I am his POA. Can I discharge him w/o issues (like them stopping me)? I feel like we haven’t really been given a choice in his rehab so I’m worried. My dad has lived an independent life. Prior to last week taking care of himself, driving, cooking etc. with only mild dementia symptoms. He fell down his steps, had a stroke and is unable to use his right hand/arm. Everyday his arm seems to get more feeling/movement but they are concerned with his dementia and living by himself. A lot of the things they seem to be concerned about have been happening when he is in a new place. He does also have confusion but we feel if we take away his car and make some modifications with his house he can still live by himself with daily checks and it be okay. In his environment he doesn’t forget direction/rooms etc. but in his current environment he is struggling. He also just wants to go home and I want him to have a quality of life as long as he can and being in a nursing home is not what he wants. I also think staying with me or another family member would also create more frustration & confusion because he isn’t familiar with his surroundings & staying with him permanently isn’t an option for me. I would rather him do in home therapy once we have his house modified but I’m worried someone will step in and say he’s not fit to go home and send him to an adult care center/rehab center.
He also can not drive with dementia .
Your choices seem to be Dad lives with someone or he moves to long term care facility .
No. This is what you WANT to happen, but he is not likely to be anywhere close to who he was and his abilities prior to this. And it is not likely ever will be again. He is no longer able to do what he did before. In some ways he is not the same dad you know anymore.
There’s so many everyday dangers in a home that we forget about. I have a friend whose MIL was in the same position. Family thought with daily checks she’d be fine. Until one day they checked in and she had put a pot of water on the stove, turned it on high, walked away, and forgot about it. Pot was boiled dry and there were several hand towels next to the burner. Had there been a fire, she might not have had the ability call 911 or get out of the house.
“I want him to have a quality of life as long as he can and being in a nursing home is not what he wants.” You need to reconsider what is SAFEST, not just what he wants. Living alone in his house doesn’t guarantee a good quality of life. He will still be struggling most of the time.
It sounds that the medicos feel that you aren’t taking the dementia and other health problems seriously enough. You are POA, but what do other family members think about this? Are you the one doing the caregiving (such as it is), and if not what are the views of the person who is most in touch with him throughout the day? It is quite common for a POA to be a trusted male who is not involved enough in the details of intimate personal care to see through 'showtiming' and realise quite how bad things have become.
To an outsider, it does seem that you may not be realistic about all this. Talk to some more of the people involved, without starting from the point of believing that they are wrong and you are right.
Of course he shouldn't be living by himself anymore. That ship has now long sailed.
And since you say that you nor any other family member can take him in, then you should instead be focused on getting your dad placed in the best facility he can afford,
Sadly life doesn't always go the way we would like it to, but we all have the choice to make the very best out of what life does give us.
I wish you well in finding the right and best facility for your dad.
He either pays for aides to care for him in his home or he will go to Memory care or Long-term care. It all depends on his finances. Not sure if an Assisted Living would take him depends on how much care he needs.
Its no longer what Dad wants, its what Dad needs and as POA your job now is to make sure he is safe and cared for. Read your POA, if immediate there is no need for a doctors letter for financial. Usually for Medical there is. Some Financial POAs stipulate a doctor or doctors are needed to declare incompetence before the POA is invoked.
Your Dad losing his independence was inevitable. His Dementia would have worsened and he would have needed 24/7 care. Time to take away the keys and sell his car. If you bring him home, the car should not be there. Its also time for some white lies. You took it for a check up.
So, to answer your question, yes the Rehab center can have Dad placed in LTC if they feel that Dad will not be cared for 24/7.
Recovery sometimes is the wrong term. Recovery can conjur ideas of returning to *before*.
Stroke recover varies. Recovery can be more like *adjustment*. Through a crises stage & into the *new normal* level of health & functioning.
By all means, have HOPE & engage with rehab & set goals. But also be realistic.
"My dad has lived an independent life. Prior to last week taking care of himself, driving, cooking etc. with only mild dementia symptoms."
"He fell down his steps, had a stroke and is unable to use his right hand/arm".
Your Dad is now a stroke survivor.
Hopefully 1: he may make more gains in his mobility over the next months
Hopefully 2: any delerium could lift (often caused by fall, stroke, hospital/rehab environment, pain, new meds)
Realistic 1: delerium can stay for weeks or months
Realistic 2: dementia is progressive
Realistic 3: stroke recovery varies
Think carefully on WHY you want Dad to go home, alone.
What thconsequences would be?
I don't know the law, but I would be very surprised if it would be ethical for health professionals to knowingly allow you to leave your dad home alone. Also, I don't think that you would be fulfilling the terms of the POA if you made the decision to leave your vulnerable father in a house, however modified, on his own - knowing that he has dementia and has had a stroke.
