Need to Backpeddle: How to Do It with Grace? - Mothering Forums

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#1 of 12 Old 04-05-2013, 12:27 PM - Thread Starter
 
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So, my grandmother has been in the hospital for about a month for sepsis and then rehab (not drugs, but regaining strength). Her doctor plans to release her Wednesday of next week. I've often cared for my grandmother when she got out of the hospital, going a couple days a week to cook and clean for her and get her through the week until my parents and uncle can help on the weekends, and so I just assumed it was more of the same. When I visited my grandmother today, she couldn't sit up by herself, walk, go to the bathroom... I really feel that she needs 24/7 care, and with a 6yo (who's in school far enough away from my grandmother's that it would require a 3 hour daily commute for her to attend), 3yo, and another on the way, I don't feel like I can provide that. I feel horribly guilty, knowing how much my 87 year old grandmother wants to return to her home, but I really don't feel like I can do it. I told my parents straight out that I don't think she can return to that house, but I couldn't talk to her doctor when I saw him today: I don't want my grandmother to feel like I'm sabotaging her escape from the hospital. What do I do?


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#2 of 12 Old 04-05-2013, 12:53 PM
 
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You definitely need to talk to her care team. They need to be realistic on what she can and cannot do at home and what help is available. I would just be clear that you have done it in the past, but with a baby on the way, the sheer physical nature of her need right, it isn't safe for you to do the care on your own. 


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#3 of 12 Old 04-05-2013, 02:34 PM
 
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she can't sit up by herself, walk, go to the bathroom... I don't know how these things work but it does not seem to me like she's ready to be discharged at all.  When my elderly dad was in the rehab home recovering from illness and injury they wouldn't let him go until he was strong enough to get himself to the toilet either by walker or wheel chair.  Like you said, she needs 24/7 professional care, perhaps she can get in-home caregivers.  Can she afford that, or something like it? If so, insist on it.

 

You would feel horribly guilty if your grandmother had an emergency on your watch that you couldn't handle.  You have nothing to feel guilty about. Definitely go back to the doctor or whomever is coordinating her care and say that on further examination you realized she needs a level of care you are not qualified to give her, what do they advise?  It would be irresponsible of the doctor to release her to inadequate care.

 

You need a change in perspective, here. You are not sabotaging anything, you're trying to make her home coming as successful as possible so she doesn't end up in the hospital again.

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#4 of 12 Old 04-05-2013, 02:43 PM
 
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It is extremely inappropriate for discharge staff at the hospital to be planning a discharge without appropriate care in place. Did your family tell hospital staff that they could provide total care? Did they talk to you about this plan? It is the social workers job to facilitate a successful discharge, I would find the social worker and see what the plan exactly is.
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#5 of 12 Old 04-05-2013, 07:35 PM
 
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I agree with the PPs. It isn't realistic for someone requiring that level of assistance to be discharged without a plan and all the necessary services in place. Not sure how it works where you are but, in most hospitals I have worked in part of the discharge planning would have been a visit by the occupational therapist to the person's home. If that hasn't happened yet you could maybe be the person who accompanies the OT. That would give you a good chance to discuss your concerns.

You could also request a family conference at the hospital. That should include her doctor and at least one of the allied health therapists (physio or OT).
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#6 of 12 Old 04-06-2013, 05:28 AM
 
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Originally Posted by rainface View Post

It is extremely inappropriate for discharge staff at the hospital to be planning a discharge without appropriate care in place. Did your family tell hospital staff that they could provide total care? Did they talk to you about this plan? It is the social workers job to facilitate a successful discharge, I would find the social worker and see what the plan exactly is.

 

Quote:
Originally Posted by katelove View Post

I agree with the PPs. It isn't realistic for someone requiring that level of assistance to be discharged without a plan and all the necessary services in place. Not sure how it works where you are but, in most hospitals I have worked in part of the discharge planning would have been a visit by the occupational therapist to the person's home. If that hasn't happened yet you could maybe be the person who accompanies the OT. That would give you a good chance to discuss your concerns.

You could also request a family conference at the hospital. That should include her doctor and at least one of the allied health therapists (physio or OT).

 

Yes to both of these. 

 

Request a meeting for discharge planning. 

 

Draft a list of your concerns. Put everything on it, including

-special diet needs,

-medication schedule

- wound care, bed sore prevention, and so on 

-exercise program and schedule (if she has is that weak and has impaired mobility, she needs some gentle exercises to help her regain some strength and prevent stiffness) 

- Activities of daily living - managing bathing, dressing, toileting.

 

A home visit is optimal, but if one cannot be arranged, it is helpful if you provide a simple floorplan, with a few measurements, of the living areas she needs to access. Measure doorway widths and distances to bed, toilet, sinks, etc. 

