nursing home for my father in law?

[wrkoutgirl]

Just want some feedback regarding my father in law being placed in a nursing home and which I wish they reconsider.

Here is the thing. He is going to be 91 in a few days. Alert and oriented until a couple of weeks ago, forgetful and according to my mom in law, he has been having hallucinations at night for the last year or so. (I did not know that). He has hx of opened heart surgery, A.Fib, some surgeries, orthostatic hypotension, and now advanced prostate CA which they found out a few months ago has mets to his bones, lungs, hips, and other places. I don't know why my mother in law did the bone scan for when she knew they are not doing anything about it. I was against him getting the injection of lupron because of the severe side effects. He started getting infections in one eye after the injection, hostile, depressed and very much "unlike him". He is a sweetheart.

A couple of weeks ago he was admitted to the hospital when he accidentally was in the ER with my mother in law as she had very high BP. while there he was rather inappropriate and the doctor decided to admit him for evaluation. He has since gone down the hill mentally. According to the doctors his dementia "suddenly worsened". I did not even know he had dementia besides being occasionally forgetful about silly things. Now he gets disoriented and combative on and off, was on 1.1 at the hospital, discharged to rehab in hope that he would behave. Yes, c-scan of the head negative and the brain was not mentioned in the report for his metastases prostate Ca.

He is now in a nursing home as the rehab place refused to keep him because he was getting "intermittently" disoriented. He wants to go home. This all happened within 2 weeks of him being home, watching the Yankees, going to shows at the senior center with mom, etc.

My mom in law is in her late 80s a very active and hard working woman but scared to take him home because she is afraid that if he gets combative at home she would not be able to physically handle him. I understand that. I even thought about taking a family leave to go to Fl and help with him. My point is that they should take him home especially now that one of his boys is there visiting, we will be there next week and the other son lives there. I just propose that they give him a chance to be at his home, in familiar surroundings, with loving people who will be (with all the respect to us all) more tolerant when and if he gets disoriented (which again he was not when he was home a few weeks ago). When we are back home, they can hire a live-in aid who can help mom and dad, I know "providing that I am right and dad's mental status improves close to his baseline when he is at "his home, sweet home"

All I ask is for them to test the situation now that the sons are there. Now, if he does not improve, what can the nursing home do that cannot be done at home with an aid and or a younger and able family member? Please tell me!

My husband gets really upset when tell him all this, he says he agrees with me but mom is scared, etc. My brother in law who just got there yesterday told us today, "The nurse says that there is no way we can take him home, at least not now. Since when is a nursing home medically advised?

Please tell me if I am wrong or what do you suggest. I see pts at my telemetry unit who get combative and the family cannot wait to take them home so that they become themselves. Am I dreaming or my dad belongs in a nursing home? We don't have nursing home in my native country, Colombia; I am just not used to this idea. If he needed especial equipment that does not fit through their front door, I may understand but he does not!!

Thank you in advance for your feedback

Regards,

Thank you, thank you.

[Nascar nurse, ASN, RN]

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.

trying to figure out how best to say this exact same thing. have admitted a resident who was driving down the highway going the wrong way and many other very scary events because families insisted they could do it safely at home.

great post

[handyrn]

I so very much agree with Ruby Vee above! And I am so sick of nursing homes getting all lumped into one catagory as bad places! There are good ones out there! It is hard to take care of someone at home. Sometimes the nursing home is a better option.

One thing we need to keep in mind about dementia or alzheimer's patients is that once they have the disease, THEY ARE NO LONGER THE SAME PERSON! This is no excuse for families to quit visiting, but the reality is that this is the reason that so many residents of nursing homes do not have visitors. When a person has dementia or alzheimers, sometimes it is so bad that their whole personality changes. It is like going up to a stranger and trying to convince yourself that he is your dad/grandpa, etc. He isn't. Sure, by blood he is, but in personality, he is not.

We also need to remember that when people are in the early stages of dementia, they know it and can hide it well! You seriously do not know how long your father in law has suffered with this and hid it. Your mother in law may very well have been dealing with increasing dementia in your father in law for some time now and maybe she has been hiding it too. Maybe him being in a nursing home or dementia unit is a relief to her. We really don't know the private lives of others, regardless of what we think. And that relative who would never hurt anyone and is the most kind and generous person may have changed into a combative abuser. (I'm not specifying your father in law, just people in general who have demetia.) I know this both as a nurse who has worked in LTC forever, and also as a granddaughter who has gone through it previously and is currently going through it. I also want to mention that my grandfather who is going through this right now was always the most kind and gentle person you could imagine. He treated my grandmother like a princess! Now when I go with grandma to visit him in the nursing home, I can see some changes. He is very pleasant to me and all the staff just love him because he is still a great person. However, he doesn't know who my grandma is, but he knows she is someone different than everyone else and he treats her differently. I have heard him be downright nasty with her.

Why not just take your father in law home for a weekend visit? Try taking care of him for a few days before you decide if he should be at home or not. You may just find out that it's harder than you think. Also, just because you may be a nurse, have the patience of a saint, and feel totally confident in taking care of your father in law, your mother in law may not. Maybe she doesn't feel capable of having him home. Maybe she is scared. Maybe she is hiding her own health secrets and knows better than to try to have him home even with help.

I know you have your father in laws best interest at heart, but, as ruby vee says above, unless you are willing to assume full time responsibility for his care, let those who are make the decisions.

