, I think the family should stay away for awhile and she will adjust better.Where I work I know it's easier if the family doesn't come every day during the adjustment period.

    Let the facility get her used to the routine and maybe get her involved in some activities. She may end up liking it after she figures out what they have to offer.
  7. by   Nascar nurse
    Quote from Dixiecup
    Some will probably disagree with me but if you're comfortable with the facility, I think the family should stay away for awhile and she will adjust better.Where I work I know it's easier if the family doesn't come every day during the adjustment period.

    Let the facility get her used to the routine and maybe get her involved in some activities. She may end up liking it after she figures out what they have to offer.

    With all due respect, I do disagree. It seems horribly cruel to just "dump" a 90yo person in a nursing home and just leave them to "adjust". Now they have the normal depression, plus anger and resentment. Who wants to live til 90 something and then just have your family dump ya! I resent family members who work against us at every turn (and I've seen plenty who do), ie: "You're pushing Mama to hard", etc, BUT the family/loved ones are very important to the residents health and mental well being. They need to be involved and they need to stay involved.
  8. by   southern_rn_brat
    I dont feel that is "dumping her" there. If the family is visiting more than three times a day, that is a bit excessive. I mean no disrespect to anyone with my post.

    While reading the OP, I was wondering what I could do to help the patient. We have an on staff psychologist...does this facility have that? She is definitely having a hard time accepting her limitations, at home and in the facility. It also sounds as if maybe she guilt trips some of the family...ie getting the uncle to do things for her that he cant but wont tell her he cant....the daughter visiting 3 times a day.

    Does she have a phone? Maybe that would help.

    She is incontinent at night but not during the day? What meds does she take that might be causing this or even causing her to sleep deeply that she doesnt recognize the need to void?

    and it is true...during the initial stay, esp the first 3 days, sometimes it helps to have the family not visit as much. maybe not stay away but at least visit once a day and only one visitor at a time.

    Has she had her hair done? that would help her feel better emotionally.

    I couldnt imagine being 96 and being unable to care for myself. She sounds like a spunky lady too! What hobbies does she have? Can activities help out?

    Not visiting as much gives the staff a chance to get to know her and pamper her a bit.

    about her incontinence....has the UTI she had cleared? maybe a UA is in order. wouldnt hurt to check.

    Sometimes it is harder for the family to accept that a loved one needs long term care. The feelings of guilt can eat you alive. Take care of each other.
  9. by   ktwlpn
    QUOTE>With all due respect, I do disagree. It seems horribly cruel to just "dump" a 90yo person in a nursing home and just leave them to "adjust". QUOTE> I used to believe this was cruel also until I saw how effective this measure can be in some circumstances.By visiting so frequently the family is actually interfering in her adjustment.It is very hard for the staff to get someone like your grandmom to participate in her plan of care when she can use the next expected visit as an avoidance tactic.She could live into her 100's and doesn't she deserve the best quality of life she can get there at the LTC? However-I am no longer the advocate for placement hat I once was.She could go to your parent's house.You have to realize that it is out of your control.What's the worst that can happen at home? She falls and succumbs to the complications? She is 96-doesn't she have the right to choose where and when she spends her last days? Does she have the right to choose between several more years in a nursing home or probably a shorter time at home surrounded by her family? She may well be a hospice candidate given her CHF and age. It's so hard to know what is right-but it is a good time for the rest of your family to discuss your own wishes.You can't make the decision for your grannie but you will someday have to do it for one or both of your parents.Good luck
  10. by   Nascar nurse
    [QUOTE=southern_rn_brat;1926122]I dont feel that is "dumping her" there. If the family is visiting more than three times a day, that is a bit excessive.


    Well I agree with that, hovering to the point of smothering doesn't do anyone any good, but the post I responded to said stay away "for a while". I guess I took this to mean many days, or even a couple weeks - that is what I disagree with.
  11. by   BoomerRN
    To be eligible for hospice care she would have to have an m.d. document that she has 6 months or less to live.

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