How can one care at home for an 85-year old who cannot sit up, or stand or walk?

I am in a very similar situation. My 86 year old, 6 foot 2, 190 lb. father fell and broke his hip a couple days before Christmas last month. He had surgery, and was sent to a Skilled Nursing Home/ Rehab facility (SNF)
Before the fall my dad was already in pain from several problems with his back, neck and shoulder. He could barely walk 20-30 steps as it was.
He has been in the SNF, just over 30 days now and he can not:
Sit up on his own, so he can't even try and get in a wheelchair
Stand, at all, not even with help. They use a lift to get him out of bed and in the wheelchair, it hurts him so badly he screams in pain every time they do it.

He can not Roll over

He can not Lift his leg while in bed.
So he is totally dependent. His wife is 83, and has several of her own issues as well.

He has a bed sore on his butt that needs to be checked and treated EVERYDAY, actually needs to be treated every time he has to get the diaper changed.
Because he is a 100% disabled Veteran he is able to get 90 days paid at the SNF, rather than the usual 21 days he would if not for VA benefits.
The facility has been asking us for at least a week now where he will go next. Their recommendation is to a Board &Care, but my dad says he IS COMING HOME.(EMPHASIZING THE (.)!!!)
I have been doing a lot of research and it's really overwhelming. I am so fortunate to have a brother who lives on the same block, and I live next door to our parents, but even with me, my brother, my step mom, and the sporadic help we get from our other sibling, the 15 grandkids, and 5 great grand kids they have its just not enough for him to be able to come home..... YET!!!
That's what we keep emphasizing.... YET...
We have just a little less than 60 days left of COVERED care at the SNF facility, and we are working on getting the house ready for him to come home at some point.
We are looking into some in- home Nursing options, caregivers, The Family Caregiver options. Then theres getting the doors widen, figuring out if we can get a lift, how we are going to transport him places, (dr. Appt, etc...) if we make the living room his bedroom, do we need to pull up the carpet so we can wheel him around easily, OMG... the list goes on and on. AND thats just the logistics. The paperwork to help pay for any of this is a whole other story.
Not to mention, these are all just ideas, and possible solutions, if he doesn't come home YET(!!) then we still need to go and find a suitable place for him that will continue PT/OT at a price point we all can handle.

I am so grateful he has lived a long life, and I know these years come with some sacrifices, like Giving up independence, not being able to drive anymore, having to ask for help to do a lot of things Then theres just the regular aches and pains that seem to keep their calendar filled with so many Doctorr. Appts and all of THIS before broke his hip.

Now my poor dad is bedridden, has been in the facility for more than a month AND JUST WANTS TO COME HOME!!!! He can't even get himself to the bathroom, let alone wipe his own butt.

I just hope and pray that OUR DADS get to come home SOON. I hope you find a nice place for him that helps him regain some of his independence so you can spend more quality time with him. Now that my dad's life is in the final chapters, I really want him to be able to NOT SUFFER.

I have found a lot of information and resources from THE VETERANS ADMINISTRATION, if your dad's a VET, if not the SNF SOCIAL WORKER has been some help with recommending resources for more information.

GOOD LUCK TO YOU.
One thing I can truly say... as I read posts like yours, (while i was researching, " How to widen a door jamb") I know im not alone, that there are other people going through a difficult time, like i am, and that the questions I have and the difficulties I am experiencing are not unique to me and my situation. That gives me hope and helps me remember im not alone.

You have a very honest discussion with the discharge person and say that there is no way that he can be safely cared for at home. And you make it clear that he can not be cared for safely in your home.
This is a discussion that you need to have with your husband first to make sure he is aware that this can't be managed at home.
You can't safely be his caregiver

I am a full time caregiver for my husband. He can not sit or stand. Our insurance has paid for a hospital, hoyer lift, oxygen in home and portable. We pay out of pocket for diapers, wipes, rinse free cloths, creams, bandages if needed for wound care pillows, wedge, bed pads, 2 different disposable pads. I have to grind his food. He goes to dialysis 3 times a week. I have a community van take him. When family isn’t available to help use the hoyer lift I pay for nurse aids at 60.00 an hour out of pocket twice a day to get him in and out of bed. I do this because he needs 24 hour skilled nursing facility at 12,000 per month out of pocket. I wish you lots of luck. I’m not sure how you would feel helping your father in law with hygiene care.

Please don't do this to yourself or him. Clearly it takes a professional team and environment to meet safety and hygiene needs. For him to be presented with this arrangement is appalling and pitts you as the bad guy.

"What kind of help and equipment is needed to provide in-home care in a situation like this?"
Everything they have in a full care facility. Hospital beds, lifts, trained staff 24/7...
Unless your FIL is extremely wealthy, home care is not an available choice.

