Tag Archives: nursing homes

Antipsychotic medications on the decline in nursing homes

Data released by the Centers for Medicare & Medicaid Services found that antipsychotic drug use in nursing homes has declined 9.1 percent for the first quarter of 2013. In 2010, over 17 percent of nursing home patients had daily doses exceeding recommended levels. The CMS launched the National Partnership to Improve Dementia Care last year and hopes to reduce antipsychotic drug usage by 15 percent by the end of 2013.

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The overuse of antipsychotic drugs in nursing homes, especially to sedate dementia patients is an issue that strikes home for me. I watched my father suffer the consequences of being kept in a zombie state on these drugs. While I can’t know if my dad suffered while on these medications, my mother certainly did as she visited my father in this drugged state on a regular basis. My father only showed minimal aggression which probably could have been treated with behavorial therapy or milder drugs with less side effects. The main reason he was so heavily drugged was because like many dementia patients, he wandered.

I do feel for the understaffed, overworked and underpaid nursing home staff, who have no doubt found it easier to give patients a pill to keep them from becoming another problem to deal with. There is no easy solution, but filling helpless people full of drugs is not the answer.

Let’s hope the CMS initiative continues to be successful.

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If we had kept Dad at home

The Alzheimer’s Prevention Initiative is seeking those willing to talk about why they signed up with the registry. As I indicated that I would be wiling to speak out for the cause, I started thinking about my reasons for being an Alzheimer’s awareness advocate. The obvious reason is because of my father’s battle with the disease.

But I also hope to encourage others to not make the same mistakes I made. #1: The rare visits. If I could go back in time, I would have visited more, both when Dad was still at home and when he moved into the nursing home. #2: Being uncomfortable around Dad’s unpredictable behavior. If I had it to do over again, I would tell my former self to get over it and embrace the now, instead of regretting that Alzheimer’s had stolen much of Dad’s former self.

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It got me to thinking about one aspect of Dad’s care that I never really thought about before too much. Wonder if Mom and I had somehow managed to keep Dad at home, instead of him being transferred to the nursing home for the last year of his life? I most likely would have had to quit my job, but hey, a year and a half later, I quit my job to take care of Mom. Maybe somehow with home health care, we could have managed Dad at home, even as his Alzheimer’s progressed.

This is one aspect of Dad’s care that I don’t regret. I think the stress of trying to care for Dad at home could have broken our family apart. And while I was not fond of the medications Dad received at the nursing home that turned him into a zombie, at home, he may have refused to take any medications, and who knows if those angry outbursts would have become more violent and dangerous?

I know there are many families who do keep their loved ones with Alzheimer’s at home and care for them until they pass away. I admire and respect that choice 100 percent. I think family caregivers need to receive more financial and community support. But on the other hand, I also respect the choice of placing your loved one in a good facility, where they can receive the supervised care they need.

One suggestion I would make

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Midnight munchies curbs Alzheimer’s wandering?

I found this article about the steps a dementia care center took to reduce the amount of middle of the night wandering by their dementia patients very interesting. The solution was simple and not nearly as expensive as medication. They simply offered the wandering residents snacks (a mix of naughty and healthy food) and the midnight snacks really seemed to curb their wandering tendencies.

I’ve written many times before about how Dad would wander at the nursing home. He was in a secure dementia care wing, so he couldn’t get outside, but he could still fall, which was the concern of the nursing home referred to in the article above.

When Dad wandered, sometimes he would have to be lured back to his room by a treat. One time it was a lollipop. Another time it was a piece of chocolate. The small bit of sweets seemed to calm Dad’s wandering spirit, at least for that night.

As the article mentions, the staff provided safe snacks for their diabetic dementia patients as well. I fully support care centers such as these that get creative in trying to accommodate their dementia residents. Offering snacks and the cleanup involved creates a bit more work than just handing out pills, but there are some centers that actually care about quality of life, versus just trying to make patients into “trouble free” zombies.

We need to encourage more of these proactive care centers in our communities.

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One of Dad’s last homes gone

It’s been 10 months since Dad’s death. It’s hard to believe so much time has passed, and all of the events concerning my Mom’s health that have taken place since then.

Recently, I walked by what was once the assisted living facility that Dad stayed at oh-so-briefly beginning around this time last year. He was so sick by then that I don’t think he realized how close he was to home. The owner of the facility was not well-liked in town. It was a big struggle for her to get approved to open the 3-bed facility, and she only lasted in town about a year before she had to close.

The window on the right was where Dad’s room was at the assisted living facility.

