Any advice on what helped your parents when they were in rehab?

Years ago my Dad was in rehab. He lived there for 2-3 weeks and he enjoyed being there, he said the food was good, and he liked his physical therapist. But he was starting to be bored.

I found among all of this, the only stress was with my Mom, as she didn't like having Dad in a rehab facility. She thought she could take care of him at home. Ah, NOT, Mom was in her 90's. We went around and around on that. Plus Mom didn't like visiting the facility, seeing all those old people in wheelchairs... [rolling eyes]. Otherwise, my Dad did quite well at rehab. We took Mom to visit less and less as she wasn't very positive on her visits.

I hope that Dad is only in rehab for a few weeks. He can't sit up far enough to feed himself, and he's in a lot of pain if he sits for more than a few minutes. I'm concerned that the depression caused by pain and temporary loss of mobility will cause him to give up the will to fight. I'm not at all impressed by the food thus far. He's on blood thinners, and they brought him a green salad as part of today's lunch.

This is an excellent question, and you're wise to address now what you can do to help. Having been through several rounds of rehab, these are some suggestions.

1. He'll be disoriented, not only b/c of the pain, but the surroundings are different and new, there's a loss of control over one's own day and body. Brings things from home that can provide a link to his home to lessen the disorientation.

I brought a military plane calendar (my father was in the Army Air Corps and relates a lot to WWII planes), photos of dogs (he also likes dogs), his favorite magazines (older folks mags, scenic nature mags, church mags, etc.), toiletries, favorite clothes, church address and phone book - things he might need while in rehab.

2. Spend some time getting acquainted with the staff so they're more comfortable when you call for updates. Wouldn't hurt to bring some bagels or donuts. Learn their names and call them by name every time you see them. Make yourself well known to them.

3. Review the medication list. Facilities have on call doctors who visit once or twice a week, depending on the facility, and often they change the meds. I've found they typically will add stool softeners, anti acid pills - regardless of whether the patient needs them.

If this happens, ask the nurse first why these were added, just to go through the chain of command, and work your way up to the doctor if necessary. I've left notes with the nurses or aides to ask the doctor, conveying that I really do need to know why med changes were made.

4. Visit often now and help him acclimate; gradually decrease your visits once he becomes more comfortable and able to fend more for himself.

5. When he can transfer to a wheelchair, take him around the facility to help him orient himself. Go past to the therapy room, main dining room, library, etc. if the facility has them. Then he won't feel so confined just to his room.

6. Help him call out to friends, make sure he knows how to use the telephone (usually dial 9 to get an outside line), go over the controls for the bed and for getting nursing or aide help. Being in a strange surrounding and now knowing how to get help is very disorienting.

The goal is to prevent the sense of isolation and helplessness by enabling him to orient himself and know how to get what he needs.

7. Pack a lunch and eat a meal with him, either in his room or in the dining room.

8. Find the activities staff, find out what activities exist, and time your visits so that you can ensure he's able to get the activities he wants.

Ask about music and pet therapy. Dog visits are more common in rehab facilities these days.

9. Bring clothes that are comfortable for him, clothes he's worn for years and in which he can link to earlier relaxing days at home. Use a permanent ink pen (such as the Sanford pens) to write his name and room number either on the clothes, or on iron on tabs you can get from a fabric store.

If you plan to take his laundry home, make a "FAMILY DOES LAUNDRY" sign to tape to a door (or wherever staff designates) so that his clothes don't get lost or mixed up with someone else's.

10. Don't stay all day; I used to time visits for either just before, during or after lunch, so that he has plenty of down time.

11. Tell friends and relatives to call, visit and/or send cards. Get one of the new card displays, some push pins or double faced tape, and pin up the cards he gets. If he's not getting many from family, compensate and bring some cards from you for the next few days so he can open them up and feel that connection with you.

12, If he wants you to, accompany him to rehab, take notes on the kinds of exercises he's doing as he may need to continue those at home either with home health care or on his own.

