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Dad fell and is in rehab. This is his second full day there. He is in a lot of pain when he tries to sit up, and I think that he's very depressed. I plan to spend several hours there every day, both to cheer him up and to provide what physical help I can (the place appears to be somewhat short staffed). Any advice on what helped your parents when they were in rehab? And any advice on how to keep sane in the midst of all the stress?

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This is an excellent question, and you're wise to address now what you can do to help. Having been through several rounds of rehab, these are some suggestions.

1. He'll be disoriented, not only b/c of the pain, but the surroundings are different and new, there's a loss of control over one's own day and body. Brings things from home that can provide a link to his home to lessen the disorientation.

I brought a military plane calendar (my father was in the Army Air Corps and relates a lot to WWII planes), photos of dogs (he also likes dogs), his favorite magazines (older folks mags, scenic nature mags, church mags, etc.), toiletries, favorite clothes, church address and phone book - things he might need while in rehab.

2. Spend some time getting acquainted with the staff so they're more comfortable when you call for updates. Wouldn't hurt to bring some bagels or donuts. Learn their names and call them by name every time you see them. Make yourself well known to them.

3. Review the medication list. Facilities have on call doctors who visit once or twice a week, depending on the facility, and often they change the meds. I've found they typically will add stool softeners, anti acid pills - regardless of whether the patient needs them.

If this happens, ask the nurse first why these were added, just to go through the chain of command, and work your way up to the doctor if necessary. I've left notes with the nurses or aides to ask the doctor, conveying that I really do need to know why med changes were made.

4. Visit often now and help him acclimate; gradually decrease your visits once he becomes more comfortable and able to fend more for himself.

5. When he can transfer to a wheelchair, take him around the facility to help him orient himself. Go past to the therapy room, main dining room, library, etc. if the facility has them. Then he won't feel so confined just to his room.

6. Help him call out to friends, make sure he knows how to use the telephone (usually dial 9 to get an outside line), go over the controls for the bed and for getting nursing or aide help. Being in a strange surrounding and now knowing how to get help is very disorienting.

The goal is to prevent the sense of isolation and helplessness by enabling him to orient himself and know how to get what he needs.

7. Pack a lunch and eat a meal with him, either in his room or in the dining room.

8. Find the activities staff, find out what activities exist, and time your visits so that you can ensure he's able to get the activities he wants.

Ask about music and pet therapy. Dog visits are more common in rehab facilities these days.

9. Bring clothes that are comfortable for him, clothes he's worn for years and in which he can link to earlier relaxing days at home. Use a permanent ink pen (such as the Sanford pens) to write his name and room number either on the clothes, or on iron on tabs you can get from a fabric store.

If you plan to take his laundry home, make a "FAMILY DOES LAUNDRY" sign to tape to a door (or wherever staff designates) so that his clothes don't get lost or mixed up with someone else's.

10. Don't stay all day; I used to time visits for either just before, during or after lunch, so that he has plenty of down time.

11. Tell friends and relatives to call, visit and/or send cards. Get one of the new card displays, some push pins or double faced tape, and pin up the cards he gets. If he's not getting many from family, compensate and bring some cards from you for the next few days so he can open them up and feel that connection with you.

12, If he wants you to, accompany him to rehab, take notes on the kinds of exercises he's doing as he may need to continue those at home either with home health care or on his own.

13. Either ask the social worker now or start researching home care agencies. When he's ready for discharge, you may only have a few days to get ready, and it's much better to have discussed, perhaps met with, and gotten acquainted with a home health staff representative before the actual discharge date.

14. If your father will be leaving to return home or to your home, and this is his first fall, ask if the physical and/or occupational therapists make home visits before discharge to suggest adaptations. After my father's first fall resulting in a fractured femur, both PT and OT came over to inspect the house and make recommendations. This is the first time any facility has had therapists who did this, but it was very helpful.

15. Inventory everything you bring so you can be sure you've gotten everything when he's discharged.
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I was typing away when you posted again. As to the Vitamin K foods while on blood thinners (Coumadin/Warfarin I assume), raise this with the nurse and then the dietician.

Actually, the pharmacists at the anti-coagulation clinic we attended for several years said that a diet that's CONSISTENT in Vitamin K foods is better than one with irregular K foods, and we did find that out.

Ask also how often his PT/INR values are measured and if they're being monitored for 2 - 3, the therapeutic range. Letting them know you understand these issues can heighten their level of respect for you, and knowledge that you're on top of these issues and want to be kept up to date on what's going on.

As to the possibility of depression, that can certainly happen, but you can also turn this unhappy situation into one of bonding and supporting him throughout his recovery. I would also discuss with his nurse what the pain regimen is going to be, to ensure he's getting enough meds to allow him to recover.

If you're comfortable with this, you could bring in an easy to use CD player with his favorite CDs (I duped them and kept the originals at home), with ear phones. Put on a CD just before you leave so he has a chance to relax to music after you've left.

The first few days can be awkward, but there should be some acclimation as the first week plays out.
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Madge, that sounds like a horrific place. Did you file any complaints or notify Medicare of the problems there? Those kinds of issues should be ones that Medicare addresses in its evaluations.
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Angie, you made a very good point about pain meds being timed to be effective for rehab. We had to work on that, but once the regimen was in place, it made a big difference.
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Years ago my Dad was in rehab. He lived there for 2-3 weeks and he enjoyed being there, he said the food was good, and he liked his physical therapist. But he was starting to be bored.

