My father is elderly but was 100 percent independent. He drove, cares for himself, cooked, lived alone. He contracted covid.
After 60 days so far of icu on a vent, a trach, and now off of the vent, trach is removed he is in acute rehab.
He will need to learn to walk, he is having trouble swallowing, he currently has a catheter and a feeding tube.
We are 1/2 a week in at acute rehab and they are telling us he will only be there a total of 2 weeks. They are already talking about when he comes home and what we (myself and my two siblings) will need to be able to care for him.
I do not want to have to help him shower, clean up messes if he can’t make it to the bathroom and that type of care. I don’t think he would want us doing that either. I also have some health issues that would make lifting him an issue.
my one sibling will be insistent that he should come home.
How do I handle this? I have a week to figure it all out.
First question is that you say your Dad was completely competent. Was he living with you? What was your understanding moving forward? Or was he in his own home.
Know that SNF is covered for at least 21 days especially after Covid. But in almost all cases in which patient is on medicare.
Let them know NOW, at once, that your father was self care, and that you will not be caring for him. That, if he requires care then he requires placement. This is much easier, esp in these times, for the Social Worker there to handle than for you. The important thing to tell them is that you are neither mentally nor physically able to accept him into your care; they will try EVERYTHING. I have been there as a nurse seeing it. They will tell you that they will get you help and together you will all make it work. They won't and and it won't work and then you are stuck, having no answer but an ER dump to get him back into care. It will be almost impossible for you to find.
Your Dad will require four negative tests (in most CA facilities, at least) to get into care; they know that. It is a pain for them and they want him in your home.
TOMORROW, ask to speak to the Social Worker. Tell her that you will not be accepting your father into (or BACK into) your home, and that he was self care, and you are not prepared mentally or physically to care for him. Tell them that he will require placement, and they will need to find placement for him, as you cannot go in "covid-19 times" to check out facilities. They will then ask you for his assets, and you should be ready, if you can, to tell them as approximately as you are able.
Good luck. You are going to have to STAND STRONG against them to accomplish this. It is no time to be a shrinking violet. The truth is that your Dad may never fully recover from this; many younger than him have been unable to, and there may still be complications of blood vessels, strokes, no lung capacity on the horizon.
I am so sorry this happened to your Dad, but do not allow them now to use you and make it clear it will not happen. They cannot do a discharge to someone not accepting a patient and they cannot do an "unsafe discharge".
Time to kick it into high gear tomorrow, and I am so very sorry your family is going through this.
That, my dear lady, is a complete sentence.
I joke right? But what if you were? What if there were no adult children?
Alvadeer is correct. They will try anything to 'close case' & move on to the next case. They are crazy busy I know. But Dad is in their care so the *duty of care* is theirs.
Tell them you are your Dad's advocate to enable him to receive the care he needs. But his care is beyond what you (as one person, or as one of three sibs) can do.
Stand firm, be polite & professional. Stay strong.
Covid rehab is not yet cut and dried. Problems can arise during recuperation, and with his swallowing/feeding issues ALONE, caregiverS will need careful training.
Please impress upon your family that you need alternative choices for care management and lots and lots of support and help with decision making BEFORE he comes home.
Do you know of a good skilled nursing facility? Do you know anyone that has been through needing skilled nursing recently?
I would start looking for a different rehabilitation facility that is committed to rehabilitation for your dad.
I had to move my dad from a facility that said he could go home because he could transfer to and from the wheelchair and bed. WHAT?!? No way! He needs to be rehabilitated to pre hospital stay or at least as close as possible.
He went to another facility, rehabilitation took place multiple times daily, 6 days a week for 3 weeks and he walked out. This after 2 weeks in the 1st facility and a 9 day hospital stay.
He needs more than 2 weeks of rehabilitation after being in the hospital and everything that he has gone through.
Please advocate for him to get the care that will let him be able to safely go home at some point.
See what he can do in the 2 weeks of rehab, it may surprise you. You can always ask if he can stay a couple weeks longer if he needs it.
You won't have to pick your Dad up. You may have a walker for your Dad to get around with when needing to go to the bathroom.
