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1. Mom was successfully placed in a great Nursing Home on Long Island this April. Well run, friendly staff, beautiful grounds...
2. Took some acclimation. Doing great now with help from Aricept. Not Alzheimers. 87 y.o, plus MBI from repeated falls & head injuries. Does not remember the past 10 years. Knows family members and her new environment.
3. Brother lives 5 minutes away and sees her almost on a daily basis. Good guy.
4. PROBLEM: -They delayed getting her ambulatory after arm fracture healed bec. she lacks balance even with a walker and could topple backwards. She can walk.
SO she spends way too much time in a wheelchair, to the point that she requests that they pull her from the great "community space" room and let her lie down in her bed because her back hurts her from so much sitting. My brother walks her at every opportunity.

Can he demand a written plan from staff to guarantee a daily quota of individual attention for her involving say 30 minutes of assisted walking down the halls? Must this be couched as a therapy order?

Second, she is a naysayer, meaning, even before all this she would turn down requests to go out to eat with is or favors be done for her. Case in point, they have nice courtyard - garden areas with raised boxes and she is growing tomato and pepper plant with my brother's help. They do not get watered by anyone but him.

How do we get the staff to be more proactive with her needs and take her out daily to visit with her garden - she was an avid gardener........

Brother is a charmer and has a great relationship with staff but not enough is being done for her anyway.....

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Danica, something else that you need to take into consideration...this is NOT the mom you knew who was an avid gardener. This is someone else, with diminished mental capacity.


My dear SIL wants mom involved in all sorts of activities, taken to the dining room...mom just wants to sit in her room and watch Fox news. There's a balance of course. But don't expect the old mom back. It's very much a grieving process.
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I think it is unrealistic to expect staff to spend extra time with your mother taking her for "30 minutes of assisted walking down the halls" and "out daily to visit with her garden". It may seem like very little, but there are many others there with their own special needs and desires as well as the routine tasks they must get through. You might ask if there are volunteers who can give your mother special attention, or hire an aide to help her for an hour a day.
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Fractures take a long time to heal in the elderly. You cannot use a walker with a fractured arm or poor balance. PT requires a doctor's order, not just a request from family. The MD can also write an order for a reclining wheelchair to relieve the back pain.
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Danica - Babalou is right in saying if the resident says "no" then acting to the contrary is considered abuse - it might seem silly but respecting the residents rights not to be forced to do anything they don't want to, should be taken seriously- from a walk to a shower - even if it's in their best interest in the long run. A good nursing home will find a way around the "no" and get "yes" eventually. That said - find out the staff to resident ratio, you'll probably see why walking your mother out to tend to her tomatoes can be a problem. My mothers nursing home has a staff -to -resident ratio that is considered to be above average - yet everytime I visit I can hear the call buttons going off all over the place non-stop. I think the best thing to do is ask your brother what he thinks of the request for staff to walk with your mom. Since he is there almost daily he'll probably have a good idea as to how do-able this is. You may find out that like many of us have - that in spite of paying a hefty monthly payment, to get the little extras you'll need to hire an outside "companion". That's what I ended up doing.
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Danica, wheeling her out to water her tomato plants *when she has repeatedly and consistently said that she doesn't want to be wheeled anywhere* would constitute abuse, yes.

I arranged PT for my by this time 97 year old great aunt, who was still able to mobilise with assistance. All I wanted the hired PT to do was toddle her up and down the passage outside her room, and on nice sunny days sweet-talk her into sitting outside. I used to get irritated, too, at the number of times "Miss S declined" was logged in the resident's record. Came the day, perfect sunshine, light breeze, balmy afternoon, and me there to help; and darling Auntie L smiled at me charmingly and said 'another time, perhaps.' We kept up the regular PT appointment to make sure the offer was there if L chose to take it up; but I abruptly stopped feeling annoyed with the staff.

At some point, when your mother says she doesn't want to join in, you are going to have to take her word for it, you know. Even if it does feel like the beginning of the end.
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Danica, I think there are limited things you can do from 5,000 miles away. Do stay as involved as you can be, but also be realistic about your role.

A family member always attends my mother's quarterly care conferences. I live 30 miles away and visit once a week, but couldn't attend the most recent conference. They offered to include me by speaker phone, and that worked great. So perhaps you and your brother could both attend the conferences for your mother, if you can do it by phone.

Aricept is for dementia -- memory and confusion. It is quite useful for some patients and less useful for others. It is approved only for Alzheimer's, but is frequently prescribed for other kinds of dementia. Do you know what kind of dementia your mother is thought to have?

Has the possibility of other medications been discussed, such as antidepressants and/or anti-anxiety drugs?

Your intentions are awesome. Your view of what to expect from the facility is perhaps not quite realistic.
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When you write "nursing home", do you mean a rehab facility? If so, a therapy plan is typically developed the first or second day of admission, and a care plan is discussed with the family sometimes in the first, sometimes the second week.

Has any of this occurred? If she's specifically there for therapy, something's amiss, because she should be getting PT regularly.

Babalou makes a good point about compression fractures. You might have to ask for spinal x-rays.
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Danica, the older one gets the longer it takes to heal a broken bone, believe me I know. Then months of physical therapy which can be extremely painful especially if one was in a sling/cast more than 2-3 weeks... longer the sling, the more the muscles will break down....

Thus the reason for the delay in getting your Mom up to walk... your Mom probably couldn't hang onto the walker as it takes months to get an arm to straighten out. And a lot of strength is gone from that arm.

I still can't lift what I use to and my injury was over a year ago. When my Dad wants me to help him get up out of a chair by me pulling on this arms, I can't do it anymore :(
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Aricept is not for depression or anxiety.

If they ask your mom if she wants to do something and she says "no" and they make her do it anything, yes, that's abuse.
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You got me interested enough to look up off label uses for aricept, they have been using it in children for ADHD, to treat behavioural symptoms in other forms of dementia, and to treat memory problems and improve executive functioning in traumatic brain injuries. I expect that improving brain function in brain injuries would help with the stress from having uncontrolled symptoms and make someone feel more themselves, but as Jeanne says, it is not the same as an antidepressant.
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