On Caregiving

[Front-Ranger]

The plot thickens! I went over to Mom's nursing home for the second time today at 5:15 pm to help her eat dinner. Afterwards, we watched the fascinating clouds moving in from the SE to the NW. . .clouds from Hurricane Irma, I have no doubt. The weather was beautiful. I think Mom could have stayed outside till it was totally dark, but I took her inside at 7 pm and a nice attendant named Kirsten helped change her and put her to bed. We talked while they were doing that and Kirsten said that, while Mom was very sweet, one time last Sunday when she was strapping mom into the foam wedge, Mom suddenly slugged her! I perked up my ears. Last Sunday was when the morphine was prescribed. Kirsten said she dodged the slug, it was all right, she was used to such occasional reactions, but she was surprised because mom was usually such a sweet and cooperative lady. I said how much Mom dislikes having to wear the wedge at night. Kirsten strategically placed some pillows instead. I was so grateful.

Maybe you could schedule a meeting with her health-care team so they can answer all of your questions about her condition. If she's getting morphine, is it because she's in pain? If yes, from what? If no, then what's the morphine for? Depending on your legal arrangements, you could probably arrange to have all physicians' recommendations be presented to you first (except in an emergency, that is).

This happened on Friday.

[serious crayons]

We talked while they were doing that and Kirsten said that, while Mom was very sweet, one time last Sunday when she was strapping mom into the foam wedge, Mom suddenly slugged her! I perked up my ears. Last Sunday was when the morphine was prescribed. Kirsten said she dodged the slug, it was all right, she was used to such occasional reactions, but she was surprised because mom was usually such a sweet and cooperative lady. I said how much Mom dislikes having to wear the wedge at night. Kirsten strategically placed some pillows instead. I was so grateful.

It's nice that in her own way, your mom expressed her feelings! She don't say much, but she gets her point across! 

This happened on Friday.

OK, sorry, maybe I missed something. I know you saw that she was on 18 meds, some of them anti-constipation ones to deal with the opioids that cause constipation. But did they say she had a painful condition that required opioids or not? 

[Front-Ranger]

She don't say much, but she gets her point across! 

I have used that Brokieism a lot lately, and I've said it directly to my mom!

OK, sorry, maybe I missed something. I know you saw that she was on 18 meds, some of them anti-constipation ones to deal with the opioids that cause constipation. But did they say she had a painful condition that required opioids or not? 

The hospice nurse said during the care conference that Mom had a surgical wound that required pain meds, so I asked why she hadn't received the morphine from 7/31 when she entered the facility. Then, the hospice nurse said that, while Mom didn't say she was in pain, the attendants know that the process of getting her dressed and into her wheelchair would cause her pain, so they give the med proactively. That's when I said I would come in early and see for myself. So, here I am at 6:30 am on a Sunday morning, sitting with Mom. She was awake and took a little water, and now she's sleeping again, but fitfully. Attendants are bustling about getting residents up and into the dining room, but they are leaving Mom alone.

[serious crayons]

The hospice nurse said during the care conference that Mom had a surgical wound that required pain meds, so I asked why she hadn't received the morphine from 7/31 when she entered the facility. Then, the hospice nurse said that, while Mom didn't say she was in pain, the attendants know that the process of getting her dressed and into her wheelchair would cause her pain, so they give the med proactively. That's when I said I would come in early and see for myself. So, here I am at 6:30 am on a Sunday morning, sitting with Mom. She was awake and took a little water, and now she's sleeping again, but fitfully. Attendants are bustling about getting residents up and into the dining room, but they are leaving Mom alone.

Oh, I didn't even know she'd had surgery! I'm glad you're keeping such a close eye on her and what's happening there. I think most nursing home staffs mean well and care about patients' well-being. But they also want to do things efficiently, and no doubt sometimes the two are in conflict. 

[Jeff Wrangler]

But that shouldn't cause pain. 

I don't doubt nursing homes sometimes do that. But that strikes me as an extremely off-label use of the medication. Maybe you could schedule a meeting with her health-care team so they can answer all of your questions about her condition. If she's getting morphine, is it because she's in pain? If yes, from what? If no, then what's the morphine for? Depending on your legal arrangements, you could probably arrange to have all physicians' recommendations be presented to you first (except in an emergency, that is).

Only a few moments to write before I need to head off to church. ... Maybe it's too late, but this is why even if you're the next of kin, these days it's absolutely essential to have a Durable Power of Attorney for Health Care.

Everyone should have one, even if it just appoints a spouse, a child, a significant other, or a close friend.

[Front-Ranger]

Yes, Jeff, you are right. I am Mom's POA and legal guardian. There is an instrument that is all-encompassing and includes PoA for health care, finances and living will. I forget what it's called; I'll look it up.

I bumped the discussion of Mom's surgery on my blog and here it is: http://bettermost.net/forum/index.php/topic,9381.msg685707.html#msg685707

[serious crayons]

Yes, Jeff, you are right. I am Mom's POA and legal guardian. There is an instrument that is all-encompassing and includes PoA for health care, finances and living will. I forget what it's called; I'll look it up.

Yeah, we had that, too. If you do it in a lawyer's office (which we did, though I don't know if you have to) I think they do all three pretty automatically, in one big folder.

I bumped the discussion of Mom's surgery on my blog and here it is: http://bettermost.net/forum/index.php/topic,9381.msg685707.html#msg685707

Thanks, FRiend! I responded there.

[Jeff Wrangler]

Yeah, we had that, too. If you do it in a lawyer's office (which we did, though I don't know if you have to) I think they do all three pretty automatically, in one big folder.

My lawyer did that when I had a will drawn up.

It's a good idea to review all these documents from time to time. I need to do that myself.

[Front-Ranger]

Mom didn't eat or drink anything last weekend, but her vital signs are all good and she has resources to go on for quite a while, especially since she's sleeping most of the time now. 

[CellarDweller]

Sometimes you have to be inventive with food.

My grandmother was never a big eater, and it decreased when she got to the facility.   However, she liked popsicles,  so mom would bring one or two that were made with all natural fruit, so that gram would get some sort of nutrition on days that she wouldn't eat.