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(I apologize in advance for the length of this:)

As of the end of June 2014, my older step-brother moved from the Southwest US up to our home in Ohio. We've never been close, there's about ten years age difference between us (he's 63) and we're very different people.

He's lived on his own for 30+ years and has a mean streak. He is highly intelligent and highly self-centered.

He suffered moderate strokes in March and April of this year. He spent two months in a TX nursing home, and found the experience very unpleasant to say the least. He very much wanted to stay on his own but finally realized he just couldn't do it by himself any longer and finally accepted our offer for him to move in with my family. He walks with the aid of a walker (when needed), he's able to bathe himself, go the bathroom, feed himself, drive around town, self - medicate,etc.

Between his SS income and his receipt of a lump sum disability payout, he was able to cover the costs of the move which included us flying from Dayton to Dallas, meeting up with him and driving back in his car.

It was agreed that we would provide him a private room, cover all his food expenses, laundry, trash, utilities, help with transportation, etc. In return, he agreed to pay us $500/mo.

My wife is a RN and it was expressed by us that having a nurse around could be useful should questions arise about health issues, medications, etc. Due to a degenerative back condition, she no longer does floor nursing. I too have a similar back condition that requires medication so more physical tasks such as moving this person are beyond our capacity.

Our hope was that he could remain independent and perhaps improve in Ohio with less stress and more help available. Finding his own apartment here in town also seemed a possible path that would've given him even more independence.

He is a 1.5 pack a day smoker....we permit smoking only outside-to which he has complied.

Until recently we'd felt the transition had gone reasonably well. We've tried to be as attentive as we could be to his requests, food preferences, laundry needs, setting up his bedroom, getting his driver's license, etc. I've also made it a point to try and sit with him for 30-45 minutes a day to visit. In other words, I/we've tried to make him feel as welcome as we could. No other family member or friend offered him a housing alternative. Just us.

The bumps that came up were...

1) a complaint of being too cold: The thermostat is set between 69-70 degrees. IN the summer, it doesn't usually fall below 72. We've also blocked the air vent in his bedroom, provided him a good quality space heater, and made available additional blankets and sweaters. He thinks we're keeping it "cold" just to :control" the issue...

2) one morning, he nastily complained that he was unsatisfied with the food situation. He claimed he spoke to my father (his step-dad), our sister, our aunt and his attorney and said if he didn't start getting prepared meals-he was going to refuse to pay his rent. I reminded him that a) the vast majority of the items he'd communicated to me that he wanted we in fact in the house and that b) if he wanted something else-he needed to let us know and c) "prepared meals" were never a daily service. Wife works 7 days on, 7 days off with 12 hours days, and my schedule is highly erratic. d) When we do have prepared meals, he's always welcome to join us. (As of a week or so ago, he acknowledged this issue had been resolved satisfactorily...)

3) the use of his car: In the month leading up to our going to TX to bring him back, he often and regularly offered us the unconditional use of his car. Knowing one of our vehicles was in need of a fairly serious repair-he almost daily remarked, "Well, once I get up there-you'll have another car to use as you need to..." To be clear-we didn't ask for this---he offered...

Once in Ohio, he continued to make the same offer, so we took him up on it several times a week. We liberally replaced whatever fuel we used. After a few weeks (and after the food complaint) he stated he was feeling abused about us using his car as we had been. I was floored. When I reminded him of all the times he'd reminded me of the availability of the car, he stated, "that's what you say." I asked him firmly if was saying I'd lied about the matter and he wouldn't answer. I told him it was certainly his car-and he had a right to change his mind if he wished on how we used it, but that I found it offensive to suggest I'd made it up. He then said "only in the case of emergencies," which we immediately respected.

Things were pretty quiet for about a month...

About 2.5 weeks ago, while the 3 of us were eating dinner on a Friday, out of the blue he tells my wife if it would make it easier on her she could use his car for work all week. We were surprised and identified a single day when it really would be helpful. Unfortunately, the next Monday, he fell in his bedroom and sustained another....

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OP, I have to say both you and your wife are wonderful people. You both gave it your best shot and went above and beyond. You have enough on your plate with your daughter and grandkids.

You can visit him in the NH. I find it very suspect that someone who isn't even a blood relative all of a sudden out of the blue gets back in contact, it sounds like he wore his welcome out in TX with everyone he knew.

