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Well, after 2+ years of living with my bro and sis in law, who have been so helpful and loving and caring, dad has reached the point that they can no longer handle him. He has multiple medical problems, stage 4 liver failure, type 2 diabetes, COPD and Conjestive Heart Failure and has recently (three weeks) had a pace maker put in. This last week he was admitted to the hospital all swollen up with fluid and they put in a cath, which the Dr at the hospital seems to think he's going to need to wear the rest of his life (he's 87). He did have a bad UTI and after a day in the hospital on antibiotics he was once again in his right mind and feeling good. That was the day before yesterday. Today he came home and my brother called me tonight telling me he's totally out of it, hallucinating, yelling at my bro and sis, not keeping his Oxygen on, pulling on his cath... Long story short, they say that this has been coming on for weeks... that my brother can't help as he's working all the time and my 90 pound sis in law is having trouble managing him and is having health problems herself from the stress and her own issues. The Dr. at the hospital said he thought it was time we seriously consider a nursing home for him where he can get around the clock care. After a family pow wow tonight it was agreed that it's time, and that the best facility for this is near where I live. So Saturday my brother is going to try to bring my dad to me (about a 7 hour drive) if there is room for him at the local rehab/nursing home facility here where I live. He will be a private pay patient and I'm hoping we can get him into a private room...if not right away, then soon. I just know this is going to break his heart if he's in his right mind at the time. Any suggestions anyone?

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My mom is in assisted living memory care, I just told her it was for safety isssues, they, cook, clean and give her meds. She fought me and cried , but when she first went in June 2016 she wouldn't talk to anyone and then all of a sudden she has friends!When I asked her if she wanted to change to another place, she said no I am content here!
I just think it is funny because she says that they are all kookoo in the head, and this is after she told me to close the window so the cat wouldn't jump out! Oh yea, the cat isn't real!
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It does sound like he is Hospice eligible so that will give him a little more one on one care in whatever facility he is placed.
There is a difference between a "Nursing Home" and Assisted Living. Would he qualify for Assisted Living right now? That also may make him feel less of an "invalid" and more able to do things himself.
It's just that so many people have a skewed idea of a "nursing home" where you are taken out of bed in the morning put in a wheel chair pushed to breakfast then parked in the hall until lunch. VS a place where you have the opportunity to have breakfast when you want then do some activities before lunch, maybe go on a day trip.....
Maybe he will be happier if you tell him "you are going to be moved so you will be closer me".
In any case it sounds like the move is for the best, he will get more professional care that it sounds like he needs at this time.
Again contact Hospice and see if he qualifies.
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1Tired

It definitely is a business. It would be a nice gesture if they did at least send a card to the family of the deceased person, but not at all surprised when there is no more contact from the facility when no money is owed.

It's nice you were able to volunteer at the facility your mom was at. You were able to see her as much as you could and help out as well.
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GardenArtist

You're welcome. It's sad, but true. Profits over people. They try to cut corners anyway they can to make,more money. You know the food must be bad, if the staff order out and/or gets fast food.
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Dustien: Well, thank you! The thing was my late mother demanded to live alone in her own home in Massachusetts. I live in Maryland and yes, I have a life. All that had to come to a very abrupt halt so that I could move in and take care of my late Mother. Definitely not a fun time, but I can hold my head high (unlike my brother). It is definitely difficult and I understand how hard it is for you with your dad. The elderly parent won't say "oh sure, you want me to go to the nursing home, no problem, I'll do it." Prayers and big hugs coming your way.
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Llamalover47, I'm so sorry for your mom. I feel really bad thinking this, but it would almost be a blessing if the same happened tg my dad. He's going to hate this so much I'm afraid and he's so sick right now. He's 87 and has so much going against him. I'm just dreading having to sit him down and have us tell him that it's time that he can no longer stay where he is, that he has to go into a place where he can get full time care. I do hope I'm wrong, but I think it's going to be very hard on all of us, but mostly on him.

I did visit a very nice home today, about 20 minutes from me. No one could tell me, it being the weekend, if there were any openings... but I do hope so.

