Can an 88 year old with Alzheimers live with a dislocated hip with only tylenol for pain?

Dear Felice: Wow, sounds similar to what I experienced with my Mom, except long before the broken hip, she had already been on a regimen of Morphine and Fentanyl patches for years, by her pain management specialist for her multiple pain issues due to severe osteoarthritis and osteoporosis, scoliosis, etc. The hip surgery just added more to her pain issues. After the surgery, when she went into the rehab center, the facility doctor who was assigned took it upon herself to replace the narcotics with something far less effective - never called me, never inquired why Mom had been previously on such a high level of pain meds - basically did not bother to read her history and did not know my Mother from a hole in the wall. The next day, I found my Mom crying and literally writhing in pain from side to side, and practically climbing over the bedrails in her rehab bed (with a broken hip!). This activity was also a sign of withdrawal, as unbeknownst to me, she had been without her regular pain meds for over 24 hours. I literally blew my top! When the nurse told me what the rehab doctor had done, I demanded they get her on the phone, and then I gave her an earful and told her I would sue HER unless she put Mom back on her normal medication regimen immediately. Well, it took almost to the next morning before the pharmacy delivered the narcotics, so in the meantime, I went home and got her morphine and medicated her myself and slept in the room in a chair until 4:30 am. It took two doses of morphine 4 hours apart before she stopped her twitching and writhing and managed to fall asleep. BTW, I made them reassign the rehab doctor to the facility medical director (who later became her primary internist as well).
MORAL OF THE STORY: YOU ARE THE BOSS - It is not an easy job, but you are your Mom's only advocate, and it is a complete nightmare staying on top of hospital/rehab nurses and doctors to ensure they are really delivering effective and quality care. It's not up to them to say they don't want a patient high or addicted. It's not THEIR pain. Who are they to reverse the medication regimen that the hospital doctor and surgeon stipulated? You were entirely correct in keeping after them the way you did, sorry it was not too effective - means you have to be even tougher! I would demand that the rehab doctor go back to the original Rx regimen the surgeon prescribed. That is the list that the rehab center is supposed to follow until progress shows that it can be reduced. I would also let the rehab people know that you will be monitoring ALL their care - bed sore care is very important, and I suggest they order one of those air mattress that undulate gently so there is no prolonged pressure on any bedsores - eliminates the need for turning frequently. They could also put pillow bolsters on alternating sides every few hours not to turn her over too far and not cause her undue pain. As to your mother saying she has no pain - that is BS when it comes to her ALZ, because it is impossible for her not to have pain. Tylenol should be used to supplement the narcotic pain meds. You have to have the order changed from PRN (on pt request), (because she will never request it), to a standing order, for example, 500mg, 4x/day, between the morphine dosages. (Note that too much Tylenol can cause liver problems). None of her meds should be PRN, because she no longer has the mental capacity to ask for medicine - therefore it should all be a standing order. I suggest you be in frequent communication with the rehab doctor and make it clear that you expect to be called for any reason, day or night, concerning any issues with your Mom's care, and in particular that you don't want any RX changes without your knowledge and consent. That means they have to talk to you. The squeaky wheel gets the grease! ( Assume you have POA? use your powers!)

You poor thing! Your poor mother! What horrible treatment she has gotten. I lost track of how many different places she has been.

They are worried about an 88 year old woman becoming ADDICTED? If your mother is in pain, and her doctor knows it, can you get him to order morphine regularly? If it is ordered, they have to give it. Can you sit in the Director of Nursing's office and sob for 5 minutes? Explain how it breaks your heart to see her in pain. That might get their sympathy, rather than making them angry and taking it out on her. (Too bad we have to think that way!)

Would she qualify to go onto Hospice? I've heard that there is a diagnosis of Adult Failure to Thrive, which can get someone onto Hospice. They are supposed to be better at managing pain.

I'm sorry the system is working so badly for you.