13. Either ask the social worker now or start researching home care agencies. When he's ready for discharge, you may only have a few days to get ready, and it's much better to have discussed, perhaps met with, and gotten acquainted with a home health staff representative before the actual discharge date.

14. If your father will be leaving to return home or to your home, and this is his first fall, ask if the physical and/or occupational therapists make home visits before discharge to suggest adaptations. After my father's first fall resulting in a fractured femur, both PT and OT came over to inspect the house and make recommendations. This is the first time any facility has had therapists who did this, but it was very helpful.

15. Inventory everything you bring so you can be sure you've gotten everything when he's discharged.

I was typing away when you posted again. As to the Vitamin K foods while on blood thinners (Coumadin/Warfarin I assume), raise this with the nurse and then the dietician.

Actually, the pharmacists at the anti-coagulation clinic we attended for several years said that a diet that's CONSISTENT in Vitamin K foods is better than one with irregular K foods, and we did find that out.

Ask also how often his PT/INR values are measured and if they're being monitored for 2 - 3, the therapeutic range. Letting them know you understand these issues can heighten their level of respect for you, and knowledge that you're on top of these issues and want to be kept up to date on what's going on.

As to the possibility of depression, that can certainly happen, but you can also turn this unhappy situation into one of bonding and supporting him throughout his recovery. I would also discuss with his nurse what the pain regimen is going to be, to ensure he's getting enough meds to allow him to recover.

If you're comfortable with this, you could bring in an easy to use CD player with his favorite CDs (I duped them and kept the originals at home), with ear phones. Put on a CD just before you leave so he has a chance to relax to music after you've left.

The first few days can be awkward, but there should be some acclimation as the first week plays out.

We all have had different experiences. Mine is based on muktiple family members at advanced age who have fallen or had debilitating hospital stays. Rehab is hard, but necessary. I've always been amazed at how much it helps. Managing the pain is necessary in order to be able to do the therapy. If it's done correctly your father should be tired and need to rest after each session. Usually the first day or so the patient is assessed and settled in and then the work begins. If it's like the ones I'm familiar with you need to make sure he has the right shoes and comfortable clothing and then be away until it's time for him to relax. Maybe come up and pick up his laundry and visit a bit but don't hover. Let him get with the program. The patient needs to do most things for themselves and the therapist or staff will assist as needed. As there are multiple patients in a therapy room, visitors are not always welcome while they are exercising. Usually you can peek into the room and see how your dad is doing but usually you should not be with him. There are other patients for him to observe. A bit of peer pressure maybe. There are exceptions. I'm speaking in generalities. Make sure you know what the goals are. Sometimes because of age they might think the person is not able to do things that were no problem for them before their injury or surgery. (My dad was at one point basically sent home to die. A few weeks later he was back out on his tractor cutting hay. This was at 85 ). If your dad was active before he should be again. Usually the goal is to return them to the stage they were before the incident. A fall, of course, covers a wide range of possible injuries and outcomes. The dr orders the therapy but the therapist usually determines the specific workouts. Some days all your dad may feel like doing is sitting in his chair and the therapist may say that's ok as your dad is still trying. But overall, he has to put forth effort or he will soon find himself being discharged before he is ready. That is not a good thing so encourage him to participate as much as possible. My mother didn't want to take pain medication so had to be coaxed into it in order to stand the therapy necessary for a fractured back. She wanted to just sit real still so it wouldn't hurt. That won't work. Additionally many clinics will offer outpatient therapy once the initial treatment is completed. That's when you can really help by bringing dad back for this therapy. He may not want to come but again, it makes a big difference. Or you could ask for home therapy. Many will opt for that and then dismiss the therapist when they show up. It's hard at first but will keep your dad going a lot longer if he will do it. So don't get in the way but know what the expectations are for your dad and support the program. The depression might be because he is afraid he's not going to recover. Whatever the problem generally speaking, it will get better with movement. He needs this for the rest of his life, just like you and I do. Therapy can help keep the muscles around bad knees and hips strong to support us, Help with constipation and breathing etc. One last thing, if he got shuffled off to a nursing home rehab where there are only old people sitting in their chairs, nodding off, then I'm not sure what to expect. My parents nor In laws nor aunts and uncles were in those. You need a rehab that is for patients who expect to get better and whose expertise can restore and strengthen the patient. If your dad was depressed before his fall, you might find that he actually gets better than before he fell. Even when I've had loved ones in rehabs I wouldn't choose to go to again, the therapist were great so I'm hoping you have a good group for your dad and that he feels better soon. It's hard to see them in pain but you can still be supportive. Let us know how it goes.

