Father has declined after hospital stay - is this normal?

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Father has declined after hospital stay - is this normal?

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My 93-year old father (recently diagnosed with dementia and living independently, with my mother), fell in the apartment 12 days ago (in fact, he also brought my mother down, as he was trying to stop her walking out of the room but that's another story - she was OK). Ambulance was called as he couldn't get up and he was taken to hospital. Nothing broken - he had a scan and a full check-up and we assumed he'd be sent home almost straight away but he's been in there for 12 days. Part of the issue I think has been lack of carers/support for him once he was discharged, so this has caused a delay. He is in fact coming out today and hopefully with a care package (although this hasn't actually been confirmed). My concern is, that while he was in hospital, he deteriorated. For example, he has never done this before, but he wet the bed and soiled the bed, on 2 separate occasions and soiled himself during the day, while he was sitting in the chair by the side of the bed. Has anyone else had experience of this? Is it part of dementia or could it be the effects of being in hospital (I am hoping it's the latter and now that he's out, he will stop this, as it will be very difficult for my mother to cope with).

Alzheimer's & Dementia Cognitive Decline Hospital Discharge

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How are things going today, Helly?

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Hospital stays are very tough on all of us. People are coming through the room, day and night, sleep patterns are thrown off, the fluorescent lights are constantly on and it can even be difficult to tell the difference between night and day. Medications are added on and taken off, someone new is in the room every half hour. The patient is constantly being “tested”. The experience can be a bit torturous and humiliating.

Help him ease into life back home. Stay close to watch his sleep patterns normalize and observe him. Hire some help to come in and assist if you are unable.

Check his medication list for changes and/or additions during the hospitalization. Read drug interactions and side effects. Closely supervise him for these warnings. He may have been overmedicated.

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When he becomes “incandescent with rage” this is your cue to call the police. There must be some guidelines in place in your country for elders like your father with an uncontrollable temper and a penchant for abusing his wife.

You’ve said yourself that you are at your wit’s end with him. Hand it to someone else. There is no reasoning with him. He will not listen nor cooperate. There is nothing you can do but wait until his next rage-infested performance and call the authorities to remove him from the home.

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I think you should be glad that he is worried. Maybe he will start to see, if this is "simply" mental illness and not dementia, that he doesn't hold all of the cards.

With bullies, you need to call their bluff.

This does NOT work if dementia is involved.

If this is a longstanding personality disorder (aka a mental illness) it will have an effect.

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Helly, has any of you ever posited to your dad, "well then, "I guess we'll just need to leave you here, as you're quite capable on your own".

-In other words, has anyone ever called his bluff, as opposed to wheedling for his cooperation?

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Yes we have. We have tried every approach. Today we said we were going to take my mum to the wedding - or just away from him - and he'd be left on his own and he was incandescent with rage. We can't do that, he said, she has a DUTY to look after him. We said, no she doesn't, she's not a slave, she's a person in her own right. So then he said he would go to stay with his niece (she hasn't seen him for 3 years, so we knew she wouldn't take him). He actually managed to reach her on the phone (my mum rang the number) and she - surprise, surprise - said she was going away and he couldn't stay with her. She advised him to go and look at the home and see what he thought, so that's what we did. It's impossible to keep arguing with him. He will never back down, they live in an apartment block, so the neighbours can probably all hear, so in the end, we have to try to cool things down. But he is worried that my mum is going to be taken away by us.

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Helly; You are between the proverbial rock and hard place. I feel for you, really I do.

Your mother is in need of support for her physical safety and in even more desperate need of psychological support to break free of this abusive relationship.

Leaving your father to his own devices, in my mind at least, is the ONLY clear way to demonstrate to him that he NEEDS to cooperate with all of you. I understand that you think it constitutes abuse. But what he is doing to your mother is demonstrated abuse. And it's been going on for a long time, from what you've written.

I am unfamiliar with the law in the U.K. regarding situations like these. I'm hoping that CountryMouse, our excellent UK poster will weigh in with one of her quite brilliant solutions to this problem.

Your fiancé sounds absolutely brilliant, by the way! Don't let anything get in the way of your wedding.

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Just take your mom. Can you get her a hotel room for a couple of week, until after your wedding? Then find her an apartment.

Let your dad figure this out for himself.

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My mum won't go and leave him. It's not that simple - or we'd have done that already. He cannot see very well (could not make a phone call), cannot hear very well and has no idea who to ring. Leaving him alone would amount to abuse. As much as he drives me crazy, he is a 93-year old man and he is my father. I cannot do that.

