Wow! What a resource you people are! Veronica 91 covered one entire continent of information, and then Igloo572 provided just as much information with no overlap! Kudos to you both!
My mom shattered her hip this summer. She is mid90's petite and no chronic diseases other than has Lewy Body Dementia. She is in a NH and has been there a couple of years. For her, surgery would have some risks BUT due to dementia she could not do any real rehab, so no surgery. Once they break thier hip and no surgery they are considered "bedfast", they should easily qualify for hospice. You should look into having her MD write the orders for that. Not all hospice are alike. It is a MediCARE paid benefit and you can select (& fire) the hospice provider.
My mom has a 4 person hospice team: RN X 2 a week, CNA 5X a week; social worker weekly and clergy weekly. They ordered and brought in an alternating pressure air bed (like what Veronica mentioned); a GeriChair and a GeriBath chair All this is billed to Medicare too and disposable feeding bibs and adult diapers. She gets bathed twice a week via the GeriBath chair and it is a 2 person bathing team - the CNA and a CNA from the NH. Then sponge baths the other 3 days. Now she had a rotor cuff repair surgery years ago and so has orders for assisted feeding which the CNA does for her lunch 3 days. The other days are kinda hit & miss with NH staff as she can still feed herself but to really get a good meal in needs help. You want to keep her diet as normal as possible and avoid just liquid meals (one of the reason for getting rid of her first hospice group) but do cut up the food. I find it as similar to feeding a toddler. I have brought in those Gerber meat sticks for mom and she can hold them & "bite". Personally I think having to bite & chew food keeps them healthy.
Make sure she gets her flu shot. For the pneumonia shot, well that is sticky in that it is a pretty significant shot and many get a small bout of pneumonia afterwards or a big hard knot at the site and super uncomfortable for a couple of days. For us, we can roll with it. But for the infirm it can be more problems than it's worth. Speak with the hospice MD about all this.
About pain meds, my mom is on morphine every other day and then Tylenol as needed. Her pain is significantly better now 60 days later so it will get better. She had bone fragments scattered so her pain was more intense than a traditional break. One big issue for her is that due to her dementia, she doesn't realize that she has a shattered hip. So she thinks she can walk and tries to push herself off the bed and walk. So what they have done is put a counterbalance weight around her foot on the break side. It is better to do this than to have to have a restraint or a tether. Her NH does NOT due restraints either. When she gets moved, the counterbalance is moved too and so she doesn't just slump or slide back and so far no bed sores or pressure points. She is petite and that help also. If they are large, this will be a constant issue to deal with.
About the hospice, there are many. Good bad & indifferent. There are a couple of bigger national groups - VITAS & Compassus. What these can do that other smaller ones can't do as easily, is to have RN or other health care providers who can carry Class 3 & 4 medications on them. If your mom needs serious pain meds, this can make a big difference. If she has any cancers, this will be critically important. Otherwise you will have to wait till someone with that ability can make it by. Also ask about their ability to order & deliver equipment. The bed & chairs are some kinda expensive and the bigger hospice groups have standing orders for them to get to their patients, while smaller group have to come up with credit approval to do so. My mom got her bed & chairs within 24 hours of hospice admission.
Also if you & the hospice group don;t see eye to eye, you can cancel the agreement and assign the benefit to another hospice group. I did it and it took 48 hours to get the transfer done. It was easy just a new set of paperwork. My issue was a total lack of communication and nutritional concerns (they had her on Ensure for 2 meals!). Good luck, not of this will be simple.
