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As I sit here in a hospital room, not how I planned to spend my New Years Eve, I have some questions for the smart folks here. Now before I explain the situation below the fold I know there isn't a "right" or "exact" answer to any of the questions I will ask. Heck I might actually answer them myself. But with that said being a long time member here and reading Diaries like KosAbility, I know a lot of folks here have experienced and dealt with what my family is dealing with now. Any thoughts and/or suggestions would be very welcome.

My grandfather is 94. I wrote a Diary about him here just the other day.

Well Wednesday night he had a massive heart attack. My uncle/his son rushed him to the hospital and left him there, cause you know he needed to pack for a trip. Why I mention this will make sense in a few graphs. Normally the first call would have been to my mother (his daugther), but they were hundreds of miles away on vacation.

My parents as they rushed home had just been told he fell down, which happens more often then any of us would like, cause he just won't slow down. Tries to do everything like he is 64 and not 94.

Well when they got to the hospital they were informed in fact it was a heart attack and his heart was operating at about 20% of the capacity it should. Now the very good news is it is awake and very alert.

Soon after hearing this news the doctor and nurse pulled my mother aside and said her brother and sister had already made arrangements for a nurse home.

Now as a kid my father use to have this phrase he used when somebody helped him out, just cause they could and never wanted anything in return. He'd call them a "scholar and a saint." Well my mother and father are that in spades. My patience, and I deal with these issues rarely, well I wouldn't be nearly as "nice" and "polite."

My uncle and aunt have been trying to get power of attorney and put him in a nursing home for years. My mother will have none of that. Now if he was a danger to himself or had a bad case of Alzheimers I could maybe see the logic in this. But it isn't a danger to himself and his mind, as my father and I like to note, maybe more sharp them our own.

And even though they only live a mile or two from his house, with four of his grandchildren the same distance away they do nothing to help out. My mom cooks all his meals. She calls him each morning at 6 AM and 8 PM. She and my father take him to doctor appointments.

They are the only family members that take him out to eat or shop. The only ones that invite him to any family events. Take him to church each Sunday. It is sad beyond words!

More sad cause he has some financial means. It would seem being a union tool and die maker and a spend thrift you can save a lot of money over a 94 year lifetime. Every six months he writes each of this children a $5,000 check trying to give away his money. He has done this for years.

But I am getting off track .....

There is no way we'll put him in a nursing home. We feel (1) If he was just put into one for a few weeks for rehab, we'd never get him out of the place (2) We feel a nursing home would be close to a "death sentence" for him. He'd just "give up." His wife of 57 years passed away 14 years ago. Now everybody he knew in life that isn't a family member is no longer with us. That has to take a toll on somebody. We feel if we took away the last thing he values, his ability to pretty much take care of himself, his independence, he might just "give up."

The good news is once my parents got to the hospital and talked to the staff they all agreed. Said far too often they see family members put a loved one in a nursing home just so they don't have to deal with them.

Now I am pissed by father hasn't talked to his lawyer about this before, heck he is on retainer, but as long as my grandfather is mentally stable two family members can't just put somebody in a nursing home can they?

My next question is about rehab. As so many have talked about here and I have as well when I got really sick years ago, doctors often don't seem to provide much information to patients and family members.

We have no idea what rehab is needed. Now he will be in the hospital for a few more days, so I guess closer to his release they'll let us know. But what the heck do you do to rehab a 94 year old person?

Sorry, I know this is kind of disjointed. I might not have even asked the right questions. I am just kind of a bull in a china shop. I am trying to stay out of things and let me mother and father handle it and just provide positive support.

I'd like to find my uncle Bob in the parking garage and have a "little" talk with him. But that wouldn't help things. I'd like to corner the Doctor and demand some answers. What rehab is needed? Is surgery at his age not an option? How about some information. But again that most likely wouldn't help things.

So you folks now have to read me rant and bitch instead ..... thanks for letting me do that.

Originally posted to webranding on Fri Dec 31, 2010 at 07:28 AM PST.

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Comment Preferences

  •  Again Any Input Would Be Helpful/Welcome (25+ / 0-)

    and thanks for letting me bitch. Wish I had something happier to report today .... but alas I don't.

    "In a time of universal deceit, telling the truth is a revolutionary act." - George Orwell

    by webranding on Fri Dec 31, 2010 at 07:28:55 AM PST

    •  Go ahead and bitch!! (6+ / 0-)

      You have reason enough!!  Those self-interested relatives give humanity a bad name, for sure!  I can only offer you a pithy saying bestowed on my by a wise man many years ago:  They have to go through the rest of their lives being them.  That's punishment enough for anyone!

      Hang tough, webranding.  Come to us for input and support anytime.

      Liberal = We're all in this together
      Conservative = Every man for himself
      Who you gonna call?

    •  {{{ webranding }}} (0+ / 0-)

      It'll be up from where you find this comment, but be sure to catch the advice by yoduuuh do or do not.  Good, solid, practical suggestions.

      Don't think of it as 'bitching.'  You've had quite an emotional blow with your grandfather's heart attack.  He's been around all your life, and in your Ode to a Cool Dude, your love for your grandfather is palpable.

      Hand-crafted toys?!?  And a hand-crafted grandfather clock?!?  OMG!  If I didn't admire talent so much, I could be very jealous.  I value hand-crafted items of all kinds more than I can express.  You are a lucky, lucky grandkid, and so are the other grandkids.  Best of all, he gave you his time.  The golf lessons were valuable for you, but more important than that was the time he devoted to you.

