Cockroach Cafe - Autumn

MIL has allowed me to accept op date.
Only because ‘I bullied her’ and ‘surgeons want you to have operations’.
Plane tickets to go down booked so all as much go as they can possibly be. She is big mad with me though.

Discussing this with friends in a similar situation we did wonder if there should be dedicated elderly person medical units dedicated to their care and maybe more abilities to do home visits? Maybe GPs who only deal with those aged 80 plus who then become familiar with the patient (continuity of care) and actually have specialist knowledge of the issues relating to elderly people which often are as much mental as well as physical.

Re the dehydration leading to UTIs my friend’s elderly MIL constantly got UTIs due to dehydration and was a doctor refuser. However the dehydration was caused by a refusal to drink anything because the only toilet was upstairs and she had poor mobility so going to the toilet was a trial. Her family suggested putting in a downstairs toilet to address the issue but she refused! As it turned out she ended up being rushed to hospital due to delirium caused by a UTI. Unfortunately they then found out she had advanced cervical cancer and died 4 weeks later. I don’t think maybe the idea of a dedicated unit would have helped her but it may for the ones who do constantly see medics who don’t identify all the issues.

@Podgedodge well the surgeons do like to have something to do... 😉

@rookiemere the other 0.1% is spent on people under 70.

Thank you for all of the replies earlier. I told my mother a lie to say the shop doesn't have an online shop any more. I feel so guilty lieing to her but I just can't cope with this. She had a list made and it was only really a few things that can all be got with Tesco. Nothing too urgent. I had a quick look at one item already and it's not there any more. I was able to buy it in the physical shop a few months ago but it's not online. A list that would only really take about 10 or 15 minutes of she was to give me the list but she won't give it to me. She wants to talk me through her list and get me to show her where she can investigate and examine things and the shop and it would take a few hours. One thing on her list makes no sense. She wrote soaf anti bac. I never heard of that brand soaf before. This isn't the first time this has happened. It happened a few times where she gets confused on some crackers or biscuits and she's not able to say it or thing or it comes out very wrong or it's mash of other words. But to be honest this isn't a surprise for me. I live with her and I can see a decline and it's clear there's something happening but I am being denied a diagnosis and support until a crisis. It's gut wrenching.

@PerdreLeBleu
That sounds sensible.
Along with things like decent patient transport, comms with family members, notes across different areas (GP, various hospital areas etc).

And community nursing!

There is also something about housing options, so many elderly people end up in unsuitable/unsafe housing, because the alternatives aren't much better from a practical point of view. Retirement flats where you have to drive?!

When I'm queen of the world I will sort this out!

@JeffLebowski , I don't want to alarm you unduly, but delirium can take a long time to settle and some folk never get back to their pre-delirium state. Obviously, fingers crossed that your ER improves quickly but it might be best if you plan on the basis that that might be a very slow and possibly incomplete process 😕

@Eclipsing that is a good point. As it came on so quickly I think I've been assuming it will go just as quickly. But I need to remember that isn't necessarily true.

Dealing with my DM when she is absolutely, inconsolably distraught because she thinks the nurses are conspiring against her is soul-destroying. And this has only been going on for a few days. I need to go and see her again in the next day or two but I'm dreading it.

@JeffLebowski
Hold on in there, we can get through this.

Are you getting updates from the hospital? Has she seen anyone like physio etc? What's her usual living situation?

I think both the organisation of the NHS and the training of doctors and nurses hasn’t caught up with the reality we all know. Ie that people live longer but with poorer quality of life for the last couple of years. They just aren’t set up to deal effectively with the merry go round of crisis-hospital-unsafe discharge-crisis.

Plus, there being a significant number of family members who still insist on the elderly being treated for everything (mentioning no names but examples of difficult siblings on this very thread).

I have a small sliver of hope that our current PM “gets it” thanks to his families experience with his dad, and his stated desire to get the often talked of “national care service” finally off the ground. It should get cross party support, I seem to recall Boris Johnson wanting to do it but it seemed to go in the “too difficult” box. If done properly it could transform the NHS by removing all the “bed blocking”. Which isn’t the patients fault!

On a separate note I had a random thought today that I thought I’d share on here as it may be helpful to someone now or in the future. Well it’s not entirely random but it would take far too many words to explain the convoluted route to get here.

For those of you keeping an eye on elderly loved ones who are just on the cusp of managing - how are their feet? At that stage my mum was washing herself and wearing clean clothes every day and able to chat - but she’d stopped paying attention to her feet but not said. One day (actually Christmas Day afternoon) she asked me if I’d have a look at hers as she’d not been able to cut her nails “for a couple of weeks”, and would I mind very much doing it for her.

I’m not squeamish about feet so I said yes of course. They were awful! Some toenails had got so long they’d curved round and were digging into the pads of the underside of the toes. There was a fungal infection so bad on her big toes that the actual fungus was visibly growing on the top. Memorable Christmas that one.

Now the point of this isn’t to make everyone but to say that it had got very painful to wear shoes and even walk in her slippers. Which contributed overall to her decline because she got it in her head that walking hurt her feet even when they were sorted.

So ask your loved ones about their feet and whether they need to see a podiatrist (chiropodist in old money). I know it may be One More Bloody Thing To Do but I do think it’s essential hygiene/health.

Plus, if it saves just one other person from spending their Christmas scraping orange fungus and finding cutting tools to deal with horn-like nails, it will be worth it.

@Podgedodge great news that MIL has accepted the surgery. Sorry it makes you the bad guy though!

@Bweave is it not soap - anti bacterial?

My DM has been a bit bizarre this last couple of weeks and I'm concerned about cognitive decline. She has Parkinson's which can come with its own kind of dementia but I'm not sure what the next steps should be. I spoke to my Dsis who agrees that DM is behaving a bit strangely.

