My 80-year-old mom who was awaiting memory care got Covid. She became sick with weakness, dehydration and was not able to get out of a chair at home for 2 days (lives with elderly husband, no longer safe home situation as he cannot provide care). She is not in an ER bed for 3 days. Day 1 she fell out of bed, day 2-3 lots of IM haldol, zyprexa, and not in 2 point restraint due to combativeness. She needs PT (before bed sores, gets weaker, etc) so we can get her out, but now there is a cycle of IM antipsychotics and STR will not accept if restraints, IM meds, etc. hospital is also telling us we need to pay bc she does not meet requirements for hospitalization, although they are doing nothing to help get her out of bed.
What can I do to advocate? I don’t want her to get worse because they are trying to manage combativeness in a lady with dementia who is wildly confused about what is happening to her.
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I would at this time be certain that any and all understand the DNR/No Code status that I assume is in place. It would in all honesty be a release from torture and torment if pnemonia (once called the "old person's friend" would take her to peace.
I would make it clear that any and all tries at medication are acceptable, because other than some chemical relief here, this is a crucible for her and for all who stand witness to this. I am so very sorry. Along with the dementia she already has it is likely that the amount of O2 getting to her brain is insufficient.
I don't think Hospice could currently provide any medications other than what is being provided, but I would speak to doctors about it.
The situation was horrendous because they refused to see they needed more help than they had or their daughters could continue to provide and their situation was no longer sustainable.
We used their hospital stays (both for covid) as a means to get them into rehab and then transferred into the facility’s NH. That was the choice my sisters and I made.
Missed it by "that much" as Maxwell Smart would say.
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Covid can sure do that, make a person weak & unable to get out of bed.
Even if not unwell enough to require ongoing hospital treatment for Covid, if Mother cannot be cared for safely at home, I guess the hospital is the option (for now).
So how to make her hospital stay SAFER? So it doesn’t bring on a cascade of negative events (eg over medicated, constipated, extra falls).
Restraints are illigal where I live. Falls risk is managed better by lowered beds & more supervision.
This may be a bed that lowers to the floor & a spare mattress/crash mat provided next to it (roll out rather than fall out).
More supervision may be by extra family visits (if possible) or paid sitters.
If she needs bedrest at this time, then she needs bedrest.
Sitting in a chair for meals can come after the acute illness phase has past. Physio can come later (if/when she can actively enage with PT).
I'm wondering.. if having someone sit with Mother helps her stay calmer? If so, sitters may be the best short-term option?
Even if there was a cost, IF it was successfull it could add safety.
I would speak up to the Nursing Manager & the Doctor in charge of Mother's care. Ask both how to;
1. Add safety
2. Reduce harm
(That may include reviewing all medications & remove/change any that increase falls).
Once stable, she will be able to get a bed in Nursing Home/Memory Care. Then add PT & OT as appropriate.
And now the hospital is saying there is no reason for her to be hospitalized . My nephew ran into this issue when his mother with mild dementia had delerium after surgery . She wasn’t a candidate for rehab since she could walk , she was not in need of PT . My nephew was told the same, that Medicare will not pay to keep her hospitalized . Luckily my nephews stalling , not answering his phone , calling back the social worker late in the day , essentially playing phone tag on purpose gave his Mom a few days to calm down. They were giving her Seroquel .
I doubt they will say your Mom is a candidate for rehab either being combative . All that is left is placement . You will have to tell the social worker your mother can not go home . You may be looking at Mom having to go to SNF sooner if not memory care. I am sorry but sometimes events happen to an elderly (especially with mod to severe Alz/dementia ) that causes a big step down that they don’t recover from .
It sounds like your mom now needs to be placed in a memory care facility. I would talk to the hospital social worker and let them know that your mom CANNOT return home as she is an "unsafe discharge" and that there is no one that can properly care for her there.
If you stand your ground and don't waiver, the hospital will have to find placement for her.
So advocate that your mom gets the best possible care in the appropriate facility.
I wish you well as you travel this difficult road.