      Whatever free time you have now, spend it with your grandfather.  He doesn't want for anything or need anything..., but he does need your presence and your time so he can continue to love you, and you can continue to love and appreciate him for however many years he has left.

      Give your grandfather a gentle hug from me, too.

      P.S.  Find out what he did in the war.  I didn't know until after he died that one of my dad's brothers was awarded medals.  I'd heard the family stories about him being part of the group that opened a concentration camp and I knew he was with a tank group, but the rest of the story was that my uncle wouldn't talk about it and damn near drank himself to death after he got back.  By the time I have any conscious memory he didn't drink any more, but I couldn't get a word out of him about his war experiences.  In doing genealogy research, I'm trying to find out if he was with the group that opened Buchenwald....  I might have a hero in the family and not even know it.

      I'm sick of attempts to steer this nation from principles evolved in The Age of Reason to hallucinations derived from illiterate herdsmen. ~ Crashing Vor

      by NonnyO on Fri Dec 31, 2010 at 10:05:50 AM PST

      [ Parent ]

  •  Your question is state specific (9+ / 0-)

    If you think you're too small to be effective, you've never been in the dark with a mosquito.

    by marykk on Fri Dec 31, 2010 at 07:31:49 AM PST

  •  Surgery (11+ / 0-)

    is generally not a great idea when someone is old and frail. It really takes a toll on elderly bodies.

    My grandmother died following heart surgery, and she was around 80, not 94.

    Good luck.

  •  My best advice is to talk to one of the hospital (21+ / 0-)

    social workers.

    They are the best people to talk to in this situation, as they can talk to the other healthcare workers in the hospital, and they also should know the rehab and nursing home facilities in the area as well.

    In addition, they can talk to your grandfather and find out more of what his wishes are.

  •  rehab etc. (20+ / 0-)

    First - how lucky to have your parents, scholars and saints indeed! Second, I have seen my uncle go into rehab following a bad time with blood pressure, diabetes, etc. Often in small towns it is a nursing home, BUT it is clearly limited stay. It usually means getting a person up and walking, strong enough to manage at home. Making sure the meds are keeping their vital signs on an even keel. Just the basics of getting better, but supervised.

    Second, call the attorney, explain your concerns, arrange an appointment. Get him to go to the hospital, or rehab center, and talk with your granddad. Sit down and tell him you want him to outlive all of you, but just in case, please don't leave a financial mess and make sure that things are secure so he doesn't get stuck in a nursing home or someplace if he is temporarily out of commission. An infection can make an older person completely confused, but in a week of antibiotics they can be sharp again. I have seen this personally with grandmother who lived to 90.
    That is my advice. Had two grandfathers die without wills. Not. pretty. Brings out worst/unresolved issues in family. PLEASE. AVOID.THIS.
    And hugs!

    by Chun Yang on Fri Dec 31, 2010 at 07:37:40 AM PST

    •  Well Currently He Is Totally Lucid (21+ / 0-)

      and he has made his views very clear. No nursing home. He also has stunning health care. Some financial means. My parents have a lot. They do live in a small rural town. But to pay for at home care wouldn't be a problem.

      I should have mentioned this. My father thinks part of the reason my aunt and uncle don't want this done, maybe for an extended time is it would drain the money they get when he passes away.

      Guess I should have mentioned this.

      But you make an IMPORTANT point. I know he has a will. But getting an attorney in to know his views in case he takes a turn for the worse, VERY good idea. Don't know why I didn't think of that!!!!!!!!!!!

      "In a time of universal deceit, telling the truth is a revolutionary act." - George Orwell

      by webranding on Fri Dec 31, 2010 at 07:43:45 AM PST

      [ Parent ]

      •  A Will isn't enough these days. (10+ / 0-)

        Make sure there is also a Living Will.

        A person's character is measured by how they treat everyone. Not just your pet group.

        by Tempus Figits on Fri Dec 31, 2010 at 08:12:14 AM PST

        [ Parent ]

      •  Very important point, indeed!! (8+ / 0-)

        Many, many people view an elderly relative with means, even modest ones, as a profit center, and their focus is EXCLUSIVELY the material gains to be achieved with that elderly relative's death.  Heed the advice of puzzled, above, and wield your best smile, your firmest voice, and stand your ground.  Your grandfather is lucid and in possession of his faculties.  It is therefore HIS decision, and no one else should have a say in it.  

        Liberal = We're all in this together
        Conservative = Every man for himself
        Who you gonna call?

      •  stop second guessing (2+ / 0-)
        Recommended by:
        AnnCetera, yoduuuh do or do not

        with this "I should have mentioned this" stuff. You don't have to tell me anything - it is your family matter. I am only concerned that you think of things that made trouble for others, so you can avoid them. I saw family members fight over small amounts of property for years, turning against each other, ignoring an elder's wishes, etc. so the more someone communicates in writing with a legal representative, the easier the healing and grief can be. The greed, not much to be done about that, but that it their problem, not yours.

        Best of luck with this.

        by Chun Yang on Fri Dec 31, 2010 at 11:01:21 AM PST

        [ Parent ]

      •  what is critical is for him to give your (0+ / 0-)

        parents his medical power of attorney - so that should he be unconscious, they can make the best decisions for his care.

