Should care home keep pushing mum to eat?

Discussion in 'End of life care' started by Suebees, Jan 9, 2015.

  1. Suebees

    Suebees Registered User

    Jan 9, 2015
    5
    My mum is asleep most of the time now. Today she was in bed sleeping when i arrived at the care home at around 11am. They woke her up and used hoist to put her in a chair, this woke her up but she went straight back to sleep once in her chair. They were quite forceful in trying to get her to eat she was very sleepy if not actually sleeping throughout this. She did eat most of a yoghurt but virtually none of the pureed dinner. Is this similar to other peoples experiences. Is it right to push someone to eat when they do not seem to want to? My mum has a pressure sore on her heel which is infected they have done a swab and are now saying that she is on the wrong antibiotics. Maybe she will improve when they give her the correct ones. They also told me that she has a second sore on her back. I don't know what is best for her. I don't want too appear callous but she may have had enough. I don't want too let her down. Wish there was a manual to follow. Just sit by her chair or bed and stroke her hair and talk to her.
     
  2. cragmaid

    cragmaid Registered User

    Oct 18, 2010
    7,942
    North East England
    We are all looking for that manual!:)
    Have a word with the Manager/ Senior Carer. Ask about seeing a Dietician and what the protocols are for these circumstances in the CH. Have a word with her GP too to ask about the ABs and sores, make sure she is getting regular pain relief.
    ....and most of all, continue telling her how much she is loved.x.x
     
  3. Suebees

    Suebees Registered User

    Jan 9, 2015
    5
    #3 Suebees, Jan 9, 2015
    Last edited: Jan 9, 2015
    Thanks for advice i will speak to CH manager she is very nice. She is having pain relief patches for bed sore on heel It does smell quite bad though. hopefully it will improve when she gets right antibiotics
     
  4. Pete R

    Pete R Registered User

    Jul 26, 2014
    2,045
    Staffs
    If it was me and my Mom, who is like a piece of limp lettuce when infected, I would get that cleared up first and then think again.

    I wish you both well:)
     
  5. Anongirl

    Anongirl Registered User

    Aug 8, 2012
    2,668
    Mum's care home say they won't force people to eat. They do sit with them and try to coerce them but if they refuse (as my mum sometimes does) they don't push it. Just try again later.

    Infection can cause chaos (I am slowly learning that!). My mum was very unresponsive but seemed to bounce back after antibiotics (water infection) and now seems to eat better (still with some persuasion!). Perhaps they need to give her fluids until the infection is cleared?

    I'm not sure if care homes have different rules and regulations about how they get people to eat.

    I'm sorry you have this worry xxx
     
  6. Witzend

    Witzend Registered User

    Aug 29, 2007
    4,289
    SW London
    I must say I would not allow my mother to be badgered or pestered to eat if she starts to refuse food, but then she is 96 with advanced dementia and her quality of life is extremely poor. I have seen other residents in a similar state to her being endlessly coaxed or badgered, albeit I know with the best of intentions, but sometimes it has made me wince to see someone who so clearly does not want the food being coaxed and pressured over and over.

    I have seen one poor lady crying and whimpering and repeatedly turning her head away, but still the carer (who is lovely) kept on. The woman's husband was right there, and he did not say anything, so either he wanted it to continue, or he felt unable to say anything, since he thought the carers knew best.
     
  7. VickyG

    VickyG Registered User

    Feb 6, 2013
    327
    Birmingham
    #7 VickyG, Jan 12, 2015
    Last edited: Jan 12, 2015
    Hi Suebees,

    It's a difficult one. Care homes / GP's / Social team etc etc all have a DUTY of CARE and this means they have to ENCOURAGE food / fluid, or at least be seen to be OFFERING..... No one can be FORCED to eat or drink, fact. Your Mum will decide what she wants and when. Make sure everything is logged on a diet / fluid record sheet, and if Mum is bed bound or sat in a chair for extended hours, a record of turns/ pressure relief should be written too. Good hygiene and turns /pressure relief along with the correct antibiotic should make the pressure sores more manageable. There are also really good creams and cleansing washes available, again through the District nurse / GP( Pro shield plus is excellent ) Does Mum have pressure mattress ? If not, they can be ordered via the district nurse.

    I think at some point, we all get or have gotten to the point where we question whether it is right to carry on with the whole food situation. We know our loved ones better than any one else and for me and my family personally, we battled with this for such a long time. In the end I took Mum out of her care home and had her to live here with me. We had the most wonderful 7 months with her, she was happy, relaxed an might I add, NO infections / pressure sores at all. She decided when she'd had enough and spent the last 6 weeks or so, with hardly any food, but managed very small amounts of her thickened fluids right up until the 2 days before she passed away peacefully, with no intervention or struggle. I know not everyone could or indeed would be able to do the same, I guess it helped that I knew what I was doing ( 15 years of working in Residential and Dementia care ). I miss her like mad. Every day.
    I guess what i'm saying is, sometimes we have to question whether it is best to have QUALITY life for the time one has left or do we just keep prolonging, at what cost ? I know what I think but I also know that people don't want to let go. It's hard, Damn hard. I'm sorry if any of what I have written has upset you, it's not my intention at all, I just think sometimes we need a different perspective.

