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Old 10-30-2012, 06:02 AM   #1
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Falling and Anger

I am writing this, knowing that I cannot do anything but watch this play out. There is nothing I can do, but I would like to vent and hope others can see what happens in different AZ situations. My MIL is 90 with AZ and lives at home with a caregiver. I don't agree with having one care giver since if the elderly patient is up 24/7 you just can't stay awake. They don't do that in AZ units or assisted living. That is beside the point.

The issue is the other day my MIL fell and the caregiver went to pick her up and MIL started trying to hit her with the cane and carrying on. The caregiver had to leave her on the floor. The siblings take turns on Sunday to take care of her. So when one son came the next day after she fell, he couldn't pick her up either since she was doing the same thing. So I have to wonder why two people couldn't pick her up since they were both there. They ended up calling 911 and the paramedics picked her up and put her in bed. Jeez.... Both SiL and I felt that if it got to the point that the caregiver couldn't pick her up that the job is too much. One of her sons is determined to have her stay there till she dies. One other son has anxiety issues a week before he stays with her. They all dread it and it sounds like a chore. I don't say anything when they complain because that is the road that they chose.

So for those that want to keep a loved one at their home, it is feasible for some and for a period of time. I think it all depends on the circumstances, finances and the individual's health and endurance.

Thanks for listening to my vent. I always read posts and gain so much beneficial information and it is good for families to have a place to go. I don't think the medical profession is geared up to inform you of all the different things that go on, you have to learn if from those that live it.

 
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Old 10-30-2012, 02:39 PM   #2
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Re: Falling and Anger

Mitsy, I did read your post and hear your warning... and hope that others will take what you have said to heart.

Yes, it is possible to keep a loved one at home but you have to have adequate and sufficient help to attend to her needs. You have to have someone that is capable of doing what needs to be done and not just leave her laying! What a horrible situation for your MIL to remain on the floor for that long. Even if she is resisting, probably because she is fearful and doesn't understand what is going on, she does not need to stay on the floor. Why did the care giver not call 911 if she could not handle the situation. Obviously MIL's behavior is deteriorating along with her physical and mental abilities. Not to mention that she is a fall risk.

Declarations that we will "keep Mom at home no matter what, until she dies" is irrational at best. In this disease it is wishful thinking and rarely happens except in the very best of situations with plenty of qualified outside help. Patient behavior is a important component. With a cooperative attitude it is easier to keep Mom at home. If she will follow direction or not resist help then you can do what needs to be done. If they are combative, paranoid, or resistant then it is difficult to help them. Behavior is the number one reason those with dementia are moved to in facility care. Then there are the physical needs. If they are a fall risk you have to be on alert at all times to potential falls. It is almost impossible to watch them every minute of every day. Sleep is not optional and if the care giver is cleaning, doing laundry, preparing meals, and other things that need to be done then falls are more likely to happen. You also have toileting, showering, and other personal care. Combativeness makes these difficult at best. And you have medical concerns. Without professionals that can go in house you have to transport for medical care and you have no one to make proper assessments of health concerns. Knowledge of every aspect of this disease is rare.

So are you doing what is best for Mom by keeping her at home? Even though you have handled the situation up until now, has the deterioration of her condition brought you to a point where keeping Mom at home is no longer feasible. Many do not even want to ask themselves these questions because they feel guilty and as if they are a failure if they place Mom in a facility. I would say to them that neither is the case. Dementia is an ever changing disease. You have to reassess the situation constantly. You have to be willing to change directions as the disease changes. There is no failure in doing what is best for Mom in the moment.... even if that is admitting that you can't handle the situation alone. Guilt should only apply when you do not do what is best for Mom.... and sometimes that is placing her in a care facility. Sometimes it is financial but there is help available as long as you are not holding Mom hostage for her money. We just need to be willing to reassess our decisions when the time comes and make a new decision based on Mom's best interest

So hopefully your venting has been helpful to someone else that is battling with these same feelings of dread while trying to hang on to old decisions that no longer fit the situation

Love, deb

 
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Old 10-31-2012, 06:12 AM   #3
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Re: Falling and Anger

Thanks Deb for your thoughts. My MIL is a fall risk. She's been falling alot lately due to two things. One is that she is too proud to use her cane, unless it's to hit someone and the other is that since all she has been doing is laying in bed, her leg muscles are atrophying.
If an person is a fall risk at home, aren't they a fall risk anywhere they go? No one wanted to pick up MIL off the floor because when they did, she would yell that you're hurting me! LIke you said, either the caregiver calls 911 or they just go ahead and pick her up. MIL always says you're hurting me, just like a kid that doesn't want to be told to stop what they're are doing. She's said it so many times, that I can't believe anyone falls for that line and behavior.
So the Fire Chief came to the house and his comment "Haven't we been here before"? Well yes they have. Is there a point when they say enough is enough and call elder care? It's a misuse of their services, especially this last time.

 
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Old 10-31-2012, 08:06 AM   #4
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Re: Falling and Anger

Yes, if they are a fall risk they are a fall risk wherever they are. But the ability to manage that fall risk is different. There are more people to watch MIL in a good facility and they do. There are devices, such as a bed/chair alarm, which alerts the staff that Mom is getting up. Obviously your care giver is not trained in fall risk or she would know that a simple chair/bed alarm could prevent falls by alerting her when MIL tries to get up. It gives you time to get to MIL before she falls. Yet as you said, the care giver does have to sleep. In the care facility care managers on duty can't sleep

It may not be pride that is preventing MIL from using her cane. It could well be her cognitive decline. She forgets to use it. I bet she would swing a broom just as easily as she would swing a cane! I am not surprised she does not know how to use it properly. Care managers in Mom's unit chase residents with walkers and canes all day. The residents walk off without them and the care managers are right behind them reuniting the two.

The care giver should have call somebody and not let MIL just lay on the floor. It is not unusual for a dementia patient to tell you not to do something. This is because they don't understand. "Hurt" can refer to something other than physical pain inflicted in the moment. Hurting me can related to fear due to the fall and not knowing what the care giver wants of her. The care giver obviously does not know how to assess injuries after a fall and what procedure to follow. It also appears that she does not understand dementia. I wonder what her qualifications are.

As for the medics... this is one of the things they do and not a misuse of their services. They will come in and pick up a loved one that has fallen, assess the situation, and make recommendations. If they are called repeatedly, they may report the situation to elder care. It is part of their duties to report any situation of abuse or neglect. Repeated falls indicate that fall prevention is not in place and is considered neglect. If they knew she had been left on the floor for an extended period that is also neglect.

It is only a matter of time before something happens to change the course of action the sons are on.

Love, deb

 
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Old 10-31-2012, 08:59 AM   #5
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Re: Falling and Anger

Deb has said it well.
I just want to add that the reason MIL doesn't mind the 911 crew members but hates her sons or family for picking up her up is that she is more polite to the strangers than the family. With family, she knows she can complain and hit them. With familiar caregiver, she can fire her and hit her in her mind. When the 911 people come or the ER people deal with her, she would put up a good face being nice and polite.
It is common. My late FIL did that all the time. He was co-operative with the caregivers in the NH but refused to comply with my husband's request to move his legs on the wheelchair and etc. We are always casual with our family but more formal with outsiders.

Indeed something has to be done to prevent her from falling. If the sons ignore her, a nursing home may be better for her.

Hugs,
Nina

 
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