Any suggestions please?

[airborn]

Mum had a fall a couple of weeks ago and fractured her hip. She's still in hospital and despite the efforts of the physios she hasn't got out of bed. When I explain the situation to her and ask her if she wants to be mobile again, she says yes but I can see her not walking again.

I've spoken to the social services person at the hospital and have the impression that Mum will be recommended for residential nursing care rather than care at home because they said she has "challenging behaviour" - this is because she shouts and screams sometimes when the nurses turn her . (Isn't challenging behaviour verbal or physical attacks or do they use it to cover whatever they want?). I think Mum just wants to be left alone. Unfortunately, I won't be able to look after her at home any longer without a care package if she's going to stay in bed now.

If anyone has any suggestions as to what I can do, I'll look forward to hearing them. But it seems that I'll be visiting some care homes in the near future.

 

[Rageddy Anne]

Sorry to see your mum can't be persuaded to let the physiotherapists help her...how hard are they trying? I do hope she'll find the will to try. Poor you, this must be so worrying.

 

[airborn]

Sorry to see your mum can't be persuaded to let the physiotherapists help her...how hard are they trying? I do hope she'll find the will to try. Poor you, this must be so worrying.

Thanks, RageddyAnne, it certainly is a worry.

When I was there on Monday, they were with her for about 15-20 minutes (not a lot but they must have a lot of people to see), trying to get Mum to straighten her legs and then sit up. But it seems that she can't sit up now without support so they won't try to stand her up.

As she could walk on her own before the fall, it's an amazing decline over two weeks.

 

[susanh13]

Hi, I am a new member here just signed up to reply to your situation. My mum fractured her hip and had a hematoma on the knee, which meant she was in a lot of pain and physios weren't getting anywhere with her because of her dementia too so weren't going in. I contacted the Patient Advocate Liaison Service in the hospital and strangely I had an apology and mum had more visits. Mum hated being rolled as she thought she was going to fall again.it took a lot of reassuring and praising to do it sometimes. Mum is now at home with a 24/7 live in carer using a hoist but at least is receiving understanding care tailored to her needs. It can be cheaper than a home and better quality but u need the right person.
Hope this helps.

 

[airborn]

Hi, I am a new member here just signed up to reply to your situation. My mum fractured her hip and had a hematoma on the knee, which meant she was in a lot of pain and physios weren't getting anywhere with her because of her dementia too so weren't going in. I contacted the Patient Advocate Liaison Service in the hospital and strangely I had an apology and mum had more visits. Mum hated being rolled as she thought she was going to fall again.it took a lot of reassuring and praising to do it sometimes. Mum is now at home with a 24/7 live in carer using a hoist but at least is receiving understanding care tailored to her needs. It can be cheaper than a home and better quality but u need the right person.
Hope this helps.

Thanks very much for your reply, susanh. Sounds like it's well worth looking into.

 

[susanh13]

Ps your mum only has challenging behaviour because she is scared/frightened as doesn't understand what they are doing to her. The nurses need to explain every step to her as to what they are going to do. Your mum still has feelings tell the nurses. Just because she has dementia they think they just can do it without interaction. My mum is diabetic and had to have a finger prick blood test before each meal, one nurse came in and just grabbed a finger and stick the needle in with no explanation. Mum hit her and she told her off and I had to explain to the nurse "well would you have liked someone to grab your hand without saying why, what would your reaction be? Things changed the next time she came in. The nurses are not geared up enough to understand and treat dementia behaviour on wards.

It's all about encouraging, explaining, praise and reassurance to help a dementia person in their new life. Do speak with PALS re their assessment if you think it's wrong because of her reaction because she is SCARED.

Susanh13

 

[airborn]

Thanks susanh, I'm sure you're right about being frightened. I think the nurses do try to explain that they want to turn Mum but probably she's still scared that she's going to fall out of bed when they do it.

 

[Noorza]

Thanks susanh, I'm sure you're right about being frightened. I think the nurses do try to explain that they want to turn Mum but probably she's still scared that she's going to fall out of bed when they do it.

