Nursing Home Quandries & Realities (father, senior, assisted, Medicare)

[rifleman]

I just had to place my 97 year-old father into a Canadian nursing home ("extended care facility"), which was very depressing for me after I spent a few days there getting him settled in.

He had lived in our family home until he was 91, and then went to a senior semi-assisted living apartment (the facility provided lunch & dinner, but no other support other than to look in on him every day or so.). When he had to have a urinary catheter bag and didn't do the necessary sterile procedures properly, he kept re-establishing ever-more-problematic urinary/bladder infections and thus incurred another 4 week stay in the hospital. Last year he was in 4 times, each time losing more weight and getting weaker.

He was also getting confused and forgetful about his daily meds. So, we all realized he needed more care.

The problem is that he's still mentally sharp, though very hard of hearing and "This d@mned hearing aid's not work a d@mn! My old [analog] one worked a lot better!" Well of course, his hearing was not nearly as far-gone as it is now, and he also assumes that, with a hearing aid, he'll hear like he did when he was 20! Sorry, dad.... ain't gonna happen!

Most of the people I see in his new ext-care facility look, frankly, like they should have expired about 2 years ago. They are slumped in their wheelchairs, or muttering to themselves, or yelling for a nurse. The "inmates" do not talk to each other, and mealtimes are silent and quite horrifying to me to watch, as the nurses spoon the food into some of these poor old souls' mouths.... yikes!

He's also in a four-bed room, and therefore cannot have his own TV for now, until he's in at least upgraded to a two-bed room. So he can't even watch Judge Judy, or Jeopardy or Wheel of Fortune or whatever, dozing off most of the time.

What to do? After seeing dad in this new place (and it's quite nice, BTW; well kept, clean and well lighted) I told my 20 yr old son that he was not allowed to put me in one of these places. Ever! I'd rather drizzle myself with sardine oil and go kick a sleeping grizzly bear up in coastal Alaska than live out my remaining months or years in one of these horrigying places.

What do you folks think? Any better options, knowing that we cannot bring him down to the US (he'd have no medical insurance), and also that I live over 300 miles away from him so I can't even pop up there more than once every 6 - 8 weeks.

I wish there was some intermediate level, where nurses could visit him, let's say twice a day. But that's also v. expensive, as I understand it.

Perhaps the whole thing is to not let yourself get to that point, to wander off into thre forest, or go for a swim in the open ocean one evening, or, as the Inuit did, walk off into a snowstorm. The loss of dignity, and of purpose in life, in these nursing homes is hard to accept, and I suspect dad will become monumentally depressed very soon.

I'm truly at a loss. Any ideas will be appreciated! Thanks!

[SouthernBelleInUtah]

No advice, just sympathy for both of you. My mother was in a nice facility with different levels of care for the last 4 months of her life. She was miserable at not being home, when she was lucid. One UTI after another kept her delirious most of the time. I finally withdrew all but comfort care (put her on hospice care) and she died 10 days later - which is what she wanted. She had been very explicit, many times over the years about her final wishes. I honored them.

[Viralmd]

I feel very bad for you and I'm sorry.

One thing I will say: you may not like it, but your father is actually BETTER off in a four-bedded room, simply for the reason that more people come into the room on a regular basis than they do into a room with only two people in it. This is something we've seen in hospitals, as wards, which had patients all down the corridor with a nursing station in the middle. The nurses could just look up and see all the patients at once.

You're in a bad situation right now. And if your father isn't ambulatory, make sure the staff knows that YOU realize they need to be turning him regularly so that he doesn't develop decubitus ulcers (bedsores)!

[tasmtairy]

I've worked in nursing homes and assisted living facilities and had a care home in oregon. i know how you feel. Having a "caregiver" come to his home a couple times a day would be ok, except you run into other problems, such as stealing, poor care, not that you won't find that in a nursing home too. Talk to a home health agency and see if his insurance would cover visits. If it is just medicare then no.

[rifleman]

It is within the British Columbia (Canadian) medical system, and the monthly fee for 24/7 care, incl. nursing, a free doctor's brief check/visit on a weekly basis, foot and skin care and anything else he needs, is only $950/mo. Amazing. A single bed room is only an additional $300/mo.

He is up and walking in his walker, or in his wheelchair if he's feeling fatigued or unsteady, both of which the facility provides. All of that part is more than satisfactory (thoug, as it's germaine to the current discussion of health care in the US, the taxes up there are a literal "bear"; the marginal rate on income over $80k is 50%. When I was a biologist consultant working in the north, I was making about $170k a year, and my taxes were about $70k. Nothing's free at those confiscatory tax rates!

And when you compare to such notable facilities as the Mayo Clinics, where I went recently for a general checkup, the levels of technology and interest in your personal well-being at their facilities is astounding. The Mayo should run the world's medical systems!

But, of course, there is no Mayo Extended Care facility, and the US medical insurers are downright malicious, wanting nothing better than to shake off those of us with chronic problems. My dad would be at their mercy down here I fear.

I'm going to try to initiate a phone conversation regime with him every three or four days, just to let him know I'm thinking of him. I'm also going to try to get the social worker to involve him in some sort of activity, even if only to prevent him from getting depressed. his mother, who was in a similar place, decided one day she wanted to die, she stopped eatnig, and a week later wqas gone.

[Giesela]

This sort of thing is probably in my near future with my Mother and you have my sympathies also. My Dad was in and out of one but my Mother managed to take him home until he had a stroke at home and died 24 hours later in hospital.
As for the whole big picture and yourself, myself...well we might change our minds when we are old but for now at least I'm putting in my will that I want to be "kept" alive with meds etc. until my quality of life is kaput - and I think here people need to get very specfic - then I want meds (except pain meds) withheld. I figure I'll go pretty fast from whatever chronic conditions I will probably have or pneumonia or something after that. I figure many of the people in these places would , but I do realize that as death approaches we do tend to cling to life harder and it will take a lot of courage to follow through.