My dad slipped on some ice today and broke his hip. He is 77 years old and in good physical shape, but he does have mild cognitive impairment and lately he and my mom have been struggling with that; while he’s still able to live with a lot of independence (which may change now), his troubles with speech and his stubbornness have really ground down my mom. She can’t add being the main caregiver for a hip fracture recovery to her plate without risking a mental breakdown. This much has become very clear in the last 24 hours.
My sister and I are trying to figure out how we can best help both of them. A stay in rehab seems all but guaranteed for our dad for the short term, which will give our mom a breather. It’s the longer term questions that are more daunting. Is it time for us to consider assisted living for my dad? Would it be good for both of them if they lived apart for some time, with my dad getting in-home help and my sister and I helping him with appointments and errands? Neither of us can have either of our folks come and live with us, so our options do feel limited.
Any suggestion or caveats are very much appreciated. This is so sad and stressful.
https://www.agingcare.com/questions/update-alzheimer';s-mom-in-assisted-living-497691.htm?orderby=oldest
The hip surgery went very well and today, my father was discharged to inpatient physical rehab where he will be receiving post-acute care for what will probably be at least a few weeks. During the last 4-5 days, but especially today during the discharge process, I saw more signs which demonstrated that my mom is not up for being in a primary caregiving role whenever my dad is cleared to return to the house. She's not just burnt out; her own mental health challenges that existed well before my dad's Mild Cognitive Impairment diagnosis are coming to the surface in a bad way. I didn't get into this in the original post for brevity's sake during the acute crisis, but she has long suffered from depression that she hasn't tried medication for, despite years of encouragement and urging from the rest of us. One of the ways in which this manifests is her finding fault with every possible solution and rushing to the worst conclusion about something. I went through this with her today when the rehab facility for my dad was determined. I had to talk her out of her initial negative impression.
It's clearer to me than ever that she's not in a position to be the point person for my dad's care. Not now, and definitely not when she's discharged. I am going to confer with my sister about this, and from there we will be identifying and taking next steps toward having The Talk with our parents about assisted living for the near future. I expect this will include a meeting with an eldercare lawyer, with my dad's doctor and hopefully my mom's too (I'm in the process of getting HIPAA forms signed for both of them), and of course, coordinating with my dad's care team at the inpatient rehab center. It's going to be a hard conversation and I'm also in the process of communicating with our closest extended family for support and advice, which has been helpful. Some of them may be part of the discourse too.
It's strange because while this is very overwhelming and stressful, there's a part of me that almost feels relieved. Because now, a scenario that I've spent the last few years worrying about while watching my parents struggle with their health and make impractical decisions is now upon us. It's getting clearer each day that my parents are not of sound enough mind to negotiate it on their own. And it's time for me, my sister, and possibly other loved ones to step in and start moving them in the right direction; with the added support of their medical providers, in light of this recent incident and its implications for my parents' health.
If any of you feel like sharing, I would be very grateful to read an example or two of what the "steps" of the process above looked like, when you went through it.
One thing I want to point out is that the more people you have involved with determining what needs to happen for mom and dad, the more complicated it gets. Everyone wants to get into the act! It's like the old proverb "too many cooks spoil the broth." You're better off making their care decisions on your own, and for that you need POA for both. I caution against sharing co-POA with sister. I've done it, and though we were mostly in agreement (because I'd often give in so we could keep the peace), it was a great strain. If you could become their POA and sister is secondary POA, she would take over from you if you're incapacitated or otherwise don't want to serve. You, of course, would be open to her advice if you wish, but being primary and only POA saves you from having to agree with her on every little thing.
As for loved ones, I had Rude Aunt, age 88. She knew everything though she'd never been a caregiver in her life, and she loves to stir up trouble so that all the attention can be on her. She refused to help take care of my dad or do anything helpful. By the end of the 5+ years' ordeal of my parents' dying, Rude Aunt and I weren't speaking and never have since. I also had Inga Binga, my parents' friend, and she and her boyfriend would call and berate me because I should do this or that. Fortunately they lived 800 miles away and couldn't be around, but there were many exhausting phone calls about what they insisted must be done. Keep friends out of it.
One reason that you might think the more people in on plans, the better: to enlist their help. Trust me - they won't help. Lots of hands show up on deck and promise you the moon as far as caregiving is concerned, but they won't stick. It'll be you and sister, and maybe not even sister. That's why, in your case, I suggest that mom and dad both go to a care facility where they can be together most of the time and where you and all these people can visit at will and enjoy their company as they enjoy yours. Caring for two parents at the same time at home is like a whole new circle of hell. Don't. You're newbies and would be learning as you go. You have no idea what you'd be getting into. That's hard on the parents as well as on you. Professionals can do a better job, and your parents deserve the varsity squad, not the wannabees.
