Anonymous wrote:We had to hire an overnight sitter. My mother was walking the halls (using her wheelchair as a walker). They said they can't restrain her. They lost her for 60 minutes one night. She was hiding in the chapel. The whole assisted living/elder care is a horrible - just a mess.

In the nursing home, we'd often find a man with his pants off in my MIL room or her in another room as she was tired and confused as to her room. It was clear they didn't know where she was for hours.

Anonymous wrote:OP here. Exhausted from last night and haven't had a chance to read all replies yet but wanted to share that we learned mom was prescribed a med by the ER doctor after her second fall. Not blaming the sibling who was informed but that sib believed the med was for anxiety. Turns out it was a pain med, narcotic category that has side effects such as increased anxiety, restlessness and frequency of urination/urge to urinate. All things mom was experiencing. She can't be her own patient advocate any longer so we need to be and to pay more attention to meds and research them. Trying it with her off of the Tramadol. More later and thanks again for all of your input. Siblings and I were not prepared and we feel bad about everything. We'll do better.

I'm sorry you're dealing with this. Take care of yourself, Op. You need your sleep. It's o.k. to take a night off, it really is. Your mom will be o.k.

OP here. Exhausted from last night and haven't had a chance to read all replies yet but wanted to share that we learned mom was prescribed a med by the ER doctor after her second fall. Not blaming the sibling who was informed but that sib believed the med was for anxiety. Turns out it was a pain med, narcotic category that has side effects such as increased anxiety, restlessness and frequency of urination/urge to urinate. All things mom was experiencing. She can't be her own patient advocate any longer so we need to be and to pay more attention to meds and research them. Trying it with her off of the Tramadol. More later and thanks again for all of your input. Siblings and I were not prepared and we feel bad about everything. We'll do better.

I'm one of the early PPs who pointed out to the OP that hospice isn't 24/7 and that it requires a prognosis of 6 months to live or less. I know from our experience trying to get hospice care for my father when his Alzheimers was very advanced (unable to walk, unable to self-care, unable to eat solid foods, etc.)

Dementia and/or old age alone will not qualify a patient for hospice. I forget the precise qualifiers but a google search will turn them up. One was a certain percentage of weight loss, another was being able to speak less than 6 words. My dad was rejected when we first investigated and then somehow qualified a few months later. He was in an excellent memory care facility, part of a much larger continuing care community, but the hospice services and personnel were a godsend. Unlike the nursing staff, their entire focus is on the patient's comfort. But as a visiting service, hospice doesn't fill the role of regular medical or nursing staff - they consult with the doctors and nurses and may take over some responsibilities like bathing on occasion, but visiting hospice isn't a substitute for nurses or nursing aides or doctors.

I don't have much direct experience with hospices houses, although I know that other relatives w/terminal diagnoses had excellent experiences in this setting. We investigated that for my dad, but it made no sense to move him from an environment in which he was well cared for.

Final point on the fall issue: as a rule, nighttime is a really really difficult for the elderly. Falling is a big problem, but so is wandering and sleeplessness. Other than paying for a 24/7 "sitter" it's a really tricky issue to solve - medication doesn't always work, it can compound the fall risk, restraints are illegal in many places because of the risks posed &/or ineffectiveness, etc.

The best advice I'd give someone with an elderly parent in poor condition is to speak with a palliative care specialist. Even if your parent isn't ready for hospice, they can help you think through what kind of care is best aligned with your parent's needs and preferences, and how to make sure the focus is on quality of life.

Pp here. And yes, many of the less healthy die of other things in developing countries earlier in life. Sicker/weaker people die off at many points- birth (smaller preemies saved here in the USA would die in other countries), the first few years, during wars, and during childbirth for women.

Anonymous wrote:I haven’t read the entire thread. This was probably suggested earlier. I work at an inpatient Hospice facility. Many of our patients are geriatric long-term patients. We have a lot of fall risks, especially with our Alzheimer’s and dementia patients. We put fall risks closest to the nursing stations and use use mattresses with alarms. We will never be able to prevent all falls, but we do everything possible to keep our patients safe.

Where is this? We could not find one in NOVA when we looked for my parent.

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Anonymous wrote:When I was growing up, most people in our neighborhood lived in multi-generational households. Typically a grandchild shared a bedroom with the frail elderly relative.

Where did you grow up? I can say that I have never once heard of anything like this. Ever. You seriously think that children should be responsible for helping their elderly parents get up off the floor when they fall down and that children should be helping their elderly grandparents to the bathroom at night? Yikes.

Much of the world takes care of the elderly in their home by family. It is only in the western world, particularly in the US where putting seniors in nursing homes
away from their families and younger generations is common.

Have you done it? You are not helpful at all. I did it for a year and it almost broke me. I couldn't work, could not leave the house or turn my back for a minute. We have a small house, so that was another huge issue.

