Mom's small room inhibits her ability continue to do for herself

Since Mom's move to a nursing home we've see declines in her strength yet her cognitive ability remains pretty good.   We're concerned about her loss of strength and I believe that the actual facility is partly to blame.  She's in an "old style nursing" home - it's been around for at least 35 years.  Her father, my grand pa, died there; her brother was there after a stroke so we're familiar with it. The rooms are small and the bathrooms even smaller.  There are no grab bars, no handicapped showers - nothing that will enable her to help herself.   There is no room for a transport bar (see previous post ) so she can pull herself up from the wheelchair.  The TV is small and attached to some contraption on her bed; it's hard for her to change the channel so she doesn't watch it.  She can't have her recliner so sits in the wheelchair which is bad for her back.   I fear it will leave her even more stooped and bent over. 

I am really distressed by this - she LOVES TV news, CNN, PBS and animal planet.  This is good brain food for her and helps keep her current.   She might be physically weaker but if we want her mind and spirit to remain strong some changes need to be made.   I am really ticked off at her physician.  I'm sure his intent is very good - he wants her to get better care than he felt she received at the ALF BUT the tiny, crammed conditions are bad for her spirit.  She can't do the things she enjoys.  Her physical needs are met but the spirit is repressed.  I don't know what to do - complaining to him will fall on deaf ears; he'll dig in his heels and get more stubborn about where she lives. I plan to call the physical therapist at the nursing home to talk about Mom's progress and what she has to do outside of these daily PT sessions.  The administrators and social workers SAY they are very concerned with her quality of life there and WANT to make her happy but I'm dubious until I see / hear of some changes.

Contacting this joint is another problem for me. I call and I call - no answer.   Mom doesn't answer, most of the time the nurses station on her wing doesn't answer.  Today I called the main switchboard and an old tired man answered.  He was quite polite but it was obvious that he was confused.   Given all of this, I'm really concerned for my Mom.  All I can do is make phone calls and plans for my next trip to see her.   She'll have to hang in there until after Easter.  Poor dear.

Getting paid to care for grand parents... Approach with CAUTION!!

I just read this question on a care giver blog:  "Can I get paid to take care of my elderly grand parents?"  I had to respond, here's a summary of what I said:   The short answer is "Perhaps".. it depends on who is doing the paying and which state you live in. Sometimes family members can be paid by the state to take care of elderly or disabled family members. The amount depends on the state. Contact your local medicaide office, or state department of health,  to see what's possible.

If your grand parents pay you then there are tax issues that you as the payee need to address. You can act as an independent contractor, a sole proprietor or set up an LLC. The easiest - yet most expensive way - is to call yourself an independent contractor and bill them monthly. This means YOU must pay all federal, state and medicare and social security taxes. Be advised that the state and federal governments want you to pay estimated taxes on a quarterly basis and the federal portion alone is nearly 16%. Be assured that when ever money changes hands, the state and federal government want their share. To understand the requirements in your state, contact an accountant to learn what's possible and what's the most least costly option. ALSO be cautious about insurance - specifically liability insurance. If you're responsible for their care - lifting, dressing, bathing - then YOU might need insurance. If you're driving them around in YOUR car, then you might need added liability insurance. If YOU are hurt lifting them, then will their home owners insurance cover you? If you drive their car, are you covered?

From a personal perspective, caring for family members is probably the most stressful of all situations. Because it's FAMILY all of the dysfunction and behind-the-scene expectations come into play. Will your parents, aunts and uncles TRUST you? Will they help? Will they provide respite care if you want a day off? Who will handle the finances as these people age? What if one needs to go to nursing home and the other is left? Will you get paid half then even though you spend the same number of hours care giving? You need to think of all the things that can go wrong; of all the people who will help you or make it difficult and have a plan to deal with EACH. I would also suggest that your grand parents complete a Power of Attorney, living wills and other documents that outline EXACTLY what they want should they become incapacitated or die. It should be detailed and include WHO GETS WHAT - down to each stick of furniture and fork or spoon. This will protect them and YOU especially if you want your family relationships to outlast your grand parents. Sorry if I sound pessimistic but I've seen way too many of these situations get really ugly, really fast. I always  hope it works out and in most instances it's fine but there are always issues because you're dealing with people going through change and every one has a different opinion of what to do.