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Perhaps you could move Mom in with you and tell Dad he will need to find care in that home he will be visiting “that you mentioned earlier”. You don’t want Mom in an abusive situation and what if she gets injured? Seems like something you may need to consider. If Mom is “recovering” with you Dad will need the care. Just keep extending it? Good luck, I’ll be praying for you.

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Hi Helly, sorry I didn't see this new thread before - what's the situation now?

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OK, so yesterday we went over (my fiance and I) and fiance, who is sensible, calm individual, talked to my dad about how worried we are about both of them and how 'vulnerable' he is, living with my mum (my dad is a narcissist, I have realised, so it's all about him). What if, when they'd both fallen down, my mum had hit her head and been unconscious (she was the one who got up and called for an ambulance)? They could have both been lying there for days! He seemed to agree with all of this. My fiance said, he (my dad) really needed to be in a home, where he'd be getting proper care and would be safe. Yes, he agreed. So, fiance suggested that he would find him a home 'as soon as possible' - and this was agreed. So, we booked him into a home that he's been into twice for respite. It's only a couple of miles from their apartment and it's top notch (and not cheap). We booked him in for 3 weeks and we were prepared to pay for it (we are getting married, by the way, in 2 weeks' time and he's already agreed to go into a home for the time we are away getting married, so my mum can come). Anyway, we turned up today at their apartment and told him the 'good news'! We've found somewhere for him and they can take him today! And he went BALLISTIC. Called my fiance 'impudent' and said he (my dad) is not a package! How dare we do this? Eventually he calmed down enough to agree to go and see the place but he criticised everything about it (although carers were lovely and couldn't do enough to welcome him and reassure him). We asked him, did he not care that my mum is about to collapse, with the stress and strain of having to care for him? ('She can manage', he assured us). Did he not bother that, by refusing to go into a home, he was potentially going to ruin our wedding? (that's our problem. We have to find him somewhere else, better than the place we showed him). We have 2 weeks until the wedding, no TIME to show him somewhere else (and get him assessed before he goes in). The other possible home in their town is full. If he refuses to go into care, my mum won't be able to come to my wedding. The only option open to us is to either pretend she is ill or to whisk her away before the wedding and force him into the care home for a week. And never allow him to come home again!!! (although how we sort out the finances for that, I do not know!). So, that's the situation. If we could cancel our wedding - which we have been planning for 2 years - we would.

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Maybe the meds made him either incontinent or made him so he couldnt move about. Whats the med for? If he didnt need med before why does he need it now? He is trying to tell you the meds are messing him up, making him feel funny. I bet its meds to settle him down which also keeps him from being able to get up out of a chair. I am a big believer in MEDS DONT SOLVE EVERYTHING.

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My mom is 96 . With each hospital
stay , over the years , she has declined . She has many medical issues and dementia. In March of this year , she fell and fractured her hip. She had hip replacement surgery and spent a month in rehab followed by 6 weeks of home PT and OT. She was very confused in rehab and most days just slept . She became incontinent . I really thought she was nearing the end of her life . Fast forward to now . She is back to her pre-fall / surgery self . We are just amazed ! While she was in rehab , they put her on a dementia medicine which really seems to be helping . So, yes, sometimes there is a decline from hospital stays and sometimes there is not . Good luck to all of you taking care of loved ones .

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Helly; your dad has dementia.

Allowing a dementia patient to call the shots is a classic "letting the tail wag the dog" scenario.

I understand that you respect and maybe fear your father's wrath. But if you all can't stand up to him (he's a bully; most bullies fold when you stand up to them, btw) then you need to step back and let the authorities take over.

I hope that you can get your mother to safety before this untenable caregiving situation does her any more harm.

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You are right. We are going to do something today. I will let you know.

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This is only somewhat responsive to your query, but have you tried adding some CBD oil to your father’s tea? I’m assuming it’s legal in the UK as it is derived from the hemp plant and is not psychoactive. It’s not like drugging someone, and there are no known side effects. They may even make CBD tea.

I suggest it because my father has dementia, and he had a sudden downturn and became incontinent over the course of a week out of nowhere. He wasn’t at hospital, but I’m saying that yes, a decline can happen that fast and sudden. When all this happened, he also became listless, non-communicative, unable to walk and talk clearly. The CBD oil in his valerian tea seemed to lift some fog overnight. He’s been on it for many weeks now, and continues to show reversion back to how he was before the sudden drop-off. The valerian and the CBD seem to help the anxiety and depression that cones along with this situation.

