Time for a nursing home for Dad but he's going to flip out. Any tips?

I'm seriously thinking that, maybe, it would be best when he get's here to take him to the ER at the hospital, and have him totally checked out (he has very good insurance), and then have him released directly to the rehab center, telling him that it was Drs orders and that it's only till they can get him strong again... As it is, he can hardly walk and he is in danger of falling.

You have good instincts. Get him to the ER, hopefully admitted for 3 nights and then to rehab ( where Medicaid will pay for 20 days in full).

Telling him that he needs to go there to get strong is the technique we used to get my mom to accept Independent Living initially. If he's not a total narcissist, would he understand that " sister can't do this anymore"?

Good luck, and I'm sorry your family is going through this.

I do feel fortunate that we got another good 3 years with him after he was told he couldn't live alone. We've been waiting for the other shoe to drop for awhile..and now it has. It's going to be a hard time for all of us, especially my sis in law and brother as they've been taking care of him and have been so close to him for the last three years. Especially my sis in law...her heart is breaking that she just can't handle it anymore and feels she's letting him down. I have tried to get her into here for the last 6 months for support but she's not a computer person I'm afraid. I don't know how I would have handled things the last few years without this site. Thanks to you all, I know this is the right thing to do for Dad and its going to help keep me strong to get all of us through this, including Dad.

Sadly we have been through this same thing twice in the last 6 mos first with my Dad and then with FIL who lived with us for 6 years. True that if they are hospitalized for 3 days (and some of them count their days as days admitted and might not count a day spent in ER) medicare will pay for rehab and you have the huge benefit of a hospital or Rehab center social worker to help you find a place. If you are going to be direct pay for a NH (crazy expensive) finding a place and getting the paperwork in order before he comes is a big benefit. Just take him directly there. the fine people at these places know how to make this work and are great at greeting a new resident. I suggest strongly doing the medical paperwork in advance so it is swift. In both cases we expected a real blow up and in both cases, they knew that it was necessary and did not even protest on bit much to our surprise. They know that family is worn out and cannot continue on some level. Both men very stubborn and difficult 6 mos earlier understood and accepted the change. I will not say they were delighted to be there, but they did not have the blow up at the door step we had expected. It does take a long time to adjust to the surrounding and some antidepressant medication helps. You must take care of yourselves and your spouses and at some point that trumps everything. For us it was when my husband got cancer sadly. Don't let it be that late for you, we spent all of our retirement caring for FIL and now we are dealing with that. Placing a loved one is not easy but in the long run they will get the care they need by skilled professionals and will be safer if it is a good NH. There is still tons of caregiving ahead for you even once he is placed. Please be sure you know your states laws regarding DNRs and the necessary forms for medical as well as POAs if you do not now, it is invaluable. Best of luck!

Dustien, you might think about trying a different doctor, perhaps a geriatrician or at least one who's more sympathetic and supportive of rehab.

I once encountered that.

One thing I learned about rehab and PT is to avoid the physiatrists and therapists who present with a specialty in sports medicine. They're TOO focused on that and not on older people in general. A physiatrist told me there wasn't anything that could be done - Dad was just old. Subsequent therapists proved him wrong, very, very seriously wrong.

When I had PT for my torn rotator cuff, I went to the facility recommended by the then doctor at the time, a rehab facility for which he had worked prior to becoming a hand and arm specialist. It was clear that sports medicine was their top priority; I was even given a punching bag type exercise to do. I countered by moving my arms in balletic positions in another exericise, trying to add some grace to what was otherwise a boring exercise.

One of the therapists commented that I looked as if I was doing ballet. She couldn't understand that ballet is just as much if not more demanding (and certainly more graceful and beautiful) that beating someone (or a punching bag) up like boxers do.

Back to your situation: Regardless of the fact that he's reached a preinjury state, there is always the PREVENTIVE injury issue on which you might be able to get therapy. This is why I suggested finding another doctor, a geriatrician or someone who respects older people and understands that rehab is one of the ways to counter the effect of aging, balance issues, etc. A different justification can be used for the reason for therapy.