Going into a care home on a temporary basis may be for the best. She isn't going to get the attention or full understanding of dementia that is needed to manage her in hospital. They just have too many patients no one's fault really. I am just considering whether the carers in a home who are used to dealing with dementia patients may have more success than the hospital staff have?

It may not be a bad thing if it is a temporary solution? I don't know just sharing my thoughts.


I agree with everyone who has said PALS, they're excellent.

 

[nita]

I just wanted to let you know that my Mum too is bedbound and is at home with 2 carers visiting 4 times a day. She has to be hoisted if she wants to use the commode or if I take her out in her wheelchair. She doesn't have challenging behaviour but doesn't like being changed as, like your mother, they roll her from side to side. They have found an easier way to do this by pulling the sheet but Mum does feel she is going to go over the side so they have to reassure her. They do tell her what they are doing and I think that helps. Fortunately, with her illness, she forgets what happens straightaway and isn't upset afterwards.

The only problem I have encountered is when Mum wants the commode between visits (for a bowel movement) and I have had to have someone else in the family to help me turn her to one side to use the bed pan. What I tend to do is to give her fruit once a day about an hour before the carers' visit is due so she is ready to "go" when they come, though this doesn't always happen.

My Mum had a lumbar fracture and had very limited mobility afterwards though she did recover some. She used the stairlift we had put in for about 6 months before she couldn't walk and had to sleep downstairs. She could just about stand but then, either due to her arthritis and lumbar fracture or due to her deteriorating mental condition, she couldn't even do that. So then she went into respite while we rearranged the room and the OT arranged for a mobile hoist and the SW set up the care package.

I agree that respite while this is being sorted out is a good idea. They don't usually send dementia patients to rehab units due to their inability to understand the purpose of rehabilitation or keep up the exercises.

 

[airborn]

Thanks, Noorza and nita, for your thoughts. The latest news is that they're now saying that Mum is medically fit for discharge but how can she be when she could walk independently before the fall and now can't (although she did manage to stand briefly today so there's still hope).

Surely she can't be discharged when there's no care package in place and/or we haven't seen enough care homes to choose one if we decide I can't look after her properly at home any longer.

 

[nita]

I think she has to be both medically fit and passed as fit by the OT as well. Can you speak to the occupational therapist when she visits your Mum? I used to arrange to be there to speak to them in the afternoon. They usually make sure the person can walk safely first and then arrange a home visit to see if they can cope at home. So I wouldn't worry too much. They can't discharge your Mum without a care package in place and any adaptations necessary in her home. Speak to the hospital SW to reassure yourself. I got through to Mum's just by ringing the hospital switchboard and asking for her - there may be one or two, but you should be easily be able to get hold of the one your Mum is allocated to.

Thanks, Noorza and nita, for your thoughts. The latest news is that they're now saying that Mum is medically fit for discharge but how can she be when she could walk independently before the fall and now can't (although she did manage to stand briefly today so there's still hope).

Surely she can't be discharged when there's no care package in place and/or we haven't seen enough care homes to choose one if we decide I can't look after her properly at home any longer.

 

[Noorza]

Thanks, Noorza and nita, for your thoughts. The latest news is that they're now saying that Mum is medically fit for discharge but how can she be when she could walk independently before the fall and now can't (although she did manage to stand briefly today so there's still hope).

Surely she can't be discharged when there's no care package in place and/or we haven't seen enough care homes to choose one if we decide I can't look after her properly at home any longer.

They can be fit for discharge but it is then that the REACT team get into play to ensure there is a safe discharge which is when they start to help you with care packages. They can't legally do an unsafe discharge.

Talk to PALS, phone the ward and ask what they are doing to ensure a safe discharge. Being deemed fit for discharge can just be the start, it can take a couple of weeks after that or longer, for the discharge to happen.

 

[airborn]

Thanks again, Noorza and nita. Mum half stood yesterday with the physios' help so we'll try again today and maybe get her into a chair.