No judgement here. Believe me I get it. I'm currently touring nursing homes in Maryland and Florida.

I'm guessing in 3rd world locations seniors just don't live as long.

Perhaps, but if they do they probably also haven't been chronically ill for as long. Our elderly are more obese and have more health problems than ever. Many older folks I know can hardly get around because they never exercised a day in their life and drank coke and ate doritos for decades. People in other countries aren't as sick as we are.

I think that when they get sick in less developed countries it's more or less a death sentence. People are living longer in the US because they have had access to decent medical care, including immunizations against childhood diseases, since they were babies. We have better access to food and clean water and life is generally more comfortable and requires less physical labor than a life in a less developed country requires.

This is the correct answer. When you have catastrophic conditions like a stroke, heart attack etc, you just die there in many cases. In a lot of cases the ambulance doesn’t get there in the critical period (esp if we’re talking rural) and the public hospital/medics don’t have the resources to provide the level of lifesaving care they provide here. Many of the ppl here who survive a stroke but are in a wheelchair or have communication difficulties would have died immediately in a developing country.

For chronic illnesses ppl don’t have access to the life extending care they need (chemo, dialysis centers, etc. which you need to go to multiple times a week) on a regular basis so they die in a matter of weeks at home. You go fast if you don’t do those things.

We had to hire an overnight sitter. My mother was walking the halls (using her wheelchair as a walker). They said they can't restrain her. They lost her for 60 minutes one night. She was hiding in the chapel. The whole assisted living/elder care is a horrible - just a mess.

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Anonymous wrote:95 year old mother was hospitalized again after a fall. The highly rated assisted living facility she is at checks on her every 2 hours at night. They claimed to have checked on her at 2am and she was asleep but they found her on the floor at 3am. There are restraint laws in Virginia that prevent her from being belted into the bed. The staff seems helpful but not overly concerned. Anyone have experience with using fall mats next to the bed to prevent injury? We are starting the process of looking for a night aid to hire to ensure that she does not get out of bed on her own but that may take a week or more to get into place. Any ideas appreciated.

Assisted living is just that. Assisted. It's not 24 care. Yes, you will need to hire someone to warch her. This is a frequent gap issue in the care system, with assisted living encompassing too broad of a spectrum of needs.

Even if she were in a skilled nursing facility, they’d have the same issue because the nurses and aids will check frequently, but are unable to provide one-to-one care. Belts and rails are considered restraints and are no longer accepted practices in any care facilities. Unfortunately, overnight one-on-one care is the best solution. I’ve seen the “crash pads” but don’t have a brand to recommend; I would ask the staff about that.

Do you know why she’s getting up so frequently? Does she have to urinate frequently, or is she experiencing pain? Perhaps there is some problem-solving between family and staff that can be done to figure out if meeting a particular need could improve things. But other than that, you are literally doing everything you can and unfortunately there’s no way to prevent some falls unless she has an overnight aide.

Anonymous wrote:It seems so riculous that they can't put up bed rails for a 95 year old or have some kind of way to keep an elderly person in bed. To pay someone to sit there and watch one person is ridiculously expensive. Pay including benefits/ss taxes is $20 an hour. Multiply that times 8 hours a night, 30 days in a month and it is $4800. No wonder some nursing homes sedate patients for the night.

The sedating is a bigger problem is some residents get out of bed sedated which makes them a bigger fall risk. In MD, they have a lot of rules about restraints but they absolutely allow bed rails. The problem is nursing homes were abusing the restraints despite the need. They are best putting a camera in the room to have someone easily monitoring all rooms at night but most will not as they don't want to be held accountable.

It seems so riculous that they can't put up bed rails for a 95 year old or have some kind of way to keep an elderly person in bed. To pay someone to sit there and watch one person is ridiculously expensive. Pay including benefits/ss taxes is $20 an hour. Multiply that times 8 hours a night, 30 days in a month and it is $4800. No wonder some nursing homes sedate patients for the night.

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Anonymous wrote:I haven’t read the entire thread. This was probably suggested earlier. I work at an inpatient Hospice facility. Many of our patients are geriatric long-term patients. We have a lot of fall risks, especially with our Alzheimer’s and dementia patients. We put fall risks closest to the nursing stations and use use mattresses with alarms. We will never be able to prevent all falls, but we do everything possible to keep our patients safe.

Sadly that is not happening at many nursing homes. My loved one was too frail for transport but had we had the choice I would have picked the hospice home. But, op needs to hire someone to get more care. Inpatient hospice probably would not be appropiate.

Why do you think inpatient hospice would not be appropriate for Op's mom?

She had a fall. She did not say if was life threatening, a major change or a few months to live. Hospice will kick her out if she gets better. They cannot keep patients that improve. That happened to us. Their support and care made the quality of life better and had to pull out till there was a change per Medicare rules. Many could benefit but the rules are clear.

