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.