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Hello,
So the 4th of July weekend was supposed to be my long awaited post-covid trip to finally visit my 91 year old Dad. He lives 500 miles away. Long story short I was going to be late, had to do a welfare check, he had fallen for the second time in a little over a week, then had to call 911 when I got there, then I finally convinced him to go to the hospital. He stayed there 4 days, discovered pneumonia, a wound on his back, a great deal of weight loss, some confusion and he was very weak. After the hospital they discharged him to rehab, let the games begin. The hospital gave me no advice on picking a rehab, they told me the 9 he got into and gave me an hour to pick. I was at work ( I work 2 jobs currently) and the social worker goes you need to pick now because I leave in an hour. So I picked based on some things in their website, not a great way I am sure. I am doubtful he will ever be able to go back to independent living. I am hoping for assisted living, but there are financial issues, and timing issues with him having an apartment, and everyone telling me to do different things, and I am so exhausted. I am going back down again this weekend and next for his birthday but it is a 10 hour drive each way, I travel at night because I have dogs and it's too hot during the day and I get back around 6 am and go to work. Last week I did a 40 hour and 38 hour stint. I cleaned his apartment when I wasn't at the hospital. I am the only child, my Mom died 20+ years ago. I would like to get him into assisted living where I live because I could do a lot more to support him, the distance is a real barrier. I am totally overwhelmed at the moment and don't even know how to start coordinating all of this. So far it has been very hard getting information out of the rehab place, they don't even have voice mail. Thanks for listening, any tips for those who have been there, done that would be great. Elizabeth

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When you say “some confusion” does that mean it’s gone far enough for him not to be able to make his own decisions? If he’s still determined to be of sound mind, where he lives is up to him. If not, do you have POA for healthcare and financial decisions? Either way, you’ll still need to learn his complete medical status and ongoing needs to help decide the level of care going forward. If he doesn’t have local support, then moving him near you would be wise. Try to arrange a meeting with the staff where he is now to help you get direction for going forward
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Definitely move him to a facility closer to you. That drive would be too much for anyone.
He may need more care than what an AL offers. He might need a nursing home. Check out a couple near you.
If the rehab isn't communicating with you, can you speak to his primary care doctor? The rehab will certainly speak to his doctor.
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Cover66 Jul 2021
Not if his PCP is not the Rehab doctor. My friend went through this. There was an "agreement" that the PCP would stick to the hospital unless they were also the NH Rehab doctor at the facility.
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I am so sorry that you are struggling with this. I can’t imagine driving all that way. I am exhausted just reading your post!

Moving him closer would help. Would he be willing to live in your area? Can he make decisions on his own?

Would you mind sharing a few more details?
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nightowl206 Jul 2021
replied in the comment section wasn't sure the best way to do it, still learning my way around this forum
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More details would be helpful:
- does he have cognitive impairment, or a dx of dementia?
- what state is he currently living in?
- are you his PoA? If so, springing or durable?

