Elderly Parents - Hospital Protocol?

I used to work in SNF. Most spouses do the same thing and come early and stay all day... if they're blessed enough to still have a living spouse. Or their spouse never ever comes at all and is basically absent. Children usually visit weekly, unless they're local then multiple times a week. Usually the spouses seem to do what they would have done at home (visit, dote, bicker, eat, hygiene things, watch tv, crosswords, books, etc). At their age and the time they've been married, Codependency is huge! Healthy? Who's to say. :) I see both sides. Its concerning yes, but its part of their changing lives now that their aging. Every couple and person will have their own way of dealing and you've got to imagine this can't be easy.

My husband and I have just been through 5+ years of this with my mom and his mom & dad. My MIL is still alive but has been sick all her life - mental health issues, health issued resulting from morbid obesity and I'm convinced my FIL's jumping through hoops to make her happy is part of what stressed his body, alllowed for a weakened immune system and eventually put him in the grave at 70. Technically he died of a serious and swift lung disease - but I think the stress of dealing with my MIL severely impacted his immune system over the years.

When my MIL was inpatient or in a rehab facility my FIL would get up every morning and spend most of his day at the facility. Eventually we convinced him to spend less time - that the staff at the facility was there to care for my MIL. She's been in a nursing home ever since and her status hasn't change even one tiny bit from when my FIL was alive and spending the day with her. he's now been gone for almost 5 years.

My mom was an elderly cancer patient. She was home on hospice care for 9 months but eventually got better instead of worse and we had to transfer her to a nursing home. My father hadn't been in the picture for more than 30+ years at that point - but we siblings tried to split our time visiting with her - there were 5 of us so it was easier on us - and better for my mom. But there is ALWAYS one sibling who is more involved and one who is much less involved. If it's a big family there will be some siblings in between. I iwas the one who, by default, ended up being the primary caregiver for my mom. I handled her bills, her medical paperwork, Medicaid filing, funeral pre-planning,e tc. Of her five kids, I spend the most time with my mom, picked her up for church most Sundays, etc. But I also lived the closest by, and I do health insurance & finance for a living. I have one sibling who, even though he lived about 15 miles away from the nursing home hardly spent any time with her - would come and visit about every 3 weeks - at best - and would stay for about 1/2 hour. But I think his wife gave him a hard time about it. I don't hold any hard feelings for him - we all come from different situations and when my mom passed away I had no regrets. I can only control my own self.

Anyway - pace yourself with your parents and realize that this could be only the beginning of a long road. As our parents age they will become progressively less well and will need progressively more medical care. Your mom will quickly wear herself out if she runs at every order from your father. Try to persuade her to stay home a couple of days a week and then when she goes to only be there for a few hours - late afternoon is probably when she can be the most helpful - it's a busy time for the staff.

This particular rehab stay for your dad won't last long - your dad will be home before you blink - they tend to get home and still need care. I suspect he will not want to have a physical therapist come to the house (too bad - insist on it) and you may be able to get an aide come to the house a couple / few times in the first week home to help your dad bathe, etc. Insist on it - ask the rehab facility's social worker / discharge planner to get this set up. If your dad balks - too bad. Tell your mom to leave the house when the aide arrives - so your dad has no excuse and your mom can get a break.

Knee replacement rehab is tough - much tougher than hip replacement because the knee is such a complex joint. So please push him to get as much rehab as he can. After in-home P/T that first week he will probably be eligible for a few weeks of P/T at an outside facility - insist that he goes. My cousin is an orthopedic surgeon - he says even the best surgery will not produce good results without good and consistent physical therapy.

Good luck mama. Going through your parent's aging and final illnesses can be a really long slog. It's difficult and filled with SO much emotion - on both your part and your parents. they will become childlike in some ways and you have to take on the role of the parent and it's not easy. Pray your way through. Always show respect and honor - it goes a long way with our parents and it makes it easier for them to defer to you for the big stuff if you show respect int he little things. And realize that your kids are learning by your example. And how they see you treat your parents is likely to be a pattern for how they will respond to your aging when that time comes. It's all useful learning experiences for us as well - WE need to learn from it so we age gracefully when it's our time.

Hugs to you - this is a tough season to go through - lots of tears, lots of sacrifice - but ultimately our goal was to be able to stand at their graves one day with no regrets. And now after 2 of the 3 have stepped into eternity we can say it's worked.

My grandparents had a good relationship. When my grandfather had to go into a nursing home for care, she spent almost every day with him, for most of the day.

Basically, there is nothing you can do to change the dynamic of their marriage. It is up to your mother to make decisions about what she will and will not put up with. It has been this way for 55+ years, so I seriously doubt anything will change now. Probably, your mom would rather keep things the way they are, even though you and I wouldn't stand for it.

