Death on the Doomstead

[18hammers]

I spent parts of the last 3 days digging a grave. I am about down to my hips when standing in it. That will be enough. I don't think one of my dogs will make the winter and I needed the grave dug before the ground freezes up. I put my dogs down myself when the times comes, always have. It is harder to do as I get older but I have found a easer way. I give them a strong muscle relaxant, let that sit for a hour, then will give them a couple strong pain killers like Morphine sulfate. The combo lays them flat out asleep and feeling no paid. Then the .22 comes out.   

[18hammers]

The old dog is still hanging in, let her outside this morning to pee, and watched her go, then laid down in the -36 snow. I think she just wanted it over. Called her back inside. I have seen the same with the elderly, there comes a point they have had enough.

[18hammers]

The old dog is done, She had a good life, I will get her in the ground tomorrow. Down to one dog now.

[18hammers]

Well it looks like a death is coming to the doomstead again. My mother took a fall a few months back, she is in her 90's. Didn't break anything but I moved her in with me as I could see she could not continue living on her own. 6 weeks ago I had to call the ambulance when she again fell hitting her head on the floor. She has been in the hospital ever since, with issue after issue, been called a couple times to come in as they thought she might not make it. I have visited every day and watched her condition go down hill. I suspect she wont be leaving the hospital.
 I got the call today for a meeting with the doctor Monday. They said it is to talk over options as they cant do more for her. She had lots of problems as someone in there 90'S does but was able to get around her house, cook, garden and look after herself very well for someone that age, now she can't stand or take a step. This loss of independence has hit her hard. I know I can't care for her in the way she needs, can't even go to the bathroom without help now. I suspect they will tell me she needs palliative care. This will hit her hard as she still thinks she is going to be going home. This is likely the future for many of us, one day you are getting by and the next you are in a hospital and will have to accept the fact you are not going to leave. It will break her heart if this is what the doctors tell us Monday, I have known this seeing her condition slide so I am braced for the news, but it has not sunk into her how far her abilities have fallen.

[RE]

Well it looks like a death is coming to the doomstead again. My mother took a fall a few months back, she is in her 90's. Didn't break anything but I moved her in with me as I could see she could not continue living on her own. 6 weeks ago I had to call the ambulance when she again fell hitting her head on the floor. She has been in the hospital ever since, with issue after issue, been called a couple times to come in as they thought she might not make it. I have visited every day and watched her condition go down hill. I suspect she wont be leaving the hospital.
 I got the call today for a meeting with the doctor Monday. They said it is to talk over options as they cant do more for her. She had lots of problems as someone in there 90'S does but was able to get around her house, cook, garden and look after herself very well for someone that age, now she can't stand or take a step. This loss of independence has hit her hard. I know I can't care for her in the way she needs, can't even go to the bathroom without help now. I suspect they will tell me she needs palliative care. This will hit her hard as she still thinks she is going to be going home. This is likely the future for many of us, one day you are getting by and the next you are in a hospital and will have to accept the fact you are not going to leave. It will break her heart if this is what the doctors tell us Monday, I have known this seeing her condition slide so I am braced for the news, but it has not sunk into her how far her abilities have fallen.

Probably in her condition she will qualify for a Post Acute Care facility.  This is the step right below Hospital care but above Assisted Living.   There is a higher standard of care with nurses on duty 24/7 along with the CNAs.  Assisted Care facilities generally only have PCAs on duty 24/7.  PCA is an even lower certificate than, requiring only a few days of on the job training.  CNAs have a 6 week curse and a state test to take.

PAC facilities vary in quality, but they are far better than AC Gulags.  There usually isn't much choice in a given area, and beds aren't always available.  If that's the case or if Medicare will not foot the bill for a PAC, your only choice is an AC unless you have a lot of money.  I am told there are some decent ones out there, however I have yet to see one.  If she does end up being sent to one, check it out carefully and shop the ones in your neighborhood for the best looking dog in the pound.  Don't just look at the menu, ask to eat all 3 meals with the residents and see if you can stomach the food.  See if they serve real Juice, or just Kool Aid they call juice.  Check out their Call Button system, whether they have 2 way intercom or just an audio buzzer.  Find out their official staff resident ratios on all shifts, then ask to see their attendance records for the last month for how many call in sick and what the actual on-duty numbers were.  Check out how many bathrooms are available in the facility, there usually are not bathrooms for every patient.  Often because many residents cannot get to the bathroom themselves, there is a schedule and the PCA bring them and leave them on the toilet for a half hour, so the baathroom becomes unavailable for long periods.  This is not usually a problem in PACs where ther is a bathroom in every room or suite shared by 2 people only.