        MOVE'EM UP! ROLL'EM OUT... MOVE'EM UP RAWHIDE!!! meeeoooow! mrraaarrr!! meeeOOOOOW!

        by edrie on Fri Dec 31, 2010 at 04:24:13 PM PST

        [ Parent ]

      •  You'll also want to have him discuss a (0+ / 0-)

        POLST order, since it appears that he has suffered a serious event, and there are limited choices for ongoing treatment.

        Orders for

        Please be sure you get a copy from the nurses and discuss this with your parents. So long as your grandad is lucid it's great - but this form allows him to choose now what he wants done in the future, now while he maintains a good grasp... not after you have an event with a bad outcome, where his mental capacity may become diminished.

        It's not morbid, truly, I saw a lot of families, in the clinic I worked at (over 80% >65 yrs old of 1200+ patients), who were very grateful they had this in place when their parents and grandparents had a serious health event. The ones without were all forced to make life or death (and quality of life) decisions on behalf of their loved ones - sometimes without ever having had a discussion with that person about what they wanted. The worst though, were the families with two or three sides - one wanting to continue life support so long as they could keep the heart beating and one concerned more about what they thought the patient wanted and the last group who felt that without quality of life there was no life and wanted to withdraw life support measures.

        Please don't find your family in this horrible position.

        My best wishes for a good outcome for your family, I can tell how much you care for them.

        Oh - and if no one else suggests it - just ask the nurses station nearest your grandad's room for the business card for the hospital social worker, there's about a 70% chance they'll have one for you - or at least the phone number to reach the social worker at. These people (social workers) are worth their weight in gold to families in crisis.

        Finally - you may find that your apprehension over the part of the family wanting to have him placed in a nursing home may be looking to use an 'at risk senior' claim. Even if he is mentally fit, there may be physical concerns about his living alone at this point. This is often determined by an assessment done by the Agency on Aging, which the social worker will be able to point you to.

        "in Order to form a more perfect Union"
        Basta de Guerra. No más. Enough War. No more.

        by Angie in WA State on Fri Dec 31, 2010 at 04:41:43 PM PST

        [ Parent ]

  •  When my father was in hospital/nursing (16+ / 0-)

    for the last few months of his life, he wanted out in the worst way.  He worked HARD, and the rehab staff wanted him to succeed.  I'm sure your grandfather has the will to do it, but I would suggest a big conference with the doctor, a rehab person, the hospital social worker, your lawyer, your parents, and your grandfather to discuss everything.  

    Convene a Life Panel.

    "Nothing in all the world is more dangerous than sincere ignorance and conscientious stupidity." --M. L. King "You can't fix stupid" --Ron White

    by zenbassoon on Fri Dec 31, 2010 at 07:43:39 AM PST

  •  check into home hospice care (11+ / 0-)

    we did this for my in-laws who both went into the hospital around the same time with serious medical issues.

    We found that it was available for them for FREE with medicaid.  Now they have a wonderful person who comes in daily, does some basic cleaning and cooking, checks to be sure they're taking their meds, and gives a general look around to see if they generally look ok, if there's anything else that needs doing, etc.

    It was amazing.

    If you can arrange something like it, between your care and the hospice worker, things should be pretty good.

  •  Yeah. No nursing home. (12+ / 0-)

    Most hospitals have care coordinators.  Their job is to set you up with home health services, including rehab.

    As he improves, some hospitals have outpatient rehab facilities which also provide transportation services.

    Good luck with your Grandpa, Web.  He's lucky to have you all.

    "There's always ten percent screaming about something." hollydem's Dad.

    by pvlb on Fri Dec 31, 2010 at 07:49:37 AM PST

  •  When my mom fell seriously (14+ / 0-)

    ill at 91, I could not get any information about the success of rehab on nonagenarians. In my mom's case, rehab was unsuccessful. You will want to speak to the doctors and nurses about what kinds of care he will need when he leaves the hospital. Your parents may be able to provide it in their home, since they can afford the cost of the help that will be needed.

    You also may want to discuss hospice. the hospice staff are angels and work to make sure that the patient is in no pain. Hospice can be carried out in a home setting. I have been through this, and my e-mail is in my profile.

  •  for mentally competent (15+ / 0-)

    elderly people, nursing homes are frequently the beginning of the end.  We had to put my mom in one for a couple of weeks to rehab after her heart attack, but it was tough.  The next time she had a serious medical event, we just took her home, and between family and Medicare benefits (nursing, OT, PT, etc.), she came back to 100%, and it was much less stressful for us than hovering at the nursing home 24/7 to make sure her needs were being adequately addressed.

    I'm sorry your family is going through this--it's hard on everyone involved.  

    There is no snooze button on a cat who wants breakfast.

    by puzzled on Fri Dec 31, 2010 at 08:01:19 AM PST

  •  Financial Responsibility (9+ / 0-)

    My Significant Other just lost her mother two months ago. She'd had some bad falls and had to be cared for in a rehab facility. She also was diagnosed with Alzheimer's and after rehab she was transferred to a nursing home in the hopes they'd care for her better than we could do at home. Long story short she fell ill and died not too long afterwards.


    My SO was her medical power-of-attorney and did all the paper work for her at the nursing home. The nursing home did their best to get my SO to sign a paper taking FINANCIAL responsibility for the bills. Even though she refused to sign, now, months after her death we are still getting bills sent to us trying to get us to pay for the bills her mother incurred at the rehab facility and at the nursing home. If she'd signed the paper taking financial responsibility we'd be very screwed right now.

