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90 year old dad's in his second week in rehab after a fall and a short stay in hospital. I live a couple of states away. Dad's a binge drinker/alcoholic and when he was admitted put on librium (and thiamine) to help with expected alcohol withdrawal. At the time, I didn't question anything - but two weeks later, after having extreme difficulty getting him on the phone and after days of unsuccessfully finding ANYONE who could provide me an update on his status I drove down here, and seeing him in person is shocking - my formerly lucid and completely dementia-free Dad is gaga and out of it. I have insisted that he be taken off this drug and have learned that it's addictive - he will be weaned off it over the next week. I've learned that an alcohol detox is 5-7 days, and there is no reason he should have been medicated for this long. Clearly I'm raging, but also concerned as I need to know if he will return to "normal" once the drug wears off or if there's another reason for this brain fog. I need to make decisions on his behalf about where he will live on release, at home with an aide or in assisted living - and until I find out of there's any other cause (he was tested for everything under the sun at the hospital and did not have a stroke or any head injury). I feel like my hands are tied. This is a vent but also a question - his equally elderly but clear headed friends tell me this is simply what rehabs are like - understaffed and chaotic. But the overdosage seems like gross negligence. Has anyone had a similar experience? I'm afraid of what will happen once I go home. Apart from this chaos, the staff seems kind and caring, the facility clean, the food looks pretty awesome, and the other residents seem nice enough. I'm throwing this mess of a question out there as this community has been so helpful and supportive - thank you.

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My father was still driving and living independently until he was hospitalized with blood sugar issues and then developed delirium. The man who returned 2 months later from rehab was unable to do anything independently. So while he may regain some level of previous cognition, be prepared that he may not. I’m sorry. And I totally agree with everything you say about rehab, my dad went last summer when there was no in-person family participation, so I have no idea what went on there but it definitely wasn’t very helpful.
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An update - two days since his dosage was reduced he has DEFINITELY improved, on today's visit he was still slow in speech but we had an intelligent conversation about vacations, and politics. And he was JUST able to lift himself up from a seated position with no help. Maybe it's a good day, maybe the reduction in drugs, maybe just general progress but I'm so pleased. And the attitude and the attention of the rehab medical team staff was 100% better than a few days ago, before I went "full Karen" and insisted on a thorough medical update, and spoke to the full team. I'm prepared for whatever comes next with Dad, but also realizing how critical it is for elderly rehab patients to have a family member physically there, in person, advocating for them. I'm scared of what happens when I go home this weekend, but at least I have actual names and phone numbers and hope I will be able to reach and speak to the physical therapists and other staff daily, to monitor Dad's progress from afar over the next few weeks.
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Of course we can't know, but I think it's probably a mistake to assume that your father's sudden and severe deterioration is ALL down to the librium. For example, I have to question how "completely lucid and dementia-free" a 90 year old alcoholic can be: a person's brain can only take so many repeated alcohol-related insults before it begins to break down, and the effects of many years' periodic abuse are not going to be recovered from in 5-7 days. Did the radiologist provide any useful observations on the imaging? - you'd *expect* there to be some changes. What about the rest of the medical summary? - liver function, vitamin deficiences and all the rest of it?

I'm so sorry for the shock you've had, it must be miserable. So you were regularly in touch before this most recent fall, and he seemed fine and doing well? Were you able to visit him in person?

I'm bearing in mind the totally coherent and cheerful conversation one of our clients was having with myself and the paramedics while we got him off the footstool where he'd managed to lay himself out like a beetle on its back and couldn't get up again, stark naked and maybe three feet away from a lit gas fire, and I couldn't get him up unaided. He told us jokes, assured us all was well, was sweetly appreciative of everybody's help, and was still talking to us about his mysterious mishap (stone me! - how did that happen?) while he walked confidently to the corner of the room and began to urinate. I won't describe the state of his house because it would disgust and depress you; and besides I came to like this gentleman enormously and wouldn't want anyone not to. All he wants is to be loved and sing Irish folk songs - and there again, as another example of unimpaired function, he had no difficulty using Alexa to play his favourites.

