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Adm, ((((hugs))))). Deep breaths, too.

When you say mom is in a SNF, is she admitted there as a rehab patient or for permanent placement?

Has she been seen by a geriatric psychiatrist?

My mom had an ischemic stroke in 2013. Went to acute rehab, did great with PT. Speech therapy, the works. Transferred her to a highly rated subacute rehab with an adjacent Assisted Living facility (because we were thinking ahead). We thought ourselves so clever.

I was sitting with mom one afternoon while the nurse gave her her pills. When mom took the last one, she looked me and said, "you see, I have to manage my own meds here". I said "what?". She pointed to her water pitcher and gave me a "significant" look. The next day, she told my brother that the aides were having sex in her bathroom. The next night, they were carting dead bodies out in the middle of the night.

We asked for a psych consult (at the recommendation of the nurses) and were told mom had developed vascular dementia as a result of the stroke. Her anxiety had previously been managed by a Geri Psych in her Independent Living facility with a very low dose of klonapin, but in the subacute rehab, the doc added an antidepressant. Later, another one was added. A cocktail of Lexapro, Remeron and klonopin kept mom calm, happy and not at all sedated.

Sometimes antipsychotics are used in this sort of situation. Psychopharmacology is an art, not a science, so be prepared for some trial and error.

Get her seen by a psychiatrist as soon as possible. And know that UTIs are also known to cause psychiatric symptoms in elders.

And to answer your last question, bringing her home is the least good option. It sounds like she is, at this time, a 2 person assist, which is untenable. What led to my mom's placement in the IL was her unremitting anxiety, which even 24/7 aides didn't help. Only meds helped.
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Adm101 Feb 2021
Thank you for this advice, and for sharing your own experience. My mom is in a subacute rehab SNF now after being in acute rehab. I hope I am using the terms right: to clarify, I mean that she *was* receiving 3 hrs/day of therapy in what I'm calling the "acute rehab" facility, and this new SNF is providing 1-1.5 hours per day. Both facilities provide 24/7 medical care, although the acute rehab facility had more or less daily supervision from physicians. The new SNF has asked if we would be considering permanent placement for the future, but we have not made any decisions about that yet, as I think we have ~20 days of Medicare-covered treatment to consider longer term options.

When she was in acute rehab, she saw a clinical psychologist several times who, along with the physicians, managed to keep her calm and well enough to participate in the therapy sessions. I am going to make managing her mental issues a top priority and try to get a psychiatrist to see her ASAP - since this all happened suddenly and near a weekend, it's been slow to make appointments and get her any substantial help. It's understandable but having a loved one losing their mind (perhaps both figuratively and literally) is a constant stressor.

Your story about how your mom was perceiving the care and imagining things is similar to what my mom is doing right now. I just talked to her and she said "they're refusing to let me use the bathroom" - but the aide happened to be in the room, and I heard her chime in over the phone, "she's on a bedpan right now." I have an initial reluctance to trust strangers over my own mother, but that's quickly changing.

After the diagnosis of vascular dementia (which I suspect my mom had already started due to years of mismanaged diabetes), what happened to your mom after subacute rehab? I don't mean to pry, but I am new to all this and your perspective is helpful and comforting that my situation isn't unique. My understanding is that dementia is not a condition that improves, but is only managed, so I am curious to know what sort of living situation your mom required afterwards. Thank you again.
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