My father has severe osteoarthitis and had 3 strokes. He cannot get out of bed by himself and deals with incontinence so he is in LTC. Since being there he is largely in denial that this is his new life. First he was hoping tramadol might be the fix that gets him to walk, that didn't work. Now he wants hip replacement which we are looking into. But even with a hip replacement, I'm not sure that it will be enough for him to walk again due to the damage done by the strokes.
Do you ever give up trying to find "solutions"? How do you help your loved one come to accept this as their new reality?
Sometimes we caregivers just need to shake our heads up and down and go about our business, we cannot fix them or convince them that there is no cure.
I have used the line " When your doctor gives us a release letter that you can go back to your apartment we will consider this option, until then you will remain here".
However, a joint replacement may be of benefit to him if for other reasons. Eg Does he have severe hip pain? If so, does his Doctor say a hip replacement would benefit him? If so, is he a good candidate for surgery? (Factoring his stroke risk & dementia risk).
What's Dad's general mobility like? Walking well? Needing little supervision or assistance? Or needing assistance & equipment?
What's his general health like?
His memory?
It may be good to take in the wider view for him. (He may not be able to).
PS It is common for Stroke Survivors to lack insight. (Medical term: Anosognosia).
PPS I didn't bother mentioning his 'going home plan'. It's not a realistic plan, it's a wish. But for thoroughness sake you may consider looking into a hip replacement.. before you change that from the plan-list to wish-list.
Cognitively he is dealing with some slight memory issues (calling me ten times to ask me the name of a medication) but nothing severe (aka he still remembers 95% of stuff)
At this point the denial is most likely a coping mechanism and you should go with what he suggest and tell him he should ask the doctor. I wouldn't spend much time tryi.g to convince him because it could possibly add stress anger and resentment. My advice is nod and encourage his range of motion exercises. Good luck. and if it is too stressful during visits, it's okay to take an break from visiting to maintain your mental wellbeing.
'Just working on it' may not always be completely accurate, but it is kinder ❤️
I know several people who had hip replacements (they were all 60 and older) and it is the "easier" of the joint replacements in terms of PT and recovery. He has to be able to do the PT post-op or he won't benefit from the surgery. Will the other hip eventually need replacement?
I would consider breaking down the goals reach in phases for him to reach. EG: If he can recover "enough" from the strokes (cognitively and physically) then he can be assessed as a candidate for the hip replacement (and his doctor does this).
Then, he has to understand/agree that he will be in rehab for a while (Medicare 3 weeks?).
From rehab he goes "temporarily" to AL where he will need to continue to be able to get to his PT appointments and do them faithfully or they will drop him if he doesn't progress. Once this happens he either stays in AL or moves back into LTC.
Once he successfully completes his PT (as assessed by the PT), in order to leave AL he needs to "prove" he can do his ADLs to his doctor (not you), and only then could he leave the facility.
Maybe you have this discussion with his doctor in the room so it's not your plan but what is "medically required". He can still have hope, it just needs to be in baby steps and realistic -- and you need to decide your own involvement level. Maybe put it in writing, so he can review and ponder it when you're not there. I'm rooting for him to go for it, as long as he is realistic.
Has this discussion even come up?
Some thoughts...
If he is not mobile now would he be willing to participate in PT PRIOR to surgery to get some strength and mobility so he would be better able to go through surgery and participate in rehab after the hip replacement?
If there is a question as to his mobility post surgery maybe the PT can assess that during some sessions and have an idea how much his strokes have effected his ability.
If hip replacement is not a viable option his doctor needs to be honest with him and maybe PT and OT sessions can help him find what his normal is.
You do not indicate how old your dad is or if he has other medical conditions but if he is cognizant then he has the right to make the decisions he wants to make this does NOT mean that you have to agree with them and you do not have to help him return to his life prior to his admittance into LTC.
You can tell him and any medical staff that you cannot care for him.
He can not live with you, that you are unable to safely care for him.
This places the burden of after care on him.
After a trip to the ER and an MRI of his brain, I had to tell dad his tumor was growing and that was causing his mobility issues. That nothing could be done medically about it, it was too dangerous at his age. But he could still have years ahead of him, it was not a death sentence.
Dad died 19 days later. He lost hope and gave up. Hope is a very important thing to have in your father's life. I destroyed my dad's hope by taking him to the ER that day and getting such a diagnosis. Let your father have his visions of walking again and going back to his apartment. It hurts nothing but helps him tremendously. So what if it's all a dream? Dreams keep many of us alive.
You told your dad that he could have years left to live, it was not a death sentence. You show such love for him.
My dear friend chose to die because she was ready to go along with her body's choice, in the room of her choice, with her loved ones.
We love her and are inspired by her.
I continue on, in ever-growing amazement at the immensity of all of
our lives, and our capacity to feel so much compassion for and support from one another and our world.
Maybe you didn't destroy your dad's hope and he chose to go on his journey.
It was, however most kind of you to share it with us as a possibility to be aware of.
Thank you.
Sending much love.
If HE doesn't give up finding solutions then YOU don't give up--my personal opinion as an old retired RN. This is an individual decision. UNLESS your father is deep in dementia, this is his decision to make.
If doctors agree to the hip surgery then let him "go for it" because what is there really to lose but his life, and he is already unhappy and frustrated with that leaking away from him one piece at a time.
Your dad isn't going gently into this good night.
Myself I would choose the end of life cocktail as soon as possibly I could, and wouldn't let them replace much of anything at all on me. I don't mind death, but I sure have no courage for the losses of aging on my doorstep now at 82.
But that's me as an individual, and despite his losses your dad wants to fight on.
Your Dad is s/p strokes. He is at risk because of that, and because surgery would necessitate his being off blood thinners, which could kill him pretty quick or injure him more than already he has suffered. He needs to fully understand that.
So this comes to
1. Individual right to own decision
2. Whether or not dementia is involved (and this therefore must be YOUR decision)
3. Measuring risk
Attend doctor meetings with him if he will allow that. Do the pro and con thing with the doc. Speak about the dangers of anesthesia at a certain age. Be certain he understands the risks.
As RNs we were taught to always follow the patient's lead. Especially so far as not robbing of hope is concerned.
With all the losses of aging for some people, hope and daydreaming of a better day is about all that's left.
Good luck.
I want to encourage the OP to factor in her needs while supporting Dad and be clear to him what she can and cannot do to facilitate the surgery and recovery.
I told my daughter you do what you have to do. I have been taking care of patients as an home health aid for more than thirty years. Some of these patients put their families through hell. Many of them have dementia so they cannot and should not be making decisions even though they think they can. These poor families. Also, living at home or staying in your home is not what it is cracked up to be. My patients sit there watching television all day. They have no visitors except maybe family. They get no social contacts. In Assisted Living, you guys get all kinds of social activities going on to keep your brain active. You get your meals done for you. You get your medications done for you, your laundry is done by AL staff, and also they clean your apartments. You can go to church, You can walk around or get around in your wheelchairs/motorized chairs in these places. I want to get in one of these places ASAP when I can no longer take care of myself. They will take you out to eat, to go get groceries. They take you to your appointments. They have special events, movie nights, people coming in doing programs. Again, compare this with sitting at home all day and not seeing a soul for months on end. Please reconsider what you are doing. Thank you!
My prayers it works out.