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80 year old dad been in the hospital for about 4 weeks with a number of issues including pneumonia, severe malnutrition, now with feeding tube. He was ambulatory prior to admission and now dependent on others for all his needs including bathing/bathroom/bedridden, basically very deconditioned. He’s having anxiety esp at night where it’s not allowing him to sleep and sleeps all day affecting participation with things like PT. I’m suspecting he is very frustrated in his inability to do much and feels some shame in what’s going on, esp the bathing and soiling himself. He was already on a SSRI (sertraline) with no improvement. I’m concerned once he’s home (discharge planning next couple of days) that his anxiety will continue and my mother who is the primary caregiver will be wiped out.

Imho, a patient in the hospital is typically going to get broken up sleep because nurses are coming into the patient's room for blood draws at early morning hours. Personally, I was hospitalized 2 and a half months ago and it was quite common for the nurse to come into my room as early as 3:00 A.M. for a blood draw, IV change out and med push or oral. Also, patients in other rooms can easily be heard - sometimes calling out for help. That said, perhaps this is occurring with your father, too and possibly medication can be administered to him to help him with sleep.
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Reply to Llamalover47
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Talk to your dad's doc about his anxiety, frustration, anger. He should be able to either help or refer him to appropriate specialist. He's gone through a lot of life changes in a brief period - its no wonder he's anxious, frustrated and angry. In addition to medical attention, reassure him that your family is there for him. Let him vent and express his fears and anxieties.

I agree about sleeping at hospitals - they are noisy, compared to home and he just may be in pain or uncomfortable. While my Grandmother was fine in a regular hospital room, while in ICU she'd get a little crazy in the wee hours of the morning - to the point my parents would take turns staying in the ICU waiting room all night long. Of course the staff thought they were being helicopter children - cause who can't handle a so sweet little old lady who was so cooperative - but usually after 1 or 2 AM out they'd come for mom or dad to have them come in and calm her down as only they could - how could such a sweet, cooperative, little old lady could become so agitated in the wee hours of the morning.

As for being released home, from what you describe dad's emotions are the least of your mom's worries. Unless there is a lot of help available she will be worn down in no time. Caring for feeding tube, transferring, toileting - she will be done in not time. Family really needs to revisit him coming home so soon. Yes my father too hated going to rehab after hospital visit, however, your father needs to get stronger before being released home.

To come home directly from the hospital is going to need a lot of support staff to help which may be too costly for your parents to pay.

Good luck.
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Reply to cweissp
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Talk with his doctor about sleep issues, It is not unusual for people to have sleep problems in the hospital - lots of noise, lots of people coming and going, lots of unusual routines... He might need a little medication to help him fall asleep and stay asleep at night until he gets his days and nights back on track. It may take sometime for psychoactive drugs to reach therapeutic levels which translates into "give his SSRI some time to become effective".
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Reply to Taarna
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This is sad but the state he is in is going to get worse and worse and he will need far more care than you can provide without completely destroying yourself or anyone who cares for him. You either must get a full-time caretaker to relieve you or you have to place him. That time has come. Save yourself while you still can - and those who are with you.
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Reply to Riley2166
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Have they suggested a rehab facility for after the hospital with the goal of coming home? At Rehab he would get more intense physical therapy and my experience with rehab hospital is I could go visit all day every day... and, depending on the rehab, more than one person could visit at a time. These places are temporary nursing homes in effect with the goal of a few weeks max.

I know your mom thinks she wants him home but it does sound like he is going to need a caregiver for many hours each week and I would be surprised if she were up to getting him out of bed... to the commode, changing depends etc. Most caregiver companies require each visit to be 3 or 4 hours at a time and most charge $20-25 an hour. If your dad was a Vet, the VA will supply someone for 2 hours at a time, maybe 2-4 hours per day for free. They are also good about ordering PT.

With the feeding tube and incontinence issues, you are nearly in a skilled nursing home situation. You need to be realistic that you are not trained at nursing and PT.

