Dad requires surgery broken hip.. many decisions to be made

Olly_Bake

I was to write to you all a few days ago to help me make a decision in regards to dads care. He was back in his home back in March with hospice, 3 Medicaid workers, and one daughter. Came April I asked hospice to take him off because they were having trouble waking him. Hospice suspected meds being administered too close. Once in the emergency room, they diagnosed him as having acute dehydration, pneumonia, low sodium, DKA, and sepsis syndrome. It was a kick in the gut because I feel the dehydration and DKA were human errors. Things that could be controlled to some extent because dad was good about his intake.

So after the hospital stay, I decided to give our small nursing home a try for skilled care. First, I tried to work with them on a plan for catheter removal because of dad’s history of not wanting anything attached to him and pulling them out or off. They just outright said no until his prostate doctor wrote an order. Then the sharing lunch in the dining area I guess changed due to covid. Then I found him this week with same clothes on from the weekend. Went to change him and all clothes are gone and everyone is giving me the run around.

Another day later, I get a call that dad had slipped out the bed but was not hurt. I didn’t visit until a day later. I saw dad was indeed hurt and breathing horribly. The head nurse was dismissive of my concerns. The next day dad was sent to the ER about his breathing. The nurse there asked why he doesn’t want anyone to move his leg and come to find out his hip is broken.

Not only am I to make one decision but I have two. I was already considering removing him from this nursing home and maybe sending him back to the larger one that I didn’t care for either based on a trial. But now this. Without surgery, no quality of life due to not having mobility and pain issues according to surgeon. If he qualify for the surgery and makes it, what then? Is it back to one of the crappy nursing homes or the crap shop at his home? If they can’t do the surgery, do I send him back to one of those places or send him back home? If I do the home option, do I go hospice route or regular home health route and get back on the payroll as part of the care team? I did it for seven years but stopped due to family drama.

The only thing about hospice in our area is they don’t offer palliative. I have a few concerns about hospice but don’t know if it is the norm. Don’t get me wrong they’re great. However, one time dad had heavy bleeding in his urine and hospice didn’t want to test for uti.  They automatically said it was his prostate cancer. After it got heavier, we took him off and took him in. It was not his cancer. Moving toward today with a new hospice company. Dad started off with a bad cough, hospice gave antibiotics. After the cough and congestion still was not clearing up, we requested an x-ray and they said they would do, but all they kept doing was giving another round of same antibiotics.

Now I’m sitting here not knowing what to do

May flowers

My FiL had partial hip surgery as a pain measure and possibly to regain mobility. It worked for the pain, the mobility never returned. He was strong enough, but after a month of PT we were told he just cognitively could not get it, he cannot follow instructions. Putting one foot in front of another, all of it. He walked sideways, backwards, leaned back, it just never came back. The best we have is he can sort of help us stand him and pivot him to the toilet or from the bed to chair. It is 90% our lifting him.

He also permanently lost other abilities after the surgery - became incontinent and lost almost all ability to communicate. But having said that, we would still have had the surgery for the pain.

Getting PT in home after surgery may buy some time in making other decisions. The local rehab facility is notoriously bad with dementia patients which is why he ended up back here.

My guess is your LO will need full time care wherever he ends up. I can’t speak to a SNF, as w didn’t go that route. We have my FIL here with us, but will have to hire someone part time soon as I cannot do it all day anymore. I know if my DH and I weren’t on the same page, there’s no way we could do this.

I hear you about hospice. I asked for three weeks for a culture because I suspected he had a UTI, and finally they decided to treat him. I don’t know why they hesitate on something so basic because it was about quality of life. I told them that. He is on Cipro now, and while it’s not great, he is doing much better. 

If you do decide to do surgery, I would ask the surgeon about a partial, and the anesthesiologist if they can do the lighter sedation. They wanted to do that for my FIL but decided against it because they saw a brain bleed on the CT, and didn’t want to risk it.

Just my thoughts.

