Conundrum of End-of-Life Care in a Skilled Nursing Facility

I have had the opposite ends of both spectrums in my husband's skilled nursing facility for his end of life care. He was first in an acute wing, and they would leave him alone too much, not checking to see if he's awake so he would miss opportunities to be out in his geri chair and would miss potential to eat anything at all on many days. The first 60 days, they had little documentation of lucidity because of this, so they started ripping his cognitive meds away because the nurse practitioner had no record of him being conscious--even though we were reporting any lucidity when we visited, it wasn't being documented.

This week we moved him to the memory care unit (my daughter pulled me out of the weeds and suggested this, and thank goodness she did). However, the first day he spent 9 hours in the geri chair because he had an unusually alert day, and the staff of the new unit didn't know how long he'd been up in the old unit. I've now made a visit or phone call to each shift (except nights) explaining how he's normally been, and how easily he is over-stimulated and they seem to be listening. Problem was...he was so alert the first 3 days, they couldn't imagine him being comatose. Well...yesterday it all caught up to him and he was unrousable from after lunch around 1 to after I left at 7p. They were astonished, but understood now that I was serious about him usually sleeping, unable to be awakened, 20+ hours a day. They did actually go back and read his chart from the other unit, also. They are empathetic to the emotional rollercoaster this surge of activity put us through at that same time they are amazed at his wide-swinging changes in capabilities.

What I have done to try to break through these barriers, if you don't get anywhere with the staff or charge nurses, go to the nurse manager or director of nursing with your concerns. I've gone as far as the administrator. Also request your hospice nurse to educate the charge nurses and nurse manager and/or director of nursing to have them communicate down to the front-line care staff about end-of-life status. The facility's social worker may be able to help you make some headway, also.  

Historically now, throughout my husband's care, the best care he's received has been in assisted living memory care, or in skilled nursing memory care. Special individuals take on memory care...often those who have experienced a loved-one with a memory problem. If members of the medical community don't choose to work with geriatric/dementia care, they are extremely difficult to educate and work with.

The Rally/Surge is Gone - Hoping Temporarily

After 10 solid months of decline and complete dependence for all ADL's (Activities of Daily Living) Wednesday, Thursday and Friday this week, we had a wonderful honeymoon of alertness that peaked between Thursday evening and Friday with my husband pressing his own call button, feeding himself dinner and drinking coffee on his own on Thursday night, then feeding himself breakfast and reading the paper on Friday morning. Then between Friday at lunch and Saturday at lunch, he gradually became a complete feeder again, and when I arrived at 1pm yesterday, he was back in his coma sleep, completely unrousable through and after 7pm, when I finally left. It was wonderful while it lasted. Complicating things, it coincided with a move from an acute wing at his facility, into the Memory Care. The staff at the Memory Care was taking his increased cognition and activity level at face value, thinking that was his current status...I repeatedly told all shifts I could be in contact with that this was temporary. They couldn't believe it yesterday when he slipped back into unresponsiveness. Now they fully understand...