It's so tough to see your father going downhill so quickly. The same thing happened to me. He was walking 1/4 mile a day, still taking care of all his own needs (except cooking and cleaning)... but after being in the hospital for 5 weeks, he was helpless. He couldn't swallow well enough and so they wanted to do a feeding tube but I refused (my grandma was on one for 10+ years and I knew he didn't want that). Once he got to a memory care, he was able to eat regular food. But he still can't walk or toilet himself or anything else. Such a difference in a matter of months, it's an adjustment for all of our family who feels he should be able to get well again with enough PT and help.
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Reply to marydys
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The Best thing that can happen to your Dad, is to get out of the Hospital, and Back Home where he healing. Feel Safe and Loved and can start healing.

You can check at the Hospital and Insurance and see what things would be available to him like with Home Health Care.

His Insurance might cover having some Home Health where a Nurse would come out to check on him once or twice a month, an Home Health Aide come 2-3 times a week to help out with bathing and he can get In Home Therapy a few times a week.
All above should be covered by Dad's Insurance.

In the beginning, if it gets too much, Your mom can hire a Caregiver to help out a couple hrs a day.

You and other Siblings can also help, to give your mom a break.

Prayers

Prayers


Your mom
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Reply to bevthegreat
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I am surprised he is not given something to help him sleep. I also may consider not bringing him home at this point unless he can afford help. Will Mom be able to handle the care of a feeding tube.

It may be better to let him go to Skilled Nursing on the basis he can come home when he improves. Then Mom should see a lawyer about assets being split. Dads split would be spent down and then Medicaid applied for. Mom would remain in the house and have one car. She would get enough from their monthly income to live.
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Reply to JoAnn29
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Is dad a Veteran? If so check with the local Veterans Assistance Commission to see if they can help determine if he would qualify for any help from the VA. It could be a little or a LOT
Same with mom, is she a Veteran? again check to determine if she qualifies for any help.
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Reply to Grandma1954
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We have had these discussions as a family. Skilled nursing is an option but my mother wishes for my father to come home esp with strict visitation rules with covid, in addition to my father himself not wanting to be placed in a facility. A stark difference from My grandmother with Alzheimer’s who after a couple of years we found a nursing facility that provided her care. Since this is quite acute and new for him to place him in a nursing home we feel would kill whatever little motivation he has left to live. He is of the personality of always wanting company esp of my mother. Not a candidate for acute rehab.

the hospital case manager is helping with set up with home health care for nurse aide and nurse visit/ /PT not sure many hours will be provided. I have been looking into some state programs through Medicaid that provide additional hours for home custodial care but my understanding that will take time and there is a wait list.

his mood/anxiety is the key feature now as the medical issues seem to have stabilized. At this point is getting him to eat properly, partipate with pt and have a more positive outlook. He is anxious and at times aggressive/agitated with hospital staff. Frustrated. Not sleeping at night, anxiety seems secondary new found state of disability. He was independent prior to admission and now even having a bowel movement he needs help.

any suggestions on anxiety tx

any additional thoughts are greatly appreciated
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Reply to Ily0724
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We have had these discussions as a family. Skilled nursing is an option but my mother wishes for my father to come home esp with strict visitation rules with covid, in addition to my father himself not wanting to be placed in a facility. A stark difference from My grandmother with Alzheimer’s who after a couple of years we found a nursing facility that provided her care. Since this is quite acute and new for him to place him in a nursing home we feel would kill whatever little motivation he has left to live. He is of the personality of always wanting company esp of my mother. Not a candidate for acute rehab.

the hospital case manager is helping with set up with home health care for nurse aide and nurse visit/ /PT not sure many hours will be provided. I have been looking into some state programs through Medicaid that provide additional hours for home custodial care but my understanding that will take time and there is a wait list.

his mood/anxiety is the key feature now as the medical issues seem to have stabilized. At this point is getting him to eat properly, partipate with pt and have a more positive outlook. He is anxious and at times aggressive/agitated with hospital staff. Frustrated. Not sleeping at night, anxiety seems secondary new found state of disability. He was independent prior to admission and now even having a bowel movement he needs help.

any suggestions on anxiety tx

any additional thoughts are greatly appreciated
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Reply to Ily0724
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Have a serious talk with mom. Can she safely care for dad in his current status?
If not talk with the hospital Social Worker and see if discharge to rehab or Long Term Care Facility would be possible.
The other option would be setting up caregivers that will come in daily to help mom. It could be arranged that if mom needs more help in the morning and evening then a caregiver can come in for 3 hours in the morning and 3 hours in the evening .
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Reply to Grandma1954
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