GardenArtist and 97YearOldMom, Thank you so much for all the helpful advice. I will mention the salad/Coumadin issue to the nurse tomorrow. I talked to the therapist and the nurse practitioner today, and they are planning to give Dad extra pain meds half an hour or so (I can't remember the exact interval) before the therapy sessions. Dad will be moving from independent living to assisted living (at the same senior residence) after he is discharged, and so that part of the plan is in place. I really have the urge to bring him home and take care of himself, but that was extremely difficult three plus years ago when he was more mobile and I was younger and stronger. I know that it just wouldn't be feasible.

About the Vit K. I agree with GA. The newer thinking is to be consistent. My mother would not eat a speck of green. She really limited her diet and she loved all veggies. Her cardiologist told her to eat what she wanted and they would adjust the meds around it. She seldom needed an adjustment because she would not eat greens. The truth is Vit K is in almost Everything to one degree or another but she was afraid of bleeding. It is hard to eat consistent when you've gone from home to hospital to rehab but while he's there maybe he can relax on limiting the greens and give it a try. I also would add to take some Clorox wipes and clean his room. Remote control, call button, light switches, telephone Etc. I did this everyday on items frequently touched. I was afraid of MRSA.
I noticed my mother was only using her left arm when she first went into rehab. I asked her why. She said she couldn't lift her right hand. The therapist evaluated this and discovered she had something called " drop arm". She could not feed herself for awhile due to this but it got better and she continued with OT for the rest of her life to keep her arm strong enough to use. This was not noticed in the hospital. Like your dad she was having severe pain in her back so we didn't notice until later about the arm. Also in one rehab she was treated with lidocaine patches that were originally intended for shingles patients. They really helped her back pain. Some patients can be helped with a back brace they told us but she was not a candidate for that.
Also when you go home it might be beneficial to get your dad a hospital bed. That really helped my mother as she could adjust it for her comfort and breathing. Also his chair needs to be at a comfortable height for his legs and a good cushion can be helpful. Again, everyone is different but notice if he needs the bed elevated to get comfortable.
Since you mentioned the Coumadin I was wondering If your dad has CHF? If he does, watch closely for swelling. The trauma of the fall can sometimes trigger an episode. Ask the staff to keep an eye on his weight as well as INR.
I also agree with GA about the meds. Can't go wrong checking on all of that.

Rehab can be very difficult depending on a host of factors - my mom spent 6 weeks in the same rehab twice 8 years apart

The first time was challenging due to her injuries and being in renal failure when discharged from the hospital and no one knowing it requiring her to be re-hospitalized twice but the therapist was fabulous and she worked hard at age 84 to get out of there

The second time was worst as she now has dementia and ownership of the place changed and her pcp no longer would visit her leaving us to a house doctor from overseas - it was an exhausting experience and I hired personal sitters to be with from 4-8 pm - I visited every other night after work and stayed til 10 or 11
Luckily she was in the room next to the nurses station so they could hear her

I always checked in and brought treats and passed out $5 gift cards to local fast food places - with a broken back and dementia she was completely prone and a handful but would try to do therapy - if a patient refuses three days in a row then Medicare won't pay

Every single personal item was stolen from her nightstand, clothes went missing even though I did her laundry and I bought her depends style diapers
If she had diarrhea and soiled her pants they would just throw them in her closet and she be left in just a diaper they wouldn't even put a gown on her

