Pureed Sweet & Sour Pork and other Reflections on LTC

Specialties Geriatric

Published

This is going to be a very rambling thread, full of brain farts and possibly unrelated comments. Feel free to enter your own. And please try to refrain from judgment - I'm venting.

I remember the first time I fed someone a pureed diet. The dietitian asked me how she did, and I answered, "She ate all of the brown stuff, half of the green stuff, and none of the white stuff." She broke up.

That stuff looks horrible to me, but we just put an anorexic COPDer on pureed - an experienced coworker, LPN, had the brainstorm - and she's eating up a storm. Feeding herself, even. My, to be so weak that chewing is difficult!

And all they ever ask me for is salt. One day I just started laughing and answered the resident, "Honey, I know. And you're never going to get any." She smiled and kept eating.

I hate force-feeding people. I mean, not anti-suffragist feeding tube down the nose stuff, but really forcing people to eat. They and nature KNOW it's time to give it up, but read those regulations! God forbid that anyone die in an SNF.

I'm sick of taking care of other people's demented, dying relations, particularly when the denial factor runs rampant. I had someone say to me about her 94-year-old mom who has in the past suffered fractures pof both hips and both legs - the COPDer - "Should I get her up and walking? I'm just not ready to see her in a wheelchair yet." No? Honey, get ready to see her in a coffin, because that's the next stop. The mom sleeps EOD, when the CO2 overwhelms her, and sleep most of the days it doesn't. Let the poor thing go!

We have a married couple with galloping Alzheimers and they no longer recognize anyone, let alone one another. Their kids want to take them home for a celebration of their 60th wedding anniversary. For whom are they celebrating? Certainly not the parents. Let go of them!

Administration has all drunk the Kool-aid. They believe in the regulations forced down our throats. We should be fighting to get back the right to put a restraint around the waist of someone who falls asleep in her wheelchair and then falls ass over teakettle to (in one case) break her neck. We always have one horribly facially bruised resident who did that. But the facilty - no facility -= is not willing to get the belt care-planned for and risk having the state cite a "pattern of restraint." We should be fighting for the right to keep people safe. The pendulum has swung too far in the other direction.

And aside from demented wanderers, most people, singles aside, could care for relatives as was done in the old days. And if the relatives were at home they wouldn't live as ridiculously long with as little function or quality of life as they now do.

I have one woman who is horribly demented - mutiple strokes and infarcts - and always frightened. She actually recognizes me now, because I talk to her and treat her kindly - most others aren't mean to her, they just ignore her - and we have to justify her Seroquel to the state. Since when are lawyers and legislators physicians?

The state's due any minute, so we have someone painting the trim on all of the doors because gouges in the paint can get us cited! Good golly, Miss Molly! Can we say, stretchers and wheelchairs and med carts and geri chairs smashing into things, oh my? Of all the unimportant bulldinky.

I'm sure I'll have more to add later. Please, express yourselves.

Oh, Ruby. I'm sorry.

One of the things I do with my folks who are stuck in the wrong time is go with it. "Where's my mother?" Rather than explain, again, that she's been dead for 40 years I say, "She's out shopping. She'll be back soon." Of course, in another 20 minutes they're worried about the baby or the puppy or something/one else.

The poor old thing. And you poor guys.

Specializes in LTC, assisted living, med-surg, psych.
Oh, Ruby. I'm sorry.

One of the things I do with my folks who are stuck in the wrong time is go with it. "Where's my mother?" Rather than explain, again, that she's been dead for 40 years I say, "She's out shopping. She'll be back soon." Of course, in another 20 minutes they're worried about the baby or the puppy or something/one else.

This is exactly what I do with my confused folks. It's so much easier on all concerned if we just enter their reality, rather than try to force ours on them.

Just this past week I had a fairly long visit with the sixty-something daughter of one of my residents, who has Parkinson's, Lewy body dementia and psychosis. For some reason, even though she has a decade or so on me, this woman thinks my advice is better than what she gets from her 'shrink', as she puts it, and she wanted to know what to do about feeling overwhelmed by her mother's problems. It's the typical scenario: she feels guilty, even though she is doing everything humanly possible to help, because Mom still can be very controlling. She also doesn't know what to do when Mom starts talking about her 'voices' (these are mean, nasty auditory hallucinations that keep her in constant terror); the poor lady is firmly convinced that they are real, and nobody can talk her out of it.

To make a long story short, I told the daughter it's OK to stop trying to re-orient Mom, and instead to join her in HER reality---you can't use logic on someone with this sort of dementia once they pass a certain point, all it does is make them even more agitated than they were to begin with. I've worked with dementia patients for a long time, since the 'authorities' were still telling us we should always try to bring them up to speed and make them be in the present time; and instinctively I rejected that advice long ago. I know how I'd feel if I knew a thing to be true and someone kept telling me my view was wrong; imagine how it would be to have dementia and all around you are people trying to make you be somewhere you don't want to be and believe things you know aren't right! Besides, as I tell every new caregiver: Who does it hurt? If a resident thinks it's 1955 and her kids (now long grown) are napping in the next room---if that's a pleasanter place than her current location---then by God, she can stay there as long as it pleases her.

Well, anyway, the daughter looked at me and I could see the relief in her eyes as she realized it didn't have to be as difficult as she thought. And that's why I still love working with this population---I enjoy educating families and staff about what these folks are going through, I'm never bored with learning about their special needs, and I never, ever get tired of listening to the stories they have to tell about their past lives and loves.

