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.
In the state I live in, we have what is called "swingbed". It is where the hospital will keep pts that are too sick (mentally or medically) to go back to their ltc and not sick enough to be in the hospital. Its like a half-way house for elderly pts only. Swingbed pts get the physical therapy, psyche help or any other skill required. There is a time limit like 6-8wks they can stay in a row, but there is no limit as to how many times they go.
I did home health for 9yrs. There comes a time when the elderly do just "give up". Once they've made up their mind - you cant hardly change them. They are tired...and ready to go. Its hard to watch- but understandable.
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.
i am as i said still figuring the posting thing out. i did not get notified when tx poodle responded so did not know until now-- or would have responded better to what she was saying--sorry-- but now i have read the whole thread instead of selected posts so better informed. standard care plan practice is to encourage pts to do as much of their own adl as possible (activites of daily living) including washing own face etc. if possible. i think it is inappropriate to use family time as a bribe. because the implication is that they are doing her a favor when in reality it should be a treat for all of them!! i find the remark "her situation could be much worse" very annoying and inappropriate. first of all, anyone's situation could always be much worse so it is a moot point, second her situation is totally rotten-- she is old her husband is dead her caregiver abused her her family sounds like they are not sure what to do, she is stuck in a home, she is old and unhealthy, she has mental issues, she was addicted to drugs for 30 years and then had to quit them cold turkey, she cannot even get a psych consult, .... i am not sure how her situation could be worse. add to that her feet do not work (it is called foot drop, i believe, and i believe it is often totally preventable). i would have to check but it sounds like she may also be obese. how could her situation be worse? as far as the bell thing--er, call light thing, good communication techniques will likely resolve the problem better than refusing to answer a call light (which could get a cna or rn reported to the board). the reason i said anything about psych consult being helpful--besides medication possibilities-- is that they may be able to help the staff deal with her, not because i necessarily think she has major issues. id on't know her. i do think it would be a good idea for the woman herself to be included on the care plan meeting? as far as "she needs to not allow herself to decline" she has the right first of all to do whatever she wants. but also, it has not been established that by laying in bed she is declining. it may be her best coping mechanism right now. hard to say. i am a little biased on this point-- sometimes on my days off i will literally sit in bed and read for two days straight-- no bath, nothing, just read-- and sleep-- and it makes me happy. i have not exercised since i was about seventeen years old (long time ago) other thatn running around at work. i am pretty sedentary. : ) i also smoke. i eat usually only restaurant food-- i do not cook and do not eat healthy-- and if someone said to me "you are continuing to decline" i would probablly rip them a new one.... on a personal level, i would say that basic communication techniques (i read a lot) and also NLP has been very helpful for me when dealing with people i find difficult. it not only helps me make my points but it helps me be receptive to their points, too. neuro-linguistic programming (big name, easy concepts)..... i would also like to point out that this woman actullay did not create many of her own problems, apparently. they happened to her. that is very sad-- she sounds truly victimized-- and a lot of it sounds like dubious medical and caregiver treatment--as far as the flair for drama goes? the whole "you must stay with me, " thing that she does and the whole being sick when she either is or is not legitimately sick? my grandma does that. someone will probably flame me for saying this, but my grandma is from the south. back when being a lady in the south, there was like this idea where if you could get people to do things for you and fuss over you, it meant something? like the sicker you were and the more attention you got, it meant you were special and also that you must be delicate and ladylike. it was a different time. my grandma is hilarious-- but i appreciate her viewpoint, it is cute to me-- she can be sitting next to the water cooler with an empty glass in her hand and she will still ask some man in the room to fill the glass for her. it drives my family crazy-- i am not sure why but i suspect it is because they are not sure about their own boundaries so when she treds on them they feel threatened or something. i am not sure. i am also not sure why she does not bother me at all--- maybe because i kind of appreciate her viewpoint. maybe part of me can relate (oh Lord, maybe it is genetic). (smile).
also, about the call lights? for the amount of money that place is probably getting to keep her there, (has she had to sell her house yet?) they should answer call lights with nothing less than enthusiasm. i am not saying i always do. but LTC is super expensive! for that amount of money they can figure out some really innovative responses to the frequent-call-lights thing.
Specializes in LTC,Hospice/palliative care,acute care.
There is a difference between LTC and rehab----a point that many nurses seem to forget....Our residents are screened by PT and OT and placed on programs when possible-but you do run into residents like this grandmom quite frequently...They have the RIGHT to do as much or as little as they wish....This thread shows how many nurses can not let go of that control.....There should be NO "bargaining" (or browbeating) They have rights.....
