Spouse fell Wed. from low diabetic sugar, as far as is known; he is hospitalized with injured right hand and now can't use walker. Advice?

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Spouse fell Wed. from low diabetic sugar, as far as is known; he is hospitalized with injured right hand and now can't use walker. Advice?

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The doctors are also checking the heart; his is enlarged, with a-fib. The VA sends a caregiver 3x weekly for 3 hrs each time; she's marvelous. Naturally, he pushes to come home; he's desperate. If he does make it home, he'll need to use a manual wheelchair. I am 68 with a hernia and have stated I can't push his 230 pounds around, so tomorrow I'm notifying his PCP that his would not be a safe release back home. To complicate matters, he's 100 percent VA covered but the EMTs took him to County General because the nearest VA hospital is 100 miles away. At the moment, I'm considering what to write in the note: "unsafe discharge," "I'm unable to help with his mobility," but does anyone have other suggestions? Thank you.

Care Decisions Hospital Discharge Mobility

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Pronker, is your husband eligible or would it be suitable for him to have an insulin pump instead of injections? That would be one task that could be done "automatically."

Also, did the VA Social Worker tell you about the various support functions available to caregivers? From what I've read in their newsletters, they've expanded beyond what was available when we were involved with VA care.

You probably are aware of this, but his first day home will be a challenge, including re-adjustment, and possibly relief mixed with fear over his recent episodes and challenges.

Make sure you take some downtime for yourself.

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Yesterday I saw he had something attached; yes, the VA social worker is very supportive and there's a phone care # for caregivers; I'm okay with downtime and am coping, with support from this site, his PCP's nurse, and Fall #2's case mgr. Thanks for replying.

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Oh boy! Unsafe discharge--based on the fact that you have left town and there is no one at home to care for him, perhaps?

Can you get a psych consult? It doesn't sound like he's acting in his own best interest.

If the Cardio appointment today?

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Thanks for the reply. Fall #2's Case Mgr says the VA Rehab facility is soon and I definitely think a psych consult is called for. He's desperate and will do or say anything to come home; there's no blame involved because he's fighting for his life and I'd give it all I've got, too. If he signs out AMA, no more coverage because VA is all he's got. Mgr said "he signed the AMA papers" which I believe was before Weds. when Youngest talked with him and Spouse said he would not leave dr.s care; this negates any prior agreement, I'm hoping. I visited yesterday 4 hrs. and Spouse seemed okay with "VA taking over my care" because he's deeply unhappy with his R hand's inability to do things he loves: sudoku, crosswords, type on his computer, in addition to practical things like administer his injections.

Cardio administered a stress test to confirm the V-tach findings; he had a Zio monitor for 1 week that got sent for evaluation yesterday; he's well cared for.

I'm unsure about discharge; I've reiterated to nurses, dr.s and case mgrs. "I cannot care for him in this unsafe environment" due to all the stuff I've stated before. He needs skilled nursing and it looks like he'll get it. After the 100 days, who knows?

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Pronker, your love comes through loud and clear. Sometimes we need to stand strong when we know that WE know what is best for a LO who may be acting a bit irrationally due to pain, fear and/or brain fog.

Years ago my mom told me that "when someone is sick, you have the lying down person and the standing up person. The lying down person is in no way able to ask the right questions or make important decisions". She already had some cognitive decline going on when she said this, but it is such a nugget of wisdom!

Wishing you both the best.

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Thank you. I need to gird my loins for the battle today because a County General dr.'s phone call stated "he wants to come home, I've told him to be careful walking" so she plans to discharge him. He's a person with broken ribs that he's asked for pain injections for, needs insulin injections, and many other nursing level attentions on his list; it's going to be a war. The dichotomy between County General jurisdiction and VA jurisdiction proves a minefield to navigate.

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Pronker, I really give you credit for your strength and adaptability. These must be very challenging times for you.

Just one comment on his latest fall. You might want to eventually switch from a walker to a rollator. He could sit down on the seat; being 4 wheeled, it provides much more support than a walker. After we got one for Dad, I realized how unsafe a walker can be.

I certainly agree that the hospital is now the safest place for him, especially given the latest cardiac DX, which needs to be addressed, and the fact that it's challenging for him to realize how much more challenging it would be to come home.

I complement you and your family on your care and strength.

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Thanks for the reply and moral support. Yes, he has a rollator that he uses upstairs; when downstairs at home and in the place of worship, he uses the regular walker with 2 wheels.

I'm doing my best to care for him from 15 miles away. He said on the phone "yes I have a new heart issue I discussed it with the MDs it's nothing" and I believe that to be untrue. He pulled out all the stops yesterday to convince me to bring his scooter so he could scoot out of there and come home: tears, 'why don't you help me,' and so forth. It was awful. He sounded hoarse and slurred from pain meds given for his broken rib and sprained R hand. It goes against all I have inside me after 36 years of us being together in the family business and regular living together not to respond. The rest of the hr. long talk was the usual sports, politics, upcoming family birthdays, etc.

I think if I say "you had a heart attack" which is one of the V-tac descriptions, he would understand a bit more and perhaps I'll use that simple phrase rather than V-tac, which would be new to him. I dread talking to him because of his obstinacy re where he needs to be for his best care.

I stated earlier that the 9/1 fall was due to low blood sugar, which it may have been, but this whole new V-tac puts a new slant on the reason, as does his statement 'my left leg doesn't work anymore' on 9/5.

