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Parent having a stroke


Antonio1981
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Hi, I'm not sure why I'm posting other than to look for some comfort and positive thoughts on the subject of stroke

 

I've had a tough 4 months. My younger brother passed away in November at the age of 47. Last week, my dad suffered a Hemorrhagic (?) stroke according to the attending physician. He is 79 years old and used to an active and involved parent and grandparent.

 

I'm currently looking for a skilled nursing facility that can provide 24 hr care for him and hope he recovers enough to bring him home. He needs 75% assistance with feeding and changing. His speech is slurred and challenging. I'm told by the doctor that a SNF is best because they a,so provide physical therapy 3-4 days a week.

 

Again, I don't really know why I'm posting this other than to get this off my mind. My mother isn't capable of providing home care for him at this time although we all really want him to be home. My 19yo nephew is extremely close to his grandfather and I'm worried about how much sorrow he can handle (his dad passed in November)

 

I'm new to this and realize my parents are getting old and this is my new reality. I'm known to internalize my worries/feelings and keep moving forward. I've gotten some encouraging and amazing advice from forum members on other topics in the past and it helped me so much.

 

Any insight on how to handle the sorrow, hope and faith for a better outcome would be greatly appreciated. He has been a fighter all his life.

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Antonio: First off, my condolences for the passing of your brother. My younger brother has/always been such a support for me all my life, you have so much to deal with, your mom and dad, your nephew and the situation of the virus.

We had a similar situation where after dad was out of re-hab. Based on his abilities, he could not go home without a lot of work to the house to accommodate him. Our best option was to have them move into a senior complex. Mom did not want to move, but did and took a one bedroom apartment while dad was on another floor where they could visit. We were thankful they had the funds for this option. I got the job of cleaning and selling the house with lots of unsolicited comments from family members.

Our goal was to make sure dad was safe and taken care of. One sibling wanted them to move in with us so we could take care of them and “save money”. ?. I had a young family, work with travel, so as much as we wanted, I had to put my family first. You will have difficult decisions to make, just do your best. I have not even gotten into finances, real estate, Trusts and powers of Medical and Financial of attorney.

One thing at a time, small steps and reach out and ask the health people around you, gather comments, do your best, hang on, it will get better. Also, be kind to yourself. Anton

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The key to regaining at least some functionality is the quality of the therapy and the personal there. That is much more important that a beautiful building and furnishings.

 

The SNF facility should have a “discharge plan” for your father with a path of therapy to follow to improve his functioning of daily living skills. His condition, determination and skill of the personal will determine if and how soon he can leave (if ever).

 

Your mother’s capabilities at home will make a big difference, too. If your father is returned to partial functionality, she will bear the burden of picking up the rest. If she can not assist him at all, going home will not happen.

 

I suggest a continuum of care facility. That is a facility that can handle the needs of seniors from completely independent living to skilled nursing (and “memory care”). Where I volunteer there are assisted living units that one spouse can need care and the other one be independent; they have physical therapy and all the support needed for someone like your father. They have staff that can help your father with as much care as he needs (bathing, dressing, toileting, etc). For your mother, help in housekeeping or meals. There are social activities, too.

 

If your father does not respond well to therapy, such a continuum of care facility can have him in the SNF and your mother in the independent living part and she can be with him every day.

 

I would look for an assisted living facility with good support staff for your father if helping him is beyond your mother’s capabilities.

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Sorry for your loss @Antonio1981, it's never easy losing a loved one.

 

Sounds like this is a new stroke for your father? If that is the case I would hope whatever facility it is can provide more therapy than 4 days a week. Therapy is critical in recovering from a stroke, so hopefully physical, occupational, and speech therapies are all involved. Continuum of care facilities would be nice as bigjoey suggested but not every facility is like that and from what I have seen they seem to be the more expensive places. FYI most places are graded on the nursing care, not on therapy so it can be hard to find where the best therapy is...but I have never been to a building where they hated the therapy staff...:p

 

And now because of Covid-19 I would assume that the facilities in your area are all on lock down, so getting skype or something similar will help with staying in touch with your Dad.