You offered your home for a ridiculous price, $500 to include food and laundry is a deal. None of us on here know for sure if his behavior is health related or as you said he has always been self centered, it doesn't really matter when it comes to him living in your home, that isn't going to work.

He is in the NH, and that is where he needs to stay.

You're wonderful people for making the effort.
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CB, a bit of distance between you and your stepbrother seems like a good idea to me. Let more water flow under the bridge, then see.

Similarly, while it's sad, you're quite right that if confidential remarks are not going to be kept confidential then you need to mind what you say to your step-sister. Well, sigh, she made her choice. If she wants to be a mediator, then she has to respect your boundaries. If she can't do that, then you can't be totally frank with her. It's a pity it isn't as obvious to her, that's all.

The car, the car, d**n that car… Well, if there's no space at the NH for residents' cars, you'll have either to find safe storage for it elsewhere, the rental on which your brother will have to meet; or to sell his car on his behalf, with his permission, and hand him the proceeds. Since it isn't likely he'll be driving it again himself I imagine he'd be better off with cash in hand than a depreciating asset that costs him money to maintain, no? Or, I suppose, you could make him a going-rate offer for it; but that last option, given his earlier attitude, is perhaps a little fraught. In case you or he might be wondering, no he can't expect you to look after the car for him, for free, indefinitely.
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C, make sure he gets a good neuropsych eval. Dollars to donuts he has some vascular dementia. He's not lying. He's not denying. He's got a dysfunctional brain.
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Update: As of yesterday, my brother officially transferred from the hospital to a local nursing home.

I dropped off some personal items for him with the nurses and fortunately discovered I know the admissions person from another long term care facility in town where I've performed in the past. (I make my living providing musical entertainment at nursing homes, retirement communities, clubs, private parties, etc...Starting my 18th year on Labor Day!) She and I had a very nice chat about how things would work at the home, as well as me giving her some additional context about my brother.

My brother called yesterday around lunchtime and commented that I hadn't stopped into see him when I dropped the items off, and I explained I was quite busy today (partly because I'm driving everybody and their brother all over the place, LOL) and that I would see him Saturday at some point. He then asked what was I going to do with his stuff-would it be ok to remain at my house for a while? I said yes...for a while. That I'd be packing his things up soon however and either putting them in his storage shed or something so we can use the bedroom for someone else. He seemed fine with that.

His tone was more reserved than earlier in the week. Neither of us referred to the offensive comments he made during that prior conversation. He did say he wanted to make sure he wasn't going to be "a burden" to us. I'm not entirely sure if he was being genuine or sarcastic.

When I see him Saturday, I assume the issue will come up and I will be frank with him. No, you can not live with us any more. But, if you regain your independence after a few months here at the NH, and they find a suitable place for you to move into, I will be agreeable to helping with the move and any other related tasks to help out.

If he's smart...he'll be fine with that. If he's not, oh well...

A related issue with my step-sister has emerged...

She and I spoke every day or so with me consistently requesting that our conversations stay private. She always agreed, sometimes with a touch of irritation in her voice. I had no issue with sharing with her my thoughts on our brother, but I really wanted to avoid any direct "Well, Bill said this" or "Bill said that..." type stuff. I communicated with her out of respect for her and as a courtesy. She broke that confidence with our brother yesterday and discussed his tasteless remarks to me the prior day.

I explained that I understood she was trying to help the situation and that there was no malice intended. Regardless, I told her it was wrong of her to violate my trust and that while I would continue to communicate with her about our brother as needed, it wouldn't be in the detailed way it has been the last few weeks.

She asked what harm did it do. I responded that #1) its a trust issue between her and I and #2) it very much effects what I can tell her because I don't want some circular confusion thing going on. We had avoided that entirely until she broke our agreement. I suspect my conversation with my brother will involve some of this come Saturday. He's already denying he said this or said that.

Oh joy...

A new question I have involves his car which is at our house. We have space for 3 parked cars. Usually, we have mine, my wife's and his. FINALLY, daughter #1 will be buying her own car in the next week or so and will need a place to park as she and her kids are living with us for a time. So, he/we need to find a different place for his car to be parked until he is driving again. I've asked the NH if his car can be kept there until he's discharged and was told they need to check with the Administrator or Director of Nursing.

