And here I thought I knew a little bit about caring for aging parents. Apparently what I knew was just the tip of the iceberg. The past week has been a roller coaster ride and I’ve cried so much! But today is a better day and I’m grateful for that.
Where to begin? I guess the move from the hospital to a transitional care facility is as good a place as any. (Sorry. This could be a long one.)
Just a few days after Dad’s hip surgery, he was informed he would soon be released from the hospital and needed to spend some time in transitional care. That was Monday. Labor Day. Dad’s birthday. I asked the doctor when this move was likely to happen.
Great. Thanks for all the advance warning.
On the spot, we were given a list of facilities and forced to select our top three options for transitional care. Without having opportunity to research or tour any of these places, we made our choices based on location, and the social worker’s recommendations. We picked three places that would be relatively convenient for family members to visit and where we knew a few friends or family members had spent time and seemed relatively satisfied. I asked the doctor how long Dad could expect to stay in transitional care. She said 7 to 21 days. I was shocked to hear how little time my 75 year-old father would be given to heal. The worst part of that conversation is that my dad was there to hear it. He locked in on the 7 to 21 days comment, and it was not an accurate statement. When we were later informed by a social worker that it would be more like 4 to 6 weeks or more, he wasn’t happy. Who can blame him?
I worked the next day, Tuesday, while Mark kept my parents company at the hospital and then drove my mom to the facility when it was time for Dad to be transported to transitional care. I left work to meet them at the facility and upon arrival in the lobby, was pleasantly surprised. The place was fairly new, bright and cheerful.
When Dad arrived we followed the guy pushing his wheelchair to the elevators and then to the third floor. Turns out the transitional care center is located in a wing that is an old hospital. (Mark tells us he was born there!) The rooms were tiny and dim. Dad’s bed was positioned against his roommate’s bed, the head of one bed coming up against the “shoulder” of the other bed creating an L shape. The only thing separating the beds was a curtain. We were all a little disheartened but remained determined to make the best of it for Dad’s sake.
Dad got an awesome roommate named Mike. Mike informed us that he is 65 years old and that he’s been in the care center since March. Mike looks and sounds pretty normal, except that his sense of reality appears to be slightly off. But he’s easy-going, friendly, is willing to converse about anything and everything. It matters not whether he’s got any knowledge of the topic. He chimes in as best he can. And he seems to want to help take care of my dad who is, for the time being, almost completely immobile on his own.
The first afternoon and evening went alright, considering Dad was still in a lot of pain, lacked any appetite, and seemed to still be in a medicinal fog. We sat with him through dinner and left just before he went to bed. When I came home, I called my sister. We talked about how hard things had been with Dad and how difficult it is to see your parent reduced to such helplessness. I was exhausted and went to bed.
Just after 11:00 on Tuesday night, I was pulling the covers up and closing my eyes when the phone rang. It was Mom. She was frantic. Dad had called her in a panic. He was freezing cold, in pain, and hadn’t been given any medications or insulin. He couldn’t seem to get anyone to ease his pain and fears. With Mom’s health so frail, she couldn’t drop everything and go. She needs one of us to take her to and from the care facility. She didn’t need that stress, so I told Mom I’d go back down to the care center and try to get Dad settled. Not having any clue how to handle this, I ended up calling my sister and picked her up on the way.
When we arrived at 11:30, a nurse was just giving Dad his evening insulin, which should have been given after dinner. He’d had no pain medication and was in pure distress. The nurse shrugged and told us the pharmacy order was supposed to have arrived around 7:00. She implied that it was late, and then added that there was an emergency on the floor that prevented her from administering Dad’s meds any sooner. So she was just getting to Dad’s medications now. She left the room to go get his pain meds and Dad informed us that in his earlier attempt to reach the phone on the bedside table to call mom, he had knocked a cup of water over into his bed. He was laying on wet pillows, on wet bedding, and wearing a wet hospital gown. The air conditioner was stuck on high, adding to his chill, and he said he had been informed that there was no one to adjust the vent until morning, so they tossed a blanket on top of it and told Dad he’d have to be patient. He said he’d asked several times for dry bedding and a gown, but no one seemed to be in a hurry to do anything.