Makes sense. Thanks.

Most people in assisted living and nursing homes would benefit from a team like hospice. We did. But, for Medicare to pay, you need specific qualifiers.

Can you give a general gist of what the qualifiers are for hospice help?

Going to die in a few months, major change that could lead to death. Look at Montgomery hospice and jssa hospice website and they list it. If you think they qualify you can do a self referral. Worst that happens is hospice says no. Best case you get help and Medicare pays for it.

Thanks. We're not nearly at that stage, yet, but maybe your answer will help Op or others in this sort of situation. I'm certainly filing it away for future reference if/when we ever need it.

If ever in doubt, just do the referral and then fill out the paperwork so its on file for when you need it. I was surprised we got it for drastic weight loss. Wish someone told me to do it earlier. Its not just end of life completely but specific qualifiers. Its such a hard process to navigate when you have no experience with it.

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Anonymous wrote:I haven’t read the entire thread. This was probably suggested earlier. I work at an inpatient Hospice facility. Many of our patients are geriatric long-term patients. We have a lot of fall risks, especially with our Alzheimer’s and dementia patients. We put fall risks closest to the nursing stations and use use mattresses with alarms. We will never be able to prevent all falls, but we do everything possible to keep our patients safe.

Sadly that is not happening at many nursing homes. My loved one was too frail for transport but had we had the choice I would have picked the hospice home. But, op needs to hire someone to get more care. Inpatient hospice probably would not be appropiate.

Why do you think inpatient hospice would not be appropriate for Op's mom?

She had a fall. She did not say if was life threatening, a major change or a few months to live. Hospice will kick her out if she gets better. They cannot keep patients that improve. That happened to us. Their support and care made the quality of life better and had to pull out till there was a change per Medicare rules. Many could benefit but the rules are clear.

Makes sense. Thanks.

Most people in assisted living and nursing homes would benefit from a team like hospice. We did. But, for Medicare to pay, you need specific qualifiers.

Can you give a general gist of what the qualifiers are for hospice help?

Going to die in a few months, major change that could lead to death. Look at Montgomery hospice and jssa hospice website and they list it. If you think they qualify you can do a self referral. Worst that happens is hospice says no. Best case you get help and Medicare pays for it.

Thanks. We're not nearly at that stage, yet, but maybe your answer will help Op or others in this sort of situation. I'm certainly filing it away for future reference if/when we ever need it.

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Anonymous wrote:I haven’t read the entire thread. This was probably suggested earlier. I work at an inpatient Hospice facility. Many of our patients are geriatric long-term patients. We have a lot of fall risks, especially with our Alzheimer’s and dementia patients. We put fall risks closest to the nursing stations and use use mattresses with alarms. We will never be able to prevent all falls, but we do everything possible to keep our patients safe.

Sadly that is not happening at many nursing homes. My loved one was too frail for transport but had we had the choice I would have picked the hospice home. But, op needs to hire someone to get more care. Inpatient hospice probably would not be appropiate.

Why do you think inpatient hospice would not be appropriate for Op's mom?

She had a fall. She did not say if was life threatening, a major change or a few months to live. Hospice will kick her out if she gets better. They cannot keep patients that improve. That happened to us. Their support and care made the quality of life better and had to pull out till there was a change per Medicare rules. Many could benefit but the rules are clear.

Makes sense. Thanks.

Most people in assisted living and nursing homes would benefit from a team like hospice. We did. But, for Medicare to pay, you need specific qualifiers.

Can you give a general gist of what the qualifiers are for hospice help?

Going to die in a few months, major change that could lead to death. Look at Montgomery hospice and jssa hospice website and they list it. If you think they qualify you can do a self referral. Worst that happens is hospice says no. Best case you get help and Medicare pays for it.

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Anonymous wrote:I haven’t read the entire thread. This was probably suggested earlier. I work at an inpatient Hospice facility. Many of our patients are geriatric long-term patients. We have a lot of fall risks, especially with our Alzheimer’s and dementia patients. We put fall risks closest to the nursing stations and use use mattresses with alarms. We will never be able to prevent all falls, but we do everything possible to keep our patients safe.

Sadly that is not happening at many nursing homes. My loved one was too frail for transport but had we had the choice I would have picked the hospice home. But, op needs to hire someone to get more care. Inpatient hospice probably would not be appropiate.

Why do you think inpatient hospice would not be appropriate for Op's mom?

She had a fall. She did not say if was life threatening, a major change or a few months to live. Hospice will kick her out if she gets better. They cannot keep patients that improve. That happened to us. Their support and care made the quality of life better and had to pull out till there was a change per Medicare rules. Many could benefit but the rules are clear.

Makes sense. Thanks.

Most people in assisted living and nursing homes would benefit from a team like hospice. We did. But, for Medicare to pay, you need specific qualifiers.

Can you give a general gist of what the qualifiers are for hospice help?