July 17th, 2013 at 10:00 am
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Health crises can force caregivers to take a stand

by Dorian Martin

As they age, elders may not bounce back as quickly as they used to after a physical setback. Along with health challenges come some big decisions. And sometimes it’s important for caregivers to stand up to elders in order to make a choice that encourages healing and a return to independence.

I now have firsthand experience with this after Dad fell in mid-June. A trip to the emergency room assured us that he didn’t break bones or dislocated discs. However, he was in a great deal of pain and was sent home with pain medications and a mandate to see his primary care physician within 2-3 days. When we saw his doctor, we learned that Dad was having far more serious health issues than his back.

Headed straight to the emergency room

Noting that Dad’s blood pressure was 80/40, the doctor sent Dad back to the hospital emergency room. Tests found that he had a rapid heart rate, fluid around his lungs, a high white blood cell count and low blood oxygen levels. While waiting with Dad in the emergency room, I saw the monitor register his top blood pressure number at 170, quite a change from the 80 number he had registered a few short hours earlier. Needless to say, Dad was admitted to the hospital and remained there for six days.

Toward the end of his stay, we had discussions with his internist about next steps. One possibility was having Dad go to a rehabilitation center with skilled nursing. Another option was for him to come home, where he would be seen regularly by nursing staff and physical therapists.

Selecting the best option for Dad’s situation

When Dad was finally scheduled for release, he was adamant about his desires. “I want to come home,” he demanded. I had given the question some thought as well and didn’t think this was the best option. I also polled several health care professionals, who thought rehab was best.

But how to change the mind of my stubborn father? Fortunately, the home health care staff who had seen Dad on the day he was sent back to the emergency room gave me some great ammunition for my argument. “Tell your father … hospitals are penalized if they readmit a patient within 30 days of discharge,” they advised. “Point out to him that he is very weak and unstable on his feet. If he falls or has a relapse causing him to go back to the hospital, they are likely to say that returning home is no longer an option. Instead, he will need to go to a nursing home.”

I shared this feedback with Dad and also pointed out that he currently needed several nurses in the hospital to help him do seemingly easy things, like getting resituated in bed. I told him that I alone wouldn’t be able to do this for him if he came straight home. Presented with this data, Dad changed his mind and is now at rehab.

Editor’s note: Another writer on our website describes the push and pull for parents and their adult children when it comes to making big decisions of this type. Rather than a medical emergency like the one here, the article looks at long-term care choices such as in-home care or assisted living facilities and suggests how caregivers can work with elders to make these decisions.

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