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Hi all! I need some advice! He fell at home, the medics came and picked him up, as usual. He’s fallen several times in the last two months because he is so weak. We missed the call from Life Alert because of the new spam crap the phone company put in. So Papa called a couple hours later screaming in pain. We called 911 and went to ER. Xrays & CTscan later, no injuries. Anxiety and panic attack was the diagnosis. His doctor admitted him because he was so weak and he had lost 8 lbs. in one week. Time for discharge, he failed the PT test, so off to Rehab he goes. Of course, he blames his doctor.


So it’s been 10 days. We can’t see him because no visitors allowed. He gets minimal therapy daily, but he’s still in a wheelchair. He calls here twice a day wanting to go home. Says if his doctor thinks he’s keeping him here, he’s got another thing coming. Wants us to get him discharged.


Issues: several days he couldn’t even get out of bed at home. And he couldn’t remember to press his Life Alert for help. He’d just lay there.
His house has very narrow doorways, so a wheelchair won’t fit, he has trouble even getting a walker through. He wasn’t eating, even though we provide meals and every goody you can think of.


He does so much better at the NH, he’s eating and visiting - instead of being a shut in, only seeing us once a day.


His body is giving out, but his mind is still sharp. Once in awhile, he will have a day or two of confusion but he always bounces back (Parkinson’s Disease Dementia Early Stages).


Any ideas on how we can keep him where he is now? I know the usual advice is to wait for a fall. That’s happened, but didn’t solve the problem.

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BeckyT, are you his medical PoA? I agree with Gramma below that now is probably not the time to remove him back to his home due to C19. IF he rehabbed to the point of being able to be "independent" in his home again, and IF he doesn't fall again shortly after being home...what would be the realistic, affordable plan for his daily in-home care? Could there even be one? With PD he will eventually need more and more care every single day and then overnight. Yes, he will be a shut-in of his own making by insisting on being there rather than a reputable LTC facility.

If he can't afford in-home care and if you are not willing to be his full-time caregiver then maybe you should consider this opportunity to transfer him to LTC since he is resistant and that's probably where he needs to be. You should start researching facilities and their prices to know if he can afford it out of pocket. If he will need Medicaid you should get him into a facility on private pay first and then apply. Make sure the facility accepts Medicaid recipients. I wish you success in solving this issue and peace in your heart as to the outcome.
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BeckyT Mar 2020
Thanks. He falls all hours, day or night. He’s too weak to bear his own weight, even with a walker. He’s putting so much of his weight on the walker, to hold him up, that it’s tipping and over he goes.

He won’t let us stay there with him and he won’t live with us. He will only accept one solution, and that is living alone. I don’t know if he is being unreasonable, or bullheaded, or if it’s the cognitive impairment. He’s always had to have his own way. Had to have his own business, because he couldn’t work under a boss. Same mentality here, no one is going to tell him what to do.

The Rehab he is currently in accepts Medicaid patients and he is already enrolled. It’s the same place he was in two years ago, for the same reason. But his body is in much worse shape now.

My sister has POA, but we’ve been told that she can’t use it because he is still too sharp. It’s a real dilemma.
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Becky, your father's chances of figuring out the discharge process, completing it unassisted, AND then making his way through the current maze of social distancing requirements and setting-up of services for isolated seniors..?

Not. A. Hope.

"We're all in quarantine, Dad. I'm afraid it's going to have to wait." Hey, it's not *your* fault there's a global pandemic on!
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At this point with the exposure to COVID 19 he has had I would say he needs to remain where he is for the duration of this.
Tell him that if he complies with rehab and even works safely on his own to gain strength you will assess the situation when the threat of transmitting COVID 19 is over.

The question is where can he go safely? Are there family members that have a set up that would make discharge to home safe?
If there is no safe place then placing him in a facility where he would get 24/7/365 care is the only option.
The big question is does he need Memory Care or Assisted Living?
And what type of dementia has he been diagnosed with? Alzheimer's, Vascular or more likely Lewy Body Dementia. With the Parkinson's a proper diagnosis is important.
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BeckyT Mar 2020
Thanks for your reply. We’ve told him that he needs to build his strength so he is safe to come home - even though we don’t think that will happen. We think his body is giving up on him.

He is not safe to go home alone, since he won’t allow anyone to stay with him, and he is almost too weak to walk. He is also blind now. His doctor says he is a permanent placement at the nursing home. That’s also where we think he needs to be. Unfortunately, he doesn’t agree.

His family doctor says it’s probably just age related cognitive impairment. It fits Parkinson’s Disease Dementia better, since some days he’s sharp as a tack, and others he is so far out of it.

We are also afraid that as soon as he learns that he can check himself out, that’s what he will do. Of course, he would have to find his own way home :)
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You say that at one point he laid in bed for several days, because he forgot how to press his Alert button. Does the doctor who thinks this is age related impairment know this? I wouldn't consider this a sharp mind. I'd consider NH or MC or around the clock care in his home. Since, he's going to be staying in the Rehab for a while, the staff should get the chance to see just what his cognitive level is and may be able to provide a proper assessment.
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Update: He is on hold for now: no one can be discharged, due to the lockdown. The Rehab was all ready to send him home, but came to a screeching halt when they were told that he could not go home on the pain medicine he is currently on in there. He is a fall risk anyway and it is far too strong to take at home, living alone. AND the medicine he was on at home didn’t start to touch the pain, that’s why he ended up in Rehab. So stalemate.

Since that meeting, he says his back and hips are screaming in pain and he has take to his bed. Which proves he can’t go home. But makes me wonder if he’s given up, or given up the act he was putting on there to get discharged.
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I think u should take this time and think about keeping him where he is. Its now what he needs, not what he wants. Spend down his assets for his care when gone apply for Medicaid. Its going to be hard caring for him.
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Becky are they weaning him off the pain meds? That would be my 1st thought.

Can you find out what they are providing for pain? This may be your ace card, papa you have to stay here to get the meds that help with your pain! Worth investigating.
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