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My mother was hospitalized 3 1/2 wks ago to have her hip bursa drained. First she tested postive for strep & was put on IV antibiotics. Several days later, she was experiencing GI problems, but was discharged to rehab. The GI problems intensified, and her sample was positive for C Diff. She has now been on Vancomycin for 8 days without much improvement (her other IV antiobiotic has also continued), She wants to return to her condo, where she's been cared for by a part time aide for the past 8 yrs. She has many, many health problems. Additionaly over the last year, her mobility has become almost non-existent and her vision has declined sharply. As an RN, she's excellent at managing her many meds, but spends most of her time sleeping.



She is insisting that she will not remain in the NH, which I can sympathize with, but I am wondering how she can possibly return home with C Diff, which is really difficult to disinfect. The NH RN said that this may go on for many months. My mother has agreed to allow more aides (though she does that every time she's in the hospital/rehab then fires most of them when she gets home). I'm wondering if any aides will be willing to take this assignment? I don't think her current aide will be willing to return as she is in the higher risk group for C Diff infection.
I work full-time, and am not able/willing to provide additional care beyond the shopping/visiting/quarterbacking that I have been doing for the past decade.

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You already know the answer. She needs to stay in the NH. She can't walk, she can't see, and she has a laundry list of other ailments. It is unrealistic that she thinks she can go back home and pretend that she is 25 again.
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I'm not a nurse, so likely I have no clue what I am talking about, but when my step-mom was in the hospital (ended up dieing within a week), she had c-diff, and because of that they would not let my dad (who had dementia), nor I go in to her room without suiting up with full protective gear, including long paper jackets, gloves and masks. No exceptions. That told me that it is highly infectious.

Seems like it would be an unsafe discharge if she needs someone to take care of her, and that person herself is concerned (with reason) about contracting it.

Again, this is just my perception, not being in the medical community.
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C Diff is an overgrowth of a bacteria in people who have been on antibiotics for infection. Most people are colonized with c. diff. It is hard to kill but getting her usual gastrointestinal bacteria back into balance is a good strategy - as well as use of antibiotics to kill c diff. Ask her doctor to prescribe probiotics that contain as many different kinds of gastrointestinal bacteria as possible. Ask her to eat more fermented foods - yoghurt, kefir (yoghurt drink), kombucha, saur kraut, kimchi... Anybody handling her soiled clothing or linen needs to wear gloves, use a laundry disinfectant, and wash hand thoroughly with soap and water - same as I do for patients in the hospital with c diff.

Her ability to remain in her own home is more dependent on whether her needs can be met at home with the care plan already put into place. If her plan is not financially possible or enough caregivers can not be found, then other options should be discussed with her. If she is mentally competent, she gets to make those decisions for herself.
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Oldestchildof4: These questions should be posed to her gastroenterologist. Even though she "wants her old life back," that may be next to impossible with her many health issues. Good luck to her.
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C diff can be acquired by strong or long lasting antibiotic regimen. She needs a yogurt or any good probiotic.
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Is she on strong probiotics, yogurt, etc? My mom got C. Dif in 2003 bc she was on antibiotics over 3 weeks. From hospital care for injuries from a fall, then UTI thru her rehab stay, then home after discharge. Her good gut bacteria was wiped out along with uti infection, & once the explosive diarrhea started @ home, it never stopped & J lost her two weeks later. Now doctors can do a fecal transplant from a healthy person which can stop the extremely painful, potentially fatal infection. I pray for your loved one. Also, I was told by a dietitian who spoke to me in her ICU room a few days before she died, that if rehab dr had not prevented me from bringing her both probiotics & yogurt, she may not have gotten C. Dif & have survived.
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I think she should be able to go home, if she has careful enough help to keep the C-Diff from spreading or contaminating anyone else.

Vancomycin is usually the first drug tried for C-Diff, but does not always work. If her doctor is stumped, she might need to see an Infectious Disease specialist.

