Help me navigate a potentially depressing Thanksgiving
November 15, 2016 11:27 PM   Subscribe

A parent fell ill 5 months ago following complications from surgery. My friend was just killed in an accident. Three days after the funeral was the election. The day after the election I found out this parent may not walk on their own again and may need to be in long-term care indefinitely. My Thanksgiving visit will be spent planning next steps for the parent. I have more emotions than I can process right now.

My mother (mid-60s) had joint-replacement surgery about 5 months ago and about a week after the surgery the wound became infected with MRSA. She contracted half a dozen opportunistic illnesses, spent several weeks in the ICU, had a few procedures to try to clear out the infection, and was discharged with one fewer organ than she had when she was admitted. She was on an IV-only diet for a while and still has GI issues they are trying to diagnose. She's currently incontinent. She has experienced about 5-10 bouts of what we now think is hospital delirium. Her dementia-like symptoms from prior to the surgery are getting worse.

She'll be kicked out of her rehab facility the first or second week of December. Her doctor told my dad that due to the atrophy from being bedridden for four months it was unlikely that she would be able to walk without assistance any time soon, and that long-term care would be a much safer choice than sending her home. My mom got wind of this and finally had three good days of PT in a row. She walked 15 feet using parallel bars, which is more than she has walked in four months. She was then sidelined on the fourth day with GI issues.

The initial plan was that during my visit I would help my dad research and visit a few long-term care facilities in their area, walk through the elder-care attorney stuff with him, and tell my mom the final plan. He now wants to try out bringing her home. Those three good PT days gave him hope he latched on to, in part because of guilt but honestly I think because of emotions from the election. He says he would take her to PT when she needed it and in-home aides would assist with getting her to the bathroom, dressing her, etc. I think is a terrible idea for a number of reasons:
* She falls (broke both shoulders and her wrist in three separate falls in 10 years) and it is likely that if my dad goes to the bathroom when an aide isn't around she'll try to walk to get a kleenex or some other shit that could wait 30 seconds. She's done it before.
* Her memory problems and lapses from reality make my father extremely impatient with her, which impacts both of them. He's been pretty calm and happy with her out of the house.
* Both of them will be able to socialize. He won't be housebound because she won't be. She LOVES talking about herself, herself, her health problems, and herself. The long-term care crowd is her people.
* My dad is old enough (early 70's) that the stress and physical intensity of care-taking will likely shorten his life. This is my primary concern.

Also worth noting: she is severely bipolar and has borderline. She was, quite frankly, a terrible mother. I had a lot of mixed feelings when she was at her worst this summer, which just made the bad feelings worse. I try to distance myself from her emotions. My dad and sibling are more likely to try to fix her emotions. (My sibling will be spending Thanksgiving with spouse's in-laws. No avoidance, just the holiday rotation. We're communicating often to stay on the same page.)

My objective is to keep the ball rolling on developing a long-term care plan regardless of if she goes home. My dad already has the names of facilities, attorneys, is familiar with the insurance/Medicare stuff. I also want to be there when they set this up so I have an idea of how it works. Secondary objective would be gently impressing upon my dad the risks of bringing her home vs. benefits of being in care. Bonus points: have a relaxing week with my dad.

My questions to all of you:
1. Are there major DO's that I should keep in mind when talking with my dad?

2. What about DON'Ts? What things should I absolutely not say or suggest to him or my mom?

3. How do you talk about someone behind her back when she can't be left alone? She might come home while I am there and my dad and I will still need to talk about getting a plan in place.

4. DINNER: I know this is super vague, but really I want any idea for a two-person meal that is holiday nice but does not seem Thanksgiving-y. Must feature large hunk of meat for each of us. Turkey dinner for two is way too much work to be worth it and I worry that any Thanksgiving-ish meal will highlight the number of reasons why the two of us eating alone together is depressing. Surely someone has been in this situation before.

5. What am I missing? Outside of the dinner question I don't even know if I'm asking the right questions.
(Please, no Trump/Medicare doomsday stuff. I'm serious. I do not have the emotional energy to expend entertaining apocalyptic what-ifs and I certainly do not have the patience to respond politely to unsolicited opinions on the matter.)