Let me know what happens, and what they bill Medicare/Medicaid.  I'll let you know if it's in line with the current standards.

RE

[K-Dog]

It is good to hear from you 18 hammers.  But I am sorry to hear things do not go well for you and yours.

[18hammers]

Well it looks like a death is coming to the doomstead again. My mother took a fall a few months back, she is in her 90's. Didn't break anything but I moved her in with me as I could see she could not continue living on her own. 6 weeks ago I had to call the ambulance when she again fell hitting her head on the floor. She has been in the hospital ever since, with issue after issue, been called a couple times to come in as they thought she might not make it. I have visited every day and watched her condition go down hill. I suspect she wont be leaving the hospital.
 I got the call today for a meeting with the doctor Monday. They said it is to talk over options as they cant do more for her. She had lots of problems as someone in there 90'S does but was able to get around her house, cook, garden and look after herself very well for someone that age, now she can't stand or take a step. This loss of independence has hit her hard. I know I can't care for her in the way she needs, can't even go to the bathroom without help now. I suspect they will tell me she needs palliative care. This will hit her hard as she still thinks she is going to be going home. This is likely the future for many of us, one day you are getting by and the next you are in a hospital and will have to accept the fact you are not going to leave. It will break her heart if this is what the doctors tell us Monday, I have known this seeing her condition slide so I am braced for the news, but it has not sunk into her how far her abilities have fallen.

Probably in her condition she will qualify for a Post Acute Care facility.  This is the step right below Hospital care but above Assisted Living.   There is a higher standard of care with nurses on duty 24/7 along with the CNAs.  Assisted Care facilities generally only have PCAs on duty 24/7.  PCA is an even lower certificate than, requiring only a few days of on the job training.  CNAs have a 6 week curse and a state test to take.

PAC facilities vary in quality, but they are far better than AC Gulags.  There usually isn't much choice in a given area, and beds aren't always available.  If that's the case or if Medicare will not foot the bill for a PAC, your only choice is an AC unless you have a lot of money.  I am told there are some decent ones out there, however I have yet to see one.  If she does end up being sent to one, check it out carefully and shop the ones in your neighborhood for the best looking dog in the pound.  Don't just look at the menu, ask to eat all 3 meals with the residents and see if you can stomach the food.  See if they serve real Juice, or just Kool Aid they call juice.  Check out their Call Button system, whether they have 2 way intercom or just an audio buzzer.  Find out their official staff resident ratios on all shifts, then ask to see their attendance records for the last month for how many call in sick and what the actual on-duty numbers were.  Check out how many bathrooms are available in the facility, there usually are not bathrooms for every patient.  Often because many residents cannot get to the bathroom themselves, there is a schedule and the PCA bring them and leave them on the toilet for a half hour, so the baathroom becomes unavailable for long periods.  This is not usually a problem in PACs where ther is a bathroom in every room or suite shared by 2 people only.

Let me know what happens, and what they bill Medicare/Medicaid.  I'll let you know if it's in line with the current standards.

RE

I don't know your system in detail, only generally but it it sounds like ours are somewhat different. Every patient in this ICU have a Proper RN qualified looking after them, they do have what's called nurse practitioners but they to my observations appear very well trained but act under the direct supervision of the RN. The Rn herself aids my mom in showering and using the toilet.
The RN is full present in the bathroom at all times or right outside the door waiting until the patient is ready to exit the bathroom. I have been told that the cost I am going to have to pay is 80 dollars a day once she is stable and moved to the palitive care wing of this hospital.
That 80 dollars a day gets her 2 people a RN and nurse practitioner available 24/7 to attend to her needs. This 80 dollars a day includes meals and any needed meds as well. Because this is a rural hospital there are full in house cooking done with custom meals for all patients, delivered by the cook herself, The food is first rate, I have tried it myself, and I give it a full thumbs up. This is not so in the city hospitals, the food is contracted out in some city hospitals I have been in and tastes like crap, but out here in this hospital it is good. Call buttons are two way communications, and they respond fast. I have spend weeks there and watched people die (this is the ICU) and seen how it is handled. I could never do the job theses nurses do after what I have seen.