Edited by Kman
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@Antonio1981, I'm sorry to hear about all the adversity you are going through.

 

Although the suggestion I'm about to make might not be practical in light of the COVID-19 crisis, when my dad needed to go into a skilled nursing facility the hospital social worker suggested we make a surprise visit to the facility. She also suggested that any facility that insists on making a ore-scheduled appointment be avoided. So, we went to one and they welcomed us in.

 

Long story short, after four hours spent talking with and observing staff, sampling dinner, touring the entire facility and meeting with therapists, nurses, CNAs, and the physician the director suggested we stop in at different times so we could get a feel for the place.

 

We selected the facility and my dad had great care.

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I'm sorry for your loss and your current struggle to find care for your dad.

All nursing homes countrywide are currently on lockdown, meaning he will go in there and you will not be able to visit him. I have a friend who put his mother in last month and now he can only talk to her on the phone, and he's wishing he had put her in there a few months earlier so he could have helped her acclimate.

If you can afford it you might want to consider a live-in aide at home for a couple of months to see if they ease the restrictions once the numbers are down.(Are mobile physical therapists making house calls now?) Especially since you won't be able to really check out a facility in person until that happens.

You say his speech is slurred but how is he cognitively? Does he understand what you say? If he's still mentally alert enough to understand why he can't have visitors, then yes, put him in the SNF for the higher frequency of care. If he's not (and it's financially doable) I'd try to look into home care options. Some states have fairly generous programs to keep people out of nursing homes.

 

Good luck.

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If you can afford it you might want to consider a live-in aide at home for a couple of months to see if they ease the restrictions once the numbers are down.(Are mobile physical therapists making house calls now?) Especially since you won't be able to really check out a facility in person until that happens.

 

Good luck.

My nephew's wife is a mobile physical therapist, and I know that the service she works for is not sending her out for house calls now, but I don't know if that is due to some public health policy or simply the policy of that company.

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My nephew's wife is a mobile physical therapist, and I know that the service she works for is not sending her out for house calls now, but I don't know if that is due to some public health policy or simply the policy of that company.
.

 

Correct, there are some therapy companies that are not sending out their home health therapists and some assisted living facilities are not allowing therapy staff in...but we are all still labeled as “essential”.

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@Antonio1981, have you talked with the social worker or caseworker at the hospital? The ones we worked with when my mom and later my dad were in the hospital were wonderful resources.

 

 

This is a big one. My father had end-stage kidney disease and congestive heart failure and was on dialysis. He couldn't take care of himself and needed to be on a special diet both for his heart disease and his kidney disease. A social worker at his dialysis center sat me down one afternoon and said "you need to make this as easy on yourself as you can" and started hooking me up with all kinds of services that I had no idea existed. It made all the difference.

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My condolences for your brother. A skilled nursing facility/nursing home probably isn't a good long-term solution for a number of reasons. After several weeks, physical therapy isn't needed or really beneficial. Any benefit will be noted in the first 6-8 weeks or so. Also, staying in a SNF is both less pleasant and more expensive than staying at home with custodial care. The absolute maximum time Medicare will pay for nursing care is 100 days per illness, so you have to decide what to do after that, unless your father has long-term care insurance or very deep pockets. You say your mother can't care for him, but you didn't say what it was about his care that she couldn't provide. Does he need full assistance to be transferred from bed to wheelchair, and to the shower, etc.? Home health care agencies have people who can do that sort of stuff. With two 8-hour shifts, the morning shift can get him out of bed, cleaned, etc., then the evening shift can help get him into bed. Home healthcare workers typically don't make much more than minimum wage. If you use an agency, you'll pay a bit more, but they'll handle insurance, background checks. etc. Assisted-living facilities are also much more pleasant and less expensive than SNF's. Medicare or insurance will often pay for equipment needed to get people in bed, transferred to wheelchairs, shower seats, etc. If we know more about the help your father needs, we can probably give more specific suggestions.

