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Good Morning, My mother has dementia and is in a nursing facility. When she is not feeling well she gets agitated. She has had two separate instances of pressure sores. The first one healed and the second is healing. It caused her some discomfort which I could tell as she was agitated and would shift around in her wheelchair. The nurse manager at the facility suggested her going to bed right after lunch to help her heal. My mother does have an air mattress. I do agree with having her have a different position to heal. The nurse also thought it was a good idea for her to nap. I did say once she is healed I would like her up in the afternoon. My mother is not tired after lunch and does enjoy being around people, though she sometimes falls right to sleep when they put her to bed. I am struggling with the issue of whether it is a good idea to have her nap after lunch. I want her to enjoy her life as much as possible and not take away her enjoyment by being awake in the afternoon. She has lunch at noon and is a very slow eater. Sometimes takes her a couple of hours. But by 1:00 they put her to bed and doesn't get her up until 4:00 to be ready for dinner at 5:00. I plan to check with the nurse on her pressure sore to see if it is healed. If so, I am thinking of requesting having her stay up after lunch. If they are concerned with her getting another sore, I was thinking of having them put her in a recliner in the community area instead of in bed for three hours. I am wondering if I am being unreasonable in wanting her up in the afternoon after her sore is healed. The afternoons are when she is visited by family/friends and I would like her to take part in that and also be around people. Any ideas would be appreciated. thanks, Aprildp

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April, I think it is quite common for anyone older to fall asleep right after a meal, whether they have dementia or not. If your Mom falls right to sleep in her bed, that means she would probably doze off while sitting in her wheelchair or a geri recliner.

So, unless someone has major plans right after lunch, like going to work, an appointment, or housework that needs to be done, I will get tired right after eating because the body is digesting food. I find myself dozing off after lunch at home or in front of my computer. Just signs of getting older. Plus certain meds don't help, either.
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They have my mom in bed in the afternoon too, and since that is when most of the entertainment is scheduled it means she seldom takes part. In our case I've discovered that mom has reached the point where she dozes in her wheelchair even when I keep her up, so I've let it be. Do you think changing her nap times would be beneficial, maybe a morning nap and earlier bed time?
And investigate getting a different cushion for her wheelchair, my mom hasn't had any recurrence of pressure sores since we upgraded to a ROHO.
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Thank you "freqflyer" and "cwillie". I guess i have to accept that mom is getting older and this is part of the process. I felt like she was missing out, but i have to think of what if best for her. Guess i am still holding on to how she used to be.

My mother is pretty good in the morning and alert so maybe it is better in the afternoon for a nap. I will check out that type of cushion too for my mother. thanks for the suggestion.
April dp
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Ff is right. In both my mom’s and husband’s facilities, you could have heard a pin drop for a few hours in the afternoon.

Does Mom have a recliner in her room? Could she relax in that for a few hours? I got my mom one of those lift chairs and she really liked it. If the pressure sores are on her bottom, you can get a cushion just like her mattress.
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Ahmijoy, It is good to know that other facilities also give naps to their residents. I do plan to get her a new cushion for her wheelchair.
thanks,
April dp
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You may not realize, but your mom sleeping means less work for the nurses. If the majority of residents sleep after lunch until almost dinner, that means more time for nurses to handle other duties, and/or relax.
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Nurses do not relax in nursing homes. At least, I've never seen one do that.
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As a former CNA, there was never time to relax or even sit down unless I went to the bathroom. Always something to be done to keep ahead of schedule. One facility we weren’t allowed to sit down unless we were feeding Residents.
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If your mom is getting bed sores, she needs to change positions frequently. Her air pressure mattress is a better place for a nap than a recliner.
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Some health experts think afternoon naps would be a good thing in the workplace! There are lots of opinions about the value and risks of napping. If your mother would otherwise be alert and interested in the entertainment and activities after lunch, then keeping her up might be worthwhile. But if she nods off or gets crabby and restless by dinnertime, napping might be a better option. When her sore is healed, perhaps you could try keeping her up and see how it goes. When she has visitors in the afternoon you could ask them how she seemed. Can you do a lot of visiting in that time slot and see for yourself?

I understand what you mean about missing out on the life she has left. But the disease is what it is, and we can't always overcome the limitations it imposes.
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April,
I'm a nurse and have worked with imobile patients but have never worked in NH's or MC's.

What I've found is that most people have energy for a few hours after they get up. Then, in the early afternoon (after lunch) it's normal to have an "afternoon slump". (energy stores depleting + digestion). That's why they sell energy drinks, highly caffeinated food and drink and energy bars. We're all trying to get our second wind.

