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Spouse has been to ER for various things 3x this week. Today is another trip for his care, something relatively minor but still needing a professional's conducting the procedure. He raved at me "don't leave me alone, I've never been so sick, where are you going, don't go downstairs, why can't I see you" before I dropped him off at ER and I would like advice on what to say if he's still raving and ER Dr wants to discharge him to me. I believe he could be better served by admitting until tomorrow. When he's not with me, he "presents" very well to Drs. I honestly do not know what to say to prevent this happening again if he's in the same angry state as hours ago when I go to check his condition and possibly pick him up.

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Tell them it would not be a safe discharge. Explain why.
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pronker May 2020
Thanks for replying. Those are the words, "safe discharge", which would mean both to him and to me, I take it?
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Does your husband suffer from a Dementia? Are you afraid for your saftey? Do you feel he needs to be admitted so they can really see his problem?

Yes, its an "unsafe" discharge. But that would mean you feel threatened or you are just not able to care for him. He has been to the ER 3x in a week. I would think that in itself would be a good reason to admit him and you want him admitted, not observed. Observed your insurance may not pay for.

From what you wrote, I think his care may be getting too much for you. You may want to consider placing him and protecting your share of the assets. Medicaid allows assets and income to be split allowing spend down for the person needing care. Its called the Community Spouse. You will have your home and a car. You will not be impoverished. You can consult with a lawyer but make sure he is well versed in Medicaid.

The other way is if he is ever hospitalized long enough for rehab send him and then have him evaluated for LTC. If he meets the criteria you can transfer him into the LTC section, if rehab and LTC are in the same building. If not, you can transfer him to another facility. Again, you can become a Community Spouse. It all depends though, or your income and assets. Too high, you may not qualify for Medicaid help.
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pronker May 2020
Thanks so much for this info dealing with down the line issues - "not able to care for him" applies because his rant at the top of his voice included "don't go outside, don't go downstairs, don't leave me, where are you when I am so sick". There is no one person who could handle a 24/7 sitch like this, I believe, and placing him is certainly on the short list of 'what to do' since I am 66. Right now, a call to his PCP at the VA when Tuesday rolls around will result, with good luck, in an aide being added to his coverage.
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Unsafe discharge. Unsafe.
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pronker May 2020
Yes, those were the words I used and it got results, thanks.
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Update 5 days later: VA approved 9 hours weekly of home health aid and the aide manager comes tomorrow for the first meeting and, I guess, appraisal of the sitch. The bedroom is cluttered, so that's going to be a problem, but I was wondering if anybody had first hand advice for me because I've never hired household help of any sort. I've dealt with contractors for roofing replacement, lawn redos, and other things, though.

Followup question is what to do if Spouse protests. I plan on telling him tonight after dinner.
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Tothill May 2020
Pronker,

You can try to introduce the person as coming to help you. Sometimes that works better than saying they are there to care for him.

If you can leave the house after you have shown the person the ropes. Let them do their job.

If you hubby balks, tell him the next option is placement in a facility.
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"I love you" and "I am so sorry". What else IS there to say in all of our sad situations?
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pronker May 2020
Thanks for the thoughts - I was referring to words for the ER Dr. The sitch resolved by using the words "unsafe discharge" in that the ER Dr. discharged him at 1.30 a.m., the hospital called me to pick him up and since I used the words "U.D.", that meant that a social services rep got on the line and made the appreciated call to hold him until daylight. Spouse is now home and resting comfortably.
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Update 10 days later: Spouse cooperates a little with the aide in exercising, but not in bathing 3x weekly and changing the pants and Depends. Aide told me "I suggested bathing and changing and his voice got louder and louder so I backed off since I do not want he and I to fight." Aide is a professional young man about 25 who knows his onions. It's been invaluable to have another pair of eyes look at the situation.

Tomorrow is /possibly/ another VA visit to do further tests; Spouse complains of "pain under his left arm and just generally not feeling well." He shoves away dinner with meat and veg after about 1/2 cup of volume, asks about dessert, which he eats 90 percent of bowl of ice cream or cake, etc. I'm also noticing the greater agitation around evening and wonder if he's sundowning.

I would like to know more about Baker Act and if the VA would do that for him while "testing for a diagnosis" re the not eating and general weakness. Spouse seems to deliberately misunderstand that if you don't eat, you get weak, and this has been going on since about March 15.
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pronker Jun 2020
More about the Baker Act is that it's for violence to self or others, so it's n/a.

VA appt is on Thursday, a colonoscopy which is an endurance test after the Golightly and dose of salts. Thursday a.m. means leaving the house at 6.30 to drive 17 miles to pick up the VA bus for a 3 hour ride to the hospital. The drivers are incredibly kind and accommodating.

Spouse is already weakened by his self-imposed starvation; upside is that Dr. okayed Ensure and that the VA will lodge us overnight. I don't think they do meals gratis but there is a cafe open till ? I hope there's a microwave in the room. I'm budgeting $50 for the meals until arrival home at 7 p.m. Friday.
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Update after VA trip: Spouse says "appetite is coming back", no more complaints about underarm pain. Let's hope his concerns about his digestion post-colonoscopy are laid to rest. Results were 2 polyps RN said were non-cancerous. Spouse tickled with all the attention; stay in VA lodge was nice and comfortable.
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From what I've read, he's a veteran. You can apply for aid and attendance benefits - this will enable you to hire someone to come in home and help you with him. The VA Doctors can help you with this, or his social worker at VA. They can get it rushed through the process quicker than you can alone. The VA has several different programs in place for situations such as this, and I'm sure you and he would be eligible for. You can also draw on his VA, and get paid for taking care of a veteran, husband or not. When a spouse in home becomes "disabled," it can and will, wipe out every asset you have, and then demand more. Check it out, now. Help is available, but you have to ask for it -- many times, if necessary. You need to get help, as soon as possible, before he becomes physically violent toward you. What you need are witnesses to his tantrums.
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pronker Jun 2020
Thanks for replying ... VA is his 100 percent provider and yes, they've been helpful with this latest issue. The aide comes 3x weekly and is wonderful as another pair of eyes to see the situation.
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