I probably left out some key facts, so please ask questions if something doesn't make sense. Thanks, everyone.
posted by good lorneing to Human Relations (13 answers total)
 
That is overwhelming and I wish you the best.
I can help with Thanksgiving dinner. This steak recipe (from Mefi's own Dersins) is outrageously marvelous and really easy. Buy a couple $20 steaks and an egg sized chunk of bleu cheese (even if you think bleu is meh, just try it). I like it with a couple cloves of smashed raw garlic added to the bleu cheese and lemon compound butter. I use a cheap stainless steel pan and it works fine. Serve with really any sides - lightly steamed asparagus or snow peas, garlic bread, or potatoes. It is SO good and tastes so fancy.
posted by pseudostrabismus at 11:38 PM on November 15, 2016 [6 favorites]


Wow, I'm sorry you're having to deal with all of this. Just one aspect is a whole lot for anyone.

I think that your intentions are good but avoidant and you're missing a chance to be kind to yourself. Would it be at all possible for you to insist that your mom stay in the rehab facility for your visit? Explain to your dad that you're mourning your friend (which I notice you don't bring up except the once), and that you really need him to help you out by providing a calm space in his home for you for the holiday.

I mean, still tour some of the elder care facilities and help him do research, but I think you should assert your need for some support yourself at this time. Maybe see if you can bring her home during Thanksgiving day and bring her back in the evening, so she won't be spending the night without live-in caretakers? You're right to be concerned and while there's a lot of scaremongering out there about caretakers it's so stressful for everybody no matter how well it goes.

Are there any folks back home who know you and your family that you could visit and rely on for some moments during your visit? Either to distract yourself with or to talk things out a bit depending on your needs. Find the networks of support wherever you are. You need and deserve kindness and although what you're dealing with is really important, you're not going to be able to do it with a clear head if you can't give yourself a break from it, either. Plan this ahead of time, ask yourself over, figure out a beautiful place to visit and make yourself go there even if everything's gone terribly. (Maybe especially if that happens.)

As for dinner, I second steak as a great idea. You could do pork chops with apples, which is easy to cook for two (I like about half an apple per chop, so that's simple) and have nice bread and maybe roasted root vegetables on the side. Or if you live near water, treat yourself to the freshest seafood you can find, cooked very simply and served with a nice rice pilaf and a big crunchy salad. In my family the default holiday meat is brisket, which if your dad has a slow cooker you can put it on in the morning, do a bunch of your mom-care research, and come home to dinner. I think that dessert is important for that holiday feel, but instead of pie, bake cookies or brownies. It will make the house smell really nice as a bonus, which can soothe stressful situations.

I'm sure there are many mefites who have more specific advice about your problems, but mine is just, please remember to take the time and energy to be kind to yourself.
posted by Mizu at 12:06 AM on November 16, 2016


People who have actually been through this say something if this is actually a terrible idea: could you schedule a couple of one or more hour sessions to talk about caregiving away from the house and your mother potentially and agree to try and keep those talks from leaking into rest of time together?

Steak!
posted by sacchan at 12:18 AM on November 16, 2016


Allow yourself a quiet Thanksgiving with your father. Order a nice meal for two rather than cook. Surely there's a restaurant in the area that you both like. Or a catering service.

Then, after Thanksgiving, talk to your father about the best option for your mother, and plan accordingly.
posted by Kwadeng at 1:23 AM on November 16, 2016 [1 favorite]


If you feel like preparing dinner yourself, what you want is Serious Eats' Perfect Prime Rib. It's delicious, and it feels very fancy, but it's criminally easy to make. Mix up a batch of this herbes de provence based rub ahead of time, then apply it to the roast up to a day in advance and let it air-dry in the fridge overnight. From there, follow the recipe from Serious Eats. The best part? You'll have leftovers, although I guarantee they won't last long.
posted by Vervain at 1:29 AM on November 16, 2016


I am sorry that all these difficult things are happening at once. My mom (also difficult) just died and between that an election, I'm a mess. And I don't even live in the US. I can only imagine how strained you must be.

