Knee replacements and Alzheimer’s

sandwichone123

Monica, people who have used that generally give vague answers like, "They're not done yet," or "they're having trouble getting supplies in," or "the doctor hasn't cleared you yet." "It'll be a while more."

harshedbuzz

 

 MonicaG wrote:

The MC does offer PT.

So assuming this person routinely works in MC, they should have some experience in getting the best efforts out of a PWD which is a good thing. Dad did PT three times when he was in mid and late stage dementia. In rehab (mid-stage after a hospitalization) he cooperated as he knew on some level it was key to getting home. The second time his disease was more advanced and while he enjoyed the PT visits he clearly frustrated the PT who dropped him once it was clear dad wasn't bought-in and working toward goals. His last stint was in MC and the PT was great at helping dad preserve ambulation. 

I realize that us family members will have to stay on top of that.

Do you know what the PT program is for her? Mine was 12 weeks with 3 "walks" a day and 3 sets of exercises. That's fairly standard. By week 6 this took close to an hour daily to do all that was ordered. 

She has to use the walker.  It’s a must.

Is it still? Most folks I know with TKR graduated to a cane by about 2 weeks. Does she need it for stability related to some other issue?

Is the walker new to her? My dad's dementia impacted his gait and balance. He was assigned a walker but because of his memory issues, he seldom recalled that he was supposed to be using it. When he was in one of his time traveling moods (back to the 70s and his 30s) he was quite resistant to the walker. If he wasn't sometimes it was best to wordlessly put it in front of him as a visual prompt rather than nag verbally. If he was resistant, it helped to validate and remain an ally as in "I know you don't need this, but it's doctor's orders and the staff are just doing their jobs".

I know it’s doing the right thing to get her proper care, but I know she’s not going to see it that way.  

It's unfortunate that your mom can't appreciate the love, thought and care with which you are making these difficult decisions but she can't. To that end, it's best not to try to convince her. Remember the cardinal rule of Dementia Fight Club is that one never attempts to reason with a person who has a broken reasoner. 

It's best to present this as a routine matter-of-fact situation. One has TKR, one goes to rehab. 

 The reality is we can’t be her 24 caretaker. but I feel guilty lying.

You need to let go of this. Guilt is not a useful emotion in this situation. You did nothing to your mother-- getting her the best available care is something you do for her.

My plan is to tell her she’s going to physical therapy and bring her in.  Because if I say she’s staying over night or suggest she’ll be there for a few weeks, that’s not going to fly with her.

Her brain is broken. She is past making decisions of this magnitude. Not only is her executive function severely impaired, she likely has very little empathy for the impact of her decisions on others. It's all about her wants now. 

Your mom has a wish to stay in her home, but she never made a plan (either millions in assets or a robust LTC policy) to ensure 24/7 care in the home. You are making the best of a situation that wasn't planned for on the fly. Please give yourself some grace around this. 

 I’m just wondering about people who got their LO’s in MC by saying something like, oh, your apartment flooded or what have you, did they then ask for how long they would be out of their apartment or did they inquire when could they go home? What do you say to them when they ask for how long they have to be at this new place for?

The best fiblet is a simple one. Since you have been handed a golden ticket in the form of the TKR-- it makes the most sense to run with that. Don't complicate it. Share your plan with the staff at MC and ask if they have suggestions. Day of, you (or whoever typically takes her to appointments) drives her to the MCF telling her she has a rehab appointment. Once there, the staff will usher her in and spirit you away. 

If this is really hard for you, practice. Seriously. Come up with a script and rehearse it in front of the mirror until it becomes rote. Anticipating her questions and demands and creating scripts to have loaded will allow you to navigate this situation with the least amount of upset for both of you. The ability to read emotion remains intact well into the disease progression, so it is another kindness to get your own emotions in check so that you don't telegraph any unnecessary emotion to your mom as she no longer has the bandwidth to process much of it. 

(my story- the day we took dad to MC we told him we were taking him to see a new doc because we wanted to make sure we were doing everything to get him the best care possible. We arrived at MC just as they were starting snack and afternoon matinee. The activities person swooped in and took dad back to the activities space, handed him an ice cream sundae and sat him between 2 friendly residents and chased us out. I would encourage you to bring someone with you; it's a difficult drive home.

Because dad recalled a 7 week stint in rehab 18 months before, we sold this stay as a fancier private rehab (dad was quite the snob and was pleased that it was in the same town as the golf club to which her formerly belonged). When he asked "how long?" we deferred to the imaginary "doctor's orders" and said we anxious for him to come home too and then redirected the conversation to something breezier. This is one of those KISS situations, there's no need to embellish- validate the frustration and redirect with a treat when you visit. 

Expect it to take some time for her to settle in. She might be pretty nasty at first. Some MCF suggest taking a 2 week breather to allow her to settle and bind with new people. If you do visit sooner, it might make sense to bring someone and stay in public areas of the facility to help keep mom from excoriating you before she settles in. 

Since we were pushing dad's stay as temporary, we did not initially decorate it to be like home. I went for a more "Holiday Inn" vibe- comfortable but not familiar. We brought stuff from home over time. Be sure everything is labeled- glasses, hearing aides, dentures, clothing, pictures, linens, etc.

HB

 

 

MonicaG

harshedbuzz, thank you so much for this reply. I keep reading your reply over to reenforce some things in my own mind. I really appreciate this reply. Thank you again