Parkridge

As you may be aware, Dad is at Parkridge  in the skilled care wing. He has been going to therapy twice daily. Yesterday I had a meeting with the therapist and the social worker at the facility. Dad is not progressing with his therapy and will be moved to long term care next Wednesday if he does not show signs of progress. Aside from standing up with the assistance of three therapists, he has not done much else and is not cooperative with their efforts. He does not seem to grasp that he will not walk again without this therapy. I believe this is because the Alzheimer's has advanced a great deal since his fall. He seems more confused now than he has ever been and I'm sure recent events only make this worse. From the ER to the hospital to surgery and recovery followed by transfer to Parkridge; this would be enough to confuse me and I don't have Alzheimer's...yet.

He just cannot concentrate. He is unable to punch through the dementia fog and see what it is he needs to do and his intolerance of pain has increased. I'm not sure where his mind is, but it is not on recovery or dealing with the discomfort of therapy.

He is also not eating as he should. I was with him at breakfast yesterday. He had a bite of egg and two bites of French toast. That's not going to make him him stronger. He will eat bananas and drink certain juices and this should help, but I do not think it will be enough in the long term. I am told that awareness of hunger and satiation is one of the things that goes in the later stages of Alzheimer's.

In all, the outlook is not rosy. I suppose he could go on for five years or more in his current state, but I do not know that. He had Alzheimer's when I got him and that was over five years ago. I do not know the duration of the stages. He may be at the end of the road or at least close. It remains to be seen.

Today when I was in to see him, it was apparent he had some visitors. There were cards and chocolate from my cousin's candy shop in Pella. Dad remembered people being there, but could not tell me who. He remembers faces and associations, but not names. I'm not sure he even knows my name. At physical therapy today, he thought he was at the dairy. He kept telling the woman that was working with him that she should get to know the drivers better because they make good husbands. It will be interesting to see if this kind of commentary becomes inappropriate...if you know what I mean. He has turned into a bit of a comedian.

When he moves to long term care, he will have a roommate. I hope it will be someone he can talk to and that they get along well together. It's important.

That's all I've got on the 'Dad' front. Later.    

I Can't Talk To You Right Now

Have you ever heard that expression from someone, maybe someone you counted as a friend, that is angry with you? They normally think that they have all the facts when they say this. It's been my experience that is not the case. Usually it's because they have one side of a multi-faceted story or they make assumptions, filling in their own blanks with what seems logical to them. Other times, they just like to get their 'mad' on and there is an addiction to the indignation factor; a self confirming 'how could they do this?'. Again, this is usually because all the facts have not been presented.

There is one other factor that brings these things to a head. It's an emotional issue that usually springs from an emotional attachment to the subject matter of the disagreement. This is especially hard because it often times pits love up against what is right. When this happens, we question ourselves, what we believe and how a situation should be or should have been handled.

I have seen this happen in the church. Sometimes church doctrine or morality will conflict with behavior of a member or members. We like to err on the side of grace and love, or we like to tow the line of what the New Testament says is righteous and so the unfriendly discussions commence...unless I just can't talk to you right now.

I have to say that I have been there and done that. I was so sure I was right and that others were wrong, that I just could not talk to them. I had to wait so I was rational when we finally did talk about the issue. I'm not sure how my refusal to speak was taken, but it did make me more effective in the discussions that followed.

What I'm saying is that waiting is fine. It's good to be calm when you are discussing something that is important to you. But it is also important that it be discussed before making any decisions about what you will do. A rational discussion helps everyone involved in the process. If we don't talk, nothing gets fixed. And maybe nothing will get fixed to our liking, but at least we will have discussed it and agreed to disagree. At some point, there must be an airing of the grievances.

Now might be the time.  

Stress

It's odd how stress amplifies things. My SSA has been ratcheted up by all the events.

You would think that despite all the distractions, I would be able to focus, but for some reason...I don't know.

I need more sleep too..I am way too wired. I wake up every two hours at night. When I am home, I keep forgetting my patient is not there. I am accustomed to listening for trouble. Now there is no noise at all except for the dog. Oliver misses his daddy. Every time he goes outside, he looks for him.

I had a crying jag this morning. Leaving the dog home alone and moving Dad to Parkridge is eating away at me. It makes me sad. There's some guilt. And there is recognition of the fact that another chapter in my adventure and Dad's adventure is coming to a close.

It is what it is. Someone needs to watch me. I am not prone to irrational behavior, but I'm feeling kind of twitchy.  

In The Chair. Update

Update...Dad is moving to Parkridge this afternoon at 2 PM
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Dad got up in the chair for the first time yesterday and he is back in it again this morning. He did not like  biscuits and gravy today, so he ate a banana and orange juice. He said the coffee was bad too. I didn't mind it, but then I like Espresso.