My only thought is that you suggest to your dad that long-term care doesn't mean forever, and that it could be categorized in all of your minds as a stepping stone to coming home after she has improved further. Once in long-term care, a goal of coming home might help your mom do the work necessary to make a safe return, and give your dad time to understand what will be required of him to make that happen. Perhaps she will love it there, and stay for a long time, perhaps she will be home by January.

Take care.
posted by girlpublisher at 5:50 AM on November 16, 2016 [1 favorite]


Are your mother's doctors as convinced about her going home as your father? Perhaps instead of trying to talk him down on your own, you can appeal to their authority.

It's probably a bit late notice at this point, but could you ask your sibling to join you in this visit? This seems like enough of a challenging situation to justify disrupting their usual holiday rotation. Especially if them not being there means them not participating in helping to make and implement some important decisions.
posted by ewok_academy at 9:02 AM on November 16, 2016 [1 favorite]


My father died the week before Thanksgiving some 22 years ago, and I thought that was rough. But my goodness ... my heart goes out to you. Good suggestions here. I wish you the best.
posted by DrAstroZoom at 10:47 AM on November 16, 2016 [1 favorite]


Are there any local friends that could visit with your mom and give you and your dad time to talk? It seems like the logistics of that alone might be a good reminder to your dad of what it may be like to have your mom be home.

If you can't talk him out of her being home, have you looked at long term care help at home, like is available from a place like Home Instead (note: I only mention that one because I know people who have used it, there are others available). I also know people who gotten similar health care as part of state programs.

On a food note, a whole roasted duck could be nice (and simple) or maybe cornish game hens. Keep the sides non-Thanksgivingy and you're good to go. Potatoes (or potato dumplings) and sauerkraut go well with duck, for example.

I'm so sorry you're going through all of this. Best wishes.
posted by freezer cake at 2:06 PM on November 16, 2016


Wow - this sounds awful and I wish you strength to get through it.

My only recommendation is to find an Elder Care Attorney in your parents' city (or State). They can help walk you through things like how to navigate Medicare / Medicaid, how to protect their assets and yours once long-term care is on the table, how to work out living wills, etc. They will also have connections to social workers in your area who can help you navigate through this. You are not alone in dealing with this sort of thing, and they will know the answers to far more questions than you would think to ask - and hold your hand through the process.
posted by Mchelly at 3:46 PM on November 16, 2016


I'm a nurse currently working in home health, and I have strong concerns about your dad's plan to bring mom home. Let me start, however, by saying I completely understand his desire to do so! Election or no, guilt or no, bipolar/borderline or no, it's completely normal for both dad and mom to be against the idea of continued placement.

HOWEVER ...

His idea that in-home aides will be there for toileting, dressing, etc, is, shall we say, optimistic. Insurance such as Medicare covers SHORT-TERM, INTERMITTENT home care. At my agency, a patient like your mom would probably get 2 nursing visits per week for 3-5 weeks at most, each visit being about 1 hour, then maybe a couple more weeks of 1 nursing visit per week; physical therapy visits twice a week for 3-5 weeks, each visit being 45-60 minutes, patient and family being expected to continue with daily exercises in between visits; and home health aides for 2 visits per week, 1-2 hours per visit, for bathing and dressing, only for the duration of nursing and physical therapy services. All the care and supervision for safety of all the other hours would be the responsibility of your dad, and whatever other local family are able and willing to assist.

If your dad has an enormous pile of money somewhere, and they live in an area where care is plentiful, then yes, he could hire in-home aides (likely at $20-$25 per hour, possibly more), up to round-the-clock even. At $20/hour it would cost over 3 grand a week for 24-hour coverage so it had better be a really enormous pile. I live and work in a rural area, and there are not enough people working as aides here to cover that kind of demand; families have to fill in the other hours as best they can between their own jobs and homes.

You say that your mom has a history of falls and of memory problems. Without supervision she is absolutely at risk for another fall with injury that would put her back in the hospital and further endanger her health. You also say she's still unable to walk without assistance or for any significant distance. Even if she's having a good day, it would be very tough for your dad to take her out in the car to someplace like PT or a doctor's appointment without additional help. Also, a patient with memory issues usually needs help to take their medications as directed, which can be a job in itself to keep straight.