I hope he's okay, I haven't seen him for a few weeks now. He won't stay in rehab because they don't let him drink (he cites other reasons, of course), he is competent to make this decision, and sadly it's getting too late for him anyway.

The point of mentioning him, though, is as an example of quite how normal someone can appear in certain respects while being in fact very ill indeed.

Back to the librium - what has the facility had to say for itself about not checking the duration of the px on discharge from hospital?
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LisaTorres Jul 2021
Thank you, this is giving me much to think about. I saw Dad on Father's Day, when he hosted a little party, plenty of intelligent chat, and socializing and a great time (until the alcohol kicked in and he got drunk and passed out). The story of your client is sadly funny and strikes a chord, but I'm pretty confident Dad's mentally lucid when sober - or was. He has several friends who see him frequently and report the same. The rehab facility put him on the librium, as well as thiamin when he was admitted. As far as I'm aware the hospital treated him just for the dehydration, with an IV/electrolyte drinks. Hospital reported no anormality in his CT scan, no sign of stroke, no heart issues beyond what he has - arythmia and a pacemaker. They didn't mention liver functions. The rehab facility has been dreadful about communicating with me, which is what prompted me to come here in person and basically stake out the place until I saw his medical team which I did yesterday. I guess I should readjust my expectations for his recovery - my gut tells me he's acting drugged, not showing sudden dementia, but this is all frank and practical advice, thank you so much.
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Lisa,

This is so sad to read. I can tell you that without a doubt that many facilities are understaffed.

My mom went to rehab. She had Parkinson’s disease. The occupational therapy and physical therapy staff is terrific at the nursing home where my mom went. The aides were hit or miss. The same with the nurses. The DON and social worker were wonderful.

Mom was purposely given a double dose of her Parkinson’s meds because the LPN told my mom that she wanted to save time by not having to return back to her room for her final dose of her medication. My mom asked if it would hurt her to double up. She told mom that it would not hurt her. Mom took the double dose but was concerned.

The next day when I went to visit, mom told me about the incident. I was upset that this incident occurred. I called our pharmacy to see if mom was in any danger. The pharmacist said that she wasn’t in danger if it only happened one time but it would not be good if it happened several times. The pharmacist told me to report it, because if this LPN was doing this to mom, chances were that she was doing it to other patients as well. So, I reported it to the DON and the social worker. The nurse confessed that she gave mom a double dose and she was written up.

My mom did regain strength by participating in rehab. Unfortunately, occasionally disturbing incidents occur. I am glad that you are speaking up on your father’s behalf. He is blessed to have you in his corner.

My mom was hesitant to tell me what happened. She was afraid that the LPN would retaliate against her for being reported. I explained this to the DON. The DON told me that this LPN would be instructed not to enter mom’s room.

My mom recently died at the age of 95 in a hospice house. Hospice care was wonderful.

Wishing you and your dad all the best.
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LisaTorres Jul 2021
I'm so sorry for your loss, and I wish we had better options for care for our elderly, it's really tough. Thank you for weighing in!
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I would think at 90 with years of alcohol abuse Dad would have shown some signs of Dementia. Detoxing someone who has been drinking for years is going to be hard on his body. I agree with MJ, he may never bounce back. It just maybe a turning point.
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He may have delirium from being in a hospital, then in yet another unfamiliar place, the rehab hospital. Add in the alcohol detox, and yeah, I'd be gaga, too. My mother was in the hospital for about 15 hours and she never bounced back all the way from it.

Will he recover completely? Unlikely. This is one of those roller coaster rides where you never quite know what's over the next hill, but one thing you can pretty much count on is that he'll never quite return to the place where he started.
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LisaTorres Jul 2021
I'll have to readjust my expectations for sure, thank you for this.
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