UP-DATE on my Dad, we have him in a assisted living place for 30 days, they are going to work with him. We told him that if he wants to come home he must reach certain goal like standing, walking getting out of bed and he has to do the PT, we want no excuses if not he will be going to a nursing home, that would be the best for him and Mom.
This is FGood4brother adding an apology, I meant to write " I wish you, your father and mother the best!. CERTAINLY did not mean to leave dear mom out:(
First, besides the fall and refusing to do anything in rehab after a fall, I'm wonderig if your father has been diagnosed with any type of dementia. I ask because if he has something like advanced Alzheimer's disease, it will certainly be difficult to reason with him. I'm hoping that even though he refused to do anything in rehab, the discharge order included home health physical therapy. Sometimes, some patients may be more cooperative in their own home - familiar surroundings. It is possible the insurance will not pay for home health physical therapy due to his non compliance as a rehab patient. It could be there was a good reason for his behavior. If this is the case, you may consider hiring someone privately. If your father does not have Alzheimer's disease, consider having your father be a part of the interviewing process. If he establishes rapport with an interviewee, and there's a mutual sense of respect, that can, possibly, make all the difference in the level of cooperativeness on his part. We all usually work best with people we like. I wish you and your father the best!
Of course he wants to go home. Who wouldn't.. But as you say, just being home won't magically cure him. He's not using his logic 😞
How to care?
Well you can see path HOME right now (doing all & sundry for him) will be a big boggy mess to all fall in.
Maybe paint a picture of HOME being the GOAL but first the detour...
Look for a slower route. A pathway with maybe some professionals alongside: Psychologist (if you suspect depression), Social Worker (to help find the right facility for now) & PT (for ongoing rehab).
Ask about *Respite Care* options. Temporary, slower, with ongoing PT.
Buying some time until he meets the fork in the road again: the prongs being Home or Residential Aged Care.
I found it does not have to be Do All care or step back Do Nothing. *Advocate* is another option.
How active was your dad previous to his injury? Was he active with no Cognitive issues?
I have seen many post here about older parent undergoing anesthesia and it really affecting their cognitive state.
I would also check to see if they have him on any new medications or pain meds since his surgery (ask the rehab or mom) to speak the nurse/case manager and go over any medications that may be affecting him. Though He may actually need an antidepressant as depression is common after facing new changes at any age. Does your dad seem the same to you - is it just motivation for therapy or do you see other changes in his moods/energy etc.
I know with rehabs they do have to meet goals or Medicare will no longer pay. If you all feel mom is unable to take on full care or pay and provide for it then you should discuss as a family and help guide your mom to place him.
I took my mom home after her stroke - I was almost 48 - (with my own health issue) she is full care as your dad is right now and it is hard. Your dad could go home with home health and request PT and OT with home health at home - though it is much less than provided in a rehab - at best it starts 2/3 times a week but goes down 1/2 x a week quickly - sometimes people can do better in their home environment (again this would be a decision made by all of the family who know him best) and if mom could afford to hire caregivers to help her at all times. I am not suggesting this to you - I am just providing information so that you can all sit together and really discuss what is best for your family. If dad does well with the in home therapy he then also can continue to a local outpatient rehabilitation. All therapies have the same criteria and he must meet goals to stay in any of them - he will be assessed at both home and outpatient.
But going home entails a lot - if he is only mobile by wheelchair it will entail a wheelchair accessible home or area - maybe hospital bed and possibly a hoyer to get him up and into the chair or toilet. He may require needing to wear depends and bed baths etc. Your mom would need a team of caregivers at home with her.
This is such alot for a family to digest - so I hope some of the info above helps you all sit with mom so she can decide what is best for them both. If he is released from rehab - he may be able to stay in the skilled nursing part of the rehab and you can ask if they will continue to offer him any PT (they may after a waiting period).
Again I would highly suggest making sure he isn’t on any new medications (sometimes things are added in by a dr at these rehabs and the family is not aware). I would ask his current bloodwork/electrolytes/urine - is he eating and drinking enough and make note of you notice any other changes. It could be more motivation that he just doesn’t have anymore or could be something else that isn’t allowing him to participate to his normal level. Only your family will know or see that difference. wishing you the best.
How unfortunate that he is being so uncooperative with rehab. Are they discharging him from rehab?
When my mom had surgery, I said she had to go to rehab. And I said she had to meet certain goals to come back home, that would make it tolerable for ME, in my home. She needed to be able to get in the house (3 steps) and she needed to be able to get to and from the bathroom from her bedroom on her own. I was not giving up my sleep or hurting my back getting her into the house.
How does your mom feel about this? It would be nice if the siblings would all get on the same page. You guys have to, IMHO, let mom know that you will NOT be helping take care of dad at home in his current condition. And you all will need to really stick to that firm boundary.
Maybe your dad can be brought to a teachable moment and will find his motivation. It's not too late for him to start doing the work that needs to be done. Or he can spend the rest of his life in bed. In a nursing home. Maybe someone needs to gently but firmly walk him through where his behavior is leading him. It would not be safe for him or his family caregivers for him to be back home. Not safe and not good.
Yes, your Mom needs to tell the SW that allowing Dad to come home is an "unsafe discharge". That she can not possibly care for a man who cannot do for himself.
Placing Dad means a Longterm Care facility/skilled nursing facility. He needs more care than an Assited Living can provide. Mom needs to protect her share of any assets they have over and above their monthly income of SS and any pensions. You may need a lawyer to help split these assets. Then what happens is Dads split is spent down and once that happens Mom files for Medicaid to help pay for his care. She becomes the Community Spouse, remains in the home and gets a car. She will get enough or all of the monthly income to live on.