Olly_Bake

Appreciate your honesty May Flowers. The surgeon think hip pinning surgery should fix the broken bone. Yesterday they had a five pound weight attached to his leg. He mostly slept but woke a few minutes to eat and every now and then woke up to tell us his leg was hurting him.

Dad was able to walk using a walker and the other things you mentioned with one-person assist. Thanks for letting me know this could very well change.

May flowers

You’re  welcome. I asked the PT nurse how many people with dementia got back to pre-surgery abilities, she said about half. And she has seen it take several months to know for sure.

My LO walked well, without a walker, prior to surgery. And he walked constantly so we were hoping for some mobility. He now scoots his Geri-chair around and does laps around the room in that. He tried to stand up a lot and walk after surgery and we helped him whenever he wanted, but he does not try now 5 months after. DH still walks him to the bathroom a few times a day, but he is bearing most of the weight. I am not strong enough for that, but I can help him stand and pivot (as long as he is willing to stand).

Olly_Bake

Dad made it through surgery. Today he was up feeding himself lunch but fell asleep shortly after. Therapist called today to say they were getting ready to evaluate him to see if he can handle two weeks rehab at hospital. If not, I still have to figure out what next and soon.

Bang head! This just sucks right now. Put him in the nursing home for safety but if you don't go on a daily basis.

harshedbuzz

OB-

I saw on another thread you mentioning the use of Flomax for urinary issues. I wasn't sure if this was for your dad or husband.

Please know that there is an association between this medication and an increased likelihood of developing dementia and proceed with caution. A number of meds for urinary issues and Benadryl, of all things, are also associated with dementia. 

Is Tamsulosin Linked to Dementia in the Elderly? - PubMed (nih.gov)

HB

May flowers

Olly, I’m glad to hear he made it through surgery ok. It’s great he is already awake and trying to eat! 

Is someone there to help him eat?  I’m asking because after my FIL’s surgery my DH had to be there to feed him and make sure he drank enough - he was too groggy to really feed himself (and for a few weeks following). The nurses don’t have time to do this (in our experience). We were told by a couple of people that the rehab centers around us were notorious for not taking time to do that as well, which is why he ended up here with us. 

Nerdyblond

Jeez Olly_bake...

I hear about things like this often. It makes me very upset. I'm glad your dad made it through the surgery though. He sounds pretty tough and determined!

We are going to put my mom in a home. My POA sister and I have been talking about it for a couple of days. Now I know what to look for and what kind of questions to ask about them. 

I am so sorry you are going through this. I would start  having someone check on him every day and start documenting things, with pictures. I would also try to get a hold of the other residents families to see if they experienced similar treatment.  Someone's gotta answer for all of that.

Olly_Bake

Mayflower, dad has eight kids still living out of ten. I’m it for help. Oh but they came to see after the broken hip because they thought he was going to die. And of course, they call now because they want to know if they'll be a lawsuit. And I tell them my concern is keeping him safe and out of the hospital back to back since leaving my home. That's my priority!

The daughter that lives in his home is of no help at all and just wants someone there to pay the bills so she does not have to as I did the month dad came home (past due ones and all) to keep down confusion. The only task I asked of her was to make sure the aids took care of eats and keeping him clean more than anything. Unfortunately I’m thinking of trying it again due to nursing home issues and thinking what I can do differently. 

When he was in the nursing home, I was going every other day and going at various times bringing him food, water, and treats. He was always excited about that. At the hospital I just make sure he gets down what they serve and that they don't take his tray away too soon. Even did a couple evening visits at nursing home to see what that time of day looks like for dad and other residents. The weekends were the worse.  At the hospital I just make sure he gets down what they serve and that they don't take his tray away too soon.

Nerdyblond. Yes, someone has gotta answer. Not because it happened but because my plea after seeing dad was ignored and because they ignored dad's distress that was visibly shown. You could not miss he was in trouble. Since the surgery, he did graduate to rehab. He keeps saying something feels funny about his leg so he knows something is different. And every now and then says it hurts.