My friend just had to have her bladder removed- cancer. She ran into several complications and ended up in the hospital for 5 weeks. They made no effort to get her up and moving so her muscles atrophied.

Now she is in rehab- and improving slowly but improving. They informed her that she is moving too slow- and told her she would be released mid-Nov.

Where does she go? She lives alone- lives on ss- and a bit of help from her daughters who both live in Texas....and are not very what is she to do?

I believe she will recover enough to be alone again but for the moment she needs in home help. Putting her into a nursing home will be a disaster....nobody ever fares well in those places and with covid- its worse. Medicare does not cover much in home care- and I believe its unsafe for her to be home alone all the time

If anyone can advise me how I can help her or what possible options are- I would greatly appreciate it. My heart goes out to her and I find her daughters awful. They blame her for her slow recovery.

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If she is considered 24/7 care and there is no one to care for her, rehab may not release her. Its called an unsafe discharge. She then will be put in LTC with her SS going to them if she has no money then medicaid applied for .

She needs to talk to the Social Worker to help her find options. She maybe able to continue therapy at home. Maybe she can get help thru Medicaid "in home" services. Or Office of Aging.
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Look for 6 packs in her area. single family houses that are for "residents",

6 residents 2 caretakers... Look online for these type of places .

and also check out the nursing homes. some have gotten better over the last 40 years, I hope...
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The answers already given are helpful. Whether or nor there is a senior center around, your friend will probably be eligible for Meals on Wheels.

One writer suggests your friend will never be able to live alone. That's a premature and possibly damaging thought. While it's possible she's correct, it sounds like her rehab facility is not making that suggestion in terms of the long term. From what you say about her income, it's worth her checking her Medicaid eligibility in her state. If she qualifies, she may get some long-term in-home care.

Meanwhile, there is the short-term problem. If she's not able to get an extension of her rehab time, I think you would find your perception of nursing homes is somewhat old-fashioned in terms of today's nursing homes. If she went directly from the hospital to rehab to a nursing home, I believe Medicare will pay, at least while she's getting skilled care, so the financial concerns will be minimal. If you have a condition that's amenable to rehab, then rehab will be prescribed for her in the nursing home. There won't be as much therapy as she is getting in rehab now, but probably more than if she were having in-home PT and OT (which undoubtedly will be prescribed if/when she goes home). I've recently had 3 friends in nursing homes, one long-term, and they've all been happy with their care. One was in a facility that had primarily Medicaid patients, and when we visited her, we were always positively impressed with the quality of her care, and with the caring attitudes of her caregivers. A few years ago, I had to stay in a nursing home for about a week because of foot surgery that required me to stayy off my feet completely for a short time. My own ome would not let me do that. Because of the sequence of events, I didn't knpw I would need a nursing home stay until the day after the surgery, and I had to find a place quickly without much time for selection. I was allowed to take my computer, which was a big help; the food, while not fantastic, was OK and nourishing. I can't remember about TV, which I was not concerned with; she might need to take one if she wants one during her stay. It's likely because of her condition she would be qualified for a single room without extra charge. I would add tha my mother had to go to a nursing home after she did not progress quickly enough after surgery for a broken hip, and my mother was about as fussy as you can get! She was fine there, her rehab went well at last, and in a few weeks was able to go home.

You have almost 3 weeks before mid-November. A social worker for the rehab facility should be able to help you find some places to check out for her. . The nursing home where I stayed was middle-of-the-road, the cost was OK, and I had a single room. Most places have private bathrooms, usually with communal showers. She would get help with showering or she'd get sponge baths. Since her incision should have healed, she may be fine for showering with assistance.

The big problem with COVID-19 now is the restriction on nursing-home visitors, as other people have written. It's pretty isolating, but if Dr. Fauci's current recommendations are followed, she's going to be quite isolated at home, too. Re safety, while nursing homes had high morbidity and mortality at the beginning of the pandemic, now most of them know what to do and what precautions they must take. If I were going to need a number of different health care providers I think it might be safer to have these providers in a nursing home, where they'll be tested frequently and temperatures scanned daily. For most of them, they won' t be working elsewhere, so there will be fewer chances for them to be unknowingly exposed than if they were seeing multiple clients. You should definitely check on this option before dismissing it!

