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Old 02-24-2012, 05:00 PM   #1
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So angry

Hi All,

I am so angry with the nursing home that my Mom is in right now I could just scream. Do not get me wrong the aides and the nurses on the Alz wing are great it is the big wigs of the nursing home that I could just throw something at. At the last care meeting we discussed that my Mom is a fall risk (on Thanksgiving I was helping her to her room and she fell and hit her head into a concrete wall, it was very scary for me and my Mom). So anyways I was told at the care meeting that they would fit her for a wheel chair. I went in the nursing home tonight and my Mom has a walker and cannot even take a cue from the aides that she needs to move her feet and they have a belt around her trying to help her, my Mom looked so sad and told me she felt dumb and stupid. I almost started crying it was that sad. I ask the aide why she was not in a wheel chair and she said the big wigs came through and said that they needed to get my Mom out of a wheel chair, so that is what they are doing. I reminded the aide that my Mom has alzheimers and how is she suppose to learn how to walk with a walker if she cannot even remember how to use a fork and spoon? The aide said I agree with you but I am just doing what I was told and I understood that. So I ask to speak to someone in charge and they said oh it is Friday you will have to wait until Monday to talk to anyone.....things that make you go hmmmm, I thought a nursing home was ran seven days a week. So I am venting to try and calm down, my Mom felt like such a failure tonight my heart broke for her. I feel so angry I do not know what to do with myself and I know I am going to fret until Monday....I just feel the need to help my Mom today. I cannot put her in another nursing home, because it would be dramatic for her, but she does not deserve this kind of treatment. Can anyone give me advice on how to help my Mom she is at the nursing home for comfort not reabilitation?????? I just need to get this out so maybe I will calm down, I feel so helpless!

Love
Julie

 
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Old 02-24-2012, 06:33 PM   #2
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Re: So angry

oh sweetie, if I could reach out and hug you I would. I had something the same happen with my mom and I stood my ground until she was helped. if she is a fall risk ask about a greri Chair, it is an oversized wheelchair that has a tray attached to the front of it and it locks into place, the problem with these is that once they get into these they tend to stay in them as it is very easy for the nurses and aids to leave them in them, no falling, no risk, no problems...If it is possible phone them and inquire about this, if your mom fell once she will again. I beleive the belt they had on your mom was a transfer belt, it is designed to help the aids or nurses help the person walk by holding onto them from the back. If your mom is a fall risk she should not be alone using the walker. I know you are angry but turn it into something useful, you are your moms advocate, if your gut tells you it is wrong then it probably is.

hugs judy

Last edited by jagsmu; 02-24-2012 at 06:49 PM.

 
Old 02-24-2012, 08:54 PM   #3
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Re: So angry

Julie, you have to look at all sides of this. My Mom is a fall risk. A recent trip to the ER for a CT scan proved that. Over the last year she has fallen at least 6 times with no serious injuries. She had a few pretty nice bruises but that's it. Yes we have been very lucky. There are days her ability to ambulate is better than others. I already have a wheel chair that belonged to Dad and has been reconfigured for Mom. Yet I will not let them put Mom in it... yet.

Mom may have had a good day when they assessed her. She might have walked ok with the walker. Yet today she could not walk at all. One assessment is not sufficient. They need several visits with her over time to make assessment on her ambulation and other needs.

Yes, the falls can be scary but I don't like the alternative. I have seen way too many residents put in a chair and left there indefinitely. I prefer to let Mom walk when and if she can, then sit on her own with staff helping her from palace to place if necessary. If she falls... she falls. I will deal with the consequences. Those are just my preferences and each has to make their own choices in what is important to them. Taking away any mobility Mom might have is too high a price to pay to prevent the occasional fall.

I do not believe in introducing a walker to any patient with dementia. That is asking for trouble. If not used properly, they are more dangerous than walking without one. Beyond that they forget them. If they have to have them to walk you can't depend on them to remember that. So I am with you in not wanting Mom to every use a walker. I had to laugh today. Mom walked up to the front of another resident's walker, picked it up, and walked off with it. That is what a dementia patient will usually do if left on their own.

The gait belt/transfer belt is definitely a way to keep Mom from falling. I used one with Dad for a while (minus the walker). It does make it easier for the staff to help hold her up. I bet if they threw the walker down the stairs and just used the gait belt she would do better. It is the walker that is confusing her.