From one only to another, hang in there! Caregiving for him should never be onerous to you. Move him close to you if at all possible.
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I’m so sorry you are going through this. I understand. I’m an only child and we navigate a slightly different world with aging parents. I went through very similar things with my dad. The best advice I can give is to realize that his needs for more and more care will definitely continue. For now… he is “safer” in rehab. Though the rehab appears antiquated technology wise. I would definitely start the ball rolling on getting him placed in a care facility after discharge. Use this time to look at different placement options and get things in line for qualifying for financial assistance. My heart goes out to you. I know the exhaustion and overwhelm. Sending you a big hug and prayers. ~ Sunny
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I am not sure the best place to leave a follow up. I live in PA and he is in NC. I have a durable power of attorney. I have reached out to an elder care attorney in his area to get more information. I am driving down this weekend and then next as it's his birthday. He refuses to talk about anything sad so trying to have a conversation just ends in oh well one day at a time, it will all work out on his part. It is very hard because most places you need to visit and contact are only open M-F 9 to 5 and I work then, and our office has no privacy and it's very hard to make personal calls when part of your job is as receptionist. He is in varying stages of understanding, there has yet to be any totally cognizant stage, he was totally out of it on Sunday night so I finally got the nurse so she could check on him. Sometimes he knows who I am sometimes not. I did get to speak to the wound nurse today so I got some information that he then contradicted, he tends to tell people what he thinks they want to hear. I took photos of his apartment before I cleaned it because it wasn't sanitary or healthy. He isn't going to qualify for any income based products because of a pension but he has not other assets, he lives paycheck to paycheck and his living expenses are so high he only has may $400ish of left over income to spend on home care. I tried to get him to move to a smaller apartment 2 years ago to save some money and he said he didn't want to move because moving wasn't fun. He is clinically malnourished now, there was almost no food in the house, whenever he wants something he can't afford he cuts out food. I can't even figure out how to get him into a facility, we really need to be getting rid of the apartment now so we could save that up while he is in rehab, but I don't have time to do it on my brief visits. My boss is not family friendly, I only have 7 1/2 days left of PTO for the year and we don't have FMLA. The gas for this month's 3 trips would in a normal month eat up all my disposable income but luckily there are 3 paychecks this month or I'd be in trouble. My dad is very narcissistic and cares more about appearances than almost anything else so getting him to part with things is very hard. I don't know that any of this helps, but it's all part of the equation.
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NeedHelpWithMom Jul 2021
My cousins on the east coast had this issue with their dad. My uncle was adamant about remaining in his home. He wasn’t eating either. He developed a UTI and sepsis. He had mobility issues due to Parkinson’s disease. He fell several times. He nearly died.

His children worked full time. They told him during his hospitalization that he would not be returning home. He reluctantly agreed to enter a nursing home. He was well cared for in his nursing home and lived another two years in the home. He died at age 96.

I truly hope that you find a viable solution for your situation. I don’t know how you could continue to travel back and forth, work and so on. It’s too much!

Speak with the nursing staff, his doctor and the hospital social worker. Reach out to everyone.
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MOVING him- there are companies that do long distance medical transports like that.
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It hurts to read about your dad and your situation. I am assuming your dad has Medicare (and a Supplemental Medicare Plan?). Medicare will pay for inpatient rehabilitation for about 100 days, then dad will have to go home or someplace else. The eldercare attorney should be able to help you make decisions. Also a social worker at the rehabilitation place or hospital could be helpful too. If the not the resident State’s Dept of Aging can offer resources. You might need to initiate Medicaid benefits now to place dad in a nursing home after rehabilitation. It probably would be easier to keep dad where he is at during and after rehabilitation until you figure everything out.
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Ricky6 Jul 2021
Also, if dad is not showing “rehab” progress then Medicare will not continue to pay for his stay. Since Medicare does not provide custodial care benefits, dad will need to go or be placed somewhere. Look into Medicaid to avoid a problem situation.
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When parents get advanced elderly they need to live near a child. Please move him close to you! As a newly retired clinical staff member of both Assisted living and a nursing home you need to visit often and staff needs to see you there! Rehabs frequently are in nursing homes. Try calling a physical therapy staff member and discuss the rehab. They often are quicker to respond. His care will be best close to you..I even sold my condo and moved myself to a retirement community at 69 in order to then move my mom in an assisted building on this campus. Her memory care facility was poorly run. I can walk over anytime. If you can not get info as needed from the rehab call the Ombudsman for your area..they will go see him and talk to management! Or try calling a physical therapy person there…they assist in the rehab for falls..as for moving him.. I started by asking church members what facilities they used for parents..I had moved here from another state . I am my moms POA..something I set up and helped her with the minute I saw she was making bad decisions on her own. This is not a fun job but a necessary one to keep them safe.
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Ricky6 Jul 2021
Your mom is blessed to have you. If someone is handling this situation for the first time it is very hard and even harder to handle if there is significant geographic distance between the parties. Even reading all the relative forum here posts can be confusing. It is always helpful if there is a another family member or friend that can help in these situations; particularly if they had the same or similar experience.
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Getting him close to you is a great idea, but check differences in cost between your state and where he lives. The ideal situation is to choose a facility that offers rehab, assisted living and nursing home when the time comes. That’s what I did, and it’s so much better. If he had a home, sell it to help with his costs. Social security will also help. Make all payments he receives direct deposits to his account so it makes everything easier. You need to have a Durable POA so you have the authority to handle his affairs. It’s not easy, but that will help you keep your sanity.
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I live in North Carolina so I'm wondering what area your Dad lives in. If it's close to me I might be able to give you some advice for future planning.
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nightowl206 Jul 2021
He's in asheville
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This happened too me, in Washington state, if it matters. I continued to research places, and was informed I could move my husband if I wished by those places. Medicare did not prevent it. Not sure if medicaid or another agency is covering it what happens. I did not since it turned out to be a limited stay.
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This happened too me, in Washington state, if it matters. I continued to research places, and was informed I could move my husband if I wished by those places. Medicare did not prevent it. Not sure if medicaid or another agency is covering it what happens. I did not since it turned out to be a limited stay. There are ratings by medicare of nursing homes online. They are not great, but they are a beginning and reveal terrible problems at some places.
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I am also an only child because my only brother died 4 years ago at 46. When this all started with my mom I had been pushing her to start going thru her stuff and cleaning stuff out so she could move in with me. She never got around to it. When she ended up in the hospital and rehab I used that time to go thru stuff in her condo, get her stuff boxed up and moved to my home, get the condo ready for the market and get it listed. I told her she wasn't going back to living on her own. Obviously my situation is different but use this time while he is being cared for and you know he is safe. If I would have waited for my mom to work with me the whole process would have been a disaster. It sounds like you have a POA, may want to get that looked at to verify you have the power to do what you need to do. Mine allowed me to sell my mom's condo which made it all much easier I just did the closing for her. Do you have any savings or a friend who can help with funds? You probably need to take a bit of time off to stay in town and get stuff done. The drive is not sustainable, plus it's 10 hours you can spend doing something that needs to be done! To add.....Find a great real estate agent she/he can help with having an attorney look at your POA and help with getting your dad's place ready to sell. (You said he had an apartment I am assuming he owns it)
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nightowl206 Jul 2021
No he us just renting his place
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Just try to get him into any rehab that sounds like they'll help him get back in shape for everyday living. Check in frequently and ask them what his care plan is, and make sure that they are doing it. Rehab is short-term, so once he is there you have some time to look into assisted living for your Dad. Talk to your Dad as soon as possible and try to get him to agree to moving to assisted living close to you. You'll have to help him with downsizing. If he agrees to living close to you, get connected with a social worker or a senior specialist in your area who can advise you on you father's options for assisted living.
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You’ve received great advice so far, especially re: the Ombudsman in his area to advocate on his behalf in your absence during the week. Also try and connect with the department of aging in your area as they have great resources.

