In reality, I could come up with 10 different worst times of the day in caring for my mom. Even when she was spending her last few months in a Memory Care unit, the same worst time of the day continued. That time was absolutely mealtime. Mom had difficulty swallowing, which becomes common in end-stage Alzheimer’s. If mom had sausage gravy and biscuits, with the sausage ground up into minuscule pieces, she would find that tiniest piece and roll it around in her mouth for hours. She would swallow everything else, including liquids, however, that minuet piece of sausage stayed in her mouth. I would think it was gone, and two hours later I would notice mom moving something around in her mouth. Low and behold, there was that piece of sausage.
There were times when mom would just not swallow, period. Regardless of the food, even ice cream, she chewed and chewed and tucked it in her cheek. I would do the procedures you should do, gently stroke her cheek, her throat, I would even say; “mom look at me, watch me swallow.”, “swallow mom, swallow”. I literally would place her hand on my throat and take a deep swallow for her to feel, hoping that relayed the message.
Mom had speech evaluations and swallowing studies. The recommendation was pureed foods and thickened liquids. A final recommendation was for a feeding tube. Now, I had a problem, I agree that extreme measures such as feeding tubes are necessary for many chronic conditions, but I truly believed that this was not the solution for my mom. Even when I ran clinical operations, I expected staff to exhaust every effort to feed, in a safe and reasonable manner, prior to the last resort.
I took matters into my own hands as an attempt to make mealtime valuable for my mom and decrease stress for me. Mom used straws to drink for years. Everyone knows that you should not use a straw when someone has the potential for aspiration. The only way my mom would drink fluids was with a straw, I had to make it work. The risk of dehydration leading to UTI, leading to sepsis was a larger risk in my eyes. Fluid intake for mom was a supervised event, she couldn’t hold a cup or voluntarily reach for a drink. We continued to use straws, and lucky for mom and us, without aspiration. Mom loved chocolate ensure and drank ensure for years, long before she ever had a need too. Ensure Plus has 13 grams of protein, 27 vitamins and minerals, and 350 calories. If mom drank 4 a day, that equated to 1400 calories. Mom also loved ice cream and sherbet, you bet that became her meal on many occasions, ice cream and Ensure. We never stopped trying to feed mom mechanical soft foods, and the time commitment to feeding still remained to be over an hour. I at least found a way to make my most dreaded times of the day a little less dreadful.