Your mom must tell the rehab facility that she is in no position to care for him if he would return to his home, and that she would like the rehab social worker to help her find the appropriate facility to place him in. It's certainly not fair to your mom at her age, to now have to assume full responsibility for a man who can no longer do for himself. It will be too much for her, as you already know. Unless your mom is willing to hire 24/7 help to come in and assist her, she will have no other option but to place him. And quite honestly, it is cheaper to have your father placed in a facility than to have to hire 24/7 in home care. Hopefully you can talk some sense into your mom. Best wishes.
Thank-you so much! This is all new to us and we don’t know what we should do. I don’t want my Dad to bring my Mom down then we would have 2 trying to provide care for.
Of the old trick of saying YES but meaning NO.
'Yes, yes OK to Aides for a while'. Then gets home, shoos out the Aide, calls to cancel or won't open the door to let them in again.
Wife & daughters then stuck with all his care.
Happens all the time. Happening to a friend now.
Whatever you do, don't invite them to live with you!
Of course he wants to go home. Who wouldn't.. But as you say, just being home won't magically cure him. He's not using his logic 😞
How to care?
Well you can see path HOME right now (doing all & sundry for him) will be a big boggy mess to all fall in.
Maybe paint a picture of HOME being the GOAL but first the detour...
Look for a slower route. A pathway with maybe some professionals alongside: Psychologist (if you suspect depression), Social Worker (to help find the right facility for now) & PT (for ongoing rehab).
Ask about *Respite Care* options. Temporary, slower, with ongoing PT.
Buying some time until he meets the fork in the road again: the prongs being Home or Residential Aged Care.
I found it does not have to be Do All care or step back Do Nothing. *Advocate* is another option.
I have seen many post here about older parent undergoing anesthesia and it really affecting their cognitive state.
I would also check to see if they have him on any new medications or pain meds since his surgery (ask the rehab or mom) to speak the nurse/case manager and go over any medications that may be affecting him. Though He may actually need an antidepressant as depression is common after facing new changes at any age. Does your dad seem the same to you - is it just motivation for therapy or do you see other changes in his moods/energy etc.
I know with rehabs they do have to meet goals or Medicare will no longer pay. If you all feel mom is unable to take on full care or pay and provide for it then you should discuss as a family and help guide your mom to place him.
I took my mom home after her stroke - I was almost 48 - (with my own health issue) she is full care as your dad is right now and it is hard. Your dad could go home with home health and request PT and OT with home health at home - though it is much less than provided in a rehab - at best it starts 2/3 times a week but goes down 1/2 x a week quickly - sometimes people can do better in their home environment (again this would be a decision made by all of the family who know him best) and if mom could afford to hire caregivers to help her at all times. I am not suggesting this to you - I am just providing information so that you can all sit together and really discuss what is best for your family.
If dad does well with the in home therapy he then also can continue to a local outpatient rehabilitation. All therapies have the same criteria and he must meet goals to stay in any of them - he will be assessed at both home and outpatient.
But going home entails a lot - if he is only mobile by wheelchair it will entail a wheelchair accessible home or area - maybe hospital bed and possibly a hoyer to get him up and into the chair or toilet. He may require needing to wear depends and bed baths etc. Your mom would need a team of caregivers at home with her.
This is such alot for a family to digest - so I hope some of the info above helps you all sit with mom so she can decide what is best for them both. If he is released from rehab - he may be able to stay in the skilled nursing part of the rehab and you can ask if they will continue to offer him any PT (they may after a waiting period).
Again I would highly suggest making sure he isn’t on any new medications (sometimes things are added in by a dr at these rehabs and the family is not aware). I would ask his current bloodwork/electrolytes/urine - is he eating and drinking enough and make note of you notice any other changes. It could be more motivation that he just doesn’t have anymore or could be something else that isn’t allowing him to participate to his normal level. Only your family will know or see that difference.
wishing you the best.
When my mom had surgery, I said she had to go to rehab. And I said she had to meet certain goals to come back home, that would make it tolerable for ME, in my home. She needed to be able to get in the house (3 steps) and she needed to be able to get to and from the bathroom from her bedroom on her own. I was not giving up my sleep or hurting my back getting her into the house.
How does your mom feel about this? It would be nice if the siblings would all get on the same page. You guys have to, IMHO, let mom know that you will NOT be helping take care of dad at home in his current condition. And you all will need to really stick to that firm boundary.
Maybe your dad can be brought to a teachable moment and will find his motivation. It's not too late for him to start doing the work that needs to be done. Or he can spend the rest of his life in bed. In a nursing home. Maybe someone needs to gently but firmly walk him through where his behavior is leading him. It would not be safe for him or his family caregivers for him to be back home. Not safe and not good.
Placing Dad means a Longterm Care facility/skilled nursing facility. He needs more care than an Assited Living can provide. Mom needs to protect her share of any assets they have over and above their monthly income of SS and any pensions. You may need a lawyer to help split these assets. Then what happens is Dads split is spent down and once that happens Mom files for Medicaid to help pay for his care. She becomes the Community Spouse, remains in the home and gets a car. She will get enough or all of the monthly income to live on.
It's certainly not fair to your mom at her age, to now have to assume full responsibility for a man who can no longer do for himself. It will be too much for her, as you already know.
Unless your mom is willing to hire 24/7 help to come in and assist her, she will have no other option but to place him. And quite honestly, it is cheaper to have your father placed in a facility than to have to hire 24/7 in home care.
Hopefully you can talk some sense into your mom. Best wishes.