It sounds like your dad needs a NH with rehab vs. assisted living as they will ensure he gets the support he needs to get stronger. I doesn’t sound like living on his own is an option moving forward and moving closer to you is paramount. The drive isn’t sustainable and it’ll mentally wear you down not knowing what’s happening hundreds of miles away. Once nearby, as mention go every single day different times of the day so they never know when you’ll show up. I can’t stress how important it is for facilities (hospitals, NH, AL) to know a patient has family looking out for them. I’m an only child too so I can wholly relate to the overwhelm I felt caring for my parents simultaneously at one point. It’s all new right now, you’ll get a rhythm going.

Do you have any friends, cousins that can help? Transparency with your circle will be such a help for you. We can sometimes be so busy trying to keep things private/secret coupled with the overwhelm, it’s unnecessarily harder. Once I started telling people what was going on, I started receiving help in different ways. Good luck to you.
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You are overwhelmed. This is evident. I, too, am an only child and understand the weight of that all on its own. Contact the Department of Aging in his state and tell them what you told us on this forum. Let them outline for you what next steps are and options. Clearly driving back and forth is not good for you and adds to your stress and anxiety. In time, he can move closer to you. Not now. Your work doesn’t seem flexible and this adds to your challenges. See what they say and see if you can find a consistent liaison/state appointed social worker to work with you.

Hang in there!
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Dear Elizabeth,
So sorry that this is hitting you all at one time. If your dad is now in rehab, you have some time to slow down a bit. Please don't rush to "complete" anything. Use your time to research and to be with your dad.

As for household, secure anything of value: paperwork, jewelry... anything that a thief might want to take. Clear out the fridge and the pantry since it will be awhile before dad could access his home. Then, hire a bonded housecleaning crew to go in and clean the home - thoroughly. This way you can spend time with dad and not housecleaning. Do the same thing with his yard.

