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Oedgar23 Asked May 2023

Mother had her neck surgery and it is going exactly as I expected. Shouldn't she at least have a neuropsych evaluation?

She had the surgery on May 10. The surgery was very long and extensive, but went well enough. She came to the room that evening, and I could already see the anesthesia effects on her. Making weird motions with her hands, saying a lot of weird things. She was happy and ate some Jell-O.


yesterday I showed up and she started fussing to go home and demanding pain pills from home. In spite of the fact the nurse is already giving her pain pills. She then began fighting with the nurses over the dosage and refusing them when they were trying to give them to her.


A rehab doctor came and evaluated her when I questioned her discharge. He said because PT wrote that she can walk with a walker, that insurance will not pay for rehab.


This has not worked out how I was initially told. I was told she would be in the hospital a week with this and then go to rehab. And the day the surgeon operate it, he kept talking about. She would be out in a few days. What happened to the week?


The hospital is an hour away. I had just gotten home last night when the nurses called me. She was upset and demanding her purse. I have her purse with me for safekeeping. She demanded her purse because she wants pain meds that she thinks are in it. I removed the pain meds. She had found some cigarettes in one of her other bags at the hospital. I did not realize were there. they had had a sitter with her all day due to agitation, and I told them I thought it was dumb. They were about to discharge someone home that requires a 24 hour sitter. The rehab doctor told me ideally she would have supervision at home either from family or a caregiver. I said I am the only family and I cannot stay awake 24 hours per day. I don’t care what PT says. She’s a fall risk. Add some strong pain pills and muscle relaxers and she’s more of a fall risk.


In last nights fit they were helping her to the bathroom, and she said they were trying to hurt her. They offered her a walker and she refused it because it was not her walker. Never mind that she normally never uses her own walker. She threatened to pee on the floor. She told me she was in a weird building and asked who all these people were? I informed her she was in the hospital and she refused to believe that. They said they might have to restrain her.


I called a few hours later, and she had settled down, but was refusing some medications. I finally had a talk with a nurse who listened. They are having a case management meeting this morning. I wonder if this big episode will get her into a Jeri psych facility or get her a neuropsych evaluation?


I told this doctor months ago about her problems and that she would display drug seeking behaviors. I told him that day also that it’s guaranteed she would get delirium. 

BarbBrooklyn May 2023
How are things going today, Oedgar?

Did the hospital set up any home health services for mom?

Was a neuropsych suggested in the discharge papers?

I seem to recall that a SW or RN had opined that mom needed AL BEFORE this surgery was on the horizon.

Please accept our questions and "nudging" as concern for your health and for "mission creep" which we see a LOT of.

((((Hugs))))
Oedgar23 May 2023
The home health services will be a little bit of wound care which should be ending soon, and Home PT. I have spent a couple of very long days at her house. Yesterday we actually got out and ran errands. She’s not driving. She had a setback. Was driving the handicapped seated car at Walmart and hit a pothole coming out. Luckily, she was wearing her cervical collar, which I made her wear. She had a flareup of pain and numbness in her left hand. So I had to call the surgeon, and he told her to take some steroids. I have not heard from her yet today.
The surgeon asked how she was doing at home. He commented and seemed puzzled that she would have these periods of confusion and agitation, yet answer their neurological questions normally. And she was much better the day I picked her up. And by the time I got her home honestly seemed with it.
she had really stabilized before the surgery. We had her money stuff mostly straight until she decided to change banks. But once again, I think all of that is mostly worked out. Her utilities are no longer in danger of being shut off. I have online access to most of the important accounts, such as utilities, so I can check on their payment status. I have immediate power of attorney, and have turned it into one of her banks. I haven’t yet giving it to the bank with her safe deposit box is. We have the roach problem under control at her house. I really felt like things with her. We’re turning into a manageable status. And I knew the surgery would de stabilized things.
CTTN55 May 2023
So on Monday:
"I bright her home, made her food, and left!"

and then yesterday:
"Today I bright food, listened to her scream hatefully at AT&T, changed her dressings and helped her shower. I inhaled her awful smoke all day."

Why did you bring her home?

And look at the mission creep already. You're now spending all day with her, changing her dressings, and helping her to shower.

I thought you weren't going to do all of this?
Oedgar23 May 2023
I was willing to do this , temporarily. What I’m NOT willing to do is move in, sleep there, Last night I at least came home to my house , ate dinner (prepped by my helpful family), showered in my shower and slept in my bed.
I still anticipate that all of this ease up, when she can drive again. And when she no longer has dressings.

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BarbBrooklyn May 2023
"She bagan smoking like a chimney right when we got home.
If her C3-C7 fusions don’t take I guess we go thru this again."

OEdgar, I hope you mean "if these fusions don't take because of her non-compliance with instructions, I guess I understand that her health isn't something I can fix."

