Options for parent post stroke

Anonymous
Dad had a stroke in September and has been in rehab at a skilled nursing facility for three weeks. His right hand is partially paralyzed, his right leg is week, his speech is affected, and he is not continent. He has walked a few times in PT with support but doesn’t seem like he is going to regain mobility. He is frustrated and depressed, but often refuses therapy and doesn’t even want to get out of bed to sit in a wheelchair. He knows he is not going back to his home, but what are the options if he doesn’t improve? Would he be able to live with family if he is not able to get out of bed and into a wheelchair - assuming we could find in-home cna? Is assisted living an option for someone like him? Or would he have to go to a skilled nursing facility? I have experience with memory care, but not with someone who is partially paralyzed or bed bound. He doesn’t particularly like other people and is extremely private so getting him in the right environment is going to be challenging. Any insight into what would work best in this situation?
Anonymous
How old is he? Is he married?
Anonymous
You need to talk to the social worker assigned to his case at the current facility. They will tell you your options given his level of mobility. From what you’re describing, assisted living doesn’t sound like an option. Sorry you’re going through this.
Anonymous
Anonymous wrote:You need to talk to the social worker assigned to his case at the current facility. They will tell you your options given his level of mobility. From what you’re describing, assisted living doesn’t sound like an option. Sorry you’re going through this.


+1 talk to the social worker op. At current level of functioning it sounds like he would need skilled nursing or 24 hr care at home with family but could be wrong as it’s just a description so definitely talk to the social worker. You could definitely do home with family but it depends on how much you can take on as it sounds like he would need a huge amount of care and home care is expensive. If he is at home with family he could get home PT and OT. Or if at skilled nursing he could hopefully continue to get rehab (if he qualifies and continues to participate) so that hopefully he can learn to transfer etc and get some of his independence back. Social worker can help you explore all options.
Anonymous
Can you or he afford to build a handicapped accessible house?
Anonymous
Anonymous wrote:Can you or he afford to build a handicapped accessible house?


Or at least a part of a house?
Anonymous
My parent suffered a stroke and went to sub-acute rehab/SNF. He improved a lot through rehab, but not enough to live independently. He will stay in the SNF facility.
Anonymous
OP - he has money for care, but hasn’t wanted to entertain modifications at either my house or his sisters house. I do have a POA but he is still wanting to make his own decisions. I don’t know much about skilled nursing facilities but have been pretty appalled where he is now - can’t imagine he would do well in such a place long term. The difference between skilled nursing and the memory care facility I am familiar with is night and day. I tried to get him moved to another facility but can’t even get someone to return my calls.
Anonymous
OP again. What is the nicest skilled nursing facility in the metro DC area? Ideally private room or suite, ability to bring in supplemental private duty aide, well-staffed. Prefer MD side of DC but want to hear about all options.
Anonymous
I think a nursing facility of any kind will always be subpar to home based care. I’d do a rehab facility for 3-4 months and get updates done to the home to accommodate. Hospital bed, handicapped shower or bench, etc. Get a home care team, hire 3-4 nurses round the clock or as needed. You have to keep him moving, once he’sbed bound for good he will lose most independence. I’d focus on recovery and strength and getting him home to improve life quality.
Anonymous
OP, be prepared for a long-haul. My parent lived more than 7 years post-stroke and was in similar/worse physical condition but was mentally acute.

IMO, it is very very difficult to do in-home care, especially when it typically takes two people to transfer many stroke patients safely. Plus, even if your dad is a bit of a loner, he may still want to have some sort of human interaction and activity other than caregivers all day.

My mother eventually resigned herself to the position she was in and began to make friends in her nursing home and among the staff members. She did what activities she could and enjoyed the entertainment the facility and volunteers would provide. We brought her home for visits by renting a specialized wheelchair accessible van.
Anonymous
Anonymous wrote:OP, be prepared for a long-haul. My parent lived more than 7 years post-stroke and was in similar/worse physical condition but was mentally acute.

IMO, it is very very difficult to do in-home care, especially when it typically takes two people to transfer many stroke patients safely. Plus, even if your dad is a bit of a loner, he may still want to have some sort of human interaction and activity other than caregivers all day.

My mother eventually resigned herself to the position she was in and began to make friends in her nursing home and among the staff members. She did what activities she could and enjoyed the entertainment the facility and volunteers would provide. We brought her home for visits by renting a specialized wheelchair accessible van.


^Forgot to add: Go to the Maryland and/or DC Elder Care Ombudsman website for additional information about facilities. They will be able to provide good advice about level of care, or problems/fines at facilities.
Anonymous
Given that he is incontinent and unable to self transfer or walk, I doubt you’ll be successful with home care. And his level of care will be SNF. You’ll have options given that he can self pay. You probably want to tour a bunch - I’d start now. If he’s a smoker, it might be more difficult to find a facility and/or arrangements he finds satisfactory.
Anonymous
Can you find a facility that offers a range of care from assisted living full through to nursing care?

After my grandmother had a stroke she ended up quite happily in a facility like this. She was more mobile than your dad in that she used a mix of Walker and wheelchair, but was mostly non-verbal and definitely had motor issues with hand eye coordination.

The facility had a range of activities and were able to accommodate participation from patients along a range of abilities. Wheelchair “aerobics”, arts and crafts with an OT. Things that kept her moving. That might be more than he wants or can do but look broadly not just at pure nursing homes.

Good luck and I’m sorry to hear this.
Anonymous
Anonymous wrote:Can you or he afford to build a handicapped accessible house?


Don't do this. If you live by it will turn into your nightmare even if you think that would be a dream. Plus, things change on a dime and contractors can screw up. It will be a money pit that won't pay off and could potentially do you in even if you aren't paying for it-the stress alone. Caregivers quit. Yes, people will share horror stories about nursing homes, but if it's a good one and you visit that is not our experience. Much easier to visit, check on things, advocate and then go home, then to have your parent in a house of horrors which it can be even with disability renovations because they end up isolated.
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