Thoughts?

Thanks again for the interest and support!

:)
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Well, from your description of your brother I would have expected this outcome. People don't change. They grow meaner, crazier, stranger or whatever as they age or get sick. He is just showing you he has not changed. Please don't be surprised. Put him in a nursing home and let him complain all day to people who are used to hearing it.
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He sounds like a good candidate for an assisted living facility. Why not check into it?
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@Linda22- It was my wife's car---I still have mine...

Yes, the insurance company will cover up to 3 days from the time they send the settlement check. But, we have to front the money and turn in the receipts...Not practical right now...
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As your only car is totalled, will the insurance company cover a rental car for you for a couple weeks?
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Do NOT let him back in your home. There are numerous posts on this site about people not being able to evict someone from their home. Pack up his stuff today and move to garage or storage unit. Let the discharge planner that do to health problems, you will no longer be able to care for him. They will find other arrangements. Let him know in front of others such as the head nurse or discharge planner. Also let him know you have already packed up his belongings. Don't wait until he is ready to be discharged to spring it on him that he can't come back. He will need time to readjust to where he is going. You wouldn't want to know at the last minute about your own living arrangements. You gave it the old college try. It's no crime it didn't work out.
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I would not put up with his attitude one minute and would be looking into assisted living nearby. I have also had relatives who never bothered to get close and then suddenly show up wanting help, and while I tried to help, it was also extremely stressful at times. If you have cooperation from someone, care giving is hard enough, but to have someone who acts deceitful and so hard to please will just simply wear you out and makes you chronically angry. Not worth it.
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You need to let the discharge planning office know that your family is unable to care for your brother's increased needs. There is no other explanation needed to them or to him. Don't let them or him try to manipulate you. Whether or not you or the staff see it yet, your brother has significant personality/mental health/dementia related issues that require professional intervention. Don't feel bad. You tried it. He has increased needs. End of conversation.
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Yes, I'd wait until he's closer to discharge to discuss alternate arrangements. Let the nursing home discharge planners talk to him about options. I wouldn't reference any of his comments or past behaviors in talking to him. Just say, "We can no longer care for you given your medical/physical needs" and stick to that (and only that kind of comment). With his temper and personality, nothing positive will be accomplished by rehashing what he said or how he said it. He won't remember or won't think it's a big deal. Focus on his physical state and the requirements for care that he has and your own physical states (you and your wife's medical limitations) and stop there. You don't need to explain or justify your position. "It's not working out for us" is more than sufficient.
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I'll be seeing him briefly today (I think) as I drop off some items for him at the nursing home. I think it best to not confront him at this time about his comments or that he's not returning to our house. I know there will be "care conferences" which will likely include myself at some point. I'm wondering if that would be the best way to communicate that information to him?

Again, I really appreciate the comments....thank you!
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Your brother-in-law could be suffering from some cognitive deficits from his strokes. Or he could just be a mean, self-centered SOB, who knows? Regardless, he's become a psychological and financial burden to your family despite your best efforts to integrate him into your loving home.

I think it's time to say, "This just isn't working." Let the hospital/rehab find him an appropriate place to live. Continue to offer emotional support but let him find his own alternative housing with the help of professionals. He's not the least bit appreciative of all you've done for him, from what you've said. You tried, it didn't work out so no harm, no foul, everyone moves on. You and your wife have your hands full with your own immediate family and he has other resources he can use to help him.

You and your wife are to be commended for stepping up and trying to help your brother-in-law. Too bad he couldn't make the best of it.
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Don't take him back to your house, not even for a little while, because a little while can turn into months.
Setting aside issues of the car, and insults about your wife's weight, you and your wife simply aren't in any physical condition to care for him.
You gave it your best shot, you tried and it didn't work out. These things happen. It really doesn't matter if he has neuro-psychiatric issues on top of his physical ailments that cause him to forget what he promised about the car, he's just too much work for your and your wife to cope with.
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4) Family Support- My Father (his step father) is 82 years old and not an option in any way whatsoever to help my brother. My older sister (60) has suffered from a stroke herself in the last year and under tremendous financial stress. After a long period of unemployment, she recently took on a job supervising a small number of mental health patients at a residence program. She cooks, cleans, keeps them company for 30-40 hours a week. She lives in Pennsylvania, (as does my dad). Her house is a 3 story structure with lots of stairs and several cats. Highly unsuitable for our brother who doesn't handle steps well at all. Plus, she is less equipped to put up with his crap than I/we are....that could never go well.

