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Old 04-25-2011, 02:30 PM   #1
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father in nursing home but still needs sitters

Dr. suggested we have sitters for awhile while he makes transition. This is week 2 and the nursing home still wants us to have round the clock sitters.
Is this normal? Is he perhaps in the wrong nursing home - so we need to check others to see if they have a specialized area that can handle Alzheimer's patients.
This is the nursing home his Dr. suggested. I don't like it because it is old - needs paint and new furniture but several people have said it was good.
Insurance stops paying on Wed. then we pay for nursing home and the sitters.
Also physical therapy stops when insurance stops - will he just lay there? I know he won't get better - or at least like he was but he has improved and just a month ago he was walking, eating and using the bathroom on his own - then he fell and was in another state so my sister and I could not push the medical system like we needed to - thats why we brought him up here.
I know I have probably left out millions of details that would help - I guess I need to know if we are doing something wrong - how much do we push the nursing home, his DR or is this what we can expect.
Do we stop the sitters and just tell the nursing home to deal with him - can they kick him out?
He mainly yells for help or mother or does Indian chants - has not physically hit anyone or been violent. He is too week to get out of bed but has fallen out once since he was at the nursing home (luckily they had the bed low and he wasn't hurt - they have since changed the bed)

Thanks

 
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Old 04-25-2011, 10:18 PM   #2
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Re: father in nursing home but still needs sitters

Cotton, I am assuming your Dad has some type of Dementia. You did say he was in bed and can not get up. Can I assume that the nursing home he is in is not accustom to dealing with dementia patients?

If your Dad is non ambulatory, then what are the sitters for? If he is only calling for help, his mother, or doing Indian chants then what are the sitters doing except watching him vocalize? Have they tried any psychiatric medications to help alleviate his anxiety?

A high low bed with a floor pad would prevent any injury if he did roll out of bed. It is a bed that can be lowered to the floor when there is nobody there to attend to him. If he does roll out it is only a short drop to the floor pad which cushions even that slight drop. When the caregivers need to attend to him them they can heighten the bed to a more comfortable position for them to do what needs to be done.

As for sitters, for a non ambulatory patient, I think this is a useless waste of money. Dad was, and Mom is in a care facility that specializes in dementia care. They never had a sitter full or part time. We used chair/bed alarms when Dad was a fall risk and also a high low bed. Dad could get pretty vocal but they never had a sitter for his verbalization. The only residents that I have seen with private sitters were extreme fall risk. It was only during the time when they would forget they could not stand up, try to stand, and then fall.

If this facility does not understand dementia, then I would suggest you look for somewhere that does understand the disease. Paying for both the care facility and the sitter has to be expensive! I would try to find somewhere that was more adapt at dealing with his behavior. I would also find a good geriatric psychiatrist that could help with medication to alleviate his agitation.

Also, if the doctor request the continuation of physical therapy then Medicare will pay. They will do an initial evaluation, set goals, and the determine if they are making progress. If no progress is made then the PT is stopped after a period of time. If there are changes, anything works, the doctor can order another round of PT. I guess my question is... if your Dad has been receiving PT, has it been beneficial? What progress has been made? It is beneficial to him to continue?

Another suggestion... have you considered contacting Hospice for an evaluation. With the dramatic changes in your Dad in the recent time it might be worth getting their evaluation.

If it was my Dad... I would be searching for a facility that understood Dad's condition and that capable of dealing with his situation without the extra help!

Love, deb

 
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ninamarc (04-26-2011)
Old 04-26-2011, 07:18 AM   #3
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Re: father in nursing home but still needs sitters

Deb - you are so helpful on this site - thank you

yes my father has Dementia
the nursing home said they deal with Dementia and it was where his Dr. recommended

at the hospital my Dad was seen by a geriatric psychiatrist and a neurologist and there was wonderful tweaking of his meds - he was making fantastic progress

he is currently on
Lovenox sq 40 mg
Depauote 250 mg
Lexapro 10 mg - PO
Synthroid 88 mcg po
Exelon patch
namenda 5 mg 2x day then 12.5 mg at night
they gradually took him off the serequel and the halidol (spell?)

I will check into the high low bed
I guess the sitters are there to calm him down - reassure him that he is OK - he has really bonded with them and they do a great job - keep him entertained

I plan to talk with the nursing home again today to get more details about the physical therapy
I also plan to talk to his Dr

his Dr. mentioned hospice as an option but we wanted to give the nursing home, these Drs and the meds a chance to see what would happen - my understanding of hospice is that the onsite hospice is only if they have 4 weeks or less left then there is in residence but he does not have a residence - we moved him up from Fl. after his fall
is that something we should consider - getting a studio apt. and bring in hospice - think the in residence does not have a "time limit"

Again I am probably leaving out details
thanks again - this site is such a help

 
Old 04-26-2011, 08:42 AM   #4
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Re: father in nursing home but still needs sitters

It sounds like you have done your best for your Dad It does look like the geriatric psychiatrist has done a good job of tweaking his meds. I do wonder why the Namenda and recommendation of Hospice. Just makes me wonder why.

As for Hospice... there is a Hospice facility here where patients can go for the last days. My FIL was in such a facility here. But there is also the Hospice and Palliative care group that will go to your Dad. That is who I used with My Dad. Dad remained in his care facility and a team of Hospice personnel (doctor, nurse, social worker, and chaplain) were assigned to Dad. The doctor made visits as needed after the initial evaluation and visit. The nurse checked on Dad regularly. The social worker was there for me and the family as was the Chaplain. They were wonderful. Most Hospice is not within their facilities but on a one on one basis wherever the patient is now. Or that is the way it is now. They are paid by Medicare and any supplemental insurance that might be there. The cost of Dad's care under them was zero. They look at the medical condition and if they think the patient is within a 6 months window they come in. Know there are different Hospice groups with different parameters... so check to see what is available in your area and don't stop with one. Ask for an evaluation. Hospice is not one size fits all and there are options there.

If the facility just wants him quiet.. I would be suspect. The high low bed, bed alarm, and other techniques will keep him safe. Is it possible for them to get him out of bed and into a wheel chair? Are there activities or common areas that might be beneficial to your Dad for "entertainment". Is it possible to drop the sitters during the day when there is more staff available? Does your Dad sleep at night and would it be ok to drop the sitters while he slept? It might have been the doctor's recommendation.. not sure why... but at some point the facility has to take over the responsibility. You are paying them right

Talk to the doctor, the facility, check into Hospice and see where you go from there. You are right... this sight is special! They were and are my salvation in dealing with my parent.

Love, deb

 
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