My 86-year-old family friend has had a heart attack, a fall and since last November been bed ridden (all within the last 9 months). She has to be changed and cleaned by staff. The numerous illnesses range from diabetes to Grave's disease. She has pain all over and it's very difficult to move her without causing her pain. She only takes the minimum amount of pain meds (Gabapentin and Tylenol), even though Hospice has offered Morphine.
Recently there have been many instances of her having anxiety attacks. I get calls from her crying saying that she needs to get out of there and they are going to kill her. I believe there are some issues with the staff being non-responsive, but not outright abusive and she has a history of being difficult to get along with and very much "do it my way or it's wrong". However, she seems to rebound quickly once someone shows up and for as dramatic has her initial response is, she is later very calm and rational. I'm afraid that she needs a psych evaluation and anxiety medication, but she refuses any meds and neither the nursing home nor Hospice have been helpful in trying to get a licensed psychiatrist to come see her. I believe an official diagnosis would go a long way to convincing her that she needs help, but every time it comes up she gets defensive and says she doesn't need psych help, she insists it's the nursing facility that is in the wrong for abusing her.
I'm not sure how to approach this, she is of sound mind for the most part and the last thing I want to do is declare her unfit to make her own decisions, but she is now in the fourth facility where she having the same complaints, ones from her and complaints from staff about her accusing them of unfounded abuse. I'm at my wits end. I want to help her, but can't keep repeating this cycle.
Any advise on how to approach her about this and possibly suggestions on how to locate a geriatric psychiatrist that will do an evaluation in a nursing home, would be most appreciated. Maybe some way to get her to understand how irrational she seems and that it's possible she may need some help.
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Have you read your PoA to make sure that only 1 diagnosis is required? Hopefully it's not 2, but 2 is not unusual.
If she doesn't cooperate with the test, this will be noted in her chart. A last-ditch option is to resign your PoA and allow the county to bring her case to a judge who will assign a 3rd party legal guardian. Then you can carry on any type of relationship with her (or none) you wish with out any of the management headache or drama.
I have spent time with two dearest LOs who were clearly reaching the end of life, and were obviously scared and filled with anxiety. Fighting death is a loosing battle for all of us, but it will happen and is out of our control. Nobody can fix something that cannot be fixed. The struggle is heartbreaking.
Being bedridden is misery enough. Being in pain is exactly what morphine was invented for. Refusing to help herself is not going to help. I've seen Hospice Staff in action and they are true professionals of the highest degree. You need to realize she is in serious, chronic pain and fighting death, so she will lash out, until she can't fight it anymore. The best thing you can do for her as a friend is gently encourage her to accept some morphine drops and stop torturing herself. She deserves to be pain free at least. Tylenol is a joke!
All her anxiety and pain can be solved by acceptance. If she has a Chaplain, that could help her accept the inevitable. Possibly soft music, prayers, reading her poetry or Bible verses? Whatever her personal beliefs are. A calming familiar voice is needed. She fears everything now, especially strangers or medical staff. Her mind is swirling like a tornado, and she needs a calm summer breeze.
I can guarantee a few drops of LIQUID MORPHINE on her tongue would be the most humane thing to do for this tortured soul. She must stop her own pain and suffering from robbing her energy. All the psych consults and medical treatments are more torture she doesn't need. Chronic pain and facing death is both frightening and exhausting. Find a way to help calm her fears and especially her pain. Just a few drops of liquid morphine will change everything. She will still be lucid, and can control the dosage using the number of drops. No shots. You will see her calm in seconds. She can ask for more if needed. She deserves peace and gentle assurance that she will not die alone. Try your best to convince her to accept a few drops. It won't kill her, it will soothe her and stop her torture she is creating for herself by refusing!
You can talk to the nurse to offer to give her drops yourself (with nurse next to you of course). I had to gently administer several drops to my beloved husband myself, with the nurse behind me, holding my shoulder...Be strong and volunteer, since she trusts YOU. I fought it all day, so scared myself...but it was the right thing to do. Her suffering will end forever when God decides. She must stop draining her energy by suffering. Try your best to convince her.
YOU CAN DO THIS. Make it happen. Call the nurse.
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It is time for the decisions to be taken away from your friend - she needs medication to calm her. That's the kindest thing to do.
If you are determined to continue being POA, then take responsibility and do what's in your friend's best interests.
You’re not going to convince her of anything, including taking meds. But she’d feel so much better if she took them. (You would too.) The question is really what do you have to do to get her to take the meds so she’ll be as comfortable as possible?
I am sorry you’re going through this, and please let us know what you decide to do. The ball is in your court as I see it.
Thinking about it, they know this patient and her history. They are THERE and can consult with the caregivers and even the administration. They have access to the doctor.
I think that this lady is now elderly enough and sounds irrational enough that the MD can simply slip in a consultant who can speak with her. I would make HEAVY AS POSSIBLE use of both clergy and social workers in evaluating that. Make use of the hospice to the best of your ability.
Short of that, there at times comes a point where the facility goes out of its way to suggest that there is simply too much mental trauma daily, too much anxiety for all this to go on. She is already on Gabapentin. No one will be surprised that she requires more.
Again, we are just a mess of caregivers from all over the world, and while many many of us have dealt with the trauma of attempting to bring some peace and lessen some anxiety, we simply do not know your friend.
Remembering that the squeaking wheel gets the most oil I would STOP talking to her about this, stop expecting a truly rational response from her (because her responses above are NOT rational) and I would lean on the medical team for all I am worth.
I wish you the very best. You are brave to take this on for a friend. It isn't something I would be brave enough to try. I hope you will update us with better news and my heart goes out to both you and your friend.