 

Eg. How many steps to enter the house? Is a ramp for a wheelchair possible? 

Can you set up a bedroom on the main level or will she have to climb stairs within the house?

If she needs a wheelchair, can it be brought next to the bed for transfers from bed to wheelchair? Or is there too little room in the bedroom to make this possible? 

How much help does she need for mobility? Can she re-position herself in bed? Transfer from bed to wheelchair on her own? Sit down and get up from a toilet on her own? If she needs help with any of these, the PT or OT should be instructing family members on how to accomplish safe transfers without risking falls or pulled joints (no yanking on arms and legs) to your grandmother or back injuries and muscle strains to assisting family members. 

Is the bathroom wheelchair accessible? If not, how many steps from door to toilet? Or will all toileting be done with bedpans or a commode chair? 

Does the home have all the typical safety features - eg. rails in the tub/shower and next to the toilet, a tub/shower chair and so on....

What kind of evacuation plan can be in place, in case of emergencies (fire etc.) 

 

A huge benefit of this kind of planning is that when your other family members realize how much needs to be done to make a home safe (most important aspect) and comfortable for someone with seriously restricted mobility, they are likely to be more understanding of your dilemma. 

 

Best wishes to your grandmother and to you. 

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#7 of 12 Old 04-07-2013, 06:23 PM
 
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I agree with the PPs, sometimes you just can not do it, and if she can not sit up by herself, she will need 24 hr care.  That is something you can not do (you have to take your child to school, run errands, get groceries, etc).  Medicare will cover a caregiver to come out (usually 3 times a week), to help with bathing, personal hygiene, and tidying GM's areas if she is getting home health therapy, but not 24/7 care.  However, as long as she is making progress towards her therapy goals, she should qualify for 100-120 days in a rehab facility.  I would ask to speak to the discharge planner and make sure they understand that she is going home to live alone.  We had problems when my GM had a stroke, b/c the planner thought she was going to a nursing home and kept wanting to send her home early.


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#8 of 12 Old 04-07-2013, 08:11 PM
 
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I took care of my 5 month old nephew 6 months pregnant and ending up fainting at nephew's grandfather's house! It was from not eating enough and being up in the night. Thank goodness that he's a fire fighter and his girlfriend is a nurse. I could not imagine how strenuous taking care of an adult who can't sit up on her own. DO NOT FEEL BAD. Pregnancy is hard work.
I think Oly's advice about writing it all out will make it sink in for your family.

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#9 of 12 Old 04-12-2013, 06:20 PM
 
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I've also been in a situation where a close family member was in rehab (after a traumatic brain injury). She was not discharged until she had basic bodily control (sitting up, assisted walking, semi-independent bathroom usage, ability to eat solid food, etc.). If your grandmother cannot do those things, I'm surprised that releasing her to home care is even on the table. 

 

You can (and should expect) to have a meeting with the family and her hospital care team - being pregnant you cannot care for her in the physical way that it sounds like she's going to require. You can't lift her for bathing, bathroom visits, etc. Not to mention all of the other stuff. I know it's easier said than done, but try not to feel guilty about that. You care about and love your grandmother very much - that's evident. The fact that you are unable to provide her with very physical, round-the-clock care is no reflection of your feelings for her, and I don't think people will (or at least, should) judge you for that. 

 

It sounds like you just need to get everyone in the same room in order to have a frank discussion on what's possible, and in the best interest of your grandmother. I'm sorry you're in this situation - it's very tough and can be very heart wrenching. Stay strong though and focus on getting everyone on the same page so you can all support your grandmother in the best way possible.


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#10 of 12 Old 04-12-2013, 06:57 PM
 
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I'd call your insurance provider and ask them if they would cover a fulltime nurse. My insurance covers full nursing care for me/spouse or parents and grandparents in situations like that.

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#11 of 12 Old 04-12-2013, 07:55 PM
 
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I'd call your insurance provider and ask them if they would cover a fulltime nurse. My insurance covers full nursing care for me/spouse or parents and grandparents in situations like that.

 

It covers parents and grandparents even if they're not named as dependents on the policy? 


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#12 of 12 Old 04-13-2013, 05:41 AM
 
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It covers parents and grandparents even if they're not named as dependents on the policy? 

 

It should, my policy just mentions parents/grandparents/step-parents, etc. I was surprised to find that out when my boss mentioned it to me when my MIL was in the same situation. We're in Canada but our insurance provider is an American so I'd guess may have something similar. 

They gave us some pushback at first but eventually with enough marriage and birth certificates, they gave in. 

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