NH is keeping pneumonia patient in 90s. Is this wise or would the hospital be better?

Nursing home will be able to provide just about anything she needs. Elderly can become very disoriented in the hospital. Being in familiar surroundings is much better and much less stressful for her. Nobody enjoys being in the hospital.

The nursing home should be able to manage this episode. Along with the reasons given above if she goes to a hospital it can expose her to MRSA or VRE which would cause additional problems. While these can be acquired in a nursing home as well, sometimes it’s best to deal with the devil you know vs the devil you don’t.
If she is able to take her antibiotics orally she should be ok.

Does the NH have the ability to x-ray her lungs? Is she getting antibiotics? Oxygen if needed? If so, and she's being monitored carefully, she's probably much more comfortable in a nursing home than in a hospital. They're not as sterile, or decoratively as cold and frigid as hospitals.

Why can't the NH do an IV? They did at my mom's NH. Or is this really an Assisted Living Facility?

My mom in her 90s would go downhill REALLY fast in the hospital. We kept her at the NH for several bouts of pneumonia and she did fine.

Trevor, your profile states that your mother's main difficulty is mobility problems? If she is static for most of the time it would make her more vulnerable to lung infections - it's the simple stagnation that does it.

Elderly immune systems are often compromised and don't react to infection by producing a fever as they might in younger persons. Also - this is just a personal bugbear of mine - do check that she hasn't been given paracetamol or NSAIDs when the temperature is taken. I have been stunned before now by (mainly) GPs stating confidently that the patient has no fever when the patient hardly could have a fever, on account of being stuffed to the gills with effective antipyretics.

The x-ray, presumably, was taken to investigate symptoms. How is your mother? How would you describe her condition, and especially any changes in her condition?

I agree that hospitals are nasty, dangerous places for little old ladies, and if at all possible you want to keep your mother out of them. But if you are still concerned that your mother is not improving, or have any questions at all about her treatment, don't hesitate to speak up to her doctors and ask for clear explanations of their approach.

Trevor, if you’re worried about hydration, ask the NH to do a clysis treatment. (Its short for hypodermoclysis which you can google) Mom has had it once in her NH for dehydration. it’s a tiny needle inserted just below the skin on her tummy and fluids are slowly taken in thru an IV bag. The RN on her floor did the procedure and it was successful.

Another thing is what was the cause of the pneumonia? If it is an Aspiration pneumonia this may continue to occur. This happens when food, fluids or solids go into the lungs rather than the stomach. This becomes more and more common as a person declines.
As long as the antibiotics are working and the pneumonia is under control there is not much more a hospital could do that the NH can't.
If this is an aspiration pneumonia the thickening of fluids and puree of solids may help for a time.

Hospitals in general are the last place you want to be if you are sick. The possibility of infection is high, CDIF , MRSA, as well as a host of others. She is probably better off right where she is. Not to mention the trauma of moving her, then her being in a strange place with people that she does not know. Nurses on a floor that have many more patients to care for than if she were in the NH.

And I hate to bring this up but if this happens again recovery is difficult it may be time to consider Hospice options.  She will get more attention, more care from others that will come in to help her and you will get information and support as well. 

Get house doctor involved.

Grace + Peace,

Bob

Is she she getting the proper care for her pneumonia where she is and what is being prescribed by the NH's doctor that is on staff? Having worked in NH's facilities as a nurse, we gave the same care as the hospital. And if she gets worse with the NH's treatment then patients are sent to the hospital.

This was a quandary for me, also. May 4, 2018 would have been my mother's 110th birthday, but she passed on at age 104 in August, 2012, after having been hospitalized at age 93 with a bad heart attack, and again at ages 98 and 102 with pneumonia, and age 99 with widespread pulmonary emboli. She went into assisted living at age 98, and spent some months in nursing rehab for knee injuries from age 97 on. She was, however, always conscious of her whereabouts and still enjoyed the family, discussing, and taking part in the myriad birthdays of us all, of which hers were huge celebrations. On all three occasions from age 99--102, we were away and I could detect her shortness of breath over the phone, but the assisted place was doing nothing about it. I had to long-distance arrange for her transport to the hospital, and called a dear friend to accompany her until we could get home. The pneumonia when she was 102 was at a different facility, and started just 4 days before we were to be on a trip abroad, so I demanded that she go to the hospital--after all, she was not on Hospice yet, so no reason to deny her the chance to get better if that were in the cards. She had developed recurring esophageal spasms in her 80's which needed Botox injections into the esophageal sphincter to allow passage of her food. It had been treated most recently when she was 101, and recurred when she was 103. I asked her if she would like me to find a doctor willing to treat it (many of whom would say not to intervene due to her age and anesthesia risks), but she herself said that she didn't want it treated. So, that final year of life she lost about 60 pounds and basically starved down to a weight that could not sustain her further, and within 8 days of claiming to be tired and wanting to go to bed, she passed comfortably and gratefully away, after a rich life. I guess my answer to your quandary depends on her quality of life and whether she can be stimulated or cajoled into still finding worth in hanging around longer. My mother had said, after the pulmonary emboli and turning 100, "I guess it's OK to be 100, but I sure don't want to see 101!" And then 2 months later she found out that our daughter was pregnant (finally, at age 38!) "Well, I guess I've got to stick around long enough to see what kind of a baby Elly's going to have" was her response. And after having been depressed by all the illnesses and hospitalizations, somewhat losing her will to power through, she suddenly found another purpose, another reason for living longer. And those 4 years with our little grandson were some of her happiest.