I think a small nap (1-1 1/2 hrs.) is a great refresher but 3 hours is too long. That much sleep compromises the sleep at night.

I would look (on Amazon or a medical supply store) for the multitude of products to prevent or assist healing bedsores. (MemoryFoam cushions, gel cushions, sheepskin throws, air cushions, etc.)
Get her up in a recliner and put the cushion in her chair. She can turn on one buttock for 1/2 hr then the other "cheek" for another 1/2 hr.
Also the doctor should be ordering some skin products and dressings for healing.

Preventing bedsores from forming in the first place is best. Rotate the person left side, back, right side, back, and repeat--every 2 hours. Use lotion for massaging the bony areas, use products as mentioned above on all sleeping and sitting surfaces. Keep bottom area clean and dry. If incontinent, use skin barrier cream (Desitin, A &D ointment, etc.). If she can walk, encourage it for increased blood flow.

If her health permits (by that I mean she doesn't have any diseases that would discourage it) she should try to increase her protein and calorie consumption to aid in healing her sores.
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Thank you for all your suggestions and comments. I plan to make some of those suggestions to the facility. Waiting to have the sore completely healed. Her wound is being treated and covered.

And I agree with you, SueC1957, that 3 hours is too long. I will see how her sleep pattern is. I plan to visit during different times to see how she is doing.
Thank you everyone!
Aprildp
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Chiming in about the ROHO cushion for wheelchairs. Late 2016 my dad developed a pressure sore we couldn't seem to get the better of, and then his OT person recommended we request an upgrade to the ROHO. It started to heal right away. He hasn't had a problem on his backside since.
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I insist mom go down for a nap after lunch although without our private caregivers to assist this might not happen

Although she misses the afternoon snack and live music I hate seeing folks slumped over in their wheelchairs after lunch plus for those that are immobile the only way to change their diaper is to transfer to bed

I got mom a reclining wheelchair but it hurts her back to recline - she doesn't have a roho cushion but an expensive one while in the chair

While she was in a nursing home for a month  - everyone was put back to bed by 3 pm and ate dinner in bed

At least at memory care, she is up again for a couple of hours in the evening
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Since she is in a nursing home, it really does not matter. Now if she were at home it does matter. I give my mom coffee in the morning and very early afternoon to help her stay awake during the day--because IF I let her sleep during the day she is up half the night. Sundowning is not only unpleasant but very very dangerous because they become like maniacs at night. They don't know what they are doing and get into everything and wander around and are undirectable. Then they sleep all day and can't do their daily care..but like to stay in bed and get stiff and make care more difficult, then repeat then sundown again at night. When they sundown is also when they fall and can hurt themselves. So I have good reason to keep my mom up during the day, and I also exercise her every morning.  But in a nursing home just let them do what they want.
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My Mom also had dementia and would constantly fall asleep-Hospice ordered a recliner wheelchair for her to help keep her safe and up from bed a lot. It was great she could still stay in the activities room even though she would fall asleep from time to time she would wake up and start to get involved with the activity PLUS she was in clear sight of staff member's instead of being in her room and was not in sight in case of an emergency.
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I'm pretty sure my mom gets a nap daily after lunch but is almost always up in a nice TV room near the nursing station with the other residents in wheelchairs (some of whom are still able to communicate well with each other) when I come in daily around 4:30 to eat dinner with her. I'm glad they don't leave her alone in her room all afternoon. Many of them are snoozing in their chairs when I come in. Mom is pretty much out of it regarding her surroundings but does still respond to people talking to her and listens to what's going on around her.
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Even though my mother did not ever go to a nursing home, she used to fall asleep often in her chair. I think you should let her be. Let her sleep and plan your visits around her schedule, not yours or other visitors.
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Murphyclm, you are the first person I've encountered who sees the congregation of residents in the TV room/lounge as "nice", to me it is just a place to dump everyone so they can keep an eye on them more easily.... almost constant oldies movies played at a volume too low to hear, 90% of them too physically and/or cognitively impaired to follow the story anyway. I've thought it wouldn't bee so disheartening if somebody bothered to actually put some thought into what they have on the screen - maybe oldies sit coms, or there are some wonderful DVDs of nature or pets. Of course it does serve a purpose though, when I ask my mom she often chooses the lounge vs her room because she is afraid to be alone.
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My mother isn't in a NH, and I know she says she is supremely proud of being "up" all day. Well, truth is, after "brunch" (she eats her morning meal at about 10...the dinner at 4--she spends most of her day in her recliner with the TV on. She sleeps much of the day, and if that's how she wants to spend her time, fine.