Unfortunately, I agree with the majority of people here, with two exceptions:

1. Yes, people have indeed taken care of their relatives since forever, BUT you have someone with spine issues. They need a care team that is familar with that. It's not as easy as taking care of someone who is just not strong due to muscle loss or with a broken hip that will heal. I'm not a medical person, but I would not think you could safely just roll him around to change the sheets without injuring him further and causing him more pain....and I would imagine it would take a full time care team with several strong people available to move him, not a couple of exhausted loved ones with even the best of intentions.

2. Someone else commented that they have someone come in for 1.5 hours a day, but don't count on that being the case where you live. Where I am, they want a commitment of 3-4 hours each visit. The cost is prohibitive, NOT covered by Medicare, and would more than use up a SS check. You should NOT take on any associated costs for his care...they should all come from his funds, but again, he has a spinal injury, so this still doesn't seem like a good idea, as family would need to care for him the rest of the time. NO, NO, NO! I can see this going from bad to worse (for him) in a short time due to pain, or worse injury, and not working well for his loved ones either, mentally or physically.

My thoughts go out to him, your husband and yourself. I would get him placed near you if possible, so your husband, and his sister, can visit, and have him transitioned to Medicaid.

Fully electric hospital bed ($1,000.00) air mattress ($750.00), and Hoyer lift - price varies but get a fully automatic one because it's way safer than the ones which are basically engine hoists. The toileting issue will be the biggest thing to get used to. If he is unable to get himself on and off of a toilet (with assistance most likely) then you are talking about diapers. My mom went from being 100% mobile to 100% bedridden pretty much overnight five years ago. I've changed more diapers than most biological parents. My saving grace is that she is not too much bigger than I am so I can do it. It's a big adjustment. Hang tough. I notice the next comment under mine says there's no way to do this at home without 24/7 hired help. That's complete nonsense. People have been getting old and being cared for by their families for thousands of years. The invention of nursing homes is relatively recent in human history.

NO WAY can this be done at home without 24/7 hired help coming in .
And then when they don’t show up you and your husband will be his “ help” .

Even with a lift this man can not be turned over in bed by one person alone .
Do not take him home . This man needs the assist of two people for every turn , positioning in bed , and transfers .

This is the standard question they all ask these days . It’s ludicrous. They ask the patient first what they want , and they all say they want to go home . Since he can’t take care of himself or live alone they then asked if you would be taking him home .

To answer your question about equipment , you would need to turn your home into a nursing home . Have a shower that a shower chair could be wheeled into ,a shower chair , a wheelchair , a Geri chair perhaps , a hospital bed. A bedside commode .

Your father in law requires a team of care in a skilled nursing facility. If the current facility will help, seek another place. Do not take him home.

DO NOT take him home.

It truly is an “unsafe discharge”

He will need to go to a nursing home, LTAC or skilled nursing types of places.

You can't. He belongs in a skill nursing facility.

This is a very unfortunate situation and unfortunately, this is a very common situation. What does your father-in-law want? Taking him home is an unsafe environment…….
The discharge planner appears to be trying to guilt the family into taking him home. Your plate is full already.
Who is his power of attorney of medical and property?Did he plan for this kind of situation?
My mother fell and broke her neck. She went to rehab and acute long-term care facility for slow rehab. My mother was controlling narcissist and fortunately had the funds to go back to her home with a 24 /7 care caregiver in a hoyer lift. With that ,it took a multi disciplinary team to care for her. I had a sister and a brother and myself (medical professionals)who were very involved with different aspects. Someone needed to take care of the finances, the home, the caregiver, all of her appointments, physical therapy, my mother and her personality.
My mother passed away in March and caring for her was one of the hardest things I’ve ever done in my life. Look very hard at the situation and decide is this something you and your family members really want to do. Is this what your father-in-law would want? Is this the quality of life that he would want to be living?
There were limited things that my mother could do, but when she started using the PT coming to the home as a social hour, I was fortunate to have her meet hospice criteria. She did not not tell me she was giving up, but she showed me by not wanting to do anything at 88 years old. My sister reminded me that my parents chose me as power of attorney of medical because they knew I would pull the plug and not that let them linger on with no quality of life. Did your father-in-law let his wishes known to anyone?
Your situation is not easy. The decisions are hard. I wish you and your family the best.

Haha! I'm laughing at the question posed to you.
No, of course you can not take him home to live with you!
There is NO WAY you can manage to transfer him and manage all of his personal cares! I can understand if the Rehab staff asked you this question, as some people do return home from Rehab, and rehab can not keep him long term, so they have to know where he is going from there.

He absolutely needs to be in a skilled nursing facility! And, if the SNF you are considering is expressing any doubts that they can meet his level of care needs, then you need to find another SNF which can meet his needs.
One SNF may not have the equipment or adequate staffing to accommodate every person's needs. You need to make sure they are able to provide the care he needs.

