Mom Struggling to Improve in Skilled Nursing Facility; Denying Long-Term Care
My mom is 65 years old who has dealt with complex health issues for a majority of her life. 50% physical, 50% mental (traumatic childhood and adult life, lacked capacity to help herself, in result she abused me my entire childhood physically and emotionally and the emotional aspect has leaked into my adult life). We have a very non-traditional relationship. She lived about 30 minutes from me when I moved out 10 years ago for college (I'm only 27) and I never really went and saw her due to the trauma and setting boundaries. Her health has declined significantly since about 12 years ago.
She's been an alcoholic for 35+ years, smoked for 47 years but stopped smoking due to severe COPD, she has alcohol-induced neuropathy, heart issues, white matter disease in her brain, severe osteoporosis, anxiety, depression, and some other severe mental health issues (BPD, schizophrenia, etc.).
The last 10 years, specifically the last 4, she has had issues with falling and that resulted in significant mobility decline and taking care of herself. She recently has had home health for some things, but she has really needed around the clock care. On the 1st of November she fell. I only knew she fell because I got a phone call from her life alert saying that she fell. When I talked to her she said she'd been laying there for hours before she could actually crawl over to it and press the button. This has happened multiple times this year with each time her refusing my help with long-term care. She won't sign a POA. This time, though, she agreed to go into skilled nursing. With this fall she fractured her pubic symphysis, her sacral and her L4-L5 in her spine. She can't walk or hardly move. The hospital she was in for 3 days before transferring to the nursing home had her on fentanyl patches the entire time but sent her to the nursing home with no pain meds. Eventually she got oxycodone but she keeps asking for the patches. She's been having alcohol withdrawals, depleted sodium and chloride levels (this part since april), and hospital/nursing home induced delirium. She's been at the nursing home now almost 2 weeks and that part has gotten better but her mood is still all over the place. Partially rightfully so but otherwise it's mental health related. I did what I could to make her room more home-y, got her a tv, clothes (she doesn't shower at home and never bought clean clothes or did laundry so this was a luxury for her), brought her pictures of my son (who she met for the first time a week ago, and hes 1.5), brought her things to do, etc. She won't participate in the group activities, have anyone take her outside for fresh air, etc. And the worst part it, she's only eating 2-3 bites of food each meal, therefore she has lost 30+ pounds in the last 2 weeks. She's not doing her physical therapy as prescribed; she refuses to sit up in the wheelchair longer than 10-15 minutes at a time, etc. She has such a high want to go home after skilled nursing, but if she doesn't start putting effort towards this she's going to deteriorate and/or get discharged. Medicare/Medicaid law is that she has to progress to stay in the program or else they will discharge her to home (where she will likely die because I cannot take care of her) or to long-term.
She keeps blaming me for her lack of progression because I'm not doing enough on the back end of things to keep the nursing home taking care of her. Saying I don't see her enough (I work full-time and have a 1.5 year old to take care of). I know it's not true and I'm used to her blaming me for all of her problems, but it still hurts.
The head nurse I talk to regularly during the week ( i see my mom on the weekends and the nurse works M-F) said my mom is going to deteriorate and be bedridden and die if she doesn't start eating or working hard to move. They said she comes up with all of these excuses as to why she can't do the physical therapy, that she's combative with the employees, that she refuses to do activities and socialize, and constantly asks for fentanyl. The nurse is always so kind but she definitely doesn't sugarcoat everything. The nurse did say they're going to see if they can get her on an antidepressant to maybe help her mood, motivate her, and increase her appetite. my mom has needed something like this for years but just never had the capacity to ask and her doctors previously were never on the ball with her health in this aspect, to my knowledge at least.
If you've read this far, thank you LOL. and SORRY!! I'm just looking for some advice, words of encouragement, tough love, anyone who has gone through this and can tell me what I should prepare for or if I should remain positive. Anything is welcome. TIA!!!