And it's to Medicare's advantage to prevent further falls in covered patients.

As to nursing homes, I encountered a situation similar to that Babalou found. I interviewed a rehab place after checking out the stats, was encouraged by one of the residents and his son who highly recommended the facility, got advice from someone who worked there, and brought Dad there.

The first day we knew I'd made a mistake. Staffing ratios weren't standard; at dinner there weren't enough aides to do the work and people waited 1/2 hour to 45 minutes for bathroom assistance. The aides were also responsible for meal delivery and dirty dish pickup.

Attention was just as lack during other times of the day.

My father's chart was lost by the second day; no one could tell me what his INR values were. The nurse I asked even said she didn't know where else to look.

The food was cooked elsewhere and brought in, a few days after it was prepared. I looked at the cod and thought it was a chunk of plaster. Seriously; I'm not exaggerating. I wouldn't have known it was food if it wasn't on a plate. The brownie was hardened enough that it had been sitting out for at least a few days.

Entering on a Monday, by the time I got him out on either Wed. or Thur., (I can't remember which), his PT/iNR values were out of control and as elevated as they were a few years ago when an incompetent primary care doctor prescribed medication which caused hemorrhaging and sent Dad to the ER.

If I had waited another day, Dad might have been in the ER again.

So, yes, do check out the facilities very, very carefully, on off times but especially at busy times such as dinner. Make a checklist, and ask about staffing ratios, day and night.

And don't, don't, DON'T rely on discharge planners. They have lists of facilities, one of which is known as the "death" facility b/c so many patients go in and come out in body bags. It was a discharge planner who recommended a facility for my mother; we had problems from the very beginning.

Sorry about the one long paragraph (I know it's hard to read and I hate when other's do it), but the program just wasn't letting me put in breaks between paragraphs. Don't know why...something wrong with the java script I think.

I even tried copying the text, closing and reopening another question page, but that didn't help either. It still would not let me put in a break.

Though I can do it this response script though...Odd. Anyway, I forgot to say that tomorrow I'm heading to a very highly rated nursing home here where I live and I hope they will be able to take him and help him....

I was wondering as I typed before why the discharge folks at the hospital didnt recommend rehab....or maybe they did and family refused. Find out

If he is in a hospital for the three days you can tell the social worker that he cannot come home under those conditions and you will have their help to get him into a facility, just a suggestion. There are lots of online reviews of NHs to get you started but of course the best are referrals from friends if you can get that. I just spent a day driving and looking at my short list of places. Your eyes and nose will tell you the truth. Be prepared for sticker shock. The cost the last year of my mothers life was around $13,000 a month. Down here it runs about $8,000 a month. Perhaps if he can get past pulling out the cath you might find an ALF that can handle his needs, much less pricey and much more freedom for him.

1Tired

Some of these comments are inadvertently comical. That being said and to your comments, sure the NH will greet the loved one and his/her family with smiles, been there done that. The activities director was all smiles and mentioned, not being Superman (who I now can't stand),and that my mom was in the best place for 24 hour care. Guess what? Mom passed, only reason this NH has contacted me is for amount owed, nothing else. No she was a nice person, sorry for your loss, etc.

Zytrhr, No matter how you look at is it is a business. I would not expect to hear from the facility my mother died at for any reason after her passing. They are paid for a service which they did very well. My father did not go to the same facility even though it was excellent because it would have been just to hard on all of us going there.

One tip that I did learn was that volunteering at the facility is very helpful. You get to see your loved one on a regular basis but also you really get to see how things work there even if you just have time to sit and read to others for an hour a week. I did exactly that at moms place since it was a trip out of town for me and I wanted to spend as much time with her as possible. I pretty much stayed there all day when I went up 1 week at a time. Really helped me to learn the routine and the people that were caring for my mom so that when I called they knew exactly who they were talking to . She was there for a very long time so it was very helpful.