    My warning to you is this: Please, be very careful what you or your family signs if you end up needing care for your grandfather from an outside provider.

  •  Rehabilitation, on a home health basis (15+ / 0-)

    may consist of physical therapy to build strength and flexiblity.  

    Occupational therapy will take a look at his home and help set up ways to organize his ADL (activities of daily living) so that he is both safe and energy efficient. That may include added handrails in the bath or shower, etc. and make sure things are in easy reach.

    He may also be recommended a speech therapist to make sure he has no difficulty swallowing, taking his medications, etc. (speech therapy is not just about speech).  

    But the first thing is to make sure all of you and the doctor are on the same page.  I also suggest, while he is lucid and alert, to have a Durable Power of Attorney for Health Care in place as well as a Living Will. The Durable Power of Attorney for Health Care will make sure the decision making is NOT in the hands of the ungrateful relatives.  

    The above is not legal advice, but common sense.  Talk to the hospital social worker as has been advised, who will walk you through what you need to do. Most hospitals have the forms as well as a Notary to certify the signatures.  

    It is horrifying that we have to fight our own government to save the environment. - Ansel Adams

    by Otteray Scribe on Fri Dec 31, 2010 at 08:02:46 AM PST

    •  Gald You Said This (9+ / 0-)

      Occupational therapy will take a look at his home and help set up ways to organize his ADL (activities of daily living) so that he is both safe and energy efficient. That may include added handrails in the bath or shower, etc. and make sure things are in easy reach.

      I've been yelling (politely) at my parents about this 24/7. In the last few years he falls down a lot. Nothing serious. No broken bones.  

      But I keep saying they need to fit his house with devices that will help him get around. Now they argue he is so stubborn he won't use them. But outside a few bars in the bathtub nothing has been done.

      I've read some on this topic. He'll fall down and not be able to get up. Refuses to call for help and might be on the floor for hours and hours before he calls for help.

      I fear one day he won't be able to get to a phone.

      "In a time of universal deceit, telling the truth is a revolutionary act." - George Orwell

      by webranding on Fri Dec 31, 2010 at 08:09:57 AM PST

      [ Parent ]

      •  There is a lot of difference (10+ / 0-)

        between installing a few bars in the bath and doing it with his own body mechanics and ergonomics in mind. The OT will look at things such as how he rotates his wrist and the most comfortable angle for his hand.  In other words, instead of a bar installed horizontally or vertically, they may determine a specific angle is best for him.  It is no accident that the side-mounted joystick control in some airplanes is angled at 41 1/2 degrees, for example.  

        It is horrifying that we have to fight our own government to save the environment. - Ansel Adams

        by Otteray Scribe on Fri Dec 31, 2010 at 08:24:29 AM PST

        [ Parent ]

        •  I Am Totally With You (9+ / 0-)

          this is the only place my parents and I might bitch at each other. His entire house, other then the kitchen has carpet and they wonder why he doesn't use his walker.

          The place he has fallen down a few times and had to call 911 is in the exact same place. Seems to me there is a cause and effect thing there.

          "In a time of universal deceit, telling the truth is a revolutionary act." - George Orwell

          by webranding on Fri Dec 31, 2010 at 08:28:23 AM PST

          [ Parent ]

          •  Carpet is not envornmentally friendly (4+ / 0-)

            Carpeting harbors all kinds of dust and mold that no amount of vacuuming can get out. It also is a trip and fall hazard unless it is commercial grade carpet with a very low tight nap.  The crap that lives in your carpet ends up getting breathed in, can cause irritation to the eyes and respiratory system, etc.  BTW, we have all hardwood floors in our house with no throw rugs or other tripping hazards.  They are a snap to keep clean.  

            I was going to get those imitation hardwood floors in our office and the contractor priced them very reasonably, I thought.  We chose to move the office instead because we needed more room, so they were never installed.

            It is horrifying that we have to fight our own government to save the environment. - Ansel Adams

            by Otteray Scribe on Fri Dec 31, 2010 at 08:41:06 AM PST

            [ Parent ]

            •  You've given such good advice, (5+ / 0-)

              I'll pass a little on to you: most laminate floors are rubbish. They are laminated on top of MDF, which is a toxic hazard itself, and a lot of cleaning solutions will promptly delaminate them. If you intend to go that route, check the brand thoroughly.

              If nothing is very different from you, what is a little different from you is very different from you. Ursula K. Le Guin

              by northsylvania on Fri Dec 31, 2010 at 09:23:01 AM PST

              [ Parent ]

              •  Did not know that. (2+ / 0-)
                Recommended by:
                northsylvania, Catte Nappe

                Thanks.  My house has hundred year old heart pine that is so hard it will break a drill bit and bend nails.  And incredibly beautiful, so it is not going anywhere anytime soon.  

                Our new office has brand new commercial carpet that has a very hard and close nap. Pretty easy to clean and deadens sound better than hardwood.  

                It is horrifying that we have to fight our own government to save the environment. - Ansel Adams

                by Otteray Scribe on Fri Dec 31, 2010 at 09:55:17 AM PST

                [ Parent ]

        •  Yeah, (4+ / 0-)

          I was going to say something earlier that I thought might sound kinda dopey for a 90+year old.

          See if there is a good sports med doc affiliated with the rehab services at the hospital.

