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Old 05-11-2015, 12:12 PM
 
Location: San Antonio, TX
11,496 posts, read 25,162,429 times
Reputation: 27941

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My dad, who has early-onset Alzheimer's, had a seizure ten days ago and broke his shoulder during the seizure. He had surgery to repair it a week ago. While he was in the hospital, he was doing okay with leaving the bandages and splint on. He's in a rehab facility now (my mother is having to stay with him around the clock because the facility isn't equipped for someone with dementia, apparently) and he is constantly removing the splint and bandages and trying to pull out the PICC line.

My mom is looking for suggestions on how to keep him from taking off the splint and bandages. She can't even leave him for long enough to go to the restroom because he takes everything off. She's working on hiring a sitter to watch him while she sleeps and while she runs errands, but the rehab facility said the caseworker had to give her the approved list of sitters, and she's been waiting days to speak to the caseworker.

Also, is there much advantage to recovering in the rehab facility, compared to recovering at home and having a physical therapist come to the house? My mom is considering taking him home because she has a lock on the door at home, so he can't wander away, and because he won't eat most of the food at the rehab facility. I took a mattress there for my mom to sleep on (they wouldn't give her a bed but said she could bring her own as long as it could be folded up against the wall during the day) and arranged for them to feed her too (I guess she was waiting for them to offer her food, instead of asking about it) but she's miserable there.
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Old 05-11-2015, 12:28 PM
 
3,992 posts, read 10,754,166 times
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I wonder if the doctor or pt person could create a partial wrap, to keep the one arm cradled, around the torso that closes or velcros in the back of the patient? Velcro would be easier for your mom to use. Or maybe a shirt/hospital gown that can be pulled shut and velcroed in the back to keep it on. One arm could be closed and his other arm could be out and free.

He only needs rehab if he needs ongoing medical care or support that his wife cannot provide or any of the equipment that the PT needs during treatment.

What does his doctor say? He should have a geriatric specialist with his issues. I understand they can be hard to find.
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Old 05-11-2015, 12:36 PM
 
12,034 posts, read 10,410,942 times
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Put a removable splint on the good arm to make it difficult to reach the shoulder.

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When my mom was in the hospital, they put tape or bandages on the PICC line to make it harder to pull out. She was very persistent though.
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Old 05-11-2015, 12:41 PM
 
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My Dad pulled his PICC line in rehab a month+ ago. Even with 24/7 care, if eyes aren't glued 24/7 things will happen. And depending on your Dad's overall demeanor, if he's annoyed with the splint and bandages, adding further restriction will make him more agitated, including having people watching him all the time. That's been my experience with my Dad the past couple of months.

It sucks.
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Old 05-11-2015, 02:10 PM
 
3,763 posts, read 11,921,897 times
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Quote:
Originally Posted by Hedgehog_Mom View Post
My dad, who has early-onset Alzheimer's, had a seizure ten days ago and broke his shoulder during the seizure. He had surgery to repair it a week ago. While he was in the hospital, he was doing okay with leaving the bandages and splint on. He's in a rehab facility now (my mother is having to stay with him around the clock because the facility isn't equipped for someone with dementia, apparently) and he is constantly removing the splint and bandages and trying to pull out the PICC line.

My mom is looking for suggestions on how to keep him from taking off the splint and bandages. She can't even leave him for long enough to go to the restroom because he takes everything off. She's working on hiring a sitter to watch him while she sleeps and while she runs errands, but the rehab facility said the caseworker had to give her the approved list of sitters, and she's been waiting days to speak to the caseworker.

Also, is there much advantage to recovering in the rehab facility, compared to recovering at home and having a physical therapist come to the house? My mom is considering taking him home because she has a lock on the door at home, so he can't wander away, and because he won't eat most of the food at the rehab facility. I took a mattress there for my mom to sleep on (they wouldn't give her a bed but said she could bring her own as long as it could be folded up against the wall during the day) and arranged for them to feed her too (I guess she was waiting for them to offer her food, instead of asking about it) but she's miserable there.
If your mom is used to dealing with your father, then unless there is some very specific medical procedure going on that she can't handle - there's very little advantage to the rehab facility.

They do offer PT, but as you point out, you can get home PT ordered.

I would have her start talking to the facility about discharge. Of course they'll want to keep him for as long as he's medicare approved.... so I'd start the conversation NOW.

(Many hospitals reflexively discharge to rehab centers, even when the family is used to taking care of the patient and the work is well within their ability - not because its necessary, but because they're used to families that DON'T provide care to the patient, and in those situations a rehab center can be a necessity.)
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Old 05-11-2015, 03:22 PM
 
Location: San Antonio, TX
11,496 posts, read 25,162,429 times
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Quote:
Originally Posted by metalmancpa View Post
My Dad pulled his PICC line in rehab a month+ ago. Even with 24/7 care, if eyes aren't glued 24/7 things will happen. And depending on your Dad's overall demeanor, if he's annoyed with the splint and bandages, adding further restriction will make him more agitated, including having people watching him all the time. That's been my experience with my Dad the past couple of months.

It sucks.

My dad is pretty agitated about everything that's happening to him. He's a paranoid schizophrenic in addition to the dementia, and having people watch him all the time really sets him off. When I went to help my mom get their stuff set up at the rehab, I told him I thought they'd picked a very nice hotel, and called the dining room a restaurant, and he cheered up a lot. I told my sister to do the same thing when she visited yesterday, to try to keep him happy with the place.



