omg that's a whole can of worms and even some of the better known places have things missing in a matter of minutes, or hours, sigh...fil is in heartland medical and while it's clean and fairly small, I've had differing phone bills from Verizon (an all he has is a small flip phone, sigh) and when he got mad at dh for not leaving money (and dh gave in) it was gone in no time...the flowers might be an allergy and considered a no no.. sure would be nice if they say something before, right?

the major problem is the change of doctors...you and her dd might sign her out and make an appt with her former primary care phys...the "official" nursing home dr is overworked and less than diligent...last in the situation of only one place close to family (like my fil..small town, and he'd be a s.o.b. at the larger city one)
and the saddest thing? they are in the only place left to care for elders who cannot be in a home situation.

She's in the same type situation as your fil. The doctor is the same one she'd see if we took her to the doctor's office as an ordinary patient. We've always given her flowers. I don't know why on that day they were suddenly verboten.

-and the saddest thing? they are in the only place left to care for elders who cannot be in a home situation.-

I'll start by saying this elderly person is very lucky to have as caring a friend as you are.

You're really between a rock and a hard place. I'm going to guess that it's her daughter and not you who has her power of attorney and who's responsible for her in a guardian/fiduciary way. If so and her placement is where either she or her daughter decided she should be, that's that. And the care is what it is - nursing homes are sad places, and even the best of them are not at a very high standard (that I've seen).

The question about her memory and good/bad days is probably best answered by her physician. Don't be surprised if her physician will only speak to whomever holds her P of A for healthcare.

You friend deserves to be comfortable and safe and to be given the care as prescribed by her physicians. It sounds like there may be gaps that could be plugged or maybe not. I'm not sure what else might be done.

I agree, there is something amiss, but then, she was placed in a nursing home in the first place due to inabilities.

I am no medical pro, so take what I say with a grain of salt. A drop in blood glucose (sugar) can cause confusion and loss of energy. In severe cases ,it can lead to a coma. If it happens during sleep time and after midnight, it may wake a person (luckily, a defense against slipping into a coma and becoming unable to take corrective action which can lead to a bad consequence, even death). The wakefulness prevents one from getting a good night's rest and they feel like dirt all the next day. Eating fast acting carbohydrates 'fixes' the situation, but not the tiredness due to lack of proper rest. That glass of orange juice in the morning can correct the blood glucose in short time and thereby hide the danger that happened a couple of hours before.

One condition that can bring this on is going on a diabetic diet to reduce high blood glucose without adjusting the insulin dose. This diet may be low in carbohydrates and as weight loss begins, glucose can remain fairly level for the first hour or 2 of sleep and then quickly fall to unsafe or uncomfortable levels. (In my case, it wakes me up and I can not get back to sleep. I check for signs of low blood sugar and make a measure with a meter if warranted. I use the reading to guide how much sugar I'll consume to correct the condition. Usually, its about 5 life-savers [equivalent to 1 tsp of sugar] The doctor reduced my insulin by 10% and the condition went away. The problem here is that it requires considerable self awareness to diagnose or a good watchdog person who checks on you often including during the night.)

Anything that restricts blood flow to parts of the brain can cause problems and may affect personality. Her tingling arm is a warning and that should be reported to the doctor. That could be nothing more than a sleep position that is putting pressure on a nerve bundle, or a cardiovascular problem. The blood pressure that you reported is on the high side and may indicate problems. However, one has to be careful how the pressure readings are made. Blood pressure can vary by several points a few minutes apart depending on surroundings and a person's state of anxiety. For example, if you carry on a conversation with the testee during pressure measuement, that can raise blood pressure by 5 mm of mercury. (When a normal adult converses, the body kicks in filters to control what is said an to prevent untoward speech, or to keep from revealing certain information. This additional alertness may raise blood pressure.)

If one has been engaging in an activity that was stressful such as driving in traffic, it may take 15 minutes or more of relaxation to calm pressure. Anger is a pressure raiser.

There are so many variables, that no one can second guess at this distance. However, I would follow up on the arm tingle with the doctor. He needs to know. Unfortunately, you may run into HIPPA restrictions here unless you are legally a care giver and have been given permission to discuss the patient's medical condition with her doctor. Without this, likely, you will be invited to "butt out"- a difficult situation.

