What can be done??

Specialties Geriatric

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I have a question that maybe can be answered here. My gma had to be put in a ltc facility about a year ago. She has always had mental issues (severe panic attacks, agorophobia, "imaginary" symptoms, etc.) and once her husband died she basically laid down and didn't get out of bed. This caused her muscles to atrophy, etc. and now she really can't get up out of bed. She had a "helper" but the helper ended up stealing from her, threatening her , slapping her, etc.

so off to LTC she went. (no one else in the family could physically or emotionally take care of her, she is about 170 lbs. of dead weight. She did not even attempt to get up, walk around, leave the house, or even watch TV She also had a habit of calling 911 sometimes several times a night for things like turning down the a/c, help to go to the bathroom , etc.)

Since being in the facility she still refuses to get out of bed and is having panic attacks. She was on valium for 35 years (!!) but had to be taken off of it cold turkey because it was damaging her intestines.

The nurses have suggested she listen to relaxing music, etc. but she just doesn't seem interested. I don't think the ltc facility is necessarily a bad one. I do think she is severely depressed, has OCD, and horrible panic attacks. She has been having these attacks for probably 60 years. It is just so sad. Are mental issues so severe common in ltc, or is it mostly your "run of the mill" depression and dementia ??

She is still very sharp and very kind (not combative at all, if anytying she is passive) but the anxiety is just like something I have never seen.

on the showering, they do that in her bed, they do everything in her bed, and she wears a diaper now too. I guess showering would be considered a sponge bath ? I am not sure. she calls the nurses in to adjust her covers, pillows, etc. She has actually been "written up" several times for constantly ringing the buzzer. the head nurse told my mother she rings the buzzer once every ten minutes. If someone does not respond right away she screams "nurse!" (I have seen that)

this was all brought about by mental problems , and now she really *can't * get out of bed. No one wanted to put her in that facility but it was all that could be done. She was not safe in her own home (being beat up, stolen from ,etc) and she was driving everyone crazy (literally) with up to 30 phone calls aday requesting candy, turning the ac down, and various other requests and complaints. My moms blood pressure had skyrocketed and she hurt her back very badly going over there one night trying to pick her up. Plus everytime shewould call 9 1 1 they would automatically call my poor mother (next of kin) -- this would happen frequently in the middle of the night, etc. And moving in ?? That wasn't going to happen and I stand by that decision 100%. My parents are no spring chickens either.

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oh but did i say the "caretaker" who beat her up got 50 years !

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re: panic attacks. hard to advise when i do not know her but many old people where i work have quilts or comforters from home. i have diagnosed OCD (nowadays everyone says they have it but i am actually diagnosed) and, although you want her out of bed, i will say that when my OCD was at its worst staying in bed was one of the few comforting things i had. so maybe she would like something like that. lots of old people like to have a light by their bed they can reach--i dont know her range of motion and would not want to frustrate her by giving her a light she cannot get to--but the CNAs who will most likely do most of the direct care can figure out what her preferences are. she will probably have lots of people encouraging her to do things she may not want to do (get out of bed go to dining room get back in bed etc.) so it might be nice if she had one of those lights you just touch and they come on-- they are really nice and have several settings-- and so she can at least control the lighting in her room--also might make her feel safe-- lots of old people like watches also with big faces so they can read them-- i have found that for pts who are anxious if i tell them when i will come back it calms them down a bit--and if she is very anxious maybe the facility would be willing to put her on 30 minute checks-- usually most residents like this-- we just go in and make sure everything is okay every 30 minutes, oxygen working, bed rails up, (if desired) call light within reach etc. so when the aide leaves she/he could say "i will be back in a half hour" and this may calm her down. it might be easier for nurses etc. to help you grandma--well, first of all if they actually see her at work--but also the description "panic attacks" is vague. would help to know what actually happens--does she hyperventilate? sweat? shake? how long has she been in the home? does she say anything when it happens? i usually talk to the people who are having anxiety which seems to help. (i talk to everybody). often people like bedtime hugs too and having their hand held. she may likle a stuffed animal.? it can be put into care plan to encourage decision making. ("do you want to wear pants today, or a dress?") which reinforces that she is cared about and her needs are important. sometimes this encourages residents to open up and communicate. sometimes it helps. run some ideas by the nurse. the aides may have ideas also. they will do the bulk of her direct care. sometimes maintenance will put shelves up i9n the room so people can look at things that are important to them and may hold pleasant memories. knick-kncks and that sort of thing. are you sure the not liking to wear headphones to listen to music is an OCD thing, or is it a pain issue? dont know if she is very vocal about pain but old people get really sensitive including ears.

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would help to know what actually happens--does she hyperventilate? sweat? shake? how long has she been in the home? does she say anything when it happens?

