Anonymous wrote:OP here - thanks for all the thoughtful advice. Here's where I am: went around mom and worked with dad to arrange for a nursing aid to be at the house with him from 8-12 every morning, get him bathed, dressed, fed, do his PT exercises with him. That way, mom can walk the dog and do her thing. There is an option to dial this care up or down depending on needs. Meanwhile, I am going to research an institutional plan B in case the in home care plan doesn't work out.

So glad that you were able to work something out! My Dad passed away recently. I am not local and I was horrified when I saw the state he was in when he was admitted to the hospital. The nurses very politely let me know that he was not getting the care he needed when he was at home with my mother. It was clear that my mom was not able to care for my dad who had cognitive decline and was a fall risk and that my mom did not have the sense to ask for help. From the hospital I was very clear that he could not be discharged to home.

Make sure to take advantage of any post discharge in home visits by nurse, PT etc. The hospital social worker can help with getting that authorized by medicare. That’s another set (or two) of eyes and hands that may help
your mom see that more help is needed.

Anonymous wrote:OP here - thanks for all the thoughtful advice. Here's where I am: went around mom and worked with dad to arrange for a nursing aid to be at the house with him from 8-12 every morning, get him bathed, dressed, fed, do his PT exercises with him. That way, mom can walk the dog and do her thing. There is an option to dial this care up or down depending on needs. Meanwhile, I am going to research an institutional plan B in case the in home care plan doesn't work out.

OP this sounds like a sensible plan. Hopefully when your mom sees it doesn't impact her day to day she will be more amenable. From what I've seen with family members, they resist the aide until they get to know them. Once they are a "person" then everything is ok. It's that initial thought of a stranger that freaks them out.

We were in a similar position as you are OP a few years back with my IL, only we didn't realize that was the case because MIL was successfully hiding her declining mental state. At least from us. We are the farthest away. Others closer suspected but didn't want to argue with MIL about these things and let it ride.
Everything broke apart when MIL slipped and hit her head. A brain bleed coupled with her declining mental state caused her to just lie where she fell. FIL has physical disabilities as well as severe diabetes. MIL gets him his food and helps manage blood sugar. Without these, he suffered from low blood sugar and fell into a semi comatose state. So they just laid like that for 2 days. SIL, who lives closest, had stopped by to see them and found them that way. They are okay now though MIL's dementia is very evident now, but we all shudder to think what could have happened.

All this to say that these things can turn on a dime. And suddenly things that work, don't work anymore and we are left wondering why we let it ride so long. There are no easy answers unfortunately.

OP - If you are out of the area, then hopefully you have engaged an aide from a reputable local agency AND that you have gotten your Dad to sign off on any form needed so that you can confer with the agency and your dad's PCP to be able to keep informed of his health and also to share information on it. You could go one step further if you wanted support and/or to separate yourself a bit from the oversight by seeing if there is a local geriatric care manager type person - with the agency or a separate person. You are doing all you can in getting your dad's care set up to give home "a trial run," but you also are wise to look at what the other options on care are for your dad. It sounds like your mother is not working with quite a full deck, so again having an agency on board, may well be wise in the future to figure out what supports she needs.

While you are there and your dad is able to think clearly and make decisions for himself, have you been able to see if he (and your mother) have the necessary legal documents in place and to get an idea of what they can afford in terms of possibly needing care for two. At this point it is time to clearly state that you just want to be sure the plans are there for both of them.

OP here - thanks for all the thoughtful advice. Here's where I am: went around mom and worked with dad to arrange for a nursing aid to be at the house with him from 8-12 every morning, get him bathed, dressed, fed, do his PT exercises with him. That way, mom can walk the dog and do her thing. There is an option to dial this care up or down depending on needs. Meanwhile, I am going to research an institutional plan B in case the in home care plan doesn't work out.

To buy time, can you push for him to get into a rehab or skilled nursing place? Medicare will cover 20 days of rehab. That's 20 days to figure something out. If you argue that he has lost function in the hospital, then say he needs rehab to try to regain the ability to live independently or with less help at home. Medicare will also cover after 20 days but there is some out of pocket (not sure how much). The case worker can help with this.

I would try to find a rehab with really good reviews that has only private Medicare covered beds AND has an assisted living facility attached. I find that the more they are away from home the more they get used to not going home. It's a big deal to say "you're never going home" to someone in the hospital because of fear of the unknown. If he can do some time in rehab/skilled nursing and transfer to AL that might be easier. If you are in the DC area I hear Goodwin House is the best though expensive (it has rehab, AL, and memory care I think).

The thing is, if he is out of the house and your mom doesn't visit, he's alone and that's not good either. But it might be safer than him being alone with no caregivers at home. Maybe he can make some friends there, too, and be less isolated. The best ones have a strong community so it can be much less lonely than being at home.