One more thing to note: look up on the internet some articles on caregiver burn out and the problems it causes when a family member is trying to take care of someone at home.

[TheCommuter, BSN, RN]

Isn't that required by Join Commission for pts's safety?

The vast majority of nursing homes in the region where I live are not accredited by the Joint Commission (JCAHO) and, therefore, do not have to follow JCAHO's mandates and suggestions.

Many nursing homes across the U.S. are adopting a "restraint-free" policy. The nursing home where I am employed has no side rails on any of the beds because the corporation that owns the facility views them as restraints.

[ktwlpn, LPN]

[quote=Ruby Vee;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.

]

Very well said,Ruby. It's very easy when one is hundreds of miles away from the situation to make judgements. Most of us will say that we want to die at home but if we were to know that we would become a burden to our loved ones/caregivers-seriously endangering their safety and health would we make a different choice?

Caring for a family member with dementia,one who remains mobile can be very dangerous unless you have plenty of support-and by that I mean people actually coming to the home reliably to take shifts

[CrazierThanYou]

Our local nursing home is accredited by The Joint Commission.

[diane227, LPN, RN]

First of all, there are a couple of considerations regarding his altered mental status: does he have mets to the brain? What medications is he on, especially pain meds, sleeping medications and antipsychotics? What is the noise level at the facility at night? Are there other environmental factors that may be causing him not to sleep at night?

[diane227, LPN, RN]

Side rails are considered a restraint device and cannot be used unless certain conditions are met. Please remember that people are killed by side rales and that their use does NOT prevent a fall. If someone wants to get out of bed, they will climb over the rails and suffer greater injury from a fall. Most of the nursing homes that I have seen will use thick pads at the bedside for those residents who are at risk for falling. They also have beds that go into a very low position, much lower than what you see at a hospital. I know of a recent case where family members insisted that the facility place side rails up for their mother. She slid out of bed and got her head caught between the mattress and the rail and essentially strangled herself to death.

[diane227, LPN, RN]

Nursing homes must follow federal and state guidelines for the health and safety of residents. JCAHO is great, but they can't close you down. The federal regulations offer specific information regarding restraint use and the facility must follow those guidelines with each resident when considering any device or environment that could restrain the movement of a resident. This information can be found on the CMS web site. These rules and regs are called F-tags. In addition, your state will have specific rules and regs as well that must be followed.

[Old.Timer]

You might want to consider requesting a hospice consult. Not sure how widely known it is, but many hospice programs also provide services, both in the home and in nursing homes, for late stage dementias. It's my understanding that the usual criteria of a terminal illness with a 6 month or less life expectancy is not quite as rigid in cases of dementia, especially when there are co-morbidities.

It has been my experience that the coordinated hospice team approach by medical, nursing, social work and the chaplains often results in a more successful management of the physical, behavioral and psychological symptoms. They can also be quite skillful in assisting and guiding families with decision making. IMO, their services are equally valuable, whether provided in the patient's home or nursing home.

I too, agree with Ruby Vee. Consideration for the wishes, stamina and capabilities of the person most directly responsible for providing care 24/7 takes precedence over all others. As others have mentioned, words don't adequately describe the world you're stepping into when you begin providing 24/7 home care and coordination of services for a late stage dementia patient. It can be done, each situation is unique, but it does require a very well thought out plan with numerous backups and a solid commitment by everyone involved.

My very best to OP and everyone whose life has been touched by this wicked wicked disease.

[retiredlady]

It is very, very, tiring to a caregiver even though they might have help. They worry 24 hours a day about their loved one. She is in her late 80's for goodness sake. Even if the children help her, I know that they would not be there all the time. My mother was in her 80's when my dad started to decline and fall all the time. It made her very nervous and she had to call the emt's to help him up. Her children were in different towns and had to work full time. She did so much better when he went to a nursing home. She visited him all the time. Yes, he did fall out of bed, but they had mattresses or pads to catch him, but the bad thing was they all ways called her when he did fall and usually it was in the middle of the night!

[wrkoutgirl]

Thank you so much you guys for your support. Some of you seem to have gone through similar situations and know how much it hurts. Unfortunately you are right Batman when you say that my MIL may be too tired. She is also scared. I was just asking her some questions, trying to do a little assessment and she got really frustrated with the firs question, "what exactly was he doing when he was at the ER with you a few weeks ago, was he at his baseline or"... she got frustrated saying that she does not remember etc. she is blaming herself saying that if she had not gone to the hospital that day be of her elevated BP, they would not have kept him when whe was (I don't know exactly what went wrong that they decided to keep him for observation.

I feel so impotent.. now they have him on seroquel 25bid, and god knows what they are giving him when he gets combative this is a man who 2 weeks ago was just an old, sweet man, with an unsteady gait, occcasional incontinence and mildly, very mildly forgetful of silly things not the important ones.

thank you again,

regards,

[wrkoutgirl]

Well, thank you very much for your input, It is just so difficult for me to understand that literally overnight my FIL situation is applicable to what you guys are saying. Ok. here is my question, "can someone's dementia become horrible and uncontrolable overnight? to the point that they have to be placed in a home because they are no longer "normal"

I thought that these conditions took over the pt slowly but surely, not all of a sudden.

Is that the case? I also want to make it clear that I am not arquing with my in laws about this, I have no saying, remember? I am just saying it to my husband.

Also, my idea was that now that the son is there and next week that we will be there, may be a good time to bring him home... just for a test??

regards, and thank you again,