Should I take Dad to the hospital or do something else?

you don't say whether your parents have will, powers of attorney for finances or medical decisions. I would talk with a qualified lawyer to see about getting these done- It may be difficult if they have dementia. Also talk with your local Hospice and primary physicians to see about eligibility. Most Hospice services are provided in the home but there are always other options

OP has not responded since the day of the post. Hopefully, she took Dad to the ER.

I have no medical training but your dad's symptoms sound a little like congestive heart failure, and, if so, it will qualify him promptly for Hospice. My dad is 95 and I just put him on Hospice after visits to urgent care and ER failed to provide a diagnosis and relief for my dad's severe pain. After about 10 days of intense intervention by Hospice, he is now resting comfortably, but dying. It has been an enormous relief to have 24-hour availability to medical help that comes to him. I chose a large, well-staffed organization for his Hospice provider.

My dad has also been a frequent flyer to the hospital over the years and there have indeed been downsides. He had a life-saving surgery at 90 but was colonized by MRSA through his catheter. He has had to battle numerous infections over the ensuing years as a result. As they age, the opportunities to treat and cure decline as the number of chronic problems begin to increase. Add in the potential for exposures in the hospital and there does seem to be a point of diminishing returns.

Your dad's quality of life is poor and Hospice will do it's best to bring him relief from his discomforting symptoms, including respiratory distress and agitation. I think it's time to make the inquiry. I found that I could contact the Hospice provider of my choice to request a rapid response team for the assessment and everything was handled in a day or two. To facilitate the paperwork processing, I called the PCP to tell them I was bringing in Hospice and they would be contacted for an authorization and medical records. It all went smoothly. No one is going to stall on a 94 year old with breathing difficulty. Best to you.

The problem with taking Dad to the ER is that you are not there to care for Mom. Your involvement is critical to Dad getting the care and attention he needs in the hospital. When I was taking my parents to the ER every few weeks I made sure that the staff knew I had medical POA and I used it. I read records, checked medication schedules, and made sure they provided PT, OT and SLP. I left messages and had the attending doctors calling me. The nurses knew to answer my questions or get someone who could. We hired someone to be home with Mom who could also bring her to visit during the day. We kept Dad going and happy until his heart gave out at almost 95. I also had to bully his PCP who was perfectly happy to just let him die at any time over the last decade, because he doesn't believe in prolonging the inevitable.

Unless it is an emergency is there another hospital you can take them to? Hospitals are different, some are better others worse. Also, some hospitals provide physical therapy. It greatly helps elderly stand and walk after being bedridden. Maybe you need to request PT in the hospital.

You must react quickly to any supposed medical emegency such as a head injury and call 9-1-1 stat.

Hi, you are caring for 2 frail, elderly people 24/7, in other words, no break, no rest. If something happens to you, they have to go to hospital for care of some sort. I think you need to consider yourself now. Your father is sleeping 20 hours a day but he is frail, and some sleep that much as they get older. His sleep is restless, you cannot be up all with him, you need your rest too.
You are doing your very best as your parents age, you have done more than enough. Isn't it time you thought of what is best for you?

Arlene Hutcheon

I agree with the OP: hospitals a lot of times do more harm than good. You will come out with more things wrong with you than when you got there, especially if you are elderly. I live in a large metropolitan area with no shortage of hospitals, and I would be hard pressed to pick any of them if I needed to be hospitalized. If you can at all remain out of the germ-laden place where all the sick people are, do so. My Dad, who had bladder cancer, was in hospice care the last month of his life and, except for medications they provided, I can't think of anything they did for Dad that we were not already doing.

Any time my Mom is, or Dad was, in the hospital, we stayed with them 24/7. My brother and I did shifts. I can't tell you how many times the overworked nurses brought the wrong meds or, didn't come in at all, even when called. The doctors and nurses certainly are NOTHING like they are portrayed on TV! Too bad!

I agree with other posters that say an evaluation by hospice might be in order. However, the required referral might be difficult to obtain with the current situation with your PCP. Call a local hospice and ask what is required to get your Dad evaluated. I think you are being a great daughter and doing everything you can think of to help your parents. They are lucky to have you.

BTW: My 88-year-old mother coughs all the time. I have had her to see several specialists and none can figure out what is causing the cough.