After 55+ years of marriage, you are not going to change the dynamic between the 2 of them now. Support your mom the best you can with weekly visits. With multiple siblings, it sounds like you can bring dinner and spend a little time at least 3-4 days a week (wasn't sure how many of you there are, but you said sisters so I'm assuming 2+). That's probably the best you can do.

I don't think you can change the dynamics of their relationship after all these years! Regardless of the negatives aspects (him bossing her around, her taking it, the two of them sniping at each other), this is who they are. This is the life they have built.

If they can handle the financial burden of her buying 3 extra meals a day on top of what the hospital is providing, and if she's willing to do it, and if what's she's choosing (or he's demanding) is acceptable nutritionally to the staff based on his health needs and medications. there's not much you can do. If your father is making her do things instead of getting up himself (which the rehab staff may want him to do), then you can work with the staff to have THEM tell both your parents (in front of you) that it's hindering his recovery. If he's sitting in bed or the chair instead of working on rehabbing that knee, that's a problem. If Medicare is going to get tired of paying for all this because he's not progressing or trying, that may motivate him (they may have to stretch the truth here to get him moving). If he's sitting in bed, he's at risk for things like bedsores and constipation, plus deep vein thrombosis (same as sitting on an airplane without moving) - so they may say to him that he MUST get up and go to community meals (if there's a dining area), go to activities, etc. If he doesn't do the exercises, he's not going to get full mobility.

Do you have a health care proxy for both of them? If not, try to get one. That's so you can make decisions but also it will facilitate the staff speaking with you with and without them. That's easy to arrange through their primary care physician. Even without that, you can speak to the staff about your recommendations, and get their advice based on the many other couples like this with whom they've worked. Your father is not the first tough old bird they've treated, and your mother is not the first co-dependent spouse.

When my mother was in rehab for a shoulder replacement, I was there every day. I think an attentive family member keeps the staff on notice that someone is noticing what's going on. However, too much time there can get in the way of the therapy. So I definitely wasn't there all the time. Not good for me, not good for her, not good for the staff. t think 8-5 is too long for your mother to be there for her own welfare, but neither she nor your father is going to listen to that. If you can get the staff to make up a schedule for your father, with PT and OT, and then work in some hours for your mother around that, it might be something they will accept. Your mother can bring your father lunch and then a bagel for the next day's breakfast (or whatever) but then he can take dinner on the hospital schedule, get up out of his bed and eat from his chair, or go down the hall to the dining area (I know some rehab places serve in the room, but others are within nursing homes with full dining rooms or are step-down facilities that have smaller dining areas). Everyone complains about the food - that's part of the experience! So your father can join in with the others.

The goal is to get your father motivated enough to do this work needed to get discharged. If your mother's presence is getting in the way of that, then she has to be convinced to cut her hours in half.

However, the sniping at each other is part of who they are, and they are both a bit lost without it. At some point, one of them is likely to be widowed and having to confront the devastation of not having that annoying and argumentative person at their side - and that may be part of the anxiety fueling this current dynamic.

Sending your strength - I know it's so difficult.

My parents were married for 56 years before my mom died last year.

They are set in their ways. When my mom was in the hospital before she died? My dad was there for as long as the hospital would allow him to stay. He doted on my mom. However, my mom was NOT like your dad and would constantly tell him to go home so he could be more comfortable (the chairs in her room were HORRIBLE!! my sister ended up bringing in one of their camping chairs).

I would check with the rehab facility and find out what changes you can make to the food - can you order food for delivery since your dad doesn't like it?? Can your mom bring a cooler of food for your dad?

For me? I am in DC. My parents are in Los Angeles. I couldn't go visit daily without a plane ride...and I'm so glad I went. My situation is VERY different from yours. If I were 40 minutes away? I would visit every day and take some of the stress off my mom.

Life changes on a dime. You NEVER know when your last hug will be. You sound VERY angry and disappointed with your dad. Maybe you need to tell him how you feel. While it most likely will not change him? It will make him aware of what he is doing. Some people are oblivious to their actions. You need to remember both are under stress.

You can build your mom up without tearing your dad down. It's a fine line. But you can do it.

My dad was 78 when he died, after several seperate month long hospital stays and surgeries. He and Mom, then 56, never got along well and the stress made things both better and worse at once. Still, she was there overnight during the scary times of recovery (times in ICU, immediately post surgery), daily for most of the day thereafter. I was only 22 at the time and was there with Mom daily during the worst times, for a couple of hours daily or every other day the rest of the time. Usually I'd visit with Dad for a bit and then Mom and I would go out to eat. When he was really being a pain, I left that to Mom to decide how much she would put up with and stayed out of it.
I suggest you visit with your dad as often as you can, take those visiting opportunities to get your mom out and get her a break from the hospital, the stress, everything. Then, stay out of it. She's put up with him for this long and as they get older and mortality gets more real, only she can decide whether it's worth it to continue to put up with him in light of possibly losing him soon.
It's hard to stand back and watch it, but you have to give her the respect to make her choice.
Good luck!

