Nursing home or not?

IndyGal · Nov 7, 2006

I think it also depends on whether he's strongly self-disciplined and will push himself to recover or whether he's someone who needs more structure and outside motivation. My grandmother had hip replacement and declined to go to a rehab facility afterward. She went home and refused to do any of her rehab exercises, wouldn't walk, used a scooter everywhere, and generally had family wait on her hand and foot. It's been years since her surgery and she STILL walks with a cane and limp. If she'd gone somewhere with a tough love approach and been forced to do her rehab, she'd be back to normal.

mommy2boys · Nov 7, 2006

Have you asked your dad what he thinks? Some people are actually more comfortable with other people taking care of them than they are with family- they feel that they're being a burden, disrupting your life, etc.

I hope he does really well no matter where he goes!

My dad really doesn't want to go to the nursing home, but he doesn't want to be to much trouble for us. I'm planning on moving home until he has recovered some to help my mom with his care (she will help with using the restroom/showering but I will have to deal with "nursing" him, she doesn't do blood very well). We have a wonderful home health nurse that we used to help out when my grandmother was dying from ovarian cancer (she was part time help as well as hospice care).

Well know more tomarrow. IF the doctors put their foot down and he has to go to LTC then that is what we will do.

Thanks

Erin

Antikigirl, ASN, RN · Nov 7, 2006

I am an ortho med surge nurse, and this is my insight.

The hospital ortho floors are geared to handle the immediate recovery and a small part of rehab to the point of certain criteria only. The criteria being that a patient can 1. eat solids 2. take oral pain meds 3. urinate/deficate 4. are stable 5. can walk at least to the bathroom and back, and up at least 3 stairs (typically steps into a house). So as you can see we aren't really set up as rehab, but a begining step to rehab for some patients.

So after people have total hips, dependant on condition, we send them to the next step, rehab. It is typically a short stay so they can get more movement going on (which helps with not having limitations in the future), adequate and reasonable pain management that tapers with the patient needs, good diet during this time, and an eye for anything unusual that can signal a probelm like infection. Many hospitals are not set up to tend to totally rehab patients and must be done in a rehab facility.

Now, your father may meet the criteria, but the MD may be concerned about something else...like the before mentioned hemodynamic state! That is serious business. Some pts overuse or underuse pain meds and that can also be detremental and can be watched at Rehab. He may not be up to par on the ROM. Other medical history issues that must be watched as well can be in play (such as heart/lung conditions).

Not to mention rehab is a team effort for one patient. It isn't easy and very back breaking work to help people post hip replacement!

And team effort is called for big time to stop another fall or displacement of the hip. I have seen folks refuse to go to a rehab and wind up back under the knife because they fell at home...but typically there is a painful family member there with them because they didn't have the right skills for transfers and OUCH...both fell! Or the time I had one lady come back because she rolled out of the bed in the night and broke the other hip! OUCH!!!!!

That is why rehabs and hospitals are 24/7 with staff available to help at any time. Things happen in the middle of the night, and many folks don't have the schedule to stay up all night on watch. (let alone a team to help for transfers and potential accidents that can occur).

I would certainly be looking at the NEXT part of his recovery...which is rehab! Hospital is recovery, LTC or skilled is rehab! Two different areas :).

You may want to keep that in mind, and also ask the MD what criteria was involved in the rehab choice so your father knows why and can hopefully set goals!

Good luck!

mommy2boys · Nov 7, 2006

After much thought and listening to all of you, I think that I'm going to recommend that he goes to the NH. I will know for sure tomarrow after talking with his doctor, but I think that you ahve made up my mind. My parents really look to me for advice about medical questions because I'm going to school to be a nurse and I have a little more of a level head when it comes to medical choices. (That, and I know a ton of people in the medical field and can usually get the answers even if I don't have a clue as to what is going on)

Thanks again and I'll keep you posted.

Erin

Midwest4me · Nov 7, 2006

I personally vote against the NH placement because of a bad experience I had with my step-mom last year. Although the reason for rehab is a great one, oftentimes nsg homes are incredibly short-staffed(and in our case my step-mom contracted various infections as well as decubiti). I'd always told her I'd never place her in a NH(though she always told me she wouldn't mind) and I still find it hard to forgive myself. If your dad can be guaranteed a short stay, perhaps it's worth a look because of the benefits of rehab.

camrave · Nov 8, 2006

As a previous HHN we had many total hips and knee replacements. We've never had a bad experience. After surgery, the pt would come home and we, the HHA would take over care as far as Physical Therapy and Nursing, drawing the PT/INR's as often as ordered by the MD and wound checks, as well as pain management teaching, bowel teaching. PT would see the pt for about 3-4 weeks then d/c them to outpatient therapy. It really depends on the pt and what other health needs he may need. If he's pretty much healthy or his health is being maintained, and he's normally an independent person, I think he would be fine at home. I would check into the HHA's around your area. The agency makes a difference also because you want their nurses to be efficient with his care and f/u with his Coumadin level, and provide effective teaching regarding s/s DVT's, s/s infection. Hope this helps if he's really against going to a NH, besides some pts heal better at home and it helps having the therapy in the home in case they have steps in the home or outside, they will know what precautions to take in the home once they get there as far as safety.

lisamc1RN, LPN · Nov 8, 2006

Our rehab SNF is awesome! The PT/OT is excellent as well as the nursing care. I wouldn't rule out a good facility. Maybe take a tour of a few facilities?

