Today was not a good day for mom, I don't know what is going on with her today. I had to go get my grandmother's old wheelchair from my aunt because my sister in law couldn't get her to the bathroom. She is really weak and shaky and her knees buckle. I had trouble getting her into bed. I have been doing this for 2.5 months and it has never been like this. She isn't heavy, I am just worried about hurting her if I move her wrong. She acted like she was in pain so I had dad come in and help pull the bed mat over. She is only 89 pounds. The bed is a little too tall for her too.
The geriatrician we use is actually in a practice that only has geriatricians. We didn't have to have a referral because she became our new primary care provider. We did have to wait on their list for some time. Some geriatricians are in an Internal Medicine practices or even a Primary Care practice. If there is not a geriatric specialty practice in your area, it can be hard to identify individual geriatricians. Our previous primary care provider had geriatrics listed secondary on his record with our state licensing and labor board. Keep asking around if you have to find one individual rather than a geriatric practice. You might can even google geriatricians within your state to locate one. In our area, they often have waiting lists so if you find more than one you may want to ask to be on each waiting list and take the first available. Good luck in your search.
My dad mentioned the lift chair that my aunt offered. Hopefully hospice supplies that because I am the only one that gets along with my aunt, and I don't want to have to go load the chair into the truck by myself.
The hospice lady talked to her doctor today, and he recommended stopping all of her dementia meds, so I think we all agreed to that.
Today must have been hard.
The next stage arrived.
The term Hospice can be confronting to many, but hopefully add much in terms of support, equipment & training.
1.. if it’s possible to lower her bed by reducing the leg size or installing a thinner /lower mattress. It may be possible to discuss with mom’s doctor the issue you are facing. There may be a need for a hospital bed at home…it must be deemed “medical necessary” for Medicare to pick up the cost. If not already in place, consider seeking rehabilitation services at home to help with strengthening as well as YOU being educated on safe transfers at home.
In the meantime:-
2….Many wheelchairs have removable parts…check to see how to remove both wheelchair legs and the side rail/armrest area..if they are removable..fantastic!!..it make the transfer effort so much easier….The following process works for transferring to any surface to include bed, armchair, commode, etc.
Bring mom seated in her wheelchair as close to her bed as possible with the wheelchair angled at about 45 degrees to the bed. LOCK WHEELCHAIR BRAKES..Remove both wheelchair legs & siderail closest to the bed.
Step in front of mom, as close as possible…ask her to grab hold of you around your waist to assist with the transfer…while slightly bending your knees (always protecting your back) lift mom from wheelchair to sit on side of bed. Continue to get her positioned in bed as comfortably as possible.
There are assistive devices, education & training that you could access through allied services such Occupational Therapy, Physical Therapy and Home Health services. Discuss your mothers needs with her medical doctor.
I hope my instructions makes your day a little bit easier.😊
One question - I am slightly confused picturing the 45 degrees angle.
Having a 90 degree (right angle) would mean taking small steps around or putting weight on one leg to pivot, then step.
Can you explain how the smaller 45 degree gap works?
I am guessing it may add some safety? By having either the chair or bed closer in case the legs buckle? But how does the caregiver fit to get close enough?
Firstly, can I say that your mum isn't "acting" as if she's in pain - she is in pain.
Even if she was in remission, your mum's body would have been affected by cancer and she is also recovering from a fracture; all of that is a lot for a frail body to deal with. However, your mum does have cancer, so she will be in pain from that as well.
You also say that your mum is recovering from pneumonia, a disease that strikes the frail and weak. My mum worked with the elderly and always said that pneumonia was a friend to the old and ill.
Your mum cannot recover, so she is at end of life. It may be weeks, months, or even a year, before that becomes easily apparent to you, however that is the situation. Everything now should be geared towards your mum's comfort, not rehabilitation or recovery.
There will be ups and downs, good days and bad; yet, overall, there will be a downward trajectory. Don't be fooled by those odd days of sunshine, but please do enjoy them. They will become treasured memories to make you smile.
Just before my mum went into hospital for the final time, I had a disagreement with her husband. He was getting the carer to walk with Mum between the bedroom, living room and bathroom, giving minimal support. She was clearly in pain and struggling to breathe.
I told him that Mum was too weak and in pain, that the wheelchair should be used the few metres between each room. The carer then felt brave enough to say that she was uneasy making Mum do more than was good for her (a more experienced carer would have done what s/he thought best).