          Those guys know an incredible amount about body mechanics, and can prescribe rehab specific to the person.  They will also probably know who the good cardiac rehab person is.  There's an association of sports med doctors, to help check credentials.

          "There's always ten percent screaming about something." hollydem's Dad.

          by pvlb on Fri Dec 31, 2010 at 08:56:34 AM PST

          [ Parent ]

  •  As long as... (1+ / 0-)
    Recommended by:
    Im a frayed knot


    as long as my grandfather is mentally stable two family members can't just put somebody in a nursing home can they?

    If someone is mentally stable, they can't be forced into a nursing home.  That said, if the person is so physically ill that living at home or in an assisted living environment is the only way that they will stay alive (i.e., if they'd die at home without proper home care), then the person may choose to go to a nuring home, even reluctantly.  Of course, they may also choose to live out their days in their home.

  •  Been there (2+ / 0-)
    Recommended by:
    webranding, Im a frayed knot

    My mother always played the role that your parents play in her extended family while her siblings too often just cared for their own convenience.

    All I can say is, you are lucky to have been given your parents' example, and this too shall pass.

  •  The other thing that I would add is that the (9+ / 0-)

    90s are where the demographic decline really begins to set in. The majority of people who live to 80 will make it to 90, but the majority of people who make it to 90 will not make it to 100. I am at the age where all my friends' parents who are still alive are in their 90s. These are people who have lived long and healthy lives. Most are pretty damned stubborn and independent, but many are starting to fail, some physically and some intellectually. Time catches up with all of us.

  •  Nursing homes when not absolutely necessary (6+ / 0-)

    are not a good idea due to transmission of disease alone. My Canadian grandmother died of pneumonia after being transferred from one to another, even though both facilities were spotless and quite well run.

    If he has some money, have you thought of hiring an in home aid to help out?  This is something my aunt and uncle, in their 80's, are doing in Canada, though up there they get provincial assistance for it. It allows them to live independently despite significant medical issues.

    •  We Like To Call My Mother (8+ / 0-)

      the "Little General." All 4'7 of her. If you tell her she can't run through a brick wall you will find her running into it time and time again to prove you wrong.

      They will get at home care and support. That is a given if I didn't mention it. But she will try to do a lot herself.  

      "In a time of universal deceit, telling the truth is a revolutionary act." - George Orwell

      by webranding on Fri Dec 31, 2010 at 08:21:29 AM PST

      [ Parent ]

      •  Do try to get your mom not to do too much (11+ / 0-)

        herself. This is a stressful time for everyone and doing whatever will relieve some of the stress is important for her health also.

      •  sewanee pat is right. You mom needs to (10+ / 0-)

        oversee the caregivers, but she needs to leave the work to others. They are trained in basic things like how to move bedridden patients. Caregivers experience a lot of stress. You need to rely on the professionals for his care. The important thing is to get the care in a home setting. You mom's job is to be his advocate, not to do the caregiving herself.

        •  Maybe The Best Advice (6+ / 0-)

          My mom will try to do everything herself. Just like I do. We got the same DNA :). We often find it hard to ask for help. In fact my mother was pondering last night how she could pick him up if needed. Her ideas didn't sound that "smart" to me.

          Going to have to figure out how to get her to manage and not do.

          "In a time of universal deceit, telling the truth is a revolutionary act." - George Orwell

          by webranding on Fri Dec 31, 2010 at 08:43:46 AM PST

          [ Parent ]

          •  Do not try to do this. (3+ / 0-)

            First, your mom may injure herself. Second, and even more importantly, she may injure your grandfather. Elderly people bruise very easily and have thin skin. You have to know what you are doing. Even though my mom only weighs 66 pounds now, her caregivers use a sheet to move her so that she does not bruise.

            Spend the money to get good help, 24-hour if necessary, and tell your parents that their primary job is to be your grandfather's advocate. Trust me, that can be a nearly full time job.

          •  A thought... (2+ / 0-)
            Recommended by:
            hazey, blue jersey mom

            Try to approach a problem such as "how to pick up granddad, if needed" from the issue, not the actor.

            In other words, if your grandfather needs to be picked up, it's more important that he be picked up promptly, carefully, and with maximum safety in mind... than it be your mom to be the one to pick him up.  It's MUCH more important that your grandfather's needs are seen to, than it is for your mom to personally perform every single task needed to meet his needs.

            (In the case of picking up an elderly patient, a home aide can attach a belt that assists with a patient regaining their footing.  In addition, they can assess if the patient can safely be moved in the first place, and they may be able to persuade the patient to use aids such as handrails, walkers, etc.)

            It's certainly sensible and appreciated to get assistance with the activities of daily living.  You never know; your grandfather might actually prefer that someone he doesn't know personally be the person to assist him with things like bathing or toileting activities.  (These are often functions that some people find excruciatingly embarrassing to perform in the presence of close relatives.)

            Again, it comes back to what your grandfather's preferences are.  If he would prefer in-home care, be sure to ask him who he wants to provide care most of the time, and who he'd like to have provide care some of the time.  (Don't offer up the option that one person could take care of him all the time - that way lies hardship for the caregiver, especially if he requires assistance or care for a prolonged period, or the type/amount of help required increases, over time.)

            Good luck!!

            "Fast, Cheap, and Good... pick two." - director Jim Jarmusch

            by AnnCetera on Fri Dec 31, 2010 at 10:57:24 AM PST

            [ Parent ]

        •  I Used To Try To Be Artist When I Used (11+ / 0-)

          actual film in cameras. I find what I take with a digital camera is never artist. Just pics. I got this one of my mother the other day.