I found among all of this, the only stress was with my Mom, as she didn't like having Dad in a rehab facility. She thought she could take care of him at home. Ah, NOT, Mom was in her 90's. We went around and around on that. Plus Mom didn't like visiting the facility, seeing all those old people in wheelchairs... [rolling eyes]. Otherwise, my Dad did quite well at rehab. We took Mom to visit less and less as she wasn't very positive on her visits.
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About the Vit K. I agree with GA. The newer thinking is to be consistent. My mother would not eat a speck of green. She really limited her diet and she loved all veggies. Her cardiologist told her to eat what she wanted and they would adjust the meds around it. She seldom needed an adjustment because she would not eat greens. The truth is Vit K is in almost Everything to one degree or another but she was afraid of bleeding. It is hard to eat consistent when you've gone from home to hospital to rehab but while he's there maybe he can relax on limiting the greens and give it a try. I also would add to take some Clorox wipes and clean his room. Remote control, call button, light switches, telephone Etc. I did this everyday on items frequently touched. I was afraid of MRSA.
I noticed my mother was only using her left arm when she first went into rehab. I asked her why. She said she couldn't lift her right hand. The therapist evaluated this and discovered she had something called " drop arm". She could not feed herself for awhile due to this but it got better and she continued with OT for the rest of her life to keep her arm strong enough to use. This was not noticed in the hospital. Like your dad she was having severe pain in her back so we didn't notice until later about the arm. Also in one rehab she was treated with lidocaine patches that were originally intended for shingles patients. They really helped her back pain. Some patients can be helped with a back brace they told us but she was not a candidate for that.
Also when you go home it might be beneficial to get your dad a hospital bed. That really helped my mother as she could adjust it for her comfort and breathing. Also his chair needs to be at a comfortable height for his legs and a good cushion can be helpful. Again, everyone is different but notice if he needs the bed elevated to get comfortable.
Since you mentioned the Coumadin I was wondering If your dad has CHF? If he does, watch closely for swelling. The trauma of the fall can sometimes trigger an episode. Ask the staff to keep an eye on his weight as well as INR.
I also agree with GA about the meds. Can't go wrong checking on all of that.
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GardenArtist and 97YearOldMom, Thank you so much for all the helpful advice. I will mention the salad/Coumadin issue to the nurse tomorrow. I talked to the therapist and the nurse practitioner today, and they are planning to give Dad extra pain meds half an hour or so (I can't remember the exact interval) before the therapy sessions. Dad will be moving from independent living to assisted living (at the same senior residence) after he is discharged, and so that part of the plan is in place. I really have the urge to bring him home and take care of himself, but that was extremely difficult three plus years ago when he was more mobile and I was younger and stronger. I know that it just wouldn't be feasible.
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Rehab can be very difficult depending on a host of factors - my mom spent 6 weeks in the same rehab twice 8 years apart

The first time was challenging due to her injuries and being in renal failure when discharged from the hospital and no one knowing it requiring her to be re-hospitalized twice but the therapist was fabulous and she worked hard at age 84 to get out of there

The second time was worst as she now has dementia and ownership of the place changed and her pcp no longer would visit her leaving us to a house doctor from overseas - it was an exhausting experience and I hired personal sitters to be with from 4-8 pm - I visited every other night after work and stayed til 10 or 11
Luckily she was in the room next to the nurses station so they could hear her

I always checked in and brought treats and passed out $5 gift cards to local fast food places - with a broken back and dementia she was completely prone and a handful but would try to do therapy - if a patient refuses three days in a row then Medicare won't pay

Every single personal item was stolen from her nightstand, clothes went missing even though I did her laundry and I bought her depends style diapers
If she had diarrhea and soiled her pants they would just throw them in her closet and she be left in just a diaper they wouldn't even put a gown on her

The opening to the bathroom was too narrow for her wheelchair to fit through and there was only one useless grab bar

The man in the next room blasted a CD player day and night playing some kind of foreign music and another man sat in the hall and exposed himself - there were no activities just a tv and this is a 5 star facility located next to one of the best hospitals in the area
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Ms Madge. That is just awful. I'm so sorry you and your mother went through that. I always try to check out the rehabs beforehand but I know it isn't always possible and we can't always imagine all that can happen.
Angie, my mother was living alone at home when she fell. I can remember sitting in her room thinking, I'm so thankful my mothers bed linens are done. I'm so thankful the floors are being mopped and the meds administered and the baths given. We had been in the ICU and then the hospital room for over a week and I was worn out by the time I got to rehab. Try to overlook the smaller issues. Focus on managing the pain and the therapy. That's why you are there so your dad will get better. The 30 min ahead of time is a good thing. Also ask about ice for afterwards. Sometimes ice works for some injuries/ patients. Sometimes heat. Talk to the therapist. Things won't be perfect but if they are " good enough" he will benefit. Not like Ms Madges situation. From that one you have to move.
If my mom had gone home she would have lay still in the bed to avoid the pain and then she would have not been able to get up.
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Thus far I'm not particularly happy with the care that Dad is receiving. I do think that the therapy is good (thus far he's had an assessment, one minisession, and one full session, and I've been present for all of them), but the physical care definitely isn't great. He already has a flaming rash (he has sensitive skin, and this is nothing new), and apparently I noticed it before anyone else did. (I treated it myself yesterday with the over-the-counter cream that his PCP recommended previously, and today the NP did look at it and will instruct the staff to treat it three times a day.) No one has made any effort to see that he brushes his teeth--in fact, I don't think that it even occurred to anyone till I asked for a basin so that I could assist him. The NP wanted to give him Benadryl for sleeplessness and possible itching (NOT a good idea because it can cause confusion in the elderly) even though two other medicines more suitable for those purposes are in his med list. He was supposed to have a complete metabolic panel this week to check for any adverse effects of an increased dose of one of his meds. The rehab didn't know about that, which is understandable because it had been ordered by his cardiologist, not by his PCP. But even though I mentioned the bloodwork to them today, I wonder whether they'll really do it unless I prod them.
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