Elderly parent in the ICU (not the one with Alzheimers) Now what?
December 12, 2023 1:20 PM

TL;DR What do you do need to take care of when a sudden brain hemorrhage takes out the person who was operating the at-home-nursing-home-for-one(his wife), and what if we suddenly have 2 people in need of long term care who have explicitly worked really hard at aging in place at home? More snowflakes after the jump. Just one snowflake as a teaser is that they are in the middle of a real estate transaction. So many other snowflakes.

The 78 Snowflakes

My partner's wonderful father is 78, brightly spirited, and so kind and loving to his wife who has been suffering (but so good-naturedly so) from dementia for the past 10 years. Let's call them Mr 78 and Mrs78.

They have a wonderful cast of in-home care givers at their home in Dutchess County, NY, and the house has been beautifully renovated to be fully accessible on the first floor so that Mrs 78 could get around without using the stairs and so that she and the home care ladies could have their own space in comfort. Mr 78 resisted in-home-care for a long time, preferring a DIY approach, but we have had the in-home care for a solid year now and it's working well. The ladies are lovely, and i think they are generally pretty pleased to be working with the 78s because as far as clients go, they are incredibly sweet people with a nice house. We actually got great answers from metafilter that help us get this set up.

Mr 78 has been still getting around, driving down to Manhattan once a week to have dinner with friends and go to doctors appts and that kind of thing and stay in their apartment uptown. He's been using a cane for a few years, and this is not the first time he has taken a spill, but he's a very independent guy and tends to brush off any filial concerns with an "I'm Fine!" he has an active social life and goes to the market every day for a newspaper kind of guy, and definitely enjoys hard booze on the rocks with dinner. He is a wonderful, fun man who has lived a truely lovely life and has managed to stay quite young at heart all this time.

His appetite hasn't been great lately, and he has been experiencing these sort of episodes where he has to "go lie down" his explanation being that he fell down and hurt his back a month ago. One of the wonderful, wonderful home healthcare workers for the Mrs. 78 noticed and called our attention to his lack of appetite over thanksgiving, but again, Mr 78 kinda brushed it off and said it was just stress from the move.

The Move.
For the past decade and a half, they have lived pretty much full time in rural/suburban area of Dutchess county NY near the CT border. Mr. 78 insisted on keeping the used-only weekly-ish 2 bedroom for a long time as it was fully paid off and the maintenance wasn't much more than he'd spend on hotels. He finally put it up for sale, sold it right away, and the same broker helped him arrange a studio apartment rental in the same building. That move into the studio apartment happened December 1, and Mr 78 arranged all the movers and donation and junk haul away. We came over a couple days, to help but generally were quite impressed with how efficient that Mr 78 had been with all the arrangements. The man wants a Pied-a-terre, and he made it happen, but again- all the paperwork to sell the old place hasn't inked yet, is scheduled for 1 week from today.

Recent Events
Suddenly on December 11, Mr 78 ends up in the ICU. One of the wonderful caregivers for Mrs 78 (the same one who told us about Mr 78's lack of appetite) noticed that he seemed extra lethargic and confused and that there was a sort of dark red bruise on his head behind his ear? She called her own husband, piled everyone into the car and got Mr 78 to the ER. That was yesterday.

Mr 78 has a fracture in one of the vertebra in his neck, and three (3) not-insignificant hemorages in his brain. He is in good spirits when he is awake, but for now he is sedated because he was confused and tried to get up and leave. He is still failing the pop quiz about who is the president and what year it is. The home healthcare worker's husband noticed that the oil in the car hasn't been changed for 20,000 miles, and it's become clear that Mr. 78 was maybe falling down a bit more often than he mentioned to his son. Mr 78 was apparently taking blood thinners and apparently you are 100% always supposed to get checked out after a fall if you are on blood thinners and not to take blood thinners if you are a fall risk. I am telling everyone I know this pharmaceutical fact from now on.

It's only been 24 hours, but Mr 78's phone has been off for we think a couple days now. He must have tried the wrong password too many times and we are just getting "iphone unavailable" on the screen. Not sure what to do about that, and not confident that he has any backups.

