nursing home for my father in law?

nurse2033, MSN, RN · Jan 16, 2011

I'm sorry for your situation. Almost anyone would agree, that if the home situation can be managed, it is better for everyone. If your family is not familiar with nursing homes they should make a visit. If your family can spend time there in shifts they should be able to provide safety. Has no one talked of home nursing care? Hope you find a solution that works. You should, of course, get all his end of life paperwork in order, living will, DNR, power of attorney, whatever. That will help guide what is appropriate. Best of luck!

wrkoutgirl · Jan 16, 2011

Thank you for your reply; I have a few questions,

Has anyone heard of any acute or sub acute care facility that does NOT have rails for the beds, even in a Dementia unit? My father in law felt out of bed today and my mother in law said they don't have rails when I asked if THEY were left down. Isn't that required by Join Commission for pts's safety?

Does any one agree with my concerns that he may get worse and real fast being there, getting sedatives and antipsychotic meds, falling and getting hurt?

Does any one agree with me that he may get better when he is at his "home sweet home"?

Do people bring their loved ones to nursing homes because they are combative and disoriented?

She says that this is not a nursing home but a "dementia place". I think it is a nursing home and he is in the dementia floor, what do you guys think?

Oh boy, this is killing me because I am trying to advocate for my darling father in law but I also feel impotent.

Thank you again, Regards,

**canoehead, BSN, RN** · Jan 16, 2011

So far I think you are on the right track. If home doesn't work out the nursing home will still be there.

CrazierThanYou · Jan 16, 2011

Thank you for your reply; I have a few questions,
Has anyone heard of any acute or sub acute care facility that does NOT have rails for the beds, even in a Dementia unit? My father in law felt out of bed today and my mother in law said they don't have rails when I asked if THEY were left down. Isn't that required by Join Commission for pts's safety?
Does any one agree with my concerns that he may get worse and real fast being there, getting sedatives and antipsychotic meds, falling and getting hurt?
Does any one agree with me that he may get better when he is at his "home sweet home"?
Do people bring their loved ones to nursing homes because they are combative and disoriented?
She says that this is not a nursing home but a "dementia place". I think it is a nursing home and he is in the dementia floor, what do you guys think?
Oh boy, this is killing me because I am trying to advocate for my darling father in law but I also feel impotent.
Thank you again, Regards,

I'm only a first year nursing student but our instructors have mentioned that there are facilities that have no bed rails whatsoever.

Again, I'm only a student, but I think its curious that your father in law's dementia had such a sudden onset and decline.

tyvin, BSN, RN · Jan 16, 2011

Some places have implemented no rail policy; please don't ask me to justify it because I totally disagree.

As for your father-in-law of course he will do better at home and it is his right to be at his own home IMO. Even if an aid needs to be hired at night or what ever you people can brain storm with to make it possible for him to be home I am a firm believer in bringing em home. The hospital would have to take it to court in order to keep him or have him evaluated as a danger to himself or to others or both and then involuntarily admitted to their psych unit in order to keep him (at least those are the rules as they apply where I live). Check it out as all states are different.

He's worked all his life to make his home I would think that his children would do whatever is neccessary to bring him home. Keep on advocating for him.

As has already been said the nursing home isn't going anywhere which BTW; if it sounds like a duck and quacks like a duck then it's a duck. In other words many places are renaming their facilities because due to the negative connotation that "nursing home" intones. So now we have nursing rehab centers and all the other new names that are popping up.

meghan91 · Jan 16, 2011

my grandfather has to be put in a nusing home a few weeks before the end of his life because he got so bad he had cancer,copd, some hallucenating and demitia because of his health and medicine they put him on. there was no way we could take care of him becase he only had me, my brother, my mom (his daughter) and my dad. he was willing to go to one and we made sure he was in a very good place, trust me if we could have had him home we would have. he would get ****** and want to go home a lot but we would talk to him and calm him down. they did end up putting a peg tube in to feed him because he wasnt eating, alot of people end up getting them and at night they would give him stuff to relax him because we wouldnt sleep at all because hed be up all night. it was really hard to watch but we knew we had to do it to help him in his final days of living.

my other grandmother now is also in a nursing home because her husband(my step grandfather) claims he cant take care of her and wont pay for home health aides. she has alzhiemerz and demienta. at times she can become combative and ticked off a lot but eing somewhere she doesnt want to be doesnt help either. i have witnessed 2 people go through this but in two different situations with my grandmother it is more what you are dealing with. she went to the ER because she almost fell one night and then next thing you know they said her dementia has taken a turn for the worse now she is in a nursng home. she also has a peg tube because she refused to eat for a while because she didnt want to eat and didnt want to at the plae she was at. alot of the people become depressed.

none of th nursing home have railings on the beds they say it is a hazzard that thy can get their heads in the rail at night instead they put pads on the floor incase they fall.

being at home can help someone especially if they are having dementia because they are in a similar place that they know where they are. youll notice if he gets confused a lot of time hell start talking about home like the one day my grandmother was telling me to go in the bathroom and get the hand otion that was under the sink(she was talkign about home but got confused because she didnt remember where she was) i think a at home nurse if posssiable would be best until someone is just so hard to take care of that they need nursing home care. he demetia floor is hard also because the person now has hardly any communication with others that dont also have dementia.