Act in your father's best interests and keep him safe. That means 24 hour care.
Please use your authority appropriately and make sure dad has full time care. Either at home or in managed care. Whether he "wants" it or not is irrelevant, he needs it.
If you REALLY believe your dad can live alone or with you, then take him in and let us know when your mind changes.
Otherwise as others have written, you have a duty and responsibility as POA that can be very heavy on your heart...but you must do what is best for your father, regardless of your personal wishes and pain.
The coming days will be very hard. I hope you make the right decision- if you can't -then resign the POA ...IF you can get someone else legally assigned by your father, which may not be possible given his alzheimers and stroke conditions.
I do agree with other commenters that with a dementia diagnosis he shouldn't be driving or living by himself any longer. The medical professionals who are caring for him now obviously are seeing deficits that OP is missing. You can't assume he will continue to improve to his former level, and if he is confused by his surroundings and can't use one arm, it isn't safe for him to be alone.
The last sentence is a little confusing to me also. If he's currently in the HOSPITAL and they are wanting to send him to REHAB, in most cases that would be the appropriate thing to do and I don't understand why OP would oppose that. In any case, more physical therapy, with the goal of him having full use of both arms and being able to ambulate steadily, seems like it would be most helpful and might eventually allow him a much better life in an assisted living environment.
OP - In the end I suppose they can do whatever they want if they feel strongly enough that you are not acting in his best interest. Why not discuss further and keep an open mind as to what they are seeing that you may not be?
After a stroke, a previously healthy person would work towards repairing the damaged neuro-pathways, so that they can be themselves again (if possible - it wasn't for my mum).
A person with dementia is already losing those pathways, even before the stroke. Their condition will have inevitably deteriorated. Rehab can only do so much - it can't fix something that is unfixable.
Having said that, be aware about his needs, and the risks to him if you move him from your house to his without adequate care. It is possible that you might be blamed if he has a bad accident while he is still ‘on the radar’ for the medical system. However once you have him in your house and are caring for him, you may be less likely to underestimate his needs. Remember that an accident (or an 'incident') can lead to a rapid decrease in his ability to meet his own needs.
The hospital and or the rehab center would be held responsible if they discharged him and it's "not safe" per their professional opinion. But there are options for your dad to live at home.
In home non medical care would be a great option, or live with family in their home. But being alone may be challenging and very risky for him and you.
I am one that believes that when a person does get the diagnosis of dementia they should not be living alone. I say that mainly because by the time family, friends notice there might be a problem often the person has been "hiding" symptoms for sometimes up to 10 years and it has reached a point where the person can no longer hide the fact that there is a cognitive decline.
All it takes is for a person to get in the car, go to the grocery store that they have gone to for 40 years, get turned around and become lost. Going the wrong way down a freeway....running into a crowd of people...driving into a retention pond....
Making the coffee that they have made for 40 years and leaving the potholder on the burner....Putting the mail in the oven then turning the oven on to make dinner.....
Answering the door for the "meter reader" and allowing him/her into the house and getting robbed....
leaving the water running .....
Trying to light the furnace.....
there are just so many things that can go wrong.
While your dad is in the care of the facility it is their responsibility that he is safe and he has a safe place to return to.
If you say he will go home and will live on his own and they feel that it is unsafe to discharge him with that plan in place they can refuse to discharge him to your care. If necessary they will get the courts involved and a Guardian will be appointed in order to ensure he is safe.
If you present a plan that will account for his current cognition and have caregivers in place they my feel that that would be a safe discharge. That plan should include caregivers, modification that need to be done to make sure he is safe.
If he does improve once he gets home and is more comfortable then maybe he will not need 24/7 caregivers.
But he should not be driving until he is evaluated.
I was really glad of this because the first visit, this year, forced her husband to move to a retirement flat in a building with a lift and carers on site (I had been pushing for this since Mum had her stroke 13 years ago). He also had to up the care calls from once to 4 times a day - again, something I had previously suggested and was told I'm too fussy.
This last hospital visit, my stepdad told me he was reducing the care calls once Mum had been discharged, but the hospital put Mum onto end of life care and have arranged carers and daily district nurse visits, so it was taken out of his hands.
He just keeps underestimating the care Mum needs and the help that he needs.
My current issue is that he's insisting on giving Mum her epilepsy tablets, even though she only takes tiny sips of water, and she's not fully sitting up, not aware, and not opening her eyes when he does this. He's so worried about her having a seizure, but if she does, she won't be aware, but she'll be very aware if she aspirates a tablet. I want her death to be peaceful, without distress, as much as possible.
I'm also concerned for him - he would be devastated if Mum was choking and gasping for breath. A peaceful death would make it easier for him to accept losing her.
It's natural to be in denial, but accepting the reality of the situation makes us better carers, or advocates, for our loved ones.
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