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I am primary caregiver and HCP for a 92 y/o man with no remaining blood relatives that my family "adopted" about 12 years ago. However, I am NOT his 24/7 caregiver and I do not live with him. I do EVERYTHING necessary for him outside his home (bills, shopping, drs., etc.) and even some help (mainly cooking and food prep and recently added laundry) inside the home. He was my Mom's neighbor in her senior bldg before she went to the NH. Amazingly he is still mentally sharp, but he is legally blind and uses a cane (with limited proficiency). He maintains himself and his apartment quite well, but is limited in cooking abilities, mainly using the microwave. He has been in quite good physical health (only took a low dose thyroid pill all these years) until winter of 2012, when he was hospitalized for pneumonia, at which time it was also discovered that he had a heart murmur and hypertension. Now he is on several medications. First week in July 2013, he ended up in the hospital again with C-diff, and released with an oral antibiotic 3 days later to "home with family care". I was furious with the hospital when I saw this on the discharge papers. The nurse claimed it was a typo "error" and that he was not being released against doctors advice. I know Uncle had railroaded the doctor into believing that he could take care of himself at home and that I would be there to take care of him as well. Needless to say, I was not happy with Uncle, told him so, and he of course denied having been underhanded. I then spent the next 10 days running ragged, with food prep, meds mgmt, laundry, housecleaning, etc. because he was still rather weak from the c-diff and the antibiotic. Last Friday, he called me in the morning and said his right leg was very swollen. I finally got over to see him that afternoon and the leg was inflamed from the calf to the toes. He flatly refused to see the doctor or go to the ER. He decided that would keep his legs elevated as much as possible over the weekend and wanted to wait until his Monday (15th) pre-set routine appt with the Podiatrist. I went along with it and put in more hours than usual seeing to his needs. It did not swell any worse, but it was redder and I was worried. By Monday he could hardly walk, but we got him to the car. I told the Podiatrist that I believed he needed to be in the hospital not only for the leg, but he had also described symptoms that morning of have a UTI as well (I was right). The Podiatrist was in complete agreement, and at my rquest, consulted with his PCP by phone and wrote me a script for the ER advising that he be admitted-DONE. I told the ER people in no uncertain terms that I was extremely PO'd with the C-diff management and this time around I wanted a Case manager on him, and that I would not be taking him home prematurely. He is now on IV as well as oral antibiotics (for continued C-diff meds, cellulitis infection in the leg/foot, and the UTI). We are waiting for results of leg dopplers and circulatory diagnostics as well. Today, I spoke with the Nurse, the case manager/social worker, and one of the doctors, and the consensus is that he very likely will need rehab (by end of this week) due to his being legally blind and also the legs are very weak. PT will evaluate him for this before discharge. I know Uncle is going to be very adamant that he "feels fine" and once again will be able to go home and "take care of himself". I would like some input from my wonderful caregiver friends on this site as to how I can diplomatically convince him that he needs to be in Rehab for a couple of weeks and not to fight me over it. He hates Rehab, and his greatest fear is the NH, which is the logical next step that we hope to avoid as long as possible. I just want to get him over this temporary setback, and will arrange for some in-home assistance after Re-hab (for both our benefit, as I cannot keep up this increasing pace with him). Sorry to be so long-winded. It's so much easier to give others objective advice, and now I need some from all of you. Depending on the situation, I'm not too good in the 'persuasion' dept. and tend to go for being no-nonsense 'firm' which usually works, but sometimes results in butting heads with frustration and anger on both sides. At 92, this is no good for him regardless of his mental competency, and I don't seem to be able to develop the patience of a saint. His PCP told me a few weeks ago that I was going to go to Heaven, and I told him IF he was right, it would probably be BEFORE my Uncle! (LOL). What kind of persuasive things can I say to my Uncle to get him to be compliant without him putting up too much of a fuss over it?

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Update on Uncle: He finally went home on Wednesday, from rehab after 4 weeks!
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Thank you, Sunflo. I made sure that the ER and nurses, Social Worker put it on record that I was not 24/7 for him and that I would not be taking him home in his weakened condition (especially without lining up immediate home health care assistance - nearly impossible to do). He should be going to rehab on Monday, and before they discharge him, I am going to do everything possible to line up home care visits for him right away. Even with that, I will probably have to visit him every couple of days at first, not only to monitor the aides duties, because I doubt he will get the # of hours in home care that I would like. One thing I'm not clear on - why did you suggest I not visit him unless a caregiver (aide) is present?
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Good news. I'm following because I was in similar situ with my mom months ago when I let drs railroad into releasing her prematurely even though we didn't have a care plan lined up. All hospitals or rehabs want to do is get patients off their books as quickly as possible so they don't have extra paperwork to file justifying longer stay and patient doesn't get sick on their watch...

That said, next time or even at end of rehab, tell the dr you will not take custody period of uncle. You can assist before hand with setting up visiting nurses or in home caregivers for whatever hrs are needed but don't sign any discharge papers or pick him up... Let hospital arrange medical transport or cab to get him home.