His Cathiter can be taken out as soon as he's able to walk.
Juse because he can't walk well, doesn't mean he can't wipe himself after a poop.
There are Shower/Tub Chairs tgat he can use snd he'll be able to wash himself.
Im sure if you asked him, he would let you know he wants to go home asap.
His Insurance will pay for Home Health Care, Therapy to be done at home, will send a Nurse to check on him and do his Monthly Cathiter change and Aides to come 2 times a wedk to help with bathing him.
You could always pay for a Caregiver yo come 2-4 hrs a day to help out.
Simply refuse to take him home on the grounds that he is not sufficiently recovered for you to be able to meet his needs within the time and resource constraints you have available and can afford. But if insurance is the issue, they will start charging you.
Dont let rehabilitation facilities and nursing homes push you around. If you have a question, google it and you might get an answer that makes sense. Negotiating your way through this morass of government, health care and insurance regulation is an absurd challenge that literally requires expert legal advice to negotiate and even attorneys who specialize in issues related to health care for the elderly don’t necessarily have the right answers. Flatly refusing to take the loved one home until YOU are ready usually gets their attention.
Your choices are either learn how to do basic care and get over your reluctance to "clean up his mess" -- or straight to the nursing home he goes. I took care of my mom with end-stage Alzheimer's for decades and in the end I had to bathe, clean and even make certain she has a bowel movement a few times a week, which often involved enemas and lactulose. If you really love someone you do what you have to do.
If you can't, or won't--then you can't--then get him placed in a nursing home, and you better tell your father that. GET WITH A SOCIAL WORKER.
You weren't faced with doing this for your dad, so pull your rocks back until you walk in those shoes.
He was diagnosed with Covid thus his care is based on what would be expected for a Covid diagnosis. Meaning he is expected to get better. How old is he?
I too would see how well he does for 2 weeks in rehab. The difficulty swallowing is no doubt from having a breathing tube and being on a vent for so long and should improve. If not he can be discharged on a puréed diet and advance up to soft then regular.
Are you expecting him not to recover? He may do very well but of course is weak now because of being inactive for so long.
If he is a commercial pay vs Medicare the rehab center will probably keep him as long as his insurance pays as commercial pay rates are higher (contrary to another poster who alluded he may get discharged faster on commercial pay vs Medicare).
I say give him a chance to work at rehab. You may be pleasantly surprised to find he recovers quickly due to your statement of how independent he was prior to Covid and Covid being his only health issue.
I myself don’t foresee gov’t insurance nor commercial carriers approving routine long term care or extended rehab for Covid patients as the majority are expected to recover quite nicely, elderly or not. I am a RN case mgr and it is a struggle to get post Covid patients homecare services due to the 10 day quarantine after hospital DC and the availability of homecare staff as we speak. It’s crazy out there. We are working on “Covid 19 time”. Staff are here today and gone tomorrow.
Thus it may be a struggle to get insurance to pay for extended rehab as it’s just not part of the Covid algorithm for treatment/payment.
But your father was in an acute setting for 60 days and that has to account for something. Unless HIS insurance is dictating the number of paid rehab days. Is that the case? I would call his insurance carrier and ask how many days of rehab are paid for according to his policy and use this info as a tool in your box to push for more days.
so we have gained a few more weeks reprieve.
I had no idea there were things called slow stream rehab, transitional care, intermediate care, or respite when my sister was originally discharged home (to fall multi times). Wish I knew then what I know now.
What a scary ordeal you have had. I hope your Dad continues to get the care & time he really needs for recovery.
What your father needs is exactly what Assisted Living provides. If you think there will be resistance, there already is from your sibling, explain to both sibling and dad that dad has just fought a substantial battle with his health and two weeks of SNF isn't going to get him back to independence.
Do your homework ahead of time. Find an AL in a community that also has IL. Explain to the sales person that your dad would likely start out in AL (or in IL with homeware, whichever is suitable and is most economically sensible) with a goal to get to IL as he recovers. You can start as a 'respite stay' (committing only a month at a time) and see how it goes.
Don't be bullied into sacrificing your own health to yield to your sibling's irrational preferences.