95 year old Dad went into the hospital As pain from what has been discovered to be a compression fracture at the base of his spine, became unbearable at night and he was not sleeping at all. One thing led to another and he was there for over a week, and his back is still no better than when he went in (long story). He has become weak and unstable (and already had drop foot in both feet) and needs attendance/support every time he wants/needs to ambulate anywhere. Poor man is still fiercely independent and quickly became very frustrated in the hospital with not having autonomy of movement, and he really doesn’t see the need for constant support. . He also developed hospital delirium again, and is still experiencing it in the rehab/SNF facility he was just moved to. In fact, while it was intermittent in the hospital, it is constant in the rehab. He doesn’t display it as much to the CNA, etc. But as soon as someone leaves, out comes the heartbreaking and extreme world he sees right now . (The police and airport security guys came in last night because bad guys were flirting with the nurses at their station, the nurses really being prostitutes who were being pimped out and one even propositioned him, etc etc etc. ) He won’t stay in his bed or a chair and can’t be walking around unattended. He took off in a none motorized wheelchair in the night, in search of an exit. They had to park him at the nurses station and he did not sleep at all all night.
My hope with him going to the facility was for him to become more stable physically so home life would be safer and viable. But with them deciding to NOT do anything with his fracture (it should heal on its own), this may not be reasonable. But, it isn’t sustainable for just me to attend his every move—especially when he is up and down sometimes every thirty minutes at night. Plus, I have a medical issue with my spine and it isn’t safe for either one of us for me to lend him much physical support. Home help isn’t available due to his history of infectious disease (which isn’t active at this time but after a week of iv antibiotics may become so, hopefully not!). If I bring him home to see how it goes, and it doesn’t work, I’ll never get him back to a SNF (without three days in hospital it is impossible around here—plus I’m sure he would not cooperate by then ).
Is it reasonable for me to be hopeful that his mind will clear once he settles in at the SNF? Coupled with his physical challenges, I am even more concerned about home life and our one month rehab/SNF deadline. He was already showing signs of some cognitive decline intermittently at home before the injury. So I do not know if all this current extreme behavior (paranoia, anger, confusion, outrage, frustration, sometimes grunting and motioning instead of using words, saying mean things, etc etc etc) is the person that will continue, or if he will get back to baseline.
I am worried that if I get him home and his mind doesn’t clear considerably, and his physical issues remain exasperated by his slow mending injury, that there is no way I will be able to care for him 24/7 alone. But to have him remain in the SNF is a hard decision—especially since he seems so frightened right now. I have been staying with him and tending to him from early in day until late evening. This isn’t sustainable (I have a wonderful, newly retired husband at home), but they can’t lay eyes on him 24/7 at the SNF without parking him at the station. Meds, the hospital doc warned, might exasperate the cognition issues. Please share your wisdom… I know many of you guys have seen it all…
Your husband, in anticipation of his retirement, asked you many months ago to move your dad out and into long-term care. You’ve put it off out of your sense of duty to your dad. The time has finally arrived. You need to give up the idea of bringing him home. It isn’t at all possible for you to meet his needs. And it would be indescribably unfair to your husband, who wants his home to be his and who deserves to be more of a priority for your time now that he has retired. Consider it a compliment that he wants more time with you!
So just begin stepping back and learn to cede control. Stop spending all day at the facility. Force yourself to relax and enjoy some time with your husband after all the years of hyper vigilant focus on your dad. Let the medical professionals do their jobs. Ask them to bring in a specialist to treat the delirium. But just let go of all the micromanaging because that is no longer your role or responsibility. Start a fresh chapter with your husband. Start enjoying your life. We never know how much time we have left.
Between all his health problems and hospital delirium, it really sounds extremely stressful for you. I hope you can find a way to trust the SNF professionals and take some time for yourself to rest a bit, have a decent meal, maybe take a walk or watch a movie.
I would say don’t worry about next week or next month right now. I’m assuming you are around 65-70 yourself. It’s ok to take breaks from being by his side. I agree that pain and agitation management are the things the SNF should focus on.
And yes, I need to relax a bit. I am extremely diligent about his care and it’s hard to trust him to others. But he is in a good place where they really do seem to care and are warm and patient. He is such a fall risk and will just get up and try any way possible to go do whatever is on his mind (a big reason I didn’t bring him straight home). That is a big part of why I have stayed so long with him during the day. If medication doesn’t help that, we might have to hire sitters? It’s just if they don’t want to come into our home because of his infectious disease history, I wonder if coming into here would be any different (perhaps so, since it’s a professional environment)? This is a really good place and he went out of pocket to pay for a month (but I told them we were playing it by ear for long term, depending on how things develop). His advantage plan denied rehab/SNF , as I guess they often do. I just don’t want them to feel like he is too much for them since so far someone has to watch him so closely 24/7, and deny him a long term placement…..(at the hospital they had alarms on his bed and chair).
We went through the times where the final nursing home where she ended up could not handle her. She kept trying to get up and had several falls. I sat many hours at her bedside trying to be her private sitter because otherwise they were trying to get her out. I think you might want to call Hospice for an evaluation on your father. Or at minimum maybe a neurologist to do the cognitive testing. This was actually the rehab places plan for my mother was to test her after her medical issues improved a bit. But she rapidly declined into very obviously end stage dementia. But like others have said, I don’t think it’s realistic for you to be his sole caregiver anymore. There are also a variety of other meds that could be given to calm your father, both by the nursing home or Hospice. I will say that Hospice has a lot more leeway with what they can try. And I know people have a lot of different feelings about medication’s and Hospice, but in my mother‘s case, she was dangerously agitated without them.
Your father is very old. He needs appropriate medications and sedation for the pain and for the mental confusion, with round-the-clock medical care. You ‘staying with him and tending to him from early in day until late evening’ is NOT helping your life or what is left of his life.
Please reconsider what you can do in this difficult situation.
Also, I am not saying that unless he completely recovers I cannot take care of him. I am saying I am concerned about the degree of confusion/delirium I am now seeing and the degree of physical support he may continue to require, and if any one person could reasonably be up to it ( he is my dad. He is 95. I guess I’m guilting myself about not seeing to his care 100% personally to the end. Just typing that I realize that is emotion and not reason, which will not be the best for dad). You gave your straight opinion about that and thank you. I guess I should have asked if anyone had ever seen someone make significant strides out of this level and length of delirium, and if there are meds to help and not hinder that (hospital doc stopped Xanax they gave him a couple of times saying it could worsen or could have been contributing to the cognition issues).And, if there is a way to tell if this is all temporary facility delirium, or some type of dementia becoming more visible under this stress…
And I know I cannot continue to stay with him for ten to twelve hours a day. He just arrived at the SNF and I wanted to take him around and chat with the people who were up and out and show him it is a nice safe and welcoming place. And make him feel more safe and secure. I will talk with the doc about meds to help.