The close nursing home is not an option. I visited it today also and it's just too dismal and dreary. Staff was low too...68 patients and I only saw 4 staff throughout the whole building? I've two more homes within a half hour drive of me to visit tomorrow. Fingers cross that I find a nice place for him...that will help. I will be spending a lot of time there and I like the idea of volunteering mentioned by 1tired.
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Dustien: Also wanted to say, if you use Yahoo for your desktop, it had a hack yesterday to the millions!
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Namenda, I meant.
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Dustien: I don't know about the Java Script, but I can't seem to get the Nameda pop up ad out.
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Dustien: While you are correct on your thought process of having your dad go to the NH via the hospital route, bear in mind that this doesn't always work. This was the route we took for my late mother...planning for her to go from the rehab bed of the NH to the long-term care bed of said NH. However, the NH pulled a fast one on us by telling my mother "ma'am, you're too well to stay here." Ahh wrong! In fact, DEAD WRONG! MY MOTHER SUFFERED A STROKE AT THE NH LESS THAN 48 HOURS LATER. She deceased several days later!
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Zytrhr, No matter how you look at is it is a business. I would not expect to hear from the facility my mother died at for any reason after her passing. They are paid for a service which they did very well. My father did not go to the same facility even though it was excellent because it would have been just to hard on all of us going there.

One tip that I did learn was that volunteering at the facility is very helpful. You get to see your loved one on a regular basis but also you really get to see how things work there even if you just have time to sit and read to others for an hour a week. I did exactly that at moms place since it was a trip out of town for me and I wanted to spend as much time with her as possible. I pretty much stayed there all day when I went up 1 week at a time. Really helped me to learn the routine and the people that were caring for my mom so that when I called they knew exactly who they were talking to . She was there for a very long time so it was very helpful.
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I live in a planned community development area, and there's no way to care for him in our two bedroom house. Then there's the fact that my 73 year old husband and my father never saw eye to eye on anything and the stress of having him here would tear us up, of that I have no doubt. So it's a nursing home for now. I will work towards getting him healthier (and will have to find another physician for him once here's here since he'll be 7 hours away from his current doc) and then, if all goes well, moving him out of the nursing home and into assisted living. That will be my goal, anyway.

I've researched all the places within a half hour drive of here and I keep coming back to our to local homes. One has a 5 star rating and high praise from local people. Problem there is they have a waiting list of 8 people and no private rooms (which I think will be important to dad). Just in case though, I put dad on the waiting list for that one.

The other local facility is an older facility... I'm heading out there later this afternoon to hit there right before Dinner and try to to talk to some of the residents, staff and, hopefully family of residents. They have a 3 star rating with the state site and other site's I've visited. Locally I've heard good/bad and read good/bad but I'm betting this will be the case with most any such facility. As I said, they are an older facility, but I think my dad might be quite comfortable in an older facility rather then a pretty shiny new place. He's an ole West Virginia hillbilly and would probably be uncomfortable ling in a shiny new hotel type place. He's always lived inexpensively and has a love of "comfy" old furniture and stuff... so this place might be right up his alley.

I'm thinking I'd rather have a 3 star NH that's only 4 miles away where I can visit often then a 4 star somewhere 25 minutes away. In the first I can be there often seeing to it he get's 4 star treatment in the 1st instance.
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Zytrhr, This was the first time I had experienced this. I later learned that the facility is run by a joint venture between a local hospital and a private corporation. This hospital for the last few years has attempted to merge with other hospitals. Two proposed mergers were cancelled after due diligence had been performed. I wish I had worked on the legal team that did the due diligence; I've love to know what they discovered.

To think though that such rubbish passes as food for people in need is so disgusting. Vulnerable people need higher levels of care, not to be considered human garbage disposals for old food.

Thanks for sharing your insights; I'm saddened to learn that this could be a major practice.
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GardenArtist

What you described is quite common, esp with for profits. They could be getting food that is close to or past the expiration or sale by date. Those older folks would not know (or maybe even care). You can bet that the workers don't eat the same food as the residents.
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1Tired

Some of these comments are inadvertently comical. That being said and to your comments, sure the NH will greet the loved one and his/her family with smiles, been there done that. The activities director was all smiles and mentioned, not being Superman (who I now can't stand),and that my mom was in the best place for 24 hour care. Guess what? Mom passed, only reason this NH has contacted me is for amount owed, nothing else. No she was a nice person, sorry for your loss, etc.
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Dustien, you might think about trying a different doctor, perhaps a geriatrician or at least one who's more sympathetic and supportive of rehab.

I once encountered that.

One thing I learned about rehab and PT is to avoid the physiatrists and therapists who present with a specialty in sports medicine. They're TOO focused on that and not on older people in general. A physiatrist told me there wasn't anything that could be done - Dad was just old. Subsequent therapists proved him wrong, very, very seriously wrong.