My dad has been in the hospital for long stretches of time. My mother visited twice a day IF he was in the hospital right down the street. Visits were not long and she kept up with her many hobbies/activities. When he was further away from her she visited once a day for mabey two hours and I visited once a day. This was still stressful for my mom but not as stressful and unhealthy as what your mom is doing.

My aunt was in rehab for 8 weeks after knee replacement surgery. Her husband and kids work. Even so, they managed to be there for about 2+ hours each each day, sometimes in turns, sometimes together. A day did not go by without her having company for 4+ hours.

Your parents are your parents and are set in their dynamic. Something you might consider following his release is to see if they might foster/ adopt a dog. It would be a good thing for both of them to have something to care for. Your father will have to be out walking anyway. Also, a dog is a great excuse to de-escalate bickering. "I would love to stay here and continue this "discussion" but you can see, the dog needs to go out."

Best,
F. B.

My hubby was inpatient for a procedure and I'd go in and stay a couple hours. Staying all day wouldn't have allowed him to rest and rehab. I'm a knitter so I'd knit and we'd chat while nurses, assistants, and housekeeping would come and go. He'd usually call in the morning and then again at night just to chat.

Let your mom know that she needs to stay home and take care of herself and maybe just go in around lunch time for a visit.

First of all, I'm surprised that your dad had an *elective* surgery at his age and with his recent health history. Wow.

If your dad is anywhere on the N spectrum chances are that your mom is an enabler of some degree or another. You will not change either one of them. The best you can do is relieve your mom once a week - i.e., bring a meal and sit with your dad so she can do something else, go home, etc.

If I were you I would not let either one of them triangulate me into their issues.

My MIL is in a nursing home due to late stage Parkinson's and her long-term boyfriend (younger than her) is there every day, though he tends to come in the hour or two before meal times so that he can wheel her to the dining room. So I don't think it's unusual for the spouse or significant other to hang around. That being said I don't think it's wrong for the caregiver spouse to take some time for herself/himself too.

Good luck with this - I know it is hard.

When my dad went into a nursing home we picked one near home. My mom was already gone. It was before I had kids so I was able to visit him every day for about an hour before or after work, and usually ate one meal with him. On my days off I usually stayed a couple of hours or took him out for the day. My sister lived over an hour away and my brother lived about 40 minutes away, so they only did weekly visits and/or outings. That lasted about two years.

Recently when my MIL went into palliative care my husband drove to the hospital 30 minutes away every day and stayed with her for about two hours before he went to work. She was in there for about six weeks. The kids and I went on the weekends. Her sister, who is retired, was there for about 6 hours a day.

You can get your mothers doctor to advise her that she is only allowed to go for an hour or 2 per day.. Decide which 2 hours this needs to be. Tell him she is becoming over worked, with stressed with all of this, and will not listen to you.

This is the time that your relationship is shifting. You will now become the care giver a guidance counselor for your parents.

You know darn well your mother does not need to be there all day, and your dad needs to suck it up and get with the program. Your mother us not his slave. He us grown man and will be just fine, eating what us served and entertaining himself.

Be strong and speak to them clearly and without guilt.

The phones still work, he can call. And when your mom is tired, she is allowed to silence her phone.

I guess you can tell I have been through this many times. Our entire family lives here in town and they tend to live for a very long time!

Ask for help from the social worker. Accept that your parents are the way they are after 65 or so years together. They are not going to change. You are not responsible for protecting your mother. Trying to stop her from spending that time with your father may cause difficulty in your relationshipwith her. The stress of staying away may be just as costly healthwise as the stress of being there.

How often and how much time others spend isn't useful information in getting your mom to change. She is her own person and not like anyone else.

I know from experience how difficult it is to standby and watch our parents struggle. I considered my experience with my parents to be a learning experience in how to recognize when I can and cannot be of help and how to take care of myself in this highly stressful situation. I had to let go of my need to take care of my mother; to accept that she'd made choices that put her in each situation and those choices can't be undone.

I needed to love her just the way she is; to give her hugs; to empathize with her; to only give suggestions when she asked; to be patient and non- judgemental; to let my parents lives play out as they had set them in motion.

if you think your father will demand that your mother wait on him to the detriment of her health I suggest you talk with the social worker about alternatives. Medicare will pay for some home care. There is a limit on how long Medicare will pay for rehab. That may be the reason for expecting him home in 2-3 weeks.