We have a younger sister who also lives in PA, who has minimal contact with the three of us. She is simply not an interested party to this issue...

As I said earlier, he has no friends I'm aware of and no close contact to "his" side of the family. I realized sometime ago I was likely his only/best option if he got to the point where he couldn't live on his own. It just seemed like the right thing to do. We've tried to teach our kids about the importance of family, with the hope they'll apply lessons learned in our home to theirs one day. This was NOT how I wanted it to go. I'd roll ....and help my wife to do the same...with the little things as we went along. I felt that was manageable. (Not easy...manageable, lol.) His comments yesterday questioning her actions on the day of the stroke would strike a nerve with any long term nurse. He then questioned her credentials. (My wife has a Masters in nursing. She's been a licensed RN for 12 years or so. She has so far been unsuccessful in passing her APN test that would permit her to write prescriptions. She is determined to pass it and will keep trying until she does so.) Yesterday he said if she hasn't passed her boards, she's practising nursing illegally without a licence. (he doesn't realize the difference between the two levels of licensing...) The implications of that comment are clear...he might have to report her to someone, blah, blah, blah.

Its an empty threat, of course....but the fact that a) he'd even go there and b) even pondered such a thing in the first place is unacceptable.

His comment about her waddling was also cruel and uncalled for. A 52 yr. old mother of 3 with degenerative back issues not striding as he thinks she should is brutal.

This was never part of what we signed on for...
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Good morning everyone and thank you so much for your responses. Just from reading the comments, I feel a tad better. This is nerve racking to say the least.The anxiety of the last 24 hours between his behavior and my wife's car being totalled is quite high. I know it will subside, but its no fun whatsoever right now.

I'd like to address a few comments/questions that I've read this morning:

1) The "car" - To be clear, that was not in any way a requirement or demand on our behalf for him to come live with us. It was something he offered over & over & over again. Once he "changed his mind" and accused us of abusing it, we immediately stopped using his car. It did not come up again until he did so by offering it to my wife in the days prior to his most recent stroke. Also, had her car not been run into by a sleepy trucker, it wouldn't have come up yesterday either. Murphy's law? Regardless, there won't be anymore issues with us asking about the car. Its his car, he has the right to say when / how its used. Period.

2) Stress in the house/marriage - There is no question its adding stress to our marriage. She agreed to this mostly out of respect for me, much as I had done 20 years ago for her Mother. She is deeply offended, and I can't blame her. This was only going to work if he followed the rules and was respectful toward everyone in the house. His comments yesterday to me about her were so far beyond the pale, I really think he's blown his chance to make this arrangement work long term. We also have a 26 yr. old daughter in rehab for heroin addiction, plus her two young kids to be helping out with. Plus two other fairly well adjusted daughters. I feel we have a great capacity to help others, but there are limits. I can ask my wife to put with some oddness or quirkiness. I won't ask her to put up with outright rudeness, meanness and disrespect. His remarks were intended to inflict pain on the person I care most about in this world. He succeeded. There is a price tag for that.

3) Mental health - Historically, there has never been any sort of mental health assessment in his life that I've ever been made aware of. He is very smart, well read, and speaks well. He's bitter about our Mother divorcing his Father in the late 50's. He was married for a few months back in the early 80's with that ending in divorce. He has no close friends that I'm aware of. He's a hyper critical, know-it-all type. He's somewhat verbally abusive to our sister depending how the rest of his life is going. She is also in poor health and under a great deal of stress. Recently, he just decided to stop accepting her daily phone calls at the hospital, which I know hurt her feelings. He easily could've said he needed a few days alone so she'd understand why he wasn't taking her calls. It was mean and controlling of him to give her no heads up or explanation. Its typical, however. Not surprisingly, after he and I had our talk yesterday morning-he immediately contacted her. Pretty selfish if you ask me. She is the type that will accept that behavior because of her own issues of loneliness, stress, etc. I find it cruel.