I let them discharge my mom and it was a nightmare I got no assistance thereafter and even though they discharged her to 24/7 care with inhome CNAs, she just fired after 3 wks. No one would help without her being read mottled to ER and they just dismissed her as ok as she lies and says I care for her and live around the block....I'm 6 hrs away in another state. It's on the records but they just call me and act like I should just quit job and come care for her.

I have made up my mind that next time she is admitted I will refuse to pick her up or visit until that have admitted her to care facility and she is safe and sound there. I have DPOA but she has to be declared by 2 drs incompetent for it to be legal...funny, even with a diagnosis of dementia and early ALZHEIMER'S from PCP and neurologist and stay in behavioral center.....no one will sign incompetent. Crazy. I love her but can't care for her and she won't budge out of her house.

You are dealing with similar. Set boundaries and stick with them. If you stay away for awhile or limit visits to once a week, maybe he'll get the picture. In fact for awhile, I wouldn't visit unless the caregiver is present in his home.
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Woo hoo! I'm so glad he's voluntarily going to rehab. I hope you get some well-deserved rest and relaxation.
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Jinx, thanks for your input. I have on occasion pulled the 'nuclear' version and told him that if he was so dissatisfied with my handling of his care (just a few weeks ago - can even remember what it was about - he just pushed all my buttons that day) that I was "done" and he could just become of a ward of the state and have a stranger handle him. He called me 3x in a row and I told him to stop. The next call was from the building manager - he was in her office crying and wanted to apologize to me. I still refused to speak to him, (she knows exactly what I am dealing with) but told her to calm him down, let him know I forgave him and to tell him I still love him and would stop by later on to visit him. I hated the fact that I let my anger do the talking, but once in awhile it happens. I just could not talk to him again until I cooled off. With this latest episode of hospitalization, fortunately he had no choice except rehab this time. I just got word that they are keeping him in hospital until Monday on the IV meds, then will transfer him. Amazingly, he has been very cooperative - I think he scared himself, realizing how sick he ended up due to his shenanigans. He actually said last night, How come I can't just stay here longer, they pay more attention to me? Well he got his wish for a few more days! Quite a character he is.
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Orangeblossom -

Sounds like you got good advice. The only thing I would have added would be the "nuclear option" - "If you insist on going home before you are ready in MY opinion, then I will not do ANYTHING for you, not even shopping and laundry. All I will do is to call you an ambulance. I will not enable you to put yourself in a dangerous position." That's really using the big guns, but he needs to know that if he does something foolish, you will not destroy your life to rescue him.

They say you can't really be called brave if you don't feel fear. Bravery is acting in spite of fear. Ditto sainthood. Someone who doesn't get pissed off is less a saint than someone who gets pissed off but acts with compassion anyway.
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Good news - Social worker spoke to Uncle about going to the Rehab facility and he agreed, because he recognized that he came home too early two weeks ago, and also that his legs are quite weak. He could not deny that. The leg dopplers and circulation tests came back negative, so no blood clots, and he is out of isolation - no longer contagious. Later the PT who evaluated his walking ability told him flat out he did not have a choice because he is no shape to go home yet. Most likely he will be transferred tomorrow. Yeah!!
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That sounds like a great plan - especially that he'll know someone who can visit him. He might also like that it's a different place since he was unhappy with the first one. But wow, expecting your mother with dementia to be present for him....he seems to have high expectations!
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Thank you, Whirlpool. Bottom line, the rehab is his best shot at avoiding the direct route to the NH. I think having the case manager break the news first is a good idea. I'm sure she is used to being persuasive and may have more success than I, but I think he will resist her also. If we then confront him together, and as you say, get him to focus on all the things he enjoys doing independently at home, and will not be able to deny his inability to operate on his own at present, that may make him agree that Rehab is the best choice for the short-term. When he had the pneumonia last winter and started on the heart meds, he needed to go to rehab for a short while to make sure that his new meds were working without complications. What an ordeal that was - he kicked up such a fuss. I finally got him to agree to 2 weeks maximum in the same facility as my Mom. That initially pacified him, but he hated it despite having a private room, because expected on-the-spot attention 24/7, gourmet meals, and my poor Mom, with her dementia would go off and leave him sitting all alone "for a few minutes" and then forget all about him for hours! LOL This time I am not going to put him with her. There is a closer facility that is better noted for its short-term care, and a male friend from his apt bldg who is still mentally strong and mobile, lives in the long term section, so he can visit with my Uncle every day as well. I am hoping that will be one of the "soft-sell" points we can use to persuade him. Thanks so much Whirlpool, I really appreciate your input.
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What a situation! As you might remember I'm struggling with a mother who believes she's far more capable than she is, refuses in home help, and lies to her doctors about how much help a local relative is giving her. So I can relate some....but also know I have had no success getting through to her so far. Its sounds like you already have a relationship with your Uncle where you can speak plainly to him. I know you want to use gentle persuasion but for this I might suggest a direct approach. First say to him that you know he wants to avoid the NH as long as possible to show him you do understand his desires and get him to focus on them. Then say that going to rehab is his best shot NOT to have to go to a nursing home much sooner than he might like. Okay...kinda sounds like a threat, but it might work. Another option would be to have the assigned "case manager" deliver this choice to him so you don't have to play the heavy. Good luck!
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