I'm guessing you and the daughter probably get on fairly well. In your shoes I would have a heartfelt talk with her, and outline your concerns. I imagine that since you see more of her mother due to your proximity, you are more likely to pickup on issues. In the daughter's shoes I would appreciate it if someone would tell me they had concerns so I could address them.

I have no advice. I just wanted to say you are a really, really good friend. I hope everything gets worked out. I think colleen's advice to have a heart-to-heart with the daughter is very good. That way she can become more observant on her visits, too. Now, with this uneasy feeling you can start to document everything. Sounds to me like they may be drugging her when it's not convenient to care for her. I would also take note of who was on duty the night before when you come in and she's out of it. You may see a pattern that way, too. It might be a particular night nurse.

blood glucose. Yes. That might explain it. I will ask her daughter about that. The lady in question decided to go to that nursing home against the daughter's wishes. She's a very stubborn old lady! The daughter didn't want her in that medical conglomerate.

I am trying to stay at arm's length and not get involved in their family squabbles, and believe me, there are some! But as long as I walk softly and suggest it seems to work. My friend gets along better with me than with her daughter. They have always clashed. Sometimes I'm asked to talk mother into things or ask for clarification of things. Not every day, but when mother is being difficult and the daughter has reached the end of her patience, she will ask me to intervene. All in all it's a better solution anyway. No one ends up upset over the problem.

Thanks for the support. My friend has an MRI today but I will ask her daughter about blood sugar and if they have checked it or are checking it or what. That just makes so much sense to me. I hope that's all it is. She was 93 on Monday.

georgysmom, That thought crossed my mind, too. Actually, that's what got my train of thought going to the question of overdose or under dose. That is something I will suggest to her daughter. I don't want to raise an alarm over the wrong thing but.........something is not right.

I would doubt her confusion and memory loss are from staff giving her placebos. More likely they are GIVING her something that is causing the problem. Perhaps a nightly sleeping pill or something for agitation, like xanax or haldol. Haldol is a big one in nursing homes and it is a bad drug (IMO) for elderly folks to have. It has a really long half-life, so stays in the system for a long time. I would first check to see what her medication list is. They probably won't tell you, but should tell the daughter. Have them explain what each med is for. If she is being given anything that would affect her brain or mood, that may be your problem.

Your friend is lucky to have you. I was surprised when you mentioned that the medication might not be given to her and exchanged for a placebo. That would be the first red flag for me. I would have her daughter mention that to her doctor if she thought that could be a problem The flowers are a small thing. My mother in law would throw away flowers and not even realize she had done it. Could this be the problem? I hope you and her daughter are able to find out what is going on with her health.
Mary

Good advice above. The only thing I'll add is to forget the flowers. My husband was in a nursing home for several years, and everything disappeared from his room, even stuff I'd marked clearly with his name.

After he died, I said I would come in for his things. "Oh, you don't have to do that," they said. "We'll gather them up for you and give you a call."

When I went to pick them up, they were in big black plastic garbage bags. I had no idea he had that much stuff at the nursing home. When I got home and opened the bags, I discovered most of the things weren't his--and most were in throw-out condition.

This was known as the best nursing home in the area. At least I do know they served better food than most.

Certain kinds of illnesses/dementias also wreak havoc with blood pressure fluctuations. My mother's can go from really low to really high in a matter of minutes. She's 93 and has Parkinsonism and AF.

I just hate that people in homes have things stolen from them. I guess she should only have things brought to her that are so personalized, no one else would want them. Like photo/afghans, where no one would steal it because it was all photos of HER family, for example. Or things with her name embroidered on it, or burned into it, etc. Grrrrr.

sleeperblues, Thanks for that advice. Haldol rings a bell, I don't know why. But there isn't any other reason for me to have heard of it.

Mary & alisande, We'd be thrilled if she threw something away! She hoards everything!

she often says things are missing but her organization skills are not up to par. The piles on the night stand, bed table, side table and computer desk tip over frequently and she is forever asking me to look for something in one of those piles. There is an old rocking chair in the corner but you can't see it for the stuff piled on and around it. It's possible the bouquet is in there somewhere! She prints off every email she gets and if there's a picture attached she prints multiple copies of it over a period of time. I have to do a sleight of hand to throw printed messages away. Even a simple "it's raining today" message from 2 years ago is printed off and saved.

I will check on glucose and Haldol today. At least I feel like I'm doing SOMETHING.