          Going to blow it up and give it to her. I don't know why, but I like it a lot. I mean a lot!

          "In a time of universal deceit, telling the truth is a revolutionary act." - George Orwell

          by webranding on Fri Dec 31, 2010 at 08:51:12 AM PST

          [ Parent ]

  •  sorry to hear that (4+ / 0-)

    you have relatives that would seemingly make decisions based on self-interest instead of the best interest of the decided on.  I faced that myself in my mother's declining years and that managed to be the most painful aspect of the whole thing.

  •  I don't have any suggestions that haven't (6+ / 0-)

    already been made, but I just wanted to say that my thoughts are with you and your family. I remember your wonderful diary about your granddad's birthday and taking him to get a burger, as well as your diary about your family's financial planning. What lovely people.

    Know that many will be praying and thinking of you, your parents, and most of all, your granddad.

  •  You have lions for parents (8+ / 0-)

    I hope you fully understand and appreciate their tenacity and devotion to doing the right thing.  They (and your grandfather's amazingly long run of good health) make for the sort of story that brings joy to my heart.

    18 months ago my stepfather died.  My mother is 71 years old and significantly disabled from several strokes, has some short-term memory issues, and has an income that just barely covers the bills.

    My siblings and I are still trying to sort out what to do for her long term care.  We hired my eldest sister as a full-time caregiver.  She earns way less than she should but the cost of care had to fit into my mother's budget.  My brother and I split big expense items like vehicle maintenance, property taxes, and home repair, and another sister and I split the duty of running Mom's checkbook (Mom has just enough dementia to prevent her from handling her own finances).

    So far, so good.  Mom is still in her own home, is well cared for, and is happy.  We can maintain the status quo over the long term, but we're one more stroke or a bout of cancer away from a real catastrophe.

    "First they ignore you, then they laugh at you, then they fight you, then you win". Mohandas K. Ghandi

    by DaveinBremerton on Fri Dec 31, 2010 at 08:20:39 AM PST

    •  To Be Honest Maybe Only Recently (6+ / 0-)

      I hope you fully understand and appreciate their tenacity and devotion to doing the right thing.  They (and your grandfather's amazingly long run of good health) make for the sort of story that brings joy to my heart.

      But as I get older yes. I never knew they were Republicans until I was in my mid-20s (I am 41). They like to say they saw no reason to force their views down my throat. Or as I like to say they let me figure shit out for myself.

      I'd argue my parents give more of their time, retired, to liberal organizations then most liberals do. The local hospital. Community college. A woman's rape crisis center. A food pantry. The local historical society.

      This is so off topic from this Diary, but I feel it needs to be said from time to time.

      "In a time of universal deceit, telling the truth is a revolutionary act." - George Orwell

      by webranding on Fri Dec 31, 2010 at 08:59:42 AM PST

      [ Parent ]

      •  Your parents are liberals (4+ / 0-)

        I'd argue my parents give more of their time, retired, to liberal organizations then most liberals do. The local hospital. Community college. A woman's rape crisis center. A food pantry. The local historical society.

        It's just that no one has told them yet.  Let's keep it our little secret.

        The conservatism that believed in community has been dead for a very long time although a few refugees survive.

        Your folks sound like seriously classy people.

        "First they ignore you, then they laugh at you, then they fight you, then you win". Mohandas K. Ghandi

        by DaveinBremerton on Fri Dec 31, 2010 at 09:30:44 AM PST

        [ Parent ]

  •  Oh this hits home all too closely (4+ / 0-)

    and I feel for you.

    Get a social worker who can explain all the other options.

    Now as for the NH or SNF...many have rehab floors. I'm not certain just what capacity your grandfather is in physically, but it might be appropriate for him at this long as everyone and I mean everyone including your grandfather understands that the rehab is what he is there for and often time they have strict time limits (usually a few weeks) for him to remain eligible for those types of beds. He would get the much need physical rehab incuding therapies (physical occupational etc) he may need for his cardiac condition.

    That said, that might also give you some time to explore and get in place other services for his return home. For example hiring caregivers (there are places that specialize in 24 hour care if it's needed) and I'm not talking strictly nursing care, just people who can watch him if needed and get into place other services such as Meals on Wheels or those home grocery market shopping delivery services. A good social worker (at the hospital you're in) should be able to hook you up with the agencies near your granfathers home that have those things or at least know where they are available. It is there job to know what resources are out there. Yes schedule a meeting asap with the whole team if possible (meaning doctor's social workers family to discuss all your concerns, needs, wishes...and most importantly keep your grandfather in the loop on this..especially if his faculties are that coherent and clear...good for you and him).

    Plus is there a health care proxy? Might want to have discussions (at some point) about end of care health decisions if he hasn't already (how much and what type of care he wants if he should become further debilititated)

    If you decide against the short term rehab stay (and I understand if you do) and home is the place you all insist on him going, again there are Home VNA services near your grandfather's house that should be contacted and in addition to the above types things I've mentioned.

    A good social worker should know who and where to get you hooked up to near your grandfather's home. Best of luck.

    The fact that your grandfather has some resources will make getting some things for his care at home much easier and give you some time to plan for the future.

    I know I'm a bit scattered and all over the place here but I'm rushing out.

