One of our home care nurses implied that we need to get her out of bed more. We feed her breakfast, lunch and dinner at the table during the day. I ask her if she wants to sit in the chair for a bit and she says "no, I want to go to bed." Should I force her to stay up or let her go back to bed? She has Alzheimer's and also had mini strokes over the years.
Personally, I would say that if you are managing to get your grandmother sitting up at the table three times a day you're doing pretty well; and if you're getting her washed and dressed you're doing fine. And I would also say that if your grandmother is still able to express a preference about what she wants, on what grounds would you overrule her?
When I was quizzed on this issue by an occupational therapist who asked me to describe mother's daily routine*, the OT stood there with her pen poised above her questionnaire until she heard me say the magic word "encourage" so that she could tick that box. The point was that "asking" isn't quite enough, because if you just "ask" someone who is dog-tired if she wants to make an effort with something she is more than likely to say no thanks all the same. But if you encourage, support, assist, facilitate her to do it; and the person is still quite clear and firm about her preference; then you go with her preference. You do NOT force.
You will encounter people who have a highly structured care model in mind and are hell-bent on achieving it. In the perfect care model, your grandmother would be up at seven, washed, dressed, breakfasted by nine, ready for appointments during the morning, lunched at noon, nap for an hour, engaged in singing for the brain, handicrafts or pet visits during the afternoon, rested before supper at six, washed and changed into her nightclothes by nine and then tucked back into bed. In a tightly-run care home this would probably happen, more or less, overlooking the daily mutinies and non-compliance, whether she liked it or not. And for whose benefit, you may well ask? Well, for everybody's, really, because order and routine do tend to make for a quiet life all round. But isn't that partly why your family has chosen to keep your grandmother at home? - so that she doesn't get treated like a battery hen?
Still. The officious nurse does have your grandmother's best interests at heart as she understands them, so do your best not to tell her that she is unhelpful, annoying and falling down on respect for autonomy. There is little hope of correcting someone who's so convinced of the theory that she sees fit to guilt you instead of praising you and making constructive suggestions; but if nodding and smiling and saying "we'll do our best!" doesn't shut her up, perhaps you could ask her to demonstrate what she has in mind and let her see for herself that it doesn't work in practice. And if she really is prepared to overstep the mark and force your poor grandmother into an armchair... it probably wouldn't come to that, but if it did you'd have her kicked off the team.
*routine was a slightly grand word for it. I was just pedalling as fast as I could.
(I particularly liked the bit about being treated like a battery hen.. lol)
What your Grandmother needs is to be "repositioned" at least every 2 hours and ideally moved slightly more often.
Moving can be as simple as adjusting the height of the foot or the head. You could also grab the sheet and slide her a bit up, down or over in the bed. This moves her a little.
Re positioning you should roll someone from the back to the side then over, then repeat on the other side. This relieves pressure in the areas the are in contact with the mattress. So head, shoulders, back, buttocks, calves and heels.
Doing this also is a time when you should check these areas for any redness or other skin color change.
A pressure sore can happen in a matter of an hour. It is identifying it when it is small and manageable and not wait until there is a drastic change or worse, an open wound.
If Grandma wants to stay in bed and that is where she is comfortable there should not be a problem. If you do not have a hospital bed ask that one be ordered. (If Grandma is on Hospice you would get it probably within 24 hours)
If the reason Grandma does not want to sit in a chair is because she is afraid of the transfer or if it hurts her that is another thing that can easily be addressed. A Sit-to-Stand or a Hoyer Lift would easily help with that and again they can be ordered.
Sit to stand is for someone that can support their own weight and can follow instruction and hold onto the machine.
Hoyer would be a full sling that you would have to place under her then hook the sling to the lift and she can easily and comfortably be lifted from the bed to a chair.
This doesn't mean it is better for the patient - it is better for the NH staff.
I agree, if your GM sits at the table 3X daily to have meals - you're doing a fine job! It is typical for up to 20 hours of sleeping daily as they age. My DH is in the 16-20 hour range and I just let him sleep. His preferred position is prone but I get him to sit in his recliner a little every day so I can change the sheets and straighten them. Invariably he reclines to a sleep position. Would you force a baby to sit up all day? Well, as they age, our elderly revert to being like bigger babies and they want to sleep. It's nature and natural.
Don't let "one of the nurses" upset you - you're doing a fine job!
Besides, sitting in the wrong position will make "pressure sores" and you really don't want to mess with them if you can avoid them. My DH only gets them in his Lift-Sleep Chair so I don't make him sit there very long.
You can fit quite a lot of salt into a cinnamon capsule.
Are you doing this on medical advice?
If you've had one of the really vicious stomach bugs that are doing the rounds this year, I think I'd give it a little bit longer before you bring your mother home. Just to be on the safe side. Hope you're feeling better but I bet you could do with a few more days to get really over it.
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