Back again, 89-yr-old Mom living with 90-yr-old Dad is coming home tomorrow from rehab after breaking her hip. Now what?

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Back again, 89-yr-old Mom living with 90-yr-old Dad is coming home tomorrow from rehab after breaking her hip. Now what?

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After a month of being in the hospital and rehab, mom will be discharged tomorrow. She has done well with her PT and her therapists have encouraged her with accolades as to how well she is doing. Problem is she is expecting to go home with the intent of running marathons. She honestly thinks she is in better shape than when she fell because she feels so much better. What she doesn’t realize is that she is under constant supervision and only does what she is told. At home she’ll do what she always does and forget all about the guidelines they set for her. Her dementia is well disguised because she wants to go home and will say and do anything to get her there. Once home, I’m sure she’ll go back to her old ways, not using her walker, bending and reaching and twisting which will only aggravate her condition (she has PMR and compression fractures, along with severe osteoporosis). Her rheumatologist thinks AL is the best place for her......but she refuses. Sister and I will share the brunt of this burden, as my dad is not capable of being a full time caregiver. I’m at a loss.
Do I just wait it out until the inevitable happens?

Care Decisions Hospital Discharge

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She needs to be told how serious a broken hip is. I knew a woman who broke her hip. Went to rehab for only a few days and back to the AL in a Wheelchair. She looked good and happy, her old self. Two weeks later she was gone.

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My family thinks l’m crazy and overreacting. Both her and my dad are delusional in the assumption that the worst is behind her. At 89 with her health issues, she maintains for awhile if she is fortunate.

(1)

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Severe osteoporosis, not good. I’m sorry but regardless of where she goes, she is very fragile. Would your dad be willing to move with her?

Depending on how advanced the dementia is, you might discuss with her that she is 89. She might like to live to 100 but chances are she won’t.
She will more than likely live longer in ALF because she would be in an environment where she would be less likely to accidently harm herself and be better able to live pain free longer. Her mind is strong (therapeutic fib) but she has physical limitations that have to be considered.
If that seems too far afield then, yes, you probably have to wait for the fall.
Hopefully, you will arrange for her to continue to have therapy once she comes home.
But remember that you and sister need to be watchful that you don’t wear yourself too thin too soon.
Please, please set boundaries. Hire help. Don’t bring her home and start doing housework and running foolish errands. MANAGE her care. Don’t provide it. You have to pace yourself. Decide before she comes home the amount of time you will contribute. She’s had someone waiting on her 24/7 in the rehab. Why would she think she needs ALF if you provide all the help.
Good luck.

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Great advice....thank you. Yes, they would both move to AL together, which would certainly be the safest alternative. We have done a much as we can to make the home safe....but there are still obstacles that makes falling inevitable. She is very stubborn and places her love of her possessions above all else ( which in part makes the home unsafe). Therapy will continue and you are correct....she will expect the same level of attention when she’s home. I don’t think we can handle it.....she will drive my dad crazy.

(3)

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Bend at the Waist - Fall on your Face.

Learned that water skiing a few years back. Yes, its true..

That rule goes with most activity at any age....

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Simple truth......Now if she can only remember that....Thanks!

(3)

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"Manage her care...don't provide it".

Please, Abby. Remember this.

Your parents are financially comfortable and can hire help. Help them find an agency.

Do not become your mom's personal servant.

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Thanks Barb.....Truth be told, my plate already runneth over with my own family commitments and this added burden will be short lived.....for both me and my sister. Especially since my brother is useless and refuses to commit himself. Sadly, my dad would never move without her.....that is until this has a negative impact on his own health.

(4)

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Let her drive dad crazy. Make HIM want to move to AL. Move him there.

Mom will be alone and she'll need to make a choice. Home alone or AL with Dad.

Abby, don't see this as YOU needing to step in. Make it inevitable.

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Abby; Has the OT been out to mom and dad's house to assess the safety?

Is the rehab stating that this is a safe discharge? Do they have a home health agency set up already?

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They did an assement the first time she was hospitalized ( 5 months ago). I was not impressed. They just went over basics....throw rugs, grab bars, etc. Transfer chair in the bathroom (doesn’t fit). To me anything that posed a threat of falling (or falling into...glass curio cases) needed to go. I feel clear and open spaces are essential.......with organized closets and cupboards to help eliminate reaching and stretching. I have found her reaching sticks tucked in corners throughout the house.
Although, I have to admit I’m a minimalist.....and mom is a hoarder. I realize I have to pick my battles, but I feel the way things are presently both parents are in harms way.

(4)

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Carefully consider the answers here, Abby. DO NOT allow yourself and your sister to become your parents' stepandfetchits.