My stepdad's position was that Mum needed to build up her strength before she was no longer able to walk. My point was that it was too late for that; Mum couldn't get better and that her body needed what little strength it had just to keep her going. Plus, there was no need for Mum to be in pain or distress.
Just a few weeks later, Mum was admitted into hospital with yet another chest infection and the decision was made to send her home on palliative care. She was prescribed morphine for her pain and other end-of-life-care drugs for her comfort.
The GP had previously referred Mum onto palliative care (although she wasn't yet deemed to need a regular nurse or end of life drugs), so she shouldn't have been sent to the hospital. But it turned out to be a good thing, as the hospital arranged for a hospital bed to be sent to Mum's home, which made looking after and transferring her easier, and she was more comfortable on the air mattress.
The palliative care team were on call 24 hours. They told us to phone them if Mum was in pain or distress, but, when I wanted to call them, my stepdad said it wasn't that bad, at least not bad enough to call out a nurse. However, a person at end of life shouldn't have to deal with any pain or distress if there's medication to take it away.
In the end, once he could see Mum's pain and distress, the palliative care team were called frequently. Each time a supplementary injection was given, the same drug was increased in the syringe driver.
Mum was assisted out of bed to use the commode until it became unsafe to move her. In fact, she was helped out of bed longer than the carers were happy with because Mum insisted she used the toilet instead of wetting the incontinence pads. The district nurse (one came each morning to deal with the syringe driver and check on Mum) tried to put in a catheter, but Mum's bladder was empty. Then, it was no longer needed.
Once the hospital doctor said palliative care should start, I accepted Mum's refusal to drink her meal replacement shake. That caused another disagreement, but there's no good in trying to extend life by days, weeks, or even months, if you're making someone unhappy in their last days.
Once recovery is impossible, the person at end of life should only be kept comfortable.
Quality of life is paramount. If there is no quality, there is no life.
Try not pulling on her - use the two-man transfer with her or the under the armpit carry. As stated by another get training from a physical therapist.
Just for information - my sister had bone cancer and when she moved in her bed she broke bones. So depending on what moms issues are, she could just have frail bones.
Get out of bed
Get her to sit up in bed, turn her so feet are on floor and she is sitting on side of bed. Lift from under her arms until she is standing. Turn with her, as if dancing, until she has her back to chair and back of knees against seat of chair. Help her to sit down.
Get into bed
Have wheelchair or chair next to bed. Make sure feet are flat on floor. Help her stand by lifting under arms. Turn with her, as if dancing, until she has back to bed and back of knees against mattress. Help her to sit. Encourage her to lean sideways and help put her head on pillow. Then, move legs into bed.
Also, the mother's legs are buckling underneath her, which means that she may no longer be strong or well enough to be moved out of bed. I don't think the OP is experienced enough to assess this.
Medicare will also pay for an adjustable hospital bed. The height is moved up to help dress her so that you don't have to bend over, and down to transfer her in and out. You will need to be taught what the proper heights are for each task. You won't own the bed unless you choose to buy it, and it will be picked up when no longer needed.
https://www.amazon.com/dp/B0BJNQY8C2?ref=ppx_yo2ov_dt_b_fed_asin_title&th=1
There are also transfer chairs you can get, but so far my mom doesn't need that.
Best wishes.
The sit to stand unit mentioned in a post is helpful.
You also need a gait belt so you have something at waist to help hold her when walking. Also if legs buckle, you can ease her to floor instead of a fall. Get a gait belt with handles sewn around it. Amazon has them.
Ask Dr to order home health with PT and OT. PT is legs and OT is upper body. You'll have to do Dr visit to get and order from him. He can do physical at same time to see if anything going on to cause sudden weakness
Moving her;
Resist the temptation to lift under her arms. instead, squat (using your legs not your back!) down to her level, have her hold on around your neck or body, then stand up together, pivot - you should have a chair placed close so that a quarter turn pivot will place her over the seat - then gently lower your body down with her until she is sitting.
If the bed is too tall, consider buying a lower profile mattress and/or box spring.
Or, if it is within your budget, get a hospital bed which raises and lowers.
It can be raised up to a level for caregivers to work without straining their back, and lowered to a level for mom to get in and out.
Depending on circumstances not given here, such as mom's condition and prognosis, family member's ability to meet her needs safely, it may be time to move her to an appropriate care facility where she can get the care she needs.