As mom is home I am assuming that this fracture may not be recoverable. Is she appropriate for hospice care? Good skin care is critical. keep it clean and dry and moisturized. Changing position will be difficult because she will only be comfortable on her back. if she is strong enough place a pole with handle over the head of the bed so she can help raise herself to be put on bedpans. An indwelling catheter may be more comfortable in the early days but the area around the urethra must be kept clean. UTIs are a danger so make sure the urine remains clear and does not develop a foul smell. Another danger as mentioned is pneumonia so encourage deep breathing exercises. Place your hands on either side of the chest and tell her to take a deep breath, hold for a second then blow out as hard as she can. the standard for this is four times an hour when awake but just do it as often as possible, a little is better than none. Pressure sores can develop on any part of the body and some people are more prone to them than others. It is not necessarily a sign of neglect so don't feel you have failed if one crops up. Obtain an alternating pressure mattress if she can tolerate it, even then sores may develop along the ridges as the channels in the mattress fill and deflate. use pillows, soft cushions and foam to keep areas that become red off the bed. Someone who is bedbound should have their position changed every two hours but one person can not do this 24/7 but when you can at least change the position of limbs, move pillows etc. Exercise is only important if there is hope of recovery. A hospital bed will ease the strain on the caregivers body and allow some repositioning. Hospice will provide one or her Dr can write a prescription The three good limbs should be put through their full range of movement, every hour would be nice but do it as often as you can. do not wake her up if she is napping. Nutrition is another area of confusion and debate.If she can tolerate it continue with her usual diet and add in some high protein drinks, but do not overload her this will put too much strain on the body. hydration is important BUT older people tend to appear dehydrated because when thin the skin will wrinkle. As long as her urine is clear and pale yellow she is not dehydrated. Pain relief is of paramount importance and as previously noted should be given regularly. if she is able to complain or shows non verbal signs (moaning or grimacing) request an increase or a different medication. Do not give over the maximum stated daily dose of Acetamylophen (Tylenol) as this may severely damage the kidneys and possibly cause death. Some of the more potent pain relievers that your dr may prescribe also contain Acetomylophen so don't be tempted to add a Tylenol PM for example because she always took one to sleep. Ask the Dr or Pharmacist. If you have hospice the nurses will tell you what is safe. Is she on other regular medications? again if there is little hope of recovery ask the DR or hospice nurse if any of them can be discontinued. At the end of the line come the bowels and they need to be kept regular as constipation will only lead to more distress, seek advice on how best to manage this. Forgot one biggie, the importance of preventing DVTs (deep vein thrombosis) these develop in the calves of people on bedrest and are painful and dangerous and can travel to the heart and cause sudden death when the blood clot that has formed in the vein in the leg breaks off and travels to the lungs. Regular bending and flexing the knees and ankles and contracting the calf muscles help prevent this. Try not to use pillow under the knees as this also impedes blood flow. Above all do not turn your home into a hospital. keep things as normal as possible. she does not need to be confined to her room in a sterile hospital bed complete with white sheets. If she usually spends her days in the center of activity keep things normal, her cat or dog can still sleep on the end of her bed and the kids can help with her care, even little ones can bring a drink or hold a straw. a hospital bed can be set up in the living room where she can see the TV and be part of the action. Sorry this was so long but here was a lot of ground to cover
Pixiegirl, not knowing exactly how severe the Alzheimer's, how fragile, or how much she can be mobilized despite the fracture, its hard to say. I guess the other question is how did she break the hip and how bad is her bone density overall? Not to be harsh, but so you can be prepared, this could be the end or the beginning of the end. If she is bed-bound, at least a GeoMatt mattress overlay and frequent turning and skin inspection will be needed, and her risks or getting pneumonia are high also. Pain management is important too, even if all she tolerates is Tylenol 4 or 5 times a day, give that pretty regularly rather than wait for her to get agitated and upset. Can she still communicate verbally about what she wants?
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My mom shattered her hip this summer. She is mid90's petite and no chronic diseases other than has Lewy Body Dementia. She is in a NH and has been there a couple of years. For her, surgery would have some risks BUT due to dementia she could not do any real rehab, so no surgery. Once they break thier hip and no surgery they are considered "bedfast", they should easily qualify for hospice. You should look into having her MD write the orders for that. Not all hospice are alike. It is a MediCARE paid benefit and you can select (& fire) the hospice provider.
My mom has a 4 person hospice team: RN X 2 a week, CNA 5X a week; social worker weekly and clergy weekly. They ordered and brought in an alternating pressure air bed (like what Veronica mentioned); a GeriChair and a GeriBath chair
All this is billed to Medicare too and disposable feeding bibs and adult diapers. She gets bathed twice a week via the GeriBath chair and it is a 2 person bathing team - the CNA and a CNA from the NH. Then sponge baths the other 3 days. Now she had a rotor cuff repair surgery years ago and so has orders for assisted feeding which the CNA does for her lunch 3 days. The other days are kinda hit & miss with NH staff as she can still feed herself but to really get a good meal in needs help. You want to keep her diet as normal as possible and avoid just liquid meals (one of the reason for getting rid of her first hospice group) but do cut up the food. I find it as similar to feeding a toddler. I have brought in those Gerber meat sticks for mom and she can hold them & "bite". Personally I think having to bite & chew food keeps them healthy.