When I had PT for my torn rotator cuff, I went to the facility recommended by the then doctor at the time, a rehab facility for which he had worked prior to becoming a hand and arm specialist. It was clear that sports medicine was their top priority; I was even given a punching bag type exercise to do. I countered by moving my arms in balletic positions in another exericise, trying to add some grace to what was otherwise a boring exercise.

One of the therapists commented that I looked as if I was doing ballet. She couldn't understand that ballet is just as much if not more demanding (and certainly more graceful and beautiful) that beating someone (or a punching bag) up like boxers do.

Back to your situation: Regardless of the fact that he's reached a preinjury state, there is always the PREVENTIVE injury issue on which you might be able to get therapy. This is why I suggested finding another doctor, a geriatrician or someone who respects older people and understands that rehab is one of the ways to counter the effect of aging, balance issues, etc. A different justification can be used for the reason for therapy.

And it's to Medicare's advantage to prevent further falls in covered patients.

As to nursing homes, I encountered a situation similar to that Babalou found. I interviewed a rehab place after checking out the stats, was encouraged by one of the residents and his son who highly recommended the facility, got advice from someone who worked there, and brought Dad there.

The first day we knew I'd made a mistake. Staffing ratios weren't standard; at dinner there weren't enough aides to do the work and people waited 1/2 hour to 45 minutes for bathroom assistance. The aides were also responsible for meal delivery and dirty dish pickup.

Attention was just as lack during other times of the day.

My father's chart was lost by the second day; no one could tell me what his INR values were. The nurse I asked even said she didn't know where else to look.

The food was cooked elsewhere and brought in, a few days after it was prepared. I looked at the cod and thought it was a chunk of plaster. Seriously; I'm not exaggerating. I wouldn't have known it was food if it wasn't on a plate. The brownie was hardened enough that it had been sitting out for at least a few days.

Entering on a Monday, by the time I got him out on either Wed. or Thur., (I can't remember which), his PT/iNR values were out of control and as elevated as they were a few years ago when an incompetent primary care doctor prescribed medication which caused hemorrhaging and sent Dad to the ER.

If I had waited another day, Dad might have been in the ER again.

So, yes, do check out the facilities very, very carefully, on off times but especially at busy times such as dinner. Make a checklist, and ask about staffing ratios, day and night.

And don't, don't, DON'T rely on discharge planners. They have lists of facilities, one of which is known as the "death" facility b/c so many patients go in and come out in body bags. It was a discharge planner who recommended a facility for my mother; we had problems from the very beginning.
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Dustien, 1Tired has some good insights. Ratings don't tell the story, visits do. We've been told repeatedly, by folks who know, that there is never, NEVER a reason for your nose to be assaulted when you enter a nursing home.

I remember clearly one lovely 5 star place in Connecticut that we really like for a lot of reasons really stank when we entered. They had all kinds of excuses, so we went back a week later. Same smell. No thanks.
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If he is in a hospital for the three days you can tell the social worker that he cannot come home under those conditions and you will have their help to get him into a facility, just a suggestion. There are lots of online reviews of NHs to get you started but of course the best are referrals from friends if you can get that. I just spent a day driving and looking at my short list of places. Your eyes and nose will tell you the truth. Be prepared for sticker shock. The cost the last year of my mothers life was around $13,000 a month. Down here it runs about $8,000 a month. Perhaps if he can get past pulling out the cath you might find an ALF that can handle his needs, much less pricey and much more freedom for him.
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Thank you 1tired, that's all a help. I found out we won't be able to do the rehab thing. Seems the insurance won't cover it because he's gone as far as he can go with all that's wrong with him. They say rehab won't help since the Dr. signed off saying that they got him to where he'd been before admittance (which as still weak from a previous hospital stay with a pacemaker put in). So it's just us and the hunt for a good nursing home now I'm afraid. I was hoping rehab would be a way to ease him into it...now he's going to be going to a nursing home weak and sick and is bound to be depressed.
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Sadly we have been through this same thing twice in the last 6 mos first with my Dad and then with FIL who lived with us for 6 years. True that if they are hospitalized for 3 days (and some of them count their days as days admitted and might not count a day spent in ER) medicare will pay for rehab and you have the huge benefit of a hospital or Rehab center social worker to help you find a place. If you are going to be direct pay for a NH (crazy expensive) finding a place and getting the paperwork in order before he comes is a big benefit. Just take him directly there. the fine people at these places know how to make this work and are great at greeting a new resident. I suggest strongly doing the medical paperwork in advance so it is swift. In both cases we expected a real blow up and in both cases, they knew that it was necessary and did not even protest on bit much to our surprise. They know that family is worn out and cannot continue on some level. Both men very stubborn and difficult 6 mos earlier understood and accepted the change. I will not say they were delighted to be there, but they did not have the blow up at the door step we had expected. It does take a long time to adjust to the surrounding and some antidepressant medication helps. You must take care of yourselves and your spouses and at some point that trumps everything. For us it was when my husband got cancer sadly. Don't let it be that late for you, we spent all of our retirement caring for FIL and now we are dealing with that. Placing a loved one is not easy but in the long run they will get the care they need by skilled professionals and will be safer if it is a good NH. There is still tons of caregiving ahead for you even once he is placed. Please be sure you know your states laws regarding DNRs and the necessary forms for medical as well as POAs if you do not now, it is invaluable. Best of luck!
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Sorry, I forgot to address your initial question. I don't have any good solutions except to keep the family close by when he's awake, take breaks in a waiting room or rotate so that some is there when he's awake but that he also has adequate time to sleep without feeling the need to maintain conversations.