My partner got a call from the the real estate broker yesterday when they hadn't heard from Mr 78 and my partner has been in touch with the associate at the law firm Mr 78 has been using to handle the sale of the house.

My partner has NOT yet spoken to the person at that firm who prepared wills and stuff like that- all presumably there is a stack of paperwork at the 78 family's home that can be sorted through, but we can kind of envision a rapidly growing snowball of stuff to do and would love some help making some to do lists and here are the list in 4 big categories we can think of so far:


Now What?
1. Mr 78 near term: at the hospital, in rehab, back at home
.At this point, It's a wait and see kind of thing, but again, he is in the ICU- so it's not outside the relm of possibility that a big hurry up could still happen. Next step is likely to be inpatienr rehab. What should we be preparing ourselves for and what questions should we be asking? We DID tell the Doctor's about the Titos habit (metafilter wisdom, natch) and he is no longer taking the blood thinners. Could he make a full recovery from this? Is that entirely unrealistic? What questions should we be asking? YANHMD, but if you have a perspective or experience in this touch & go realm, we are all ears.

2. Keeping the 78 householdS together, We are pretty sure there is a folder of instructions somewhere but we haven't found it yet and aren't sure how urgently we need to be getting up into Mr 78's business, but How do we go about getting access to bank accounts and making sure bills are paid? One of the home healthcare workers has a debit card for household expenses and groceries but presubably there are other bills to be paid. Mr 78's Phone is locked, not sure yet if we have computer passwords written down someplace, he's definitely a paper guy, so we probably will find account statements and checks, but any practical advice on taking over another household's bills (temporarily or beyond) would be super useful.

3. What the heck do we need to do about this real estate closing next week. especially if Mr. 78 remains sedated. Also what the heck do we do about the 2nd apartment? That's a longer term question, but it's definitely a question.

4. Mr. 78's moving forward prognosis and possible lifestyle adjustments to existing home care arrangements... We're anticipating more days at the hospital and a trip to the inpatient rehab after that, but like... then what? I suspect the home healthcare ladies for Mrs 78 just don't pick up the additional care for mr 78, right? or do they? How does it work if there's two patients that need in-home care?
Mr 78 is quite tall. We could probably move his bedroom downstairs into the formal living room (next to the new ADA addition crafted for Mrs 78) but like, if he's confused, he might try to put himself to sleep upstairs anyway, and I am not sure one of the ladies who helps w the Mrs could be quite as helpful with a big tall guy who has already tried to walk himself out of the hospital with a brain hemorrhage. This is just one of a zillion possibilities I could imagine here and i recognize i am spiraling a bit so i will stop here.

Please help us come up with next steps, questions we should be asking, ducks we need to line up, loose ends we should keep an eye out for, and any helpful advice you might have about coping with this.


Thank you for your help, Metafilter- we are truly grateful to have this community to ask questions of.
posted by wowenthusiast to Human Relations (12 answers total) 6 users marked this as a favorite
Get lawyers.

Contact all financial folks ASAP. Let them know that you are trying to get your ducks in a row, but a heads up this may be coming. Finding those accounts? yikes. Grab all the mail? Get some passwords? Ugh.

Again, get lawyers involved.

4. Yeah, you are going to have to pay for Mr. 78's home care. You might be able to get a deal, with 2 patients.'

Also: IANYD but why stopping the blood thinners? I am on them currently, and other than random wounds, (of which I tend to), even though I have convinced my doctors that I can go off them, feel little need to do so until I feel healthy/healed enough to play soccer again. They lower stroke risk and etc.

I am only 60, and spent three days last year at this exact time, in the ICU. On a ventilator. With sepsis, congestive heart failure, non functioning lungs, hideous surgical wounds...

But here I am! Mr. 78 can surely recover. But for the third time, get some lawyers. Find the accounts, get the permissions, look at the will.

Sorry you have to go through this.
posted by Windopaene at 2:02 PM on December 12, 2023


"I suspect the home healthcare ladies for Mrs 78 just don't pick up the additional care for mr 78, right? or do they? How does it work if there's two patients that need in-home care?"

