Mom in NH w/Dementia and very non-compliant. How to get her to behave?
Mom's dementia is getting progressively worse. She cannot seem to remember what you told her less than a minute ago. She is on very strong pain meds, blood pressure and anti-depressant meds and an antibiotic. Sedatives would just compound the systemic depressive effects of the pain meds so we are not willing to give her sedatives on a regular basis. The immediate problem is that she has a 'venous stasis' ulcer on her lower leg, and both legs are quite swollen. They clean and dress the wound every day and wrap her leg in ace banadages, which she invariably unravels. Even if they tape the edges she will pick them off. Now the wound became infected (Mersa virus?) and they are cleaning hands disinfecting everything she touches. Wound care specialist came in Wednesday and put a special bandage and dressing and some kind of boot, which supposedly is harder to remove. 2 hours later it was gone! Nurse was very upset with her and Mom swore up and down she never touched a thing and the 'doctor had just come in and removed it'! This is so typical of everything she says and does - she is never at fault - and truly believes that she is not misbehaving. We all realize it's the dementia, but it is so frustrating. She is supposed to keep her legs elevated, but 'walks' around all day paddling in her wheel chair. She will not stay still and elevate her legs during the day. You can't even get her to stay put in a lounging chair. I suggested to the nurse that they attach the leg rests onto the wheel chair and elevate her feet for at least 2 hours a time and just keep an eye on her - they can see her in the community room by the nurses station most of the day. The nurse said she is going to talk about it to PT tomorrow. Unfortuanately they don't have a trapeze pulley, or they could have hooked it up over her bed to keep her legs elevated (that was my 92 y/o Uncle' suggestion - he's pretty sharp!). There is probably no viable solution to this issue, but thought I would toss it out and see if anyone else has any creative ideas.
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The practice of nursing homes to sit the elderly in chairs in front of the nurses' desk for hours on time, isn't comfortable for the elderly. It isn't a replacement for good elder care which needs to be one to one. However, it is the rule rather than the exception. If you mother is expected to spend hours sitting in a day space to make it easy to monitor her, she will likely remain restless.
Adding restraints may solve the one problem but often the elderly get very angry and upset which may not be exactly what you need either. While she may not be able to communicate it, having two swollen legs has to be uncomfortable/painful.
I will pray that the legs begin to heal. Don't worry about what your mother says, she is doing the best she can--God bless her and you.
We wrap horses legs all the time to reduce injury and swelling. Trust me, they don't try to do anything to keep the bandages on or to keep their legs up.
Mom's veins are shot in her legs. Swelling is a continual problem and at some point it the body just fails to be able to keep up.
Lizann, thank you for your comments also. I believe the meds are all OK, and I doublecheck fairly often to make sure they have not altered her pain meds as they work like a charm (I think she has an iron constitution, but in reality she has built up a ton of resistance over the years - without them she would be in agony, so it's a trade off for the cumulative effects they have had on her brain). I have to call and find out if the PT people have authorized attaching the leg supports on her wheel chair - gotta keep after them. This NH is very 'anti-restraint' and it would have to be a situation like Ferris mentioned. Fortunately she does not complain of pain in her legs - probably due to her regular pain meds. Thank you for your prayers.
Crispy, fabulous suggestion about the equine leg wraps - never heard of them - will check them out on the internet and bring this to the attention of NH. Maybe I can get the wound specialist to order them so they will be covered by Medicaid. You are right - they are too busy to monitor Mom's 'picking' and she usually goes off to her room and removes the bandages while they are not looking. It is true her veins are shot too - due to 'venous insufficiency', so swelling is going to be an ongoing problem, especially with Mom's non-compliant behavior which of course she is totally clueless about. Thanks for your creative suggestion.
Crispy - I found the info about the 3M-Vetrap Bandaging tape and printed it out. Also found a NEVSCO-northeast supplier. Printed out and will try to be at the NH for the next wound care specialist visit.
But you are right in that I do spend a lot of time worrying over every issue and searching for solutions which can be mentally exhausting leading to physical exhaustion. When I get that conference at the NH, I will lean on them a little harder to come up with the solutions that I should not have to be dealing with. And I will try to "chill out" a little more. Thank you.
They also gave her blank sheets of paper and watercolor markers and she would spend quite a bit of time "writing".
The hospital put these "mittens" on her hands to keep her from pulling out her lV's. They looked like soft puffy boxing gloves with no thumbs. They were only mildly annoying for her for a short time and then she got used to them.