Care for Dad

ripscott

My 101 year old dad just got out from a 3 week hospital/rehab stay. He has regressed so much. He can barely walk now. They placed a catheter in and he doesn't understand it at all. I am afraid he is going to pull it out. He is now also fecal incontinent. He is totally uncooperative and will not do anything we ask him to do so we can take care of him. Appetite is not good. Often will not answer our questions- just stares. How do you clean him up when he gets so combative? He was a mess tonight and we can't safely get him in the shower. In rehab they would place him on his back and roll him over to clean him and then yank on his clothes - he screamed and fought every time. I do not want to treat him that way. How can we keep him clean and not treat him so rough in order to do it. He's strong when he fights against us so I think he could do more to help himself, but he doesn't understand that would help him. I'm not sure I understand palliative care and hospice. Do you think he is at the point of hospice? My sister and I just want to keep him healthy and safe but we're struggling with him being so uncooperative. He acts worn out mentally and physically. We're scared we are doing him more harm than good trying to take care of him.        Just venting I guess

Pat6177

You can call one or several hospice agencies to come and evaluate him for hospice or palliative care. Check their website to see if they provide both hospice and palliative care. Then they can explain the 2 levels of care and recommend the best option for your father. One rule of thumb is that palliative care is for folks with a year left to live and hospice is for folks with 6 months. My understanding is that Medicare will pay for the hospice care but not the palliative care. The hospice care can be provided wherever he is - at home, in assisted living, in memory care. I haven’t used hospice care (yet) but I gather that you would get an aide to help with bathing a couple of times a week. They would help teach you best methods to get him cleaned up. The hospice folks would also help with pain medication. This might make cleanup time a little easier. Hospice will also provide medical equipment like a hospital bed which would make cleanup a lot easier on your back! I think they will also provide a wheelchair if indicated.

I don’t know what your finances are but you might want to look for some in home caregivers.if you are able to find someone with experience with folks with dementia, that would be best. And that would then be another source of training for how to clean someone up. 

You don’t say why he was in the hospital or rehab and you don’t say haw advanced his dementia is. But you may want to check out different facilities nearby in case you need to place him in a hurry.

Again, I have not needed to do this yet but I gather from other posters that your LO’s doc can write an order for in home care. Something you could ask the hospice agencies that you speak to.

Hang in there! 

M1

You have nothing to lose by asking for a hospice evaluation--no doctor's order or input needed.  I suspect he will qualify.  Another thing we didn't talk about on your other thread--without careful hygiene, that foley catheter is going to get infected in a New York minute--maybe already is, and he could easily die of sepsis from it.  Maybe that's okay--but you need to think about that and be prepared for it.

Iris L.

Unless there is a strong medical reason for a catheter, I would get it removed.  It has to be removed by a nurse, not a layperson.  There is a balloon inside to keep it in place, if he pulls it out, it could injure his urethra and cause more problems.  Also, as M1 says, indwelling catheters are prone to becoming septic.  They are supposed to be replaced daily, but usually are not, due to low staffing in hospitals and facilities.  They use catheters for staff convenience.   He will have to be in adult disposable underwear.  

Iris L.