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Family is debating what's best for dad. He's 95 and in rehab right now following a hospital stay for a leg infection. Mom is 90, in OK health but has pretty bad short term memory problems. They were living alone taking care of themselves before the hospital stay.


Dad has no control over bowel movements and has a urine catheter. This happened as a result of the hospital stay. Mom wants Dad to come home so she can take care of him. Not sure if he will ever be able to walk again.


My question is- can in-home health care workers really be able to properly care for him seeing he needs to be changed several times a day. If so, should it be 24 hour care?


We're really worried my Mom will hurt herself trying to care for him. At the rehab the aides are always telling her to stop trying to help him. My father is always asking her to help him.

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Perhaps the tactful way to put it to your mother might be "not yet"? If you can keep putting off his hypothetical return home, it's a lot gentler on her than saying "when you took care of him he landed in hospital with a leg infection. Great job." Brutal but true, after all.

Would funds allow for them both to move together into a facility?

Could the aides find jobs for your mother to do that she can manage? E.g. hold his hand while they're washing or dressing or transferring him, assist with eating, plump his pillows during bed changes, that kind of thing. It might be better to distract her with small contributions to his care than to leave her wringing her hands and then trying to do it all when they're not looking.

I can only imagine the frustration of what the family is going through, though. You can't ask your father to stop asking her for help. You can't explain to her that when he does ask, she needs to say "yes, I'll see to it" and call the aides.

Does she visit him every day and then return home alone?
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If he can't walk, has a catheter and wears diapers it is time for a nursing home, your mother will not be able to properly care for him. The aides at rehab are correct, she needs to tell him no, we have the same issue with my step dad, he thinks that his wife is his servant. They are now living in AL and he refuses to get a scooter, so she pushes him around in the wheel chair and he doesn't use his feet to help her, she doesn't have the backbone to say no to him, causing issues. The hospital actually sent her home when he was in the hospital, she always wanted to stay overnight and she was in their way...plus she would get lost and they were always looking for her.
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You are never going to be able to find anyone who will just pop in several times a day (and night) to attend to his needs, and bathing, positioning, and transferring would be next to impossible. The only possible way he could return home would be with the help of 24/7 aides and having the house set up with all the features of a nursing home.
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Home health care workers are not miracle workers. Dad should be in a nursing home. The cost of 24 hour home care would outstrip the cost of a nursing home.
Your mom is 90 for God's sake! She cannot care for an invalid.
Things will only go downhill for both of them from here. Urine catheters lead to frequent UTIs. Recognizing the signs of a UTI in an elder is a constant thing to check.
If dad is a veteran, they will probably pay for his care at an approved home. Check into Medicaid if they have few savings. Time is not on their side. I think your mom will need assisted living or living with a younger relative within a year for her memory problems, as they only get worse. Been through both scenarios and it's sad and awful to see a loved one deteriorating physicality and mentally.

YOUR dad's doctor will do what you ask or recommend. He doesn't know your parents home situation. Get nursing home care in place before he is released from rehab. The people at rehab are there to help your dad and mom with everything.
GOD BLESS
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my2cents Jul 2019
Read bones53 above. If caring for him at home is financially doable, he would be happier at home and it doesn't matter if it costs more. UTI's are very, very common in a facility so a nurse could be included in the home-care plan to check on things. (Plus, I'd think when the same people care for him day to day and don't have multiple people to take care of at the same time, medical issues like UTI would be noticed sooner).

If they cannot afford round the clock care, then he needs to stay in facility. Since the question came up on this board, sounds like the family does have the financial option to do it either way.
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Hopefully, LTC is attached to this rehab. I suggest that that u have Dad evaluated for LTC. He probably will qualify.

How are their finances? If paying privately will drain them you need to talk to Medicaid and ask about her becoming the Community spouse. This is just an overview. She will be able to stay in the home. Their assets will be split. His half will have to be spent down to the cap allowed in your state, my state is 2k. His SS and any pension will be used for his care. How much of it will be determined by what she needs to live.
There should be a Social Worker at the rehab that may becable to give you more info. But my feeling is, there is no way a Social Worker knows all the ins and outs of Medicaid. Everyones situation is different. I personally would talk to Medicaid. If this all seems overwhelming, contact a lawyer versed in Medicaid. You can use ur parents money for this.

I hope there are POAs in place. It will make this all so much easier.
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If they have the finances to pay someone for 24\7 care, he can be cared for perfectly fine at home. He will have to have the 24\7 care, it can not be left to your mom, no matter how badly she wants to care for him! My mom couldn’t do anything for herself other than self feed, and she got excellent care at home, from ladies that were NOT even CNA’s. BUT, it takes finding the right caregivers who are willing to work, and NOT call out all the time.
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In home care is expensive. You’d need it 24/7 . In my area there are assisted living facilities with apartments . They have care but they could be together. If your mom already has memory problems my concern is how safe are they alone? If there was a fire could they escape? What if she forgot a pan on the stove?
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dkentz72 Jul 2019
Janner, you're correct on this. I know others had success with in-home and it is truly great for particular situations. Real life is not what you see on the commercials for Visiting Angel's.
To really get Medicare/Medicaid help one must be at poverty levels to State guidelines. It only covers 32 hrs a week, I tried for my Mom/stepfather. All nursing homes do not accept Medicaid, the assisted living group home my Mom resides will not accept Medicaid or ALTCS (AZ Long Term Care Services) BECAUSE they can legally go after resident's assets and then their children to pay back. The owner of the 3 group homes does not the government going after estates of the people. They came from Romania, so there's history with government run programs. Our daughter is an RN, she said she'd never place us in a Medicaid nursing home.
Going through all of this for exactly 1 yr and 3 most, I am of the opinion to place Mom/Dad in the best companion based facility so they're together for as long as possible and have the needed care and attention.
Find all the money you possibly can to make sure their estate is sustainable BEFORE you have to open your checkbook. Better to use their money for them than waiting for an inheritance people THINK they're entitled.
For those of you who are concerned about your inheritance....you're entitled to nothing so don't get upset with the family member who is doing the all the work while you're waiting for the plug to be pulled.
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Our family decided home care was better for my 84 year young wife, suffering from seizures, than an extended care facility. Daughters interviewed and hired 6 aides to care for her almost 24/7 and did a great job of it. Aides were with her for almost 2 1/2 half years before she passed. For our family it was the right decision. Don
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If you have access to his present caregivers and therapists and rehab center social services team, collect as much information as you possibly can concerning his present needs and how they need to be addressed.
If Mom has what you characterize as “pretty bad short term memory problems” at 90, a proactive approach to providing care for BOTH of your parents is probably a necessity, if not now, soon.
Are you assuming that your father may regain control of his toileting needs upon returning home? This may or may not happen.
All said, it is probably the best approach to plan to provide over amply, have a sense of both residential placement AND in-home care, and observe as objectively as you can.
Your mom’s safety and welfare are at least as cautious a call as Dad’s, as you probably already realize.
Hopes for successful care for them both.
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Can they afford in home care? If yes, in-home health care can do the same things at home that they do in a facility. Take him home. If you're going to go this route, you will have to prepare for the return by getting all the medical equipment lined up (bed, bed tray/table). Is the bathroom big enough to install a bath chair lift (doesn't have to be a huge room)? Check out 'safebathtub' online. My mom has very tiny bathroom and I installed one of these - best money ever spent. No more sitting on a bench freezing to death while showering.

If not financially doable, he is where he needs to be if she is unable to physically turn him, diaper him, and take care of him in the bed.
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