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My condolences for your brother. A skilled nursing facility/nursing home probably isn't a good long-term solution for a number of reasons. After several weeks, physical therapy isn't needed or really beneficial. Any benefit will be noted in the first 6-8 weeks or so. Also, staying in a SNF is both less pleasant and more expensive than staying at home with custodial care. The absolute maximum time Medicare will pay for nursing care is 100 days per illness, so you have to decide what to do after that, unless your father has long-term care insurance or very deep pockets. You say your mother can't care for him, but you didn't say what it was about his care that she couldn't provide. Does he need full assistance to be transferred from bed to wheelchair, and to the shower, etc.? Home health care agencies have people who can do that sort of stuff. With two 8-hour shifts, the morning shift can get him out of bed, cleaned, etc., then the evening shift can help get him into bed. Home healthcare workers typically don't make much more than minimum wage. If you use an agency, you'll pay a bit more, but they'll handle insurance, background checks. etc. Assisted-living facilities are also much more pleasant and less expensive than SNF's. Medicare or insurance will often pay for equipment needed to get people in bed, transferred to wheelchairs, shower seats, etc. If we know more about the help your father needs, we can probably give more specific suggestions.
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It may also be that 8 hour shifts aren't needed. My mother lived in an independent living facility in Atlanta, but she did need more care beyond what the facility provided. My sister made an arrangement with an agency to stop by morning and evening. The morning person got her out of bed, showered and dressed, breakfast and morning meds. The evening person got her ready for bed and did meds again.

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Thank you all for the overwhelming and outpouring of advice, suggestions and support. It's truly appreciated ? Due to hospital and SNF lockdown, I still have not seen my dad but have multi- daily updates.

 

We got him into an SNF on Wednesday afternoon and thought All was well since the hospital had told us that all vitals were good, his brain bleed was improving. He also tested negative for Covid before leaving the hospital. Got information this morning that dad might have pneumonia and on light oxygen. I'm shocked. Less than 24 hours from hospital to SNF.

 

Again, not sure why I'm posting other than to find an outlet since I remain fairly private with those around me (work). I haven't been very spiritual in the past, but I've been praying a lot lately and looking for any glimpse of positivity.

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My condolences for your brother. A skilled nursing facility/nursing home probably isn't a good long-term solution for a number of reasons. After several weeks, physical therapy isn't needed or really beneficial. Any benefit will be noted in the first 6-8 weeks or so. Also, staying in a SNF is both less pleasant and more expensive than staying at home with custodial care. The absolute maximum time Medicare will pay for nursing care is 100 days per illness, so you have to decide what to do after that, unless your father has long-term care insurance or very deep pockets. You say your mother can't care for him, but you didn't say what it was about his care that she couldn't provide. Does he need full assistance to be transferred from bed to wheelchair, and to the shower, etc.? Home health care agencies have people who can do that sort of stuff. With two 8-hour shifts, the morning shift can get him out of bed, cleaned, etc., then the evening shift can help get him into bed. Home healthcare workers typically don't make much more than minimum wage. If you use an agency, you'll pay a bit more, but they'll handle insurance, background checks. etc. Assisted-living facilities are also much more pleasant and less expensive than SNF's. Medicare or insurance will often pay for equipment needed to get people in bed, transferred to wheelchairs, shower seats, etc. If we know more about the help your father needs, we can probably give more specific suggestions.

 

Thank you for sharing this feedback. He has been in a SNF now for 5 days so it's still hard to determine his needs. Especially with the lockdown, I can't physically go in and assess his condition or progress other than a phone conversation or FaceTime. His speech is impaired so I chat have a conversation with him. As of now, it seems like they are trying to control his blood pressure, appetite and the cause of a fever he had a few days ago. The right side of his body has been affected as well as his ability to control his bowels/bladder which means he will need full home assistance with feeding and changing. We have good and rough days. Some days he can say words - other days he doesn't. I can't figure out if he's frustrated or just fidgety I'm new to this and trying to focus on the improvements as a guiding light. Thank you for listening. I'm trying to be the calm and collected

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