A Slow Form of Suicide

My dad continues to be depressed.  They changed his medication from Prozac to Zoloft.  He also sees a psychologist. 

The biggest issue around is depression is that he refuses to eat.  This started before his fall and hospitalization.  Once my sister and I stepped in and took over his care, he slowly began to eat some of his old favorites.  In fact, we learned that he had gained five pounds during the last month or so he was home.  Since he has been in rehab he has gone from 150 pounds to 134 pounds. He is slowly starving himself to death.

We have all tried to talk to him about it.  Today when his OT encouraged him to eat he told her to stop talking about it.  When she pursued the subject and told him that bad things were going to happen if he didn't eat, he told her that it was fine with him; he was done here anyway.

Is this the depression talking?  Is it a response to his aging....that he knows that it is the time for him?  

It's so hard to know what to do and how to support him.  Even if he does recover from the fall and the depression, he knows that his life will never be what it once was.  He understands that he has lost his independence and freedom.  I just don't know if he can learn to accept that and move on to the life that he will have.

Depression

Although my father is in an excellent rehab facility, his depression is worse and it is interfering with his progress.  While he refused to take anything to treat his depression in the past, he agreed to begin taking an antidepressant.  Unfortunately, they don't work immediately and can take even longer to work in the elderly.
Before he fell this last time, he told an OT who treated him at home that he was going to take his gun and kill himself.  He tells the rehab staff in the evening to not come into his room unless they have a gun and plan to shoot him.
We did ask that he see a psychologist and according to his day nurse he agreed to see him and to talk to him.  He had his first visit today.  
I am so grateful that the staff at rehab realizes that depression in the elderly is not a normal part of aging and is doing their best to treat it.

After the stress and the hunting, my father was finally admitted to our first choice for rehab.  I have to say, it appears to be an extremely well-run facility and my sister and I are feeling a strong sense on relief that he is here and is getting the help he needs.
I'm looking back on his hospital discharge which I felt was rushed and sloppy. Medicare gives you a twenty-hour window before the hospital can place you in any facility that has a bed.  While Medicare does say that the discharge mus be "safe and adequate", there is no real definition or protocol in place to explain exactly what that should look like.
Here are some things I wish we would have done differently:

• started to look for a rehab facility the first day my father was admitted to the hospital. Instead, my sister and I both stayed with my father in the hospital when one of us should have spent that time looking at facilities.   Before his discharge we found two places that were acceptable to us and as it turned out neither had beds available.
• widened the area in which we looked.  My dad, of course, wanted to be close to his home.  However, we are fast learning that emotional comforts, such as being near his friends so they could visit, are often not feasible.
• followed up with the doctor to make sure that she did what she said she was going to do.  When the doctor found out that we were having trouble finding a place, she told us not to worry, that she could medically keep him for a couple more days.  However, she never did rescind the discharge order.  She was a resident and while she took excellent care of my father while he was in the hospital, she probably was not aware yet of all the rules required by Medicare.

We did end up appealing the discharge, which we did only to get more time.  This is what I understand about an appeal.  If you appeal the discharge you do not have to pay for the services you receive during the appeal.  Medicare will review the medical records and if they find that you do need to be discharge, they will cover your hospital services until noon of the next day.
This seems to me a very costly way to buy more time, but it finally did feel like the only option open to us. 

No Matter What You Call It, It's Still a Nursing Home

Last week after refusing Assisted Living once more, my father fell again--the third time in four days.  This time EMS took him to the hospital.  Once there, they found that my dad was dehydrated, had a severe urinary tract infection (which can cause confusion and disorientation in the elderly) and had a condition where his blood pressure drops when he stands up.  His face was bruised and there were skin tears up and down both arms.
Fortunately, antibiotics cleared up the UTI, but the fall and infection weakened him considerably. 
Now we changed our focus from Assisted Living to a Sub-Acute or Rehab facility.  My sister and I choose two that were acceptable to us.  Neither had beds available.  
On Saturday, the social worker told us that there was a bed available in a place called Autumn Woods.  We checked it out and saw a place in serious need of paint and with people sleeping in wheelchairs in the lobby. 
Later that afternoon the social worker came by again and said we had to move him or Medicare would not pay for the hospital stay. We began to get anxious.  In their minds once a bed was available, you had to take it. Needless to say, we had a restless night.
The next morning another social worker came in.  Again we were told we had to take the available bed.  Once again I refused.  I told her in what I hoped was an assertive, but not aggressive way that we other places to look at and were doing so that very afternoon.  During all this my father is getting more and more agitated and scared, worried that he was being sent away without any say in the matter.
Later, the social worker came back and wanted me to sign a paper saying that we had been told that we could appeal the discharge and refused to do so.
Wait......what?
Appeal?  No one had said anything about an appeal.  
What we didn't know as elder-care virgins is that Medicare has an appeal process in place. Once you call and ask for the discharge to be appealed, the case is reviewed by a nurse and a doctor.  But what this really does is give you 2 to 3 extra days to look for an acceptable facility. 
Good to know.  I'm sorry we had two sleepless nights over this, but now we know and can begin a new search tomorrow.  
We're keeping our fingers crossed. 

