Another fall

psg712

And another injury to the same arm she tore open 6 weeks ago. No pool of blood this time, but a small fracture at the top of her shoulder (acromion, no displacement of the AC joint for the medical folks here). They wouldn't have found it if I hadn't pushed for more evaluation after the plain films were done on the arm and they wanted her out of the ER … but she couldn't move the arm or shoulder without crying out (even in dementia she is normally quite stoic) and the degree and location of the swelling made me worry about the clavicle. So a shoulder CT showed the fracture.

She is back at her MC tonight with a sling, Tylenol and lidocaine patch. I am praying that she doesn't try any adventuring out of bed alone tonight. Although the sling is just for comfort, and she was cleared to use her walker, I wonder if she will keep both hands on it.

The ER doc called her facility before she released her, saying that she had to confirm they could handle her level of care. They said as long as she can stand and transfer to a wheelchair, she could come back. ER doc said the alternative was to admit her tonight to the hospital and have PT start evaluation for a higher level of care tomorrow.

I'm so grateful that her MC took her back tonight. I am not ready to think about a standard nursing home. Should I be looking though? I will be at her MC tomorrow to meet with the PA and nurse to talk about all this. Clearly, her mobility is becoming a prime concern. Yet there are a few residents there who are entirely wheelchair restricted.

Appreciate ideas from others' experiences. I really want her to stay in MC till the end of her days if at all possible. Her stint in rehab at a SNF last year gave me a bad taste for the lack of dementia-informed care there.

housefinch

I’d ask for their honest opinion about whether hospice is appropriate. I’m guessing your PWD can’t remember care instructions or movements to avoid with that arm, etc. I personally would be doing whatever I could to decrease medical evaluations, unless she has an injury which needs inpatient hospice for pain management. I’m sorry for being blunt. Falling and getting these injuries is likely to continue.

psg712

https://alzconnected.org/discussion/comment/228157#Comment_228157

Thank you for your frank opinion. That's what I need. I agree that falls are becoming more likely for her. And you are correct that she cannot recall instructions.

The ER made a referral to orthopedics for follow up on this injury. I doubt that i will take her. I'm not going to consent for elective surgery, she already has OT for her last injury, and she has proven that she can wriggle out of a sling ... what else would they do at ortho in this situation?

Hospice may be a tough sell for my family, since mom is not "sick". I'm willing to do it, if it would make it more possible for MC to keep her there for the duration. Will discuss with the health director. Appreciate your advice.

housefinch

I’m sorry—it’s very difficult, no matter what the situation. There are always different opinions and levels of understanding within families. Sending you strength and comfort.

Emily 123

Same here psg—I don't think Mom's meaningfully progressing in rehab. She can't because of the dementia. I think she's going to be pretty wheelchair bound. Really would prefer her in MC rather than the facility's SNF side, or to staying in the rehab much longer.

I had hoped to get her back to MC and get hospice.

No harm if you have hospice come out and assess her, right?

psg712

https://alzconnected.org/discussion/comment/228288#Comment_228288

I agree. I had a good but quick discussion with the PA and nurse this week, but due to other competing issues going on at the MC, we didn't get to the topic of hospice. I do plan to discuss it though. It sounds like a good option for helping keep her in MC. There are a few residents there using hospice care, but most of them appear to be more physically disabled than mom is.

I have since heard from a couple of the staff that even before last weekend's fall, mom was leaving her walker behind at times. When reminded to use it, she would drag it behind her or push it only with the good arm. Disaster waiting to happen ... I'd rather see her in the wheelchair than falling down because she can't use the walker correctly. But even with the wheelchair, she'll try to get up to walk to the bathroom. There's no way to prevent falls completely.

CaliforniaGirl-1

I feel so bad for you. I know that feeling of desperately worrying what will happen after a hospitalization if the MC won't take them back and the feeling of relief when they say they will.