If it were me I would be harassing the PCP and have him in there again for more tests and a better answer. Go into the room and appointment with him and don't accept anything until it sounds plausible and like a good plan to you and part of that plan must include reasessing in say 2 days and moving on to more intervention if things havent improved. At the very lest they will get a good set of vitals and know what to do with the results, they may send him to the hospital. Unfortunatley it doesn't sound like you have a great hospital, if there are choices maybe do a little reconosense on which one is better, who do the people in the doctors office take their loved ones too, where would the ambulance personelle prefer to take thier dad to? Sometimes you do have a choice, they just don't tell you that. But either way a hospital visit takes a lot of villagence and time from family members (you) to be as successful as possible. When my mom goes into the hospital one of us is basicly with her the majorety of the day at least and sometimes through a good part of the night when warrented. We try not to make a neucence of ourselves, we help in every way we can and always apreciate the people attending to her but particularly on some floors they are so over worked and or used to elderly paitents who rarely have visitors that without us there making sure she gets what she needs I'm sure we would have had some of the same experiences you have. It's work preventing a hospital stay from setting an eldery paitent back in some way for sure and I am very lucky that both of my siblings are able to take time as well to be there when these things happen so we can take time being together as well as relieveing each other and provinding almost round the clock "oversight". We have also use her Amazon Show or Face Time before that in her hospital room to be there when we aren't physically which has helped her remain calm and feeling secure and enabled us to be there whenever a doctor came in if we hadn't made it in in time. I have to say as much as I'm sure they expected that to be a PIA we have had many say it was very helpful and what a great idea that was. Of course a large part of that is she has aphasia after her stroke so doesn't always express words well and is deaf in one ear, 50% in the other (no aids) and just agreeable all the time but no retention so once they understand that they aren't getting real answers or any understanding from her it makes assessment easier when one of us is involved. It's work but if they need to be there it can be done but it's important someone that knows your LO well enough to know when something has changed or isn't right is around because the hospital staff doesn't know them and what's normal for the person in the bed next to him may not be normal for him (picking up UTI early). Just my 2 cents but don't wait any longer to get him some intervention it may be needed for both of them and sounds to me like you know he at least needs more than you can and are doing right now. Sometimes, often it's simple interventions that make the biggest difference too so don't just expect a big deal and if this PCP isn't doing a good job move on to another either in the office or in another one, you know better than I how reliable and competent they are for your situation and can weigh their relationship with your dad too.

At 94, I told my DH that I would not take him to the hospital again, ever, unless he broke something, like a hip - then I would have no choice.

He lived at home to 96 yrs 8 mos and I kept my promise of no more hospital stays.

P.S. busymom is right - call for HomeHealth and ask about Hospice.

Personally, I think I would be calling in a hospice team to evaluate "Dad." If they determine he's a candidate for care, this would likely mean no hospitals and no "heroic" treatments. It would also mean making him comfortable and giving only medications that are most necessary for him. They would be there to support you and to provide some extra hands for his care.

I trust you will get the help and the answers for yourself and for your dear dad. These are very difficult days for a loving family member as you appear to be.

Before your parent leaves the hospital to come back home, ask the social worker to set up nursing visits from a Home Health Care agency. Medicare should cover these. The nurse (and sometimes a PT) can help you manage some of their health issues and prevent re-hospitalization. You father might also qualify for in-home hospice care.

I would call 911 and have the ambulance take him to the hospital. Like MsMadge mentioned, I would be worried about sepsis, particularly if he is having hallucinations/delirium and is very lethargic and unable to eat/drink very much. The respiratory infection could have gotten into his bloodstream, which can be life-threatening, and he is at risk for getting dehydrated.

Take Dad back to the Doctors office and start requesting (demanding..but nice) that he be tested for an underlying problem.
This as you described could be caused by any number of things, some easy to test for some a bit more difficult.
If you can not get him back to the doctor it might be easier (and less expensive) to bring him to any one of the "Urgent care" sites that most hospitals have. This keeps "non-emergency" cases out of the hospital and most likely he will be seen faster and most tests can be done right there since the Urgent care site is affiliated with the hospital and in addition any notes will be put into his record so his doctor can view what transpired. (the sites I am talking about are ones that have testing and imaging centers not the ones in the local drug store)

I see from the answers already that you’ve gotten conflicting advice. I’ll say from our experience that the hospital is most definitely my dad’s enemy. Each time he’s there for one problem it invariably creates another, usually more challenging one. Walking is key for him, so any time at all in a hospital bed sets him far back on that. Hospital staff don’t make him get up and walk, family is often seen as mean or demanding for making him do it but that’s exactly what we’ve learned is a must. He always gets a UTI, just always, no matter what is done or what he’s there for. There are also issues of fluid building up and the emotional ones of getting a bit too into being waited on for everything. In short, we avoid it if at all possible. Your dad is older than mine, and it sounds like you’ve done all the care in the world, I’d doubt the hospital has any magic fairy dust to add at this point

I went through this with my mom. She went in with a broken arm and ended up with a bad UTI while in there and then she was sent to rehab to walk again and ended up with a stage 4 wound. I am truly stunned at the lack of care out there. It was not until mom went on hospice that she was treated like a human being. Hospice did provide her with antibiotics and insulin, not to prolong life but to keep her comfortable. They were the best thing to happen in this situation for us.

How are dad's vitals? BP, temp and respirations?