My 72 yo old friend stayed longer in rehab because she had delirium after knee replacement surgery. She could go home only because her husband could help care for her. More recently, at 76, she went into rehab and wasn't strong enough to go home after 4 weeks. She had to move to an assisted living residence.

Just a thought that might help with perspective. I'm 71 and still spending most of my time taking care of people. If your mom is physically active she may be OK. She is used to your Dad's behavior. Give her support. Relieve her when you can. Perhaps one of you stay with Dad while another takes her out to eat and rest. Tell her you need to do this for yourself. Tell her you know she can take care of Dad and he'll get well quicker if she lets the rehab staff manage him.

if she han't responded to your concern for the way her husband treats her up until now she's not going to respond to those arguments now. Try to get her away by appealing to her health and how she needs tat to help your Dad. And try using the idea that you need a break, a meal, a ? And take her with you.

At te same time do not try to change her and do not allow yourself to feel responsible for her choices.

I would help your mom out a bit by preparing some ready-to-go meals... Maybe some kind of breakfast casserole that can be tossed in the oven in he morning, and she could take it with her to give him a hot breakfast. Then some kind of dinner that can be served cold or heats up in a microwave well. (That leaves lunch open, but I'm sure she could use a mid-day break, and driving out for a meal would give her something to do...)

Maybe stop by your public library and find some movies/shows they would like, and borrow the DVD. (Free.)

That way, you are actively participating in his recovery without having to drive so far so often.

I would still visit at least 2-4 times a week... Depending on how close you are with them. When my dad was hospitalized for several weeks, my sister and I took turns driving nearly an hour every day to visit him together after work.

Diane B had excellent comments. Please take them to heart and see what the rehab facility itself can do to facilitate your mom spending less time there. It may very well be hindering his progress in recovery. And, again, you can't change the nature of the relationship they have maintained for 55+ years. Don't try. It will just upset all of you. You can encourage your mom to take care of herself SO THAT she will be better equipped to take care of him when he returns home.

If this is taking a toll on her, imagine what it will be like when he is discharged and she has him full time back at home and no nurses or therapists on staff to help. And she still will likely have to drive him to some sort of out-patient therapy afterwards.

Good luck.

At that age, I would visit them daily. I would take some FMLA and be with mom and him.

No, they should be in rehab programs to strengthen their injured areas. They need to be able to do their stuff and rest. She needs to stay home and let him find out what it's like for her to not be at his beck and call. Poor lady.

She'll be completely lost if he goes before her. She was raised in a different generation than you and she was raised to be her husbands caregiver. She only has that role and it's her job and what makes her feel whole.

Unfortunately, I don't think there is a hard and fast answer to this.

My mom is one of three girls, and when Gram had her stroke (Gramps died 11 years earlier), between my mom, my aunts, and me, there were only 3 evenings across the three months until she passed, when no one could be at the hospital, and we all felt horribly guilty about it.

Fast forward 10+ years, and my mom had both knees replaced (at the same time, by choice) and was in the hospital and rehab for ~3 weeks). Aside from the actual day of surgery, my dad went almost every day and I went every other day. My dad and I both had to work, so we called when we could during the day and headed over there in the evenings. But I am a single mom with a young daughter, and it just wasn't feasible to be there every evening or to have a sitter multiple times a week.

Two weeks ago my mom fainted at work and needed 8 staples in her scalp and an overnight stay for testing. Thankfully, everything came back normal, but it was tough. Someone had to get my daughter from her afterschool program and both my aunts had full agendas. I left work early, my dad came directly after work, but then left to get my daughter.

We needed to retrieve my mom's car, so I had to leave shortly after my mom got settled in her room to get my daughter home for homework, shower and bedtime on a school night and to free my dad and aunt to get her car.

Now, I will say that it sounds like your dad is more dependent on your mom than my mom is on any of us (she is younger - 69).

The hard answer is that you still have to live you life - you still have to grocery shop, attend school functions, deliver and pick up your kids for activities, work, etc. etc. All of the quality hospitals in our city at 30-45 minutes with no traffic.

I fear for a time when my mom might have a stroke or something and being an only child, trying to balance visiting and living. Since you have siblings, you can divide and conquer. If someone can distract your mom for a day, that would be helpful to her too.

It might also be time for you and your siblings to step in with some tough love, which is really hard when the tables are turned and you need to direct it to your parent.

No easy answers, unfortunately, but hope this helps a bit. Saying a prayer that he is up and about soon and that you find some peace with managing all of this. No fun being in the sandwich generation.