Mental and physical decline in rehab facility?

Glad he's doing better. Keep a record of that antibiotic & dosage, in case you need to know for future events.

ABoston, how are you holding up on this rollercoaster?

I am glad that you have found a care home and he is doing better. Modern medicine isn't all it's advertised.

Hugs 2 you, this is so trying.

Update on my stepdad’s situation. He is doing much better. We’re getting ready to transfer him to a home care assisted living. I really think it was the antibiotics that were too hard on his kidney and he was failing because of that. The last culture taken of his foot wound did not show any MRSA. Such a roller coaster! I had him on hospice for two days and realized he was making a comeback. We’ll see how he does in his new environment but I’m hopeful!

I am so sorry you, your stepdad and your family are going through this very challenging time. While he is on hospice, I hope your stepdad can receive better healthcare than he did in the skilled nursing facility.

Based on my experience with my mom having been in 2 skilled nursing facilities after breaking her hip, I can confidentially say that most Skilled Nursing Facilities/SNFs are interested in profit and not rehabbing patients.

Please look into hospital or institutional delirium and also any narcotic meds. These both contribute to delirium and to lack of appetite. Also UTIs in the elderly can cause delirium. My mom was in 2 SNFs for about 5 months then ICU, then long term care hospital and finally acute rehab before returning home, a total of 7 months. Once my mom got home, her appetite and her mind returned completely! It was like night and day!

After the first 2 weeks in the SNF facility I spoke with the Dr re my concerns about my mom’s psychological health, she didn’t seem interested in her usual things and she was sleeping a lot and not eating.
Meanwhile the physical therapists said my mom wasn’t cooperating by getting up for physical therapy and the nurses said my mom was not interested in eating. She was doped up the entire time, what I had mistaken as post hip break depression and some kind decline with poor appetite was instead narcotic lethargy and institutional delirium. Both SNF Doctors did NOT address my concerns about the symptoms of delirium, neither facility even mentioned the term until I requested a psych consult at the second facility. My request was after my mom had a really bad day of paranoia and confusion of time and place.

If you can get an outside doctor to evaluate your stepdad’s situation it might be helpful.
The hospital and ICU stays were all due to SNF negligence. After 10 days in the ICU my mom was moved to a regular hospital room, sitting upright, eating like nothing happened and engaged in physical therapy. I asked the hospital doctor, why is my mom improving so much in the hospital even though she just got out of ICU?
Doctor’s answer: quality of care.

Do you think that perhaps he's had a medical "event," e.g. T.I.A.?

You might want to see exactly what medications they gave him when he started the decline. My mom was in rehab for broken hip and she could not stay awake to do physical therapy. When I checked the nurse had given her not one but 3 pain pills in one day. Of course she could not wake up. I had to request they only give her Advil and nothing stronger.

Hispice can be such a blessing, please use the services offered to help you through this difficult time.

Hugs!

Thank you all for your responses. We signed him up for Hospice today. The good thing is if he does make a miraculous recovery he can come out of hospice and be put back on the rehab track. Since he would not/could not participate in rehab he didn’t qualify to stay at the facility any longer. They discontinued the antibiotics because it was too hard on his one remaining kidney. I think the coming days and weeks will be very telling as to how his condition will progress. The doctor said his dementia will interfere quite a bit with his recovery. I so appreciate everyone’s input, so helpful to have the wealth of knowledge and experience.

My mother has been in rehab for 2 weeks now; she's 92 and had hospital delirium (which is very real) while in the hospital for 6 days, and hasn't had much improvement now while in Rehab, either, unfortunately. She is babbling and making NO sense most of the time, yet other times she's fairly lucid. It's a horrible thing to witness, I know. Definitely insist your stepdad be checked for a UTI, and if it's clear, look into a hospice evaluation. What does the rehab doctor have to say? The whole thing is really a nightmare with these old folks going thru these illnesses, isn't it? My mother had double pneumonia, which she's recovered from, but I'm really not sure if she'll wind up recovering from the REST of it.

Wishing you all the best, my friend, and sending you a big hug

Insist that a urine test be done. UTI is common reason for people to act incoherent and kind of 'crazy'. Happens all the time at facilities. I don't have a medical reason for it to happen, but my own opinion for some of it is putting a person in diapers when they didn't use them before. You are expecting someone to just pee/poop in a diaper while their mind tells them it is not normal so they hold it longer than they would have.

