My grandmother is 75 years old and is currently in hospital. I have been her part time caretaker for 7 years.
Medical history: rheumatoid arthritis, osteoporosis, history of alcoholism, peripheral vascular disease, and venous leg ulcers (5 years)
She has lost a lot of her mobility and strength in the past 3 weeks. She developed cellulitis in her legs and was admitted to hospital 4 days ago where she has been receiving IV antibiotics. Her eating has also deteriorated badly in the past 3 weeks, even more so now that she is in hospital. She has always been a picky eater but right now she is only managing spoonfuls of food at a time.
Her doctors aren't being clear about what is going on. Nobody will answer anything clearly, not about the plan of care or even worst of all if they can't do anything for her. I was called dramatic for asking to involve her vascular doctor who has been treating her for three years for these exact ulcers that now have the infection. They said she is "not eligible" for a vascular consult? I don't understand what this means and it feels like the language they are using is some code I don't understand.
She is currently experiencing delirium (confusion about where she is, seeing things that aren't there) likely from the withdrawal which is something I have seen happen to her more times I can count when she enters prolonged periods without alcohol but combined with everything, I am scared and struggling to know how to advocate for her when she can't herself. I don't know what to do. Any advice or support for a carer trying to understand doctors when they aren't communicating in a way that makes sense to a non medical professional would be appreciated. Anything I could be doing better to frame my questions more clearly? I am just lost and really worried right now.
If you feel they are speaking in "code", ask if there is an ombudsman or patient advocate in the hospital whom you can meet with.
My understanding, when they say she is not eligible for a vascular consult, it could be that her insurance will not cover it. Trust that the medical team knows how to treat her infection.
If you haven't already, it is important to inform the doctor and nurse in charge of your grandmother's alcohol use, as suddenly stopping can be dangerous or at least cause detrimental side effects.
I wouldn't worry so much about the food intake. If she was already a picky eater, and she is in a strange environment, suffering from delirium, she is not going to be interested in eating. Especially hospital food. You can try and encourage her to get more fluids. Dehydration can cause delirium. If she doesn't drink enough plain water, is there something else that she likes which you could give to her? (not alcohol) but, even soda or gatorade will give her body fluids, sugars, and sodium which could help with the delirium.
I’m sorry your GM has become addicted to alcohol and that you have witnessed her withdrawals many times. Has she been treated at this same hospital for this in the past?
If or when your grandma has lucid moments have her sign a HIPPA release form. You can usually get this form from the admissions office or a social worker. This might enable the staff to legally speak more clearly with you.
Understand the role of the hospitalist and know that GM’s insurance may or may not be allowing alternate treatment based on the diagnosis she has been treated for many years, this based on your post.
If you aren’t listed on her insurance as someone with authority to speak for her with them, then it is more difficult for you to know if the insurance is refusing requested treatment options.
Again, If you have no standing with the hospital to be given personal information about GM then they may be legally unable to share with you.
Try to find an Al-Anon meeting to attend. You have been traumatized by witnessing this behavior for perhaps all of your life. You may not like the meetings but they could provide needed support and education as you try to accept that you are powerless over GM’s addiction and the consequences. Additionally you might find strength there to manage enabling behavior. Whatever your reaction know that they have much to offer you.
In your shoes I might ask the doctor if GM should speak to hospice when she completes detox. The answer might give you more insight to her medical condition at this time.
She has a lot of comorbidities that can have associated pain and inflammation. Google “foods to help eliminate inflammation” . There is a lot online to help learn about this.
Here is a link on vascular wounds.
https://www.nhs.uk/conditions/leg-ulcer/treatment/#:~:text=Stop%20smoking%20and%20moderate%20your,and%20wear%20comfortable%2C%20well%2Dfitting%20footwear.
Here is another for Al-Anon. They also have virtual meetings.
https://al-anon.org/
Come here anytime and let us know how you are doing. We care.
I like Peggy Sue's response to you on April 8th.
Dad did not eat much his last 5 years or so. I think he got most of his calories from alcohol. His stomach was torn up from decades of alcohol abuse.
In a hospital setting I think the priority is to detox the alcoholic and then go from there but again as Peggy Sue mentioned I'd request to speak to the Social Worker and see what the plan is.
If you have not been to AlAnon or AlAteen for you I would check out some meetings.
Outside doctors have to have privileges to see their patients in a hospital. This maybe why they won't consult with Moms doctor. I don't like that the hospital doctors don't at least consult with the patients doctors. I think less mistakes would be made.
I am not a fan of grandchildren caregivers and situations like the one you describe are the reason why. I hope as you navigate your grandma’s hospitalization you can investigate and consider other options for her care that don’t involve being enmeshed, even part time, in a dysfunctional family situation.
Even if she mostly recovers she may now need a higher level of daily care and this is beyond what you should be doing at your young age.
Being alcholic is not going to help her physical recovery. There are alcohol-specific problems that may be in store for her, such as Werneke-Korsakoff dementia or even cirrhosis, If she returns home and thus to drinking she compounds and hastens her physical and mental decline and makes herself an increased fall risk as well. And, assuming she was driving herself to buy the liquor, she should probably not be driving anymore. No one should be buying the booze for her - especially you.
If she never assigned a PoA (Power of Attorney) to manage her affairs when she is no longer able then the likely outcome is that the social worker will get her on a track for a court-assigned guardian who will then manage everything going forward. This would be a good solution. They may get her an emergency guardian and who will then be able to legally make decisions for her, and transition her into a facility for her future, permanent care.
In this scenario, if you are living in her home you made need to live elsewhere.
I also wonder where your parents are in all of this?
👏👏👏
Some of what they are saying sounds like it involves what type of insurance coverage your grandmother has. She may not qualify for a vascular consult based on her current condition, based on her going through withdrawal from alcohol (extremely dangerous), or because she already has some doctor taking care of her outside the hospital.
You should ask to speak with a nurse or doctor and tell them you have zero experience with this and don't know much about the processes in the hospital or insurance, and you would like them to talk to you in plain easy to understand language about your grandmother's condition. They may tell you they can't tell you anything specific bc you're not on the list. You can still ask them for general information about any nonspecific patient who might have these conditions, what would they do in a hypothetical situation like this one as far as care, what the outcome could be, etc.