When we thought we might need to do the same thing, I called the agency that employs my mom's caregivers and the answer was yes, they could take on my dad's care too, for an additional fee (it worked out to about 20% more in our case).
posted by bfields at 2:04 PM on December 12, 2023


Who has power of attorney and medical power of attorney for your partner's parents? I am guessing that Mr. 78 has both for Mrs. 78 *and*, given her health status, that they are activated. Are these powers set up devolve to your partner if Mr. 78 is incapacitated? Or to another relative?
posted by eirias at 2:10 PM on December 12, 2023


#1: The lawyers will know if there a power of attorney document set up. This will help, if it exists. they should also know about the health care power of attorney stuff too.
#2: Let the real estate agent know that there will be a delay in closing. Postponing the closing because the seller is in the ICU seems like it would not be a huge problem if you anticipate that you will be able to close fairly soon. By the way, a notary can come to the hospital and get documents signed and notarized there, as long as the patient seems mentally competent.
#3: how did Mr78 pay bills before? if the bills come to the house, then the caregivers can open the mail and let you know what needs to be paid. If you can get access to his bank account on-line you can pay bills for them that way. It might be a little dubious pretending to be him but since the money comes directly from his account and goes directly to pay his bills, I don't see any big risk here. If not, can you pay with the debt card? If not, can someone in the famiy pay the bills and get reimbursed later?
#4: it sounds like the family is not local but this may be a good time for someone to fly out and help with arrangements as well as scour the house for passwords and paperwork.
posted by metahawk at 2:11 PM on December 12, 2023


Mr 78 might already have financial and healthcare powers of attorney set up. I doubt it is your partner if they don’t know it, since presumably that person, or people, agreed to perform these tasks. If not the attorney will know. That person will immediately have full power to access bank accounts and pay bills. For my aunt this necessitated in-person visits by the person with financial POA, loaded with her own legal ID to my aunt’s bank and to her investment bankers (Merril Lynch, Fidelity) and took a few days to get appointments and all the notarized papers. The lawyers took care of prepping the paperwork. The home care ladies, I am sure, will not continue their care if they are not paid. If Mr 78 is competent he can set this up while hospitalized - my aunt did just this from an ER and her attorney sent over a paralegal to get signatures. You must sort out the powers of attorney both for health and finances. He could also assign the legal ability for his financial POA sign his real estate contract, which would get that off the table and add to his supply of cash at a time he may need liquid assets.

It’s very positive that Mr 78 has been so independent but it sounds like there are holes in his healthcare history. For instance why was he on blood thinners in the first place? Does he have a history of clots? Does he have underlying a-fib? The hospital should have contacted his PCP for medical history.

The scenario you describe about his progress from ICU to rehab, but there are unfortunately other, less happy pathways patients can experience. Patients get pneumonia. Older people are susceptible to other hospital-acquired infections.Sometimes other conditions are discovered. Please prepare yourselves for an up and down path forward.
posted by citygirl at 2:51 PM on December 12, 2023


We do think that partner likely has Medical Power of Attourney and all of that stuff, but the paperwork packet for his son prepared by Mr 78 is back in Brooklyn at his place, and now he is up at the hospital and stayed over with his mom- Those places are 30 mins apart, ~120 mins from our city. Partner will come back to Brooklyn today and start figuring out what he has.

thank you to everyone for the thoughtful advice so far. definitely a lot of stuff stuff we haven't thought of and much please keep it coming and appreciate everyone taking the time to help some strangers with advice about heavy logistics.
posted by wowenthusiast at 3:02 PM on December 12, 2023


Great points citygirl about ICU experiences -- people who spend time in ICUs are also vulnerable to delirium. This isn't always lasting but can be scary and would mean periods of time of non-competence to make decisions, I expect.
posted by eirias at 3:14 PM on December 12, 2023