[RE]

Well it looks like a death is coming to the doomstead again. My mother took a fall a few months back, she is in her 90's. Didn't break anything but I moved her in with me as I could see she could not continue living on her own. 6 weeks ago I had to call the ambulance when she again fell hitting her head on the floor. She has been in the hospital ever since, with issue after issue, been called a couple times to come in as they thought she might not make it. I have visited every day and watched her condition go down hill. I suspect she wont be leaving the hospital.
 I got the call today for a meeting with the doctor Monday. They said it is to talk over options as they cant do more for her. She had lots of problems as someone in there 90'S does but was able to get around her house, cook, garden and look after herself very well for someone that age, now she can't stand or take a step. This loss of independence has hit her hard. I know I can't care for her in the way she needs, can't even go to the bathroom without help now. I suspect they will tell me she needs palliative care. This will hit her hard as she still thinks she is going to be going home. This is likely the future for many of us, one day you are getting by and the next you are in a hospital and will have to accept the fact you are not going to leave. It will break her heart if this is what the doctors tell us Monday, I have known this seeing her condition slide so I am braced for the news, but it has not sunk into her how far her abilities have fallen.

Probably in her condition she will qualify for a Post Acute Care facility.  This is the step right below Hospital care but above Assisted Living.   There is a higher standard of care with nurses on duty 24/7 along with the CNAs.  Assisted Care facilities generally only have PCAs on duty 24/7.  PCA is an even lower certificate than, requiring only a few days of on the job training.  CNAs have a 6 week curse and a state test to take.

PAC facilities vary in quality, but they are far better than AC Gulags.  There usually isn't much choice in a given area, and beds aren't always available.  If that's the case or if Medicare will not foot the bill for a PAC, your only choice is an AC unless you have a lot of money.  I am told there are some decent ones out there, however I have yet to see one.  If she does end up being sent to one, check it out carefully and shop the ones in your neighborhood for the best looking dog in the pound.  Don't just look at the menu, ask to eat all 3 meals with the residents and see if you can stomach the food.  See if they serve real Juice, or just Kool Aid they call juice.  Check out their Call Button system, whether they have 2 way intercom or just an audio buzzer.  Find out their official staff resident ratios on all shifts, then ask to see their attendance records for the last month for how many call in sick and what the actual on-duty numbers were.  Check out how many bathrooms are available in the facility, there usually are not bathrooms for every patient.  Often because many residents cannot get to the bathroom themselves, there is a schedule and the PCA bring them and leave them on the toilet for a half hour, so the baathroom becomes unavailable for long periods.  This is not usually a problem in PACs where ther is a bathroom in every room or suite shared by 2 people only.

Let me know what happens, and what they bill Medicare/Medicaid.  I'll let you know if it's in line with the current standards.

RE

I don't know your system in detail, only generally but it it sounds like ours are somewhat different. Every patient in this ICU have a Proper RN qualified looking after them, they do have what's called nurse practitioners but they to my observations appear very well trained but act under the direct supervision of the RN. The Rn herself aids my mom in showering and using the toilet.
The RN is full present in the bathroom at all times or right outside the door waiting until the patient is ready to exit the bathroom. I have been told that the cost I am going to have to pay is 80 dollars a day once she is stable and moved to the palitive care wing of this hospital.
That 80 dollars a day gets her 2 people a RN and nurse practitioner available 24/7 to attend to her needs. This 80 dollars a day includes meals and any needed meds as well. Because this is a rural hospital there are full in house cooking done with custom meals for all patients, delivered by the cook herself, The food is first rate, I have tried it myself, and I give it a full thumbs up. This is not so in the city hospitals, the food is contracted out in some city hospitals I have been in and tastes like crap, but out here in this hospital it is good. Call buttons are two way communications, and they respond fast. I have spend weeks there and watched people die (this is the ICU) and seen how it is handled. I could never do the job theses nurses do after what I have seen.