During the last 2+ weeks at the hospital, I've heard the staff use words like "depressed", "angry", "down," being used to describe his mindset. He has seen a psychologist on the rehab unit a few times, who indicated he was having some level of adjustment difficulties. To my knowledge, there has been no medication from a mental health perspective prescribed in his treatment plan.
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It DOES sound as though there is some underlying psychiatric dx, but it also sounds like some dementia going on.
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Getting a correct psychiatric/Neuro diagnosis also matters so that you and your wife understand that he's not lying, he's not remembering.
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I started wondering a bit, too, Ba8alou; only more along lines of autistic spectrum - CB, has your stepbrother ever had any kind of mental health diagnosis of that sort?

It matters, not because it makes you more or less responsible for him (it doesn't) but on the contrary because it could increase his entitlement to support and assistance from professional and specialist organisations.
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Has he been diagnosed with vascular dementia due to the stroke?
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I notice you mention other family members. I didn't notice you mention any other volunteers when it comes to supporting your step-brother. I wonder why that might be…

I agree with the consensus, and join in Jeanne's thanks for your detailed and moderately-voiced account. Really, I think you've done all you can, don't you? It's a pity your stepbrother hasn't taken this opportunity to become part of your family, but as they say you can lead a horse to water but you can't make him drink. This horse isn't thirsty. And he's not your responsibility, either.
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You need to let him and the NH know that you and your wife are unable to care for him any longer due to your own physical health. He will not be returning to your home. How do you think either of you can handle him getting up and down the stairs? Or do you have a downstairs bedroom? I would start packing up his things and make arrangements for either a move back to Texas or assisted living near you, provided you wish to continue being a part of his life.

There must be a reason he had no options in Texas and decided to bring his meanness to prey on you; a step brother he had no real relationship with. Once the disrespect starts you are best to set boundaries to limit contact.
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I agree that you are handling it well. How much did he expect for $500 a month. Even in TX that isn't a lot of money. I would have been grateful if someone had done for me what you did for him.

I am a little less kind than Jeanne. :) I would be very upset if he had talked about my spouse like that. Your loyalty is with her. If he finds fault with her, then he doesn't deserve to live with her. If he does regain enough ability to leave the NH, perhaps you could help him find a place to stay. There doesn't have to be hostility, but you don't have to live with him, either. $500 is not enough money to put up with someone making your home stressful.
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Bill, your post is articulate and well-organized. Thank you for providing so much detail.

I really don't know what you need suggestions or advice about. You are handling this well, in my opinion.

He's angry, he's depressed, he's afraid, and really, that does kind of give him license to say anything that pops into his head. Or at least it obligates you to crank up your compassion and make some allowances. If this were the first time you were having problems, I'd say let it pass, wait and see how he is if/when he completes rehab, and make decisions then.

But this really doesn't sound like it has been working out well. Is it adding stress to your marriage, or can you take it in stride?

In my opinion, once he refused you the use of his car, you should have just dropped it and never brought it up again. It is a control issue, and each time it comes up you fight that battle all over again. If he hadn't moved in, or if he didn't have a car, you and your wife would have figured out a way to handle it. Figuring it out without consulting him would have been the best move, I think.

But that brings up the lack of warmth in this relationship. He hides the car keys in his bedroom? Huh? He accuses you of making things up? He insists on services that were never promised him? This all just sounds stressful to me.

You've never been close. This has been an opportunity to grow closer, to get to know one another, to bridge the difference in age and personality. But it doesn't sound like that opportunity was fulfilled.

It appears that you have been able to address difficulties in this situation and get beyond them, one by one. How much effort does that take? Does it take an emotional toll on you? Is it interfering with your relationship with your wife? What does she think about the possibility of your step-brother returning? If anyone could make this work, you sound like the guy! But at what cost to you? Are you willing to pay that cost? That is for you and your wife to work out together.

Please keep us informed and this plays out. We learn from each other!
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Today was h*ll day...

To start with, my wife's car was totalled by a tractor trailer drive who fell asleep on the interstate and crashed into her parked car. Thankfully, while the car was totalled, no one was inside it at the time.

We badly need a 2nd car. Knowing it will take several days to sort through the insurance stuff and find a new car, and as much as I did NOT want to ask him, we felt we had no other options. Thinking this surely would qualify as the "emergency" he required, I asked him. He then got very snippy and nasty and basically said "well, since you two won't help me with the cath, I'm not inclined to let you borrow the car." This was the mean streak coming out I mentioned earlier.

