My family member with dementia was at the time of placement reasonably ambulatory with cane or walker. Mentally engaged. Recognized family members and others routinely involved in her daily life (caregivers, neighbors, etc). She was moved to NH (3 weeks ago). I went to see her on a Friday, Tuesday went back to find her slumped in wheel chair, no longer walking, not engaged at all and did not appear to recognize or respond to me. She is and has been for years not able to articulate, so is non verbal so I cannot ask her about herself. I am concerned and frightened by the sudden change. My imagination and guilt for putting her there is running rampant. Is this sudden change a normal progression or could there be something more sinister to her decline?
My great aunt, aged 96, in full possession of her mental faculties but physically too frail to live alone, was admitted "temporarily" to a nursing home. A few weeks later, she was not at all herself. Sleepy, not engaging when we visited her, no appetite, not much interest in her usual favourite drinks (Canada Dry ginger ale, e.g., had always been well-received before).
I tracked down the general practitioner who oversaw residents' medical care, and tentatively but in terms asked her whether my great aunt was being given any kind of sedation or similar to "help her settle in to the home's routine, perhaps," I think I said.
The GP was indignant. She would *never* countenance any such thing. She was appalled that I could even think it.
Well, I can't be sure and I never was sure, maybe auntie just perked up of her own accord and had been going through a rough patch for entirely different reasons; but following that conversation the next time we saw her and thereafter for two or more years she was back to normal.
So if I were you I would put the question to them. It will help if you are your family member's health proxy or at least have HIPAA authorisation, but you don't need either to express your concerns. Be as clear as you have been in your post about the Before and After picture, and ask if they can explain.
Even on returning home, it takes a few days to get back to their pre-hospitalization "normal" though never quite fully. I am FT caregiver, have been for 9 years, and dearly pray that I never am faced with the decision to have him in a nursing home.
I do recommend testing for UTI as well, as previously mentioned, as that definitely has a very negative impact overall. When my LO started talking nonsense I told doctor I thought he had a UTI though he'd never had one before. To which came the snot reply "are you in the medical field?" No I am not. "So do you have experience with this?" No I don't.... yet. "Well, he has dementia so....." I insisted that his urine be tested, and Dr. pushed back because it was tested on admission 48 hr. prior. I pushed back, demanded. Guess who called me that night with an apology and a much better attitude???? Caregivers know their LO. Yeah he has dementia and he can be cantankerous. But he has yet to talk nonsense albeit sometimes uses wrong word. But when he said he wanted me to take him to local police department and I enquired to reason... "so we could buy more room" huh, what?
Dementia and ALZ patients go through plateau periods, then step down. Sometimes the plateau is short lived, or longer than previous ones, that step down is barely perceptible, sometimes steep. Environment is key to both in many cases as are meds. All the best to you and please do not blame yourself. You have done the best you could, and can be pro-active in following some of suggestions posted here. God bless you.
She could easily have suffered a stroke and that's why she's no longer ambulatory and you're seeing such a decline. Not to mention, dementia can progress rather quickly, even if she didn't have a stroke, so that's something else to consider, but I'd be inclined to think stroke myself.
Good luck!
I would also suggest a geropsychiatrist. Or the doctor serving the facility could try a low-dose antidepressant. Depression is common in recently placed people and can look like a drastic decline in function. I'm sure you did everything possible before placing her and had no alternative. Home care is actually not safe in most cases of late stage dementia.
Dr. Gross
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