    Hang in there and do not hide anything from your grandfather about what is going on and why. He's probably already got a lot of it figured out about people's motives and who really is concerned about his quality of his life at this point.

    It will not matter how much money was in my bank account, but the world may be a better place because I was important in the life of a child.

    by emal on Fri Dec 31, 2010 at 08:27:45 AM PST

  •  I don't have any answers for you... (7+ / 0-)

    But it looks like you're getting a lot already from others. So, I send you a big hug and a thanks for this. I love hearing about your good family, even under these horrible circumstances. I can tell how stressed you are from your post, which is totally understandable. I've been there. Or somewhere kind of like it. I guess I do have a little advice for you: Make sure you don't run yourself down too much during this time: eat and drink regularly, get sleep and exercise, and breathe deeply when you want to scream. It will help you deal with the emotions and everyday tasks while helping to resolve your grandfather's future. I'm so sorry this happened, webranding, but it's good to hear that the doc and nurse expect him to make it through this. Take care, buddy.

  •  Be carefull (1+ / 0-)
    Recommended by:
    Im a frayed knot

    with directives.My mom died because her MD withheld treatment because she had one.

  •  I ache for you (1+ / 0-)
    Recommended by:

    but I must advise you:  DON'T DO A NURSING HOME!  Every fear you mentioned will be realized and more. We had my dad in an "assisted care" unit for Alzheimer's, which was little more than a nursing home.  Any time he got an infection, they were running him off to the emergency room of a hospital.  The tubes and intrusion to his body were torture.  The hospital billed hugely, then gave a cut to the home.  They would not let his body go once he had left.  They tried to turn him into a cash machine.  It took the intervention of my doctor brother and my attorney brother to make them stop it.  Meanwhile, he sat in a chair or laid in his bed.  They would hoist him from his chair to his bed with something like a small crane.  This was no way for him to die.  If he still has his mind about him and is ambulatory, he should not be in one of these awful places.  I have given strict instructions to my children that I am never to go into a home.  When I am no longer able to function, I am to go into hospice to die peacefully.

    You're sleeping on a featherbed of lies - Scott McKenzie

    by Im a frayed knot on Fri Dec 31, 2010 at 09:15:18 AM PST

  •  Location, location (4+ / 0-)

    You have gotten a lot of excellent advice to connect with social work staff at the hospital. However, I also note that the hospital (and potential nursing home/rehab ctr) is in a different state than where he usually lives. You may find that S.W. staff are not as knowledgeable about what is available closer to his home. Here's a link that might help you:

    Welcome to the Eldercare Locator, a public service of the U.S. Administration on Aging connecting you to services for older adults and their families. You can also reach us at 1-800-677-1116.

    You can search it by zip code.

  •  I cannot top the excellent advice you (2+ / 0-)
    Recommended by:
    nchristine, Im a frayed knot

    have already gotten, but I would just like to say that your gut feeling about nursing homes is spot on. DO NOT let anyone railroad him into one. They are purely profit vectors these days, in my experience, and there is nothing that can be had from them that cannot be better achieved with in-home help.

  •  asdf (0+ / 0-)

    "I'd like to corner the Doctor and demand some answers. What rehab is needed? Is surgery at his age not an option? How about some information."

    Unless you have medical power of attorney, you may not get very far on getting information due to HIPPA.  Now, that doesn't mean that you can't badger your mom to talk to the doctor.  There's weird protocols for dealing with family and who the doctors/nurses can and/or will talk to.  There are traveling nurses that can work with your gp in home after he's been discharged.  If for nothing else than to just have another set of eyes keeping an eye out for him.

    I agree with your assessment of your grandfather probably giving up if moved permanently to a nursing home.  Some of those old coots are just as stubborn as a mule.  I think you are correct in that your folks are saints for caring for their father so well.  Your mom's brother and his wife are something else.  They can sit and spin for all I care.

    "You know I am not very religious. But I believe in Karma. He might be dropped off in a nursing home by his children sooner then he realizes. Karma can be a mean bitch .... "
    Oh, yeah baby, karma is definitely a mean bitch.

    •  Karma... (0+ / 0-)

      Is no meaner than the people to whom it applies.  (In my mind, this means each person, as an individual.)

      There are only two people whose behavior has ever made me utter the phrase, "You know what?  I hope he (or she) finds the person that he (or she) deserves."

      People who heard me and didn't know me well, thought it was a wish for happiness.  The couple of people who knew me well turned toward me sharply and gasped; it was the meanest thing they'd ever heard me say.

      "Fast, Cheap, and Good... pick two." - director Jim Jarmusch

      by AnnCetera on Fri Dec 31, 2010 at 11:04:00 AM PST

      [ Parent ]

    •  My uncle sounds just like your gf. (0+ / 0-)

      He's 88 and just the same.  Has lived alone for 20 years or more and would die a wretched wreck if forced from his home.

      He suffered a heart attack a few years ago.  Rehab and social services came to his home after he was released from the hospital and (apparently) got him back up and running.  Social service judged him able to live on his own, so he does.

      I live cross-country from him, as does the rest of the family so we're not much help to him on a day-to-day basis.  Your gf is lucky to have local support.

      Go with your instincts.  I know for a fact that my uncle would rather die from a fall down the stairs than live in a home.  And I respect that.

