I am not sure if I can get help here or not....My grandma

[hang a left]

recently had a hip replacement surgery. She is also a schizophrenic. She was transferred from the hospital ward to a rehabilitation unit on another floor in the same hospital.

She is not doing well. This is her eighth day in rehab and she can't do anything for herself. She falls asleep all the time, is not cooperative with her therapies to get her to stand and to walk with a walker. They are threatening to discharge her to a nursing home because she is not participating or responding to the attempted physical therapies. For the first few days she wouldn't open her eyes or lift her arms.

From what I am being told this is a surgery where you get up fairly quickly and by this stage she should be walking with her walker with minimal assistance. And preparing to be discharged to go home within few days. She had the capability of being at this facility for 14-20 days. However because she is making NO progress, not even dressing herself and has to be helped in and out of the bed, they want to discharge her to a nursing home where she will get even less attention and therapy. Bottom line, the insurance will not continue to pay for her stay if she is not progressing.

Here is my point. I am wondering if she has had some type of psychiatric break down. Because when I look in her eyes, she just isn't all there. She doesn't seem to have the initiative to help herself and all she wants to do is sleep. I have been goggling to try to find some kind of answer. Perhaps she needs an augmentation to the stelazine she takes or something. The Psychiatrist was in and recommended adding a medication but my grandmother didn't want to do that (stubborn old bird). I just feel real powerless and not sure what it is that we can do for her at this point other that some serious tough love and shoving some new meds down her throat.

If she goes to a nursing home she will be miserable and will surely deteriorate, as well as not receive the therapy and care that could help her out of this jam. And I just don't think the family is able to take on a 24/7 invalid with everything else that is going on in our lives.

Any suggestions, advice, experience, words of wisdom, or benzo would be greatly appreciated.


Thank You

[Redstone]

1. Jesus, I hope SOMEONE can help you. I can't. I wish I could.

I wish you and your grandma the best of luck with this, I really do.

Redstone

[Waya]

2. How old is your Grandma?

[hang a left]

20. 83

[LaurenG]

3. Ask for a psychiatric consult before she goes anywhere

People sometimes have psychotic breaks from being in the hospital. Both of my parents went through this. It may help if they can send her to rehab and get her re-oriented.

edited to add this link
http://www.merck.com/mmhe/sec06/ch083/ch083b.html


ICU Psychosis
Causes

Development or worsening of almost any disorder can cause delirium. Any person can become delirious when they are extremely ill or are taking drugs that affect brain function. However, delirium can result from less severe conditions in older people and in people whose brain has been affected by a stroke, dementia, or other disorders that cause nerve degeneration. In such people, delirium can result from a relatively minor illness, such as retention of urine or feces; sensory deprivation, such as that due to being socially isolated or not wearing glasses or hearing aids; or prolonged sleep deprivation. For example, the sensory and sleep deprivation that occurs in intensive care units (ICUs) may contribute to delirium. This disorder is sometimes called ICU psychosis.

Being in the hospital can also contribute to or trigger delirium. About 10 to 20% of older people develop delirium while they are in the hospital. Delirium is also very common after surgery, probably because of the stress of surgery, the anesthetics used during surgery, and the analgesics used after surgery.

[uppityperson]

4. how old is your gramma?

edite to add, that sounds really tough. Can she get a psych consult before being sent somewhere? Could be having problems recovering from surgery stress, exacerbating her symptoms.

[pacalo]

5. Keeping this kicked.

I feel for you! Good luck in getting the advice you desperately need. :hug:

[Master Mahon]

6. Drug interactions?

Could she be having serious drug interactions?
Hip replacement surgury can be painful and debilitating, especially
for older people.
The combination of pain medication and antipsychotics can be having
a major impact.
Post surgical depression is very common in the aged. This on top of
schizophrenia can result in a lengthy recover period.

[Waya]

9. Was thinking that, too...

..not everyone recovers at the same rate from Surgery....or adheres to the 'recuperation guidelines' of the medical experts.

People react differently to pain meds, too....Some of those can dope some people up more than others.

There could be many reasons why she is not responding....seems that they might want to spend a lil more time trying to see if they can find any reasons instead of 'unloading' her to a Nursing Home posthaste.

[MichiganVote]

15. Second that. Also, I was told once that for every hour under anethesia

expect a corresponding month for rehab. Many nursing homes have a PT component. She may need a home that has something to help her with a slower than average recovery.

[BlueEyedSon]

7. Arent there any social worker types at the hospital?

[Extend a Hand]

8. my mom

had a bad reaction to anesthesia after an emergency surgery and was not lucid for 11 days. The insurance was willing to pay for 30 days in a rehab center. It really did wonders. She was back in touch with reality after about two days of their program. Her surgeon was able to direct us to a place specializing in rehabilitation. Apparently there are quiet a number of nursing homes that are calling themselves "rehab" centers now that really aren't all that great-- so if this is an option be careful.