Feliceavenue, I am so sorry, and so angry on your and your mother's behalf. Yes, we have to be advocates for our loved ones in these situations ... but that is so much easier said than done -- particularly if you, like me, are not a forceful, assertive, or confrontational personality. I can and WILL step up when I have to, but I know how inadequate and sickly unqualified *I* feel when I start to argue with trained medical personnel about care ... both because they are supposed to know so much more than I do, and because I don't want to make them angry/angrier at my loved one and even less inclined to care well for him/her. It's an awful, awful position to be in ... and anyone who's ever been there can only feel horror at the prospect of what her OWN future medical care might be like, when SHE'S the one who's too frail or unconscious to advocate for herself. :-(

I agree with ferris1 that this sounds like exactly the sort of situation for which I would personally make the effort to pursue legal redress. It's not about the money so much as about holding the nursing home financially accountable for the neglectful actions and the pain and harm it caused ... this seems to be the only kind of punishment that many businesses take seriously in terms of actually changing the way they operate -- so pursuing a case in this instance may help other patients to avoid suffering the way your mother has. No, I am not a lawyer or in any way associated with that industry or the health care industry, and yes, I realize that litigation contributes to the high cost of health care in this country ... but good God, a story like this one is just so egregiously bad; the nursing home really should not be permitted to just skate on it. Please do not let too much time go by before you consult with a lawyer. You and your lawyer will find it easier for to gather clear, supportive evidence -- including photos, records, and depositions from attending personnel and caregivers -- the closer in time you launch your suit to the original incident. A competent personal injury lawyer will assist you. I have never personally sued anyone, but as I understand personal injury law, most such suits are filed on a contingency basis, which means that if/when you win your case, the lawyer takes a percentage of the award as his fee, so you probably wouldn't need to come up with any money up front. I know that your mother is -- and should absolutely be! -- your primary focus, and you probably don't feel as if you have an iota of leftover bandwidth, sanity, or time to deal with another thing ... but please do at least noodle on this, and as ferris1 says, start taking pictures if you haven't already, and making very detailed notes about what happened and when. If you haven't been already, keep a diary moving forward.

On a final note, I absolutely HATE the drug-phobic policies in this country that have driven doctors so completely, manically afraid of prescribing adequate pain medication to patients -- particularly terminally and chronically ill patients, and ESPECIALLY those who are unable to communicate for themselves -- who legitimately need it. It is beyond ridiculous to hold out the notion of keeping people from becoming "addicted" as the highest, most important priority rather than of preventing or minimizing actual and acute suffering in their final weeks, months, or even years!

I ran into a similar problem. My Mom went into a nursing home for rehab from 2 fractures. She had been on a fentynal patch and 2 Percocet a day for pain in her knees for years and when she went into the nursing home the order from the hospital came saying as needed. My mother also has dementia. She said whenever they asked her she wasn't in pain. She told me every time I saw her she was in pain. I fought them for 5 weeks and the doctor at the nursing home told me she didn't need that strong medication and that Tylenol would be fine. I went to her primary and had her call him and tell him what she needed. Then he finally changed it and put her back on the patch and the Percocet.

Wow Jinx and Orange Blossom, two great answers for Felice. This board is awesome and so rich with knowledge from others. Felice, good luck with your mom. You've both been treated horribly; I hope you can get things back on track for your mom. I can't imagine docs who treat elderly patients with Alzheimers so poorly. I hope karma comes back to bite them in the butt.

I am absolutely horrified at your story about the first nursing home. You have an excellent law suit for negligence. Secondly, that wedge has to be put inside the legs with a Velcro ace bandage and I am sorry she did not get that. I cared for a lady in a nursing home, and it was trying for her to keep that wedge in place, but she also had to begin walking days after surgery. I would strongly caution you to take your mother off that acetaminophen (Tylenol) because it can become toxic to her liver very quickly. The FDA has recently put a warning label on all brands. I know she will die anyway, but her liver can be spared by switching to ibuprofen, an anti-inflammatory. As far as morphine, what could it hurt? So she becomes addicted. At this point in time, I'm more worried about the decubiti (pressure sores) and MRSA compromising her body so that she might not survive those. Again, you have an excellent law case. Find the best personal injury attorney and do it now. You will need photos too. I am sorry my nursing profession let your mother down, so you should hold them accountable.

To add insult to injury; the nh probably expected payment for their "service"????? Some place are good, but some are such nightmares that you wonder how the law allows them to operate......and until enough people sue - and win - they will continue!

Wow this is ridiculous of coarse she feels pain and a lot of it. There is no way that Tylenol is going to comfort her pain. You should have the Dr. put her on Fentanyl right away, the nursing home can not refuse a Dr.'s orders. The ulcers that she has is from not being repositioned which is necessary as the skin is so thin it wears it down from the pressure. At this age who cares about addiction to pain meds it is her comfort that you need to address, besides she is already on all them meds for her other issues. I would contact elder abuse against the home and have them deal with them as well as her Dr.. Very best of luck to you and your mom.