Contact the real estate people and see if this could be pushed back a full month. There must be some time built in for emergencies, but if you can gain a month, that will tell you A LOT about what things will be going forward. Whatever time you get, the decision of whether or not to proceed will be determined either by Mr78 or by the person with a power of attorney, hopefully in agreement with the 78. Will the studio, if purchased, be a major bone of contention if Mr78 cannot stay there on his own? If going upstairs alone is a problem, heading downtown alone would be much worse! Mr78 might knowing he has a place to go would be an extreme temptation that could be hard to resist. Could he be persuaded to let go of the purchase of the studio with the idea that his trips to town aren't over, he'll just be using the connivence of a hotel? That frees him, and you, up to not have the hassle of taking care of a place that may or may not be used. Phrase it such that he understands that these trips may not be as frequent, or continue as long into the future, as could be wished, but could still be possible with modifications. If he's capable of being reasonable and thoughtful, he will consider that a sensible way to go.

It sounds like you're in an excellent position with care people that can step up to cover what you need to have done. I doubt he'll be released if there's an issue of his being unable to comprehend about living downstairs. If not, then you may have to provide for additional adaptations such as barricading off the stairs. Your care providers should be able to work out ways to deal with any situations that arise. There are male care workers that could also be assigned to him.

He sounds like a delightful man. It sounds like he's been very proactive in planning for changes to his lifestyle, and I hope you are able to talk to him and work with him about other changes that will allow him to live the way he wants safely. If he's capable, you could gently hint to him that it would help you if he would get his ducks in a row, so that any sudden hand off proceed without a glitch.
posted by BlueHorse at 4:31 PM on December 12, 2023


Talk to the hospital social worker - they can help guide some of these things like rehab.

My dad had an aneurysm. It sounds like his brain injury may have been worse but here’s what happened: he was in ICU for ~3 weeks, then on the floor for a bit, then rehab for a few months, then a year of outpatient. He also developed a lot of complications, notably UTIs (which presented as extra confusion) and the flu.

My dad was younger, mid-60s, but due to the capture of his bleed, his prognosis was poor. We really had to advocate for rehab. I’m so glad we did. He had physical, occupational and cognitive therapy. Some was around fall prevention.

Traumatic brain injuries can result in a long healing period where the patient’s emotions and thoughts are off. You may want to be prepared for Mr78 to be more emotion about decisions made (that doesn’t mean don’t make them.)

I hope for a strong recovery.
posted by warriorqueen at 5:40 PM on December 12, 2023


When he's ready for rehab, the hospital should give you a list of facilities that take his insurance. The facilities are usually very happy to answer questions, give tours etc. I would recommend asking how many days his insurance will cover, if there will be any out of pocket costs, and what documents you will need to produce - most likely will include vital records and bank statements. When he's done with rehab you can reach out to the home care agency you're already using to discuss an increase in hours and the rehab social worker can make referrals for any other services he might qualify for.
posted by fox problems at 7:14 PM on December 12, 2023


My family just went through a scenario almost exactly like yours. To be honest, it sounds like you are already way more on top of things than we were!

Here are a few quick thoughts:

- One thing that kept me calm was making a list of issues, and keeping close track of which had to be solved today and which could be ignored for a week, or a month. You are having a crisis /right now/ and need to make it through the week. Fun fact: nothing bad happens if you don't pay your bills for a month or two.

- There are going to be a ton of new players in this crisis: doctors, nurses, case workers, lawyers. Keep notes about who is who. Don't hesitate to ask them questions, or for help. If they're anything like the people on my list, you'll find that you're surrounded by people who are already experts on all of the topics you're nervous about.

- If there's extended family that's on good terms, start a group chat or a mailing list and delegate as much as you can.

- Don't put in all-day bedside shifts at the hospital. Visit, but also eat, rest, pace yourself.

All the best for you and yours. This is going to be hard but in a few days the action will slow down and you'll have plenty of time to plod through the pile of work ahead.
posted by eraserbones at 10:33 PM on December 12, 2023


thank you so, so, so much everyone. This has been super helpful to our family and we really appreciate everyone for thinking back and sharing wisdom from difficult times in your own lives. Much love.
posted by wowenthusiast at 3:44 PM on December 13, 2023


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