Grandma finally got her knee replacement, how can we make people understand we can't take care of her? -

Grandma finally got her knee replacement, how can we make people understand we can't take care of her?


On August 24th my grandmother finally had her knee replacement and has been in the skilled nursing/rehab place in the hospital since then. It's been pretty hairy these past few days. When I saw her on Wednsday, she didn't really understand why she was there and needed rehab twice a day. She thought that after her surgery she was going home and could do rehab there. My mom, dad and I visited her again on Friday and she was worse. Couldn't follow the simplest conversation, confusing a TV commercial for and actual TV show, confusing the sore from rehab to actual pain like she felt after surgery, wanting more pain pills. What really scared my mom was how long she was one Oxycodone and she kept thinking that she didn't have her knee surgery yet. When we were leaving, we talked to the nurses about the amount of pain medication and how long she was on them and how she is after taking them. I am sure that she has been cut off from the pain pills and now is given Motrin. My mother visited on Sunday and the physical therapist had mentioned that the doctor was thinking of releasing her on the 8th (today). My mother was horrified and told the therapist that before the surgery, she was living alone in her house and there were staires to get into the house and the basement and how was she going to manage? Mom, Dad, and I in a couple weeks are going to see my sister graduate nursing school in Virginia and then in mid October go to a wedding in Texas so there would be no family in Ohio to take care of her. Grandma living with us isn't an option. Both full baths are on our 2nd floor and there is no way she can handle 13 steps up and down. With how narsasistic she can be and the physical and mental abuse when she doesn't get her way, it's not happening. My coworker asked how Grandma was doing and I told her that the hospital was going to release her today and we let them know that there is no caretaker set up and our home is not elder friendly, we would not take her home. My coworker let me have it saying that my family was going to get into massive trouble with APS due to neglect. I know full well that we can't get into trouble if they want to release her and we don't take her home. Her daughter took care of her after her hip replacement and her brother took care of her 104 year old mother in England and that was their choice and that was the family dynamic, so that is what she is going on. At the time of the hip replacement a couple years ago she was mid to late 70's, my grandmother is 84 with kidney disease. What can we do to make people understand we can't take care of her at home?

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Simple - with the rehab staff, you calmly tell them it's an unsafe discharge to release her to her home, that there is no possible way for her to get the care she needs. Be firm.

With everyone else from co-workers to extended family to nosey Nellie neighbors, you thank them for their concern and tell them your family has it taken care of. And then change the subject or walk away. The lesson many of us have learned is that you can talk till you're hoarse only to have them say "yes, but..."

People have their opinions based on their own experiences with family or they project what should happen based on no experience with their own elders or they project if they were the elder in this case. You're best served by telling people very little and discussing it very little.

In any case, I've come to believe that people's opinions on elder care are right up there with religion, politics and other potentially inflammatory subjects. Take care - there's lots of support for you here.
Helpful Answer (8)

Don't panic.

The rehab facility will not send your grandmother home without a formal discharge plan. The exact planning procedure won't be identical to ours (I'm in the UK) but all the same there will *be* one, and it will involve some kind of assessment of your grandmother's ongoing care needs and of her home environment, looking at what needs to be put in place before she can safely go home.

If it is not possible to provide adequate support for her at home, she may need to be transferred instead to long term care, and that would be a whole 'nother discussion. What conversations have taken place since Sunday?

And caution your mother not to listen to gossip. If it ain't written down and signed by the manager, it ain't necessarily so.

And finally, don't waste your breath or your heartache justifying yourself to people who have no business telling you how to manage your family. Come here instead and let us know how you're getting on :)
Helpful Answer (7)

Number 1. Your co-worker doesn't know what she is talking about. It sounds like your grandmother needs long term care placement. You have let the rehab know that there is no one to help her at her home. They should looking for placement now. Number 2. Don't feel guilty for not being able to care for grandma. You know your limits and so do your parents. The home isn't suited for her rehab. It has only been two weeks of rehab. That's a lot to ask of anyone, much a senior in her 80's. I would suggest you don't share with your co-worker. She's a downer and she hasn't walked in your shoes.
Helpful Answer (6)

Perhaps the surgeon who made the decision to give an 84 year old woman a knee replacement without seeing that she had care provisions can take care of her. Was she and her family made aware of the recovery, rehab and dangers involved in this type of surgery prior to the surgery. Knee replacement surgery is not a quick fix, and it is not without risks. Serious complications, such as blood clots and infections, can occur—but precautions can be taken to prevent or control them. In addition, the road to recovery can be difficult and time consuming, particularly with joint replacement surgery recovery is harder the older the patient.
The risks that come with the general anesthesia needed for this type of surgery for a patient of this age are huge, one of which is acquired or worsening dementia.