Held Hostage

The day after the last post my father told us he changed his mind and he wasn't going into Assisted Living, thank you very much.  He could, he said, take care of himself.  
Over the holiday weekend he fell four times.  911 was called twice.  
At this point my sister is so upset that she can't talk about it anymore.  Yesterday I had an uncharacteristic meltdown over something so minor that I scared myself.  The challenges to our strength and patience seem overwhelming right now.
My dad has always been a difficult person.  One of the things that is the most frustrating to me is his lack of compromise over any issue.  It always has to be his way and he would gladly cut off all contact with me than to do things any differently than the way he wants to do them. To date he's turned down every option we presented to him. He won't move in with either of us.  No to moving closer to either my sister or myself (I live 3 1/2 hours away; my sister lives over an hour from him).  He won't have anyone come in the house to help out. And now he refuses to move to an assisted living complex.  A place where he can have his own apartment with patio right outside his door, a full kitchen and an accessible bathroom. 
I guess we could turn away until he changes his mind.  But left on his own he doesn't eat and falls all the time.  I feel as if we are being held hostage emotionally. 

My dad spent his days after our weekend away trying to show us that he was still capable of living on his own.  He refused to use the wheelchair when he went out and even worse, he started to drive again. Then, on a day when neither my sister or myself could be with him, he fell in the parking lot of his condo and laid on the ground until someone came along and was able to help him up.

I don't know that I can describe how it felt to hear that.  It was like our worst nightmare had come to life--the nightmare in which he falls and lays helpless on the ground in pain and getting weaker and weaker.  It's horrible and I literally felt sick in my heart when I heard the news.

Fortunately he wasn't badly hurt, but it did mean that it was time for some very hard conversations.  Up until this time we were trying to be respectful to his feelings and while we brought up the idea of assisted living, we never pushed it when he said he wasn't ready for that just yet.  However, the fall in the parking lot changed all that.

We finally sat down and told him that it was time.  We told him we were worried that he was going to fall, break a bone and then all his choices would be taken away from him.  That if he was badly hurt his only option would be a nursing home and that was not the life we wanted for him.

This was very difficult for him to hear this and for us to say it.  I do believe that he has the right to determine how he was going to live the rest of his life, but things were at the point where I couldn't believe he was making thoughtful, rational choices.  He had always been a practical man and now he was telling us that he was still completely independent when the truth was that my sister and I were cooking his meals, washing his clothes, giving him his medication and setting up and taking him to all his appointments. 

And so we had our conversations.  My sister and I tried to be respectful and kind. We did what we could to help him hold onto his dignity and tried to help him mourn another loss in his life--the loss of his independence.   All of three of us cried and lost sleep.  

In the end, my father made the decision that my sister and I could look at places for him.  It was not a happy choice and he was very depressed about it.  It was very hard to do what we thought was the right thing for him when he hated it so much.

The Express Bus to Crazy Town

Let me tell you something about my dad.  He was in the Navy during WWII and he is a retired firefighter. Those two facts should tell you a great deal of the kind of man he is.....proud, independent, tough.  So trying to help him is a delicate dance; the old two steps forward, one step back.
When my dad first began to fail, my sister and I swooped in determined to help set him right as only two people who have spent their lives in the helping professions can do.  We made appointments for hearing aids, the doctor, OT and PT.  Because we felt he could no longer be by himself, one of us began to stay with him all the time.  He had basically stopped eating and was pretty much living on a cup of milk a day, so we started to cook him dinner every night.
In the space of a few weeks my dad rejected his hearing aids saying that he can now hear just fine.  He told the PT and OT not to come back anymore.
Last weekend, my sister and I planned a couple of days away.  A little vacation with a girlfriend.  A time to shop and walk on the beach and relax. 
 As my dad had fallen four times in the past two weeks, we discussed with him that we really didn't feel he could be alone anymore.  He agreed. And then would disagree a few hours later.
My sister had a friend of her daughter come to spend the weekend with him.  Hours before we left, my dad and my sister had a huge fight over this.  My sister told me that she thought she had won.
We left and spent most of the weekend talking about my dad.
On Sunday I began getting phone calls.  My sister's friend was, in his words, about to worry him to death.  He wanted her out.  If she wouldn't leave, he was leaving.
"Do you really think he will leave?" I asked my sister.
"No, he can't get out of the house by himself anymore.  He can barely make it to the bathroom using his walker." said my sister.
A little later, my sister got a phone call.  Dad had left. Using his cane. He drove away in his car.
We called his lady friend and she found him and got to go home.  Thank God, he didn't kill anyone while driving.
How do you help someone who refuses to admit that he needs help?  How do you help someone who tells you over and over how depressed he is, but then won't make any changes to make his situation better?
Oh, we did get him to the podiatrist and had his nail cut.  I guess that's something.