      Power isn't something you are given. Power is something you TAKE.

      by lonelyutahdem15 on Fri Dec 31, 2010 at 11:12:23 AM PST

      [ Parent ]

  •  I'm there now. My father is 90 and in a nursing (3+ / 0-)
    Recommended by:
    hazey, emal, Catte Nappe

    home, but every situation is different, of course. My dad does have Alzheimers. While I do have one sister, she lives in London, so she can't chip in to help much at all. I haven't been able to leave town in about 7 or 8 years. Even though he's in a nursing home he needs me in addition to the staff because I'm the only person he confides in and feels he can trust.

    The staff needs my input too as I have power of attorney and his mind is too far gone to make rational decisions about anything. He often can't remember my mother's name (she passed away in '93) even though they were married over 30 years.

    Even though he has a long term care insurance policy, it only pays about half of the $6,000 a month (!) bill that it costs to take care of him there. He's had multiple strokes, he's catheterized, in a wheelchair and wears diapers.

    Anyhow... I used to get very frustrated with him because he refused to exercise when it was still possible for him to do so. So I saw this coming years ago -- that he would eventually be incapacitated and that I'd be the only one left to take care of him.

    He's not a wealthy guy and was always terrible managing his money. His retirement and Social Security add up to about $3,000 a month, which I just hand over to the nursing home, along with the $3,000 he gets from his insurance policy. This leaves nothing at all left over at the end of the month, but I have to maintain his house and all of his possessions. Last year there were major plumbing problems that cost me about $7,000 to repair. I won't go into details but I'm barely scraping by without having to find the money to pay for stuff like that.

    One point I'd make is that, at least where I live, the "Rehab Centers" that help the elderly - like your Grandfather - often double as nursing homes. But that doesn't mean that everyone who goes there ends up staying, eventually decomposing and dying there. In fact my dad's been in the rehab place twice and both times it helped him a LOT.

    So my .02 cents is to talk to his doctor and if s/he feels your Grandfather would benefit from staying in a rehab center a while, then explain to him that this would NOT be a permanent situation and would simple be, well, rehabilitation.

    Besides, if the rehab center(s) in your area are like the ones near me, they are getting very crowded and the staff wants people (who can still take care of themselves once back on their feet) in and out as quickly as possible.

    Good luck to you and your granddad. These are the times that try men's souls.

    This ain't no party. This ain't no disco. This ain't no foolin' around!

    by Snud on Fri Dec 31, 2010 at 09:56:00 AM PST

  •  Tough times... Hugs (3+ / 0-)
    Recommended by:
    emal, blue jersey mom, AnnCetera

    Sounds like there is a question related to g'pa's current condition and his ability to continue to live independently.

    There is also a difference between rehab [short term] and just "nursing home" [long term] both in objective and who pays. Rehab can be done on an outpatient basis. My dad had PT at home and my neighbor goes to a clinic 3x a week.

    Would your parents consider having him live with them as an alternative? We used a home health aide for bathing for both my mom and dad. What does your g'pa want?

    The POA is really needed especially with no spouse. My brother and I had POA jointly for both my mom and dad. I was primary for health care and my bro was primary for financial. This was important as my widower dad's stroke left him totally 'dependent' for 4 years before his death. This also gave us the decision ability to carry out his wishes on his advance directives. We had had POA discussions when my mom got a terminal diagnosis. Word to the wise, have you had such discussions with your parents before you are faced with a crisis situation with them? [Fortunately we tended to agree on his care 90% of the time and the other 10% could be negotiated]

    Mostly you are in a tough place with emotions running high dealing in the first stage of grieving without enough intel to make any real decisions. You may want to have someone hanging out at the hospital to catch his Docs during rounds to get some real info about his medical condition and the course of treatment that they are pursuing.

    Again, hugs.

    "...fighting the wildfires of my life with squirt guns."

    by deMemedeMedia on Fri Dec 31, 2010 at 10:53:17 AM PST

  •  If it was me (0+ / 0-)

    Having someone at Pops house during the day is my first choice, as long as his mental decision making is sound.

    At 94, surgery is going to be real tuff, maybe not an option, then rehab and Physical therapy is a must.

    Asking family members who dont do a lot, to do more, might be the wrong thing at this time.


    FDR 9-23-33, "If we cannot do this one way, we will do it another way. But do it we will.

    by Roger Fox on Fri Dec 31, 2010 at 11:45:26 AM PST

  •  webranding, (0+ / 0-)

    if you can email me - my 93 yr old mother has gone through a fall, actually several falls, this year.

    the rehab facility isn't like a nursing home - it is where the patient is given extensive physical rehabilitation to bring their health back up.

    they will continue with home care for some weeks after he is released.  medicare allows for (i think) 90 days of rehab, then a number of weeks of in home follow up visits.

    please talk to the staff of the hospital and check out the rehab facilities that are available to you.

    you have a lot of work to do in a short period of time, but your family seems willing to do what is best for him.

    i am thankful that my sister lives near my mother (i'm 3000 miles away) - but this is a daunting task - not unrewarding, but daunting!

    i am sending you and your family and grandfather healing thoughts... and well wishes for his return to his home.

    (you might also want to talk to him about giving your parents "medical power of attorney" - to keep the uncle from stepping in and trying this again.

    blessings to you all for a much happier new year.

    and, email me.

    MOVE'EM UP! ROLL'EM OUT... MOVE'EM UP RAWHIDE!!! meeeoooow! mrraaarrr!! meeeOOOOOW!

    by edrie on Fri Dec 31, 2010 at 04:15:54 PM PST

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