Make sure she gets her flu shot. For the pneumonia shot, well that is sticky in that it is a pretty significant shot and many get a small bout of pneumonia afterwards or a big hard knot at the site and super uncomfortable for a couple of days. For us, we can roll with it. But for the infirm it can be more problems than it's worth.
Speak with the hospice MD about all this.
About pain meds, my mom is on morphine every other day and then Tylenol as needed. Her pain is significantly better now 60 days later so it will get better. She had bone fragments scattered so her pain was more intense than a traditional break. One big issue for her is that due to her dementia, she doesn't realize that she has a shattered hip. So she thinks she can walk and tries to push herself off the bed and walk. So what they have done is put a counterbalance weight around her foot on the break side. It is better to do this than to have to have a restraint or a tether. Her NH does NOT due restraints either. When she gets moved, the counterbalance is moved too and so she doesn't just slump or slide back and so far no bed sores or pressure points. She is petite and that help also. If they are large, this will be a constant issue to deal with.
About the hospice, there are many. Good bad & indifferent. There are a couple of bigger national groups - VITAS & Compassus. What these can do that other smaller ones can't do as easily, is to have RN or other health care providers who can carry Class 3 & 4 medications on them. If your mom needs serious pain meds, this can make a big difference. If she has any cancers, this will be critically important. Otherwise you will have to wait till someone with that ability can make it by. Also ask about their ability to order & deliver equipment. The bed & chairs are some kinda expensive and the bigger hospice groups have standing orders for them to get to their patients, while smaller group have to come up with credit approval to do so. My mom got her bed & chairs within 24 hours of hospice admission.
Also if you & the hospice group don;t see eye to eye, you can cancel the agreement and assign the benefit to another hospice group. I did it and it took 48 hours to get the transfer done. It was easy just a new set of paperwork. My issue was a total lack of communication and nutritional concerns (they had her on Ensure for 2 meals!). Good luck, not of this will be simple.
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Pressure sores can develop on any part of the body and some people are more prone to them than others. It is not necessarily a sign of neglect so don't feel you have failed if one crops up. Obtain an alternating pressure mattress if she can tolerate it, even then sores may develop along the ridges as the channels in the mattress fill and deflate. use pillows, soft cushions and foam to keep areas that become red off the bed. Someone who is bedbound should have their position changed every two hours but one person can not do this 24/7 but when you can at least change the position of limbs, move pillows etc. Exercise is only important if there is hope of recovery. A hospital bed will ease the strain on the caregivers body and allow some repositioning. Hospice will provide one or her Dr can write a prescription The three good limbs should be put through their full range of movement, every hour would be nice but do it as often as you can. do not wake her up if she is napping. Nutrition is another area of confusion and debate.If she can tolerate it continue with her usual diet and add in some high protein drinks, but do not overload her this will put too much strain on the body. hydration is important BUT older people tend to appear dehydrated because when thin the skin will wrinkle. As long as her urine is clear and pale yellow she is not dehydrated. Pain relief is of paramount importance and as previously noted should be given regularly. if she is able to complain or shows non verbal signs (moaning or grimacing) request an increase or a different medication. Do not give over the maximum stated daily dose of Acetamylophen (Tylenol) as this may severely damage the kidneys and possibly cause death. Some of the more potent pain relievers that your dr may prescribe also contain Acetomylophen so don't be tempted to add a Tylenol PM for example because she always took one to sleep. Ask the Dr or Pharmacist. If you have hospice the nurses will tell you what is safe. Is she on other regular medications? again if there is little hope of recovery ask the DR or hospice nurse if any of them can be discontinued. At the end of the line come the bowels and they need to be kept regular as constipation will only lead to more distress, seek advice on how best to manage this. Forgot one biggie, the importance of preventing DVTs (deep vein thrombosis) these develop in the calves of people on bedrest and are painful and dangerous and can travel to the heart and cause sudden death when the blood clot that has formed in the vein in the leg breaks off and travels to the lungs. Regular bending and flexing the knees and ankles and contracting the calf muscles help prevent this. Try not to use pillow under the knees as this also impedes blood flow.
Above all do not turn your home into a hospital. keep things as normal as possible. she does not need to be confined to her room in a sterile hospital bed complete with white sheets. If she usually spends her days in the center of activity keep things normal, her cat or dog can still sleep on the end of her bed and the kids can help with her care, even little ones can bring a drink or hold a straw. a hospital bed can be set up in the living room where she can see the TV and be part of the action. Sorry this was so long but here was a lot of ground to cover