If you put her in a wheel chair you will probably have a period of time when she will not remember that she is supposed to stay seated. She is more than likely going to try to get up. Especially with the leg rest in place this also creates a danger. Many times the staff will push them up to a table and lock the wheels to prevent them from getting out but this leaves them stuck in one place. Geri chairs will prevent them from getting up but not prevent them from trying. With either they do tend to be forgotten.

Mom's emotions are probably not directly related to the walker or gait belt. It is a boarder emotional response to the confusion and losing her abilities. No matter what we do we can't fix that for them. Mom was tired late this afternoon and doing her dramatic lean to one side which throws her off balance. She needed to sit down and rest but felt the need to keep going. Where we do not know, but just keep going. I put her in a chair, leaned her back, and propped up her feet. My hope was that she would doze off for a while. Instead she would stiffen to try to scoot down. Then she became frustrated and I actually saw a tear slip from her eyes. IT was the same frustration your Mom had. The inability to do what they think they need to do. So I got her up, put my arm around her waist, and we walked some more until it was time to sit down for supper. I wish I had a gait belt

Moving her would have negative effects and you said yourself the staff was not the problem. Hang in there until you can talk to the appropriate people. Ask if she has been trained by physical therapy to use the walker. If she has not then tell them that you refuse to let her use a walker until she is certified safe by a physical therapist. I doubt that will ever happen! If they want to continue walking her with a gait belt then that is ok but you want a wheel chair for the times she is unable to walk on her own. Ask them not to leave her in the chair all day but to get her up as many times as possible. She can even walk behind her wheel chair. What I would do... is ask them for a PT consult with someone that specializes in geriatric dementia. Then let them make the necessary decisions and adjustments to her ambulation.

We can not fix what is wrong. All we can do is make them as comfortable as possible. We are their best advocates and just need to keep doing what we think is right in the moment. If somebody seems to know better then ask questions, find out the reasoning, ask for second opinions, and know that the situation changes from day to day. As long as you have caring staff on the floor you have a good situation. A compassionate caring staff member can make any situation tolerable and help you figure out what needs to be done.

I do hope you can get some answers Monday and at least find out what their thought process was. Maybe you will end up educating some middle management on just what dementia is!

Love, deb

 
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Old 02-25-2012, 01:43 PM   #4
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Re: So angry

Thanks Judy I have had time to cool down and know that I need to approach this is a calm manner, that is why I came here to vent I love this site and I thank all of you for your kindness!

Love,
Julie

 
Old 02-25-2012, 01:46 PM   #5
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Re: So angry

Thanks Deb you are right knowledge is power! I have had time to cool down and I need to be smarter and wiser and not let my anger get in the way. The Staff is so caring and giving to my Mom. I just get so frustrated that people who do not work with her at all come in and make decisions about her care. You have so much knowledge and I thank you for sharing it with me. I will seek out a physical therapist and see that they approve of Mom using the walker. I off to the nursing home but wanted to thank you for taking the time to help me.

Lots of Love
Julie

 
Old 02-25-2012, 03:26 PM   #6
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Re: So angry

its so hard to deal with nursing homes. i feel so much for you. glad you calmed down and vented. it so helps on these boards. keep venting

 
Old 02-25-2012, 06:28 PM   #7
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Re: So angry

Julie... I have more experience than I ever wanted to have!! I have been in this disease in some way since back in the mid 70's. Having worked in a facility also helps to see both sides. Yep, those that waltz in thinking they know it all and pop out a recommendation that is off the wall are an annoyance to everybody.

One thing I have always said her is don't react out of anger and total frustration. Unless it is life threatening take time to chill, investigate, and research. Then you can go in with calm knowledge which goes a lot further than emotions. Surprisingly, it is easier to dismiss a tear or a curse word than it is fact and logic.

I had an episode Thursday with the New New Unit Coordinator. Yep the new one! Staff meeting at 2:30 so she sent all the care managers and then went herself leaving the unit in the hands of a brand new, not CNA qualified, Rec assistance! Can we say against state and corporate regulations? I was there so I just did what I know how to do and waited to see how long this would last.... an hour and 20 minutes!!! .... with no qualified staff present in the unit. I waited until her office was empty, walked in, and ask her what made it right. Yes, the New Rem Coordinator is new but she has now see my calm logical wrath. I accepted NONE of the excuses and assured her it would never happen again!! Then calmly wrote an e-mail to the ED explaining the situation. I will deal with the fall out from all that the first of the week. OH well... here we go again is all I can say

Love, deb

 
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Old 02-26-2012, 11:50 AM   #8
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Re: So angry

I once told a director that excusses were unacceptable, mistakes kill patients...

hugs judy

 
Old 02-26-2012, 08:56 PM   #9
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Re: So angry

Quote:
Originally Posted by CAJ0818 View Post
Thanks Judy I have had time to cool down and know that I need to approach this is a calm manner, that is why I came here to vent I love this site and I thank all of you for your kindness!

