Transition from hospital

psg712

Hi. My mom has been in the hospital for two weeks with Covid and cellulitis. Thankfully she has recovered from both problems and is medically cleared for discharge.

Prior to admission, she was living in AL but waiting for a room in MC at the same facility. A room is assigned but the current resident is waiting for an open bed at a skilled nursing facility before he can transfer out and open the MC room for my mom.

Now that she has been hospitalized, she is less mobile and definitely unsafe to return to AL. The health director of her facility is going to come assess her before they will accept her into MC. The problem is that over the holiday weekend, she has started to refuse food and fluids and is unwilling to get up. PT was working with her last week with a walker, but of course they did not work this weekend, and the nurses were not assertive in making her get out of bed (I am a nurse too and have had plenty to say about that). I am concerned that MC will not take her if she is too debilitated. Plus they may not have room yet. PT thinks she will not be a candidate for inpatient rehab. That will leave only a standard nursing home, a setting that I'd like to avoid for her.

She responds to me when I speak to her, but will only answer yes or no, will eat a few bites if I feed her- I handed her the fork today and she very deliberately set it back on the tray - then she closed her eyes and wouldn't answer me anymore. Over the past few days it has appeared that her cognitive status is back to her baseline, but she is making choices not to do things that she has capacity to do.

Any suggestions?

M1

Have you thought about involving hospice care? May not be what you want to hear, but she may be indirectly telling you. Im sorry, these decisions are so difficult.

Emily 123

My mom (stage 5) had covid about 2 months ago, and while I knew she was slowly eating less starting in June, the Covid really pushed her forward a bit. In the last two weeks she's bounced back enough to being able to leave the facility with me for lunch, but she's frailer. She’s been much eating less and sometimes sputters when drinking. It’s hard to pin it all on the covid, since in terms of her progression through the stages it seems about time, but the covid made it more abrupt. I will say that I didn’t think she’d have any bounce back, so will take what we can get.

Only my telling her that the NP says she's lost weight makes her eat. Like you, I feel like some of this is a conscious choice. I asked her if she was full, or didn’t like the food, or just wasn’t feeling hunger, and she just shrugged and said she didn’t want to eat. Maybe the Covid takes so much out of them they're just too exhausted to make the effort? Good luck,

psg712

Thanks, I appreciate the ideas. This morning she was a little brighter and more interactive, I pushed her and the staff to get her out of bed for breakfast. She transferred decently with a walker and standby assistance. She fed herself though still didn't eat much.

I heard from case management and her facility that they are ready to take her to a temporary (shared) room in MC, pending the facility's evaluation of her this afternoon. I hope that this happens. I am more than willing to involve hospice if she doesn't gain strength or engage much at MC.

M1

Keep us posted, i hope they can take her.

Anonymousjpl123

I really hope you can get her into MC and take it from there: this sounds exhausting. But it is really good you had those wheels in motion.

psg712

The health director (RN) from her current facility came to the hospital to assess her this afternoon. She recommended a short rehab stay at one of the skilled care facilities, then move into MC at her current facility. She is concerned about how weak mom is and thinks she needs to be where she can get PT and OT daily for a few weeks to rebuild strength and do our best to avoid falls.

I see her point, although I don't like the idea of 2 moves and the overwhelm of confusion that will undoubtedly occur. But she can't stand without someone close by for safety now, and she doesn't have capacity to understand that she should ask for help.

M1

Well I hope she'll be able to cooperate with therapy. If she doesn't, you always have the hospice option in your back pocket.

psg712

Good point. It's hard to know how much she can improve. Two weeks ago, she walked on her own (with a cane, but without help from me), and now she can't stand for more than a minute on a walker.