When my dementia addled LO decided that he needed carpal tunnel surgery (because his brother had it) and he was only 73, I took him to hand doctor for evaluation, back to his neurologist (who was very aware of his dementia) for test and then to the hand surgeon who was hot to schedule him for the surgery -- none of them mentioned the specific risks involved for a dementia patient - just ready to do it and collect that $$. I told the hand doctor that I was concerned that since he could not walk - and that his hands were his only strength - why would he have surgery scheduled to do both hands at once and since he had dementia -- what were the dangers of the general anesthesia. I also told him I was his only caregiver and had to work fulltime, so the doctor needed to make sure he was released to a facility that would be able to care for him while he recovered and rehabed. Well that surgery was cancelled pretty quick - they were doing it for the $$ nothing else, three doctors, a patient who could barely say his own name and they "oops - didn't know he had dementia" which was bull because it was both evident and on his record.
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It's the other way round. Her chronic kidney disease will affect the rate at which she metabolises the oxycodone, which may have exaggerated its side effects; but the oxycodone won't have hurt her kidneys. We noticed hallucinations after around 48 hours but no long term harm done; the main disadvantage was having to cross yet another useful analgesic off the list of things that mother could tolerate. Dang!

I'm glad the social worker is helping? Hope things go more smoothly and less alarmingly from here, and that your grandmother starts to recover well. Best of luck, please keep posting.
Helpful Answer (2)

Wednsday through Friday was interesting to say the least with my grandmother. Wednsday my mom visited her and met with the social worker and the hospital released her to go to rehab. My grandmother thought that my mom was going to take her to the rehab place but my mother said with how low her car sits, she was going to have to take the medical transport since she can't bend her knee enough to get into my mother's car. My mother was very surprised that my grandmother hasn't even tried to bathe in the two weeks she was in the hospital. There were nurses that could have helped her bathe. After my grandmother somewhat settled in, we got a call from Grandma on Friday because they were thinking of releasing her on Tuesday and she was all freaked out and wanted my mother to fix it for her. Mom told her to talk to the social worker and the rehab people and have them figure it out with her. But Grandma still manipulated her into going over and helping her. After I got home from work, I heard all about it. Grandma still hadn't bothered to bathe and told my mother to fix the situation about rehab. My mother had told the rehab people how her house was set up and how ours was set up and that she lived alone before the surgery. Mom had also said that for two weeks we would be going out of town and we wouldn't be there to care for her and we can't take care of her. Before my mother had left, she told my grandmother that from now on, the ball is in her court and she has to make the plans and figure this out since she is considered competant. She also stated with her kidney disease, she can't afford to use the wipes they gave her anymore. They are fine for every other day that she doesn't take a shower but not for almost three weeks. Grandma couldn't understand why and Mom told her that she quite frankly stunk to high heaven and she was running the risk of some sort of infection with her kidneys. Grandma had a tantrum and Mom left. My Mom talked to the nurses and asked them to help her bathe because she hasn't had one in almost three weeks. The nurses said they would help her and they have many tricks they can use to get her to bathe. Now we are letting her stew because we are not going to help her with this stuff anymore.
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My mother talked to my sister who is graduating from nursing school in a couple weeks and was horrified that the nurses didn't pick up on the pain pill issue and say something to the doctor. Grandma has kidney disease and we are wondering if that has messed up her kidneys even more and told the social worker that and that she was on pain meds, not Tylanol or Adivil after 3 or 4 days. She was taking pain meds for almost 15 days. We made sure the doctor and social worker know that just because my mom doesn't work, our house isn't set up to take care of her and never will be because of her needs and all the steps in our house. If Grandma would come to stay with us and my Grandmother is getting help from my mom and Grandma falls, my mother could end up paralyzed.

The social working called back from her meeting with Grandma's doctor and physical therapist and she is going to a rehab facility. She told them that if she was living alone, she would need more therapy to be able to manage on her own.
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Why is your mom promoting that grandma's house and her house is set up for grandma's needs. Promoting it that way seems counterproductive to me. A better route might be to be honest and say there is no way she can stay at home alone or with me. So, other arrangements need to be made. That's pretty clear.

From your last post it appears that grandmother is still in rehab, right? While she's there, perhaps she can have an evaluation to see if she is mentally able to live alone. Her behavior suggest more is at work than her kidney and knee problem.
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Cough splutter - please don't use pejorative terms like 'too lazy' when you're talking about a person of your grandmother's age who, given that you say she was ill enough to need a doctor, was also unwell at the time. She was old. She was ill. I understand the frustration, but have a heart.

But never mind that: you do not need to provide rehab and the hospital with "acceptable" reasons for declining to take over your grandmother's care - you need only to make it unambiguously clear that neither you nor your mother is prepared to accept responsibility for her. So stop telling them about how your home is set up and make them concentrate: Mrs X on her return home will be living alone and without family support. The plainer you make it, the more likely they are to focus on meeting her needs properly. I'm concerned that you think they still think it's an option that the family will provide care - is your mother being too nice in conversation with them? She's going to have to tell it like it is and if that means she gets snotty remarks from people well poo to them. They can save their opinions for their own families.

Grandma wants to stay at home? Then Grandma, supported by her rehab team, can work out how that's going to happen - she doesn't have any right to make it your or your mother's responsibility.

How's your mother coping with all this by the way? Is she okay?
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I know my mother is stressed out, I'm stressed out but right now, we are taking it easy and looking forward to a trip to Virginia to see my sister graduate from nursing school. It will be good for my parents and I to get away for a little bit. I can't wait to see my nephews and spoil them a bit. But the too lazy bit was if she was starting to feel really bad, why didn't she call somebody (ambulance etc) to help. This is why we are asking for someone to take a deeper look and make suggestions or tell her what she really needs. My dad made it plain to my grandmother that if she can't take care of her yard and the neighbors can't do it for free forever, she probably should move. The inside of her house is a wreak too.
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