Continuing saga:94.5 year old dad living with us for 5.5years. Drop foot both feet, considered high fall risk and multiple falls, last two backwards with hitting head. Currently compression fracture base of spine. Macular degeneration both eyes and very low vision, hearing problems despite hearing aids, fine motor issues but can feed self if food cut up, no sense of smell, CKD, colonized UTI, cdiff history, pacemaker, Urostomy, cancer three times (currently cancer free), hypothyroid, mild COPD, constant sinus issues, at times incontinent number two. Cognitive decline well hidden by charm and rehearsed responses but some deficits emerging. Impulsive and unsafe in motor planning and other choices. Does not sleep at night and is often up and down and needs help to move from bed to chair, etc (so I sleep outside his room and go help when I hear him up—sometimes up to seven times a night. He won’t ring a bell and I know would not accept an alarm). Will go outside on front porch at four am to smoke, not knowing the time. I could go on and on. Daily care includes taking BP and HR and oxygenation twice daily before administering BP med, daily weight and observation for edema and PRN water pills, med management of lengthy list, scheduling two pages of doctors/specialists plus labs including monthly urinalysis ( which is quite complicated with a Urostomy), daily hydration encouragement and monitoring, daily exercise encouragement and creative planning so will do, support and supervision for managing Urostomy and safe ambulation, daily poop monitoring for diarrhea or constipation, picky eater so constantly working on nutrition choices, seems slightly OCD as constant adjusting and smoothing of bed clothes, his clothes, etc needed. AND bathroom mistakes and issues to clean up sometimes multiple times a day, sometimes can go weeks with everything ok. Toilets self but does not really get himself clean.
He is currently at a SNF post hospitalization and they are saying they will not accept him long term and had a sister ALF call me. No way is he a fit for ALF (and Hospitalist doc who has treated him while hospitalized for two years said he would not be safe in one, when I discussed long term plans for him with her). I have had difficulty with in home help because of his infectious disease history.
I don’t know what to do. I have asked to meet with decision makers at the SNF, as to how they arrived at the decision. So far nothing quantitative. The social worker for intake who did the cognitive eval literally gave him many answers, going beyond the “hints” they are allowed to do. He is witty and charming and fiercely insists of doing for himself, which I respect but his ability and judgment do not match his commitment and stubborn insistence and puts him in danger. I have severe osteoporosis and cannot lend a lot of physical support safely.
Suggestions? I am really frustrated as it took a lot for me to consider long term care in the first place and I have been conflicted by it, but I know I cannot be his sole caregiver anymore—it’s not safe for either of us. Plus, his filters are increasingly failing and as I annoy him when he doesn’t think he needs help, he can get really nasty. He does not have enough money for ALF plus hired caregivers to supervise 24/7. My other relationships are very strained by the care attention I need to devote and lack of freedom. I want what is best for dad but I am drowning and it feels like the preserver I counted on being there when things became too much, has been yanked away!
You are not failing your dad by saying you cannot do this anymore. With his fall risk, nighttime wandering, vision loss, toileting issues, medical needs, and your own osteoporosis, this is unsafe for both of you.
I would ask for a formal care conference with the SNF administrator, social worker, nursing director, therapy team, and doctor. Ask them to explain in writing what level of care they believe he needs and why. I would also ask his doctor to document that assisted living is not safe if that is the medical opinion.
Most importantly, I would not agree to bring him home unless there is a realistic and safe care plan. Loving him does not mean you have to destroy your own health trying to provide 24/7 care alone.
If the current SNF is billing to Medicare, there is a limited number of days which Medicare will pay. If that is their reason for discharging him, you can resolve that by paying out of pocket (using your dad's funds) or applying for Medicaid for him if his assets and income are low.
If he can not stay at his current facility, find another SNF. Schedule a tour with an admissions director of at least 2 or 3 facilities. They will want to know what his abilities and requirements are before accepting him as a patient.
The care management nurse that we pay a monthly fee to to help monitor his healthcare choices says it may be that since he isn’t very compliant with waiting for assistance, and I have him down to not be sedated, etc, they may just not want to deal with him. No matter what I will be seeking something to help him sleep at night…..I’ve just always been concerned it would add to fall risk and if he is awake even a little bit, he is going to do whatever he feels like doing.
Hire an overnight aid (that he pays for) so that you can at least get some sleep. If he doesn't like it, tough toenails. Tell him the option is a facility.
Option #2:
Get him assessed for LTC. Find a LTC facility that has Medicaid beds and move him. Tell him it's temporary. When he runs out of money, apply for Medicaid for him.
Is he on any medication for his nighttime agitation? If not, I would talk to his doctor about this soon.
Lealonnie1's Mom was in MC and fell 50+ times. There is no solution when an elder doesn't have the wherewithal to stay seated or use a walker. They eventually will break their hip or femur and become bedridden, solving the problem in its own way.