When is it time for a MC facility?

Andy Easton

 Hi everyone.  I’ve posted a couple of times and have gotten some amazing advice and feedback so here I am again. 

For those who have a loved one in a MC facility, how did you know it was time?

I’m 95% certain it’s time for my mom to be in one.  The proverbial last strawberry happened earlier this week when my mom physically assaulted my father. It’s not the first time, but it was intense and I fear it could escalate by her just happening to be near something sharp and grabbing it. 

My father has been in a lot of denial, understandably, as her primary caregiver.  I sat him down and told him we are at a point where it’s too much for him, it’s not safe, and they’re both suffering.  She’s not getting the care she could really benefit from and his mental and physical health are suffering.  Mine is too as I’m at their place several days a week and have started neglecting some of my responsibilities.  Compounding all of this is an upcoming hip replacement in three weeks, which I know can greatly exacerbate her cognitive challenges  

I have visited six facilities near them and I liked them all and know she would benefit greatly.  My father is despondent at the thought of her not being at home all the time and I’m trying to get him to see he will get the best of both worlds in an impossible situation:  he will be able to do things he can’t while getting to be a husband again while she gets care she needs   

Back to the 95% number. That 5% doubt is when she shows flashes of her old self.  There are some times when she’s fairly lucid, although it’s fleeting.  And there’s the hope that perhaps after surgery when she’s not in pain she will rebound a bit (she will be spending 1-2 weeks at a skilled nursing facility and then would go to the MC facility or home). 

I imagine everyone struggles with this decision, so anything that anyone can offer with a terrible awful decision would be much appreciated.  

Emily 123

Hi,

 Your plan to go from rehab to a MC is sound, and it may seem like a less sudden move to your dad, if that makes sense.   

You need to select the care based on where she is for 95% of the time.

The surgery and rehab may be disorienting, and she may progress either temporarily or permanently, so MC is a good choice.  I woud discuss with her physician(s) about her getting physical with your dad--it might be better to have meds adjusted prior to her surgery, as you don't want her to go through it and then fly off the handle, perhaps pushing back her progress.

harshedbuzz

When is it time?

When ever your dad says it is. Your job is to get his buy-in. I had a great deal of difficulty convincing my mom to place dad. She was really loath to commit to the financial costs for an undetermined period of time as dad had lost much of their nest egg in the market earlier in the disease. Like you, I was dropping my own responsibilities to put out fires at their house.

What finally worked for me was a 3 pronged approach-

I expressed concern for her health as she was distracted/depressed and letting important prescriptions run out. Alas, I was not able to make this happen soon enough and she had a health crisis just after dad died that cost her her vision in one and consequently her drivers license. Her stage 8 has not been what she'd hoped it would be.

I called her on all of the ways a facility could provide better care. Dad was difficult and would often refuse to take his meds, shower, change clothes, etc. She didn't always respond in the best manner when his behaviors kept her up all night or when he became aggressive with her. 

I assured her that should she die first, I would place dad in the first available SNF (my Plan B was to take him to the SNF where he'd done rehab previously as they would accept him without the usual vetting a new place would do) while I shopped for somewhere better. I told her if she wanted a say, she needed to make her choice now. 

You don't flesh out how old your mom is nor the stage of dementia in which she is currently which may play into the hip replacement. Is this elective hip surgery and truly necessary? Given the decline associated with this particular procedure, anesthesia and the hospitalization around it, you will likely see a real decline in function- perhaps it will improve a bit but probably not to her previous baseline. Given the mix of dementia, pain meds, post-anesthesia fog and a change in routine there is a real risk she will be quickly dismissed from rehab because she is unable or unwilling to participate meaningfully in her rehab which could lead to a result that was not worth the risks of surgery. 

I have had 2 aunts with dementia undergo joint replacement.

Aunt C had TKR in the early middle stages. Her knee was horribly swollen and she had a lot of pain. The surgery went well but she suffered a stroke in recovery and never walked again. She did seem to mostly rebound to her previous cognition after about 3 months. Most TKR is done under light sedation and spinal anesthesia so less impact on the brain.The pain was relieved and she lived another 10 years, so it was a not entirely bad outcome.

Aunt N fractured a hip in the early middle stages and had hip replacement. Her surgery was a complete success, but the anesthesia took a real hit on her ability to function. She went from a stage 3 to a stage 6 seemingly overnight. She couldn't do her rehab and constantly forgot she had to use a walker and ended up needing 24/7 sitters in the SNF going forward. She couldn't afford that, so mostly family pitched in to be there for 16 hours daily which was difficult because there were only her DD, her son's widow and her 85 year old sister local to them. She died within 3 months of the surgery. 

HB

Lindsay22

I'll tell you what someone said to me:  If you are thinking that it's time (and 95% is pretty close) then it's time. I think the plan to go from rehab to MC is a good one.  Also, I disagree that your father is the best judge of when it is time.  People often need someone who isn't living in the home to point out how untenable the situation has become.  Sometimes you are too close to see how difficult it has really become, and I would imagine this is especially so with a spouse. You should be prepared for her to decline after the surgery, I know that is a very common thing.