My dad 93 was weak when he came here in Sept and we have worked with him while Covid had assisted living closed up but the goal was always to move him. He was doing much better, walking 1/4 mile a day and doing other exercises. He has some dementia but copes pretty well on the day to day stuff, like dressing and eating. Anyway, the assisted living opened up dining and some activities so we moved him to it... it's one of the big names and pricier choices. Close to us which is a plus. He loved it and was so excited to be going. But in less than a week he has declined a lot. He was recently on prednisone and came off about a week ago and was feeling tired when he moved. I presumed it was because of the prednisone withdrawal. Now, however, he's falling in his apartment and seems disoriented etc. I'm SURE it's strange being in a new place and not knowing your way around or how things are done. Maybe it was too much for him. He fell twice today within an hour of each other. He doesn't press his call button but they just found him on the floor; he was rushing to answer the phone. He really wanted this one bedroom place and I see plenty of very old frail people there (as well are more higher functioning people), Maybe this wasn't the right place for him. I know a week is not enough time to evaluate, but two falls in a day? (he fell twice in 9 months at my house). The care staff are in and out all day and he is on level 2 care. How can you tell if it's the right place for your LO? At that age, does anyone adjust to this big of a change?
It is a huge upheaval for them, especially with dementia, and yes, it takes time to acclimate. They also probably won't acclimate to a level of what was "normal" before, because when someone has dementia (at least in the case of my mother), any shock to the system like a move, an illness, or an emotional shock (my dad's death) results in a step down in her ability to bounce back. The bouncing back also takes a LONG time once it does happen.
One thing I did for both the nursing homes my mother has been in was to write a short biography of my mother for the staff. It gives them an opportunity to know a bit about who she was before she came to live there, plus I also put in important information I felt they needed to know. For example, she has macular degeneration and can't see faces, so I asked that they identify themselves when talk to her and don't touch her without speaking to her first, because she may not see them coming. I also gave that biography and the notes to the hospice people when I signed her up with them as well, and they were thrilled to have it. They meet their clients for the first time at the end of their lives, so it's been very good for them to understand what kind of person she once was.
Consider writing a biography for your dad to share with the staff. Be in touch with them, let them get to know him, and obviously stay in close touch with your dad as well. Remember to be part of the team that cares for him, not an adversary.
Wishing you and your family all the best.
Concerns:
Lookup says this medication suppresses the immune system and has withdrawal issues:
"Prednisone withdrawal: Why do I need to slowly taper down the dosage?
(from mayoclinic)
If you abruptly stop taking prednisone or taper off too quickly, you might experience prednisone withdrawal symptoms:
*Severe fatigue
*Weakness
*Body aches
*Joint pain
*Nausea
*Loss of appetite
*Lightheadedness
Prednisone is similar to cortisol, a hormone naturally made by your adrenal glands. If you take prednisone for more than a few weeks, your adrenal glands decrease cortisol production. A gradual reduction in prednisone dosage gives your adrenal glands time to resume their normal function.
The amount of time it takes to taper off prednisone depends on the disease being treated, the dose and duration of use, and other medical considerations. A full recovery can take anywhere from a week to several months. Contact your doctor if you experience prednisone withdrawal symptoms as you are tapering off the drug."
At least 3-4 of the withdrawal issues they list could lead to falls. How long it takes to wean off depends on what it was for and probably how long he was on it and the dosage.
Since you had been "working" with him at home, getting him walking and active, it might be a good idea to have a good checkup and perhaps get OT/PT in to help him build up more stamina and strength.
Good checkup should include blood work and a urine culture. Since this is an immune system suppressor, he could have picked up a UTI or other infection. If he isn't eating and drinking enough, it can cause imbalances in the blood. Even drinking too many fluids can lead to issues - my mother managed to do that and end up really looking ill and confused! Once they stabilized her with an IV drip bag, she was back to her grumpy old self!
I don’t know if getting off prednisone contributed to falling...
When I saw the nursing home put button in my mother’s hand, I told staff she will not know or remember what it’s for or how to press it.
He Probably needs nursing home facility. Hugs 🤗
As for the falls, has anything been added to his meds? My mom was given muscle relaxants for spasms (it was really shingles onset) and this caused her to fall 3 times in 4 days at her ALF. She did not use her call button, either. At that time she also had an undiagnosed uti and was dehydrated.
I have had her home with me for 11 months now bc of covid. She has just received her 2nd vax and will be returning to her ALF. She has declined from when she left and I, too, am wondering whether the care will be enough.
