Hello XXXXXXXXXXXX,
Are you and your Mother located within the United States; and does your Mother have medicare coverage?
My mother and I live together in Rego Park, Queens, NY 11374 She has medicare
and United Health care (indemtity option) as secondary carrier from her former
employer, I really would to change doctors and the nurning home. The doctor
was quite willing to let my mother die before I gave him the information regarding
the feeding tube.
So, if I am understanding you correctly, your Mother is currently in a nursing home?
And does she have a gastrostomy tube, or a nasogastric tube inserted? Also, why is she not able to swallow?
Presently she is at the hospital where the peg tube was inserted and her esophagus
is curly and tortous plus she has a large hiatel hernia.
OK, then what you need to do is ask to work with the hospital discharge planner that is arranging for her discharge. She does not need to go to a nursing home, if this is not what you want to do. You can take care of a feeding tube at home, but you will need training. They can start teaching you at the hospital, but hospital nurses are not always the best at teaching. And though the care is not difficult, there is much to remember and to understand. Having the feeding tube can cause many complications if you are not diligent, and some that will occur even if you try to prevent them. You just need to be aware. Someone would have to commit to being with your Mother full time. Whoever that person is should receive this training.
Here is a link that explains Home Gastrostomy Tube Feeding.
Also, the discharge planner can arrange for Home Health nurses to come into the home to continue this training, and they will help monitor your Mother's condition and progress on the feeding. Medicare pays for this. Since your Mother has been in the hospital for some time with pneumonia, she will likely need some physical therapy as well, which she can also receive through Home Health.
The other option is to transfer her to a nursing home (this is what the hospital and the doctor will try to persuade you to do) for skilled care that Medicare will pay for (100 days, with the first 20 days being fully covered, then day 21 to 100 a combination of Medicare and a copay that will probably be covered by her secondary insurance). If the nursing home is a good one, the staff there can also train you and make sure she gets some PT to get her up and about as much as she is able. Once her therapy is done, the nursing home discharge planner can arrange for Home Health to come into the home to help with the care of the tube and make sure you (or whoever) knows how to care for your Mother properly.
If you are up to the challenge, my own opinion is that she would most likely do better at home. I have worked in nursing homes for many years, and though some are very good at rehab and skilled care, you have to pay attention. The best of nursing homes still have problems with short staffing and poorly personnel. It's not the nursing home's fault, it's just the way the system is.
Let me know if you need more information.
Nurse (RN)
35+ yrs skilled nursing experience; Dir of Nursing Skilled Nursing/Rehab; Elder Care Consultant
What can be done to correct my mother's esophagus which is curly and tortous as
as well as the large hiatel hernia ?
Hello,
At her age, there is likely nothing that can be done about that. She would most likely have to have surgery to try to correct it. Even in much younger people, surgery for hiatal hernia is not always successful. And even if a surgical procedure were done, there is no guarantee that she would heal sufficiently for it to allow her to swallow normally again.
She would have to be examined by a Gastroenterologist who may have a better idea of what would need to be done to correct all of her esophageal problems.
Would my mother be able to travel in a cab to take her to doctor's visits with this
peg tube?
Yes, of course.
Usually the feedings are administered every few hours, depending on how much she can tolerate in her stomach at once time without worry of reflux and choking. And some people receive the feeding continuously by pump over the course of the night, so they are free to be up and about during the day. Then, she would only need water occasionally put through the tube during the day.
Once the feeding is done, the tube can be plugged or capped and then held in place with a gauze dressing and some tape, or an abdominal binder that is loosely applied around her. Just to protect the tube and keep it from dangling which will pull on the stoma. She can then go anywhere, or do anything she would normally do.
I would take a precaution and have a change of clothing along just in case the tube were to come uncapped and leak. It happens occasionally.
I neglected to mention:
If you are interested (although they may have already done this), and your Mom wants to go through this, there is a test that can be done to see what happens when she swallows. It's called a barium swallow. You can also request from Home Health that she have a Speech therapy evaluation to check on her swallowing ability. Speech therapists do swallowing therapy as well as speech. The speech therapist can arrange for a swallow study to be done to see if there is any hope of her being able to swallow on her own again.
I live with my mother on a permanent basis but I have to go shopping for food
and medication as well my own medical appointments, is this feasable ?
If your mother is cognitively intact, sure it is. What you want to wary of are things like your Mother being confused, pulling on the tube, trying to put something into the tube, anything that she might do to injure herself.
If she does have periods of confusion, you can arrange for a "sitter" while you are out. If you don't know anyone that could do this for you, the Home Health nurses would probably have some suggestions. They can be a wonderful resource.
Another thing:
If you are not comfortable doing this, it doesn't work out, its too much for you to handle, whatever.....
you still have 30 days from the day she discharged from the hospital to place her in a nursing home and medicare will pay.
And if you do want to place her in a nursing home, take some time and check out some of the facilities in your area. Talk to the staff. Choose one you feel comfortable with.
I have a pro-life belief and do not believe people are expendable because of age. How can
find a physician with similiar viewpoint? When my mother was at this nursing home
she refused to take any food and medication because this was her method of
avoiding physical therapy. She became extremely ill and her physician informed
me that she was dying. This was a doctor was recommended by a friend
to facilate gaining entry a hospital for hip surgergy. Ater the her operation,
she had eating problems and congestion and he was only interested getting her
into the nursing home without having her problems investigated at the hospital.
When she was very ill the nursing home, he did come not forth with information
regarding a peg tube or tpn. I was able find this information on my own
partially from your service and some kind individual. When I said do not
make me watch my mother starve to death to do the peg he called for ambulance.. When she re-entered
this hospital, an excellent community facilty, he only gave TPN when I brought
this issue to the table. If needed, is there a way find a pro-life nursing home.?
I am an ordinary person and the best health system in the world extremely
navigate for protecting my mother. This my last reply. Thank you
The only way to do this is to visit each facility and talk to some key people there. The Administrator, Director of Nurses and Social Services person will be the people that guide the staff in caring for the elders in their facility. If these people have an attitude similar to yours, and/or if they understand your attitude in caring for your Mother, they will make sure the staff takes care of your Mother as you would.
I worked for a time in a nursing home in Maine. Coming from the west coast at the time, I was very pleased with the general attitude of long term care in the area. It seemed that people in the east tend to honor their Elders a bit more than in the west. Maybe it was just that facility. But there are nursing homes that are staffed by people who genuinely care about the quality of life and happiness of our Elders, no matter how old they are, and no matter what their physical limitations may be. For the most part, it has been my experience that people who do "stick it out" in nursing homes are people who really care because they sure don't get paid enough to stay the job. My only concern is the time the staff is "alloted" by the system (corporate, medicare and medicaid payment systems, governmental regulations etc) just doesn't do our Elders justice. The facility I worked for was privately owned and all private pay. So I am sure this made a big difference, since the staffing levels were better than most.
In general, a good nursing home's staff will bend over backwards to make you and your loved one happy. But you have to be realistic in your expectations of their ability and time. Also, your Mother's attitude about placement will make a big difference. Some people cannot tolerate nursing home life. And if you have to pay privately, it might cost a bit less to have someone care for her at home.
Anyway, like I said, if you find the Administrator, DON and Social Services to be "pro-life" when it comes to your Mom's care, then this is the place you want to be. Talk to them. Once you talk to a few nursing homes' staff, you will be able to tell the difference between the genuine people, and the ones just giving you lip service.
Good luck in your quest. I wish you and your Mother all the best.