Sorry to hear about your stepfather. There could be a myriad of reasons for his decline. One possibility is hospital delirium . You might want to look into it.

When patients suddenly become confused
Hospital delirium is common and often goes unrecognized
https://www.health.harvard.edu/staying-healthy/when-patients-suddenly-become-confused

With every illness the "recovery" will not be as complete or as quick as the previous.
His body is battling an infection, pretty serious one at that. So it is understandable that he is tired and wants to sleep.
Try encouraging the eating but do not force it. If he is entering EOL (End of Life) his body will not require food and it would do more harm than good to feed him.
Keep an eye on this. If you fee up to it call in Hospice. They will help you as well as him. They will answer your questions and make him comfortable. It is never to early to contact Hospice he may not be ready but they will let you know that.

I’m so sorry about this! If he’s not eating & he’s sleeping most of the time, I hate to alarm you, but I’d be very concerned, at least if he had normal appetite before & was aware of environment. We went through something very similar last year with my 89 year old father in law.

Are they keeping a good check on his sugar levels? I’m guessing you can’t get blood work done more frequently to determine if infection is worse/sepsis developing/kidney failure is occurring?

Sending you a big hug!!!

Thank you, we are all trying to be as supportive as we can. It’s just hard to see him so ill. We will just keep praying for the best for him, whatever that is.

It does sound as though everything is going downhill quite fast. Perhaps the best thing is just to go with it. Even 'bounce back' may not be the best thing if he continues to be so ill. Have courage. He is in the right place for care, so what you can give him yourself is some love.

ABoston, please request and ensure that he is getting a good probiotic, antibiotics destroy our gut health and leave us open to a lot of issues.

They need to be given 2 hours either side of antibiotics. So if he is on an iv drip with antibiotics, those don't run 24 hours, give 2 hours after the bag is empty and 2 hours before the new bag goes on. They are completely safe to give more than 1 a day, that is to maintain a healthy system, he needs to heal his, so I would give 2 caps everytime for at least 1 month. They are so important and so disregarded by western medicine.

Get a good one from a health food store. I buy liquid and drink it with strawberry juice whenever I have to take antibiotics. I found strawberry covers the sour taste and it is yummy.

My prayers are with you and your stepdad, may you both receive strength and peace for this difficult time.

He does have osteomyelitis in his heel bone. I spoke with the infectious disease specialist today and they will have to weigh the risks and benefits of the antibiotics which can be very hard on the body and organs. The doctor also thought the antibiotics may be what are making him sick. I would just like to be prepared for whatever may happen, but I just am not sure whether I should hope for a bounce back? My main concern would be as you mentioned, him developing sepsis. And not eating can be devastating to your strength reserves.

He could be developing osteomyelitis from the diabetic ulcer. That is a bone infection which takes a long time to resolve & usually requires IV abx.
& can progress to amputation. He may be developing sepsis (system wide infection),or he could be having low or high blood sugar swings which is harder to control as when a diabetic gets an infection it can affect blood sugars.
These are a life threatening illnesses & your dad is very sick.
Does he have Advanced Directives or a Living Will? It may be a good time to make sure his final wishes are known re resuscitation & when to stop treatment.
I hope he improves.

I don't think so unless his dementia is pretty severe. I am not trying to freak you out but I had a friend that ended up in the hospital with the same issue and she ended up passing away.

Try to get protein in him, engage him as much as possible and have as many visitors as possible.

I believe my friend had given up because I was the only one that would visit because everyone was frightened of the MRSA. Her family stood at the door one time talking at her. I have never seen anything so sad, her reaching out to them and they were not willing to suit up and touch her. I suited up and gave her as much physical contact as possible, the nurses said she was only peaceful when I was with her. They didn't even go see her in the hospice facility.

So give him a reason to recover if at all possible.

Normal? For some it may be. For some it may not be.

Where was he living before?

MRSA is very difficult to treat. Boston, how was his behavior and appetite before?

Stepdad developed MRSA. He ended up in the hospital for two weeks.