An ICU is an Intensive Care Unit in a hospital here.  The won't keep you in one of those here for long term care unless you need to be on a respirator.  Usually the limit is about a month for normal recuperation, then you get transferred to Post Acute Care facility.

ICU costs are far more than $80/day here.  Just a normal bed in a private room in a hospital is around $3000/day here.  Cost to keep me here in a Post Acute Care facility is ~$650/day.  Most of it gets paid by Medicare/Medicaid, I end up paying around $100/day of it.

Even in hospitals here, the RNs do not give showers or bed baths or change diapers and linens.  That work is always done by the Nurse Assistants.  Nurse Practiotiners don't do hands-on stuff, they can adjust medications and do most of what the doctors do on a daily basis.  Doctors set the overall plan of care.

Post Acute Care facilities at best have a supervising doctor on call, these days they often contract that out to an agency.  Hospitals have Attending doctors, and residents and interns in a teaching hospital.

I'm sure due to the socialized system the costs in the Great White North are much less.  I do wonder about the staffing issue though, since the nursing shortage is global.  Also the number of available beds in ICUs is even lower there than here, and it didn't seem like your mom needs intensive care, just help and 24/7 monitoring.

RE

[18hammers]

Oh no, she did need intensive care, Three blood transfusions in the first three weeks do to uncontrolled internal bleeding and also something about low hemagloban where her oxygen level was falling below 55 %, then a severe bladder infection, some cognitive problems do to the fall and hitting her head, then lastly water build up, I can't remember if it was in her lungs or in the organs around her lungs that had to be drained off so she could breathe.
 During the first 3-4 weeks the nurses really did not think she would make it, They did not tell me that of course but I was sure she was done for, not even eating, must be under 100 pounds now.
They are short nurses, what they seem to do is have adequate levels during the day but very light levels at night. In fact do to the shortage I have seen them call in Palladin security officers, (paid little, 20 a hour) to sit at the door of some patients and their  job is to call the nurse or nurse practitioner if  anything looks wrong with the patient.  In this ICU unit the patients rooms have their own private bathrooms and showers  free tv and phones. I have rented worse apartments in my younger days. I could show you a picture of the room but I have been unable to post pictures here before.

[18hammers]

I made a mistake, the patients are assigned a RN or LPN with a Certified Nursing Assistant (CNA) to help them. I got mixed up in the finer points of who is who.

[RE]

It sounds as though you are talking about acute care in a hospital or hospice setting, not long term care in assisted living or nursing homes.  This is apples and oranges.

RE

[18hammers]

No, this is the ICU unit of the hospital. No if ands or butts about it, of that I am sure. I have watched two die right across the room from my moms since I have been there,  Now that she is some what stable the discussion now is about transferring to her to hospice or acute care and that will be when the costs to me start at 80 dollars a day when that happens, but I have just been told that there is no room at the moment (hospice or acute care ) unless I select another city to transfer her to but I do not want her to go far away where I cant visit, so I expect some unpleasant conversations next week.

[RE]

Yes, you have been talking about acute care in a hospital setting, I was explaining choices in post acute care after she leaves the hospital.  As I said, there probably won't be many choices and they probably won't be very good.

RE

[RE]

Now that we have clarified the situation some, I can explain how it would go if she was in an FSoA hospital.

She was not expected to live long, so was kept in an acute care setting with RNs on duty 24/7.  The amount of time they will do that is generally limited, they don't have that many beds of that type.  Besides a respirator, if she can't or won't eat and needs a feeding tube that also keeps her in hospital a while longer.

To clear the bed, they need to discharge her and send her to a post-acute care facility.  Choices are limited and they usually aren't very good, for all the reasons I mentioned.  However, they can't discharge you unless you sign the discharge papers.  There is a lot of pressure put on you to sign.  I assume you have her power of attorney.

Your other choice is to take her home and care for there, with some help each day from a home care aid.  Here the home care system is failing due to lack of people who will do this work.  Not sure of the situation there.

How old is she?  Keep us updated on progress.

RE

[K-Dog]

She is in her 90's.