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It has been two months since mum fell and broke her hip.

When we discussed options with the medical team at the hospital, the only real option was surgery to mend her hip. This was palliative surgery. It was unlikely that she would ever bear weight on the leg again and so, it was explained to us,  the surgery was to prevent mum from being in pain. At this stage of her dementia, she was too well and alert to just offer her pain relief rather than surgery. Down the track ‘though, it would be an option.  This was a difficult conversation and we made sure that we were all present, her three daughters and dad, so that no one person could be held responsible for the outcome.

Nursing home care was the only option for mum but we all felt the weight of guilt at leaving her there. She went in feisty, defiant, ambient, continent and alert. She was immediately labelled as difficult and hard work. Two months later she is passive, drowsy, incontinent and confined to a chair. How much of this is the natural progression of Alzheimer’s?

Last night the nurse on duty gave mum her evening medication mushed up in pureed apple. Mum took the medicine from the spoon like a baby.  Out of curiosity I asked what she was taking. Endone and Panadol. She has this combination of pain relief three times a day. My concerns go a bit like this: Should she be on this level of Endone? Should she be on Endone at all? (The surgery to repair her hip was palliative and she should not still be experiencing pain bad enough for this amount of Endone). Is it chemical restraint? Is it better for her to be in this state of non-comprehension or should she be allowed to be more awake and aware? Are we being kind to her or cruel? Should we leave all decisions up to the staff and medical team at her nursing home or should we advocate for pain relief that is less dependent on medication; such as massage, diversion, hot and cold packs? Aged care, like everything else, is budget driven. What is our role as family now that her care is in the hands of others?

It is so hard to visit now. I punch in the code and open the door to the dementia unit. The smell of pineapple scented disinfectant is overpowering. Mum tackles her dinner – sandwiches, soup, raspberry fluff, milk and cup of tea – all served at once. She takes a bite of sandwich then a spoon of the fluff then she tries to take a spoon of sandwich. Realising this is not going to work, she goes back to the fluff. She is propped up uncomfortably in a chair and parked in front of the television. The volume is up high. It is an old Western and no-one is watching it. There is nothing to talk about. I just sit with her and tune in to the film.