Saturday, May 30, 2009

Elder Care Part 2

So it begins...

My father-in-law had a massive stroke Wednesday night. My mother-in-law found him the next morning lying near his bed. He must have been getting ready for bed when he collapsed. The time frame between the incident and the ambulance arrival was too long to administer the medicine they give stroke victims to minimize damage. That has to occur within 2-3 hours of the stroke. As such, he's in ICU. His CT shows damage to 25% of his brain. His right side appears to be paralyzed. For the past 48 hours he's been in and out of consciousness.

My 83 year old mother-in-law cannot take care of him if he survives nor can my husband and I. He will require skilled nursing round the clock. We will look to Medicare or Medicaid for assistance. With an uncertain prognosis, we have to prepare for any eventuality..

If he lives, he will be put in a private, nearby nursing home for the first 120 days. After that, we are told Medicaid kicks in and he'll be moved to a state run facility at least an hour or more from here. We know that scenario. It's the same everywhere. If you're lucky, the facility is clean and decent. The help is always questionable. There are many dedicated people who work in this field. There are also many not vetted and uncaring as well. I think of the many issues, the bedsores, the neglect, the cleanliness or lack thereof. It's depressing. Of course, if he rallies and can be rehabilitated, that's another scenario in itself.

If he dies, his 90 year old brother wants him buried in the family plot in Kentucky. We'll have to have him transported. Having been through this with my dad in '07, I know what caskets, preparation for the deceased, funeral services and transportation cost. My father wanted to be buried in a military cemetery several hundred miles from where he lived. His plot was paid for by the government thanks to his military service. Still, when it was all said and done, we spent almost $5000 for a modest casket, embalming and preparation for an open casket, services and transportation.

I haven't looked in to transportation to Kentucky but I know it will be sizable. The death industry is not cheap. It's a business. Many of these places manipulate the emotions of the surviving family. Just picking out a casket was an incredible experience. I did it online as I was 3000 miles away and had to make a decision before I got out there. Luckily, I did a good job with my brother's help. I think the more modest one we chose was at least $1200.00. It was perfectly nice but not fancy. I think the cheapest one was $400-$500 but I never saw it. We actually got a discount on the whole procedure. Weird.

My brother and I were in synch on pretty much everything. There was no family discord, only cooperation, and boy did that help. When siblings or remaining family members disagree, legal wranglings can occur, particularly if there is no medical power of attorney and durable power of attorney. Those are two of the most important documents to get from each member of the family. Something to show the hospital with regard to the wishes of the patient as well as who is the designated LEGAL decision maker in these matters. A living will also covers these things.

In the end, someone has to make the hard decisions.

Post Script: My husband just called from the hospital. His father opened his eyes and recognized him and seemed to understand his son when he was told "I love you." My husband's relief in getting to speak to and be understood by his father was palpable. I am so grateful.

P.S. #2: I started this train of thought in April with my post Elder Care.


Minka said...

Hard times. I feel for you, not knowing what I would do in a similar situation, realizing also that we will all (more or less) have to make decisions like the ones you are describing.

I wish you strength.

Brian Miller said...

pulls my heart. we just had to bury T's mom about 18 months ago after a long bought with a blood disease. making these decisions is never easy. sorry to hear about the stroke. sending warm hopes your way.

Nancy said...

I am so sorry. This is such a difficult time. Thanks for sharing your story - it helps the rest of us. We are currently waiting for something like this to happen to MIL, age 96. Her husband died a couple of months ago, and so far she is doing well, and not needing to be moved to the skilled nursing care section of her retirement home. Making sure they get excellent care requires diligence. So hard if you are far away.

Marguerite said...

I am so sorry about your father-in-law. I understand because my mother had a stroke in 97' and we were able to take care of her at home for 4 years, until she passed. She could not speak or walk, but she could understand everything that we said to her, which was such a huge blessing. I will keep you and your family in my prayers.

California Girl said...

Hi Minka: Thank you. I think my husband feels I invade his privacy when I write about it but I disagree. I've lost both my folks at advanced ages. My mother was a stroke victim, paralyzed on one side, who lived another 18 months in bed. She hated it but we had an amazing caregiver. People need to think about this and what they will do.

Brian: I am guessing T's mother was probably not too old as you appear to be in your thirties (I hate guessing because one is always wrong). I find it more heartbreaking the younger the person is. Everyone lives so much longer now. What I've noticed is things seem to start to go wrong in the eighties. That's a gross generalization but if one lives a life relatively free of disease, the eighties will start the process.

LOL: Women tend to show a great deal more strength after the loss of a husband. Another gross generalization but it's what I see in the older folks. She may be fine right up to the end. My father's mother, Grandma, lived to be 100 & 3months old. She was born in 1877. I was 22 when she died. She was in great shape til her 96th year when she fell and broke her hip. After that she was bedridden much of the time, poor thing. But she wanted to be 100 and she made it. Jeez. I never want to live to be that old. Maybe I'll change my mind when I'm in my eighties but I don't think so. I guess I'm quite the caustic philosopher tonight.

California Girl said...