I think rule out medical causes for your dad’s falls and give it a little more time and make sure he has and uses a walker.
Wishing you both better days.
Until that's all cleared up it's impossible to say - and more especially after only one week! - whether the ALF and his care plan are right for him.
I would approach this from a methodical manner and don’t rush into moving him again. Moves are hard on them and usually take 3 months to adjust to them.
It's possible that he has experienced a small stroke, which is why he is having balance problems and disorientation. I would recommend a medical evaluation.
It's also possible that he may need a higher level of care now - but he should be evaluated medically first.
a camera can’t hurt! Best of luck!
Dad is reluctant to go to activities because everyone is masked and he's basically deaf and lip reads so he's frustrated that he can't sit near someone and talk to them face to face.
I have a tablet set up with a daily agenda calendar that he refers to of all the events as well as his doc appointments or reminders from me. However he can't seem to remember when the time comes to get to the event. If I call him to remind him, he has done it... but I can't keep that up!
Another question, did he go off his prednisone "cold turkey" or was it tapered off. If it was the first, he probably needs to go back on prednisone on a tapering dose.
I love the biography idea. We do that for every new move in and share it with staff. It gives us a chance to know them more.
Hopefully time will help. And hopefully you can do inside visits. We are able to do that now with essential caregivers.
I guess you, your Dad's docs, and the place itself would know more and have better guesses than we might. I suspect we are as puzzled here as you are. I sure do wish you luck.
I can see in my mother, now 96, that her ability to adapt and learn is becoming extremely tenuous. She really should have moved to residential care at least 5 years ago when the change would have been easier for her. Even then the choice would not have been assisted living, but some range of nursing care. In our state there are specific behavioral guidelines regarding the type of care each level involves. "Assisted living" behavior looks like someone who could manage well enough at home, but benefits from a little help now and then. I think Mom wouldn't have qualified for that much past 85--and at that age she was adamant that she wouldn't go. Of course, that decision would not have lasted long if she didn't have daughters to fill in where she was no longer able. The longer it goes on, the less she is able to see that she really can't manage. That will become part of the problem of adjusting to a new place when the move absolutely must be made.
We all wonder if we have made the right choice in enabling Mom to stay in her own home for so long. The worse she gets, the harder the move will be. It is so very difficult trying to make the right decisions in caring for the elderly. Each is so different and the "right" decision is never very clear. The fact is that the end of life is a really difficult time and we will probably always doubt the choices we make, however good our intentions.
This will tell you how seniors were not taken care of in nursing home
Not Just Cuomo: These Other Democrat Governors Also Jammed COVID-Stricken Patients Into Nursing Homes
MARCH 11, 2021 By Tristan Justice
New York Democrat Gov. Andrew Cuomo went from liberal hero to embattled emperor of the Empire State in the fight for his political life within just 12 months.
On Tuesday, the governor’s book publisher cited a federal inquiry into Cuomo’s deadly nursing home cover-up when it announced a halt to the promotion of his pandemic manifesto touting his “leadership.”
While conservative media has been consistent in highlighting the disastrous March 25 nursing home policy from Cuomo that jammed COVID-stricken patients into the state’s long-term care facilities, the New York governor was promoted to celebrity icon among leftists in the corporate press for his aggressive pursuit of draconian lockdowns. All along, Cuomo’s state has led the U.S. with the highest coronavirus death rate in the country, a feat accomplished in no small part by Cuomo’s nursing home policy, which is estimated to have sent nearly 6,500 patients to an early grave.
New revelations related to the governor’s early actions on New York nursing homes have now provoked a long-anticipated reckoning on Cuomo’s pandemic leadership. According to data unearthed in a Freedom of Information Act case brought by the conservative think tank Empire Center, Cuomo was manipulating the numbers on nursing homes to underestimate the devastation of his nursing home policy while he paraded around the country to brag about pandemic triumph. Subsequent reporting from The New York Times found the nursing home death toll in New York at more than 9,000.
Yet Cuomo is far from the only U.S. governor who implemented a deadly nursing home policy forcing coronavirus-infected patients into close contact with the population’s most vulnerable. And it’s become clear that the reason for this policy is money: “The hospital lobby directly engineered this approach, and these governors obliged.”
Michigan Gov. Gretchen Whitmer
Michigan Democratic Gov. Gretchen Whitmer, who shared in Cuomo’s media glory as an aggressive lock-downer throughout the pandemic, signed a similar order that forced COVID patients into nursing homes on April 15.