The best of luck to you as you sort it all out.
Make use of rehab for as many weeks as he can remain there. Meanwhile, start looking at assisted living facilities, and skilled nursing facilities. Skilled nursing facilities will be like rehab, only long term. That doesn't mean he has to be left there forever. It's possible, although unlikely, that he could improve enough to move to a different level of care.
Be prepared for this incident to further impair his cognitive function. It's not uncommon for a hospital stay to result in brain fog. Your mother can not take care of him following the broken hip recovery along with his current and progressing cognitive impairment.
Your parents might consider moving in to assisted living together, if that will provide enough care for their needs.
Last year hubs had hip replacement surgery (no fall, it was seriously degraded) and discharged home, not to a facilty. His was posterior insert with dissolving stitches covered with long waterproof bandage so no at-home woundcare needed. (Yeah!) He’s abt your Dads age. Had a 2 night stay in the hospital with 2 sessions of PT & OT and discharged for in home health done for 2 weeks. Followed by outpatient PT regular and pool. He’s still WFH. The biggest challenge was the absolutely no bending over to be done at all for weeks. Got couple of pairs of Sketchers fixed back heel slip in shoes and several prs of all elastic waistband pants. He sat only in chairs with firm seats & armrests so he could push up to stand then use the walker to get around & the 4 footed cane when doing stairs. Have a device that fits in the car door lock that’s a handle so he can grab it to swivel in & out of the car. Grab bars in our bathrooms. And toilets elevated and have a fixed grab bar next to the mattress (did these when he was dx with RA). The adaptive devices imo made a difference. No driving for weeks as lower leg & foot swelling can last for months.
For me, the challenge was dealing with all the drugs (both post op and his regular dz+) and monitoring movement. Solid sleep is really hard to get. Our son came in abt 4 days after surgery for a couple of weeks and we’d take turns being “hall monitor”. That’s when I finally got my sleep. Kiddo also reset our whole WFH set up.
The bending over is oh so automatic. It can cause complications if it happens. If your Dad cannot follow aftercare and PT directions, his being safely home will be challenging. You can help your mom make the house more user friendly. Clearing stuff off the floors and moved things lower to a higher eye level. I took rugs to be cleaned & I’ll put them back down for Easter. Just 1 less thing to fret about. All new light bulbs interior and exterior. Put lights on timers if that seems to be needed.
The big takeaway for me was all things that involves lifting, bending over, solidly using your legs, using a step stool/ladder, he won’t be doing at all for weeks and weeks. He won’t be driving. So all will be something your mom has to do or get others to do if they remain in their home. So to me, the issue then becomes……What are her own abilities like? If she herself has been the type that he is the one to do most things around the house including yard stuff and shopping, his coming back home is imo a recipe for disaster. They may be good candidates to move to IL where meals, activities and transportation provided. Or AL if they both have some cognition problems.
For us, I’m somewhat younger and am a freelancer, so my time is flexible for taking hubs to his many doctors/labs appointments. My only health blip so far is getting Euflexxa every 6 mo. Hubs work is fine with him being WFH & Zoom. Use Uber, DoorDash, parking aps, MyChart, AMZ, so that cuts down on stressors. If your folks are already heavily dependent on you & your Sister for things before his fall, having them move into IL or AL using this hip surgery as a rationale, will be a golden opportunity for this.
Talk with her. Really listen to the said and the unsaid. Her sense of duty may be overriding her ability to evaluate the situation.
Ask Mom if she wants to join him now or later ( or maybe never ) .
Right now while he's in rehab is a good opportunity to visit places with your mom. Some have waiting lists, some might be able to accept them when they're ready.
Or, since you mentioned possibly moving just your dad to AL, does your mother want to continue living with him, or is she looking for a way out? (No judgement if she is.)
Regarding mom I'm not sure why it would be beneficial to keep them apart? You know the dynamics better than we do on that. The most financially feasible thing is normally to move both spouses to AL and then sell or rent out their home to pay for it. At my mom's AL there is a basic rent and then additional services are a la carte, so you generally wouldn't be paying for more than she needs.
Your Mom has to hire in-home help. Aids can take your Mom and him to appointments but if the medical management is too much for her, then one of you needs to go.
She can consider hiring a Geriatric Care Manager, who can help with the management part.
I hope your Dad has a PoA and that it's someone other than your Mom (like one of their children). If not, it's time to get him to a certified elder care attorney to get their legal ducks in a row, and for them to consult with their financial planner to get the lay of the land as now they will begin spending the money they saved for their future. It will go fast once you see the cost of care.
Do NOT have them live with you or you live with them. DO NOT no matter what. They must spend the money on hiring care or living in a good care facility.