I feel your pain. I'm a 70 y/o single male. My 88 y/o mother has lived with me since 2019 after my step dad of 30+ years died and there was no way that she could live alone and take care of the house and pets and everyday stuff alone, and she lived an hour away. In the last year+ she has had Covid, a broken hip, colon cancer surgery, broken foot, four hospitalizations, Hospital induced delirium, and cataract surgeries. She has been unable to walk or stand for almost a year, and if she sits up for more than a few minutes her blood pressure crashes and and she passes out, gets covered in sweat and her bowels go haywire. She is now completely bedbound. Luckily her mind is fine. I have someone that comes to our home for 1.5 hours M-F and sometimes on the weekends. The charge is $75 for that 1.5 hours, and her SS is enough to cover that out-of-pocket cost. The person cleans and baths her, changes her diaper and bed linens if needed. Sometimes I have to do these things myself, and I'm perfectly capable of doing them, but having someone else do these things gives me a much needed break, and mom has someone else to talk to. She has now been on hospice for about a year, so Medicare covers the cost of a hospital bed and any other equipment, her meds, diapers, supplies, etc. We had a Hoyt lift for a while, but never used it. A nurse comes by once a week to check her out. So, if the worse case scenario happens and you father does have to come home to live with you, then try and find someone local that can come by and help to give you a break, and you should probably have him put on hospice. He sounds like he might qualify.

I guess it’s a question on their sheet to tick
my fathers got a knee lock so bed ridden at the. Moment
seriously
you can’t do it without care coming in to clean and wash
My dad has two carers in four times a day and that’s the min you need
you can’t do that
even with a hoist to list them it’s two people and you’ll get burn out
you should really get him assessed and find out what options are available.
it may be prudent to look at care options
and then decide
it’s a lot of work and sacrifice - are you ready for that
.

I agree, my son has cp, they’ve wanted to send him home to early from different surgeries and I refused.
From experience, we would end up right back in the hospital. Having to go through the er. Trying to explain what ever the problem is.
I would ask them if they have lost their minds?!
At his age and his predicament, I would ask about Hospice or Palliative Care. Once they get involved they will take good care of both of you. Give you options, that are reasonable.

Short answer: You can’t!

Just wanted to add 100% agreement with the other people posting.

I took care of my bedridden mom, using the type of equipment you saw. Never in a million years should you try using a Hoyer Lift on someone like your Dad who has a broken back or back or spinal surgery. Too risky, too dangerous and don't even consider it. No!!

This is too much for you, and I am sorry someone at the facility even mentioned it to you. They are wrong. He needs professional care at a facility. No exceptions.

People can say whatever they want to you, even crazy things like "were recommending home discharge " but you can also say back "you're nuts. This is an unsafe discharge. Figure out reasonable next steps." He's not going home with you unless you're a billionaire who can afford 4 caregivers per day.

Just say no. Say no to the facility. Say no to your husband. Say no to his sister. They need to say no to their father. No, no. NO. This is not just for yourselves, this is for your FIL's health and safety.

Gobsmacked is a fair reaction. My mom lost every physical capability, could literally do nothing, and became a two person assist for every move. There was simply no way her level of care could be accomplished in a home setting. My mom made no progress after extensive therapy and transitioned to long term nursing home care, from private pay to eventual Medicaid. She received competent, compassionate care throughout. Don’t believe you can take this on, and don’t allow FIL to believe it’s a possibility. Some things are just sadly too hard. I wish you well finding the best care in rotten circumstances

Get him in to a good facility that has LTC and accepts Medicaid. He starts out privately paying and then eventually when his assets are depleted, he can apply for Medicaid. Have him discharged directly into the new place. Don't take him back to your home for any reason.

My MIL was in an excellent facility in LTC for 7 yrs on Medicaid. She got great care.

Well, you've got an admissions coordinator who must be a moron. To work in that business and not see that it's impossible for dad to be cared for at home is absolutely ridiculous.

You must insist that he can't live with you. Look around the rehab at the equipment they use for him - that's what you'd need ++++++ more as his condition worsens. In today's world, health care people assume that the average caregiver can provide care for persons with health issues like your FIL. During my days as a family caregiver for my parents and another relative, I was expected to give shots in the stomach, load a 45 lb. wheelchair into my car trunk after transferring a 175 lb. man from the chair to the passenger seat of the car, remove doors from their hinges so a wheelchair could go through the door, and more.

My best advice is to look stupid, hunch your back over a bit and walk with a cane. That's what I wish I'd done before I got roped into services that I looked able to do but wasn't.

The amount of care your FIL will need is extensive and costly. When I was researching at home care for my uncle it was approximately $30 per hour and he needed 24 hour care because he is also completely immobile and over 200 lbs.

Does the facility have a long-term care wing? You need to discuss with the social worker that you do not have the ability for your father to be cared for in a home setting and he will need long-term care in a facility.

Also your fathers POA will need to consult with an eldercare attorney to start the Medicaid long-term care application if your father cannot pay a selfpay rate. If there isnt a POA in place the eldercare attorney will assist with that too.

If this facility will not keep him you need to find another one. No, you cannot take care of a bedridden man of that weight that needs 24/7 care. The facility my mom lives in has several patients that cannot walk, some cannot sit unassisted. They are cared for and moved by staff members. It's their job.