The only advantage that the rehab facility has over my parents' house is that the bathroom is more accessible. My mom had really huge vanities put into the bathrooms so there's only about 6" of space around the toilet. She may have to just get a bedside commode for my dad until he's more mobile, I don't know. She also has tons of furniture crammed into the house, so I'll probably have to go move all that stuff out so my dad can get around. I already told her that my kids and I will clean the house so she's not embarrassed to have the home health or PT people come out.
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Old 05-11-2015, 04:07 PM
 
3,462 posts, read 3,345,600 times
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That's a tough situation, for sure.

If there could be a marker placed on the wraps and PICC line that he might respect, that may stop him from removing them? Was he in the military? Sometimes old icons from that time still means something to former service men and women.

Nursing homes and rehab facilities can't splint the other arm or it would be a restraint and illegal.

Home health aides, nurses and therapists are pleased to help people be home. They understand the challenges and are usually very non-judgmental about clutter and such.
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Old 05-11-2015, 04:10 PM
 
Location: Wisconsin
19,476 posts, read 22,803,529 times
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Quote:
Originally Posted by Hedgehog_Mom View Post
My dad, who has early-onset Alzheimer's, had a seizure ten days ago and broke his shoulder during the seizure. He had surgery to repair it a week ago. While he was in the hospital, he was doing okay with leaving the bandages and splint on. He's in a rehab facility now (my mother is having to stay with him around the clock because the facility isn't equipped for someone with dementia, apparently) and he is constantly removing the splint and bandages and trying to pull out the PICC line.

My mom is looking for suggestions on how to keep him from taking off the splint and bandages. She can't even leave him for long enough to go to the restroom because he takes everything off. She's working on hiring a sitter to watch him while she sleeps and while she runs errands, but the rehab facility said the caseworker had to give her the approved list of sitters, and she's been waiting days to speak to the caseworker.

Also, is there much advantage to recovering in the rehab facility, compared to recovering at home and having a physical therapist come to the house? My mom is considering taking him home because she has a lock on the door at home, so he can't wander away, and because he won't eat most of the food at the rehab facility. I took a mattress there for my mom to sleep on (they wouldn't give her a bed but said she could bring her own as long as it could be folded up against the wall during the day) and arranged for them to feed her too (I guess she was waiting for them to offer her food, instead of asking about it) but she's miserable there.
I am so sorry that is happening to your family.

What was different in the hospital, that meant that he did not bother with his bandages and splint? Did he have on some other type of splint or covering over the splint? Perhaps a second hospital gown over the splint so he didn't see it and be reminded of it? Did he have more supervision? Was he on more medications to "calm him down"? Was it quieter (so he didn't become agitated)? Were the lights softer? Were their fewer people "watching him" or perhaps a smaller window in the door? Or something else? ? ?

If you can figure out if there was a reason why it was better in the hospital perhaps you can duplicate whatever that was. Good luck.

They used a special elastic "glove like" tight bandage over my hubby's IV lines, plus lots of tape underneath the glove taping the line to his hand & arm, so that he did not pull them out. They were like finger less gloves that went half way to his elbow. He couldn't figure out how to get them off.

PS. It is a shame that they don't have a rehab hospital that can deal with a person with dementia. Did the doctor or hospital even look for one? Is there a social worker at the facility that can try to help your mom find help or a better place for your dad?

Last edited by germaine2626; 05-11-2015 at 04:19 PM..
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Old 05-11-2015, 09:20 PM
 
Location: San Antonio, TX
11,496 posts, read 25,162,429 times
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I think it was better in the hospital because they were giving him pain meds that made him sleep almost all the time. He was in ICU so there were more people around him, watching him. They had a CNA sitting with him around the clock.


I talked to the social worker from the rehab facility today. She called to say she was worried about my mom because my mom won't go home and get some rest, or leave to get something to eat. I told her my mom didn't feel like she could leave because there was no way to lock my dad in and because he keeps taking the bandages off. She said that she gave my mom the list of sitters, and we talked about how it will probably be best if they find a sitter and have them come to the rehab facility for the first couple of days, then after that my dad can go home and the sitter can come and care for him there. She told me where we can rent a hospital bed and also that it would not be hard to find a physical therapist to come out to my parents' house. So it sounds like he can go home pretty soon if my mom will just find a sitter.
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Old 05-12-2015, 07:31 AM
 
Location: I live in reality.
1,145 posts, read 1,287,556 times
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Quote:
Originally Posted by Briolat21 View Post
If your mom is used to dealing with your father, then unless there is some very specific medical procedure going on that she can't handle - there's very little advantage to the rehab facility.

They do offer PT, but as you point out, you can get home PT ordered.

I would have her start talking to the facility about discharge. Of course they'll want to keep him for as long as he's medicare approved.... so I'd start the conversation NOW.

(Many hospitals reflexively discharge to rehab centers, even when the family is used to taking care of the patient and the work is well within their ability - not because its necessary, but because they're used to families that DON'T provide care to the patient, and in those situations a rehab center can be a necessity.)
Can your Mom lift your Dad to a bedside commode alone or assist in his toileting alone? Can she bathe him, twice a week or more if needed, without assistance? When she is asleep at home, who will watch those shoulder sling/bandages to make sure Dad doesn't pull them off and get his dirty hands into the incisions (IF he had shoulder surgery)? Can your Mom give him around the clock meds for pain, deal with his agitation in his dementia? IF she goes out to run errands and get groceries or meds filled, who will stay with him? THESE are all reasons people go to Rehab and I disagree that people are just sent to them for 'as long as Medicare approves'. If he has dementia, and they are not used to caring for people with that diagnosis, I am certain they will allow him to go HOME, as soon as medically able to. There will be another Medicare approved patient to take his place.
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