Deficient Health Care for the Elderly

On Sunday I left the nursing home with a feeling of optimism.  My mother was happy, talkative, and involved with activities there.  Her dementia was being controlled with Aricept and her delusions were under control with Seroquel, two drugs I fought off initially, but my mother’s increasing agitation, delusions, and aggressive tendencies gave me no choice.  I was glad I made the choice to have her put on these drugs.

Monday morning I got a call at 5:30 a.m. from the nurse at the nursing home.  My mother had a seizure and was being taken to the emergency department.  I made an immediate, panicky trip to the ER.  I got very little information from the emergency room doctor or the nursing home originally.  The doctor suggested her increasing back pain that was causing  her to scream and cry in the ER may have been due to the seizure, perhaps being put onto the floor or perhaps the aide had let her slip or fall in the process!  I went to the nursing home for more details.  I didn’t get much, but I was told she did not fall.  Her pain was so excruciating she was given morphine and later Percocet.  I wondered why the morphine didn’t kick in right away, so when I asked if she could be given more, the nurse discovered that actually she had never received the first dose!  The entire emergency room visit was a catastrophe.  No one knew for sure what had happened to her or why she had more back pain, except the x-rays showed two compression fractures most likely from her two previous falls although it could also have been a result of her treatment for uterine cancer.  I was never told about the compression fractures by the nursing home.  In fact, one of the nurses told me she was faking the pain to get my sympathy and actually told her to stop doing that.  Her pain was not adequately treated at the nursing home because they didn’t really believe she was in pain.   Because she may have had a cardiac event that precipitated the seizure, she was admitted to the hospital for observation.  She was put into a room with an elderly woman who had just had an operation for a broken hip.  The woman talked constantly, mostly gibberish punctuated with yells and screams, which upset my mother.  She became confused and disoriented, thinking the woman was her roommate at the nursing home and they were doing something to hurt her.  I stayed with her all day but the confusion increased.  The pain was excruciating.  She could not move in the bed without pain and more pain medication was given.  She did not eat or talk much.  I stayed until 5:30 when they brought her a dinner she did not touch.  The physician on the cardiac unit (a doctor I was all-too-familiar with from previous hospitalizations) indicated to me that because of my mother’s age, there was really nothing to be done.  He stated she was at the end stage of her life and he did not believe in helping her live longer.  He had stated the same thing previously right after after her diagnosis of uterine cancer, telling me to just let it go, that no treatment was available for her.  That turned out not to be true, she was treated with radiation, and even though her oncologist told me in August that she had at the most three months to live, she has outsmarted them all.  This, however, seemed to be a definite decline toward the end.

I got a call early the following morning.  My mother was screaming in anger that they were all lying to her.  She told me they said I was dead and then she thought I was the person in the next bed they were hurting, and it was hard to convince her that I was alive since I was speaking to her on the phone.  I told her I would come up.  A short time after that I got another call pleading with me to come up as soon as possible.  She was out of control.   An aide was sitting by her side when I got there assuring her she was not lying to her and I would be there shortly.  There was no calming her down, so it was decided that her strange surroundings were upsetting her and arrangements were made to return her to the nursing home.  She was given lunch but she didn’t eat it, and even though I was told she was dehydrated when she came into the emergency room, no IVs or liquids were given to her.

By 2:00 she was back in her room at the nursing home and seemed fine when I left.  A few hours later I got a call from the nurse telling me she had fallen again.  (She had two falls in two days a few weeks prior which apparently caused the fractures).  She was upset with her roommate for leaving the room without her.  She was sitting in her chair and suddenly decided to go after her and she fell.  Back to the emergency room for more tests and x-rays.  The only funny part was that what I assumed was dried blood all over her and the bed was actually chocolate.  She had apparently fallen on top of a chocolate donut.

After four hours in the ER, tests showed no major problems except a urinary tract infection which would explain the sudden change in her behavior, but the doctor decided not to treat it since she had similar problems before!  Again I felt that she was being treated as if her life did not matter because of her age.  I knew the nursing home doctor would order treatment, so finally at 8:30 p.m. she was returned to her room.  She had not eaten all day or had any liquids.

This morning when I called her, she did not know where she was.  She said she was all alone there, although she was not, and there was no convincing her otherwise.  Her anger at me and irrational thoughts are hard to deal with.  She is no longer the mother I once knew.  The mother I shopped with and talked with several times a day and went out to lunch with and shared my days with is gone.

I know that my generation will be filling nursing homes and dementia unit facilities in the decades to come.  I may soon find myself in the same condition as my mother.  It frightens me.

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