Should I fight to get my dad into a better rehab center?
November 7, 2013 1:55 PM   Subscribe

My father was in an accident two weeks ago, involving some broken bones and head trauma. He was released from the hospital yesterday to a rehab center that is awful. I’m having major difficulty getting him into a better one. What do you suggest?

As I posted in my question last week, two weeks ago my father fell from a 30 foot ladder and suffered broken ribs and minor (according to the MRIs and CT scans) head trauma. He was released from ICU after 9 days and released from the hospital altogether after 13 days. The hospital told us we had to pick a rehab facility immediately and gave us a choice of two places. We chose one of them because the other one seemed to be a geriatric home. My dad was sent there yesterday afternoon.

The place he’s in is a nightmare. Everyone there is severely, SEVERELY mentally incapacitated. My father does not belong in this place. In the past week, he has been so communicative with us – he recognizes everyone, knows the answer to every single thing we ask him, is talking about thanking everyone who’s helped him, having a big party when this is all over and going to Hawaii to celebrate, etc. The ONLY thing that seems to be cognitively “wrong” with him is that sometimes he will search for the right word to use. But he’s barely been sleeping. As of today, Thursday, he hasn’t slept since Monday. So he is profoundly exhausted. I know I am completely unqualified to make any assessments of his mental faculties but… to me it appears that his brain is fine – he’s just really, really, REALLY tired. If I missed one night of sleep, I’d be less coherent that he’s been.

We fought like hell to get him into a better rehab center today. The one we had in mind is bright and clean and accredited and focuses mainly on physical therapy. We convinced the first place to release him and the new place to accept him, pending the assessment. But when they sent the therapist from the new place over to assess him, he was so exhausted and out of it, that she could barely even get him to open his eyes. So she decided that he was not acceptable to their facility because she thinks he has neural damage and can’t follow commands, etc. And she said that the first (awful, nightmare) place is the best place for him.

To say that I’m devastated and terrified is an understatement. I feel like my dad is being treated like he’s way worse than he really is and because of that, he’s going to stay in this awful place where he will just get more and more depressed and drained.

My question is, should I keep fighting to get him to a different place? Or should I defer to the so-called professionals and leave him in this creepy place and hope he’ll start sleeping and get better? Everyone is telling me I should try to get him into a better place but other than the one that rejected him today, all the other places are farther away. Then my family wouldn’t be able to visit him, and the ONLY thing that’s keeping him going right now is that he gets to see my mom and sisters every day (and me on the weekends). I’m so scared and I don’t know where to turn.
posted by silverstatue to Health & Fitness (9 answers total) 1 user marked this as a favorite
Family BlahLaLa is dealing with elder issues right now, and the best thing we did was pay $750 to a consultant to help with precisely stuff like this. She knows the area, knows the available facilities, knows the staffs, knows what the state and federal rules and benefits are. That was a lot of money for us to spend, but it has paid off tenfold.

I'm not in your area, however. We found our lady by asking around. You could also try googling "elder care consultant" +your area.
posted by BlahLaLa at 2:02 PM on November 7, 2013 [1 favorite]

Is there a social worker, coordinator, or case worker assigned to him from either the hospital or the "bad" place? If so, getting that person on your side could be an important step to getting him moved. Those folks often know the ins and outs of the system and can be a tremendous resource. After one of my siblings had traumatic brain injury, my mom was able to get a lot done with the help of a sympathetic social worker originally assigned to the sibling's case by the hospital.

As for him being rejected from the better facility, that may not be a final and forever decision. People with head trauma can improve and change over time. If your dad is thought to have improved, it may be possible to get a new assessment after a bit. However, are you sure your dad should go to a place that primarily focuses on physical therapy? Maybe he needs both types of therapy. I wouldn't want to write off therapy focused on the neurological issues without discussing that with the neurologist. What therapy resources are the place he is in now? Is he getting all the therapy recommended by his physician?
posted by Area Man at 2:18 PM on November 7, 2013 [1 favorite]

Yes, talk to a social worker right away. But I agree with Area Man that it sounds like your dad may need OT as well as PT due to his post-concussion syndrome.