Love,
Julie
Julie,

My FIL stopped walking on his own with his cane last May. He didn't start the wheelchair until Oct. We got his chair in Nov. However, now in the early morning, he can still use his walker with LOTS of help from the caregiver to walk. He is not walking by himself. He can still hold the walker and walk some steps. The caregiver has to tell him when to turn or even turn the walker for him. He really cannot walk anymore.
So far he needs no therapy and he hate therapy. Since it is part of Alzheimer's progression, therapy is not going anywhere. The staff in the NH know how to do this kind of thing. The elder stops walking and they try to make him walk as much as possible until he really cannot walk with the walker for longer distance. He cannot use the walker with lots of help even in a big room. For a few steps, he gets tired and breathes hard and has to sit down. (He has congestive heart failure.)

So far we go with the flow of the NH's way. He is at severe stage and there is no point to really make him walk or what. The best thing is make sure he is comfortable and at peace. If he likes the walker for a short time, they let him use it. If not, they put him in the wheelchair. Now he sleeps most of the day. He is a little more alert in the morning. It is part of the disease.
I would go with the comfort care when you choose what to do with your Mom.
If she hates the walker, don't do it. Complain to the director and stop it. My FIL liked to walk, but if she does not like to walk, stop it. If she likes the wheelchair and is at peace, so be it.

Sometimes the NH has a point but the family takes a while to see it because we are not the medical professionals. Sometimes I told the director not to force my FIL to walk even in the morning for breakfast. It is really hard to walk on the walker for him and he cannot use it without the caregiver's help whatsoever. However some exercises are good for his heart.
But nothing is perfect. Comfort care is the key.

Nina

 
Old 02-26-2012, 09:20 PM   #10
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Re: So angry

Nina, I suggested a physical therapy consultation on the safety of using a walker, not for actually ongoing physical therapy. There is a huge difference. We all know you can't "teach" someone with Alzheimer's but PT has other uses as well.... such as evaluation and consultation. Having working in a facility I know that there are many who can not make an informed professional recommendation when it comes to the necessary appliances needed and when they can be used safely. That is best left to the professionals who are trained to make those assessments. I would have never made such a recommendation without PT consultation!

My Dad began having difficulties ambulating and Mom hated the idea of a wheel chair. There was a suggestion of a walker so I did ask for a PT consult and assessment. It was determined after several visits on two different occassions that he was incapable of using the walker safely and they recommended he not use one for his safety. It sounds like a good idea to just get a walker and let them use it. But especially with the cognitively impaired it can be more of a danger than a help.

Recently I had a discussion with our facility physical therapy group about this very issue. When I ask him about this topic he got on his soap box because way too many just pull out an old walker and then he has to come back and work with the bumps, bruises, and breaks it caused. He agreed that no one, especially those with dementia, should use a walker without a consult and evaluation.

Yes, this is near and dear to my heart having watched my FIL's journey after breaking his neck falling over a walker!

Love, deb

PS... I might add this is for those in later stages of dementia.. those in early stage (with a lot of instruction) can use one safely. But they do have to be trained

Last edited by Gabriel; 02-26-2012 at 09:26 PM.

 
Old 02-27-2012, 12:39 PM   #11
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Re: So angry

Deb, I asked the NH to get a PT to check on my FIL's situation.
My FIL got sick Thursday having trouble to breathe. It has to do with his old heart and the unknown infection.
I don't think it is right that he uses the walker and breathe so hard. The good thing is he can tell the caregiver he wants to stop. So he is given the wheelchair when he stops the walker.

Thanks for the tips.
Nina

Last edited by ninamarc; 02-27-2012 at 12:41 PM.

 
Old 02-27-2012, 04:36 PM   #12
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Re: So angry

Exertion is not what he needs if he is having shortness of breath. With heart issues and an infection he has earned the right to ride for a while. At least he can tell them to stop. You might want them to check his blood oxygen level when he is using the walker. PT can do this by putting a finger monitor on his finger while he is walking. If the oxygen level drops with the exertion then you know it is not beneficial...

Love, deb

 
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