Honey, you can't care more about someone else's health than they do.
Oedgar23 May 2023
Yes her non compliance is appalling. I kind of have a feeling if he said more surgery she’d say no. And I’d be great with that.
As some one else suggested, I’d prob get proof she agrees to rehab. She won’t sign , or would scoff at doing it in writing. She’s a career paralegal. I would at least video the discussion.
Today I bright food, listened to her scream hatefully at AT&T, changed her dressings and helped her shower. I inhaled her awful smoke all day.
Crossing my fingers she gets over this surgery. We’d actually gotten her life pretty stable.
CTTN55 May 2023
So your mother is still deemed mentally competent? And you have a springing POA? Then if she wants to, she can go home, even if she's an unsafe discharge.

In a much earlier post, you said you didn't mind going to her house during the day, but that you wouldn't sleep there. Is this still true? You told the dr. that you can't watch her around the clock because you need to sleep, right? They don't care about that...we read plenty on this forum about 24/7/365 caregivers who are sleep-deprived. But you in essence told him you would be with her at least part of the time.

Were you giving her those special osteo shots once/day?

What is your plan if she does get released, even if it's AMA. Are you going to be able to wash your hands of her?
Oedgar23 May 2023
I have immediate POA now
golden23 May 2023
Oedgar - my mother, BPD, had a neuropsych eval and it was thorough. She did relatively well on her cognitive test because she was very bright but they consulted with me regarding that. They knew some of her history going in which helped. Are there any medical records of your mum's psych history that they can or have accessed? I suspect she won't fool them. She already is showing strange behaviours that the nurses will have noted.

Please look after yourself. I know how stressful this is. Mother had hip surgery and wanted my help. I refused. She had discharged herself early from rehab. She was in an ALF at the time and had enough help there.

BarbBrooklyn May 2023
Oedger, how are things going?
Oedgar23 May 2023
She came home yesterday. They didn’t do the psych eval. Just decided to send her home with home health. I bright her home, made her food, and left! She was with it enough to call bank and check her balance, make logical plans for paying bills.
So if she messes up her meds , it’s her choice not because she’s got delerium.
Her mood is a bit hyper and irritable at times. She’s getting around the house pretty well.
She was giving the Tymlos bone builder ink herself before. It’s on hold now till her post op.
She bagan smoking like a chimney right when we got home.
If her C3-C7 fusions don’t take I guess we go thru this again.
Oedgar23 May 2023
Update 2 Neurosurgeon NP called and says she’s been agitated all day and trying to leave. I gave her more history, psych history. She seemed pretty shocked. They don’t want her home alone. They are ordering a neuropsych eval. Im terrified she will pass or fool then. However, this is one of the best hospitals in the country (vs the small town medical care in our area). Hopefully they will get to the bottom of this. They want to get her into skilled nursing. I guess this could be where the Medicaid ball starts . I hope they can tell if this is a temporary delerium or what. But if it is, it’s on top of her long time psych issues. The NP perked up when I told her my brother, a Masters Degrees LPC, sees signs she has Cluster B personality disorder.
I need relief from this hell.
SnoopyLove May 2023
I’m glad to hear she is at a great medical center— it sounds like you’re doing all you can do.

Hope you can rest and relax!
BarbBrooklyn May 2023
Oedger, it might be "nice" for mom to go to rehab and work on balance but unless she's not mobile, she may not qualify for Medicare to pay for rehab in a facility.

She would probably qualify for at-home services--PT, OT and nursing services for a few weeks.

If I recall correctly, you have been estranged and no contact with your mom for several years prior to this. Frankly, given her issues, it may need to go back to that situation.

sp19690 May 2023
When you posted about mom needing neck surgery you said you told your mother she might need to go into a facility afterwards. Mom agreed to this.

I advised you to get it in writing. Did you? If you did show her the paper she signed.

Mom decided to go ahead with the surgery knowing you would not be taking care of her should she need assistance and she may have to go into a facility. Which shocker she does.

Now she is calling you a bit-h because you are trying to get her in rehab and doctors are also going back.on what they said.

Please for your own sanity dint take her home and dont cave and agree to help her for even a minute at home. Stand firm and fight to get her into rehab and then a facility after that. Once she leaves the hospital it will be 1000 times harder to get her placed.

BarbBrooklyn May 2023
Oedgar, please remember that your mother demanding to go home in no way obligates you to provide care for her there.

I hope the geripsych admission comes through and that she can get the help she needs.

If people are competent and independent, they need no propping up. Sometimes we need to let our loved ones fail in order for them to get the help they need.