“A long-term care facility must not prohibit admission of readmission of a resident based on COVID-19 testing requirements or results,” the spring order read, which was renewed repeadedly throughout the summer until it was finally rescinded in September.
The true toll of the Whitmer order remains unknown to the public, as the governor’s Department of Health and Human Services (DHHS) stonewalls Freedom of Information requests for information to determine COVID deaths in long-term care facilities. The Mackinac Center Legal Foundation filed a lawsuit on behalf of Pulitzer Prize-winning Michigan investigative journalist Charlie LeDuff to unearth the data hidden by Whitmer’s public health department.
California Gov. Gavin Newsom
On the west coast, California Democratic Gov. Gavin Newsom, now facing an imminent recall election, signed an executive order on May 15 that “patients hospitalized, or receiving treatment at an alternate care site, with COVID-19 can be discharged to a [skilled nursing facility] when clinically indicated.”
According to the Los Angeles Times COVID tracker, nearly 13,000 have died in California nursing homes. Newsom now faces a recall effort that picked up steam after he was caught violating his own lockdown edicts that prohibit indoor dining.
Organizers for the movement report having collected more than 2 million signatures, far above the nearly 1.5 million needed by Wednesday to force an election, likely to come late this summer or in early fall.
New Jersey Gov. Phil Murphy
New Jersey Democratic Gov. Phil Murphy gave the green light for an order from NJ state
This will tell you how seniors were not taken care of in nursing home
Not Just Cuomo: These Other Democrat Governors Also Jammed COVID-Stricken Patients Into Nursing Homes
MARCH 11, 2021 By Tristan Justice
New York Democrat Gov. Andrew Cuomo went from liberal hero to embattled emperor of the Empire State in the fight for his political life within just 12 months.
On Tuesday, the governor’s book publisher cited a federal inquiry into Cuomo’s deadly nursing home cover-up when it announced a halt to the promotion of his pandemic manifesto touting his “leadership.”
While conservative media has been consistent in highlighting the disastrous March 25 nursing home policy from Cuomo that jammed COVID-stricken patients into the state’s long-term care facilities, the New York governor was promoted to celebrity icon among leftists in the corporate press for his aggressive pursuit of draconian lockdowns. All along, Cuomo’s state has led the U.S. with the highest coronavirus death rate in the country, a feat accomplished in no small part by Cuomo’s nursing home policy, which is estimated to have sent nearly 6,500 patients to an early grave.
New revelations related to the governor’s early actions on New York nursing homes have now provoked a long-anticipated reckoning on Cuomo’s pandemic leadership. According to data unearthed in a Freedom of Information Act case brought by the conservative think tank Empire Center, Cuomo was manipulating the numbers on nursing homes to underestimate the devastation of his nursing home policy while he paraded around the country to brag about pandemic triumph. Subsequent reporting from The New York Times found the nursing home death toll in New York at more than 9,000.
Yet Cuomo is far from the only U.S. governor who implemented a deadly nursing home policy forcing coronavirus-infected patients into close contact with the population’s most vulnerable. And it’s become clear that the reason for this policy is money: “The hospital lobby directly engineered this approach, and these governors obliged.”
Michigan Gov. Gretchen Whitmer
Michigan Democratic Gov. Gretchen Whitmer, who shared in Cuomo’s media glory as an aggressive lock-downer throughout the pandemic, signed a similar order that forced COVID patients into nursing homes on April 15.
“A long-term care facility must not prohibit admission of readmission of a resident based on COVID-19 testing requirements or results,” the spring order read, which was renewed repeadedly throughout the summer until it was finally rescinded in September.
The true toll of the Whitmer order remains unknown to the public, as the governor’s Department of Health and Human Services (DHHS) stonewalls Freedom of Information requests for information to determine COVID deaths in long-term care facilities. The Mackinac Center Legal Foundation filed a lawsuit on behalf of Pulitzer Prize-winning Michigan investigative journalist Charlie LeDuff to unearth the data hidden by Whitmer’s public health department.
California Gov. Gavin Newsom
On the west coast, California Democratic Gov. Gavin Newsom, now facing an imminent recall election, signed an executive order on May 15 that “patients hospitalized, or receiving treatment at an alternate care site, with COVID-19 can be discharged to a [skilled nursing facility] when clinically indicated.”
According to the Los Angeles Times COVID tracker, nearly 13,000 have died in California nursing homes. Newsom now faces a recall effort that picked up steam after he was caught violating his own lockdown edicts that prohibit indoor dining.
Organizers for the movement report having collected more than 2 million signatures, far above the nearly 1.5 million needed by Wednesday to force an election, likely to come late this summer or in early fall.