When you have time at home, research online all the assisted living and full time care residential facilities near you that accept Medicare payments and Medicaid payments. Sadly, most seniors do not have enough resources and usually end up on Medicaid. Visit your top 3 choices for assisted living and total care. I would recommend finding a place that can move him from assisted living to full care when the time comes, While you are researching, also look for places that do hospice. Given your dad's age, hospice may be needed at some point.

Based on your research, make arrangements for dad to move from rehab to you when he is "done" with rehab. That date is usually dependent on his insurance. The social worker at the rehab facility should be able to help you with this.
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Check out a place close to your home and they should be able to help you with what to do next and who to talk to..

Tell the rehab Place where he'll be going.

Check with his Health Insurance and see what is covered.

If your Dad can go back to his own place he should have some Caregiver help.

If your Dad has been in the Military, he can get up to 30 hrs a week Caregiver help.

You might ask about Respite Home Health Care where a Nurse will gi to your Dad's home once a week to check on him and do his vital signs. They will also send an Aide 2-3 times a week to help with bathing and they will send Therapist 2-3 times a week to help him.
You can call Senior Help line where he is and let them know that you would like to move him close to you and see what help they can offer.
Prayers
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Dear Elizabeth- I hear you & can empathize!
Hopefully your Dad already has a case manager and THAT person is your immediate go-to for the very basics. From medical updates to dietary, the rehab center needs to provide each nugget for your sanity.
I would get a notebook and an accordion folder to keep with you- sounds paltry, I know, but very handy for keeping information when so much is on your shoulders. Like someone else said , at least he is being cared for .. it’s not always what we want for our parents, I know.
The program ‘ A Place for Mom’ online can also help you to find locations for your Dad. It was one less thing for me to plan.
Ascertain POA forms - you can get them online for your state- and keep them in the accordion folder.
Can you do any of your job remotely/ online?
Visiting Home Nurses can also be a help for the transition time for Dad if he can return home after rehab. They offer more support than some assisted living facilities and you would have immediate feedback for peace of mind.
Breathe, dear lady. You can only do so much. Hugs !
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I am so very sorry you are going through so much....as an only child with no other family, I had similar overwhelming responsibilities with my more, and I can relate to the trials and tribulations you are going through with your dad.

The path you are on right now - working long hours, driving long distances and trying to handle all the situations regarding your dad, is not sustainable for much longer. It seems that your work environments are not helping the matter. Taking small steps, one at a time, is the only way to do this. Break everything down into steps - and then check them off as you go. Write everything down - I kept a steno pad with every note so I wouldn't have to remember things and I could look back and see what date/time/person I talked to and what they said or what was talked about. No having to remember anything - cuz I couldn't remember squat!

Start with - Can you leave you dogs with a friend or board them during those times you have to drive to help?

Your dad is in a facility - it might not be the best place for him right not, but it is a place. This gives you the ability and time to do further research. Ask for the facility's plan of care for your dad- it will show you what the plan is for your dad. He must be on Medicare so you do have up to 100 days to have him stay there, as long as he is participating in trying to improve and showing improvement.

Can you, on your next trip, arrange to have a dedicated 1 on 1 meeting with the facility providers to go over your dad's Plan of Care- the administrator, the social worker, the PT person, the Nursing Director - should all be in attendance - real time or via zoom. It will give you an idea what their plans and goals are for him and the estimated time line for this. Can you set up a bi-weekly 1on1 phone call meeting with the facility to get updates?

Partner with a service such as CarePatrol Senior Placement to help determine the best facility for your dad based on needs and finances (I did and it helped immensely in determining which facility to place my mother). Although A Place for Mom also is a source, I found that the 'agent' I was assigned was actually working out of state and had never, personally, been to any of the recommended facilities. CarePatrol does- or at least the one I worked with did It is a free service, so utilize what you can.

This is a biggie - Is all your dad's legal paperwork in order - appointing you as POA and that would allow you to handle health care decisions and financial matters? If he does, do you have copies of them (make lots of copies - many many places want their own copies of these dox). If he doesn't have POA dox, and he isn't of 'sound mind' then you need to talk to an atty cuz you can't just appoint yourself.

