My brother has been moved to a health and rehab place after being hospitalized with heart failure for over a month. He is hallucinating and is quite delusional. He is bed ridden still, but cooperating with the physical therapist and making a little progress physically. He is still receiving medications from the hospital doctors for his heart and gallbladder. My niece and I wonder if we need to also have palliative care to oversee his needs. We both work, I teach and am also my mom's advocate for her care, and my niece has to go back to FL for a few weeks to take care of her flooded house. There continue to be questions asked to us about my brother being discharged to his home at some point, not right now. We can set up care for him at home eventually, but it will take months to get his house back in order for him to live there. He let it fall into so much disrepair in his hermit lifestyle that it is taking forever to fix everything. The bathroom is torn out for repair, the carpet and most furniture is thrown out. All with his okay. It is difficult to get workers right now to build it all back. Anyway, we are overwhelmed and feel he needs more care than the rehab place provides. It is a really nice place. Nurses and administration are great and we have been allowed compassion visits to him every day. We just can't keep this up. We will hire some sort of aide to go in a couple times a week to help him get oriented, as he thinks he's at home, still in the hospital, or driving his Hummer. When we are there with him he calms down and situates himself somewhat in reality. Should we leave it to the rehab place and the aide they will help us hire, or should we get palliative care involved too?
Your father cannot go on palliative care and hospice while he is receiving treatment (which rehab is) toward recovery. Palliative care and Hospice are for the "end of the road" when it is recognize there will not be great improvement, that the patient has entered the end stage of disease and recognizes this, and doesn't want further tests and treatments toward "cure" but will accept all medications toward comfort (ie he would still take his medications to help eliminate fluids). Then he would be medicated (in Hospice) to keep him sedated, comfortable, without air hunger or pain, knowing that death draws near. Palliative care also recognizes there will be no cure and that now it is important to maintain a happier quality of life even if the quantity of life in days is shorter.
Most importantly here though is that it sounds as though this is going toward their suggesting he COME HOME. I suggest that no one take him into care without a full realization that this is the dedication of your life to his care 24/7 and even THAT may not be enough with the hallucinations.
Go NOW to Social Services and Case Management and tell him that it seems your father will now need 24/7 care and placement.
Staffing is just not available due to the pandemic. No one likes it but it is what it is. CG’s are home now teaching their kids virtually, etc. Many are hesitant to work due to the real risk of catching Covid.
If brother needs 24/7 care now, begin to work with the DC coordinators & seek placement for his discharge from rehab date.
Brother will improve at rehab gradually due to his deconditioning from his long hospital stay. But if you are expecting daily support at home from Palliative care, this is an unrealistic expectation.
The family will need to provide 24/7 care paid for with your brothers resources or he will need LTC placement and be re-evaluated there for DC as he progresses and stay there if he does not.