Good luck!

[Lil]

10. If she is taking new medications - especially ones for pain . . .

. . . ask them to evaluate the interactions of all her medications (if they haven't) and possibly adjust those - for starters.

edit - oops crosspost with above.

[BrklynLiberal]

11. When something like that happened to my mother it was because she had

been over-anesthetized.
She had been taking anti-seizure meds since she had epilepsy, and when they put her out for surgery they did not account for the meds in her system.
See if you can check into that possiblity..or if you can even get anyone to admit the possiblity.
We got officially stonewalled, so we could not sue, but did find out the truth off the record.

[beingthere]

12. i do have some experience with this kind of thing and

your gram needs an advocate. Check if your area (city?, county? has an "Agency on Aging") - it would be free, and provide social work and other necessary services. Also, talk to the hospital social worker. All hospitals have them. Remember, nowhere can a hospital discharge a patient without "discharge planning". Also, of course, demand frank answres from her doctors. What meds is she on ?? Did she possibly have a slight stroke during surgery? Explain what you've noticed, and you have to be assertive. Health care is a battle in this country. Write down the meds. Get online and research the side effects. Find out from docs exactly what the prognosis is. Also, don't forget the importance of nutrition and hydration. Is she eating and drinking? Try to have family members visit at mealtimes. Patients who don't eat often don't get fed, because of busy staff just not bothering. Write me back how you make out, or if you have more questions.

[NC_Nurse]

13. Has her Psychiatrist been to see her?

It may be the anesthesia and her psych meds have sent her off of her usual balance. Seems like you ought to be able to demand a psych consult before they can discharge her.
If the issue is partly psychiatric, it may be she needs to be in a different type of facility where they can address both issues.

[Quakerfriend]

14. Prayers and healing going out to your grandma. I do have

some suggestions that may help. I worked with hospital patients for many years.

First, I would suggest that you find out exactly what time she is receiving her meds and what time the physical therapist has been to see her.

I would suggest that you ask the nurses to have the therapist see her ONLY BEFORE she receives any meds in the am. I suspect that the PT is coming around later in the afternoon. Not a great time for grandma.

Secondly, I would ask the MD (gen'l med doc following her in the hospital) to write a "letter of medical necessity" stating why he feels it's necessary for grandma to get some additional days of coverage for PT and to prevent the need for nursing home placement. Fax this to her insurance co.

Best of luck. Please, let us know how she makes out.

[EC]

16. Are they giving her meds for her schizophrenia that would

cause her to be tired or lathargic?

[still_one]

17. talk to the Doctor or a MSW at the hospital

[Ian David]

18. You need to find a professional patient's advocate of some kind

Patient Advocate Foundation
[e-mail]
700 Thimble Shoals Blvd
Suite 200
Newport News, VA 23606
Phone: [phone]
Fax: [phone]

http://www.patientadvocate.org/


Also, I hope that she is not in Texas.

[cornermouse]

19. If all else fails and she goes to a rest home, you might want to

research the rest homes in your area before you come to a decision. Url below
http://www.medicare.gov/NHCompare/Include/DataSection/Questions/SearchCriteria.asp?version=default&browser=Firefox%7C1%2E5%7CWinXP&language=English&defaultstatus=0&pagelist=Home&CookiesEnabledStatus=True

If the link doesn't work go to

http://www.hhs.gov/resource/index.shtml
Scroll down to nursing homes and click on nursing home compare

[Warpy]

21. She may have given up

I know that's really hard to deal with, but that's what it sounds like to me.

In any case, make sure her psychiatrist is consulting and can rule out a worsening of her schizophrenia. Major stress on the body due to a broken bone and surgery to repair it can make a lot of other things go haywire, and mentally healthy people can have a hard time with it.

If she doesn't have a regular psychiatrist, make sure she sees one very quickly.

Even with the rapid repair and early walking we can do today, hip fractures in the elderly are 50% fatal within 6 months. That is a horrible statistic and I hope your grandma is in the 50% who decide to stay around, for her sake and yours.

Good luck.

[hang a left]

22. I want to thank each and everyone of you for your helpful input.

I have gotten many ideas. I am on the way to the hopital with the cell phone, laptop, and an attitude. No one is gonna push around my Grannie!!!! I only hope I can return the favor at some point.

:hugs:

[hang a left]

23. I just wanted to update and let everyone that was so nice and offered

help, that Grannie was doing better yesterday. I am going to go over this morning and hand out with her through her therapy. Yesterday she was really trying hard and moving her feet trying to walk with the walker. I will keep you updated. Thanks so much to my invisible friends.

[trotsky]

24. That is good news

and I'm glad she has such loving and devoted relatives such as yourself.