She's been undiagnosed as yet but has gone through a series of tests and the docs have not found anything. She's had some memory loss, weakness in her left leg and falling. In addition she had a heart attack over 20 yrs ago. Her most recent hospital stay was for congestive heart failure. Her doctor sent her back to a nursing home for rehabilitation. This is her second stay there. Since she was discharged from the nursing home in April, she has been back to the hospital 3 times. Once for pneumonia, once for not having any magnesium or potassium and once for congestive heart failure. She hasnt been home very long. She lives alone and I'm thinking it may be time for her to stay in the nursing home permanently. She doesn't care for herself at home very well and is limited. In addition, she has diabetes which is not controlled. We aren't sure who to speak with to get help on possibly making her a resident at the nursing home.
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In the meantime, make a list of your concerns - it will come in handy the next time she's in the hospital. I presented my list to the facility's social worker (when Mom was about to get discharged from rehab) and bluntly but politely explained that Mom had nowhere to go where she could get help with her extensive list of needs and I'd like Mom to stay at the facility where she would be SAFE. The place she was at had both rehab beds and nursing home beds, so they started working on getting her a nursing home bed. Caring for her at home had been a disaster. I was the primary caregiver, but I needed more helpers - which weren't available and/or did not come forward. Bringing Mom home again was not something I could commit to.
On that note, be careful how much care you yourself attempt to provide. I still have not recovered from caring for Mom at home. Her needs kept increasing and she got more and more demanding. I'd be getting her food & she'd be yelling from her chair about where her water was?? I know it sounds cold, but be very careful when getting involved in a caregiving situation in someone's home - especially when the person doesn't have a lot of motivation and drive to do better & would just as soon get waited on hand and foot.
Does she sign for her own release? Do the discharge planners know she lives alone? Do they send someone to her home to make sure it's a safe discharge?
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Since she doesn't seem to want to stay in a nursing home at this time, maybe you can get her to accept Home Health assistance? That might be the first step to getting her into a nursing home permanently. Who knows?
When you have a "frequent flyer" [Yes, they are called that by the hospital and nursing home staff;) ] like your Mom who is in and out of the hospitals/nursing homes repeatedly, something eventually happens that results in them having to stay in the nursing home permanently. Unfortunately, as long as your MIL is able to make her own healthcare decisions, then you are just going to have to wait until that day of reckoning comes.
FYI: Medicare and Medicaid frown on patients who are repeatedly admitted to the hospitals and/or nursing homes resulting in the hospital/nursing home being fined for having these type of patients.
I don't know if talking with your MIL's doctor or with the hospital or nursing home social service department will help, especially if your MIL doesn't want their help. I am sorry that you and your husband are in such a tough spot right now. All you can do is ask a lot of questions and maybe someone will have the right answer for your MIL's situation. Good Luck.
I'm sorry to hear of everything your mother in law has been through. Are you able to talk to her family doctor or a social worker? Maybe Adult Protective Services? It's really tough.
It sounds like she might have had a mini stroke, or its a combination of her uncontrolled diabetes, high blood pressure, cholesterol and congestive heart failure combined. It would be better if she could be monitored full time and have proper food and liquids.
I hope you can find her the help she needs.