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Elder Stroke Victim

My 86 year old mother was sent home to die three weeks ago after suffering from a massive stroke.  She has since started eating soft foods, is able to speak a little, and appears to be in no pain and in stable health.  We need to know what form of rehabilitation we can provide her so that she won't spend the rest of her days lying in a bed waiting to die.
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Avatar universal
what state are you in? contact medicare, because your mother is entitled to upt to 100 days at a skilled nursing facility who will provide her rehab. Check your mother's EVIDENCE OF COVERAGE to know what she is entitled to.
144586 tn?1284669764
One of the big problems is eating, and a stroke friendly diet.

It is important not to feed while your mom is sleepy and to exercise great care to ensure food is not aspirated. The nursing facilities like ensure, but there are better options. A sure winner stroke friendly organic pea soup. Take a 14 ounce package of organic split peas, soak and rinse for an hour. Take five sloices of organic ham and mince. Take five cloves of garlic, peel and mince. Take a large yellow onion and mince. Next comes an organic tomato. Sautee the onions and garlic in extra virgin olive oil and butter and a tablespoon of water until the unions are translucent. Add in cut up tomato.  Mince one large organic carrot or eight or nine baby carrots. Use a full cupo and half or store bought organic carrot juice. Place the peas in a large pot and cover generously with water. Add the cooked onions, tomato, garlic and a half teaspoon of sea salt, oregano, marjoram, a half teaspoon of celery salt and a dash of all spice. Then splash in four or five squirts of hot sauce. Brinhg to a boil and let simmer for two hours. Add liquid as necessary. After two hours remove and opuree in a blender. Then return to pot to slow simmer for another hour.

It can be serves with oyster crackers or tiny bits of tofu, which will float. It is nutritious, adds liquid to the diet, and fibre, and can be a daily staple.

Jello is always nice, served with whipped creram of organic cream. Also cotage cheese with organic apple sauce and a dash of maple syrup.

I have a stroke patient and I always use the tiny two ounce cups. They can be handled easily and if there is a spill, the damage isn;t too bad.

And I have a "four flavor rule". At every meal there are at least fouir flavors of liquid. It could be carrot juice, chocolate milk, orange juice, prune juice or water, for example. But ALWAYS a choice of four juices.
144586 tn?1284669764
You also need to think hydration, hydration, hydration and maintain a daily hydration log. It is likely the patient will not take on enough fluids, if left to their own devices.

Hot chocolate with organic milk is ideal to both hydrate and provide a vehicle for administering a crushed daily vitamin supplement.

At every meal make sure FOUR flavors of fluid are provided, without exception and that water is always available within hands reach.

It is not enough to simply make the water available. It must be poured in a small cup between meals and physically placed in the patients hands. If they won't drink one flavor of fluid, try another.

And bananas are also good. Cut them in two inch pieces, and slit the skin so the patient can remove it without frustration.

You need to make sure the patient gets cod liver oil every day without fail. It now comes in flavors and is very palatable.

Plus oral B-12 with folic acid.
144586 tn?1284669764
And don't give up! Last year they sent my 100 year old patient to die in worse shape than that! She will be 102 at her next birthday and isnow talking (haltingly), reading, walking (haltingly) and has a full range of facial expressions and laughs all day long. Two weeks ago she regained full motor control of her hands!
144586 tn?1284669764
There are a lot of programs to deal with restoration of the ability to swallow, but most are too complex for the stroke damaged patient to understand. Soft,  tasty, visually attractive stroke friendly foods provided in small quantities at extended intervals.

The ability to handle food is also something that can be developed.

A very nice "stroke friendly" mock-pizza for elederly stroke patients can be made from saltine crackers topped with a half teaspoon of cooked ground beef, grated parmeson cheese and a half teaspoon of pasta sauce. Use a microwave for about two minutes. Experiment. The little cracker pizzas serve a rehabilitive goal in developing hand coordination. Plus, they are soft enough that everything can be swallowed. And they are nutritional.
144586 tn?1284669764
Also go outside every single day during the summer for at least an hour. Going outside can be very frightening. Early morning after breakfast during the very hot months is a good time. Take care to makes the trips outside interesting, and not simply "runs around the block". Get the appropriate outdoor wheelchair with resiloient tires and a good cushion under the buttocks and behind the back. Wheelchair rides can be very hard on a patient without these precautions. They also sell an inexp[ensive gell pad you can keep in the refrigerator and put under the buttocks during the summer. You put a slip over cover on it so it will not chill.

You need two wheelchairs. One for outside with resilient tires. And a small four wheeled hard plastic wheeled chair for within the hose and rooms. Plus a good cushion for the seat and back of the wheelchair. During the summer use a hat or scarf and avoid the sun on the head for long periods. The stroke disables are very vulnerable to heat stroke. They may not be able to compensate properly. Make sure you bring two varieties of cold drink and offer sips ar fifteen minute intervals. Make sure the sunlight hits as much skin area as possible. Ideally for at least 45 minutes per day. The value of a moderate amount of sunlight every day cannot be underestimated. Make sure the patient recieves a daily vitamin supplement, including a half teaspoon to a teaspoon of cod liver oil daily. They now come in flavored varieties and are quite palatable.
144586 tn?1284669764
Elder stroke victims often have what some call "the package". That is to say, a host of syndromes and maladies associated with old age and brain deterioration. Nevertheless, there are a lot of things that can be extremely helpful.

The importance of touching and holding, for example. If you are in the room and not holding the loved ones hand, for all practical purposes you might as well not be there. Oralternatively, placing a hand on the shoulder. It is very interesting toobserve the modern hospital, where it is not unusual for patients who be admitted through the emergency room and spend weeks in a hospital, and never have skin-to-skin contact with another human being. When I see a nurse reach for the latex gloves before she touches the wrist of a stroke patienjt I want to bite right through my tongue.

Communications may be a big problem. A dry-erase board is helpful, but in many victims of stroke they won't be able to recognize the letters, at least not initially.

Get a throw-away camera and take pictures of things that are necessary for rehabilitation. As an example, the shower. Or the toilet. Or a plate of food. Or the park. Have these images blown up in a self-service store like Kinkos and fasten the images tofoamcore, obtained at staples. Have anotherpiece of foam core upon you have written: "Yes or No". Put the images in front of the patient. A picture of an ice-cream soda, for example. You may find you will be aknowledged with a nod or a hint of a smile.

Do the same with pictures of family pets or relatives.

Have a daily "orientation" briefing where the time, day and weather and day of the week are written on the dry-erase board.
144586 tn?1284669764
Incidentally, pate on crackers can often be tolerated while swallowing other solid foods cannot. Chicken liver pate on a saltine cracker with a dab of mayonaise is good, and also salmon pate on cracker. Mmmmmm. The handling of the cracker is also helpful during the rehabilitative process. The rule is simple. In the case of cheeking or spitting up of food all feeding stops for fifteen minutes. And remember, just because the patient opens his/her mouth does not mean they are ready for another bolus of food.
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