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She is basically bedbound with severe hip pain due to advanced osteoarthritis (with broken hip 3 years ago). Yesterday I found out that she is no longer agreeing to be taken to the bathroom because of the pain, which still exists even though for the last 10 days she's been on daily meloxicam + Tramadol (PRN, but she's asking for it every 6 hrs). She's in rehab again after being transported to the ER 10 days ago for severe hip pain. Another extensive workup in the ER (including CT) showed: nothing. She is at her baseline for everything. Per her ortho doc, she is not a candidate for surgery or any more cortisone injections.
This time the hospital didn't admit her, but kept her over the weekend for observation, because she wasn't safe to go home. This exact thing happened in late April, she went to rehab, returned to her condo in May, spent weeks with in-home PT. A month after she finished PT, here we go again. Before this episode, she had been prescribed Tramadol PRN, but up until now was unwilling to take any pain med regularly due to a fear of worsening her kidney function (& possibly dying young, I guess).
She is now on a total of 11 medications. I asked for a palliative doctor to see her in the hospital; this is the dr. that prescribed the pain meds she's currently being given. This doctor said my mother absolutely should not return to her condo; she needs to be in a facility. She predicted my mom will be right back in the ER if she returns home.
Currently, my mother has CNAs coming in the mornings M-F. She had refused to have anyone on the weekends or the evenings. Her mobility has declined precipitiously over the last year. She has been getting around her condo by sitting in her rollator & being pushed by an aide, or pushing herself with her feet when no aide was present. She does not have the ability to use a wheelchair, and it would be difficult for anyone to manuever one in her crowded condo. I think that PT is fruitless at this point.
Her first care meeting for this stay is scheduled at the rehab tomorrow; I already told the SW that mom absolutely cannot go home on Wed, as I can't get aides rescheduled by the agency that quickly. I don't feel that she should be going home at all. She cannot take care of herself. We are fortunate that she has the means to pay for 24/7 in-home care, but the reality is that it is very difficult to manage it (we have done this for shorter periods before). My mother's regular aides have all missed work this summer due to health problems of their own, & the aides that have been sent for the overnight shifts in the past are not wonderful. My mother is now showing evidence of cognitive decline. But she is adamant that she will not go to a facility - she thinks that she's refusing AL, however I think her needs are too great for AL - she's now a nursing home candidate. The palliative care doctor wrote in her notes that she did not feel my mother is at the point where the health care POA should be invoked.
My brother said that my mother is going to do what she's going to do, and we should just let her go home. He has stopped visiting/calling her (it's been a long 9 years) and I don't think he understands how poor her condition is. I'm SO sick of this, but in good conscience don't feel I can throw up my hands and walk away.
I could sure use some advice.

Any way you can actually see this palliative care doctor face to face and go over the situation so she’s perfectly clear what exactly she’s signing off on? I’d ask for a meeting before discharge to include the doc and casually mention the word liability in polite conversation. If no one bends on seeing mom clearly needs POA activated and a nursing home admission, then you’ve done all you can. What a screwup! I’m sorry for you and mom both
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Reply to Daughterof1930
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This is of course an "unsafe discharge" plan. Whomever is POA does now need to contact discharge planning. Someone bedbound cannot return alone to their condo.
There is currently no POA in effect. Let Discharge Planning know this and let them know that in that circumstance you will NOT be ASSUMING ANY CARE. Stick to that. Inform your mother of that in front of witnesses.

Be certain your mother has a phone to call 911.
Stay out of it.

Call APS if mother is unsafe at home because your brother is SPOT ON CORRECT; neither of you have any power here to change anything but to do the above.

It is impossible to manage unmanageable seniors. At some point, if they die at home, one must accept that this is their wish and there is no legal power on earth to prevent it.
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Reply to AlvaDeer
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I would tell the SW the situation, Mom is 24/7 care. Her son no longer has anything to do with her. You will not be her caregiver. To send her home would be an unsafe discharge. She needs LTC. If there is no one to care for her she can be forced to go to LTC. My GF was.
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Reply to JoAnn29
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Ask The palliative doc to prescribe her more potent painkillers as she can only do pt with them. If she becomes a greater fall risk, then a rehab is best able to handle that and work with her doc to adjust dosage.
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Reply to PeggySue2020
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Rhetorical question .

But what is wrong with these doctors ? sheez. They are chickens and leave this to the adult children , who the parents won’t listen to.

Can’t one of them be alittle more forceful and try to tell her she can’t go home ? Ask a doctor to talk to her. Tell the doctor that Maybe she would listen to the doctor because she won’t listen to you .
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Reply to waytomisery
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At meeting, I’d ask for an extension based on inability for her to be safe in her home without aides. Make it clear You are not an option (for example I have back issues).
once she’s home, research local facilities and see about adding a backup aide.
discuss with her Health care proxy and her wishes next time she’s in the hospital. Enjoin palliative care
doctor in this process - they get it.
also Did / will mom give you health care proxy?
(In our state POA is for legal matters, health care proxy is for medical -

also seems like she’s not ready for DNR/DNI but something to discuss with palliative care provider.

Im in a similar situ. The hospital extended stay over the weekend while backup aide was arranged after hip fracture / replacement surgery.
Mom has Latex insurance that covers 24/7/365 for 36 months (11 months spent).
when arranging I used aging.com website to find a local staffing agency That has folks on hand. Maybe they can help.
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Reply to AliOJ58
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Oldestchildof4 Sep 2, 2024
I am her health care proxy (& POA) - doc is not ready to activate it. She has a good home healthcare agency (this is the 3rd in 8 1/2 years), though they use an outside agency for overnight (not as good).
She has signed a DNR already, but not really pertinent to the immediate issue, which is that health care providers can make recommendations, but a patient that is not deemed to be incapacitated can ignore them. She has been advised for the past 8 years to enter assisted living due to her many health issues, but has refused.
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As the doc did not sign off on poa, there’s not much you really can do other than try to persuade her.
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Reply to PeggySue2020
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I agree with the Doctor she needs to be in a facility .
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Reply to KNance72
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