One last thought: by mid-November, your friend might have a spurt of improvement, in which case more rehab may be prescribed, or she may be more ready to go
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AlvaDeer Oct 2020
You truly are correct that nothing can currently be known about long term care and need for it. But the fact that the bladder is removed means this was a quite serious cancer diagnosis; can't know what scans show regarding any pelvic spread, but that will figure in as well, and the fact that there is no bladder means that this dear woman is going to have to learn some specialized self care to be OK at home. I think it is very unlikely by mid November, but who is to say where that will find her in terms of being able to negotiate activities of daily living. This is currently an unknown as to moving home, but 5 weeks hospitalization was a very very long one, and rehab has already suggested that the predicted progress isn't being made. I hope that things will improve, but would plan for a need for placement at least in the short term, with no family in the area. Hope there is a huge improvement and my prediction is proven absolutely wrong. My worst fear in this case would be a good friend and neighbor thinking that she could lend enough support to prevent an unsafe homegoing, or for the patient believing there could be more support at home than there really is, or for the daughters not to understand that they need now to step forward and be ready to help, or act for their Mom.
What I read, stated that the doctor limits the patient's activity after this particular surgery.

Have her ask her doctor, and get the rehab fully informed. imo.

She is improving. Rehab could be wrong about moving too slow.
The doctor has the power to explain the needed recovery, and to request an extension to the rehab through her insurance/Medicare?

Her daughters could be behaving badly because they are scared they will lose their mother. Try less judgment, more understanding all around. This friend should not have to face judgment in addition to her illness. imo. Placing blame when one does not even know if they will survive is cruel.

Getting your friend a support group specific to adjusting to living without a bladder may help. A cancer support group.
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Ronnid, a few random thoughts...

1.  Search online to see if there's a Gilda's Club near her.   She might get suggestions, and even help, from them.   I was really impressed when I met with one of the staff.

2.   See if there's a Senior Center than can deliver meals.  Not only would it avoid the challenge of cooking, it'll provide her with a bit of companionship even for a few moments, and it's also people who can check in on her when they deliver meals.

3.    Ask if the Senior Center has a social worker; I've found the one in my father's area to be quite knowledgeable on resources.

4.    Contact  the county offices to see if they have respite care, and what else might be available.   

5.     Have her contact her doctor and script for PT at home; that'll not only give her some human interaction but can help her regain her strength.    The therapists can also give her sheets of exercise instructions, so she can do them on her own, or you can do them with her to provide support and companionship.

Have her also ask the doctor if she/he will script for additional rehab care in a facility.    My understanding of several years ago was that it could be extended if the patient needed it.  That's how we got longer care for my mother when she broke her leg and was nonweight bearing for about 6 weeks.

6.      What you can do is make meals for her and pack them in single portions, preferably in microwave dishes so she doesn't have to stand and warm them up at a stove.    Good nourishment will be one of the real needs as she recovers.  

I'm wondering if she'll need to be on a special diet?

You might also consider shopping for her, if you're comfortable doing this.

7.  I don't know how elimination is handled when a bladder is removed, but if it requires some assistance, that's another justification for her doctor to script for home care, including a nurse possibly for longer than would be normal for home health and PT/OT.

8.   Spend some time with her planning her days, what she needs, and arrange things around her favorite chair for easy access.   That would include phone, her address book (some of us still use these old fashioned things), Kleenex, meds, blankets, etc.  

9.    If you want to extend yourself more, have her keep a running list of things she needs at home, including meds, and pick them up for her.   My sister had friends do this during her chemo sessions as it was too demanding for her to even consider driving.

10.   Your profile indicates her gait is unsteady.    She might need a rollator, which is more stable than a walker.    Her doctor could script for one; you might want to research on line to help her choose, contact DMEs and see if they'll deliver to her apartment.

11.    I would purchase or get money from her for no rinse shampoo and soap products.  They're just as thorough as rinse products, and that would avoid the challenge and danger of getting in and out of a shower.  

12.    Lastly, I'm wondering if she could qualify for Medicaid.   One of her doctor's staff, or even someone at the nursing home might be able to help determine this. 

That's all I can think of now.   You're a good friend to be so concerned about her, and I hope she heals well and safely, and that you as well remain safe and as healthy as we can be these days. 
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Alva gave wise insight. How old is your friend? Can her family be more engaged? Helping her research aid and in-home help and residential options that may be available to her will be extremely helpful. Bless you for sticking with her. Just also take care of yourself.
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You are a good friend, but I think there is no way now to know what condition your friend will be in on discharge. It is extremely unlikely that she will be able to live on her own at home after this. What goes on between her and her own family is something they will now have to work on, and she will be busy getting assignment of (likely a family member) to be her Health Care and her DPOA.
I think that you should function as a good friend, but do know that it is up to your friend, her family, and how well she can function what the next steps will be, and they well may be going into care either for some period of time, or permanently.
So continue to be a good friend, to be there to comfort and to listen.
There is very little else that you can do, as a friend.
I am so sorry for all her problems. And I understand how upsetting it must be for you to see.
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