anonymous782208 Asked December 2018

Should I take Dad to the hospital or do something else?

I've taken each of my parents to the hospital this year. Mom has been 6-7 times. Dad was there only once, when he fell on the front porch and hit his head, requiring staples. He also broke his nose.

The hospitals sometimes fix one problem while creating another. For instance, Mom's dehydration was resolved in that 5 day visit, but she left there unable to stand or walk, whereas she had done both prior to that.

In her last visit, she didn't get changed unless she asked, so it ended up being only 1 or 2 times daily, whereas at home, I do it at least 3 times daily. She got a UTI, and her peg tube wasn't cleaned so the incision site got nasty.

I'm saying all this because I'm not sure if I should take Dad in or not. He's 94 and fragile and I think hospitals are at their best with more cut-and-dry emergency issues like broken bones, a head gash, someone in labor.

A couple of weeks ago, he developed a cough. I took him to a PCP who put him on antibiotics, and he got well....for about 2 days. Then, Mom got a cough. Then he got his cough back.

Hers sounds like congestion whereas his is a dry cough, which I thought was because he has started heavy mouth breathing while he sleeps. Since he sleeps 20 hours daily, I assume he's drying out his throat. I've tied sashes around his head to keep his mouth closed, and even put elastic ouchless tape over his mouth. That worked at first, but now his breathing has gotten too heavy so nothing works. I have him surrounded by humidifiers that have LED lights with soothing colors so he can see when he goes to the bathroom.

He is wheezing and coughing at all hours, though might go 3-4 hours without coughing.

He has been sleeping long hours all year, so that isn't new, but in the last 2-3 days, he can't even stay awake long enough to get through a bowl of soup. I spoon fed him today but had to keep nudging him awake.

Worse is that he seems to be hallucinating a lot during sleep. He scratches endlessly at his scalp, talks, and reaches out for things. And his eyes are almost always open. Mom says he's always done that, but I've been here a year and haven't seen him do it this much. Today, more than ever, he's having a hard time being oriented to where he is and what is happening around him. Right after giving him his nebulizer meds, I asked him if he knew where he is. He said "yes." I asked "where are you?" He said "I'm in the place where they give medicine."

I'm worried that I'm not doing enough, but don't know what a hospital could do. And I fear him on being on another round of antibiotics this soon after the round just 2 weeks ago.

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You are looking after two people in their nineties. One is incontinent and has a PEG site. Both have been acutely ill in the last fortnight. And you are doing this entirely alone, and without even the support of a reliable PCP's service?

I share your reservations about taking frail elderly people to hospital unless it's obviously necessary and you have a clear idea of what you expect the hospital to do. But for you to be attempting this job without any advice or help at all is crazy.

Where else can you seek medical advice?

This is just a thought, mainly from the point of view of getting in nursing expertise: have you considered asking for a hospice assessment?

Helpful Answer (14)

I agree that a consultation with a palliative care group such as hospice would be helpful to you. It sounds like you are providing the best care you can provide but it also sounds like you might be in a little over your head now.
A palliative care consult would keep your parents comfortable and avoid unnecessary hospitalizations. The doctor should have a number you can call.

Helpful Answer (11)

Honestly, your parents are at the end of their lives. It's not a matter of if, it's when. If they die because you, their sole caretaker, failed to seek medical care you could have a ton of trouble and your conscience would bother you. So... If I were in your shoes, I'd call any local hospice and ask for both to be assessed.

I had a marvelous experience with mthr's hospice service- she even graduated because she got better! When on hospice, they can treat things without going anywhere. They can also relive pain if the person is actively dieing. Their doctor can asses if either patent is eligible,which means being likely to die in 6 mos. Mthr was on the service for 2 years! Then they can treat them at home -mthr even had a mobile x-ray when she fell. No charge to the family. Your legal and moral duty will be fulfilled.

Helpful Answer (10)

Medicare has gotten very strict on what qualifies for hospice anymore so they may not meet the criteria but it’s worth asking their doctor who has to be the one to refer. Sounds like a new doctor is needed the way it’s going.

(1)

I see from the answers already that you’ve gotten conflicting advice. I’ll say from our experience that the hospital is most definitely my dad’s enemy. Each time he’s there for one problem it invariably creates another, usually more challenging one. Walking is key for him, so any time at all in a hospital bed sets him far back on that. Hospital staff don’t make him get up and walk, family is often seen as mean or demanding for making him do it but that’s exactly what we’ve learned is a must. He always gets a UTI, just always, no matter what is done or what he’s there for. There are also issues of fluid building up and the emotional ones of getting a bit too into being waited on for everything. In short, we avoid it if at all possible. Your dad is older than mine, and it sounds like you’ve done all the care in the world, I’d doubt the hospital has any magic fairy dust to add at this point

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Very insightful answer!

(1)

How are dad's vitals? BP, temp and respirations?

First indicator that mom had sepsis was lethargy and all three vitals were elevated- by the time I got her to the ER, she nearly needed to be in ICU

Helpful Answer (6)

Instead of going to the ER at the hospital, take Dad to an urgent care office. Dad will get the same care, and if the urgent care feels that Dad is in a real emergency situation that they cannot handle, they will call 911.

I hate to the brunt here, but why on earth would you tie anything around your Dad's head or put tape on his mouth. He could have easily suffocated. Never, ever, do that again. Open mouth breathing while sleeping means your Dad's could have a stuffy nose. This is something a doctor should check out.

As for the cough, it could be anything. From dry air [which can cause dry scalp thus the scratching], and you only need one humidifier in the bedroom and one humidifier where Dad watches TV. Too many could cause mold which can cause someone to cough.

What medication is Dad taking? If Dad is on blood pressure pills, that can cause dry mouth and coughing. Dad could even be developing acid reflex which also causes coughing.

Helpful Answer (5)

The thing I tied around his head is no different from those people buy online to prevent snoring...it's just homemade. He does not have a stuffy nose, which was confirmed by the ENT and the PCP and they are aware of the tape, which he can- and does- pull off at will.

(1)

If he was my dad he would be on his way to the doctor or hospital. What can they do that you cannot do at home? Oxygen, medications, IV fluids for a start. Check his vital signs etc.

Helpful Answer (3)

Someone should be covering for vacationing doc. