First official review

[Raindancer11]

I have an official review with mums care home tomorrow over Zoom, with some difficult subjects to discuss!
Although they review care internally on a monthly basis, I think it is three monthly with us at the moment. Mum has only been in there since December 14th, so it is still a settling in period by all accounts. They have confirmed that she does need supervision and 24 hour care and is not able to do her daily care or toileting independently. She is putting on weight, eating well and looks so much better. Following on from the deprivation of liberty order, tomorrow we have to discuss end of life care plans and wishes and DNAR ( which I am taking to mean 'do not resuscitate'?). It's that that has floored me! I know that it has to be discussed but I am finding it difficult to get my head around. Also one member of staff let slip previously that her previous GP records ( she has moved counties, so now registered with new GP's etc), indicated that she had not been receiving adequate care and it appeared that ' they had not done enough for her'. With that in mind, and following on from a thorough medical review with new gps, I will be discussing their findings tomorrow. Communication from the previous gps was very poor and I had to fight to get any info about anything! I am happy with her care so far in the home and the last two visits have been a success. BUT - I don't know what to say about the end of care plan tomorrow, my mind is frozen! Any advice would be most welcome!

 

[Sarasa]

Hi @Raindancer11, first of all I'm very impressed that the care home has regular review meetings. I had to ask for the only one I've had with my mother's care home and that was over a year ago. It sounds like your mother is in a very good home, and I'm glad they are being very thorough about checking her health etc.
On the DNAR notice, I flagged this up at the care home meeting, as mum didn't have one. She had some capacity when she'd moved to the home the previous year and I know if asked she would insist on every medical intervention going. As far as mum is concerned dying is an optional extra! The manager and I agreed that it would be a good idea if one was in place. A week or so later the local GP phoned me. She was lovely and very sensitive to my needs. We both agreed that if mum needed something like a broken hip fixing she would go to hospital but otherwise she would just be kept comfortable at the home. I think it helped that mum was pretty well physically at the time (still is) so even though she is in her nineties I didn't expect her to become seriously ill imminently. I think the wisdom of our decision was proved a week or two later when mum had a fall. The home were concerned she might have broken something so off she went to A&E where I met her. By the end of the very thorough series of tests mum was being vile to all the staff, trying to rip out cannulas etc and I was finding it more and more difficult to cope with her. I was so glad when she was allowed back to the home and I could leave her being made a fuss of by her favourite carer.

 

[Bunpoots]

Hi @Raindancer11 my dad made his end of life wishes known to me but even if he hadn't I would have said the same. DNAR is as you think - do not attempt resuscitation - which can be brutal even for a young fit person and I felt my dad should be spared that at his age. The plan we decided on, while dad was well enough, was to allow antibiotics and pain control but nothing more invasive and just hope for a peaceful end. And this is what I repeated when dad was poorly in hospital and the doctor asked me.

I hope this helps.

 

[Dimpsy]

My mum lives with OH and I and I love her to bits, but can't bear the thought of putting her frail, 90 year old body through the trauma of a resuscitation; to what end?
To keep her in my life? But at what cost and pain to her.
We all have our time in the sun, let her go with dignity and in peace.

Edit: should add that, yes, of course, we are all for any treatment/intervention that can keep mum's (pwd) quality of life as it is now. She eats/sleeps well, fairly mobile and very (mostly) cheerful,but she has declined, like many pwd over the last year.
All we can do is our best.

 

[Raindancer11]

@Sarasa @Bunpoots @Dimpsy - Thank you for your input which was really helpful! The review went very well. We have agreed with the DNRA and have put together an end of life plan which I know she would approve of. She is very settled there now, eating and sleeping well and is finally joining in with activities. Sadly she is now in hospital following a fall last night and has fractured her right upper arm. She is being kept in as her sodium levels are also low as a result of recently being put on anti anxiety meds, these have been reduced. They are keeping her until the end of the weekend as to check for any infection and get the pain meds at the right level. Luckily she does not need surgery but is in a collar and a sling. Unfortunately it is her right arm that is fractured which is the arm she uses with her crutch ( she has a walking frame that she refuses to use). The home are trying to put a routine together which will not mean she has to isolate when she returns. Fingers crossed for a happy outcome!