And make sure that each of you gets your own rest. Although it may sound callous, a good meal out would be beneficial for you as well. You'll need the time to recharge.
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Dustien, I think you and your siblings have a very good assessment of the situation, are thinking ahead, and taking the right steps. Just to be on the safe side, I would clarify with Medicare about the 3 day hospital stay having been established in his earlier 5 day stay.

Given the drastic change in behavior, the fact that he's not keeping his oxygen on, the UTI, he may need a few days in the hospital anyway just to be get stabilized before going to rehab. The 7 hour drive will be tiring, perhaps unsettling, so he may actually be ready for a rest in the hospital with a higher level of support before going into rehab.

I think your family has arrived at what is the best decision although it won't be the most pleasant for your father. Bear in mind that at this point you're making the decisions for him, and although he may not realize it, you're doing what's best for him.

Some of us are in a similar situation, waiting but dreading facing this traumatic situation. Your courage and strength are an inspiration.
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I'm sorry, Medicare, not Medicaid. Medicare will pay for 20 days of rehab after a qualifying 3 midnights hospital stay ( admitted, not just under observation). They will pay 80% for another 80 days if the patient continues to make progress.
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I was wondering as I typed before why the discharge folks at the hospital didnt recommend rehab....or maybe they did and family refused. Find out
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I do feel fortunate that we got another good 3 years with him after he was told he couldn't live alone. We've been waiting for the other shoe to drop for awhile..and now it has. It's going to be a hard time for all of us, especially my sis in law and brother as they've been taking care of him and have been so close to him for the last three years. Especially my sis in law...her heart is breaking that she just can't handle it anymore and feels she's letting him down. I have tried to get her into here for the last 6 months for support but she's not a computer person I'm afraid. I don't know how I would have handled things the last few years without this site. Thanks to you all, I know this is the right thing to do for Dad and its going to help keep me strong to get all of us through this, including Dad.
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Babalou... I just went reading what you said about Medicaid paying for 20 days and I found out that he can go to rehab if he's been in the hospital at least 3 days in the last 30. He had the pace maker put in less then 30 days ago and he was in the hospital for 5 days... this last time I think, if they count the day they took him in as day one, then he was also in for 3 days then...and just got out yesterday. So i could still take him to rehab if not through the ER... I'll try the ER first though, unless he really fights that. He said he's never going back into the hospital.
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You have good instincts. Get him to the ER, hopefully admitted for 3 nights and then to rehab ( where Medicaid will pay for 20 days in full).

Telling him that he needs to go there to get strong is the technique we used to get my mom to accept Independent Living initially. If he's not a total narcissist, would he understand that " sister can't do this anymore"?

Good luck, and I'm sorry your family is going through this.
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I'm seriously thinking that, maybe, it would be best when he get's here to take him to the ER at the hospital, and have him totally checked out (he has very good insurance), and then have him released directly to the rehab center, telling him that it was Drs orders and that it's only till they can get him strong again... As it is, he can hardly walk and he is in danger of falling.
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Sorry about the one long paragraph (I know it's hard to read and I hate when other's do it), but the program just wasn't letting me put in breaks between paragraphs. Don't know why...something wrong with the java script I think.

I even tried copying the text, closing and reopening another question page, but that didn't help either. It still would not let me put in a break.

Though I can do it this response script though...Odd. Anyway, I forgot to say that tomorrow I'm heading to a very highly rated nursing home here where I live and I hope they will be able to take him and help him....
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