senior-spectrum.com - joyce christensen

This is the fifth column in a 10-part series by Sacramentan Joyce Christensen on her experiences caring for her elderly mother, Thelma Price. To read the previous installment, CLICK HERE.

It all started with the carpet cleaner shampooing the rug in Mom's apartment.

I spoke to the manager and asked if safety provisions were taken when carpets were wet. I was assured it was "no problem." I told Mom to be extra careful and I would talk to her later that evening.

When Mom got to her apartment after dinner, the carpets had been cleaned. However, the maintenance person had left a maple chair on her bed during the cleaning. Instead of Mom asking for help to get the chair down, she attempted to lift it herself. She fell backward, the chair fell on top of her, and she hit her head on her maple table.

It was estimated she was out cold for an hour. Something reminded her that if she was hurt, she should push the button on her medical alert on her wrist. This action saved her life. The paramedics came and took her to the emergency room.

Since Creekside Oaks is an independent living community, the management was not responsible to check on the residents in their rooms. Our loved ones are safe in an independent retirement home as long as they are -- as stated -- independent.

Mom never fully recovered from her accident. She began to have poor balance and some memory loss. As much as I hated having her move again, I knew it was time to find an assisted living home.

This really created a problem. Mom was very popular at Creekside Oaks, and had many wonderful friends. The thought of leaving them seemed unbearable.
In her mind, assisted living meant a place to prepare to die. We made the rounds of potential places to move. Mom was quite surprised to find everyone was friendly and it was much the same as where she had been living, just with more assistance to keep her safe. She decided she could adjust.

Her first choice of a new home was Aegis of Carmichael Assisted Living. That could be a problem, since I had been offered a job to work there as the move-in coordinator. I asked the director if it would be acceptable for my mother to live there. He was pleased I liked it enough to want her to become a resident.

What a great arrangement! I could peek in at Mom during the day, spend time with her after work hours, and not have to drive 20 miles to see her. She made friends quickly, and our lives leveled off once more.

A few months after Mom got settled in at Aegis, I planned a weekend out of town for my birthday. I was confident she would be well taken care of. She was so busy, she probably wouldn't even miss me.

When I checked into my hotel, there was a message for me. Mom had fallen.
She had broken her hip and again was taken to the emergency room. They needed medical information immediately so she could be admitted to the hospital.

By now, Mom was age 87. Her bones were fragile and her hip was broken in three places. After her hip repair operation, we were informed she would spend the next five to six weeks at a nursing home for rehabilitation. This proved to be heartbreaking to Mom. Another move, and more tears.

I had the option to request the location for her to recover, as long as it had a good therapy program. Finding an available bed was not easy. I hit the road checking out potential nursing homes. I went to five skilled nursing facilities and "blended." I spent about 20 minutes at each location, sitting in the lobby, engaging in conversation with family members who were visiting. I have to admit, the first thing I did was smell -- if it had a bad odor, I left.

When I went to Manzanita Manor, I found the staff and family members to be friendly. It was clean and well-kept. I requested that Mom be sent there. Fortunately, there was room for her.

Any move to new surroundings for an elderly person is traumatic. Mom had heard many negative comments about nursing homes. The positive part of this move was that is was temporary, and she would be back in her own apartment in a few weeks.

During her rehabilitation period, I never met the staff doctor in person. I had what I called "niggles." That's when I feel something is wrong but can't pin down the problem. It had to do with Mom's slow recovery. When I went to visit her, she was what I called "loopy." She didn't make sense when she talked. She often got angry. That was unusual.

The nurses told me she was taking high-dosage morphine for pain. That could create mind-altering changes. I knew morphine is highly addictive, and questioned how soon she could be taken off. Of course, that would be the staff doctor's decision.

I finally reached his nurse and requested she ask the doctor to review Mom's medications. It was determined there was a communication breakdown regarding her pain medicine. In other words ... she had been forgotten. She had been kept on the drug several days longer than she should have been. The doctor ordered all pain medication stopped the next day. If pain occurred, she would take Tylenol.

Mom began to recover rapidly, and never requested any type of pain relief. She was released after six weeks to return to her home at Aegis. Her friends made her feel special with a big "Welcome Back" sign with balloons on her apartment door. It seemed that things were looking up.

The caregivers at Aegis knew Mom was weak and could easily suffer another fall.
Everyone tried to keep her safe, but nobody could watch her every minute. One day, her medical alert went off when she was alone in her apartment. She had fallen and injured her mending hip. She was rushed to the hospital's emergency room, again.

After a few days in the hospital, she was taken to SunBridge Brittany nursing home for further rehabilitation. This was a painful process, and all Mom could think of was getting back to her home. This goal made her work extra hard to gain back her strength and learn to walk again.

A nurse from Aegis had to evaluate her in order for her to return to her home.
With stubborn determination and a lot of prayers, Mom got the OK to leave the nursing home after six weeks. She looked good, and was animated about being able to leave.

There was one problem I questioned several times. She had a terrible case of diarrhea when she was released. This did not make sense to me. I asked the doctor if she was truly ready to leave. I was told by the nursing staff that diarrhea was "normal" due to medication.

Even though her desire was to go home, I wanted her to be fully recuperated so she would not have to go back to the hospital or return to SunBridge. The nursing home and nursing staff at Aegis agreed she was ready to return. Later, both denied they were aware of the diarrhea. My question is: Was her doctor ever told I had asked if she was ready to go home?

Once back at Aegis, the diarrhea continued. Mom was still very weak.
Assisted living does not have medically trained caregivers for the residents. There is a qualified nurse on staff whose job it is to oversee the health and well-being of the residents.

Due to the number of people in any assisted living home, a qualified nurse seldom has hands-on time with residents unless a specific request is made. I insisted the nurse review Mom's recovery pattern, since she was not showing signs of improvement. I was told it "would take time" for her to get better, and it was "hard on the caregiver staff trying to give her the extra time that was needed for personal care."

Two days later, I went to the nurse again. She was off for the day. I spoke to her assistant, a licensed vocational nurse, or LVN. She felt Mom had a staph infection that was getting worse instead of better. I was not familiar with the words "staph infection," so I did not know what signs to look for. The LVN also stated, "Thelma should not have been released from the nursing home with any diarrhea."

The LVN recommended that we request a home health nurse to re-evaluate her.
I did not know this option was available. It was determined she indeed did have a staph infection and she was immediately sent to the emergency room for further tests. The home nurse said she was very sick.

Emergency kept her until 2 a.m., then told me she could go home. I had to get a family member out of bed to help me. I later learned I could have insisted she be kept until morning, then put into the hospital for observation. Like most people, I thought whatever the emergency person said was what I had to do. I got her "home" at 4 a.m.

The nurse at Aegis came by her apartment at 9 a.m. and said I had to return her to SunBridge for recovery. I felt like we were being tossed around from one location to another, never understanding what was the right thing to do.

Mom was never able to leave the nursing home again. I will always wonder, if the infection had been handled properly, would Mom have continued to live a healthy lifestyle?

My anger over the infection not being handled properly took with it a dozen excuses of "he said-she said" from everyone who had been remotely involved.

I was not aware that there are excellent senior advocates, and didn't think about the many newspaper articles available to review. I could have learned more about patients' rights regarding elder health care issues. That's called hindsight.

Next week: The reality of life in a nursing home.