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My elderly dad lives 1,200 miles away from me. He chose not to move back closer to me when he started having mobility issues and now is at the point that he can’t fly and the cost of assisted living in my state is too expensive for him. In the last three months he has been hospitalized three times and in three different rehabs. Every time he goes home he falls. He was home for 10 days and had to call rescue 7 times to help him up. I had to take a month off to be with him I arraigned a CNA for 20 hours per week through the VA and that wasn’t enough care and he isn’t eligible for anymore. He is out of his Medicare days and is being discharged in two weeks. I arraigned placement at an assisted living and he is refusing to go saying he is going to go home or just die. My days are spent on the phone with his healthcare providers, social workers, his friends telling me how bad he is and him calling me and complaining about everything. He can’t walk and lives basically in his recliner when he’s home. He calls me in the middle of the night because he’s cold or thirsty when I am 1,200 miles away. I am the only family he has. I’m depressed, mentally exhausted and at a loss. My adult children and husband are starting to resent him because they see what a toll this has taken on me. Thanks for listening.

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“He chose…..” “He falls….” “He can’t….” ‘He won’t….” “He calls…” “He is refusing…”

Probably the hardest situation possible, for the LO who keenly bears responsibility for someone who is/is not, able to manage his own care while simultaneously refusing help.

”Caring” should always try to approach “balance” for both care needer AND care giver, and you and your father are obviously not there, for EITHER of you

If he lucid, and proven lucid LEGALLY, HE MUST arrange for help, because you are RIGHTLY unable to drop your life and manage his needs from where YOUR life is.

If he is NOT lucid, you must establish your legal right to provide SAFE care for him, which appears in his case to be Assisted Living, and provide it.

You are “the only family he has” but that does not, and should not mean that you have to shape YOUR LIFE around what HE WANTS OR, EXPECTS, because he KNEW where you were and what choices he had available when he was able to make choices.

If none of HIS CHOICES served him as his circumstances declined, the list of choices HE could make became shorter. That’s NOT on you!

Don’t allow yourself to be the decision maker UNLESS that’s legally your job!

Remember, what he needs AND WHAT YOU NEED. Sometimes, (maybe this time) there are no happy, pleasant decisions that will please every one involved.

If you do the very best you can do, be at peace with what you decide. You deserve to be.
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Amanda, I don't know what to say. You need to focus on taking care of yourself. Think of when you are on an airplane and the oxygen masks go down. The adults are instructed to put their own masks on before assisting their children.
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Amanda1996 Dec 20, 2023
So true , Thank you
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Part 1. Choices & Consequences
Stop. Breathe. You do have choices.

Your Dad has choices too. All choices have consequences.

Dad choose not to move to an AL near you. Consequence #1 he lacks assistance, #2 He lives far from you.

You choose to stay with him & arrange CNAs to improve his safety at home.

What were the consequences for you? Reflect on this.

YOU get to decide for next time. What & how much you will do.
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Amanda1996 Dec 21, 2023
Thank you🙏🏻
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Why is rehab releasing dad to go back home to live alone, in his condition, I don't understand that???? When rehab wants to release him, tell them he is an UNSAFE DISCHARGE and has nobody at home to care for him. If this rehab is a Skilled Nursing facility, they probably have a long term care section where he can move into. If he has funds to private pay, he does so until he runs out of money and then applies for Medicaid. Speak about this with his social worker and case manager now, before they want to release him. And tell them about his falls at home and calling rescue 7x in 10 days.

Best of luck to you.
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You are going to need to have him assessed for competency. You should be communicating to the MD the history here and the fact that a discharge without placement is an "unsafe discharge". In truth, if you are RESPONSIBLE as POA you should now be asking for an assessment, because given recent history your father is not competent in his decision to do this. You may need Social Worker at the Facility to work to get you temporary guardianship over him.

Now if he is COMPETENT and honestly wishes to go home to die, one of these times he will do so. That is for certain. It IS an unsafe discharge.