The opening to the bathroom was too narrow for her wheelchair to fit through and there was only one useless grab bar

The man in the next room blasted a CD player day and night playing some kind of foreign music and another man sat in the hall and exposed himself - there were no activities just a tv and this is a 5 star facility located next to one of the best hospitals in the area

Ms Madge. That is just awful. I'm so sorry you and your mother went through that. I always try to check out the rehabs beforehand but I know it isn't always possible and we can't always imagine all that can happen.
Angie, my mother was living alone at home when she fell. I can remember sitting in her room thinking, I'm so thankful my mothers bed linens are done. I'm so thankful the floors are being mopped and the meds administered and the baths given. We had been in the ICU and then the hospital room for over a week and I was worn out by the time I got to rehab. Try to overlook the smaller issues. Focus on managing the pain and the therapy. That's why you are there so your dad will get better. The 30 min ahead of time is a good thing. Also ask about ice for afterwards. Sometimes ice works for some injuries/ patients. Sometimes heat. Talk to the therapist. Things won't be perfect but if they are " good enough" he will benefit. Not like Ms Madges situation. From that one you have to move.
If my mom had gone home she would have lay still in the bed to avoid the pain and then she would have not been able to get up.

Madge, that sounds like a horrific place. Did you file any complaints or notify Medicare of the problems there? Those kinds of issues should be ones that Medicare addresses in its evaluations.

Angie, you made a very good point about pain meds being timed to be effective for rehab. We had to work on that, but once the regimen was in place, it made a big difference.

Thus far I'm not particularly happy with the care that Dad is receiving. I do think that the therapy is good (thus far he's had an assessment, one minisession, and one full session, and I've been present for all of them), but the physical care definitely isn't great. He already has a flaming rash (he has sensitive skin, and this is nothing new), and apparently I noticed it before anyone else did. (I treated it myself yesterday with the over-the-counter cream that his PCP recommended previously, and today the NP did look at it and will instruct the staff to treat it three times a day.) No one has made any effort to see that he brushes his teeth--in fact, I don't think that it even occurred to anyone till I asked for a basin so that I could assist him. The NP wanted to give him Benadryl for sleeplessness and possible itching (NOT a good idea because it can cause confusion in the elderly) even though two other medicines more suitable for those purposes are in his med list. He was supposed to have a complete metabolic panel this week to check for any adverse effects of an increased dose of one of his meds. The rehab didn't know about that, which is understandable because it had been ordered by his cardiologist, not by his PCP. But even though I mentioned the bloodwork to them today, I wonder whether they'll really do it unless I prod them.

dental care is such a basic and no one ever helped my mom while she was in rehab and even now in memory care some residents look like they have a week's worth of food in their teeth

I do my best to get mom's teeth brushed and flossed before bedtime but it isn't enough as she's starting to have problems even with trips to the dentist every 3 months

You've gotten wonderful suggestions so far. My dad was in rehab after a stroke. He was a Chief Master Sergeant in the Air Force, so was used to ordering people around. He was rude to the staff when they didn't hop to it when he rang. I finally had a stern talk with him about catching more flies with honey than vinegar. He listened (for once) and was nice to the staff from that point on. You want them (and need them) on your and your dad's side. So being kind and considerate of the difficult jobs they have goes a long way to seeing that your dad gets good care.

The fragmentation you're seeing in your dad's care is rampant. The left hand has no idea what the right hand is doing. No one communicates or double checks. Your dad is lucky he has you to advocate for him about tests and meals and results. Just imagine the poor seniors with no one to look out for their best interests.

My dad did great in rehab and regained about 95% of his function after being at death's door right after his stroke. So rehab can be a wonderful experience with excellent outcomes. Good luck and people keep us posted.