There is a difference between LTC and rehab----a point that many nurses seem to forget....Our residents are screened by PT and OT and placed on programs when possible-but you do run into residents like this grandmom quite frequently...They have the RIGHT to do as much or as little as they wish....This thread shows how many nurses can not let go of that control.....There should be NO "bargaining" (or browbeating) They have rights.....
they do have rights. and if nothing else this thread has made me realize how strngly i feel about that; i work in a good care cntr so i do not have to re-evaluate my stand on pt rights very much because i tend to respect them. i wonder if grnadchild should just let herself be a grandchild and let the nurses be nurses and cnas be cnas. may be better for her grandmom and for her both. talk about boundary issues-- not the grandma-- the child. as far as her past behavior goes, ocd or no ocd, the past is past. and should be regarded as such. as far as illness goes, legitimate or not, is not our place to say but still sounds to me as if she has legitimate issues that should be treated as such. i still say she does not sound like such a handful or so atypical of LTC residents.
i had a resident die yesterday. all i care about now is not whether she did PT or showered right on schedule or whatever. i care about how many times i was able to make her smile and the fact that when she put her hands on my face and cooed at me like i was a baby (which to her, i probably was) i did not pull away. i gave her lots of hugs and kisses. and suddenly (usually we can kind of tell but not this time) she was gone. i did not get to say goodbye in the proper or usual sense-- just a sudden acute situation and then her heart stopped. so the only consolation i have is that i tried to be nice to her.
Specializes in LTC,Hospice/palliative care,acute care.
i had a resident die yesterday. all i care about now is not whether she did pt or showered right on schedule or whatever. i care about how many times i was able to make her smile and the fact that when she put her hands on my face and cooed at me like i was a baby (which to her, i probably was) i did not pull away. i gave her lots of hugs and kisses. and suddenly (usually we can kind of tell but not this time) she was gone. i did not get to say goodbye in the proper or usual sense-- just a sudden acute situation and then her heart stopped. so the only consolation i have is that i tried to be nice to her.
you are awesome!!! and i agree with your philosophy......
i wonder if grnadchild should just let herself be a grandchild and let the nurses be nurses and cnas be cnas. may be better for her grandmom and for her both. talk about boundary issues-- not the grandma-- the child. .
I guess I don't understand what you mean by boundary issues. I am simply concerned about her and was wondering if anyone had seen anything similar and if there were any solutions.
No one likes to see their loved ones "give up" on life, and refuse to get out of bed.
Specializes in LTC,Hospice/palliative care,acute care.
I guess I don't understand what you mean by boundary issues. I am simply concerned about her and was wondering if anyone had seen anything similar and if there were any solutions.
No one likes to see their loved ones "give up" on life, and refuse to get out of bed.
I think you just received the best advice in the entire thread-just be her loving grand daughter.. It is not easy to see a loved one "give up on life" in theri old age or die of cancer or a car accident-but death is a natural part of life and letting go of control is the hardest thing for us all...There comes a time when you just can't DO anything....just be there....We have all seen similar situations-you can frustrate yourself and upset her by engaging in a struggle for power and control to get her to live a life of your choosing or you can try to enjoy the time you have left together by finding some way to make a visit with her pleasant......Merricat gave you some good suggestions on ways to help her feel in control of something in her environment....Let her be the "matriarch" she thinks she is and you remain her grand daughter-I think that is the boundary issue....She still has much to offer you-enjoy her....
I think you just received the best advice in the entire thread-just be her loving grand daughter.. It is not easy to see a loved one "give up on life" in theri old age or die of cancer or a car accident-but death is a natural part of life and letting go of control is the hardest thing for us all...There comes a time when you just can't DO anything....just be there....We have all seen similar situations-you can frustrate yourself and upset her by engaging in a struggle for power and control to get her to live a life of your choosing or you can try to enjoy the time you have left together by finding some way to make a visit with her pleasant......Merricat gave you some good suggestions on ways to help her feel in control of something in her environment....Let her be the "matriarch" she thinks she is and you remain her grand daughter-I think that is the boundary issue....She still has much to offer you-enjoy her....
It's like if we try and encourage her to get up , invite her places, etc. there's a boundary issue, but if we ignore the problem we are neglectful.
Bottom line she is mentally ill and should have gotten help decades ago.
It's like if we try and encourage her to get up , invite her places, etc. there's a boundary issue, but if we ignore the problem we are neglectful.
i really like ktwlpn. i did not mean to say or even imply that if you try and encourage her to get up, invite her places, etc, there is aboundary issue. i also do not believe if you ignore "the problem" you are neglectful.
Specializes in LTC,Hospice/palliative care,acute care.
It's like if we try and encourage her to get up , invite her places, etc. there's a boundary issue, but if we ignore the problem we are neglectful.
Bottom line she is mentally ill and should have gotten help decades ago.
I don't recall anyone saying that you are neglectful-The thread encompasses 2 very different approaches and I am sure I am speaking for us all when I say I do hope we have been helpful......You have to do what you feel comfortable with. You received a great deal of good info on this thread....maybe you are not hearing what you want to hear? I'll bow out of this one now -seems that I don't understand what you are looking for.-I did not mean to offend you-sorry
RN92
265 Posts
In the state I live in, we have what is called "swingbed". It is where the hospital will keep pts that are too sick (mentally or medically) to go back to their ltc and not sick enough to be in the hospital. Its like a half-way house for elderly pts only. Swingbed pts get the physical therapy, psyche help or any other skill required. There is a time limit like 6-8wks they can stay in a row, but there is no limit as to how many times they go.
I did home health for 9yrs. There comes a time when the elderly do just "give up". Once they've made up their mind - you cant hardly change them. They are tired...and ready to go. Its hard to watch- but understandable.