Contact Social Services at the rehab. Stop enabling this with any in home care, as if he isn't cared for 24/7 this is still unsafe. Rehab isn't the answer. His balance and fragility makes him unsafe to be home alone.

I hope you will update us after speaking to Social Services.
We on AC have had cases like this, one a mother of a member who constantly refused placement and chose home. She did die at home alone. That was likely her wish, in fact, and she did so after a fall. I am so sorry you are currently going through this from so far away but what you can do about it is completely dependent on what kind of power you have, and currently that is--not much.
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Southernwaver Dec 21, 2023
She also needs to tell the social worker that even with CNA they are not 24 hours a day (he is more alone than with someone) and he has still fallen 7 times while hiring them. It’s obviously not helping.
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Part 2. The Downsize
I see this as a new life stage is before Dad: The Downsize.

Sort of like he can get a much smaller car to drive. One he can still handle.

I heard a frustrated Doctor yell at his patient once, "I told you last time you fell & the time before that.. Choose you nursing home or your family will. The time has now come".

Most of us want the dignity to choose for ourselves.

Maybe a Licenced Social Worker who specialises with the elderley can help Dad explore this stage & to understand the consequences of his choices?

PS I would suggest Dad get a falls alarm if going home is still a viable option.

PPS I'd warn I was not his concierge. Won't be answering late night calls. Certainly NOT able to bring a blanket or a glass of water! What's that about? If he is independant to live alone, he can place a blanket on the end of his bed & a glass on his side table, right?
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You need to use these words: unsafe discharge. Idk if it will help but he is NOT SAFE at home so it may be to the point where he doesn’t have a choice.

Put your phone on do not disturb when you go to bed. You are entitled to 8 hours of quality sleep. He made his decisions. If he has a crisis, he can call 911.

You can opt out of playing his games. Stop being so competent and available. stop rescuing him.

When you step in to clean up his messes, I have no doubt he thinks he is doing just fine. He thinks he is handling his life.

Also, have you ever told him how this is affecting your life, sleep and health?

Tell his friends if they are so concerned, they can go over there and help him.
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Amanda1996 Dec 20, 2023
Thank you, I needed to hear that. I just have to get myself strong enough to stop rescuing him. The guilt eats away at me. I always tell them he’s not a safe discharge and lives alone but when they find out he has a Cna they always let him go. He doesn’t qualify for Medicaid and doesn’t make enough to private pay so they just boot him out
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You might consider filing a complaint regarding unsafe discharge with medicare's quality improvement organization https://qioprogram.org/locate-your-qio

In terms of guilt, please try to be kind to yourself. You did not create this situation. Boundaries are a good thing.
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Amanda1996 Dec 23, 2023
Thank you🙏🏻
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I hear you, I have been in similar situation, although not geographically far. After the last fall and hospitalization and rehab hospital for my dad, I had him placed in assisted living under the understanding at the time that it would be potentially temporary and subject to reconsidering going back home. I was then considering letting him go back home , but thanks to advice on this forum, I have not , and he is staying in assisted living. For my health, and his best interest, it really needs to be that way....
For your scenario - it sounds like the CNA who visits home is no more? in that case, if your dad ends up getting admitted again, can you then push for placement?
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Beatty Dec 21, 2023
Sometimes you do have to push, sometimes just not jumping in.

A poster's FIL (Way's? or Peggy's?) was adament his family would move in & be his 24/7 help (again). Not their first rodeo.. so instead of stepping in, they stood firm together. Hospital Social Worker said "I see" & that train changed tracks.

Struggling, you were a quick learner!!
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That’s amazing! One night hearing commonsense on the site is enough to help Amanda change her approach! So it is all worthwhile, fellow posters.
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NeedHelpWithMom Dec 23, 2023
Yes, it’s wonderful to see that Amanda didn’t fly across the country to accommodate her father’s needs. He will receive care around the clock from a professional staff at his assisted living facility.
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