His mind is another issue. He asked me how my wife was doing. This is funny in so many ways. He says cute things like that quite a bit now. Somewhat nonsensical, but entertaining at the same time. Right now he's rearranging the items on his meal table. Last night while he was trying to eat, I noticed he needed a new napkin. I told him I was going to get one. He told me to stop by the Dairy and get a case. He was also explaining to a visitor how they put everything in plastic bags now. Not sure what that was about, but his explanation of the process was very thorough.

His physical condition is better than it was, but not good. He is stronger, but not strong enough. The edema in his right leg is much better, but there is still some 'weeping'. His incision seems to be healing well. His arms are black and blue in various places from IV punctures and blood draws.

I have not heard when the move to skilled care is coming. I will have to ask. I am going to be going back to work this week in the evenings, so I hope they are planning on a morning transfer. I do not want to be running around at the last minute trying to get all his stuff together. It would be nice to be able to plan.

That's all I've got right now. Later

Shopping For A Nursing Home

Have you ever done that? The process is interesting in some respects as well as educational. I visited five places in the immediate area and presented my needs or should I say Dad's needs. What I learned was that it's tough to get a bed if it's a quality facility. Further to the point, these care facilities are picky. They seem to want only a certain clientele. This is because of what they are allowed to do by law and how some care insurance policies are structured.

Some places do only assisted living. They may well have memory care facilities, but they only want people that do not need much in the way of supervision. They like independence in their residents, but they do not like it when they try to escape. Did you know that if a patient may require the assistance of more than one care worker, they can not live in an assisted living facility? Patients with this requirement must go into long term care.

Further to the point, if your insurance policy is an older policy, it will most likely only cover long term care. It cannot be used for assisted living with only some exceptions. Many care policies also have a 45 day waiting period where the insurance carrier pays nothing. Some places want a down payment or earnest money. There are damage deposits involved on rooms too just like apartments. In all, it seems to be a very profitable business, so it's no wonder it's so heavily regulated.

My Dad is going to need two things. Skilled care to recover from his hip surgery and then long term care for his worsening Alzheimer's. I have determined that an assisted living situation would not work for him. He is going to need all the help he can get. When searching for a nursing home and when there is a need for both of these care levels, it is also very difficult to find an adequate place that can do both. By this, I mean that a facility may have beds available for skilled care, but not long term care after that. Much of this is a waiting game.  Doing both of these at the same facility is optimal for the patient, but many times is not possible because of room availability.

I have chosen a facility close by for the skilled care Dad will need. It is my hope after he is back on his feet (with a walker), that a bed will open up for him in long term care. If there is a room available, Dad will have to go through an evaluation to determine if he is a flight risk. If he is deemed a flight risk (called elopement), then he will have to move to a secured facility. It's required by law apparently as are many other things in that business.

Whether any of this happens at all is going to depend on Dad. Since his surgery yesterday, he has refused to get out of bed and sit in a chair. He has not been eating to regain his strength. He is a bit dehydrated and he is sleeping quite a bit. All of this magnifies his Alzheimer's symptoms. He is sun-downing and it's not pretty.

Today, the physical therapist got tough with him and cranked up his bed to sit him up. They did manage to swing him around, but they could not move him to the chair. He refused to cooperate.

I had to tell him today that he would die in bed if he did not get up and start using that new hip. This is no exaggeration. The orthopaedic surgeon said that the mortality rate in the first year for hip surgery patients is 50% and it's because the patients refuse their therapy, refuse to participate in their recovery.

There is a great deal of pain and soreness involved (as well as stubbornness). I understand this, but if he wants to survive and have some quality of life, he is going to have to fight. I am not sure he understands the consequences and it's most likely because of his Alzheimer's. He is not a coward. I know this. I grew up with him. He taught me not to fear pain; that it's a part of life. He has apparently forgotten this for himself.      

If you want to pray for him, pray that he will get up. It's what he needs to do right now.

Dad Update

Dad's surgery was a success.  He is a bit sore and miserable . They are going to set him up in a chair later. Ouch. I do not think I will be here for that.

Anyway thanks for the prayers

Dad

Many of you already know, but Dad is in the hospital with a fractured hip. Yesterday, in the morning around 7:15, he was out in the yard with the dog. He went up on the east deck of the house, turned around and came back. As he stepped down from the deck into a pile of leaves, he slipped and fell. I was inside at the time. I had just showered and was getting dressed. I heard a pounding upstairs. I finished dressing and came upstairs. Dad was not in his chair, so I went outside. He had been pounding on the deck wall. He had pulled himself up on the deck wall and was standing, but said he couldn't walk. I went to the garage and got Grandpa's walker. I got him to the car with the walker and we went to the ER. X-rays revealed a fractured hip. He will have surgery today. Rehab is in his future and then, I think, full time nursing care at a facility. His days of being home alone during the day have come to an end. I do not believe he is safe. It's interesting because it was just Monday that he was riding the lawn mower and chopping leaves. Things can change fast.

I will advise about how the surgery went later. Thanks so much for your prayers and visits. Christian friends and family are the best.