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Dad broke femur... 5 days before my respite trip!
JeannieSD
Posted: Wednesday, December 5, 2018 1:33 PM
Joined: 2/26/2018
Posts: 18


I'm freaking out and need some advice and reassurance.  My dad took a misstep off a curb a few days ago and landed hard on his knee (honest mistake he's not prone to falling). X-ray today shows a medial femur metaphysis fracture! This is the leg that has a below knee amputation as well so he wears a prosthetic which he can't wear now so he's confined to a walker and wheelchair. We have an appointment with ortho this afternoon. All this is happening five days before I was suppose to take a respite vacation overseas and I'm freaking out.  Dad is still in the mild Alzheimer's phase but is approaching a mid/moderate stage, hallucinations and fog come intermittently now.  He lives with me and is usually home alone during the day and I come home from work and take care of him.  I am his sole support.

I don't yet know what the treatment will be, but the timing couldn't be worse.  I really hope surgery isn't what the ortho will recommend as that will make his Alzheimer's so much worse if he goes under anesthesia.  I honestly think the best option would be a rehab facility for him. As you all know, with Alzheimer's any injury is 10x worse.  My dad doesn't remember that his leg is injured and at night he tries to get up and when he can't bear weight he tries to crawl on the floor. In the morning he has no recollection of doing this.  After the first night I put bells on his walker so that I could hear if he was trying to get up.  

My questions:

1. What should I make sure I bring up to the ortho re: alzheimer's, living situation, prosthetic, etc.

2. How do I convince ortho that rehab facility is best option without making it sound like I'm just pawning him off because I can't afford 24/7 care in home while/if I'm gone on my vacation? My therapist is adamant I need this vacation.  Are there magic words that lead to a rehab facility?  I'd rather it be "doctors orders" than for me to just put him somewhere.

3.  What else should I be thinking about that I'm not.  It's hard for me to think clearly when I'm a crying blubbering panicking mess. 

Thanks!


ruthmendez
Posted: Wednesday, December 5, 2018 2:18 PM
Joined: 9/8/2017
Posts: 1606


JeannieSD wrote:

2. How do I convince ortho that rehab facility is best option without making it sound like I'm just pawning him off because I can't afford 24/7 care in home while/if I'm gone on my vacation? My therapist is adamant I need this vacation.  Are there magic words that lead to a rehab facility?  I'd rather it be "doctors orders" than for me to just put him somewhere.

I don't know if you're already at the appt. but if you read this beforehand, don't hesitate to just ask.  I'm sure the ortho hears about this type of stuff and as we know, these type of issues is only going to grow much more in our near future.  This is a huge problem for many of us.

I don't know how that works with rehab facilities and requirements, but let us know.  Do you know anyone you can ask to be there while you're gone in case the rehab facility doesn't work out?  Anyone? 



SelEtPoivre
Posted: Wednesday, December 5, 2018 3:03 PM
Joined: 3/8/2018
Posts: 562


Rehab is certainly an option post-surgery, especially if you make it clear to the docs you're unable to take him home.

 I totally understand the need and importance of a respite vacation (still haven't booked mine), there's likely going to be a lot of logistics to coordinate in the next five days, and afterwards as well. This may put more stress on you, too. As unpleasant as it may be, is it possible to reschedule your vacation? (fingers crossed you have travel insurance). If you can't cancel, how will you feel about coordinating care from overseas, esp during a break that was supposed to be therapeutic for you? You definitely need *a* vacation, the timing may not be best for *this* vacation.

*hugs*


VWwife
Posted: Wednesday, December 5, 2018 3:16 PM
Joined: 8/15/2017
Posts: 68


My Mom, who is about stage 4/5 was living with us until she fell in August. She broke her hip (actually the upper part of her femur.) She did have surgery and yes, it did temporarily make her confusion worse. But she went to rehab for about 3 weeks, and it was pretty much expected by ortho that she would go there. PT at home was also offered, but the care and rehab at the facility was really most appropriate and thorough. It was covered by Medicare because she was in the hospital 3 days with the surgery. They worked with her twice a day and gave her complete care the rest of the time. 

Is there anyone who could check in on him while you are gone? It really wouldn't be absolutely necessary, of course, as long as they could get in touch with you via email, etc. Although that might defeat the purpose of respite for you. Not an easy decision. 


JeannieSD
Posted: Wednesday, December 5, 2018 5:49 PM
Joined: 2/26/2018
Posts: 18


So, short update.  The fracture does not require surgery, he is now in a cast. The doctor's agree he should be in a rehab facility while he recovers.  Unfortunately, since he didn't require a 3 day hospital stay that released to SNF, medicare won't cover a SNF.  His secondary insurance won't cover SNF either since medicare won't cover.  So now it looks like private pay whether it's at home or in a facility.  Not sure what the cost comparison is for 24/7 in home vs. SNF.  Anyone have any suggestions?
SelEtPoivre
Posted: Wednesday, December 5, 2018 7:34 PM
Joined: 3/8/2018
Posts: 562


(Get ready for sticker shock from NYC area prices)

We were paying $4k a week for agency 24/7 aides as supplemental staffing for mom. NH rehab costs are $14-18k per month.

But rehab will include/provide PT/OT services (you’d have to coordinate  visit providers at home), and all the other patient care/supervision/meals as well.


JeannieSD
Posted: Wednesday, December 5, 2018 10:39 PM
Joined: 2/26/2018
Posts: 18


Well, after looking a several options, I've decided that respite care at an AL facility with Memory Care will be the best option while I'm out of the country.  It costs $285/day (San Diego) and that includes everything.  The place I found was actually highly recommended by other facilities I called that couldn't provide my dad what he needed, and after one phone call to them it was clear this was the best option.  When I come back if I need him to have more care, I can arrange to have my Mom come from out of state to help me during the day while I'm at work.
NC caregiver
Posted: Thursday, December 6, 2018 6:03 AM
Joined: 2/7/2018
Posts: 650


I hope all goes well so that you can enjoy your respite.  Let us know how you are doing!    I'm finding it very difficult to leave Mom for more than a few hours.  I know it must be very stressful for you right now.    You deserve this break for sure!
VWwife
Posted: Thursday, December 6, 2018 6:17 AM
Joined: 8/15/2017
Posts: 68


Sounds like a very good solution. And after the extra stress of this week you need and deserve respite even more. Hope you have a great trip and return refreshed.
RobOT
Posted: Friday, December 7, 2018 12:36 AM
Joined: 3/12/2017
Posts: 19


What a mess! Just ask the ortho, he or she is likely to be sympathetic. These guys know how hard caring for dementia patients can be, and they'd generally rather you got some rest and took him back home rather  than burn out and place him in a SNF for good. Good luck!
 
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