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Old 02-12-2008, 12:18 AM
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Default What to send in care package?

My grandmother has been in a nursing home for a few months now. It was only supposed to be a temporary thing; she was supposed to go home after a couple of weeks, but it didn't work out that way.

She's depressed and not eating. She was eating sweets at least, but now not even eating that.

Honestly, she's being quite nasty to my mom. Mom tells her that if she doesn't start eating, she'll die and gram responded, "you've been telling me I'm going to die for one reason or another for the last 10 years and I'm still here."

Does anyone have any ideas of what I could send her in a care package? I live 1500 miles away. I've sent her flowers and pictures of Gabe already. I guess I'd like to take a humorous approach - everyone is badgering her to eat, to participate in her therapies, and she's just not having any of it.

I want to send her something just to show her I'm thinking of her without any nagging undertones (I don't want to send her food, for example.) I just want to get her to laugh. Or even chuckle.
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Old 02-15-2008, 05:38 AM
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I am sorry to hear that she is unhappy in her current accommodation. My last grandparent passed away at the end of last year. All my grandparents have been in nursing homes/hostels. One by choice (a nurse), one because she thought that she could live with my parents but it was too hard on them, and the last got dementia and couldn't be looked after at home.

What to send??? This all depends on what she likes and is in to. We used to always send food, as she loved to eat and she didn't use the other things that we sent. If she likes gardening you could see if she could have some space in the facilities garden beds. A lot of facilities allow residents to plant flowers and ussally the areas are just outside their windows and doors so that they can see everything growing and flowering. If this is the case you can send/take plants for her to plant.

If she is into handy crafts, find out what she is currently working on and provided more/new materials for her. The current trend is for felting. It is easy to do, is great therapy and she could see some of her work at fetes.

Most hostels/nursing homes are nice welcoming places, but the residents are 'trapped' in them all day, every day. I know that some community services organize field trips for senior citizens. They come around with a bus and pick everyone up and go to movies, galleries, etc. You could contact one of them and pay for a few activities for her to get out of her place. You can then make up some simple gift certificates to make it more special and send them to her.

Back on the theme of the garden. A ;ot of residents feel that they have lost their identity when they move into these places. The rooms are often small and dull. It is a matter of making the room their own. Raid their belongings (I mean this in a nice way). If they have moved out of their own place and most of their belongings are at your parents place, go through looking for things which signify her to you, they could be important to her identity. Stuff like jewelry (not expensive stuff though), talc powders, art work, lamps, photos of the grand kids!!!(they do compare amongst other residents ). What I'm trying to say is that she needs to know it is only a new phase of her life, people are not trying to take away her life.

The list:
Lollies/sweets (depending of tastes as to cost)
seeds/plants (if they like gardening)
photos in frames with 3M removable hooks (nurses and mantance are more likely to put them up if everything is provided)
Soaps/powders (if they like that stuff)
Items from their own house.

Hope this is of help, its what I used to take/send.
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Old 02-15-2008, 10:16 AM
LesleyJoy
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Geena,

Perhaps your grandmother is grieving not only the loss of her health and home, but is also dealing with all the other developmental stages of the older adult (see "integrity vs. despair" at http://allpsych.com/psychology101/so...velopment.html ). If your grandmother's grief has become depression she may benefit from a clinical evaluation. Counseling, medication, exercise, proper diet, social involvement, and/or exposure to adequate light cannot take the place of meeting what Erikson describes as the essential tasks of aging, but they can most certainly help.

My mother, well old enough to be your grandmother, thoroughly enjoys reading "Maxine," that cartoon about a sharp-tongued and cranky old woman. Perhaps a bit of biting humor would benefit your grandmother.

Please keep us posted, OK? Thanks.

Joy

PS My own mother took steps to avoid a bit of the disequilbrium associated with the losses of aging by choosing to make every effort to live well in her old age: She chose an assisted living facility, maintained a good diet and exercise plan, and enjoyed a large variety of social activities. She was very proud of her accomplishment. Proud, that is, until the day I called after not hearing from her in two weeks. Her voice was weak. She was dyspneic. And - worst of all - she lacked her usual dictatorial manner. It took almost nothing to get her to tell me that she was recovering from pneumonia. Over her protest I said I would see her the next day.

That next day, after driving more than 6 hours, I arrived to find one very angry woman. So angry was she that not only did she not invite me to sit down, she said, "You might as well keep your coat on because I have booked you a room at a hotel." With that she ushered me out of her hallway and out of the facility. She led the way to the parking area, head held high, and breathing like a steam engine. She insisted I follow her in my car as she drove her own vehicle to the hotel. There she left me with the terse instruction to meet her for breakfast before I left town the next morning!

Years later she still lacks insight into just why she was so upset with me. You see, mother has always done precisely as she has chosen to do. For her to acknowledge she might need a little daughterly/nursely oversight was galling beyond tolerance. She remains a fiercely independent individual whose only wish is to die before she become dependent upon anyone. "Erikson be d---ed," she exclaims with pink cheeks and raised fist, "I have nothing to resolve!"

If anyone is interested, I willl tell you funny stories about my mother, one of the sparklers in this world.

Joy

Last edited by LesleyJoy; 02-15-2008 at 11:38 AM. Reason: syntax errors
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Old 02-15-2008, 11:42 AM
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Originally Posted by LesleyJoy View Post
Perhaps your grandmother is grieving not only the loss of her health and home, but is also dealing with all the other developmental stages of the older adult (see "integrity vs. despair" at http://allpsych.com/psychology101/so...velopment.html ). If your grandmother's grief has become depression she may benefit from a clinical evaluation. Counseling, medication, exercise, proper diet, social involvement, and/or exposure to adequate light cannot take the place of meeting what Erikson describes as the essential tasks of aging, but they can most certainly help.
She's being treated for depression with medication. She refuses to particpate in any sort of therapy. I don't think the meds are working. She refuses to eat properly. I'm surprised she consents to get out of bed. She has lost the use of one arm due to some nerve condition (I can't remember the name of it). I KNOW that's a big part of it. She used to be really into cooking, playing cards and dominoes... now she can't do any of that. I'm positive it's having an effect on her quality of life, but she refuses to acknowledge it or talk about it.