Hi Marguerite: Thank you for sharing. Yes. Your situation sounds like the thing I fear most. I really feel for everyone in this as there are no easy decisions. We were at the hospital this afternoon and while he didn't show any sign of consciousness, he was moving his right arm and leg alot. I was shocked. The doctor came in and said, "If you had asked me if I thought we should give him food through a tube last night, I'd have said 'No.' Now, I don't know what to think."

Baino said...

Hi Cali. I feel for you, I really do. You sound very level-headed which is a good thing at times like this. It's so hard to keep a cool head when making these decisions and you're right, the Power of Attorney is often neglected when people make their wills. Here it's a Power of Enduring Attorney that allows you to make medical decisions on behalf of someone else. Both my kids have that in my case. Unfortunately as a widow and with both my parents now dead, I've had to think about these decisions too many times. Good luck, chin up . . warm wishes from down under.

Mary Ellen said...

Thanks for including us in this difficult journey. I appreciate the reminder about the living will - it's too easy to just assume all will be well, even in our middle-of-life years.

California Girl said...

Baino: you are too kind. I guess I'm more "level headed" now than when I was young and way too emotional. I'm not so "cool" as I am resigned.

ME: My goal is to make it personal while giving instruction people can remember and relate to.

Mrsupole said...

I am so sorry to hear about your FIL, but am glad that he is still with you. My prayers go out to you and your husband.

A Living Will is so important and we still cannot get my mom to get one. She is under the belief that if she gets one she will die the next day. She has seven kids and in California we all have equal say as to what is done if there is no will. Luckily my father was in Nevada when he died and the oldest child is in total control. They passed that law to make it easier to get things done. The sad thing is that I had to make all the decisions because my older sister has a different father. But I survived and my younger siblings were thankful they did not have to make any of the decisions. Funny thing is my older sister kept trying to make them anyway. Good thing was that no one in Nevada cared. Her decisions were different than mine. She did not like it at all.

Also I wanted to say that I have had 3 strokes. They were the lowest level strokes brought on by medication. My left side of my face is still partially paralyzed and I feel it everyday. I was in my late 40's when this happened and so was still young. The good news is that if I want to eat a really hot pepper I cannot feel it on that side of my mouth. And if someone slaps me on that side of the face it does not hurt. Just wanted to lighten up what happened.

I sometimes do have short term memory problems and even long term memory problems. But I survived and that is what counts I suppose. I do not know what lies in store for your father in law or any of you, but each day that he is here will be a blessing for you all. One never knows what to say because we do not know what you are truly going through, and all we can do is offer to pray and listen to what you say, or read, for those of us here.

May God be with you all during this time and may you know that our prayers are going out for you all too.

God bless.

Unknown said...

My dear, I am so sorry to hear of your FIL's condition. But his ability to recognize his son in that short period of time is a huge plus. I fear that we are approaching similar issues soon, as DH's mother is 82 and dad is 78. My own parents have been gone for many years. Thank goodness we persuaded my in-laws to see our attorney last year and they had a will and all the powers of attorney, living wills, etc. drawn up. That saves so much heartache. We've also done the same for our children.

I will keep your family in my thoughts as you deal with all this.


California Girl said...

Mrs: You have just added a great deal of helpful information as well as personal experience. I guess your strokes were TIAs? You've not had since so did stopping the medication solve the problem? The scariest thing in that is your taking medicine in good faith and that's your result.
My husband couldn't get his mother to sign a will for a long time. Now she's signed one. I think it's interesting you bring up the eldest making the decision thing in Nevada because I heard the same thing about California. A close friend of mine worked in hospice until recently and she said the eldest child was the decision maker there too. You might want to double check to see if the law in CA has now changed. Thank you so much for sharing your experience.

Hey Susan: Good idea to get DH's folks on the same page with you so it's not a struggle. I've heard people tell me they tried to draw up a will or POA for their parent who then turned around and accused them of "taking advantage" or worse. That doesn't make one feel too good.

Anonymous said...

Thank you for sharing you and your husband's situation with his dad. I hope he makes a speedy recovery in spite of the stroke. I know it's not simple.
Today I was with my parents (they live about 225 miles away) for my dad's 85th birthday. He walked into the living room with the funniest look on his face, his mouth and jaw were slack and he didn't answer. My mom hugged him and sent me to the bathroom for a wet washcloth. When I put it to his face he shivered and snapped out of it like nothing happened. He was actually much more alert than usual the rest of the time I was there (He has Alzheimer's).
My parents still live in their home and my mom is caring for my dad. She is fading somewhat as well.
It's a help to know we all share some of the same concerns.

California Girl said...

DV: Perhaps you should have an EEG to see if he had a TIA (mini stroke). My father had those about once a year for quite a number of years. He never had a major stroke and he usually snapped back from the TIAs after a short while. Mother, on the other hand, had a few but went on to have a major stroke which left her paralyzed on one side & bedridden the last 18 mos of her life. I'm not trying to scare you but it sounds like you should consult his doctor.

ArtSparker said...

Sorry to hear of the sudden change to your circumstances, I remember the earlier post very well. I hope your father in law continues to improve.