If Vancomycin does not stop the C-Diff, there are more specialized drugs, like Dificid, that may do the trick. Dificid is frightfully expensive, but perhaps she would qualify for the company's Patient Assistance Program,

I do know that it works.
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You should confer with your mom's gastroenterologist or infectious disease specialist. C. difficile is not so uncommon when patients are treated with antibiotics, esp in a hospital setting. If vancomycin treatment doesn't work in eliminating her carrier state, there might be other vancomycin-like treatments and recently fecal replacement from a healthy donor is possible.
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Is she surrounded by things from the condo that might make her feel more at home? Nothing valuable, but personal. This helped with my dad some- we eventually told him there was a plumbing problem at the house and he couldn’t return until it was fixed. Thinking he would be returning helped ease his anxiety and along with some personal items, he eventually got used to his new home. Good luck!
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She may well be and RN and so am I, but I can tell her that at 85, this is how my bro died.
He got strep, then antibiotics and vicious diarrhea. He was treated for C Diff tho I was told that it was "not testing positive for c diff despite their eyes and nose telling them different". The docs wanted him in care on IV antibiotics and they wanted him in for at least a month. SNF was the answer. He decided that he could not stand it anymore and wanted to go home even if he died (had a diagnosis of probable early Lewy's dementia, and to tell you the truth I am quite certain he WANTED to die).

His ALF would not accept him home without Hospice. He got hospice. He was put on by mouth antibiotic. He was dead in less than two weeks time.

If your Mom knows the risks and this is what she wants and you consider her rational then I don't see what choice you have in this matter. It IS an option. See to it she has enough care and understands the risks.

For my brother, despite its outcome, this was the right decision. I don't think he would have survived the SNF any better than he survived leaving it, IV antibiotics or no.

I would allow your mother to make this decision were it me, full well understanding the outcome.
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Oldestchildof4 Sep 2023
Thank you for your kind answer, AlvaDeer--I read your replies all over this forum, and you are always so wise.
The thing is, my mother doesn't want to go home to die. She wants her old life back, and just won't accept reality, though she's been dying steadily for years. This year's reality has involved 2 ambulance rides to the ER, followed by hospitalizations. She is cared for by a team of 6 specialists for her various conditions, including adult onset autoimmune hemophilia--and she's also on a blood thinner. For years, I took her to her constant medical appointments; for the last 8 years it's been an aide. I'm really sort of amazed that she won't give up. She's outlived her siblings, husband, friends, and probably soon, her son (my brother). A retired RN, she has unrealistic expectations for the CNA(s) that care for her, and is consistently belligerent with the care staff, wherever she is.
So, what's my question? I'm trying to figure out how we'll deal with the infectious aspect of C. Diff. when she returns home. I really don't want to get this, too. And I'm very tired--I can't quit my job, because my family & I need the health insurance coverage.
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If Mom is not improving ask that she be taken to the Hospital. If they will not do it, then you call 911. Rehab is not skilled nursing. They will keep her there as long as Medicare is paying 100%. You may want to call her PCP and run all this by him/her. You have the right to call 911 if you feel tge Rehab is not taking proper care of her. Rehabs are not prisons and they are not mandatory. Rehab can always be turned down.
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Many NHs wouldn't discharge until C-Diff has cleared.

I don't blame her for not wanting to stay in the NH.
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In alot of cases the patient is placed in rehab/ nursing home to overcome it
Then may go home afterwards.Have you considered a live in aide for her?
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Try these supplements in addition to the antibiotics for your mom to help her body fight the cdiff infection. All probiotics should be taken at least 2 hours before or after antibiotic is taken.

One is brewers yeast the other is a probiotic I cant spell but it's in this article.

https://pubmed.ncbi.nlm.nih.gov/9753273/
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Oldest, welcome!

Here's the thing. This decision is out of your and mom's hands. The discharge planner has the authority to decide if discharge home is a "safe discharge".

I would leave the decision in her/his/their hands and not facilitate any transport.
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LilyLavalle Sep 2023
I would respectfully disagree with this. My mom’s discharge planner at a a well respected facility failed my mom twice. The second time was when she discharged mom into home hospice after telling the hospice agency that I LIVE with her, when she knew this was untrue.

In my experience the discharge planners just want to get people out when Medicare no longer wants to pay. You already said mom will fire the additional caregivers, and the original caregiver may not stay either. I don’t have a good answer for you. I am just warning you not to trust the decision to a discharge planner.
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