My mother in law's back in the hospital

[chrisinhouston]

This has been an interesting month. My mother in law got a new shoulder back in early December. Her shoulder replacement had failed from a torn rotator cuff so they did a new kind of replacement called a reverse shoulder implant. Basically they put the ball coming out of the shoulder blade bone and a socket on the upper end of the arm. They rework a muscle to do the job of the rotator tendon. The surgery went great and she had a post op check up at Christmas and the doctor gave her PT orders to get her shoulder working again.

Then she got a bad cold and about a week later (like January 2nd) she started throwing up a lot so we took her to the hospital. They treated her for a few days and she went home but it started again so back to the hospital she went. We had our trip to Istanbul planned so we went ahead since our sons are here and could handle things and we figured it would only be a few days. Things went from bad to worse and they ended up removing her gall bladder and found she had a really bad urinary infection so treated her for that. We got back from our trip and it's been 2 1/2 weeks and we are just starting to feel like she may be well enough to be discharged. The Dr. said today that most likely Monday he will release her and she will need to go to a skilled nursing type place as she is still a bit weak to go to her independent living apartment.

My wife usually goes to see her on the way to work and tries to be there to feed her breakfast, she wasn't eating for so long that they were feeding her intravenously and she just has so little an appetite from her stomach shrinking and the lovely hospital food. I go at lunch and my wife goes back at dinner on the way home. The hospital is super busy with sick people so the nursing staff has limited time to sit and feed her.

Anyway, a bit of a long post here but it got me thinking again about aging and how we deal with it. She is lucky enough to have Medicare and a really good secondary insurance through her late husband's retirement package from Xerox. Just about everything is covered 100% which is good. But it made me wonder about the costs of keeping older people alive. Don't get me wrong, I'm not advocating leaving her to die but one has to wonder about the costs. I have no idea what the shoulder surgery cost but I imagine a lot as it was at a special orthopedic hospital and the Dr. was one of the top guys in his field here in Houston. And then there is what will be 3 weeks in the hospital, the surgery and after the surgery when she was still not doing well she was on a floor with care just a bit less than intensive care, essentially pretty much every hour someone was checking on her and taking BP and temperature. I would imagine that this will be at least $25K or so for all this, maybe more. And then there will be the skilled nursing facility to come next week, maybe a 1 or 2 week stay. After caring for my parents and seeing myself and my wife aging I wonder if this is what I want to do. I think about the quality of life when you are at an advanced age and with all kinds of health problems.

Sort of a ramble here but I hope I don't end up in a situation like this. Maybe my kids or grand kids will just push me out in the snow.

[Gravdigr]

Well, shit, man.

[Griff]

I'm sorry as well Chris. She was pretty old to be getting that surgery wasn't she? My mil got a hip replacement and isn't moving at all so outside of pain reduction the surgery was a waste. They probably could have blocked the pain...

[chrisinhouston]

Just a catch up post. My mother in law finally got discharged from the hospital about a week and a half ago after a 21 day stay! Part of her stay was in a wing that is just below intensive care. While she was there not only did they remove her gall bladder but she had countless x-rays, cat scans and MRI's and lots of blood work to figure out why she was so sick.

Because she was so weak they sent her to a "skilled nursing facility" basically rehab. I had to handle all of that as my wife was in Los Angeles on business. So now after a week and a half she is doing better but still needs help getting in and out of bed or her wheel chair or the toilet. She is getting pretty intensive physical and occupational therapy. The PT folks work on building strength for walking or motor skills and the OT work on things like getting up or down or getting dressed or undressed. We met with her care team yesterday and they think she will need to be there through February! They are also concerned about her long term prospect for living independently.

I don't mean to sound negative but I hope I don't live long enough to get into this kind of situation!

[xoxoxoBruce]

My mother went through a couple years of hospital, rehab, home, with the length of the home part dropping steadily from several weeks to three days.
It was a grueling merry-go-round, I wish you a better ride.

[glatt]

My FIL went through a round of that in the Fall. He's back in his apartment now at the assisted living place. And the last time I saw him, he said that he would try his best to hide any symptoms he has next time so he doesn't wind up in the hospital. It was hell for him with all the xrays and poking and prodding. Turns out the only thing good they did for him was to put him on medication to get fluid out of his lungs. The rest was just a long painful boondoggle (admittedly in hindsight.)

The rehab place was great. They cared for him and rehabbed him, and he improved dramatically there.

[chrisinhouston]

Well just an update. Looks like my MinLaw will come home tomorrow. My wife got back from LA last Friday and we went over and visited mom on the way home and agreed she is ready to leave the "skilled nursing" center. Don't know what that term defines. It's basically like a nursing home where she gets some PT and OT each day, 3 meals served and assistance if needed.