Just my two pennies' worth.

She also doesn't know what to do when Mom starts talking about her 'voices' (these are mean, nasty auditory hallucinations that keep her in constant terror); the poor lady is firmly convinced that they are real, and nobody can talk her out of it.

I have one woman whose husband used to regularly beat the tar out of her. When she gets frightened that he's coming to beat her up again I just tell her, "X, you don't need to worry about that xxx. I called the cops and they slapped his ass right into jail" and she cackles with glee each and every time.

Why break their hearts over and over again re-orienting them to deaths of loved ones?

Specializes in Case mgmt., rehab, (CRRN), LTC & psych.

The medicare rehab unit of my nursing home is a real cash cow, profiting from the unrealistic expectations of family members who actually believe that their 98 year old mothers with severe footdrop will miraculously walk again and live independently. Here are a few of my scrambled thoughts on this issue...

1. Some of the orthopedic surgeons are unscrupulous for performing bilateral knee replacements and total hip arthroplasties on 90 year old ladies who have been bedbound for 5 or more years. The surgeon is happy because (s)he can bill up to $50,000 for the surgery, and the family is happy because they have the false hope that their loved one is actually "rehab" material.

2. The nursing home is unscrupulous for marketing the place as a facility where everyone can be "reconditioned," regardless of their prior function. They will send very demented, terribly unmotivated patients to therapy sessions daily for several months until the medicare money runs out. By the time the family realizes that the therapy did no good, the facility has made big bucks off their false hopes.

TC! I was hoping you'd post.

Amazing what families will believe. Denial - it ain't just a river in Egypt.

I am loving this thread!!!!!!!!!!!!!!!!!!!!!!!!

I instinctively went along with what my Mom was saying as soon as she started in with the, "My Mother came to visit me," stuff. I'm so glad to know I wasn't totally off-base in doing that. The only times I've ever "corrected" her is when the reality of the situation really is better than what she's thinking. She specifically has mentioned how much she wishes Miss Reba, her cat, hadn't died. When I say, "Mom, Miss Reba lives with me now and she's doing great!" her face just lights up. It's sweet and heartbreaking all at the same time.

One interesting thing that has happened with my Mom is that her sense of humor is way BETTER than it used to be. She always had a sense of humor, but rarely let it show. I swear that since her stroke she's funnier, and she reacts more quickly and just MORE to funny stuff than she ever has. I don't know why this has happened, but...we take our silver linings where we can. ;-)

Again, a HUGE thank you to all of you who work with people like my Mom. I'm so thankful you're there!!!!

Penny

The only times I've ever "corrected" her is when the reality of the situation really is better than what she's thinking. She specifically has mentioned how much she wishes Miss Reba, her cat, hadn't died. When I say, "Mom, Miss Reba lives with me now and she's doing great!" her face just lights up. It's sweet and heartbreaking all at the same time.

I love it!

TC! I was hoping you'd post.

Amazing what families will believe. Denial - it ain't just a river in Egypt.

My Mother's sole surviving brother is the one closest in age to her. He finally came to see her about a month ago. He lives about 1,500 miles from here, and is not in the best of health himself, so it was understandable that he hasn't been up here before now. However, it has been so incredibly frustrating to deal with his long-distance "assessments" of the situation. For nearly a year he kept asking when she would be ready to go to assisted living. He just was not accepting that she would NEVER be going to assisted living. Only when I told him that if I wheeled her into an apartment and left her there, alone, I would be arrested did he finally start to accept the situation.

Oy. You guys are all saints, as far as I'm concerned.

Only when I told him that if I wheeled her into an apartment and left her there, alone, I would be arrested did he finally start to accept the situation.

*snort*

What part of "permanent brain damage" do you not understand, Uncle?

Administration has all drunk the Kool-aid. They believe in the regulations forced down our throats. We should be fighting to get back the right to put a restraint around the waist of someone who falls asleep in her wheelchair and then falls ass over teakettle to (in one case) break her neck.

As someone who has worked in an acute neuro trauma ward and seen people denied sedation(this was reasonable given their head injury) and restraints (because the clueless in admin don't want us to hurt the patients dignity siigh).

Much more dignified in their eyes that she pull(or in one case part pull) her PEG tube.

Sometimes restraints are necessary, it's balanced use of them that is hard.

Levin

Specializes in Nursing Home ,Dementia Care,Neurology..

I'm so glad that you guys agree with me about reality orientation!! I never use it on confused demented residents but my manager and dep.manager say we have too.The carers on days will do it causing so much pain and agitation and also end up giving themselves a hard time because the residents become combative. As you have said get into their reality but think on your feet ! I have chucked imaginary people out of beds before now and looked after countless crying babies so that their "mothers"could get a sleep!

The one exception I will mention was an old man who had been his wife's carer before she had died.It was kinder to tell him that she had passed away than to say she was at home sleeping because he became agitated that he was not there caring for her.I had all the carers on nights schooled with the details of when she died etc. It was heart breaking to tell him but it actually calmed him down.He had very short term memory problems but,by telling him the same details over and over again,slowly but surely some of the details worked their way into his long term memory and ,when you started to tell him the story he would add in bits and calm himself down.

nightmare, that's so sad. But what a kind, good old man. :)

Orient those with no memory-making abilities left. Right-o. I'll get right on that, assclown administrator.

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