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hyperventalates , claims she can't breathe unless we "come sit with her for hours" etc. . It has been happening since my mom was a child. Docs have said there is absolutely nothing physically wrong with her . she is also very closterphobic, etc. has lots of little "fears". (tons more than the average person) As far as the headphones are concerned it's all ocd. She would spend hours straightening things, obsessing over cleanliness, etc. If the chord isn't just right or something like that , it will drive her crazy.

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would help to know what actually happens--does she hyperventilate? sweat? shake? how long has she been in the home? does she say anything when it happens?

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hyperventalates , claims she can't breathe unless we "come sit with her for hours" etc. . It has been happening since my mom was a child. Docs have said there is absolutely nothing physically wrong with her . she is also very closterphobic, etc. has lots of little "fears". (tons more than the average person) As far as the headphones are concerned it's all ocd. She would spend hours straightening things, obsessing over cleanliness, etc. If the chord isn't just right or something like that , it will drive her crazy.

wow. kind of like my grandma except worse. (my grandma has every medical disorder known to humankind, except docs say is legitimate). well-way out of my scope! i hope you get your psych consult. wish i could help but donot know what to say.
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Specializes in FNP, Peds, Epilepsy, Mgt., Occ. Ed.

DON'T feel bad about putting her in LTC, it sounds as if it was the only livable possiblity for any of you! It's a shame that the right medical treatment for her mental health issues- and there's no doubt she has them- would have kept her functional, but the past is past.

My first question now, though, is where is her PCP?? Why has he/she not done more about the issue of the disappearing psych doc? He- or she- could and should raise Cain with the psych. If the PCP cannot or will not deal with her issues, then perhaps it's time for a change. Someone has suggested a geropsych unit; if that's at all possible, I think it's a good suggestion.

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I am soo sorry but what is a pcp ???

are you talking about the original psychiatrist ?

He just came that once that i know of.

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Specializes in LTC,Hospice/palliative care,acute care.

PCP-primary care physician

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Specializes in ER.

Although she certainly has some serious problems I think there is some enabling as well. If she hollers do they come and take care of whatever little thing is bothering her? what if she was put on the 30 minute checks, and no adjusting of pillows etc betweentimes if she rings the bell. She'd still have her bell for emergencies, and they would still respond promptly, but she'd have to save up all the small requests.

Make a list with her of things that she can do, and that the staff can help her with to relieve anxiety. What does she enjoy? Also make a short easy list of things that you would like her to do for herself. Wash her own face? eat a meal sitting up in her room? and trade those small accomplishments for time 1-1 with family at the bedside, or treats from home.

Although she is old and deserves a little slack, she is also an adult and needs to be responsible for taking other people's needs into account. She has an opportunity now when people are trying to work with her. Her situation could be much worse, she is blessed with a family that cares about her. But the street runs both ways, she needs to respond to others within her ability and not continue to allow herself to decline. My advice- be loving but firm.

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My advice- be loving but firm.

thank you, thank you, thank you canoehead.

there is indeed too much enabling, which is making grandma's condition worse.

as i have done in the past, i have:

1. established a very therapeutic relationship w/pt.

2. explained to patient, they will be getting out of bed for x amt. of time; with much reassurance and frequent checking and/or sitting near a place/person where pt. feels safe.

3. same goes for shower days.

4. continue to give them as much autonomy as possible but again, with limit setting.

this is after eliciting behavorial plans from psyche.

now texaspoodle, i am not endorsing this plan for all psyche pts.

but what i am saying is this type of anxious and demanding patient does respond to firm but loving interventions.

leslie

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Although she certainly has some serious problems I think there is some enabling as well. If she hollers do they come and take care of whatever little thing is bothering her? what if she was put on the 30 minute checks, and no adjusting of pillows etc betweentimes if she rings the bell. She'd still have her bell for emergencies, and they would still respond promptly, but she'd have to save up all the small requests.

Make a list with her of things that she can do, and that the staff can help her with to relieve anxiety. What does she enjoy? Also make a short easy list of things that you would like her to do for herself. Wash her own face? eat a meal sitting up in her room? and trade those small accomplishments for time 1-1 with family at the bedside, or treats from home.

Although she is old and deserves a little slack, she is also an adult and needs to be responsible for taking other people's needs into account. She has an opportunity now when people are trying to work with her. Her situation could be much worse, she is blessed with a family that cares about her. But the street runs both ways, she needs to respond to others within her ability and not continue to allow herself to decline. My advice- be loving but firm.

great advice, thank you.

as far as what she enjoys she seems to enjoy going to the dr ! :(

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(off topic) You pointed out one of the biggest problems in LTC-lack of communication....Who delivers the hands on care via the care plan? The CNA's.....You should be more involved-if not at the team meetings at least the charge nurse should hold a meeting on the floor for a few minutes each week to bring everyone up to speed.....Many nurses feel care plans are a waste of time-I find them very effective especially in geriatrics-specifically in dementia care..,.
oh-- sorry did not respond-- still figuring this computer posting thing out. actually-- we (cnas at my facility) spend an average of an hour a day either giving or getting report! how cool is that! i work at a good LTC
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