However, having read your previous post, I’m not sure it would actually change your father’s abusive nature, but it can at least calm him down a bit and maybe (hopefully) help make him clear enough to be less of a burden to your mother. Or it may do nothing at all... But if sending him home to your mom really is the only option, I would try a few drops in his tea. Or at least switch him to valerian tea so he’s more mellow and calm.

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thank you, that's thoughtful and certainly something to consider (we would have to do it without him realising though as he would NEVER agree to take something that a doctor hadn't prescribed - and even then, he's very suspicious and cautious!)

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It is very common for elderly to get Urinary Tract Infections as they return home from hospitals. Set an appt to have this checked. UTIs can cause memory loss, confusion, unsteady walking/standing, slurred speech, etc. Takes them totally out of their normal routines. I've seen this happen so much in my approx. 20 years of healthcare.

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Helly; I'm hoping that one of our UK posters will check in and tell you how to get your father placed.

Is your mother willing to say that she can no longer care for him? Is she willing to say "no, I won't take him home"? Is she willing to leave with you, at least temporarily?

Caregiving your difficult, mentally ill father is going to kill your mother. There really is no way to sugar coat that message; I saw it happen to two of my aunts. They were both convinced that only they could provide proper care for their husbands and "what would the neighbors think?".

Not surprisingly, both husbands lived quite contentedly in care for quite a while after their wives' demise. It's a very common, and very sad situation.

It's true, you can't force him into care. But you CAN say "we can no longer safely care for him" and "no, mother cannot do this alone".

By the way, when mom dies, are you going to move in with him to keep him at home? What is your plan for when mom expires? Believe me, I'm not saying this to be mean. You really need to think about what the long term plan is here.

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You are quite right, of course. My mother has to be the one to say 'I can't/won't do this any more'. When she says that, he will have no choice but to go into a home - and pay for it. We are going over tomorrow and my partner is going to talk to him. He might take more notice of him as he just speaks to me in the same way that he speaks to my mother - mostly with complete disrespect. Thanks for your reply. I will report back if/when there is some news!

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My aunt's doctor told me the last time she was in hospital:Just remember every time your aunt is hospitalized, she will decline. She is in there for a reason, ie; falling, UTI , etc. but just know she is at this age and she will decline. She will never go back to the normal she was just prior to the incident that caused her to be hospitalized.

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Very interesting, I didn't know it was so common.. But yes indeed, my mother was significantly different after each hospital stay. (But I should mention that in 2018-19, she probably went to the E.R. 4 times. (I knew that meant her end was near).

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Thanks for all your responses, although, as I'm not in the US, most of them don't apply! I cannot force him to go into a home. He is a very, very difficult man (home now and he is refusing to take the medication that he was sent home from the hospital with, as he believes it's not the right stuff. He is waiting for a call from the ward so he can speak to a nurse and won't take it until she calls). He has carers coming in this evening and in the mornings, for the next few days, to help him get up, dressed etc but he is already indicating that he will be sending them away. He IS booked into a home for a week from early July and we are hoping that will be that and that he will agree to stay (you are all throwing your hands up in horror at this BUT we do not have POA - he refused it - and he is the only one who can afford to pay the £1100 a week charge for the home. The state won't pay it and we can't pay it so he HAS to be the one who agrees to going in and who will then pay it).

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Sometimes all you can do is shrug your shoulders and laugh.

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If you’ve been asking how to help Mom and get Dad away from her, now is the time! Tell them he is an unsafe discharge.

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This is very normal. However, after a hospital stay, Medicare pays for in home skilled nursing and a aide for baths etc. Also if needed PT. You should ask the hospital about this. They usually get this for 2-4 weeks depending on the need. Maybe ask about a hospice evaluation too. There's a criteria they have to meet for Medicare to pay hospice. But if he has declined mentally and physically it may be time to check into this.

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I am not in the US, I'm in the UK. We don't have Medicare.

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Yes this is very common after an elderly hospital stay. Unfortunately it usually takes four days for every one day they were hospitalized to recover and sometimes they never get back to their old “norm”. My mother spent ten days for a UTI last December (due to her age and Medicare paying the bill the hospital has no problems keeping them for that long) she is 94 never used any walking aids at all and now after ten days flat on her back she needs a walker, she will probably never get back to her old self but she will be 95 in August 😉. Btw hospital incontinence and Dementia decline are very common in elderly hospital stays. At home PT will help. God Bless and good luck.

