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So, my mom’s in LTC, she’s 88 next week. She has a stage 3 pressure wound. Won’t (can’t, now) get out of bed, she has no muscle tone whatsoever. Recent bloodwork is good. Recent X-ray shows no osteomyelitis. Being treated for a UTI. There are other co-morbidities such as COPD, diabetes, depression and full incontinence. I am forced to make a decision: to keep her comfortable,(and let her deteriorate naturally), or to keep aggressively treating the pressure wound. The LTF NP says that it seems as if her body has “forgotten” about her wound and doesn’t work on healing it, and abrading doesn’t seem to shake things up. This is a hard decision, and it’s all on me as the only child. I need facts and rationale. (And moral support.) I’m interested in arguments for and against. Regardless, she most likely won’t recover, and even if she does, her quality of life will not change: laying in bed all day, no interest or capability in doing anything, no memory of anything more recent than 20 years ago, eating with her hands. The other day she asked me who was taking care of the horses… which we haven’t had since the late ‘90s. Thank goodness she recognizes me, I would be devastated if she didn’t know who I was. This sucks. FYI, dad and stepfather have already passed; we are alone. My husband is moral support, but he is leaving this to me (as expected). She is on Medicaid with a Medicare Advantage plan.

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Why not talk to some hospice companies, as her co-morbidities make her eligible? At least they could be a sounding board. It doesn't sound as if her wound can heal, and improvement may be unlikely from what you describe. My mom is also late stage dementia, fell, broke her hip, wheelchair bound, now has a pressure sore on her heel, fully incontinent, mostly knows I'm her 'someone', sometimes knows me by name.. She's hitting every branch of the dementia tree on her way down, absolutely the end she didn't want for herself. We did do some post-fall rehab so she has recovered enough to be able to do a stand and pivot with assistance, so she can still be in memory care, but hospice will be our next step. If she can't die in her sleep I hope that she gets something like pneumonia that will help her pass peacefully.
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Reply to ElizabethY
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Is the treatment for the wound hard on your mom? Is the abrading painful or annoying for her?

If the efforts to aggressively treat the pressure wound take away from your mom's already seemingly low quality of life, then I'd say... Why do that to her? But of course, I'd probably want to go this route for any of my loved ones, too, and treat as much as possible. Sigh. 💛

You're in such a difficult spot, but I think if the treatment isn't a guarantee of healing or prolonged quality of life -and- it detracts from the little QOL she does have at the moment... then that's a no. 😔
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Reply to AliBoBali
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You say that this is a decision.
It isn't. There is no decision here to make, because of course you would choose healing if there were.
If you are asking if it is time for Hospice or palliative care, then, yes, it is almost certainly is, as it sounds as though your mother will not make it a whole lot longer.

You mention diabetes. I know that you know that this is something that affects every single system in your mom's body, and if she's been diabetic for any time at all, then you understand how devastating it is for the kidneys, the heart, virtually every system, and especially the skin and healing.
Further, being bedbound means that circulation is now at a minimum. Without it, and with the constant pressure of the bed, sores are inevitable.

Choosing palliative or Hospice recognizes where you ARE. I believe that given the circumstances any doctor can tell you that death is likely within the next six months or so. The goal then is COMFORT.

But DO KNOW that comfort includes attempting to heal, get the best bed available for circulation, and TREATING that bedsore.
Palliative or hospice care doesn't mean that you do not treat things like bedsores, pneumonia, UTIs. It is a part of COMFORT CARE to prevent these things from bringing pain and discomfort.

You are not "giving up".
You are realizing that your Mom cannot go on any longer. She hasn't the will or the strength to do so. It is recognition, not choice.

I so wish you the best of luck. Discuss all of this with Hospice during an interview, and make your best choice. Continue to insist on wound care to attempt healing. It well may not happen, but it is crucial to comfort and assessment.

I am so very sorry.
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Reply to AlvaDeer
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dunazee Dec 16, 2024
AlvaDeer, you always have the kindest way to say things. Thank you for your empathy.

At this point I have decided to move forward with comfort care, which will include treating existing conditions. No hospice for now, but it's not ruled out.

FYI, the results of the x-ray were un-readable, I think they couldn't get the right angle. However, there are masses in her abdomen and the NH NP fears cancer. Of course, to get a diagnosis for either a bone infection or potential cancer, she would have to go to the hospital for a CT scan, and a biopsy, and they advise against moving her. The last time she had a CT scan, when she was able to move on her own, she freaked out a bit. She can't lay flat comfortably. If there is cancer, however, I'd like to know what kind it is so I can keep an eye on myself in the future. We have shared a few of the same medical issues as I'm growing older.

That said, I can change my mind about getting the CT scan so I will think on it for a day or two.

