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.

[wrkoutgirl]

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?

Those are exactly my concerns. I know that when they did the bone scan, the report did not include the brain as been mets as well. I am concerned that the more meds he gets the worse it is going to be, also, he is in a dementia unit and god knows what he is getting when he does get combative.

regards, Irma

[Ruby Vee, BSN]

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,

`i'm not going to comment on how fast dementia can develop -- i'm not an expert on that. what i am is someone who has lived through a grandparent with dementia, a great uncle, four uncles, and now my mother and mother-in-law. my own future isn't looking so hot.

the spouses of dementia patients are exhausted -- there is absolutely no way you can comprehend the care and supervision involved unless you've lived through it. yet many of them try very hard to cover up the depth of their loved one's dementia for various reasons. my sisters-in-law (and my husband) always used to minimize my concerns about mamita's mental status by saying "that's just how she is. she always has to be the center of attention." i suspect in large part that was denial. dh and i lived hundreds of miles away -- we didn't see the day-to-day behavior, and those who did live near her saw her through a lens of contempt for the attention-seeking behavior mamita had always exhibited. when you've always acted out, dementia is difficult to spot. what to my husband's family looked like dementia that happened "over night", in retrospect, was coming for years.

my father who had physical health issues knew that he could not continue to live in his lifelong home without my mother's physical strength to help him. she was strong as a horse, he had all of his marbles, and for a long time, they got by. mom was able to hold it together enough to appear just a bit forgetful for short periods, so when i'd talk to her on the phone, i had no idea of the depth of her problems. dad hid it because he (rightly) suspected that if anyone else knew how bad it was, w'd insist on getting them some help. removing mother from her home, no matter how dangerous she was to my father and to herself , meant that dad would also have to be in assisted living of some sort, and he was determined he wasn't leaving his home until they carried him out feet first.

mother's dementia didn't develop overnight. your father-in-law's may not have, either. reading between the lines of your post, i'm suspecting that it really wasn't that sudden and that your mother-in-law, for whatever reason, was helping him to hide it. of course, if it is brain mets, it literally *could* have happened overnight.

[casi, ASN, RN]

A person with dementia can hide it for a long time. A family person of a person with dementia can be in denial for a long time and hide it as well. You really don't know how long he has had dementia for or how long he has been having outbursts for.

[CoffeeRTC, BSN, RN]

When you say dementia unit, are they are specific unit trained on how to deal with dementia pts are are they just the dementia pts grouped together? There is a differenence. We do not just give meds for behaviors. Even if we do, they are not nearly enough to snow our residents. Look into that aspect, but again, if there is something else going one like mets...thats a entire other ball game.

I've seen dementia progress slowly and with others...fast and hard.