they will probably put him on sedatives eventually especially if he is combative. my grandmother had a psych eval on her because my step grandfather requested it and she had all her meds changed due to it which causd her big problems and she would go to bed at 7 at night because they would give her this sedative/sleeping pill and then the next day since she had dematia the sleep aide wouldnt have worn off all the way and when it finally did she was all messed up throughout the next day.

just make sure everythign is being done in his best interest. make sure meds he gets are being kept track of and know what is going on at all times. make sure whoever has POA is doing what is best for him. try and explore him going home:getting a home health nurse, having him sleep in a spare bedroom at night instead of with his wie etc. keep and eye out for bruising and stuff to make sure he doesnt fall (usually they all have alrams hooked up to their wheel chairs which alert the nurses he is up and to come get him and at night they all get pads ont he floor) make sure to watch for the psych meds and sleep aides because some screw with the person and their other meds.

my grandmother was bad when she went into the hospital but now she is getting slightly better because she got some strength back dur to therapy, me making her eat, stuff like that. they all have their good and bad days thats what you have to rememeber sometimes he might be miserable and combative the next day he might be all smiles and talking up a storm about regular stuff.

good luck and i hope he starts coming around and feeling better!

NotFlo · Jan 16, 2011

Thank you for your reply; I have a few questions,
Has anyone heard of any acute or sub acute care facility that does NOT have rails for the beds, even in a Dementia unit? My father in law felt out of bed today and my mother in law said they don't have rails when I asked if THEY were left down. Isn't that required by Join Commission for pts's safety?
,

Joint Commission has nothing whatsoever to do with nursing homes. You can't compare the rules and regs in hospitals to the rules and regs in a nursing home; they are totally different.

In my state, full bed rails are absoloutely not allowed. None of the beds where I work have rails anymore, just little handles that pop up if the pt. needs them to help positioning. Bed rails are considered a restraint and every facility I know around here is a restraint-free facility. Plus, there have been incidents of people climbing over or getting stuck in bed rails and injuring themselves much worse than they would have if they'd just falled out of the bed.

Now, if we were taking care of an intemittantly confused man with your FILs history we would have him in a low bed with mats and pull, pressure and possibly lazer alarms. I'm not saying that is a good solution but low beds and alarms are the only tools we have to prevent falls out of bed.

Batman25 · Jan 16, 2011

I'm starting to face something similiar with my own FIL so I feel your pain. Physically he is going downhill but mentally he is 100%. We are putting rails on his bed and have hired overnight help as that is when he is apt to fall. We also are trying briefs to see if that helps out.

I'm with you and feel the same as with my FIL...I want to try the home route first. His g/f of many years isn't scared but she is tiring as she's late 80s. That could be the issue with your MIL as well. She might be too worn down to care for him. If care however is affordable and can be put in place I would 100000% favor home care.

I don't get the feeling your FIL has a long life left nor does my FIL. I much prefer they die at home in their own surroundings being aided by loved ones and people hired by loved ones in a familiar place. It breaks my heart to read this as well. If you can get down there and advocate for him do it. I think heartbreak could kill him even faster.

Let them know how can be a trial basis and that he deserves that chance. The NH will always be there as a safesty measure need be. It's so worth a shot.

meghan91 · Jan 16, 2011

no in pretty much anywhere besides a hospital they dont have railings on the beds because it is seen as a hazard plus as someone else mentioned they can be seen as restraints to people. its really hard to belive that they wouldnt have rails on thoes beds when dealing with patients in this kind of a state but you can make sure he always has the floor pats down, bed lowered as low as it can go, some places also have special mattreses where the sides sort of come up and the patint is sunken down into bed more, making it hard to fall out of bed. also try putting some pillows on both of his sides to keep him in place during the night.

Ruby Vee, BSN · Jan 16, 2011

i've just come from visiting my mother in assisted living; last month i visited my mother-in-law in a nursing home. i know this isn't what you want to hear, but sometimes that's what is best for the patient. i respectfully submit that if you aren't there, you cannot evaluate the situation. you have to trust that the family members who are there are doing the best that they can.

another thought: the people who should be making the decision about whether or not your father-in-law should be in a nursing home are the people that would actually be doing the work if he were at home. that would be your elderly mother-in-law who has valid concerns about his confusion and combativeness and the sons who are there right now.

i don't know the situation with nursing home beds in your area, but i will never forget the three weeks i cared for my mother (alzheimer's) at home before we could find her a place. during those three weeks i had to keep an eye on mother constantly -- i could not close the door when i wanted to use the bathroom, nor could i ever go completely to sleep. one night i heard noises in the kitchen in the middle of the night when i finally got mother settled and thought i could get some sleep. i got up and found mother stuffing the wood stove so full of wood that it was glowing red. i'm lucky she didn't burn the house down! another time she went outside to empty the litter box wearing her nightgown and slippers. it was 35 below zero, and she couldn't find her way back inside. i had only left her alone (supposedly sleeping) for a few minutes so i could take a shower. it was the longest three weeks of my life! if a nursing home bed is available now and won't be open again when you need it, you should be very careful in considering whether or not to take him home.

if you're willing to take your father-in-law home and assume full responsibility for his care, feel free to bulldoze or cajole the rest of the family into going along with it. if you're not there to provide the care, please do your best to support whatever decisions are made by those who are.

Nascar nurse, ASN, RN · Jan 16, 2011

Joint Commission has nothing whatsoever to do with nursing homes.

Not true. I work in a Joint commission accredited LTC facility. It is not mandatory that facilities have this accreditation but some do.