I visited Dad’s room once there, when he was sick in the hospital across town. The building was kind of run-down and looked like it could have once been a medical office or business of some sort, so it did not have a homey feel to it all. It was chilly and a bit damp. They had ordered him a new bed to prevent bedsores. The owner was trying to find a chair for the room so Dad could sit in it when he returned.

I don’t know if she ever found that chair, or if he ever set in it. He returned back to the facility for a brief few days before he landed back in the hospital, even more ill than before. He then ended up in Albuquerque, where he eventually died.

The space where the assisted living facility used to be is undergoing an extensive renovation. It looks like the insides are being gutted. I don’t know what’s going to replace the facility, but I’ll always remember it as one of Dad’s last homes, no matter how brief his stay was there.

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What a year can bring

This time last year, Mom was getting ready to move Dad closer to home. Dad was in the latter stages of dementia, but still ambulatory. He had fought a few mystery infections over the summer, but there was a glimmer of hope, that at least Mom would be able to visit Dad more often.

Of course, those hopes were quickly dashed. Those infections came back with a vengeance, and whatever medication the nursing home used to treat the symptoms caused Dad to have a very severe reaction. It was something that he never fully recovered from.

So as I watch the leaves fall from the trees as the fall season takes hold and transforms the world around me, I’m thinking about Dad entering the last seasons of his life last year. I remember the trepidation I had in my heart, worrying about the nursing home move and the impact it would have on Dad’s well-being. I had no idea for the roller coaster ride in store for me.

This year I’m on a different roller coaster ride of emotions, as my mom is now the one sick. You just truly never know what a year will bring.

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Lack of control is scary

So Mom had to go on antibiotics for a tooth infection, and it seems to be causing her G.I. issues that are manifesting themselves through her colostomy bag. This is to be expected, as antibiotics are known for causing side effects like that. I’m going to check with the home health agency to make sure probiotics are safe to give her.

Mom of course is depressed about the prospects of a colostomy bag for the rest of her life, and the lack of control she feels it presents. But the flip side isn’t always pretty either. Dad lost control of his bladder and bowels as his dementia took over. This manifested itself once he was in the nursing home. On my first visit, he would still try to communicate that he needed to go to the bathroom. By my second visit, he was completely incontinent.

One of the most painful memories I have of Dad’s stay at the nursing home was the call I got from one of the nursing assistants. They told me Dad had been taken to the E.R. This was nothing new by that point. I asked if he had fallen again. No, the staff member said. He had gotten into a fight with another resident. Dad had went into the other resident’s room, ripped off his diaper, and defecated. As one might expect, the other resident was not too happy. He hit Dad as he tried to get Dad out of his room.

Losing control can be a mental or physical thing, and sometimes it’s both. Mom is mentally aware and the loss of physical control is hard for her to deal with. I’m not sure if Dad realized the abilities he was losing rapidly to Alzheimer’s. It’s again one of those terrible mysteries that has to be buried with Dad.

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Dad’s nursing home experience a mystery

Dad spent about 10 months at the nursing home before he became ill and landed in the hospital, then was transferred to a skilled nursing facility where he died.

Mom spent just over six weeks at a nursing home. She still talks about the place like it’s a second home. She knew all of the workers and residents on her wing by name. She even talks on the phone with her former roommate from there.

Thanks to Mom, I knew every detail about the nursing home operations and was kept updated on all of the nursing home gossip.

Dad and I at the assisted living facility, March 2011.

It just struck me recently how little I knew about Dad’s experiences at the nursing home. Almost all of the information gleaned from his stay was from third-party sources: nurses, aides and my mom. By the time Dad entered the nursing home, he wasn’t communicating that much. What we did learn from Dad directly was that he had a falling out with his roommate. (Mom also had a falling out with her second roommate; nursing homes are not much different than high school when it comes to petty squabbles!)

On one of my visits to Dad’s nursing home, he told me which residents couldn’t be trusted. Unlike Mom, who was a social butterfly at her nursing home, Dad seemed to be a loner who didn’t interact with fellow residents. Without the dementia, I’m not sure how Dad would have reacted to having to stay in a nursing home. I think he would have been okay as long as he could have his smoking breaks!

It’s interesting to see my parents go through somewhat similar experiences (emergency surgery, long hospital stay, nursing home) but react in such different ways. I just wonder what stories I will never know about Dad’s stay at the nursing home.

