Mother has stage 3 pressure wound, decision time.
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.
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. 😔
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.
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. ...)
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.
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.
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.