This is something of a sequel to a post I made about a few weeks ago, when my 77-year old dad slipped on ice and fractured his hip. He had surgery and was in the hospital and then inpatient physical rehab for about two weeks. Today, at his and my mom's request, he is being discharged to their house.
I have been feeling quite anxious about this, for a couple of reasons. Their house has a significant number of stairs, including exterior stairs to reach the front door. My dad's PT/OT has been going well and he's made enough progress that the care team at the rehab facility didn't consider the discharge unsafe, even when presented with the number of stairs at the house. My folks' plan is to have my dad live on one floor for the next few weeks, with access to a bathroom and his office. But even that presents some challenges. The layout of the bathroom could be difficult to move around with a walker. The walk-in shower is snug enough that the shower chair takes up most of the space, which will make backing up toward it and lowering onto it tough. And the limited hallway space means that my dad won't be able to do a lot of walking unless he's willing to basically do laps. Plus, even with nurse visits for PT/OT and medication, and the possibility of additional hired help, my mom will have a lot of daily work to do here.
The rehab experience had some significant shortcomings; mainly the level of care that my dad received when he wasn't doing PT/OT (which was very good) and the extra work that this created for my mom and the rest of us during our visits. This frustrated my parents enough that both of them grew fixated on getting discharged to the house. My mom is banking hard on the idea that being back in a fond and familiar place will be better for my dad's recovery, and while I do think it could lift his spirits, I can also see the functional challenges of the house undermining those benefits.
I regret not putting this on the table earlier, but the other day, it occurred to me that what might serve both of my parents better than transitioning right back into the house is the possibility of my dad going to an assisted living community for a short respite care stay; where he could continue getting more hands-on assistance and a higher level of care, as he keeps building up his strength for eventually returning to the house. (They will be selling it and moving to a more aging-friendly place when the smoke has cleared from this acute emergency.) My parents have the money to pay for this, but it's often very hard to persuade them to make investments in their own health; evidenced by how much time my sister and I spent trying to persaude them to downsize and move from their current house. And if the transition back home doesn't go well, then I'm going to have to try and persuade them to spring for short term respite care at a good facility.
I wondered if anyone here has been through this and if so, what angles of persuasion worked best? I can make the case for why short term respite care could be a major relief for both of them, and I'm also prepared to assert my own boundaries, as to how much/little I can help them with challenges that result from a premature rehab-to-home segue. I've already called three assisted living communities near them to get information on their short term options and rates.
You're getting too involved. You are too worried and fretting over how to fix it.
You say yourself: " if the transition back home doesn't go well, then I'm going to have to try and persuade them to spring for short term respite.."
That is exactly right. Let them try it at home. They are both looking for their life to return to "normal" and they aren't seeing how difficult this is going to be. Let them find out. Don't swoop in and try and fix it for them. Let them fail all on their own.
If you try and make it easier, they will get a false sense of independence. When they come to the realization that they need help, that is the time for you to suggest short term respite. Actually, it doesn't have to be "respite". Just have him stay for an indefinite period of time in a short term rehab, or skilled nursing facility that offers adequate PT and OT. Many long term care homes DO NOT have adequate physical therapy, so check it out thoroughly before making a decision.
You are expecting their care at home to fail. They may just surprise you and succeed. Wait for them to ask for help.
Aides also showered my parents, helped them with all of their needs including toileting and Depends changes, laundry, getting up out of bed, etc. Aides were but a button press away.
Good luck convincing them to do this. If they insisted on an early release from rehab, what makes you think respite care in an AL will be appealing? I hope I'm wrong and you're successful. The elders really hate PT, most of them. My mother chose to go into a wheelchair permanently rather than exercise!
Best of luck.
One telling sign for me was that my dad had been chomping at the bit to go home for a week, but on the eve of his discharge, he suddenly got more anxious about going home. And upon getting home, he was still anxious. I know this can be normal for a lot of patients recovering from surgery and going from one place to another. But still, I found his change of heart kind of troubling; perhaps a sign that he could still use more constant support.
The only thing Dad may get in an AL, is an aide to help him bathe. He will be expected to get himself down for meals maybe with some assistance. Not sure if the aides would be expected to walk him or help with exercises. Another thing that can be done at home. You will need to see what an AL is willing to do.
Unless in an over-55 community such as the one where I live, most houses are not equipped for rehabbing those in your dad's situation. We have grab bars in our showers, near toilets, wide doors that wheelchairs can go through, etc. The homes were built that way, and these things are a great help. I suggest that you modify their home so that grab bars are handy, and perhaps he'll need ramps to navigate the stairs. This is a major undertaking, and you may think it's foolish to do these modifications when he's going to recover, but believe me, as former caregiver to elderly parents and now my spouse, it's one thing after another.
With the bathroom problems, I was able to remove the door from its hinges (by myself in my 70s at the time). I stored it in the garage and put a curtain rod up in the doorway, then hung a shower curtain on it for privacy. This afforded slightly more room for wheelchair and walker navigation in the bathroom. See if dad's bathroom could be temporarily modified that way. You could also contact an agency and hire a bath aide to help him. Mom may think she can bathe him, and maybe she can, but the hands-on care is difficult when they're slippery and perhaps resistant to bathing anyway. Better to get someone who is professionally trained.
Your mother's uplift of spirits when dad gets home could be short-lived. She'll return from fantasyland soon, and it will be a hard bump when she lands. If she thought there was extra work for family to do in rehab, home will be ten times worse. Be ready. I'll also add this thought: don't be too ready to jump in and save them from their decision. Let it sit and impress them that they can't do home care forever, because they can't. Home being a suitable rehab facility is highly questionable no matter how they la-la-la joyfully approach "we're home again, home again, happily happily together at home la-la." More like "ha-ha-ha, we made a mistake but don't want to admit it." And "no worries, our dear heinrich will fix it." Which they will then expect forever after as they live into their 100s.
So chin up, progress to the next step, and prepare for worse. They're lucky to have you helping them. *(But again, don't be too eager. Until they are able to understand and experience the consequences of their decisions, they'll be like hamsters on a wheel, unable to stop running in the same direction till they fall off.)