He didn't stop there...He said some way out of line things about my wife's weight, how fast she responded to his most recent stroke, etc. It was offensive.

I told him he was way out of line and that I'd talk to him later. He then explained he was getting kicked out of the hospital and would I help him find a NH to go to. I explained to him that the hospital would handle that. If he needed some things from home, I'd drop them off when time permits.

We have made the best, good faith effort we know how to make him comfortable. We never expected anything warm and fuzzy. We showed him respect, courtesy, gave him his privacy and tried to make him feel welcome. The rules were pretty simple. Follow our rules, try and stay healthy, don't complain to other family members about things he wasn't happy about (come to us directly) and be respectful to everyone in the house.

We are furious...

Not because of his decisions about his car, but the manner with which he handles it. To refuse us the use of his car after today's crash, even though his car hasn't moved in over 2+ weeks, is punitive. He's refusing to let us use it to exert control over us, and to heck with the consequences. His additional comments toward my wife are unacceptable.

This could've worked out really well for him...This is now 3 strokes he's had in the last 6 months. I know he's angry, he's depressed, he's afraid, but none of that gives him license to say anything that pops into his head.

Right now, we're thinking we've acted in good faith and he's acted out in the ways he has before in life. We don't see how he can ever return to our home again, given everything that's happened. Tomorrow, he moves into a nursing home and if he recovers further and regains independence, we'll be telling him he'll need to find some other housing. We'll help him out here and there as we can, but that's probably it.

I again apologize for the lengthiness of the posts...but wanted to provide as much context as possible.

Suggestions, advice, etc. are strongly welcome...

Thank you for reading...

Bill
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He has been in the hospital for 15 days as of tonight. He's voiced harsh dis-satisfaction about most of his doctors. He seems to like most of the nursing and aid staff. His left arm was pretty useless for the first week or so, his balance was effected by the stroke as was his bladder control. He's been unable to pee on his own, and requires a catheter.

He's missed a great deal of his scheduled rehab time due to various pain / dizziness issues. They were quite clear with him that he needed to do his rehab work with the goal of going home for him to stay on the rehab unit. If he decided he couldn't go home-then they'd have to find him a nursing home to continue his rehab in. (As a new Ohioan, he has no health insurance, but is medicaid pending)

They began to train him on cath-ing himself but after the 1st successful attempt several days ago-he's refused to do it again.

We've been asked if we're willing to do this for him and we've declined. They say he needs constant supervision. Both my wife and I work full schedules and there are long stretches when neither of us are home. As I said before, we both have degenerative back issues, for which we both take prescribed medications. Neither of us is comfortable having to support, move, reposition him. Finally, neither of us is comfortable cathing him. Its beyond the scope of the support we offered.

Ideally, he would've rehabbed enough to be able to do that himself, and work on his minor balance issues and return to our home. With his refusal to cath himself and the time he's missed for various reasons in rehab, the hospital decided today he'd need to leave the rehab unit and go to a nursing home. I suspect a month or two in the NH, and hopefully he'd be independent again and be able to come back.
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(Cont.) ...minor stroke. He never lost consciousness but did fall, and cut his head on the edge of his desk. It was his first fall since arriving, where in TX, he was falling on a regular basis.

Once my wife realized what had happened, 911 was called, EMS arrived promptly, he was placed on his bed, a short discussion took place and after agreeing he needed to go to the hospital, EMS placed him on a chair type device and he was carried down the stairs. They spent about 15-20 minutes with him in the ambulance, and then a 10-15 minute ride to the ER. Another 30 minutes or so in the ER where they assessed him and tried to access his medical records in TX. Then came a video-conference with a Neurologist at a bigger hospital in the area. All of this took place, in less than two hours...

He was lucid, correctly answering all questions, and making a few jokes...

During one of the down times we had together, I reminded him that tomorrow was the one day we'd wanted to use his car. He then asked if it was a real emergency-to which I said no, but reminded him that he'd brought it up a few days prior. he then stated the keys were hidden in his room and his car wouldn't be available. I didn't push at all, I accepted his decision without objection. I thought it odd and basically felt like he was using the car to exert some level of control or something. Understandable, I guess given how many things he no longer "controlled."
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