@Exhaustedpickle Oh no! Not another one.
Can you give her GP a ring and try to get her a quick appointment?

There is a dehydration, UTI and delerium bench over here, @JeffLebowski and I can budge up and give you some space, we have cranberry juice. 🙄

@JeffLebowski it's horrible seeing them in distress. The worst memory of my DM's final stay in hospital was when she got a UTI and was completely out of her gourd. Her partner and I both thought she was dying-dying. Long story short, the next day I came in and found her chatting happily to the nurses - new antibiotics had sorted it.

Phone call this morning from the ward. "Has anyone called you about doing a stretcher assessment on ER's house?"
Fuxake, do they never a) talk to the patient b) write anything down. No.
I mean she's been bouncing in and out of hospital the past couple of years and they were in her house a week or two ago...

"I am (two counties away)... She has a key safe," I say with practiced civility.
"They can't use a key safe, someone has to let them in,"
(Oh dear, is there a bad apple in the paramedics who nicks stuff? I do not say.)
I say the neighbours are very helpful (bless them) and ER has their numbers.

I texted ER (because I do talk to her, unlike them, and sure she's old and frail, but broadly speaking the marble count is A-OK) and she said, "you're on holiday... I'm coping very well". Bless her.

I'm not actually worried that anything much will go wrong so I count myself lucky there. Thanks to Mr ER who left her v v comfortably off.

My vague plan is to go down next weekend when we're back. Depending on how she's doing, I can suggest she gets a private physio in daily to help her claw back as much function as she can.

The care home convo may be drawing closer. But she may just want to be At Home With Her Cat and I can understand that.

@Podgedodge 🏆

@MysterOfwomanY maybe the person doing the stretcher assessment is a vampire and has to be invited in.

You deserve a medal! I am squeamish about feet, even my own.

But you make an excellent point. My DM is diabetic. I know at some point she used to be visited by a podiatrist regularly.

In my town there is a foot clinic. For £30 he does a proper toenail cut. Not a podiatrist, kind of next level down but much more medical than a pedicure.

Thinking of the UTI and hospital delirium issue. One problem I saw with DM was the heavy dependence on catheters in hospital. She had a catheter for over a year and very frequent UTIs.

I think catheters were seen as the 'easy' and perhaps 'medical' approach. Now she has pads which require personal care rather than nursing care. She hasnt had a UTI for many months.

Toilet management is a huge problem in hospital when someone has restricted mobility. Commodes next to the bed are awful. The patient needs to be able to anticipate bladder and bowel needs so that there is time to summon help which can take a long time to come.

Toileting was a huge source of distress for DM.

I think the issue of dealing with toileting is one of the many things that a more sensibly put together elderly care system could improve. My DF spend months in and out of a 'frailty' ward in hospital towards the end of his life due to lung problems. His actual illness did not prevent him from using the toilet normally but he was too frail to get there on his own so ended up having to use incontinence pads/pants simply because there were not enough staff members to reliably take him every time he needed to go. Which of course meant less dignity for him, more issues with sores etc and a more unpleasant and time-consuming job for the staff. The ward was noisy day and night, primarily due to patients with dementia/delirium etc which meant no patients got proper rest which won't have helped them. The staff were clearly trying their best but there simply were not enough people to have time to deal with every patient as they needed. My observation was that those with cognitive problems often had to be left (so that other patients could be helped) until they were in a position that they were likely to cause harm to themselves or others.
In reality most of the patients there didn't really need full hospital care- they would have been better off with some sort of nursing facility without doctors etc but with trained staff to keep them comfortable as they recovered from falls/infections etc. Of course, patients and their relatives would need to be aware that such a facility may not be able to offer the same actual treatments/emergency response etc as a hospital and this really does seem to be a conversation that many HCP seem very reluctant to have. Which I think is at the heart of a lot of this- the choice between focussing on quality of life towards the end, or extending life as long as possible. As @funnelfan mentioned, many of us have siblings who push for the latter, which doesn't help.

Thanks @MittensTheKittens I am fairly sure it isn't a UTI this time. We've been through that before and it was mayhem! This is more strange somehow - talking about recurring dreams, not instantly recognising people, being unable to use her mobile phone after years of no problems. In other ways she is still fine so it's hard to gauge.

@rookiemere to be fair they were polite, but I know enough to get out the bit about where I live early on in the conversation nowadays!

Bless them, they (HCPs) always start with, "nothing to worry about...", but tbh if Mother Nature had decided to gather her up in the night, it wouldn't be the worst thing.

ER's neighbours put her bins out, and they're are as old as she is, but much more fortunate as regards health and fitness.

@bigdogpaws that's the scenario I'm worried about. Just being able to totter a few steps with the walker and get to a commode and back would be a big win vs being immobile (which comes with big risks like pressure sores and pneumonia).

Cognitive soundness is at once a blessing (she won't forget she can't walk and try to get out of bed at 3am) and a curse (she knows what's happening to her and it's up to her to discuss ceilings of care etc with the medics).

Sidetracking a bit, a few posters have mentioned arrangements for putting ER bins out. It may not be the case in all areas, but I found out that where DM lives the bin collection team will come on to the property to collect and replace bins for elderly people who can't manage to put them out themselves (as long as there is no locked gate and they can be seen from the road). It's called 'assisted bin collection'. It was arrange with just a call to the council- no proof of age/infirmity etc needed. It's only a small job but was one thing ticked off the list of reasons to have to visit or organise someone else to do.

You've reminded me, we had to get that for my DGranny when they first introduced wheely bins "it's bigger than me!" she was tiny.

We arranged that for mum, they needed to be left in front of the garage for access but she kept putting them in the garage as she thought it looked untidy. So we were forever going up to find out the bins hadn't been emptied yet again.