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Get the folks at the rehab on the horn today to set up home health coming out Friday at the latest.

If your parents call with an "emergency" call 911.

Look, your parents have the means to fund their own care. YOU are not a retirement plan. You have your own family to care for and you are not a spring chicken (and neither is your sister).

You need to say "I can't possibly do that".

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Safety, comfort, contentment. You actually have (sort of) four choices.

You can choose to place her her and her spouse in the nicest AL you can find.

You can allow her to return to the life she was living before she fell, to fend for herself with her spouse’s help.

You can bring her home with full time live in help.

You can bring her home and plan to be her full time care giver.

The decision making? BRUTAL. But as painful as it is, when you consider her medical status and your father’s willingness to accompany her AND her medical provider’s input, the decision seems a bit clearer.

Of course, SHE REFUSES. EVERYONE with dementia refuses, because of the dreadful and undeniable effects of dementia. And while it is tragic in every case, her “refusal” however poignant, is the LAST consideration to be using to decide what can be done to help these dear people to a life that is “safe - comfortable - content”.

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You stated that PT /OT did an assessment 5 months ago. They should have done another assessment this week prior to your Mom's discharge from Rehab. The first visit doesn't sound like they did a very good job at evaluating your parents house or evaluating whether your Mom could safely take care of herself.

When my Mom was discharged from Rehab, both Physical Therapist and Occupational Therapist came to our house and had Mom perform some of the activities that she would normally do: use the toilet, get into and out of the shower, get into and out of the bed, get food out of the refrigerator and put it in microwave, etc. Once PT & OT were satisfied that Mom could perform ADLs (Activities of Daily Living) by herself safely at home, THEN they released her from the facility.

I agree with Barb, call Home Health immediately and ask for an evaluation for aide assistance, companion, therapy and nursing to take care of your Mom.

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Actually they did go through ADL’s at the rehab center.
She made scrambled eggs, took a shower, used the microwave, etc. I expressed concerns that a walk-in shower isn’t the same as a tub....and that cooking under supervision isn’t the same as being home. They feel she can be home alone for about 3 hours so my dad can run errands etc. I disagree. She will have VN, PT,OT, and home health care aids starting on Friday. She has run out of Medicare benefits and is adamant about not spending a dime to extend her stay. Dad agrees. Medicare will pick up her home services for a limited time. Last time PT stopped coming because she wasn’t progressing (just two months ago). I am at wits end. Next breathe she tells me she wants round the clock care if it comes to that....even though her experience with the rehab center was a positive one....she thrived on all the attention she received.

(5)

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So, Abby. She's not dealing with a full deck of cards, is she?

Do you have medical POA? I think not.

As damaged she is, it's your mom and dad's right to make poor decisions. And it's your right to say "no, that's a really stupid choice mom. Why have you saved for a rainy day if you're not going to use it to fund your care?".

Get the money question out in the open.

When we realized my mom needed facilty care and that it would cost 5k per month, my mom said " oh, I can't afford that". Fortunately my sil the MBA said " don't be silly. Of COURSE you can afford that".

You need to be very tough here, Abby. You need to let both of your parents know that you're not signing up for this gig.

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I even made arrangements for them to visit a lovely AL facility just 8 miles away. Very highly rated. Weren’t interested. My dad is digging in more and more to oblige mom. At this point, I can’t see getting through to them until something happens once again. I will continue to take her to drs. appointments because I feel the need to stay in the loop since I can’t trust her feedback. She lies and her perception is not reality. I will continue to fill her pill box once a week. Sister made arrangements for the home to be cleaned on a monthly basis ( not our idea....it should be done weekly). Short of that I will not do any more. If brother wants to fill in the gaps he’s welcome to it.

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Good for you, Abby!

We have a longtime poster here, Frequent Flyer. Her parents went to look at an AL ( because she couldn't do the home upkeep for them anymore). Parents said " maybe when we're old" ( they were 95 at the time)

The mom fell, hit her head, major brain bleed. She died. The dad then happily moved to IL and then memory care.

Sometimes, all you can do is wait.

Keep in touch. We care!

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I am so glad I found this site.....kind, caring people who pretty much understand the struggles and challenges we all face as our loved ones grow old. Great advice from kindred spirits. How fortunate we are. As always, thanks again Barb.

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Thanks for letting us know about the home health care arrangements. Now you will have other people who can observe your parents and see their "true" selves and behavior. Maybe the VN, PT,OT, and home health care aides will notice the dementia and mental or physical impairments and eventually start to encourage or suggest that your parents move to an assisted living or nursing home.