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Giving up the little things at the nursing home

Today, my mom and her roommate were complaining about some of the things that were not being done around the nursing home. The complaints didn’t involve serious infractions, but it did make me think about how little control you have once you have to check into a nursing home.

Both Mom and the roommate said their bedsheets hadn’t been changed in two weeks. With my mom’s colostomy accidents, I would think you would need to be changing the sheets much more frequently. They also did not receive a fresh set of towels for the past two days. Again, little things, but both of these women are with it enough to want to maintain good hygiene, so it’s a shame to see their efforts thwarted by a shortage of clean supplies.

In the dining hall, I saw a woman in a wheelchair struggle to pick up her napkin, which had fallen on the floor. She almost fell out of her wheelchair trying to get it! I was about to get up to help her but then I saw an aide come to her table. But she ignored the poor old woman, assisted someone else, and left. Her tablemate noticed her struggling and helped her get her napkin.

I don’t blame the staff members, they are so busy trying to hand out the correct meals, then feed the many who can’t feed themselves. A dropped napkin is obviously not a priority.

But it goes back to dignity. And though ideally the nursing home is about restoring your health, which can boost your self-esteem, it also can be a place that kills your spirit.

Luckily, I’ve been able to help Mom out with some of the stuff she has needed. But I think about my father at the nursing home, and those long hours and days alone, when his needs may have been ignored as well. Not intentionally, but just as a side effect of being short staffed and my dad being a very quiet guy with dementia.

So many of the elderly’s struggles go unseen and unheard within the walls of the nursing home. While of course it’s depressing, I’m glad I’ve had the opportunity to witness the good and the bad of elder care firsthand.

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Feeling like an alien in the healthcare system

As anyone knows who has served as a caregiver for a family member, you enter this world that operates quite differently from the so called regular world which you’ve grown accustomed to.

This world of illness and hospitals and nursing homes definitely works on a different time zone. Long hours are spent waiting, then all of a sudden there is a storm of activity that leaves you with whiplash when it’s over with. I really feel for those that have no one to help them through this, because everyone should have a healthcare advocate. There’s no way my mom or my dad would have managed dealing with the healthcare system without having someone in their corner to ask the important questions, to stand up for them, to be their support system.

I wish I had done more for Dad so I’m trying to erase that guilt by being here for Mom now. I certainly feel her gratefulness and appreciation, and know in my heart I have made the right decision to be here with her.

It’s frightening how we are at the mercy of the healthcare system to provide for our medical needs. The simplest task becomes an ordeal. You have to put so much faith in a bunch of strangers who are overworked and stressed out. Hospitals and nursing homes are woefully understaffed, but there seems little concern to addressing the issue, because when you are sick and in need of care, most often you will choose the hospital or care center closest to where you live. It’s not often that you hear of hospitals shutting down. Nursing homes don’t close up shop unless they are socked with a major infraction, like patient abuse.

When I receive a day or two of respite, I find it hard to try to adjust back to the normal world. The one where people are not always talking or thinking about illness, the one where people don’t spend all day in the hospital or care center. I feel a bit like an alien observing a different life form.

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Finding comfort in the nursing home

If there is one way I know Mom is at least on the road to recovery, it’s her obsession with makeup. Today her personal tragedy was that her eyebrow pencil was almost all used up! Mom carries her little pink makeup bag with her everywhere. She places it on her lap as she wheels herself in her wheelchair to and from the dining room. I think there’s a comforting ritual there, the “touching up” of her face after eating a meal, and “putting on her face” in the morning. She may be sporting a colostomy bag in this new phase of her life, but she’s going to make sure her lipstick is on!

With Dad, food was the comforting thing he held onto for as long as possible, until he lost the ability to swallow. He would eat everything in sight at the nursing home, and would enjoy the treats Mom would bring him on her weekly visits more than the visit itself. (Because at a certain point he didn’t remember Mom as his wife, just as this woman that would bring him diet Sprite and cookies or candy.)

I think it’s instinct to try to find some comfort, physically or mentally, even when you are really ill. Some people turn to medication for a chemical form of comfort. Games and hobbies are a great diversion in this setting. I saw one woman at the nursing home today clutching her word search book as she was ushered to the dining room. One of the therapists said the residents sometimes refuse to go to therapy because it interferes with their Bingo game!

It’s interesting to stop and think what truly bring you comfort in life, the people, pets or objects that make you feel calm and whole. Sadly, when one ends up in a nursing home, one is often cruelly separated from those most cherished comforts, so one finds peace wherever they can. If a tube of lipstick brightens my mom’s spirit as much as her face, so be it.

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