New Jersey Gov. Phil Murphy
New Jersey Democratic Gov. Phil Murphy gave the green light for an order from NJ state
I have PT coming in 4 x a week (people he was familiar with) but that only covers 4 hours. I have paid caregivers coming in 4 x a week (who he knew from before) and that covers 12 more hours. I did this because I wanted him to have familiar people around and because I can only visit for 1 hour per week. Still, they can't be there to bring him to the activities because their schedules don't coincide. So I may have to hire more caregivers!
It's ironic because the things he needs help with appear to be different than the "standard". he can dress himself, and yet the caregivers keep trying to dress him. He can put in his hearing aids but he sometimes forgets to close the battery door or change the battery... they OFTEN dont' think to do that for him (EVEN THOUGH it's in the care plan). He puts on his CPAP at night but sometimes forgets to put it back on after he goes to the bathroom. I asked them to check on him, wake him up and have him put it back on. It's taken nagging daily (and a camera) to prove they aren't doing it!
I am glad to know that the confusion MAY get better as he gets used to the place. I'll give it more time. While he has some dementia, the problem is more his hearing and so I really don't want him to be in memory care until it becomes a MUST. If people take the time to talk to his good ear, he can have an intelligent conversation. I know that won't always be the case and that memory care is only a short way away.
I just really am shocked that even when I said "let's up the care plan" they said they can't do it!
1. Your father is 93, and at that age, things happen very fast, and folks can go downhill in a matter of a week. Accept this because you can’t change it.
2. You state in 1 of your posts that “no matter what I won’t be satisfied with the care”. You are a problem...you love your parent, but your expectations are ridiculously high and you can’t buy your way out of it by expecting the facility to literally babysit your father 24/7 for a higher payment. There are others in there that also need care, not just him.
3. Assisted living is just that. It sounds like he needs a nursing home for 24/7 care.
4. You made a really ugly comment about you should get a job for minimum wage at this place so You could take him to activities., Please don’t “put down” the caregivers in these facilities....these folks work very hard for low pay and they have duties and responsibilities to carry out as they are issued. Does it occur to you that you don’t get to choose what your duties are in a facility? If you want to do everything for him, and won’t be happy with care in a facility, then bring him home and become his caregiver, because it sure sounds like you will do a much better job. Let us know if you do this and how it works out.
I’m not trying to be mean,,,my dad is in LTC and I’m just grateful he has people there that do care, and do their best every day, He also would not use his walkers.,,would not listen,,..wasn’t deaf... wasn’t sick...etc etc. His own stubbornness caused his rapid declines. I do not hound his caregivers, and i do watch for any mistreatment. We are all doing the best we can, as are many on this forum.
He doesn't need skilled nursing so a nursing home is not a solution at all. The only other thing is memory care.
I know his falls are his own fault for not using his walker. I am not blaming the facility. But I don't understand why they can't take him around to activities etc and why they expect me to hire a person to sit in his room before during and after an activity just to get him there and back? But that is what I guess I must do. For a high end Assisted living place, it doesn't seem like they are assisting in the ways I requested.
If your father is refusing to go, they cannot make him. I so wanted my mom to have a better outcome with where she lives. She refuses to be involved , all the while complaining of being lonely. I cannot help her.
can you find a different in home company that can work with you and your fathers schedule? I had very good luck with an independent company...maybe they can only go twice a week ,or once a week during the schedule you would like, it would be a start.. then your dad may acclimate and want to go....just a thought...
we brought him home yesterday (Sun) for dinner and he seemed far weaker than he was on Friday for the doc appointment. I don't think he's eating as he didn't eat much of his favorite dinner last night either.
He had an "episode" I caught on camera which he doesn't know that I know about. He s*** all over himself because he didn't make it to the bathroom. That never happened before either. I'm wondering if he is withholding food from himself because of fear of that happening again. The caregivers helped him get all straightened out but I'm sure he found it embarrassing.
I've called the doctor to see if he could maybe prescribe an appetite stimulant or something, at least temporarily.
I'm still working on getting myself hired as a caregiver so I can come and go (assuming they don't say no, because I AM circumventing their rules for family). I have to have fingerprints, background check, pass my CPR/First aid class, Get a physical and TB test and take the agency's class on personal care assistants. So it will take time to accomplish that. I'll write back if it works because then maybe others can do the same if they are as frustrated as I am.
I KNEW this was going to be hard on him, but I never imagined it would be so hard on me too. It's way more work and worry, however my husband really doesn't want him here permanently so there isn't much option.