Quote:
For her to acknowledge she might need a little daughterly/nursely oversight was galling beyond tolerance. She remains a fiercely independent individual whose only wish is to die before she become dependent upon anyone. "Erikson be d---ed," she exclaims with pink cheeks and raised fist, "I have nothing to resolve!"
This is very key - gram is a bit demented to the point where she could not manage her own medications and my mother (who is a nurse) had to start sorting them for her. She deeply resented having this done for her and would usually sabotage mom's efforts to help her.

Obviously, this is either her literally dying and she's in the end stages, or her desire for control is so great that she would rather starve herself. Duh!!! I can't believe I didn't put that all together.

Thank you, Joy. Truly great advice. And I'd love to hear more about your mom!

P/J - also very good advice, thank you. I'd sent her flowers, but they die rather quickly as compared to a plant. Maybe if she had something to take care of, it might help. Couldn't hurt. I'll definitely look into sending her an easy plant to take care of.... she had lots of plants while I was growing up.

Last edited by geenaRN; 02-15-2008 at 11:43 AM. Reason: maimed the quotes.
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Old 02-15-2008, 04:56 PM
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Do you know what anti-depressant she's on? Mirtazapine (Remeron) causes an increase in appetite so it can be helpful in that regard. Sounds like she doesn't have end-stage dementia (at which point eating often does stop) if she's just "a little demented" (but when is the last time you saw her vs. getting other people's reports?) A key to getting someone w/dementia to eat is "soft and sweet" Also activating other senses: I know of NH where they bake fresh bread or cookies as the smell can be an appetite stimulant.

Something else you might want to think about is a discussion of TF. If she continues to refuse to eat, someone is likely to suggest a PEG tube. While she still can discuss her preferences, it would be good to get an idea of what she does/doesn't want (beyond DNR/DNI). If where she lives has a POLST, that would be good to get filled in. If not, something like Five Wishes might be a good idea.

You also may want to see if her pain in controlled. Pain can cause depression. If she has chronic pain, scheduled dosing might be better than PRN (that is, if she has anything even ordered)

Lastly, VRFF (voluntary refusal of food and fluid) is real, and utilized more often than we might want to think about. As you yourself noted, she could be doing this willfully (even more reason to have the TF issue discussed).

Genna, I realize I haven't answered your care package question, but I hope this was helpful anyway. What other people have said are good ideas--surround her with things that matter to her, find things that may engage her. If you can get a chance, go visit. Also, talk w/your mom, as she is probably going though her own process around this and may need someone to talk to (and remember, just b/c she's not living w/your mom, she's still acting as a caregiver with all the attendant stress and burden. Make sure she's taking care of herself too!
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Old 02-23-2008, 09:36 AM
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Maybe she needs friends. Possibly if you could send somethings that she had enough to share with others this might spark a friendship. even with alot of people around--she could just be lonely.
Maybe if you called and talked to the DON or even the Social Worker you might find out more about what she is doing when there is no family there. Whatever she is feeling she might be more likely to take it out on her family. Maybe even try to make them feel guility about "putting" her there.
Care packages are just fun--put in alot of different small things--lotion, (no powder please), some nice smelling bath and body works type stuff, warm socks with no slip things on the bottom, nice pjs, maybe even a comforter and nice pillow cases. What ever you can think of that would make her feel "special".
Most of the time it doesn't matter what is in the package it is just the act of getting a CARE package that matters. Write her a long letter, send her snapshots of yourself and your family on a regular basis. Send something small every week--cards, letters, pictures, jokes.
Activites are to be individualized so speaking with the activities director might be something you could do as well. Find out what they are doing with her. If she isn't participating outside the room then they are supposed to be doing in room activities with her.
The more you discuss her care with the facility staff the more you will learn and the better able they will be to learn about her from you and individualize her care. You know her better than they do. And they need to learn from you and your family.
There is an adjustment period---some residents actually go thru the stages of grief. It is a loss and a stressful loss. Loss of independence, loss of their home and belongings. Antidepressants help but they still need to grieve the loss.
Hope some of this helps
P.S. MayVita helps increase appetite too. It is like Geritol.
I have a friend who is an RD--ex-state surveyor--I'll see if she has any suggestions.

Last edited by gracenotes1; 02-23-2008 at 09:38 AM. Reason: P.S.
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Old 03-14-2008, 02:13 PM
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Default Just an update

Just wanted to let you know that my grandmother passed away this week. I was there to see her before that happened; I was really shocked at how badly she'd deteriorated over the last few months.

I saw her the day she died. She was a little uncomfortable breathing-wise, but not in any distress. I brought Gabe to her and she smiled at him and seemed very happy to see him.

She'll be greatly missed. Thanks to everyone for the suggestions above.. I'll keep them in mind for the future.
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Old 03-14-2008, 02:36 PM
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Geena,

So sorry for your loss. You and your mom and Gabe are in my thoughts. I'm glad you got to see her one more time, and she got to see Gabe, and that her passing wasn't too hard.
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Old 03-14-2008, 04:21 PM
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Thank you for sharing with us Geena. I am so glad that you were able to see her, and for her to see Gabe before she passed away. My thoughts are also with you.
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Old 03-15-2008, 02:15 AM
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(((((Dear Geena)))))

I am so very sorry.

Praying for you all,

Joy
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