(short related story... two years ago my mother broke her wrist, which is what started this whole oddessy, and it was right before Christmas. Hospitals are short staffed during the holidays, so everything takes twice as long. She was in the hospital for 10 days. ...)
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I would hope that the LTC shebis in has a woundcare RN caring for that bedsore. They know whatvto look for. My daughter is one and saved my diabetic father from getting worsebin rehab. He had blisters on his heals that broke and were not being properly cared for. She saw immediately dead skin. Went to the DON and told her his admitting paperwork already showed pressure pointsvon his heals. First sign. He should have had an air mattress from day one. Mom should have an air mattress.
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Reply to JoAnn29
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dunazee Dec 16, 2024
Yes, they do have a wound care RN. She is on an air mattress, and they say she's not improving. They think she is not going to heal.
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With diabetes her wound will be slower to heal than a pressure sore on someone else.
Mom may be eligible for Hospice.
Hospice WILL treat the pressure sore.
Hospice will do what they can to keep mom comfortable.
If I were your m om that is what I would want.
Does mom have diagnosed dementia? If not this is a discussion you should have with her. If she has dementia or refuses to talk about this what would she want? I am sure over the years you at some point have discussed, maybe just in passing, what her wishes would be if she would be unable to make a decision like this.
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Reply to Grandma1954
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dunazee Dec 16, 2024
Yes, she has dementia. I spoke with her a long time ago about the end of her life and she doesn't want a lot of hoopla. She has DNR. I spoke with her twice in the past week about it and got conflicting answers, but always prefaced with "I can't think, you decide". When I visit her recently, she is laying mostly flat in bed, on an air mattress, and she barely talks. She lost her hearing aids, so to speak with her I have to yell. (I got her a cheapie hearing amplifier as she will lose another set of hearing aids, and she doesn't wear that.I don't think she understands that they need to be charged.) Point being I've seen a big decline recently, the staff says she is combative and uncooperative, which is also a recent behavior change.
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When my dad had dementia plus a whole host of incurable conditions and no chance of recovering, he said he had had a good life and just wanted it to end. He asked for euthanasia many times to every medical person he saw plus me and my mom. We opted for home hospice and I have no regrets. That was last January. He had ups and downs, but overall more downs, until May by which point he kept falling and injuring himself, it was a daily crisis. We then opted for a hospice facility which made him very angry. He had a lot of pressure sores by then and was skeletally thin. They gave him an air mattress. Within a couple of days he developed aspiration pneumonia from his own saliva. I opted against antibiotics and at that point. Something has to be the proximate cause of death — like in your mom’s case, if it isn’t the pressure sore, it will be something else.

Anyway, at the hospice place he was receiving palliative oxygen and morphine every two hours for pain and agitation and it worked wonders. He passed shortly thereafter. Again, I have no regrets. It’s really hard though. I wish you peace.
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Reply to Suzy23
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Dunazee, make sure she gets tested for a UTI, a common cause of behavioral symptoms in elderly folks.
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Reply to BarbBrooklyn
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dunazee Dec 16, 2024
Yes, she is being treated for a UTI. She gets them all the time so they test for it often.
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I will find out more about X-ray and blood test results on Monday. Having these facts will hopefully help me with my decision.
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Reply to dunazee
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I’m so sorry, and sorry it’s all on you. When my mom was in LTC under different circumstances, she wanted nothing more than to leave this world and the mere existing her life had become. We did all we could to make it better, but still knew it was never enough. You’ve reached that awful point with your mom of more issues with fewer and fewer solutions. In your shoes I would opt for hospice care and give mom the great meds they provide to keep her fully comfortable to live out her days in peace. Please know she’s been blessed to have you in her corner. I wish you both comfort and peace in the days ahead
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Reply to Daughterof1930
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dunazee Dec 14, 2024
I visited today, and I don’t think she understands that keeping her comfortable is a euphemism for letting nature run its course. All she can say is “whatever I want”. I want to make a decision that she is comfortable with, but I fear the ability for her to have a grasp of the situation is not there anymore. A couple weeks ago she had a psych evaluation and she scored 12/15. Yesterday she scored 0. Yikes.
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Dunazee, welcome!

In your shoes, I would ask for a hospice evaluation and see if they think it's time for comfort care

I've been down this road; it's hard and lonely, even with siblings. Please be at peace with your decisions.
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Reply to BarbBrooklyn
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dunazee Dec 14, 2024
The LTF has broached the topic of “comfort care” as they call it. X-rays and blood work were done Friday. I spoke with the staff today when I visited to find out if they were able to get her to cooperate for X-rays and they said they were. There have been some personality changes lately. She recently has been very combative with the staff, not wanting to be touched, cussing them out, which is not like her. I think that the answers I get are different than what she says to the staff when I’m not there, that she says what she thinks I want to hear.
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