GatorRN · Nov 8, 2006

I had a hip replacement last yr. I was in the hospital for 6 days post op. I worked with PT many times daily, I had one of those bars with a grip thingy(can't remember the name of it) over my bed. Before they would discharge me I had to be able to get out of bed with assistance to the BSC, walk a certain distance, go up a couple of steps, all with the help of a walker, and be off the PCA Dilaudid.

I had a choice of a rehab or home. I chose to come home, mainly due to my fear of nosocomial infections and lack of care due to understaffing at the rehab. My bf took a wk or so off to help me at home after discharge, so I knew I would have assistance around the clock at home, not to mention the basic comforts of being at home. My sister lives very close and would come check on me throughout the day after that. I had in home PT 3 times a wk for the first 6 wks then outpatient PT after that. I also done my exercises on my own the days PT didn't come. It is VERY important that your father religiously does his exercises, not only for rehab purposes, but for strengthening/support purposes indefinately. If your father is motivated to do it on his own he will be fine rehabing at home. If not, then the NH may be a better option.

I would probably also recommend a home care nurse checking in on him due to his clotting disorder, vascular condition and incision assessment. My surgeon glued my incision closed so I had no stitches or stapels to contend with. And being a nurse myself I knew what to look for as far as any indicators of infection at the site, and young and healthy otherwise, so I didn't have a home nurse.

Two things I would highly recommend for at home use post op is a BSC (the type that can be placed over the toilet) and a tool called the reacher (the longer one). I got mine at Lowes for about $20.00. Insurance will probably pay for the BSC. Your father will have certain restrictions post op and these things he will need.

Of course, it's entirely up to your father and your family as to which way to go. I'm sure that you all will make the best decision after speaking with the surgeons regarding the best option for post op care. Sorry this post is so long, I was on a roll...LOL. I wish your father good pain control and a fast recovery. Feel free to PM me if I can answer any other questions.

ebony2 · Nov 8, 2006

Having worked in long term care for many years I woild just like to say that the care in some facilities is excellemt. You have a group pf nurses, therapist and activity directors who dedicate themselves to the residents entrusted in their care. You have nursing staff to take care of the daily needs your father will have, nurses assessing the resident for progress and potential problems that are identified early and addressed quickly. Your dad will have the opportunuty to meet new friends that may have the same or similiar problems as he does. His therapist will progress him to his former functional status according to his abilities. When dad goes home he will have had time to adjust to any changes presented after surgery. Many people do not want to impose on their family members and this eliminates this potential guilt. Home care is an option but depending on how much and how long your father's recovery takes that may place added pressure on family members. If you plan to persue Skilled nursing facilties familiarize yourself with the facilty prior to committing yourself. Tour the grounds. Observe how residents look, and interact with staff and each other. See wht residents are doing in the gym and take nte of the interaction in that setting.Take note of the esthetics of the facilty and ask questions to get a feel for how the staff reacts to you, Hope this helps.......GOOD Luck with your decision

CaseManager1947 · Nov 9, 2006

For a gentleman of his age, who is alert and well able to participate in therapies I would rec. rehab, you mentioned he is covered by champus... has your case manager explored that avenue, or do u all feel the care is substandard, (i have no idea). Rehab would get my vote OR even home with home health and Home PT IF home is laid out for easy care,

be sure you get walker or whatever PT sez he needs before u leave, can be delivered to hospital. He may stay 7-10 days, but that would be pushing it.

hope this helps

mommy2boys · Nov 9, 2006

After speaking with his surgeons, it has been decieded that he will go home after the surgery. He will have to stay longer than other hip replacement patients because of they will need to regulate his blood thinners. Once he is discharged, he will have home health come out every day or every other day (depending on how he is doing). His insurance company is paying for all the supplies (bed rental if needed, walker, toliet seat, etc). PT will be done by HH until he can move better to go to PT/OT. If he needs extra PT they will send somebody to the house to get us started.

He is very happy about being able to stay home after the surgery and we are happy to help. My mom is taking off work to take care of him, I'm moving in to help until things get easier, and my sister will be in and out helping out. Home health will be their to help with PT and patient care. If we feel like we need extra help we are going to hire a private duty nurse to help us.

Thanks again for all the great advice. I'll keep you posted on how the surgery goes and how his recovery is going.

Thanks

Erin