Long story, but I am in the process of getting my father placed into a SNF. He will be 90 years old in 2 weeks, had a very serious fall at home 3 weeks ago, subsequent surgery for herniated disc, and long hospital stay, and is currently in rehab. He was previously living alone with part-time caregivers and has been stubborn for years about moving anywhere until this fall has forced him to. He has Parkinson's disease, CHF, T2 diabetes, previous stroke, HBP and is on loads of meds. He can no longer walk in his own and needs 2-person assist. He does not have dementia but def has cognitive decline, memory issues and is now much more confused than normal ---he did experience hospital delirium, which in the past got better but it has not this time, and seems to be getting worse.
One week into his rehab stay I got a call stating they found him unresponsive and sent him to ER. He came to after about 20 mins, before he got to ER. His heart rate was dropping super low, into the 40s and 50s, in Afib. He experienced this while in the hospital before surgery for his herniated disc with Afib. Then it stabilized. I am now convinced this is what happened and made him fall at home because he has no memory of how he fell and when.
Since he's been in rehab, he only wants to sleep most of the time. He does do PT and has done ok, and then sleeps the rest of the afternoon and night except to eat. He is quite confused about things sometimes, but not all the time. He does now accept he needs SNF because 2 doctors told him and not me. He is very confused and just wants to sleep mostly. He is also very congested and coughs alot, typical of CHF, it's not any kind of virus as he was tested for everything.
For those with loved ones with CHF, does this sound similar to the progression of the disease? He can't see his cardiologist until July, but they have decreased his heart meds and will start him on a live heart monitor next week for 30 days. The ER found no explanation on tests of why he became unresponsive at the rehab facility- all tests were normal except for low heart rate episodes and then it stabilized again.
I am just wondering if we are heading into end stage CHF? Or does anyone have similar situations they've gone thru with the HR dropping and passing out?
I am prepared for this to be the beginning of the end, I just wish we could get more answers. I am an only child and caring for him for 7.5 years is wearing on me. I have my husband to help but that's it and he can only help so much. I also am honestly relieved he'll be in SNF where I won't be constantly worried and at his house for a million things, I need some normalcy back in my own life. We also have a teen daughter who needs us still. I think I am just burnt out but I am glad he will get the care he has been needing and resistant to for years. Just wondering if others have been thru this with CHF/Afib and maybe what I can expect. Thanks for reading my long vent.
She went from being okay to going to bed and never coming out again, just like that.
It's hard to say what 'the end' looks like for a CHF patient, but I'd get your dad a hospice evaluation stat. He does not need to see his cardiologist first; her PCP can write the recommendation for it, and you can choose the hospice company. THEY are the ones to make the final determination anyway, the doctor just makes the recommendation. The hospice nurse knows just what signs to look for in the elder.
Wishing you the very best of luck with a tough situation. I too was where you're at now, after caring for mom for 10.5 years and watching her wither away, between advanced dementia, AFIB & CHF, neuropathy in her legs/feet, a stroke, and a bunch of other ailments too. I was relieved when she finally passed and was able to rest and reunite with my dad and the rest of the loved ones who had passed before her. She was the last of her family to pass.
My mom died of CHF in 2020. She really had no other underlying health conditions.
Her hospice nurse told me that CHF is very "tricky" in medical personnel being able to predict "the end".
What you're describing with your dad is pretty much what my mom went through throughout the last year of her life. The constant napping, falling without knowing how it happened, blood pressure dropping extremely low (especially when sleeping), confusion, memory lapses, etc.
In my mom's case, she went from being "status quo" on a Friday to actively dying on the following Sunday. I can't say where I saw a marked, significant change, although her hospice LPN had told me the Thursday prior that she though my mom might be starting to transition.
I'm sorry I can't give you a better definite. I'm glad that you have been able to settle your dad into an SNF if he needs that sort of help, especially transferring; my mom was (relatively) mobile until she began transitioning, but at that point she was bed-bound, mostly unresponsive and in incontinence underwear, so transferring wasn't an issue.
If you haven't already, have you considered seeking a hospice consult? Although some posters here have had some issues in the past with hospice coming into SNF's, where the SNF staff sort of backs off care of the patient, figuring that hospice will pick up the slack, so that is something to keep in mind.
I wish you and dad peace through this time.
My dad died from covid but, he was in the hospital for open heart surgery. He had CHF and A-fib and towards the end, the nurse told me that they couldn't get the fluid off him, so I think that was what really caused his death. He was really tired, congested and out of breath for the last week of his life, he would gasp when speaking.
That was my experience.