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He is in decline and I doubt that there will be any reversal. He is old, the parts are just wearing out. Hopefully he is on his way to rehab and not going back to the apartment.

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Yes, I think this is part of the hospital stay. I have recently went through this with my mom.
She went in the hospital thankfully only due to a bowel impaction. She was weak from not eating (she didn't have much of an appetite) but was otherwise independent and mobile. Long story short, she spent one week in the hospital and over 3 weeks so far in rehab.
Just from one week in the hospital, she went from being able to clothe, shower, toilet, feed herself and do her own laundry (we do all other chores for her) and errands to stores where she would walk with a shopping cart once or twice per week to not even being able to lift her head off the pillow. I honestly didn't think she might make it.
It's been a long road, but she's now dressing, feeding and clothing herself and going to the bathroom on her own (from soiling herself, etc). She's not walking like she used to, but I expect that will improve. She gets PT every day and I told her I want her to continue that at home.
When I had the care plan meeting with the nursing home, I let them know in no uncertain terms her decline just from 1 week in the hospital! Her mobility was not 100% but she was at least mobile on her own. She had a low baseline to start with from not hardly having any muscles or strength and that 1 week of them just having her lay in the bed exacerbated that by 1000%.
I hope this helps. It has taken a lot of work and encouragement for my mom to start doing things on her own again, but she is on her way to being home and hopefully getting back to where she was. I hope you will find the same for your dad.

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I believe Helly is in the UK.

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Thanks Barb. Makes a difference.

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Sorry, yes a hospital stay could cause a decline. He is in a strange place with strange people.

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My opinion, you haven't realized how bad Dad really is. Medicare would not allow a hospital stay this long if there wasn't a reason. I am actually surprised he hasn't been transferred to a rehab.

I agree, this is the time to place Dad. You need a meeting with the DON to find out what is going on. Then u need to tell them what goes on in ur parents home. He can be put on Medicaid and placed in LTC. Mom will be considered the Community Spouse and will not made impoverished.

Him living with Mom is not fair to her. He may one day hurt her.

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I am not in the USA. We have no Medicare or DON (?)

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Helly, please let us know how this is working out.

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You have the perfect opportunity NOW to get dad away from mom. He is not a safe discharge for him or your mom. Take advantage of this situation, demand rehab, then a permanent placement for dad. Your mom cannot nor does she want to be his caregiver any longer.

Or just get mom out of there now!

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My mom's decline started with a fall but in hindsight the fall was really just a symptom of her increasing frailty, something that had been happening so gradually that I had failed to notice even though I was with her all the time.

It seems pretty clear that he are no longer safe living alone in the community without 24/7 help, I agree with the suggestions to look into rehab for your father and some king of permanent supportive arrangement beyond that.

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Helly's previous post indicated that the dad regularly keeps his wife from moving about freely and both are bruised from physical altercations. The title of that post is " I have to get my mom away from my dad asap"!!

Have you spoken to the social workers at the hospital about the situation in your parents' home? You have an opportunity here to place your father. I'm not sure I understand why you and your mom are not seeing that.

If dad is incontinent in the hospital, why do you think it will improve at home? Will he willingly wear pullups? Is your mother physically strong enough to change him if he resists?

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Im sorry but if he can bruise his wife he can change his own damn diapers

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It’s possible that Dad has reached a new level in his disease, or he could be confused and anxious over his recent hospitalization.

Unsolicited advice: You say Dad is “hopefully” being discharged with a “care package.” You aren’t certain? Dad has cognitive issues, is a fall risk and now may be incontinent as well. You need to step in and make sure their discharge plan will keep them safe and get them the help they need. The fact that they kept him in the hospital for almost two weeks because they were concerned about lack of proper care for him is a serious red flag.

Even if Mom and Dad say they’re ok and even if on the surface they’re putting up a good front and refusing help, behind the scenes you and your sibs, if you have them, need to make sure they’re getting the help they need. The fact that they kept him in the hospital for almost two weeks because they were concerned about lack of proper care for him is a serious red flag.

Mom may say she’s ok and doesn’t need help, but I can tell you from experience that she needs help and probably doesn’t want to ask for it. If Dad is so needy that he would endanger himself and Mom by trying to grab her to keep her from leaving the room, their situation may warrant a discussion about ramping up his care.

I hope I’m off base here and that you and any sibs are keeping a close eye on them. However, because falls can happen in a split second, and this time, Mom was “lucky” and wasn’t injured, maybe it’s time to have a discussion about changes that might need to be made.

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Father has declined after hospital stay - is this normal?

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