I have seen more families than I'd like to admit in this situation. They are firmly attached to the idea of Bringing Mom Home and then discover they are in over their heads -- for example, Mom is wandering the house during the night because she wakes up and has to pee, doesn't want to bother anyone by waking them up to help her, and has a fall. The problem is, once the patient is home, it is not easy or quick, even with the above mentioned enormous pile of money, to get the patient back into placement (assisted living, skilled nursing facility, long-term care). It can take weeks and is a rough time for everyone.

I know this is all discouraging and I'm sorry for that. I agree with Mizu's post above where zie suggests bringing Mom to the home for part of Thanksgiving Day, both so you/Dad/Mom can spend some holiday time together and (this is the sneaky part) so you and especially Dad can get a realistic idea of how Mom would function in the home. Are there steps at the entrance or within the home? How accessible is the bathroom? Are there tripping hazards like area rugs, clutter, pets? Does Mom use her walker/wheelchair/other assistive device or does she insist on doing everything on her own?

It is not realistic for your dad to tackle Project Bring Mom Home without a great deal of ongoing help. I hate to be this pessimistic, but there are *so* many things that can go wrong here even with the best will in the world. In my opinion, the best thing you can do to support your dad and to ensure your mom's ongoing safety is to help him with the long-term placement process. Mom probably won't like it at all ... but she'll be safe.
posted by shiny blue object at 3:52 PM on November 16, 2016 [6 favorites]


My grandfather is currently in hospice type care - advanced Parkinsons, with dementia (mostly sundowning) and idiosyncratic medication responses (SERIOUS violent personality shifts with endone for example). My grandmother cared for him at home until he had a serious fall (getting up to go chase cane toads in the middle of the night...), and her own doctor pointed out she was making it likely that she would die before him with the strain of it (physical and emotional). She cared for her mother until she died last year, and has been caring for her youngest son with brain damage for the past 10 years or so. She has been there with the toileting and the showering and the mobility issues and the dementia and all that. And she knew, with this last fall, that this was beyond what she can handle.

So the new family routine is visiting with him earlier in the day, afternoon with her, she often spends evenings there (they have been together long enough that even if he can't recognise her as her, he believes her and is calmed when she says who she is). Overnight the hospice nurses care for him. We occasionally gather at home, or a familiar local pub, but even the hospice was cautioning about that too much as shifting and moving is hard, emotionally, for him.

This is with my socialised health care and my uncle being mostly physically able. This is with multiple aunts in the area providing respite. This is with respite and home care nurses. This is with a seriously buff old lady (like, I once took a basket of fruit off her and almost dropped it because it was a good 30 pounds and she was carrying it like it was nothing, but I was worried about her on the stone stairs).

The kindest thing for my grandpa is this: he is in a familiar care unit (my grandma worked there), with other old people who know what he is talking about in the area, it is designed to support him getting out for a walk, to help him. We can all visit and he can come out when he has a good day - which are getting more frequent now, because he has a very firm daily routine, he has his meds sorted, he isn't falling. He isn't worrying about my grandmother either - he misses her, like fury, but he knows she isn't wearing herself into an early grave either.

I am so sorry for this. It is a hard place to be.
posted by geek anachronism at 8:06 PM on November 16, 2016


Thanks, everyone. The "good" news is that my mom got sicker right before my visit and so there is now no possibility of her coming home any time soon. My dad already scoped out the top local facilities and the nicer one has a bed available now. The visit with the attorney went GREAT, not least of all because he ran my dad through all the worst case scenarios so I didn't have to. Her spirits and health are terrible but she's safe and we have a plan.

The bad news is that my dad thinks I like turkey dinners so we had an indescribably terrible one at the rehab facility dining hall with my mom today and will be having a second, home-cooked one with allll the trimmings, for two of us, on Saturday. But we made steak last night at least.
posted by good lorneing at 8:42 PM on November 24, 2016


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