My 84 year old dad has been in the hospital for 32 days now. He went in for chest pains. When he got treated they told us he had a slight heart attack and his gallbladder was bad also. He was too high risk for the gallbladder surgery so he now has a drainage tube long term. He’s also has a catheter that’s been there since he went to the hospital because he has a prostate problem, which I thought was under control with medication. He’s been on 4 liters of supplemental oxygen for about 10 years due to COPD and emphysema. He also is starting to show signs of dementia not all the time but he’s pretty forgetful. On top of all the health issues, he tested positive for COVID when he was in the hospital (he was negative when he was admitted). He’s been on the COVID unit since November 25. He hasn’t been eating or drinking and he’s so weak he can barely talk. He’s been pretty much bedridden for the 32 days. Now they want him to go to a skilled nursing facility. We are so upset that we won’t be able to visit because of the COVID restrictions. He’s in such bad shape that the hospital called one night saying he took a turn for the worse, but by Gods grace he pulled through. Will the SNF really do rehab on someone in that condition or will they transfer him to long term care?
Let me give you a basic rundown of what will likely happen so that you and your family can make some informed decisions.
Upon arrival at the SNF, your father would be evaluated by the different therapies (Physical Therapy, Occupational Therapy and Speech Therapy). Most likely, PT and OT (and possibly Speech Therapy) will make a plan of care with goals to attempt to improve his level of function to the best of his ability. Once they start working with him, they will see if he is responding to the therapies. Sometimes people bounce back but possibly to a lower level of function (needing more assistance with mobility and self care, short walks only with a walker, or wheelchair level). Sometimes, if a person continues to be too compromised to make significant gains, they may stop therapy and make recommendations for the level of care he will need at this new baseline. That recommendation can include long term care where a person requires significant levels of assist for all aspects of care. Long term care can be done in the residential (nursing home) part of the SNF (which is not paid for by Medicare or private insurance, but if he is on Medicaid it should be covered). Or the family might choose to take him home at his new baseline and arrange for care in the home setting with services and family assistance. This can be a very tall order, especially if someone has become quite dependent, and quite often the spouse is not the right person to provide the bulk of that care (because of age and their own health concerns). It needs realism and thorough planning, and if your family can pull together you may have some fruitful conversations about how to proceed. Palliative care and/or Hospice services can be a very helpful but they do not provide the daily care for mobility, dressing, feeding, etc. If your family and your father are receptive, you might consider an informational meeting with them just to find out what they have to offer. Their care puts the comfort and needs of the patient first and they can be a very invaluable support to the patient and family when facing end of life issues. It's important to be thinking NOW about possible contingencies so you have some level of preparation for the next step(s) depending on how things go for your father. We have a saying in rehab: Hope for the best, plan for the worst.
It is never easy, and it's especially hard now with covid. This is an added layer to an already complex and emotionally demanding situation. As I said, be realistic and have a plan for different contingencies. Being prepared will help your family make more informed choices that are not hastily formulated in the midst of a crisis and are in accordance with your father's wishes and what the family is ready for as well.
If he goes to a SNF, have a conference with the social worker early on about options post discharge and what that would mean for your father and the family, both in terms of care that will be needed, projected length of stay, and also how it's paid for.
Wishing you all the best.
Can mom care for dad IF he comes home.
If the answer to that is no then rehab if he complies then AL or possibly Memory Care if his dementia reaches a point that that would be appropriate. (Many MC will not accept a resident that has a drain or other "attached or inserted tube" as dementia patients will often pull them out)
It does sound like dad would be eligible for Hospice. It might be possible that with the help of Hospice and the supplies and equipment that they would order he could be cared for at home.
Most rehab facilities are in Skilled Nursing facilities since often someone needing rehab needs skilled nursing for a while.
If he complies with rehab they will do what they can. But if he does not comply the transition to Skilled Nursing would be in the plan.
You can have Hospice if he is in Skilled Nursing but not if he is doing rehab.
If I were you I would wait until after he has been in rehab for a while and see if he shows any progress then make a decision. But just so you have information I would contact 1 or 2 Hospice and "interview" them.
Of course, you do have the right to take your father home and care for him there. He will probably need round the clock care as well as in-home physical therapy. Most families are not able to handle the round the clock care by themselves and would need to hire home health aides. I would suggest talking to his doctor about his probable survival over the next 6-12 months and use that to determine if you would rather have him home with hospice, home care with daily therapy sessions, or care inn SNF.
If he wasn't walking when he came in, they are probably not going to get him walking. Also since he is so weak they can't take that chance that he will fall and break something trying to stand him.
Soctal workers are great and can help you. Good luck
If the Hospital is transferring him to a long term therapy then I would bring him home and have his Insurance pay for Home Therapy.
He might just make it then.
Prayers
There's another possibility which is step-down long term care, with the goal of healing but not hospice. It is expensive, and I don't recall whether or not Medicare paid for any when my father spent time rehabbing after serious and multiple complications.
I think before any plans are made, a conversation should be had with one of the hospital discharge planners, but better yet, one of the medical staff providing treatment, to get a good assessment of what they've observed and predict.
Gallbladder surgery is not what it used to be. Its maybe 4 little incisions and they pull it out through those incisions. But again, he has to be stronger for that.
He needs rehab to get him stronger.
She would occasionally fall. She had balancing issues. Neurological issues such as Parkinson’s disease are very challenging.
Rehab is wonderful for the people that participate in the program.
My mom worked extremely hard and it paid off. She gained strength and balancing skills.
Rehab doesn’t prevent future falls but being in the best shape certainly helps.
The big phrase that physical therapist use is, “Use it or lose it!”
The physical and occupational therapist will design a program specifically for your dad.
They will do everything that they can to motivate your father to work as hard as he possibly can.
They will not design a program that exceeds his capabilities.
I had the same concern as you wondering if it would be too hard for mom.
She improved because she went to rehab with a positive attitude everyday.
Did she like doing the hard work? Absolutely not! She did like the results.
My mom was never afraid to work hard.
She was successful at anything she did.
She’s a perfectionist. I knew that she would never be a slouch, it’s simply not her style.
Yet, here was a frail woman who is just over a hundred pounds doing several hours of rehab a day, so I really didn’t think she would be able to do it.
Ha! She was other people’s inspiration. It was amazing to see.
Chances are your dad will exceed your expectations if he has the right mental attitude.
Be supportive. Even though I doubted my mom, I told her that she could do it!
It’s a tough work out. She did exercises in the morning right after breakfast, short lunch break, then back to work.
It helps if they know someone is cheering them on.
There were no visitors while the residents are in therapy. I could visit before or after therapy. I went to see mom after her sessions. Personally, I feel this is best. I was told if a resident sees their family members, they would rather sit and visit rather than do their exercises.
She was exhausted after her hard work. Your dad will be tired but he will also be gaining strength and balance.
Best wishes to you and your father.
Sure,he will be pushed to do exercises. He needs them to get stronger. Rehab will do their best to try to get him independent enough so he can safely return home. They will check his home for safety concerns.
This is what you want for dad. It will be a benefit to him to help lengthen his time for independence.
And from your profile the worst thing for him would be to return home to an abusive wife. Dad being home may just be enough to push mom to the edge.
Above all else dad needs and deserves to be comfortable and safe.