getting paid to take care of grand parents, getting paid to take care of handicapped getting paid to care for grand parents grandparents 

Getting sneaky to do what's best for our elders

Dealing with family members while your parents or elders are aging is often THE most frustrating and hurtful issue we face.   I hear all kinds of terrible stories about family who take advantage of elders or who are in charge of money and health decisions but don't care what the elder wants.  After being so protective of my own parents for so many years, I have an immediate and physical reaction when I hear bad stories.  I get passionate and angry.  My blood pressure rises, and at my age that means hot flashes and nausea.  My reaction is also because I just can not comprehend how someone would steal money or belongings, or fail to consider the emotional and "quality of life" issues when making decisions about elder or sick people.   I just can not understand how people could take advantage of the vulnerable and the lonely.   It's all greed and lack of a conscious I guess.

The situations I hear about most are caused by financially strapped people who think an older person doesn't need much anymore so they feel entitled to Grandma's money.  Because Grandma or Grandpa says, "yes", when asked to a request for money doesn't mean they have it to spare. And, it doesn't mean Grandma or Grandpa understands that "yes" will compromise their finances.  Some people also seem to believe that their idea of what should happen is better than that of anyone else; they have huge egos or a control freak personality.  They want control and will manipulate, lie, coerce their elders or siblings to become the decision maker, have control, get money or belongings.   When I've talked with such people, they often have sane-sounding reasons for doing what they do but they look at situations from THEIR filter and don't consider what's best for their specific parent or elder. 

Sometimes the lieing and manipulating must be done by the "good" party - someone who comes into save the elder from another who's taking advantage.   An acquaintance of mine recently had to do a lot of work to get her mother out of a bad environment.  A grandson and his pregnant girl friend were living with the 78 year old.  The grandson completed credit card applications with himself as an authorized user - not responsible for paying the debt. He ran up more than $50,000 of debt in less than a year and grandma quickly fell behind on payment because he tossed the bills.    Grandma was buying all the groceries, including their cigarettes and alcohol.  When her daughter brought it up, Grandma felt that the kids needed her help and that they were there helping her.  She didn't s notice the dents in her car, piles of laundry, the dirty ashtrays everywhere. She didn't comprehend the added costs in water, heat and electricity.   She seemed relieved that grandson was "taking care of those details now..."  Actually, Grandson had not paid bills in months and Grandma was close to loosing her electric and gas service.  My friend was wise to collect more than 3 months of bills, canceled checks and receipts.  This was the hardest thing of all - to quietly collect information while someone was taking advantage of her Mother, but it was necessary.  Before doing anything she saw an attorney about filing bankrupty for her mother.  She also contacted the local county authorities about charges she could bring against her nephew for elder abuse and fraud. She was armed with information about the charges she could bring against her nephew and she got a restraining order. 

After collecting enough information, the daughter immediately went to work. She took Grandma to spend the week with a cousin and had Grandma sign a complete and durable Power Of Attorney.   With that she went to the bank and changed all of Grandma's accounts.  She closed the charge cards and changed the billing address for all bills to her own.   While the Grandson and Girlfriend were out, she put their belongings in garbage bags and placed them in the car port. She changed the locks on the apartment and warned the neighbors and land lord that they were evicted.  She found him and told him he could not return to Grandmas and gave him a copy of the restraining order.  She gave him $1000 in cash and told him that would help them get settled elsewhere.   Once that week was over, she still had more work to do  - there were legal issues with her Mom's debt but Grandson/Nephew was gone so dealing with Grandma/Mom was easier.  She sold her Mothers car, moved her to assisted living and now handles all of her business affairs.