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Spouse wanted to come home yesterday despite dr.s orders, which would negate his VA coverage. Last night Youngest visited and we discussed options: if we, either singly or together, visited, Spouse would see that as "ok my ride is here release me" and thus miss his cardiologist appt. Tuesday morning; he told me he "could go home and then come back tomorrow morning for his appt." as if a hospital were a hotel. It did seem to sink in that the VA coverage, which will be for a bill I'm estimating at $50k thus far, would be to his detriment if lost. On tenterhooks all yesterday to deal with whatever came up. The man is irrational. I'm calling various VA numbers today to report all these events, but I will not call him or even the hospital because the nurses assume I want to speak with him - which I do, to comfort and console - and gave him their phone yesterday. He does not have a cell phone. If my call triggers the irreversible "I'm releasing myself" speech, then I will not call.

Of course he wants to come home. I would, too. New developments are 1. somehow ER missed the broken rib he incurred on Sept. 1 and which hurts him now and 2. A-fib developing into V-tac (SP?)

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The reality is you can't care for him at home especially now with his further immobility. And you sound really tired of putting up with his verbally abusive and controlling personality. There is no reason for him to be rushing to the bathroom when he is incontinent and wears depends that he refuses to change as needed on a daily basis. His refusal to work with you regarding his care and basic hygiene is a major reason why he should not be home and should remain in skilled nursing. Did you get your hernia caring for him?

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Thanks for the swift reply. I've done much heavy lifting for the family business in past years and it caught up with me in a hernia that currently requires no surgery; I'm not risking lifting him or other heavy lifts to aggravate it. The situation worsened with his mobility and I've prepared a hot list to speak with the hospital about when I visit later today, any suggestions welcomed!

1. Most important, the daily insulin injection.
2. 16 sorts of daily meds prepared in pill tray and given to him
3. MOBILITY WORSENED RE L. KNEE COLLAPSE
4. R hand bad sprain (no fractures per Xray) because he fell on it on 9/1. Stated last night "when my R side is touched or moved in a certain way it hurts".
5. Changing Depends infrequently.
6. Hoarding snack packages around bed, computer, etc., which the EMTs noticed last night and commented on.

It's important to say he handled #1 and #2 himself for many years now to his great credit. I do not know how I would handle all these issues for myself.

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Interesting, he is home already. Does he heal fast?

I was in the hospital earlier this year with new diagnosis of Diabetes and I stayed for 8 days, The medical team wanted to monitor and check m diabetes to get it under control.

If he was there for 3 days, wouldn't he be eligible for rehab straight from the hospital?

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He was home and fell last night, resulting in another ER stay. He stated his left knee gave out while using the walker and after initially refusing to go to the hospital, became convinced he wanted an answer to the new problem. Thanks for the reply. It was indeed an unsafe discharge. The diabetes is ongoing for some years now and he monitors it well. Thanks for replying.

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@Garden Artist Yes, the VA social worker is due to call, when the holiday ends. The hand gripes him continuously and most activities he adores can't be done; he's asking me to help on the desktop computer, which I know next to nothing about. The worst is that he expects me to inject him with his insulin and I refused. He managed to stick himself as needed with my help in some things, however. I honestly feel that a convalescent home is best for him that will include PT until the hand's condition is known more fully.

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Pronker, is there a bathroom on the first floor? If not, is there someplace a commode can be privately placed? If so, I would find a way to anchor or brace the legs so they don't tip (that happened to my mother).

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Yes, there's a bathroom on both floors and commode available. Thanks for the advice.

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I think to prevent unsafe discharge you are going to having to refuse to take him back into the home. that will at least buy some time through rehab. You will need also to consult with your own doctor who should write a letter stating you are unable to push a manual w/c due to age and physical disability and that you cannot assist with transfers, etc for in home care.
Quite honestly for the future you may be looking at a need for placement simply because of the weight problem. They will do all they can to get him home as anything else costs them. They will say they will get you more help and help you "make this work". Really you already KNOW that will not happen.
I would make you letter on unsafe discharge start with the sentence that you cannot and will not accept your husband back into home care; that at least rehab and possible placement is necessary due to A) your own condition B) his weight and debility.
Good luck.

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Thanks for the reply and wishes. I realize everything needs to be documented thoroughly. The house has a stair lift which is wonderful; it's the toileting, of course, which is a main issue because he does try to reach the bathroom in time. I've seen him at dinner realize he's flowing, smelled it, and watched him hurry as much as he can into the downstairs bathroom 15 feet away. He just can't do it.

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Contact the VA let them know he was taken to the hospital if you have not done so. They will most likely not have a problem. Talk to a Patient Advocate and or a Social Worker. Let them know that you can not care for him at home until he is able to get around more easily by himself. They most likely will transfer him to a VA approved Rehab when it is time or they may even have him transferred to the VA hospital. (unlikely)
Also look into other programs the VA has . I had my Husband on a program called VIP (think it stands for Veterans In Place) but they keep changing the programs and the names of them but I am sure he/you can get more help. Also you can get equipment that will help you. A PT and OT will help with anything they think you might need when he is ready to come home.

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Thanks for the swift reply. I've contacted the VA 2x since Wednesday so they know the situation. I'm going to the VA clinic in person this morning to add a handwritten note to the appeal because the VA clinic and county hospital are near each other.

Spouse fell Wed. from low diabetic sugar, as far as is known; he is hospitalized with injured right hand and now can't use walker. Advice?

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