This was the most frequent question I heard at the rehab. Dave's mental state deteriorated the longer he stayed, and the results were mixed. As of 8-25-2010 he was able to walk 100 feet with two people supporting him on each side. This was the good news. The bad news was that he was in a delusional state most of the time, never understanding that he was in a rehab facility. He became combative, refusing medication and refusing to cooperate with his nurses. Most of Wednesday he thought he was in a courtroom at a trial and everyone there (other patients) were members of the jury. The day before he was preparing for a speech he was supposed to give to a bunch of bad kids who liked being bad. It would be on his ex-girlfriend who was the granddaughter of a Mafia kingpin who put him up in a lean-to under the causeway in Galveston.
On Wednesday he tried to escape twice by getting into the wheelchair in his room and attempting to wheel himself out of the building. He also refused to stay in his bed and presented a major fall hazard by attempting to stand over and over. As soon as a nurse would leave the room, he'd try to get out of the bed again, setting off alarms. On Tuesday they asked me to get him a sitter at night, and by Wednesday they asked that I get one for the afternoons as well. I became the Wednesday afternoon sitter, but I told them he needed to go back to his assisted living facility since he didn't feel safe at the rehab. Of course, when I would sit with him, he would also make an effort to stand up (basically trying to swing up from a sitting position), but we surrounded his bed with the reclining chair I was sitting in and the hospital food table on the other side of the bed. I just kept saying, "Dad! You're making me miss my show!" and then he would lay back down. A cardinal rule everyone understands: Never get between someone and "their show." As the evening went on, every show was my show.
The saddest part about all this is that (1) he was making progress, but (2) he still can't stand or walk on his own and (3) he will get far less therapy with the home health care service with no equipment and much less space to move around. As delusional as he is, he never made the connection between staying in the rehab and working with them and an ambulatory future. As terrified as he was of the rehab situation, I felt that going back home was the least crappy choice.
I think his ability to walk again is poor due to the his extreme muscle atrophy, Parkinson's, confusion, continuing refusal to eat sufficiently to build muscle, and a broken hip. It may be that he will continue to have falls since the rails do not go all the way to the end of his hospital bed mattress and he can climb off. He will set off alarms if he does so, but he can always have a fall before anybody gets to the room. As they said at the rehab, "He's fast. I'll give him that."
So he went home and was in his new wheelchair. He spent the rest of the afternoon trying to get out of his wheelchair. They called to ask if they could belt him into the wheelchair and I said yes. I asked them if they possibly restrain him in the bed, but legally they cannot. I understand this law because I'm sure the practice has been abused in nursing homes for years, but NOT restraining him at night is going to lead to another fall, and another break, and I consider that much more cruel. About the best they can do is, if he won't calm down, put him in his wheelchair at night and take him from room to room with them as they do their other duties.
When the assisted living caregivers told him he couldn't walk on his own yet, he said, "I've been walking around all day!!" I don't think he's lying. I just think the dementia has put him in a very dangerous position. I don't hear the assisted living manager hesitating to take him back, but after a few days I think they may decide he's beyond what they are set up for and if that happens he will probably need to go to a nursing home. All any facility has to do to get rid of someone is to require a sitter. At $16.00 per hour, that's $160 per night. Not paid by Medicare.
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Went to Dad's house to drop off sheets. He's much more at peace. Working on a wedding he's planning(?) Not happy because someone stole the guest list from his pocket, but happy to be home and telling the other tenants how much he missed them. Wheeling around in his wheelchair fairly well. Within a couple of days he'll be much more skilled.
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