When she arrived she couldn't get out of bed, in or out of a wheel chair or on or off of the toilet. Now she is classified as a minimum assist meaning she can get around pretty well. She still needs some help dressing and undressing, basically she wears these one piece floral print, the style is what is known as a muumuu. Because she never got the PT for her new shoulder that was put in last December due to this bout in the hospital and the gall bladder surgery her right arm is pretty useless and is always in a sling. Makes it harder for her to get up and down or to walk using a walker where one needs both arms.

Anyway, she is getting grumpy, a sure sign she is feeling better. She told me last week she hates physical therapy and isn't paying another nickle for it! She forgets that this whole thing is covered by Medicare. And the kitchen does their best but the food generally sucks. The food is always too salty and high in fat and usually meat based. I guess if you are a vegetarian or vegan you are hosed if you go into this stage of life. She absolutely hates poultry, always has and can't stand the sight or smell of it. So we told everyone when we registered her and they all say they know but since chicken or turkey are big menu items for hospitals and nursing homes they still bring it to her every few days only to have it sent back. Also she doesn't really like breakfast in general but will eat a pancake or waffle for the most part and doesn't really like their nasty scrambled eggs but every few days they send her a big plate of eggs. Mostly the dinner and lunch choices are meat loaf of any kind of over cooked meat, usually minced up or chopped up because I guess most of the folks don't have their teeth. Lots of mashed potatoes and gravy and soggy vegetables.

Speaking of teeth she only has 5 of her own left and wears an upper denture. She didn't have it when she got there as she was so sick in the hospital and on a liquid diet. So I brought her the denture I found in her apartment bathroom. She kept trying to fit it in but it would not work. Turns out it was the wrong one... like a denture from 10 years ago before she had some other teeth pulled so there is no way it would fit. "Now why would you keep an old denture" I asked her. "I paid a lot of money for it" she replied.

Besides the quality of the food the only other thing that bothers my wife is that 2 times when she came to see her mom she was lying on the bed with no sheets, just lying on the plastic covered mattress with a light blanket over her. She said she wet her self and the nurse changed her and stripped the bed but never came back. So my wife found a nurse and asked for some sheets another blanket and the bed comforter and the nurse was so confused and had to go unlock the linen room to get one and didn't bother to come make the bed, she just handed it to my wife. When we mentioned it the next day to the case worker (some kind of social worker) said that she must have gotten up and stripped her own bed as they would NEVER let a patient just lie there. This is the same woman that can only just now even get up on her own.

So Friday we told them we want to start the ball rolling to take her home this week. My wife is worried she will start getting depressed (she has some issues with depression) and loose hope and we think she will do better back in her own apartment with her little dog and cooking what she likes to eat. We met with the head of nursing and she read over the nurses notes and was pretty cool with our idea to leave. Then she called the head of therapy and she had a totally different attitude and couldn't believe we were taking her so soon and that she felt they could do so much more for her. She finally said they would need to do some assessments and that if all went well she can leave on Tuesday but she was kind of patronizing and we didn't really like her. I got the feeling she was also looking at the bottom line and that her leaving meant less money from Medicare.

We then met with the social worker and the lady in the business office and they were surprised we were planning to take her home but ok with it and had us sign some papers to be submitted to Medicare. We told mom what was going on and she seemed happier knowing her time there was limited to a few more days only.

My wife keeps telling me if she ever gets like this to just shoot her or push her out in the cold and leave her there to die. I keep reminding her that I plan to be long gone before she gets to that stage of life!

[glatt]

I'm glad she's getting out of rehab. I hope she has a better quality of life now.

I'm surprised they haven't pushed a visiting home rehab person on you yet. My FIL got that pushed on him. It's all paid for, but he wanted none of it.

[chrisinhouston]

Well we finally got her home on Tuesday. Last Friday we had told the nursing center we would get her at 10AM on Tuesday which was fine with them and also let the senior's apartment complex know she would be coming back and to please make sure they cleaned her apartment as we noticed not much was touched in the 6 weeks she was gone. We also asked once again for the bug man to treat for roaches. They told us it would all be taken care of in time.

So we stopped by on Tuesday at 9AM to drop off some things at her apartment and found everything had been removed from the kitchen cabinets and drawers for the bug man and no one had run a mop or vacuumed! My wife went to the main office and tore someone a new hole in their rear end and in 2 minutes we had the head of housekeeping and the director of the whole place there assuring us it would all be done quickly but they needed her to stay away until 1PM for the bug stuff to not be an issue for her or her dog. Not happy but we agreed and went to get her. Took her to our house where she had lunch and slept on our couch. Picked up her dog from the kennel, just under $1000 for 43 days boarding! Wonder if we can submit that claim to Medicare?

Finally loaded her and the dog in the car and took her home. She started crying when she entered saying she forgot all the things she had in the apartment! I said we should have cleared a bunch of it out and moved her into a smaller one if we had known she would forget. You don't understand but every square inch of her floor, walls, closets etc is covered and packed with stuff.

She seems to be doing pretty well so far. She is cooking a bit again and takes her dog out for walks while driving her electric wheel chair. Only time will tell, she turns 88 next month. I guess she is doing better than a lot of folks her age.