If she is recovering and you expect her to get stronger and better in the near future, there are skilled nursing rehab facilities designed for short term stay and focus on rehabilitation.
Diet is a big factor in available energy and warmth. The less they eat, the less energy they're going to have and the colder they'll be.
Also, if she can't stabilize herself, you may want to put a transport belt on her any time she stands up to give yourself something to grab hold of without hurting her. You can make a really nice belt of parts from a hardware store. They sell 2" wide web strapping (in a pretty blue) by the foot and plastic snap buckles. That makes a belt that's much easier to get on and off than the metal threaded buckles at the hospital. Plus, the blue is much prettier. I've made several of these and have them stashed around where I might need one.
Yes, you could hurt her.
She should be in a hospital bed so you can adjust the height.
And perhaps get a very experienced caregiver in to help you -
If it were my mother ... If you have to keep her in ... your home (?) - hire a social worker or someone who can help you / support you to get the equipment / care she needs. Call hospice? Senior Services through your county.
She certainly could fall out of bed. I would get her to a facility for care wherein they can provide 24/7 care with bedding, equipment, personnel available to support her needs.
Gena / Touch Matters
When I contact our geriatrician (primary care) about a new problem, the first question she asks is how long has this been going on. She always emphasizes that if it is a sudden onset there may be an underlying cause. If it has been gradual then it may simply be a progression of aging or the disease process.
If it is sudden she investigates a lot more thoroughly. If an issue is identified, once treatment is begun improvement usually follows. The ER doctor and other specialists do not know your mother, the same as her primary care provider does, because they only have time to check records for what pertains to the current visit and/or what applies to their specialty.
A few years ago our cardiologist suggested we consider hospice based on a red flag due to number of trips to the ER. I told him that some trips related to caring for his PEG tube (which always requires an ER trip) or falls that I needed to verify he had not broken anything. Very few required ambulance transport and/or admission.
If you do not already have one, I strongly recommend finding a geriatrician for primary care for anyone 65 and older for the same reasons most choose a pediatrician for babies and children. Most geriatricians specialize in internal medicine first. Geriatricians often allow a lot more time than a simple 10-15 minute visit because they understand seniors need more time to communicate their concerns.
If you are saying you can’t handle it at home if she’s not mobile , just have her placed in a facility now, if not a hospice than SNF. Don’t go through trying to get her to leave the house again .
When there is a sudden change in yourself you would be going to the doctor . Unless I’m missing some previous information , I don’t see why you would approach your Mom’s sudden change differently .
You might want to get a bedside commode so you don't have to schlep her to the bathroom. Incontinence underwear should be used as a backup so that speed isn't necessary.
I dressed my mom in jogging pants because they were warm, comfortable and could work as pyjamas and daytime wear. Most importantly they also provided a sturdy waistband that I could grab to help me with transfers.
Getting her out of the recliner will also be easier if you have a sturdy waistband to grab, she can put her arms on your shoulders while you brute strength her onto her feet then turn and pivot to the wheelchair.
If she can sit up without supports the easiest way to get her out of bed will be to move her legs to the floor then reach around her back to help her sit upright on the side of the bed.
This all presupposed she is able to weight bear, if there is any doubt it may be safest to not attempt any of these manoeuvres.
A Sit to Stand if she can support some weight or a Hoyer Lift if she can not support weight.
In the mean time maybe the best thing to do would be to keep her in bed.
The key to safely keep her in bed you need to move her at least every 2 hours. And to move her all you have to do is shift her a bit in bed either up or down or to the right or left.
Depending on the testing and diagnosis she may be a candidate for LTC or hospice.
I will also recommend calling the hospice agency of your choice and have them come out to do an evaluation, as it sounds like she may qualify for their services.
If she qualifies, they will provide a hospital bed, and any and all needed equipment, supplies and medications along with a nurse coming once a week to start to check on her, aides to come bathe her at least twice a week, and you'll have access to their social worker, chaplain and volunteers. And all of this is covered 100% under your moms Medicare, so please look into this.
She didn't seem to be in pain this morning when she sat up in bed. We were going to go to the bathroom, but she didn't know how to get out of bed and I dont want to move her too fast if something hurts so I let her lay down for another hour to see if she will be less confused.
Have you noticed any signs or symptoms of illness yourself?
UTI? Fever?
Can Mom communicate how she is feeling? If any pain?
Having a wheelchair to use sounds a good practical idea in the short term. But finding out what is going on will be important.