AboutMargot RN BScN CGN Expertise I nursed my own Mother and Grandmother at home when they were dying so I have personal experience with the emotions involved. I have also spent the last 15+ years as a Registered Nurse caring for The Elderly and Terminally Ill and it has brought me great satisfaction. I am willing to answer any questions I can.
Experience
Past/Present clients Hundreds of Long Term Care Residents as well as hundreds of Cleitns and families in the community (including my Mother and Grandmother).
Question my husbands grandmother was just recently put in a nursing home. my husband and i are confused about a few things and cant seem to get a straight answer. first-when we found out last thursday that she went into a nursing home for "rehabilitation" we were shocked. we were told that she was refusing water, food, medicine, and that she was incoherent and did not know who people were. well, we immediately went to see her. she was very much coherent. i asked her if she wanted some water. her lips, mouth, tongue were so dry they were cracking. she whispered, very weakly, yes please. so i swabbed her mouth. she acted like she had not had water in days!! So, i continued to let her have it while we were there. my husband asked why she didnt have an iv. the nurse called my husbands aunt to see about getting her one for fluids only, and she flat out refused. why? i understand that her outcome will be the same. but we feel it is SO unhuman to not give her fluids/food. after several times of swabbing her mouth, she began to talk with a little more ease. she knew EXACTLY who we were. No question about that. she even took her medicine crushed up in some pudding!! And then she had a little bit of broth. and....more water. well, we left and returned the next day and basically did the same as we had the night before. well, yesterday i went and spent the whole day with her. i actually had her drinking small sips of water out of a cup! Very small sips and I had to give it to her, but she kept wanting more! I have noticed that she is starting to get the "death rattle" sound. not bad or anything, just sometimes she coughs and you can hear it. she clears it, and it goes away. the nurse said that fluid is starting to build up and that the sound will get worse. well, i know what it sounds like. i heard it when my grandfather was passing. it is a horrific sound. one that i will never forget. my question is this. wouldnt an iv make her a little more comfortable? it seems the only time she is getting water is when my husband and i are there. i know it would not "cure" her. we understand that. but is there really any sense to NOT have an i.v.? We just don't understand. She has congestive heart failure. one more question, last night while we were talking to her, we could understand her SO well!! Her eyes were wide open when we got there. almost like she was waiting for us to come back like we told her we would! Her whole face lit up when we walked in the room. And she actually smiled!! Just seems she is improving from the fluids that we give her while we are there. Maybe thats not the case, but everyday we have seen a little more improvement. More alert, talking more, seems more at ease. Could she possibly get better if she had an i.v. with fluids running through it? Also, at one point last night she seemed very confused. She asked me "who that man was",,,,,it was her grandson. My husband. And then she looked at me and said "have you been here before?",,,,,,,is this normal? ANY suggestions you have would be GREATLY appreciated!!! Again, we know that she is old and has had a long life. But does it REALLY have to end now? Or with the help of an I.V., food, certain medications, could she perk up even more then she already has the past couple of days and live a couple more years? Thank you! Michelle
Answer Hi Michelle and thanks for writing,
Obviously I am not familiar with the details, but from what you tell me it does sound like the home is doing the bare minimum in regards to care and pretty much nothing in the way of rehab.
An IV can put her into Heart Failure, but it can be used safely if she’s monitored. I suggest you (i) ensure someone is with her to assist with food and fluids at least twice a day (even if it means getting the whole family doing shifts or ven hiring help for a few weeks) and (ii) ask for a meeting with her primary physician and head nurse asap and ask:
-what I her plan of care (ie: is it “rehabilitation” or is it “leave it alone and see if she dies”)?
-are the staff not here to assist those who need it?
-what guarantees can we have that she will be given the time and assistance she needs to ensure she receives adequate nutrition and fluids every day?
Make sure you also review ALL of her meds and find out what each one is and IF she really needs it – try to get her off as many as possible, especially any which might sedate or confuse her.
I always tell people to be firm but polite – the squeaky wheel will get the oil. If the staff know you are involved, concerned and closely following her care then they will put more of an effort into actually seeing that she is cared for.
There is always the possibility that she is just in a bad home and maybe you need to look into her options – are there any others homes in her area she could be transferred to? Talking to licensing always gets the attention of the people in charge and believe me, if the administrator and director of care take an active interest in her wellbeing then you will see a dramatic increase in the care she receives (as sad as that is, it is true).