When the nurse came back to give Dad his pain medications, we informed her that Dad was laying in a wet bed. She told us she would find an aide to change the bed and Dad’s gown. After she left, we waited, then had to go in search of her again to see if this was going to happen any time soon. Finally, Dad’s bedding and gown were changed and the staff got him settled back under his blankets. I went to hug and kiss him and found that his pillows were still soaking wet. Frustrated and exhausted, I went back to the nurses’ station to request dry pillow cases so I could change them myself. Another member of the staff sitting at the desk looked at me and explained, “We’re not even supposed to be here right now. Another shift is supposed to be taking over right now, so just so you know, we’re not being slackers.”
I shot her a look, took the pillow cases and walked away. I didn’t want to say anything I might regret and that might prompt the staff to neglect my dad in retaliation for anything ugly I might say.
Another nurse came to Dad’s room and informed him he would give him pain medication. I had to inform him that Dad had already had pain meds and should not be given any more. “Oops,” said his demeanor. Then he came back and said, “I’ve got one more pill for you!”
We asked what it was and he said it was a nutritional supplement. “For what?” we asked.
“It’s given along with pain meds,” he said. I’d had a conversation with a nurse during Dad’s hospital stay. “Is it Vistaril?” I asked?
“Yeah, that’s it,” he said.
NOT feeling very confident in Dad’s care at this point, but we could hardly pack him up with his fractured hip and take him home.
Finally, after getting Dad settled, my sister and I hung out in his room, hoping he’d fall asleep. He didn’t, but relaxed enough to urge us to go home and get some sleep.
The next morning, Wednesday, I knew I couldn’t just leave Dad alone there for the day after such a traumatic night. I went to work just long enough to attend a meeting I’d already rescheduled due to Dad’s accident. In the meantime, my aunt (Dad’s sister) and my cousin went to sit with him until I could get there. When I arrived around 10:30 am, I found my aunt and cousin holding Dad’s hands, patting them, and encouraging Dad to stay awake. Dad had been unresponsive when they’d arrived. The doctor had just left the room before my arrival. He said that Dad had a painful night and was given additional pain medication at 5:00 am and stated that my Dad had been “overdosed” on pain meds. It was up to us to keep him awake. We spent all day and evening trying to keep my groggy Dad alert. I also spent several hours attempting to reach Dad’s regular doctor and calling other care facilities to see what I could do to improve Dad’s situation. I spoke with the staff social worker and the nurse manager, explaining Dad’s unique health issues and expressing my unhappiness with the way he was treated the previous night. I was informed the “overdose” was an allowable dose, but they now knew it was too much for Dad.
Unfortunately, after several phone calls to medical facilities, and subsequent conversations with a couple of coworkers in similar situations with their parents, I soon understood that this is just sometimes how it goes. It takes the staff some time to get to know the patients, and it takes the patients some time to get used to how things go in this kind of setting. I heard that we as the family have to be my Dad’s advocates, and sometimes, his watch dogs. Somehow, I allowed myself to be convinced that Dad’s first night was the combination of first-day jitters and a rare kind of chaos with the night staff. And truthfully, his next couple of days went fairly well, and we met some absolutely wonderful, compassionate nurses and caregivers.
Then came yesterday. My aunt again spent the day with Dad. She kept me updated, letting me know his appetite was non-existent and that he was having some pain. I was hoping to go home after work and then go sit with Dad in the evening hours and stay at bedtime until he fell asleep. But knowing that he wasn’t doing so great, I decided to instead swing by on my way home from work in time for the dinner hour. Upon arrival, I found Dad wheeled up to a table that sat against a wall. Although there were several tables with openings and other patients, they had my dad sitting all alone and facing the wall. The same was true for another gentleman. It made me so sad to see my dad and that other man like that. I joined Dad quickly. He was happy to see me, but tired and not feeling well enough to care too much about sitting alone. Still, it bothered me and I found myself fighting tears for the umpteenth time in days.
