I'm devastated

  1. I need some advice - hope some of you have been there and can help! I'll try to keep this as compact as possible. I am my Dad's Health Care Proxy. He is 84 year ols. He has Parkinsons (advanced) - very symptomatic. Confused and disoriented at times. After taking a close look at his labs, found he had an elevated BUN and creatinine. Took him to a nephrologist and had renal ultrasound done - showed hydronephrosis. Took him to a urologist for bladder ultrasound, bladder was full. MD gave him the option of a suprapubic catheter placement or letting nature take its course. So - if he has the catheter placed - he cannot stay at the assisted living facility due to restrictions involving assisted living residences. But if I decide not to have the catheter placed - he will further compromise his kidney function - possibly putting him in a position of having to be dialzyed. Dad currently resides in an assisted living facility (that I am very happy with - after signing him out of a nursing home AMA) OR - I can elect not to do anything and let nature take its course. I know my Dad would not want to be kept alive mechanically, vented (etc), but this - I don't know. The urologist told me that he has a dual problem - BPH and rigidity caused by the Parkinsons on his sphincter muscle. It's tough having to make these kind of decisions for a loved one - I have been very depressed over this - would appreciate hearing from anyone that has been in a similar situation. Thanks so much. God Bless.
    •  
  2. 27 Comments

  3. by   l.rae
    gambro....l don't know what to tell you but l just had to tell you how very sorry l am. Dialysis is a huge compromise, seems to take it's toll on ppl and obviously without it would become very ill, suprapubic catheter placement seems relatively simple by comparison and therefore may help quality of life, which at this point is probably more of an issue than length of life....hopefully someone with more exp can help you with this....hugs and prayers to you and your dad...........LR
  4. by   sunnygirl272
    Originally posted by l.rae
    gambro....l don't know what to tell you but l just had to tell you how very sorry l am. Dialysis is a huge compromise, seems to take it's toll on ppl and obviously without it would become very ill, suprapubic catheter placement seems relatively simple by comparison and therefore may help quality of life, which at this point is probably more of an issue than length of life....hopefully someone with more exp can help you with this....hugs and prayers to you and your dad...........LR
    gambro-
    i agree with what my evil twin said...
    IMHO: dialysis sucks and is not a way a loved gentleman of his age should live out the remaining time he has left on this earth...definately would not add quality of life...superpubic caths are cake in comparison....this of course based on what you have posted as to your choices...
    would Dad qualify for a SNF, as opposed to the ALF in which he resides now?
  5. by   l.rae
    [QUOTE]Originally posted by sunnygirl272
    gambro-
    i agree with what my evil twin said...
    IMHO: dialysis sucks and is not a way a loved gentleman of his age should live out the remaining time he has left on this earth...definately would not add quality of life...superpubic caths are cake in comparison....this of course based on what you have posted as to your choices...
    would Dad qualify for a SNF, as opposed to the ALF in which he resides now?
    [/QUOTE

    EVIL......me
  6. by   sunnygirl272
    Originally posted by l.rae

    EVIL......me
    well...I certainly can't be the evil one....:angel2: :spin:
  7. by   kids
    This is really bugging me so I have to ask...why can't he stay in the assisted living if he has a SP cath?
  8. by   BBnurse34
    What does he want to do?
  9. by   oramar
    I support the two of you in whatever decision you chose to make. However, I have one question. Would not medicare pay for admission to facility with higher level of care in case of a superpubic cath?
  10. by   sunnygirl272
    Originally posted by kids-r-fun
    This is really bugging me so I have to ask...why can't he stay in the assisted living if he has a SP cath?
    i assumed it was more of an adult home type setting and that it would score him too high....

    but perhaps i should not assume...:imbar
  11. by   flowerchild
    Hi GambroRN,
    I believe Florida has laws that protect your Dad. The laws were designed to help people like your father and are called "aging in place" laws. Your Dad should be able to stay right where he is now. Many ALF's have different licenses that allow them to provide different levels of care. Some can not provide the care to the catheter but the person can stay in the ALF if they can care for the cath themselves. A HHC nurse can come in and do the initial teaching. You could care for it too. As long as they don't have to do it, he can stay. The other levels of ALF licensure allow for more technical care to be provided through the ALF. I think the ALF he is in either wants to get rid of him or is misinformed about how to handle this situation. Find out what kind of license they have. Last resort may be to hire a private duty nurse that can help him with his catheter. As long as the ALF is not providing the care, he can stay! If they have an extended care ALF license they can provide the care. Perhaps a move to another ALF that has the resources and licensure is another option you could consider.
    MCA will pay for up to 90 days in a sub acute facility for rehab and/or stabilization but that is it. Private insurance will also pay for sub acute care but usually authorizes less time in the sub acute. IMO, if the only thing he needs is cath care then he doesn't belong in sub acute either except for a short period after the procedure. LTC is an option but is very expensive as you already know. Wishing you and your Dad success in finding the right solution to the problem.
    Last edit by flowerchild on Nov 2, '02
  12. by   nakitamoon
    Hi,,, gambroRN,,,,,

    As DON of a fully licensed Assisted Living Facility in Florida,,,, I have to agree with what flowerchild says,,,,,

    The laws in Florida,,, have changed,,, so residents can 'age in place',,,, Having a HHA,,, come in to do cath,, teaching,,, care,, is acceptable,,, you as well could help take care of it,,,, He can do all he is able,,,, and with our ECC licensure,,, we can take care of it,,,,

    Hope this helps,,, would be much better than facing dialysis,,,,,

    I don't know where you reside,,, but if I can be of any help,, please pm me,,,,,,,

    ~~kitamoon
  13. by   renerian
    CAn't they just bump him up to another level in the AL to keep him there? The aides could empty the cath with proper education. I have seen alot of people with caths in the AL.

    Let us know what you decide.

    renerian/susan
  14. by   cargal
    I don't know about Fla and would go with what Flower Child and Nakita stated; here in Pa I had residents with foley catheters that home health came in and changed monthly. Can they use a foley cath and coude catheter for a while and see how that works out?
    I'm glad you came to the board-the support here is priceless. Let us know how things are going.

    Blessings,

close