    Take care and hopefully your Mum will be made a bit more comfortable once she has the correct antibiotic etc.
    Vicky x
     
  8. Suebees

    Suebees Registered User

    Jan 9, 2015
    5
    Thanks for all the kind comments have spent most of the weekend at CH with mum. She is still drinking fluids but is starting to cough and splutter a lot when drinking from the sippy cup. They are going to start with thickened drinks. The doctor came out this morning and says she has chest infection so has prescribed more antibiotics. She's still only eating porridge and yoghurt. The doctors says it can go either way but as she is refusing most of the antibiotics I can't see her getting better. She sleeps all the time except when they come to try her with food/drinks or to turn her every two hours
     
  9. VickyG

    VickyG Registered User

    Feb 6, 2013
    327
    Birmingham
    #9 VickyG, Jan 12, 2015
    Last edited: Jan 12, 2015
    Hi again,

    Glad the GP came out to see her this a.m, did they prescribe liquid antibiotics ( easier to take especially when a little thick and easy is added, or at least a crushable tablet that can be added to a bit of custard or yoghurt ? ) Either way, if your Mum's coughing and spluttering, it's not easy to get it down :(
    It's hard isn't it :(
    Hope they hurry with the thickener, but in the meantime, did you know you can get an artificial saliva spray, it comes in natural or flavoured ( help keep the mouth moist and fresh ), you can buy it over the counter in a hurry ( it's not cheap - approx £9.00 per small tin ) but the GP may prescribe it for your Mum. It was a godsend in Mum's final days as it just keeps the mouth comfortable and moist. Anyone who's not taking much fluid can use it.

    Take care now x
    P.s It's called Glandosane (50 mls) the one I used for Mum
     
  10. sunray

    sunray Registered User

    Sep 21, 2008
    1,428
    Female
    East Coast of Australia
    I agree with the "encourage but do not force" policy. That is what I would want for myself if that time comes. The body knows when it does not want to process food. I know the weight loss etc is hard to watch but sometimes that is the way end of life is. It depends too on what the family is saying, things like: "I just want you to keep trying ....etc" can be hard on the staff who have their own reactions.

    I went through this with my Mum and my husband Ray, choking, refusing food, pneumonia (aspirational is when food goes into the lungs not the stomach) endless antibiotics. All of it postpones death but at what cost? I often wondered why we were doing all of this, whose benefit it was for etc.

    Do talk to someone who knows what all of this is achieving and set up some guidelines. I agree that the right antibiotics, reduction of pain and fever will make a difference too. It is getting everything back into the right perspective again and a good life balance that seems so hard to do.
     
  11. Navara

    Navara Registered User

    Nov 30, 2012
    181
    My mother is now in a nursing home. The difference I've found between this home and her previous care home is that if she doesn't want to eat they don't push it but just go and get a Fortisip meal replacement (like a thick milkshake) which she can sip through a straw. Lets face it there's nothing worse than having food pushed down you if you aren't hungry and choking on every mouthful can't be very pleasant.
     
  12. catbells

    catbells Registered User

    Jun 14, 2010
    384
    Cambridgeshire
    Hi suebees. I have just gone through a similar situation last week re Mum. CH for 3 years, cardio vascular. She had two D&V`s just before Christmas, seemed to be recovering, then we were hit with a pressure ulcer on her right ankle. Hospital bed ,pressure boot, antiobiotics etc etc anyway to cut a long story short, I recognised the progression of the dementia also took a massive drop, after much discussion with carers, manager and GP. we now have a care plan which allows Mum to stay in bed for most of the time but up for meals. I visit daily at lunchtime to feed Mum. She would eat anything offerred so I was concerned that having a week when she was poorly refusing her pureed food - (indiciated by turning her head and pushing the spoon away) that I said I was uncomfortable, feeling I was force feeding her. I was assured by the GP that dementia patients almost to the end can and do refuse food, they`ll bite you, keep the spoon in their mouths etc I was also reminded that the patient might have forgotton what food is and how to feed themselves, but the body hasn`t. Questioning food intake they all said it is important for Mum to eat because it helps with the healing of the ulcer. At first she was refusing when unwell, but once the infection was under control she started to accept food. (Purreed and thicken drinks), however she is now exhausted and being hoisted/fed, up for about an hour to eat breakfast, lunch and tea. She soon drops off to sleep once back in bed and turned every 2 hours. GP is monitoring closely The ulcer still weeps but her foot and ankle are not infected, however a diligent district nurse today has prescribed more antibiotics, as she thinks there is a little infection in the ulcer. I`am told that as long as she is accepting food the ulcer will continue to heal albeit slowly.They may be a time when us as a team see that getting her up is becoming too much for her, then she would be bedridden, but they will continue to encourage food and drink.
    It is so difficult, we have such a responsbility its hard to define if we as the relatives are making the right decisions along with the caring team. I rely on them to speak from medical training (GP), and experience (carers and managers) and I have every faith in them, last week I was a wreck,partly trying to accept this massive drop in progression, and trying to decide whats best now, but talking with "the team" has helped a great deal, the decision is being shared its not all on my shoulders. We, the team, will review her care once a wek this includes meeting with the GP at the home. They are doing what`s best
    This is my experience Suebees and hope it helps. I understand dementia patients in their own time will let us know when enough is enough in their own way and nature will take its course.
    My thoughts are with you and all those walking the same path.
    Heather x:)
     

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