My mom is almost 92 and in the final stage of Alz. She is completely bed bound, cannot move on her own, incontinent and non-verbal. She has started developing bedsores, the worst is on her butt, but now has one on her hip and starting to get them on her heels. We try to change her position as much as possible but she is in pain on her side and always falls back to lying on her back. We are using patches, med.ointment, position changing and keeping her clean and dry. She also seems to have trouble breathing on her side as she winds up getting face down on the mattress or pillow - we use props to keep her in place but again she still winds up face down. We are using an air pillow to relieve the stress on her butt, but now she is developing sores on her hips (lying on her side) and on her heels. She cannot move her arms or legs so we do that for but her joints are freezing up. Any ideas of what we can do to help her? Her nutrition is poor as she no longer wants to eat, so we keep her hydrated with home-made smoothies (yogurt, fruit, juice and her meds) as this is something she will take. Does anyone have any ideas of what else we can do for her? She is at home under hospice care.
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Getting bedsores to heal
Getting bedsores to heal requires restoring circulation and for the open wounds, making sure they stay clean and dry. If bedsores are just starting, the best time to catch them is early. The earlier the better. Don't let them get infected, and definitely don't let them get too deep! If the bedsore is a pretty bad one, your best to have the patient admitted to the hospital so the pros can take care of this. If you can take the patient by car, you can save a ton in transport but make sure you tell the receptionist and your intake nurses that you need a thick enough mattress to actually conform to the patient so that it acts as a pressure relieving mattress if this is in the ER. With enough patience speaking up about gurney mattresses that are too thin and cause even more problems on an already existing underlying problem such as arthritis and in your case, bedsores among other things, we can raise awareness and make "backboards" and "yoga mats" a thing of the past. I'm glad some hospitals are actually listening, because if you yourself have never been on some of the gurneys out there, it's very hard to understand what the some specific types of patients are going through if you yourself have never been in their shoes and if you yourself have never been on some of the nightmare gurneys and even some of the exam tables and some of the rooms at some of the hospitals or doctors offices. A hard table or gurney actually intensifies and already pre-existing problem whereas thicker mattress of about 4 to 5 inches or more lessen the pressures on the body, especially in certain specific areas like hips, backsides and shoulders. These are actually some of the most common areas to get a bedsore or even trigger pressure induced arthritis pain that radiates deep into the joint and sometimes beyond.
Another thing to help with preventing and even healing bedsores is to pay special attention to reposition patients more often. It's nice if a patient can reposition themselves if you give them one of those overhead things they used to use in hospitals that has a grab bar with reposition assist. If the patient can't re-position themselves, then someone needs to go in and turn them every so often but this should be done with the help of an assistant or two so that it goes more smoothly. In fact, there's even a new type of bed that does the turning for you with the push of a button by an assistant. I'm not sure if they're out on the market just yet, but anything new I heard usually starts in California and works its way across the US. You might want to look into this type of bed, it looks like they may be very beneficial. If they are not yet available, they may still be in development and testing mode. Modern technology is beneficial for not just lifting and transferring patients, but also for helping with those who are bedbound since they also need just as much help as anyone else. Not turning the patient often enough causes bedsores if they're left in the same position long enough to start developing even the warning signs of bedsores when they can't reposition themselves turn themselves. The problem is quickly enhanced if the patient is without a pressure relieving mattress. Years ago even I had to start using a pressure relieving mattress because I not only had pressure point problems, but also my body was misaligned allowing urine to not get to my bladder in the night, which would cause my kidneys to hurt, which would wake me up. As soon as I got up, the urine immediately dropped to my got up, the urine immediately dropped to my bladder. The Tempur-pedic bed I sleep on actually helps with this particular problem as well as pressure point pain and even arthritis/bursitis
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If you take the pressure off the affected area it will allow the blood to return to that area and help prevent further breakdown.
Hospital beds and alternate pressure mattresses can be helpful but sometimes at the end of life there is no way of preventing them. There are dressings whose name escapes me right now that can be placed over the sore to aid healing. They work by encouraging the dead tissue to slough off and healthy tissue to form underneath. I have seen bedsores even on the ears that were in no way due to a neglectful caregiver.
Some people will yell "Call a lawyer" if their loved one in a nursing home developes bed sores. I say "Not so fast" First find out if your loved one has been receiving proper care. This does include getting out of bed but not being left sitting in a chair in the same position all day or waiting hours for a diaper to be changed.
Spend 24 hours with your loved one and you will soon discover the type of care they are receiving.
The circulation begins to slow and does not reach areas where there is pressure, and deprived of a good blood supply the tissue begins to die. I have seen sores even on noses and ears! Your hospice nurse should be on top of this so follow her advice.
Real sheepskin is wonderful but unfortunately can't be cleaned. The synthetic stuff is pretty worthless you need the natural oils from the sheepskin.
I have seen lawyers looking for business state that bedsores are always a sign of neglect. Not true they can happen with the best of care. As someone mentioned they do take a long time to heal. Make sure the patient is not suffering pain from the sores or other causes. I would rather be pain free and sleepy than suffering. So if hospice offers medication use what ever you feel comfortable with for your loved one.
Can you ask if the mattress can be changed to one with alternating air chambers. This will take the pressure off all areas for a short period of time as the chambers empty and the fill.
Hospice should provide all the covers that are necessary as well as any ointments.
At some point I think the sores are inevitable as the body can not heal itself well enough to keep up with the decline. The body is working as hard as it can keeping the heart, lungs and brain functioning. the skin takes a back seat to "the important stuff". the pressure sore that my husband had/has on his heels took a long time to get better, one is gone the other getting better but this is after almost a month. The body just does not heal fast enough to keep up.
These are not your fault! Even with the best of care I think they can not be prevented completely.
- An air mattress (monthly rental),
- Two foam pillows : one under his legs and an other one between his feet and the bed end, in order to avoid that his heels rub on the bed sheet,
- Silicone gel adhesive hydrocellular dressings to apply on bedsores ("Allevyn" from Smith & Nephew),
- High protein sip feed with fibre -Apricot-Peach, Chocolate, etc...- ("Fresubin"),
These products (buy the pillows) were prescribed by our general practioner and / or the nurse visiting us at home and were paid directly (air mattress) or reimbursed by our Social Security (we are in France).
If she stops eating and then drinking as my mom did...make sure hospice uses those stick sponges to help clean out her mouth and make it more comfortable for her...
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And with hospice I had them make sure they called me when I was resting when the signs of her breathing were starting to indicate the end was near...this way I could be by her side as she passed. It was truly an amazing experience. You truly feel the love...and almost have your life with them go before your eyes as it happens. Hugs...she will be okay......concentrate on your being okay and the rest of your family...
Bless you.