The only way that you would be able to properly help with whatever meds she is taking is to get a signature that you qualify as a Health Care Power of Attorney. As a HCPOA, you can attend and have input at her care plan meeting that happens every 90 days as required by Medicare. Otherwise, you are out of the picture with meds.

Her primary might be good physician; however many don't know enough about aging and the problems that occur. Please ask whether that person has a lot of experience with geriatrics and in particular those in a nursing home. If the scope of practice is only Family Practice, then the training and such might not be appropriate for your friend.

Dementia (of which there are several kinds) can come out many different ways. Don't assume that it is Alzheimer's, as it might be something else. There are health issues that also show confusion. Again, you probably don't have access to her medical records to determine whatever diagnoses are listed. Ask the family member for a copy, if you feel it would help the situation.

Most nursing homes are divided into separate areas (hospital rehab, long term and dementia for instance). Each of those units should have a salaried person in change, find that person and ask questions. Don't be confrontational, but explain your concerns. There should be a social worker on site, ask that person some of the same questions.

Another way to get on the good side of the staff is to provide 'treats' of some kind. Not just for the day shift, but for all care givers in that area.

I am not a health care worker (the missus is a geriatric NP), but I worked in the nursing department of a nursing home for almost five years. I learned a lot while being there.

Jim

Nursing homes are highly regulated. Blood pressure, food/fluid intake, medications, are all documented. If the daughter is concerned, she can request a meeting with the director of nursing, to discuss her mom's care. If the daughter is still not satisfied, there's a state ombudsmen advocate, she can contact.

You're getting lots of good and thoughtful advice here, I'd just add I've seen loved ones who have experienced periodic confusion due to low blood oxygen levels. My SIL thought for a few years that her father was having some dementia that didn't quite make sense to me. If tired, overheated (warm day for his grandsons graduation), there were some problems - but a good nights sleep in an air conditioned house and he was totally bright, cognitive and conversational. He had a valve failing in his heart, no dementia - what we were seeing was low blood oxygen.

Something similar happened to my own father in law when he mixed up medications and inadvertently quit his diuretic, fluid around his heart caused low blood oxygen and a few frightening days that were resolved with a hospital stay.

I wish you luck and hope you can help to resolve this for her best outcome, clearly you are worried.

Posted by frostedcharisma (My Page) on
Fri, Dec 5, 14 at 11:13

Nursing homes are highly regulated. Blood pressure, food/fluid intake, medications, are all documented. If the daughter is concerned, she can request a meeting with the director of nursing, to discuss her mom's care. If the daughter is still not satisfied, there's a state ombudsmen advocate, she can contact.

What she says is so true...an there is a medication nurse that gives out all meds on each shift and she must keep very good records....It isn't done by just anyone and everyone.....I am sure there has been an unscrupulous nurse somewhere along the line but 99.44 % of them take the medication very seriously...

Having regulations and having them followed are two different animals. Most nursing homes have minimal staff and will only get an (advance notice) inspection every few years -- by an overworked dept. of public health. Having regulations is meaningless by itself.

I know it is a challenge to adequately care for elderly, ill, often cantankerous patients. However, facilities are often free to operate without careful observation *because* few patients have friends or family who visit often and who will challenge the facility -- and because the people receiving the services are elderly, ill, cantankerous, and totally dependent on staff.

The nursing home in my former town was owned and operated by the MD who was also the town's director of public health. The skilled nursing facility in my late mother's retirement home was directed by a felon who had no training for his position.

You are the *rare* friend who visits often and who can stand up for your aged friend. Many facilities are understaffed (with underpaid workers), especially so at night. Rendering patients quiet with meds is a common practice. Because each patient represents income to the facility, unless there's an endless waiting list of paying patients, management has a vested interest in keeping patients *alive*, but not *lively*.

(I may be entirely wrong about THIS situation, but I'm writing from my own experiences as an individual and as a former board member of my local visiting nurses assoc.)

Thank you so much, Jim-1, frostedcharisma, morz8, ruthieg__tx, & chisue. All things I can look into and all things I can discuss with her daughter. The low oxygen is something I had thought of originally but then my brain got so overloaded with "what if" and so many concerns I forgot to ask about the oxygen/blood. I had a 2 minute visit with the nurse on duty today. And now they know that we are aware of "things". No confrontation or accusations, just telling my observations and wondering if her life was winding down. I don't believe in keeping pets or people alive just so they are still breathing. I will be sad when she isn't here any more but I would never vote to keep her alive just so I had her here to talk to.