I asked Dad how his day had gone, and he repeated what my aunt had told me. He also shared that when he pressed his call button for assistance, often no one came for a half hour or more. When an aide came to get him for dinner, he stated a particular need and she ignored his request and told him they had to hurry to dinner. I won’t elaborate except to say that it caused him significant humiliation. Can you just imagine being 75 years old and having to tell your own daughter of the kinds of personal indignities that can happen in these situations? Soon after Dad shared this with me, my youngest brother arrived with my mom. I was going to go home for a while since they were there to keep Dad company. I needed some dinner, then planned to come back later to see Dad through to bedtime. Before leaving, I discreetly told Mom of Dad’s dilemma and asked her to get someone on staff to assist Dad. When I came back two and a half hours later, though my mom had asked, he still had not been assisted. I wish my mom would have pushed harder to get this done, but even though she hadn’t, Dad’s aide should have done her job without having to be nagged about it.
My sister was there by then. Mom and my brother went home and my sister took charge. She found Dad’s aide and tried to maintain some patience and courtesy while requesting that she please do her job and assist our Dad with his needs. The little b*tch rolled her eyes at my sister but did finally do what was necessary. She took him to a large restroom where he could be assisted, then left him alone in there for long enough that we finally went in search of her to ask that she check on him and help him back out again.
We stayed to make sure Dad fell asleep. We prayed he would stay asleep and not need assistance from the aide who seemed incapable of performing her duties, then went home crying and vowing to get him out of there asap. I couldn’t sleep much. I was awake before 5:00 this morning. I puttered around the house for a bit, then finally went to see Dad at 7:30. He was looking better than he had in days. His morning caregivers were bubbly, friendly and full of kindness to the patients. I joined Dad and some of his new friends at the breakfast table and watched the goings-on for the rest of the morning. I could see a clear pattern. There are plenty of daytime caregivers and they do a good job. The night staff tends to be at a minimum, and some seem less experienced, and lacking in motivation and compassion.
I met a woman named Joanie who is staying at the care center as a returning patient. I learned about her injuries and all about her many stays at various transitional care centers. I also met Joanie’s husband and when Joanie left for physical therapy, I asked him if he minded me asking him some questions about their experiences. I shared my concerns about Dad and he told me, just as others had, that the care isn’t going to be phenomenal anywhere, and the patient and family have to be their own advocates. He said this place is just about as good as he and Joanie could expect. But he also encouraged me to look elsewhere. If Dad is going to spend the next several weeks away from home, he reminded me that we need to be comfortable and feel secure in the place where Dad is staying.
And so, my sister and I made a visit today to another facility this afternoon. It’s the farther-away place that Dad originally wanted to go, but which we discouraged because the current place was easier to get to for many of his potential visitors. When we arrived at the new place, we walked into what felt like the Taj Mahal. We were quickly offered an impromptu tour and found beautiful, spacious rooms with all the newest equipment. The rooms were bright and cheery, with many amenities meant for the comfort of both the patients and their families. There were staff members everywhere. Patients in common areas were well-attended and seemed happy. The dining rooms and food service were like 5-star restaurants in comparison to what Dad is getting at the current place. And the kicker? I asked what the additional cost was for the private rooms. Our tour guide told me that Medicare covers these rooms just the same as where my dad is staying with a roommate. Because this place doesn’t offer anything but private rooms, there’s no additional cost for a private room as there is in the place Dad is now. The exact same cost for facilities that are a million times better than where he is now.
I found myself crying again, thinking what we’d just made my dad endure for the past five days when he could have been here. Additionally, there’s a beautiful adjoining long-term care facility and assisted living complex. We checked these out too, in case we need to consider living accommodations for our parents beyond this transitional stay. We actually ran into a woman in the nursing home that we knew from the church our family had attended when we grew up. Her son was visiting her and invited us in. He proceeded to tell us how happy his family has been with his mom’s stay in this facility. SHE told us how much she loved it.
When we walked out, my sister and I looked at each other and said, “We’re moving him.” Screw the driving distance. We’ll make this work. We can’t request a transfer until Monday at the earliest, and I’m praying everything falls into place to make this happen.
I’ve learned a lot this week.
- When someone hurts my dad, I feel ferocious! And I’m not afraid to speak up and do what it takes to protect him.
- Aging can be very, very ugly.
- Not every caregiver does the job because they feel called to it.
- When it’s my time, I hope it’s quick and easy.
Monday can’t come soon enough. I want to get my dad out of there. Sadly, I’ve made friends with several of the patients there and I’m truly going to miss them when I no longer have the chance to see them again. But we need to do what’s best for my dad. I pray that we’re moving in the right direction.