First indicator that mom had sepsis was lethargy and all three vitals were elevated- by the time I got her to the ER, she nearly needed to be in ICU

Someone should be covering for vacationing doc. Does the office have a nurse practitioner? Definitely look into hospice care for both parents. Depending on what their needs are you can have access to in home nurse visits, cna 2x a week for showering assistance, O2 concentrators, meds, ect. They are a great group of people who are wonderful to work with. By having them come in things such as a cough can be evaluated and hopefully treated before it becomes a more serious problem down the road. It will be easier on your parents and on you with a little bit of extra help and not having to run out to see a doctor every time. Does dad lay flat while sleeping or propped up? Laying flat may cause more coughing, harder to breath. If laying flat, thet sell wedges that fit between the mattress and box spring to raise his head, yet another good thing about hospice is that they can get you an adjustable hospital bed for his / her use. If you can not get ahold of his doctor, try speaking to the patient advocate at the hospital, they may be able to help you get your parents evaluated for hospice care or at least point you in the right direction. Good luck, you have your hands full with caring for both parents. Hope everything works out for all of you.

Honestly, your parents are at the end of their lives. It's not a matter of if, it's when. If they die because you, their sole caretaker, failed to seek medical care you could have a ton of trouble and your conscience would bother you. So... If I were in your shoes, I'd call any local hospice and ask for both to be assessed.

I had a marvelous experience with mthr's hospice service- she even graduated because she got better! When on hospice, they can treat things without going anywhere. They can also relive pain if the person is actively dieing. Their doctor can asses if either patent is eligible,which means being likely to die in 6 mos. Mthr was on the service for 2 years! Then they can treat them at home -mthr even had a mobile x-ray when she fell. No charge to the family. Your legal and moral duty will be fulfilled.

I agree that a consultation with a palliative care group such as hospice would be helpful to you. It sounds like you are providing the best care you can provide but it also sounds like you might be in a little over your head now.
A palliative care consult would keep your parents comfortable and avoid unnecessary hospitalizations. The doctor should have a number you can call.

You are looking after two people in their nineties. One is incontinent and has a PEG site. Both have been acutely ill in the last fortnight. And you are doing this entirely alone, and without even the support of a reliable PCP's service?

I share your reservations about taking frail elderly people to hospital unless it's obviously necessary and you have a clear idea of what you expect the hospital to do. But for you to be attempting this job without any advice or help at all is crazy.

Where else can you seek medical advice?

This is just a thought, mainly from the point of view of getting in nursing expertise: have you considered asking for a hospice assessment?

I would either take him to a local urgent care center or if it’s a challenge to get him up and out, call 911.

Sounds to me he needs a thorough pulmonary assessment- nebulizer treatment and continuous oxygen to get him through this episode.

So far you’ve done your best but now it’s time for professional care.

I would also look into changing to another PCP. I too have had dealings with the situation you describe about dad’s PCP being out on medical LOA & having another part time physician cover him. That is a true burden on the patients and families that need that PCP’s care. Sometimes those doctors don’t know when to quit and don’t realize the problems their own health issues effect others. If your dad’s PCP is sick now, his condition may only worsen. You have to look out for your parents which will be ongoing so changing to another PCP would be prudent.

You are doing nothing wrong.

I would be concerned with pneumonia, he sleeps alot and that could be the cause. Fluids can settle when we are not active.

I would get some probiotics and have everyone in the house take them. These will help his body replace the beneficial bacteria. I order my from Swanson vitamins and pay a fraction of the price, like 7.00 for 60.

I would recommend getting him to the ER, what you describe sounds like my dads symptoms the last time he ended up in the hospital, pneumonia and sepsis because the pneumonia had been going on for a while.

I gave my dad a good multivitamin and probiotics everyday. I had him use hand sanitizer all the time in the hospital. I also brought in bleach wipes and cleaned anything he would be touching, oh my, I flipped out. Edges apparently are never cleaned, so do the best you can with that, but get him to the ER.

Hugs for all you do!

I would call his primary doctor, describe his symptoms and decide if he should go to ER or urgent care. If it’s after hours leave an urgent message for the on-call doctor.

If he was my dad he would be on his way to the doctor or hospital. What can they do that you cannot do at home? Oxygen, medications, IV fluids for a start. Check his vital signs etc.

Instead of going to the ER at the hospital, take Dad to an urgent care office. Dad will get the same care, and if the urgent care feels that Dad is in a real emergency situation that they cannot handle, they will call 911.

I hate to the brunt here, but why on earth would you tie anything around your Dad's head or put tape on his mouth. He could have easily suffocated. Never, ever, do that again. Open mouth breathing while sleeping means your Dad's could have a stuffy nose. This is something a doctor should check out.

As for the cough, it could be anything. From dry air [which can cause dry scalp thus the scratching], and you only need one humidifier in the bedroom and one humidifier where Dad watches TV. Too many could cause mold which can cause someone to cough.

What medication is Dad taking? If Dad is on blood pressure pills, that can cause dry mouth and coughing. Dad could even be developing acid reflex which also causes coughing.