Heck, I'm only 61 and I nap almost every day. Just an hour or so "power nap" but I can't get through a day w/o that decompression time. I would be very resentful if somebody was trying to hustle me off to watch a show or "socialize" during my one hour alone!
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cwlllie 
Having residents all together in one place is nice, for the nurses. It is easier for the nurses to keep an eye on them, dole out any medicine when needed, and wheel them to lunch, dinner when it is time. The majority of the residents are just waiting until it is the next time to eat. They slowly become "institutionalized"
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When my mother retired 20+ years ago she always had an afternoon nap at home, she’ll be 91 Sunday. She doesn’t nap much at the NH, if she has a bad night before she’ll take a nap. She doesn’t watch much tv anymore, but she likes to go in the Common Area where they do activities and the tv is also there, along with music. Staff try to get them engaged in what is going on...if the Residents are tired, let them rest. Their bodies are old and wearing down,forcing them to do stuff isn’t fun for anyone.
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Why don't you call ahead to NH when visitors are going to see her to insure she stays up or has a shorter nap otherwise let her nap - if your mom is in wheelchair & falls asleep she could fall out & get injured - I think the revitalization of a nap keeps the sundowning to a minimum
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Aprildp: Many, bordering on most, elders fall asleep quite easily even after having slept through the night. Even a simple task of eating a meal can wear them out. My own late mother said "I don't know why I am so tired." My response was "because you're 94 and held a job outside the home until almost 80."
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I say let your mother have her afternoon nap! I take naps on all my day-offs if time permits. If she’s comfortable and wants to nap, so she should.  
Regarding the pressure ulcer- unfortunately prevention of pressure ulcers is a daily goal in a NH or long term care.  A pressure ulcer can develop so quickly as the skin of our elderly folk is already frail, their immobility, and poor diet. As Sue said quite nicely in her response above, Follow those guidelines to prevent skin breakdown.
My mom developed a pressure ulcer on her heal a few months before she passed and we got right on that- alternating pressure mattress, booties, etc. It resolved in about a month. Fortunately no skin breakdown - it was diagnosed a Stage 2 PU. 
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Midkid58,

I agree with you. Sometimes it takes me 30 minutes to fall asleep and I do not like being awakened by the phone or whatever. I need to sleep when I sleep. You do not want t be bothering people during REM sleep which restores the body. Some people act as if they are dealing with children instead of adults. Back off. Let them do what they want to do.
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My dad has an afternoon nap written in his care plan. Sometimes he is in bed sometimes he sits in a chair in one of the community rooms and naps.
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It's a sad situation and seems to rub some the wrong way, but if the people in nursing homes were lucid, bright-eyed and bushy-tailed and full of vim and vigor, they probably wouldn't BE there in nursing homes. I say, if they want to sleep, they should sleep, they aren't going to be playing canasta or running on a treadmill. Most of them can't follow a tv show at all and could care less what's on the screen. I would go visit my mother half an hour every week before or after lunch, and inevitably after lunch, most of the residents including my mother would be dozing off. If mom was awake and lucid, we would look at magazines or go for a 'ride' outside, but once she was asleep, what was the point of rousing her, poor old thing?
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It used to be thought that taking a nap was an indulgence particularly 'of the weak' - these same people proudly say they take no meds even when they need them - there was an old belief that those who were sick 'deserved' it as they had been 'bad' - we can thank organised religion for this view but lots of older people still think this way - I AM HEALTHY SO I AM GOOD - poppycock & fuddle duddle

We can't change old mind sets but it is worthwhile knowing where they come from - my mom declares she never needs a nap but I often find her asleep in her wheelchair but she always made sure on Sat & Sun we were up by 8:30 - she persieves that sleeping during the day is a weakness
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I often wonder what it is that some feel they just have to stay awake FOR. I'm 66, I am retired, sleep badly, and in the afternoon often take a little nap. Why on earth NOT? I have no family, no loving hordes of siblings and children and grandchildren. No one takes me on outings, or to the mall, or road trips or vacations. I don't have a big zesty group of Sex and the City-type friends to take me on saucy adventures.   I am still mobile, still drive, still do things around the house, and often enjoy my life.  It's not like I'm in a wheelchair in a nursing home, but if that day comes, so be it.....If MY one kid ever came over prodding me awake for some ungodly reason,  now or when I am in the Shady Rest home, they would deeply regret it, I can tell you that right now.  
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