This case took some sneaky work and it was the right thing to do on behalf of Grandma/Mom.  I suspect that the daughter glossed over the details of the Power of Attorney.  I doubt she told her Mother just how much power and control it would grant over Mom's affairs. I suspect the Daughter realized her Mom was forgetful and becoming needy.  In the strictest legal sense, Grandma/Mom was probably not 100% competent which might nullify the PoA if it were challenged, but WHO would do that?  Grandson/Nephew didn't have the funds or know how to challenge anything.  Grandma/Mom's competence was borderline and experts could probably be found to argue either way.    The Daughter is doing the right things at the expense of the relationship with her nephew and her Mom's grandson.  However, the relationship was not positive for Grandma, it was a life-sucking parasite.  Even though Grandma misses that part of her family, she is safer without them and that's the ultimate goal.

Sneaky family hurts grandma, how can i keep my brother sister from stealing from mom, sister brother lied to get POA power of attorney

Urinary tract infections in the elderly, hard to spot but cause big trouble

Urinary tract infections  (UTI) are very common in elderly people and can cause secondary problems. A UTI is a term that covers bacterial infection in the bladder, urethera, kidneys and the tubes that connect these organs.   Generally symptoms are burning and frequent urination; sometimes there's a need to pee with little or no urine discharge.  Your elder might also have low fever and urine with a strong odor and bright color.   Often, there are no symptoms at all.  If the infection spreads to the kidneys there can be back pain below the ribs.   UTIs are treated with a variety of antibiotics and when caught early, are easily treated.  In my Mom's case, the bacteria is drug resistant ecoli and it is slow responding to antibiotics.

When undiagnosed, a UTI will weaken the elder's immune system and can mean that elders are more susceptible to other infections. I've heard several reports of grandma or grandpa's confused or mean, aggittated state going away after treatment for UTI.   I've also heard first hand accounts of elders getting confused or seeming demented when taking strong antibiotics for UTI.  In my own experience, I believe my Mom's UTI weakened her system, which meant her epilepsy meds weren't absorbed normally. This meant she had a lower than optimum levels of the medicine leading to a grand mal seizure.  For this reason it's probably good practice to test for UTI -or other infections - regularily.  I definitely suggest it when you see sudden changes in your Elder's personality.  If they are suddenly confused about current events, people or things around them, or if they become argumentative, hostile or agitated - ask that they be tested.  


It's been my experience with Mom's assisted living facility that I had to push for things like this; they were not proactive unless the resident complained of pain or the family was assertive..  My Mom complained of strong colored and smelling urine for weeks but she was taking multi-vitamins which could also be the cause. She always has pain in her back due to arthritis so a new pain might go unnoticed.  Given this, there was no reason for the assisted living staff or me and family to suspect a UTI.  It was discovered when she was hospitalized for the seizure.  

Because I'm not a physician or nurse, I feel it's important to include information from a trustworthy source, I copied this information below from Web MD.  If you're concerned about yourself or your Elder, please talk with your physician immediately about being tested.  


From Web MD: Urinary tract infections (UTIs) in older adults

Urinary tract infections (UTIs) are common in older women and men. Factors that make older adults more likely to develop UTIs include:

• A reduced ability to control urination and bowel movements (incontinence), which increases the chance of getting bacteria into the urinary tract.
• Hospitalization or residence in a long-term care center, where the person may have a urinary catheter inserted, making bladder infections more likely.
• Problems with the bladder dropping down out of its normal position (bladder prolapse or cystocele). When this happens, the bladder cannot empty completely, making infections more likely.
• Lack of estrogen in women who have gone through menopause. Lack of estrogen may allow bacteria that can cause UTIs to grow more easily in the vagina or urethra and cause an infection in the bladder.
• In men, partial blockage of the urinary tract by an enlarged prostate.
• Other conditions, such as diabetes, lack of activity, poor hygiene, or problems releasing urine.
• Use of medicines that can cause difficulty urinating or a complete inability to urinate. If you think your medicine may be causing urination problems, talk to your doctor.

Older adults also are more likely to have conditions that complicate UTIs, such as a lower resistance to infection. They may require more thorough evaluation and longer antibiotic treatment than do young adults with uncomplicated infections.

Author	Monica Rhodes
Editor	Kathleen M. Ariss, MS
Associate Editor	Pat Truman, MATC
Primary Medical Reviewer	E. Gregory Thompson, MD - Internal Medicine
Specialist Medical Reviewer	Avery L. Seifert, MD - Urology
Last Updated	June 8, 2009