Also, question the caregivers about why they are not doing more to help your dad get the rest he needs. IANYD's D, but a standing order for Ambien as needed is practically part of hospital protocol for admitted patients - is he getting medication to help him sleep, and if not, why not? He probably wasn't getting this initially because he was in for brain injury and altered mental status, but once the team started telling you that he was suffering from insomnia you would think they would have changed the plan.
posted by treehorn+bunny at 2:37 PM on November 7, 2013 [1 favorite]

Definitely keep pushing- talk to whoever will listen to get him moved. The ability to follow commands can really vary, especially early in rehab and with people who are unfamiliar. In the meantime, see what you can do to get him a better sleep pattern- private room, medication, schedule some do not disturb times with the nursing staff/ therapists there. Don't be afraid to be obnoxiously persistent-you and your family are his best advocates for sure and you will be able to get the best care he needs. Take care of yourself too, it is early days in his rehab.
posted by bookrach at 3:42 PM on November 7, 2013

Could your dad's insomnia have anything to do with a loud environment? I ask because my sister is in a rehab centre at the moment and is having troubles with noisy patients and (very!) noisy nurses. It's a simple thing, but soft silicone earplugs have helped her a lot.
posted by Naanwhal at 3:50 PM on November 7, 2013 [2 favorites]

Response by poster: I think perhaps he does need some cognitive therapy too. I just wish we could properly assess his cognitive state, because I truly believe 90% of his problem right now is that he's so completely exhausted. I'm going there tomorrow and I will sit down with them and figure out strategies for fixing his sleep patterns. I will check out his environment and see if he needs different lighting/earplugs/white noise/more comfortable pillows etc.
posted by silverstatue at 7:52 PM on November 7, 2013

Whatever you do, don't give up on this. Stay in close touch with your father, stimulating his mind and not letting him lose awareness of where he is, what day it is, what's happening in the world, etc. It's really easy to go into a mental decline in a place like the one you describe. I'd say what he needs is something to give him, first, sleep, and second, hope that he'll get out of there someday.

Sleep deprivation is, I believe, one of the most ignored medical conditions out there and ignored at our peril. It causes such mental derangement that leaves a person confused, delusional, fearful - even panicky. I'd be willing to bet that half the people who go off the deep end and shoot up places and people are sleep deprived - certainly a lot of car accidents are due to an inability to think clearly and respond to situations quickly due to the driver lacking sleep for many hours.

Keep yelling and fussing until you get the attention of someone who can get him put in a more appropriate environment for him - he might even do better in the geriatric facility if they let him sleep and are pleasant and encouraging.

Most importantly, don't blame yourself for any of this. You're doing all you can and a damn good job of it and old people fall and mess up their bones and their brains and it just happens. Your Dad is lucky to have someone fighting so hard for him, but you must do it battle by battle - you can't do the whole war at once. Take care of yourself because you know he wants you to.
posted by aryma at 9:46 PM on November 7, 2013

You really need to discuss this with a social worker, his case management, or some other professional.

I am very sorry this happened to your father and you are obviously terrified. However - you need to make decisions based on facts. A major injury two weeks ago is head trauma. It's terrific that you and family members are having conversations with him. That doesn't mean his docs should call him healed.

From this question and your original question, it sounds like you are clinging to the idea that rest and chicken soup are all that's needed and then it's time for party in Hawaii. Iam hopeful that this is basically true.

You keep talking about his not getting sleep. How do you know this? Has it been charted? Serious bone breaking accidents are exhausting. With or without pain meds. If you are concerned that he is not getting enough sleep, that is a serious issue and the facility should be willing to discuss.

You say you fought like hell to have him moved - what does this mean? How do you know the condition of every other person in the facility? After his fall and injuries, you father needs medical care. Please work with a professional who understands your family's concerns and your father's needs to get this sorted.

Also keep in mind that your father may be working very hard to continue being good ol' Dad with a capital D to try and ease any family stress.
posted by Lesser Shrew at 6:14 AM on November 8, 2013 [1 favorite]

Yes, engage the help of the social worker from the hospital. Also, I'm assuming that you expressed your concerns about your dad's exhaustion to the therapist who evaluated him? Did she dismiss your concerns outright? Was she willing to set up another appointment to re-evaluate him in a couple of days? If not, maybe talk to her manager.

Have a talk with the head nurse of his current facility and insist that they do whatever procedures they need to do during the day, and otherwise disturb him as little as possible at night, other than keeping an eye on him. Bring in a white-noise machine. Stay outside the door one night and make sure no one goes in to bother him so he can get some rest.

My dad was in a rehab facility for 90 days, and my stepmom stayed there with him the entire time (the *ENTIRE TIME* - she basically moved in) to make sure he was getting proper attention (of course, his situation involved a trach tube, but still, the point is your dad has family, they can't, or shouldn't, kick you out).

I agree to check with the dr to see what light sleeping-aid he might be able to get. If not ambien, maybe valium? (I'm sure sleep aids are tricky with head trauma though).

Try to get some rest yourself. Put on your own oxygen mask first, as it were.
posted by vignettist at 1:05 PM on November 8, 2013

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