Is it better to bring him home or force him to stay in rehab?

Dadandme asked...

Hello, I know you all get many questions every day, but I have no where else to turn and I desperately need advice. My father (77) had a stroke, a piece of plaque had moved and lodged lower in his brain stem. He, at the time of the stroke was walking 3 miles a day with high blood pressure being controlled with medications. He laid in the floor for 24 hours after the stroke until he was found. He was treated for 9 days ICU in a certified stroke center. His BP climbed post stroke to 190/200 and his heart rate was at its lowest 24. The Doctors could not find out why. He was moved to a skilled rehab on Oct. 30 and here is where my questions start. He is severely depressed, in horrific pain and making small progress. He after 6 weeks cannot move his hand or arm (left) nor can he move his leg but can wiggle his toes. The have to discharge him because he is not improving and he wants to go home. The hospital wants him to go to another center, but I know that it would kill him.

He is desperate to get home and we are training with the rehab to care for him and take him to therapy 3 times a week. The rehab does not support this decision and said that we are hurting his progress by bringing him home. Is this true? He feels that if he gets home he can get better and I think that if he is put in another center he will die. It is me and my older sister who are there the most and will be caring for him most. Can it be done? Does it sound like he will recover at all? Please, any response will be cherished. Thank You, Teresa

Expert Answer

Carolyn Rosenblatt, R.N. and Attorney is the author of author of The Boomer's Guide to Aging Parents. She has over 40 years of combined experience in her two professions. As a nurse, she has extensive experience with geriatrics, chronic illness, pain management, dementias, disability, family dynamics, and death and dying. As a trial attorney, she advocated for for the rights of injured individuals and neglected elders. She is also co-founder of AgingParents.com.

Dear DadandMe: It sounds as if you are under pressure to make a serious decision about continuing rehab at home instead of in the rehab center. I'm sorry you must struggle with this question, for which there is no simple answer.

Here are some of the pros and cons to consider: First, as he is now very dependent and will need a lot of both physical and emotional care, you and your siblings must be prepared for the heavy job of 24/7 care, which takes a physical toll as well as being stressful for both of you. It is certainly possible to do it, but it is not going to be easy for anyone. The skills involved in doing a good job and keeping him safe go further than what the rehab center may be able to teach you. However, visiting nurses can continue the lessons for a short time after he is home, and Medicare may cover the needed teaching by skilled nurses for a limited time, if the doctor orders this. Ask. Your dad's emotional health is a very big part of his healing. If your family, in your best judgement, wants to take dad home to give him the love and attention that no facility can match, it may be worth a try. However, you need to consider that his needs can overwhelm all of you, despite your best intentions, and you have to consider what to do if he can't make it at home. Another very important factor is that his Medicare coverage takes care of rehab in the rehab center after hospitalization, as long as he has "rehab potential", as it's called. Once a facility determines that he's not improving or not improving enough, Medicare will no longer cover his stay in a facility. The financial aspects of this are a part of the decision-making. If you bring him home, and he's there for a time and then needs to go to a facility from home, coverage for rehab can be lost. If you feel very sure that dad isn't going to make it in a facility, that he's not going to get much better in such a facility, and that you want to take care of him at home, you have every legal right to bring him home. Neither you, nor your dad can tell if he is going to get better at home or not. No one can accurately tell you, 100% of the time, someone's progress will or will not be hurt by going home, as the love and attention of family have a great deal to do with how well someone progresses after a stroke.

Finally, I think it is very important to honor the wishes of the elder concerned here. It's his life. If he wants to go home, and isn't getting better where he is, he may be much happier in his own home. People usually are. I urge you to discuss this with all family concerned, and with dad, as well as the doctor who is treating him. No one can force your dad to go to a facility unless there is no one at home to attend safely to his needs. I wish you courage in your decision making. I think if everyone can focus on what makes dad happiest, that may be the best guide you can find.