My 95 yo mother was recently diagnosed with Heart Failure, New Onset Afib and Dementia. Came to visit from home which is out of state in June and never left. Dad living with my husband and I; mom recently moved into a memory care unit.
She is incredibly unhappy, lashes out at us, sleeps most of the day and has been to the hospital twice in the past month. With Covid, there are restrictions which do not allow me to sit with her in her apartment or spend more that 20-30 minutes with her per visit.
I have brought in geri psych who diagnosed borderline personality disorder, with severe anxiety/depression. When he wrote medication orders, the ALS nurse blocked the orders because she didn't agree with them and mom didn't receive these medications until 2 days later. The MD followed up with these concerns, yet the nurse remains in the facility. Yesterday, they sent her to the ER for a bloody nose. Held her Eliquis in the morning, but I then received a call from the same nurse at 4:45 pm asking me to call the MD to get a written order to hold the evening dose Eliquis - I'm pretty sure that isn't my job, but in an effort to get it done, I called and initiated the request. VNA is also involved, and was told that they could not take a PRN order for Lasix for when mom is going into heart failure and has 2+ edema to her lower extremities. I will not bring her to a nursing home where care is worse, but really questioning "chronic and stable" and what that means exactly.
I am trying desperately to not involve my dad in the challenges as he has his own health issues, but my gut says I should make arrangements to bring Mom home to my house and care for her myself with the assistance of private caregivers.
I am a Geriatric Care Manager, nurse and advocate for those who can't advocate for themselves. When it's your family member, it is increasingly challenging. I'm just not sure where to turn next. If I convey my concerns to the facility, nothing seems to happen or change.
Should she stay or should she go? From day one, I told them they needed to do a better job than me. They are failing us and it is costing a ton of money. Any objective thoughts/advice out there?
And NO your should not have called the doctor requesting the night-time med stopped. That is the RNs job and I would have told her that.
"VNA is also involved, and was told that they could not take a PRN order for Lasix for when mom is going into heart failure and has 2+ edema to her lower extremities."
Who is they, the VNA or the ALs RN? If a doctor orders something again, a nurse is obligated to carry thru the order. And I have never heard that you give Lasix when needed. Sometimes by the time its determined it is needed, the person is already in danger if they have CHF. Their lungs fill up with water. With ur Mom she is showing signs of water build up. Why is she not being given Lastix on a reg bases?
This is just my opinion and I know the ALs RN has already made you question her decisions but she may have blocked the Drs orders in good faith until she spoke with the Dr. But having another agency come in for Mom is really sort of overriding the ALs RN. She should be the only one supervising Mom's care. Working with the doctors and ordering prescriptions. She needs to keep very accurate records for the State. This means the VNA nurses should be working with her. They should be telling her what they are doing and the care plan they have so no mistakes are made. All medication should be dispensed by the ALs RN unless there are Medtechs.
Just reread ur post and see your an RN so you know what I am trying to say. My daughter is also an RN and I worked as a secretary for a VNA association. If one of our clients ended up on "in home care" after a hospital visit, we did not see that client until the other agency discharged them. Rule of thumb, no two agencies at the same time.
Mom also getting alternating 20/40 mg dose of Lasix. Noted 2+ edema and asked for additional Lasix order to be written to diurese and avoid hospitalization. Nurse says cannot have additional PRN order. SO basically, wait til she's drowning and send her to the ER. Makes no sense.
My mom was well cared for in NH for 4.5 years with CHF and mild dementia. This was not a fancy place, but one that accepted Medicaid patients.
From the description of your mom, skilled nursing is exactly what she needs.