Hospital woes (long story)

Mom developed another UTI at her MC. After a day of antibiotics, she refused all food, fluids and meds and stopped talking. Her facility sent her to ER and she was admitted.

After some IV fluids and one dose of IV antibiotics, she perked up and was almost back to baseline. The hospital was ready to discharge her, but of course she cannot return to her facility without a new FL-2 and a visit from the MC health director to assess her fitness to return. This meant that she stayed over the weekend.

Predictably, she has become more confused with the extra length of stay. In spite of me telling multiple providers and staff that she is still continent much of the time, nursing staff would not help her to the bathroom but expected her to use the Purewick system for incontinence in the bed. This also in spite of a PT eval in which she walked successfully to the bathroom with a walker and standby assistance. So this morning when she was restrained from getting out of bed, she began hitting, scratching and attempting to bite. All unusual behaviors for her. She could not convey her needs verbally other than to say. "I need to go!"

Finally someone had the good idea to do a bladder scan. Still they did not get her to a toilet or potty chair, but they put in a Foley catheter. Lo and behold ... 1600 ml of urine! And immediately she calmed down, laid down and went to sleep.

A couple of providers have asked my permission to order psychoactive meds for her if she gets aggressive again. I have refused this request and asked them instead to call me if it happens again. I pointed out past instances of her receiving these types of meds - it has NEVER gone well - and also that they could try toileting her BEFORE she gets to the point of discomfort and frustration.

I would spend 24/7 in her room, but I am currently just nine days out from major surgery myself and do not have the stamina. My DH and I got her up to the commode after lunch today, as she was a bit restless and I thought she might need to have a BM. She could stand well enough, but needed lots of direction to operate the walker and became very weak on the way back to bed. If the MC health director had witnessed that, she'd be saying she has to go to rehab before returning to MC. We went down this road 1 1/2 years ago after she was hospitalized for COVID. She's much further progressed in her dementia now. I'm not sure she could follow instructions for aggressive rehab. And aside from the therapy, we were not pleased at all with the SNF. No dementia-informed care at all.

My sister and BIL visited from out of state yesterday. Mom had a rare afternoon of lucidity, much better than she's been for the past year! Then this morning her behavior tanked. It's going to be hard to get sis & BIL on board with a higher level of care after they saw her good performance yesterday. I don't want her in a SNF either, but I'm afraid her MC won't accept her back in this condition and the hospital case manager will insist on discharge as she is not appropriate now for acute care.

Thanks for listening...I am open to thoughts from anyone else's experience.