Oedgar23 May 2023
I should clarify. The doctors comment about planning for rehab because she would not have the social support was stated months ago when we first started planning the surgery. That’s why I am blown away that in reality, we are having problems sending her to rehab. Right now they’re telling me that there a risk management team is going to look at this. And look at getting her into skilled nursing.
I’m still not sure how that would work out because she is still currently refusing. She has not been declared incompetent. She is being referred to as “mildly confused “in her medical record.
What’s also funny is that in the record? The doctor is telling her that I’m adamant that she goes to rehab. And my mother stated “she can go be adamant in someone else’s life. B*tch. “
sad and funny part of that statement is that she would totally say that about me behind my back even when not confused.
I am actually OK with her going home after rehab if her mind is better and she’s capable of managing her medication‘s. She’s fixated on pain meds, but only has about two weeks worth of post discharge. But she’s on other medicines as well. I would like to see her strength and balance to get better in rehab before she goes home. PT right that she’s OK, but yet they also write that nurses are assisting her to the bathroom.

Beatty May 2023
Probable delerium.
Patient lives alone.
Requires 24/7 supervision on discharge.

"The rehab doctor told me ideally she would have supervision at home either from family or a caregiver".

Fulltime supervision from family not possible.
** If this is the reality - speak it loud & clear *

I see you have & resulting in;

"He replied “Ok let’s plan for rehab since she won’t have that social support at home“.

Job well done 👏✔️

Rehab will be loathe to accept without firm discharge home or LTC plan. Home will be presumed.

That is what you want after rehab, home, yes? Otherwise, suggest involving the Social Worker now for alternative discharge plans.

cxmoody May 2023
Just throwing out my support for you.

Having to parent a parent is just plain crazy-making!

Oedgar23 May 2023
Update: Spoke bluntly with the neurosurgeon NP. Now the discharge has been stalled at least for today. I told them I can’t be there 24/7 and there is no money for aides. I think what got their attention is me saying this post op has gone way differently than the dr initially told me. I recalled that chat in great detail, that I was told she’d be in hospital a week, then onto rehab. And that Id warned the dr this would happen, and that again, I’m not the full time help. He replied “Ok let’s plan for rehab since she won’t have that social support at home “ The NP said they have the same safety concerns about her meds. They’d earlier told me to limit her access to meds to one day at a time. I said got her a pill box but she would probably throw it at me. I’m serious.

I was going up today but not now with no discharge. I think it would agitate her. Nurse says she’s fine now with a sitter. Let’s see what the evening brings as far as behavior.
SnoopyLove May 2023
Thanks for this update. I’m glad you were able to make some headway getting your concerns to the powers that be. Hope your mother has a calmer night.
JoAnn29 May 2023
First you need to make it clear that you will not be caring for this women. Get an evaluation for 24/7 care and if they say yes she needs it, get her placed in a LTC facility. Tell them that she does not have any money for aides. Tell them you have been trying to tell everyone that she is mentally ill. That she is under a doctor's care for it with him prescribing special medication. Maybe you should call her doctor and ask that he call her attending physician to explain to him/her what is going on.

You know you can not care for her. No one can care for someone Mentally ill. What I would do in this situation, allow the State to take over. You are not going to be able to continually deal with this.

Are you going to be involved in that meeting? Will her Dr. have some input?

Medicaid will pay for her care in a NH if she fits the criteria. I think this is ur opportunity to have her placed where she will be safe and u do not have to worry so much about her. You can't fix this.

BarbBrooklyn May 2023
Oedger, once she is settled in a NH, why would you not be able to take her out to specialty appointments, or have her transported to them and meet her there?

My mom was in a NH for 4.5 years. I still took her to dermatologist visits for excisions.
Oedgar23 May 2023
I have no idea how this works, will her ins pay, or how she will behave. The logistic of it are unfamiliar
Oedgar23 May 2023
It does seem to. My main issue with this is that if I refuse to pick her up or she ends up permanently in a facility, she will not get the specialty medical care she’s getting. She has a specialty medication injection that we had to go through a lot of hoops to get, and the hospital won’t even give it from her home meds. I don’t know how to keep the continuity with that or even getting her to follow up with the Neurosurgeon who is an hour away from our home. if we stick her in a facility somewhere, she’s not going to get that care. I feel obligated to keep on top of that since I’m the one who brought her to it. And I didn’t like what we were doing, but her doctors seem to think it needed to be done. And she had not been declared incapacitated and wanted to do it also.
SnoopyLove May 2023
I’m so sorry!

This could just be me, but I’m having trouble following what you want to have happen: you want her in rehab, you don’t want her in a facility, she’s drug-seeking, she needs special drugs, you’re trying to make her understand things, you’re angry the hospital staff don’t realize she’s out of it …

Do you see what I mean? It kind of makes sense but it’s also crazy. I think the doctors and other health professionals are confused about this whole situation too. And meanwhile your mother seems sadly irrational and as difficult as ever.
PeggySue2020 May 2023
Tell the hospital that you will not be taking her home and there’s nobody at home. That she is an unsafe discharge.

BarbBrooklyn May 2023
Oedger, stand fast.

"Ideally"-- just say "No, I can't possibly do that". You have zero obligation to agree to discharge, pick mom up or stay with her.

Tell them it will be an unsafe discharge as mom will be home alone.

Consider not visiting the hospital. It appears to agitate mom.

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