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HI- My sister and I faced a similar situation with our parents. After firing 10 (yes, 10) home health aides-we had no choice but to help them move into an AL apartment. My mother expected my 88yr old Dad with Parkinsons Disease to help her and manage his own medications. (Was not happening) Year and a half later, they have been separated due to my mother's continuing fighting with everyone-my father, the nurses, the aides, my sister and now, me. There is no one left. She has demanded a night aide, in addition to living on the concierge floor-which is kind of a joke. If I told you how much it costs--oh my goodness!! But still the little tyrant makes constant demands and driving us all crazy. My piece of advice-as the others mentioned above, manage their care, get them in a safe and comfortable environment and go and visit once a week. Maybe then Mom will acclimate and find some others to complain to-I mean --talk to. I never thought our lives would turn out like this--theirs or ours. My mother expects me to be at her beck and call and actually told me that if I didn't have to worry about HIM (my husband of 37 years) I would have alot more time to care for her. What a peach! Don't let her go back home alone-something will eventually happen that will necessitate their going into AL. A good AL facility will work with you-I think they exist mostly for the daughters and sons who stress about doing the right thing for their sadly diminished parents. Good luck. Be strong. this is tough.

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re-reading-my mother fired the 10 health aides. Most were lovely women who did not deserve to be treated poorly. Why I allowed myself to be treated that way for so long, I don't know.

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You do have cause for concern. Talk to the Social worker in this Rehab about getting Mom a caregiver for those 21 days from her Medicare and Mention too about other things you can do to help her. They will probably suggest this caregiver temporarily is a good idea, but out of Pocket or off to a Facility, Once that Caregiver Gift ends.

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She refuses to go to AL, which is understandable. I had two aunts who gladly went to AL before they 'needed' to, because they didn't want to be a burden to their families. My mother totally freaked out when I took her to AL, and I felt like a complete failure as a person and daughter, and yet, I had no other choice. My mom was in the AL apartment less than one day when she had to be moved to Memory Care, because that was really the stage she was in. The story is long, of course.

Back to your mom, refusing. Can you say to her, "we (her daughters) are not capable of providing the care you need now? We don't have the skills necessary to care for you on a 24 hour basis. Please let's consider AL so that you have what you need, we can continue working, etc, and we will enjoy our visits with you on a regular basis."

I know this is very difficult and perhaps seems impossible, but you cannot give up your life for someone else, even a parent.

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I got to laugh because my late mom was like that. My mom would forget about using the walker to get something from the kitchen. I would hire a caregiver from one of agencies such as Home Instead if your mom can afford to pay out of her pocket. If she doesn’t wander at night, then hire someone to help her eight hours a day except for the weekends. If she wanders at night, start finding a nursing facility now before she breaks another bones.

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Yes, I would wait until the inevitable happens. These are not your children. Too many 'adult children' end up fighting with their parents trying to control them, (stop driving, go to an ALF, use a cane, etc.) It's a waste of time and energy to fret over your parents choices. At least your parents have the MONEY to go into an ALF. That's a major plus! I would back off when it comes to 'Rescuing' them. My sister has been rescuing my Dad. She now is terminally ill with cancer and Dad is more worried about him than his own daughter. Given the fact that Dad chose to not work much in his younger years, retired in his 40's and conned all of us kids into letting him leech off us, we are done. He has no where to go now so will become a ward of the state. This is what happens when you burn your bridges with your children.

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There are home health companies & "hospice" that can assist and help set-up ur "team". As they must be=truely caring & dedicated=bcuz they focus upon "end of life" situations,(its amazing!)... & as professional people, who can guide u & ur sister through the many choices u will face; even before the Durable Power (medical &/or financial) becomes active . I am definitely impressed with 2 national companies! P.S.===The companies are= (1st one begins with "S" & is ___stice; & the 2nd company is=Amer. Holistic ____) *F.Y.I. :IM unable to actually list/endorse here but U can easily discover the correct company names).
(Continuing:) previously I worked as "livein night attendant"-who worked closely with them thru two Separate situations/clients& I learned Hospice includes a support-chain of people already available! From the weekly RN checks to twice- a-week bathers, to personal case worker/liaison, to the wkly spiritual advisor=all worked together with family/ client =the choices are available. As I learned so much from these people & I can confidently say that Hospice is so much more than most people assume! Its not just caregiving for the last few hours/days/weeks/monthes OF LIFE , ITS the quality of people who will give advice if u ask & they can be ur own lifeline to provide home care that isn't chaos-- I can also state, its regardless of how long or how many times u may be told by doctor(s): they have ___much time left...only God knows that -so son the surprised by humans ability to survive longer/more times....Indeed I am still exhausted after last client, but maybe in few monthes of rest/respite-I will definitely return to be caregiver in a few monthes, because of the understanding gained from Hospice caregivers & Nat'l Caregiver Assoc.- Take Care of yourself 1st...Regards!🌹

