OK all my LTC experts and coworkers - I'm looking for your expert opinions again.
I have a very sweet little lady who is over 100 years old and spry as can be. She easily keeps pace with me walking down the hall and doesn't use any type of assistive device. I just bet she could put her foot on her nose if she tried to. She is in that awful stage of dementia tho and is soley focused on going home. She really doesn't try to leave on her own but constantly wants to call her family to come get her. This is very difficult for her children (who are a carbon copy of Mom - they're old too but sweet tempered and act/look several decades younger).
I learned today that the careplan team told the daughters that they should not visit for at least 2 weeks to allow the resident a chance to adjust to our setting. I want to know your opinions on this "theory". I just don't believe in this at all - it just feels wrong and I'm not sure it really makes any difference. (I did tell the daughters today that I do not expect them to continue staying away for 2 weeks. I said "This is your Mom and at her age the days are numbered. Enjoy the moments you have").
Apr 18, '12
Each pt is different and perhaps it would be worth a try to see if it would help, but like you said, her family may want to spend as much time with her as possible. Is she stressed when they visit? Just because she talks about going home is not a huge deal unless it really stresses her out. And I am not 100% on this, but can't dementia come and go? So even if they stay away and she adjusts over those 2 wks, that doesn't mean she will stay adjusted.
Don't know about disagreeing with the careplan team...seems to be giving the family an idea that you all are not working as a team. Probably would have been best to discuss with them your concerns and then present both ideas to the family as it is up to them to decide anyhow.
Apr 18, '12
Nascar nurse, this is one of things that I just can't make up my mind about. My gut feeling is that I don't like the idea at all and really, 2 weeks seems far too long to stay away.
There has been one time when I suggested to a family member that they not visit quite as often for a little while. The newly admitted resident was constantly asking to go home, and became really distressed when the family visited, with constant pleading 'please take me home', 'why can't I go home', etc and the family in turn would become upset and anxious and each visit ended with everyone in tears with the resident dreadfully unhappy and very restless and the family almost prostrated by grief and guilt too.
They were a very close family and had been visiting twice a day - I gently suggested that it might be an idea to cut that down to once a day or even every second day for a while to give the resident a bit of time to get used to the new environment and a chance to start getting used to the staff, and a chance for everyone to calm down a little.
I think it helped, but perhaps it was just time that did the trick, I don't know.
I don't think there's any harm in having the family know there's a difference of opinion on the best way to handle this; it's a learning experience on everyone's part when a resident is admitted and if one suggestion isn't working or doesn't suit that particular resident it's good to show the the family that the staff are wiling to listen and adapt or change their approach to get the best outcome.
Apr 18, '12
I don't agree either. The way I'm looking at it is this, the patient is in advanced stages of dementia, she will never adjust completely. It doesn't matter if her family stays away for 2 weeks or 2 years, she is always going to wake thinking it's the same day and the same issues are still there, she wants to go home, this will never change. So no, I don't think the family should stay way at all, like you said her days are litterally numbered, they need to spend time with her if they can. I have a special place in my heart for demetia patients and I'm a firm believer in "living their truth" I don't reorient them, so adjusting them is just not an option IMO.
Apr 18, '12
Thanks everyone. Petstopeople - Just an FYI - I was very politically correct about disagreeing with the careplan team in front of the family and just more or less said "if it's not working for you and Mom keeps calling you crying then there is no use continuning to stay away. In this case it would appear to be doing more harm to all of you then good". The family was very relieved to be allowed back to visit.
It is heartbreaking for all of them each time. We are handling it much like a kid in day care. When the family gives the signal they are ready to leave we distract the resident with activities and allow the family to sneak away. The resident is a tad upset when she can't find them later but no more so then when she wakes up in the morning and doesn't know where they are. I spoke with the daughter at length yesterday about trying to build a wall around her heart and try her best to realize that all the guilt that gets spewed out is really just the disease talking - not Mom. She was tearful but pretty accepting. We are going to try and find a good alzheimers support group for her to help her find some coping skills.
The best part of this (and probably the most heartbreaking too) is all of these people are just wonderful. This is the dream resident with a dream family.
Apr 18, '12
I'd let the family visit. Two weeks probably won't make a difference since at this stage of dementia, time doesn't mean much.
Apr 28, '12
Personally I like the family to be around as much as they can, at least until the resident has a change to familiarize with the surrounding and staff and the drastic change in lifestyle and maybe, if necessary, taper their visits. To be just 'dropped off' without a familiar face would be traumatizing. Again, just my opinion.
Apr 28, '12
In most situations, I encourage the family to visit as often as possible in the early days after a resident moves to my facility. I've seen way too many folks who were basically dumped there, and watched them deteriorate both physically and cognitively as they waited in vain for children who would never visit, take them out for a meal, or even call to see how they were doing. It's almost every elderly person's worst nightmare, and it's heartbreaking.
Apr 28, '12
I have no rpofessional experience with this, but I can tell you as a person/family member there is NO WAY I would stay away unless the facility could explain exactly what behavior/symptoms increased because of my visit and first tried other methods to allievate/treat them. Asking family to stay away for two weeks seems wrong for so many reasons. At the top of my list is the residents age and limited time. What if the resident died suddenly during those two weeks? A close second would be that simply by virtue of the request, my abuse radar would be up and running like crazy if someone asked me to stay away from any helpless family member for two weeks. Perhaps you could suggest creative ways for the family members to leave if it is only the transition that is the problem. I watched my grandmother do this beautifully when dealing with her brother with dementia in a LTC facility. She would frequently tell him she had to go milk the cows (they lived on a farm as children) and when he said "oh, I have to go do my chores" she would tell him that "Zeke (another brother) was always so lazy, I'm going to make him do your chores today. You just rest, you deserve a day off." It worked beautifully with him. I know that not every attempt at distraction/etc will work with every patient, but it might be worth having the family (who seems receptive) try a few ideas.maybe they can visit without identifying as family if the resident doesnt recognize them. They could come in and sing songs, play a game, bring a beach ball to toss to the resident, etc.
May 18, '12
Our facility has never suggested families stay away. Is there a better time that she is less anxious than not? We had one resident whos husband would come at a certain time and just agitate her for no reason. We did ask him to reduce his visits and come at different times for a short period and she did better at his visits. Have you tried telling her that they have appts or are work instead of distracting her without her knowing they were leaving? sometimes that is less distressing.
Jul 31, '12
I've only had to advise one family to avoid visiting for a few weeks. They were actually relieved. I think this should be an individualized plan. And the family should be involved with the decision when possible.