When the VA and/or hospital strongly suggests a permanent nursing home for your loved one. Thoughts?
I put an elderly relative whom I'm caregiver for into the VA hospital for treatment of a urinary tract infection and painful legs, probably arthritis. He's been bedridden for the past few days. Now a team at the VA has told me they want to refer him to a nursing home on a permanent basis. I said I could probably handle things as long as I could get a visiting nurse to help me change him and his bedding each day for less than an hour. They claim a visiting nurse has to come for three or four hours at least, which I know is nonsense because I've had them come for half an hour for this relative and my mother before him. I know the VA wants to be done with him and get him off of their hands, but I feel annoyed at being lied to and with their relative insensitivity. No, these are not evil people, but they want to do what's most expedient whereas that might not work for me or my relative, who is very happy at home. Confusing the issue is that my caregiving duties have increased lately and I fear my own health may have been compromised, so part of me just wants to let them do what they want to do, yet I feel disloyal to my loved one at the same time. I think people just assume you want to put the older person in a nursing home when in reality you have very mixed emotions about it. Anyone been in this situation with a hospital/doctor or the VA? Any thoughts would be appreciated.
9 Answers
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I recently had the VA strong arm my grandfather into the Veteran's Home when I felt he wasn't bad enough to need that yet, but they were very sick of him constantly complaining about medical problems that they had done everything in their power to diagnose and never found anything wrong with him that they could treat. It is a tough place to be, but I try to console myself with the fact that care giving for the elderly is not the same as care giving for my children (which was the only thing I had experience with). Children get older and it moves them toward independence, however, the elderly get older and it moves them away from independence. :( It is not easy, but it is reality.
The VA, which is in the middle of a financial crisis, would prefer a nursing home for him because if he comes back home they will have to continue to pay for ambulances to take him back and forth to the VA, the visiting nurses, and other things that they would rather the nursing home/medicaid take care of -- can't blame 'em, I guess. I also lodged a major complaint against a nurse with one of their programs who told me he had a broken hip when such was not the case, so I'm sure the VA would like to be done with both of us.
However, I've made the decision that, sadly, a nursing home is the best place for him now. [Although I don't know if it's really that easy to get someone out of a nursing home once they're in and the home is getting their income plus money from Medicaid. I figure I would need a court order and a swat team!]
Anyway, thanks so much for your kind and informative answers. They are much appreciated.
You really do need to take care of yourself right now and allow pros to take care of your lo. It will be best for both of you. Best wishes.
Your profile says your loved one has dementia. By its very nature dementia gets worse. A hospital stay often triggers a downhill spiral. It isn't always permanent -- the patient may eventually recover back to his pre-hospitalization baseline. But it often takes months.
Meanwhile, you have compromised health yourself. Don't risk making it worse.
Having someone come in and change the loved one and the bed once a day sounds good. What if it needs changing an hour later? Today when I visited my mother (93, dementia, arthritis, broken hip) in the nursing home she was having a bad day. She needed her bedding changed -- all sheets, blankets, spread, pads, the works had to be laundered. It takes two people and a sit-to-stand machine to get her out of bed. Her clothing had to be changed, and her skin cleaned also. All of these things had already been done at their scheduled time. This was the second time that day. And who knows, it might not have been the last!
Could your loved on go into rehab instead of directly to a nursing home? At the end of what ever therapy and rest they can give him, then evaluate what his needs really are. Can one person get him out of bed? Is he continent? What is his cognitive level? Can he cooperate in his care? What he is like right now in the hospital may not be what he will be like in a couple of months. He may recover some and be easier to care for than it appears right now, or the dementia may progress.
If you can't arrange a rehab period, then at least realize that a nursing home is not a prison and you would be free to take him home if his health and your health both improve to a point where that is feasible.
When a loved one needs a nursing home your caregiving role changes, but it doesn't go away. He will need someone to advocate for him, make decisions, and visit often.
Best wishes to you and to your loved one.