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Unless your parents are deemed incompetent OR allow your DPOA to take effect, there really isn't a whole lot you or your sister can do. If I recall another of your posts correctly, there were/are concerns about the house/set up. Is there any way to limit living space to downstairs? Bringing in outside help you had said was an issue with dad, but it sounds like your mother might agree to this and if he just wants to comply with mom, then it might work. If you haven't access yet to their finances, will they agree to pay for services? For the short time we had 1 hour check visits, I had already taken over mom's finances and we just told her Medicare was paying for it. Moving to MC, we said Medicare and VA... She has no clue how much or that it is her money (she saved it all for when she might need AL, so whaaaatttt???)

It doesn't sound like she needs a nursing aide, but do these companies hire out "companions", someone who can keep her from doing stupid things? I suggested before that when bringing these people in, introduce them as your friends, who have come to help YOU (be sure the services are aware of this too!)

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OOPS, reading an update to another posting I realized the stair and dad refusing aides was from that post, not yours. still.... if the shoe fits...

The tub vs walk-in shower... that is a concern... transfer chair won't fit in bath, will her walker fit (that is if she uses it!) Also, sounds like she is open to having help... or was that just talk because she wants out of the rehab?

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My mom's AL facility had rehab services. At the end of rehab, she just continued living there.

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You don't wait for the inevitable to happen. You take control now - not them. She doesn't get to refuse an AL. You'd best speak with a social worker.

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Can’t really do much without them being diagnosed as incompetent. Mom does have dementia, but dad insists he can deal with it.

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I hope you didn’t let them discharge her home...I wish I saw this post before. You know it’s going to be a disaster at home...she probably end up doing for your father. Then she’s going to fall again & re injure herself. I recommend they both go to ALF together. Hugs 🤗 & let us know how it goes.

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Actually it’s my dad that does for her. But being 90....and in decent physical shape.....I don’t anticipate his health will last long. She refuses to go to AL and my dad obliges. My sister and I both have been trying to convince them otherwise. We had thought after the fall, this would be a no brainer....but they are both digging in. They are foolish enough to think their assets will remain intact while they live out their remaining days in their home. We are at wits end.
Hugs are much appreciated😊

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Abby: Dad cannot deal with it. I echo CaregiverL.

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First off, I would call and talk to the rehab's SW. Tell her upfront that you are not signing for her release, that you are not tending them or living with them, but simply medical transport. That is your boundary and that's all you can do.

Next, don't sign anything. If she can leave on her own signature, great!

If you truly believe she needs to live in AL or higher, please back off and hold onto your boundaries. The less you do, the more obvious the need is.

Have you read Dorker's thread?

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I appreciate your advice, esp after having dealt with similar situation 2 yrs ago. Unfortunately, I didn't know to be very adamant about set boundaries, so I not only had to provide (on a weekend) med.transportation for my client( bedbound/wheelchair/hoyer etc) but became the main caregiver bcuz she had already 'fired' the only 3 companies that would come to our urban area...anyway-I definitely echo ur advice & would add- get in touch with the case manager for the insurance.comp. and with Medicare/Medicaid advisors and even an APS liaison= get informed & become fully aware of who cover/pays for what & who requires the "doctor's orders" for services & med.equipeme t. Also find out if you can be compensated as her caregiver && setup respite care so u/ur sister can take a break-its worth everything to have the support & knowledge to make decisions & understand what u r commiting to before u discover ur overwhelmed! Best of luck to yall & God Bless the Caregivers!

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Why are you asking a dementia patient anything? - they will always go for the most comfortable option for them - tell her in no uncertain terms what the new reality is .... do this in a kind but firm way with the help of professionals there at rehab - even tell her that it is the 'next step up' - maybe dad will go there too

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Frist and foremost you need the legal right to make decisions for your parents. Get that P.O.A. ,Trust, Representative Payee etc. They will get to the point when they can't make the right decisions for themselves. If you let the state step in you will have no power for anything concerning them. If your mom and dad can stay in their own home safely then that's where they should be however some of the AL's have fun stuff for your parents to participate in. Sometime they have open house or free lunches. Take them out for a free Lunch! Also tell your mom of your fears and give her a choice, in home help or AL. Involve a social worker.
Good Luck

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Back again, 89-yr-old Mom living with 90-yr-old Dad is coming home tomorrow from rehab after breaking her hip. Now what?

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