I can't even imagine how someone manages in rehab without an advocate. I feel sorry for the aides, too. I can see that they are really overworked, especially on the weekends. I've been going over in the middle of the day to help Dad with lunch and to talk to his nurse, therapists, and so on, as needed. I really don't like to go home and leave him there. I feel like I'm abandoning him. But I can't stay there 24/7--it would drive everyone crazy, including me.

Angie, you might have to list the areas of concern, ask for a meeting with the DON and whoever's in charge of the aides, and ask whether these are issues they address. Perhaps not, but at least you'll be aware they're not getting staff attention, and can make plans to integrate them when you visit.

I don't think the aides really get involved in daily dental hygiene and similar tasks though.

If you made a checklist for your father to follow, in a sort of matrix for different days and different times, do you think that would help him? You could keep a copy and if you call in to say good night to him (which I always did), you can then check off which items have been taken care of. If they haven't, you can call back in an hour or so.

It is unfortunate that family needs to be so involved in some of the ADLs, but overall, I guess I'd rather do that than some of the other tasks the aides take care of.

GardenArtist, Thanks for the suggestion of the checklist. Using a checklist might be very helpful. Dad and I had planned to take care of the tooth brushing together after lunch every today, but yesterday he was too tired (because lunch was preceded by a lengthy therapy session). I was able to talk to the nurse practitioner yesterday. She looked at the rash and set up a treatment plan for it. I'll ask Dad if it's being followed. I was also able to discuss Dad's meds with the nurse practitioner in some detail (I already had received a med list that the weekend nurse printed out for me).

Communicate with nursing staff and therapy to make sure he has his pain medication before therapy so he can show progress. Ask therapists about non-medication methods for pain management if appropriate for him -- ice, heat, or other modalities they may have. If he is walking or able to transfer from surface to surface, see if therapy will do a home assessment with him to give him more encouragement about returning home (if that is the plan). Talk with occupational therapy staff to see if they can incorporate some of your father's interests in a daily therapy session (puzzles, gardening, tools, fixing things). I hope this helps.

I had my dad in AL a couple of times. The facility is supposed to be one of the best. They messed up his meds, ignored him when he came in to go to bed, and made him eat in the dining room when he didn't want to do so. Some of the CNA were the sweetest people; don't know how they could stand to work there, but bless them. The place ran out of clean linen and that they noticed at the end of the day so that I had to go to our IL apartment and get some. They moved him out of his room because somebody else wanted it and lost his clothing in the move. Some patients took off their clothing and sat among the others in the buff. The answer to why was that patients were free to do what they wanted. I moved my dad back into IL with me the next morning. The worst part is it's mostly the management, not the CNAs. I hire a caregiver when I need one and thus keep costs down. I also do all the work myself as the IL section is equally poorly managed. There is a market for quality AL services.

AngieJoy

What can help parent(s) in rehab is getting them out of there as soon as possible.

Zyrthr, That's our goal. If Dad can go home (assisted living) soon with an increased level of care, that would be our preference.

mrussell, Dad is supposed to receive pain medicine prior to the therapy sessions. For the most part, that has been happening, although we've had to remind them once or twice. The pain seems to be lessening now as Dad heals.

Check to see that your dad is getting the best advice and the equipment for easing his sitting pain. Press for answers about the equipment. My mother should probably have had a donut pillow to sit on or a special cushion. She had hurt her tailbone which had been fractured earlier in life. ~ Make sure the physical therapist has a complete history of past injuries as well as the present. AND make sure that the people who ARE there are encouraging. (Otherwise get him to someone who will actually help him improve.) I wish I had done all these things before it was too late. You might consider an "improvement poster" so he can track his improvements toward his goals. (He should have at least one or two :) They help a lot.) Along with a healthy dose of sympathy (not pity) and a cheering section maybe his depression will improve. Chronic pain is depressing all by itself. I hope this helped in some way.

Watch them because they may make the patient do something too soon! One had my mother doing PT @ 7:00 A. M. Now I ask why...a 94 year old woman?!! She ended up having a stroke and she deceased!!!!!!!!