Btw- his confusion could be the result of his hospital stay/medications. My mother had post-operative delirium/confusion that gradually subsided 10 days after being released from the hospital - but during those 10 days EVERY medical person deemed her with 'dementia' - and she did not HAVE dementia- things cleared up after those 10 days.

I agree with another poster here - next trip, remove as many valuables from his place as possible; clean out frig and freezer (in case lose power) (just toss it all). Then research cleaning services (CarePatrol might even be able to help with that as well), and then next trip see about hiring someone 2x mo.

It is challenging when you are the only one who is responsible for absolutely everything and don't have someone else to partner with - even if it is just talking about options or ideas. This is where this forum helped me as well because so many have gone through something similar.
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Invisible Jul 2021
I like the idea of contacting CarePatrol or a similar local service (talk to social workers at the nursing home, in the hospital -to find out who is in your area. They are free.) I started with the online places like A Place for Mom and 1) they had no personal knowledge of places and 2) they only recommended the places that subscribed to them. When I had to move my father from his memory care to another place on short notice while he was in rehab, the person working with me was wonderful. She was a great source of information and did much of the footwork for/with me. Expedited the process, set up appointments/tours, etc. I wish I had started with her 3 years earlier in my search for the right place for Dad.
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Dear nightowl
Your dilemma is heartbreaking. I am sorry for your situation.

the only answer would be to get your dear father into a SNF near your home because what you’re doing now will eventually take a toll on your physical and mental health. Get help legally to assist you. I’m not sure where to go but search. I’m very familiar with the falls then rehab merrygoround because I’ve been through it. Not to say rehab isn’t worthy but for frail, older individuals sometimes with dementia, it’s not always what’s needed.
You can’t continue on your current journey and remain whole. I hope you find help.
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Whew. Please start finding help for yourself. Like someone who will keep your dogs. Someone who will cover your work shifts. Therapist you can vent to. Consider moving Dad to rehab or assisted living in your town. Finally, I will pass on a piece of advice a friend gave me at the beginning of my similar journey. It helped reduce my anxiety. You don’t have to make decisions right now for the rest of his life. Just make decisions for the right now.
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nightowl206: Good grief! You certainly cannot continue along these lines, e.g driving ten hours and then going to work. I honestly don't know how you accomplished that feat. No one human being in SUPER HUMAN. It is IMPERATIVE that your dad be housed in an assisted living facility since it was quite apparent that he was doing so poorly managing his health and required emergency medical care, which then prompted convincing by you to go to the hospital.
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Breathe. I also felt overwhelmed the first time I had to choose rehab and they didn't give me more than 24 hours notice. They just assume you are already familiar with them. I was told to choose 3 and then the social worker would find out which one had an available bed. My father did three stints at rehab after falls. I picked ones close to me so I could be there daily to monitor his progress. I would also recommend looking at the menu, visiting at the dinner hour to find out if they are serving nutritional food. Some of the nursing homes still serve a lot of crap like school lunches used to be.

Totally agree with getting your father into assisted living near you. Proximity will make it much easier for you to keep track of your father's situation and address any future problems. You just can't do this remotely over the phone.

Then adopt a one-day at a time philosophy. You do the best you can. Don't expect perfection. Good luck. You can do this.

P.S. Got a friend who can help with your dogs in a pinch? You will need to create a support network for yourself. Keep asking for ideas and referrals.
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Ricky6 Jul 2021
Please note that medical professionals and social workers will not make a recommendation for a NH and/or REHAB place unless you ask. Many times they know which are the good places and the not so good places, but you have to ask.
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Hi... It sounds like you are on the path. You have also reached out to this online community. People on here are most helpful and understanding. We all share similar experiences and struggles. You're going the right direction. God bless and good luck.
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Not a plug but A Place for Mom was a great help to me finding rehab and AL for my mother. They will ask you the area you like, price, physical limitations, etc, At least it’s a place to start. They probably get a fee from each referral but the case worker was a huge help to me. Ask around at work, church, etc for recommendations and other peoples's experiences.

If you don’t like a place you can always move him. My mom was at 3 different places last year until we found the best fit. Ask about emergency placement near you, Medicare may cover the first 20 days, I’m not sure about this but know they will cover rehab. Call any facility you are considering ask ask how they can help you with paperwork, etc. That alone will give you an idea of the kind of place it is. And remember that Mose senior facilities are for-profit and want to keep beds filled.

FYI you will need to provide furniture, linens, etc in AL. Although some keep a furnished respite room for short term stays which might be a help to you.

Check with Social Security and Medicare and any other insurance about what documentation you need if you do plan to move your dad. I hope you have POA and MPOA documents and/or fiduciary in place. States may not recognize a POA issued in another state and the Federal government doesn’t recognize a POA so you will need to be appointed fiduciary to deal with Medicare and SS. Also you need to get banking and any other legal matters sorted sooner than later. Get yourself added as a signer on his banking accounts ASAP. If your dad had an attorney set up an appointment to review wills, etc.

Have you discussed getting family leave from your job(s)? Even just a few weeks can give you some breathing time to regroup and do some visiting. Ask friends and family for help, this isn’t an easy job for one person. And make sure you keep your Dad updated and agreeable.

Good luck, keep us updated.
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Invisible is very visible, saying "Got a friend who can help with your dogs in a pinch? You will need to create a support network for yourself. Keep asking for ideas and referrals."
* Really good advice.
* People call me when in need of these things as I offer care management. Try to find someone in your area who assists with managing all this, be it an ind person like myself or a [medical] social worker; it will pay off in the longer run to pay a bit more upfront for a few hours of guidance now.
* S-T-O-P breathe, meditate (for 10 minutes).
If you do not take the breaks you need TO FUNCTION, you will burn out and not be able to care for yourself, your dogs, or help your dad. This is essential.
- I usually start when I wake up asking God to help me and I am not religious (I lean to Buddhism and spirituality). Still; this helps me be willing to humble myself to what I need - and need to do.
- Exercise is important for me. You probably get enough of that with the dogs. ALTHOUGH... a walking meditation may help you considerably. Measured steps as you become aware of how / when your weight shifts (you could walk slow with the dogs - so you both get what you need).
* Choosing a care facility is 6 to 1 .... 1/2 dozen of the other. You do what you can with the information (and time) you have. Don't get on your own case about this.
Let it go - move on --- to calm, breathing.
* Realize it is one foot in front of the other, or one decision / need at a time. Perhaps write down all that you need to do and/or all that you dad needs and then prioritize how / who you call / do what when. Seeing all of it in black and white and the process of writing may help you.
- Get a binder and track calls (who, what and when) so you can refer back and track behavior (your dad's).
* I'm not sure of moving him closer to you is an option?
* DON'T LISTEN TO EVERYONE TELLING YOU WHAT TO DO.
- Write down supportive feedback / input. If you don't know if it is supportive or helpful, instead of going into IMMEDIATE overwhelm, write it down and look at it a few hours later, or the next day. Who are these people? medical personnel? housing/facilities?
- Be okay with not knowing how to proceed or the best course of action. We are all on a learning curve 'as we do' - if you find someone who really listens and feels helpful, listen to them and let the others be in the background. Avoid overwhelm so you can expend your energy as you need to.
- Tell people you are overwhelmed and how you can 'hear' them - writing notes, phone call, text, emails? A list of priorities? What works for you?

* Yes, your dad may not be able to go back to ind living. Consider, if an option to have a person move in - a 'live-in' caregiver. They will need days off however, they will get free rent for however many hours you need them available.

* This is overwhelming - for several reasons and mainly because people (family) are not experienced or educated in how to deal with these things until it happened NOW in the moment. Many people do not know how to set boundaries (for self-care) or have any knowledge of what dementia is and how to interact with their loved one. It is a lot to deal with. Make sure legal matters are in order and money is managed (your dad's) and track expenses / expenditures / incoming. Track it.

* Distance seems to be a major issues for you. If at all possible, stop these 9-10 hours of driving. Fly or have someone else drive (so you can sleep) if at all possible.

* Enlist neighbors - yours (and those close to your dad, if possible) for their support.

* Know it is more than okay to need support and lean on others (when it actually is helpful).

* Keep writing to us here - even if to blow off steam. We all know that 'exhaustion' level. I won't go into what I'm doing - if I can meditate for 10 m. a day, stretch or do my slow jogging for 20 mm. eat more on the healthy side when juggling 20 balls in the air.

Gena / Touch Matters
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Sunnydayze Jul 2021
Valuable information!
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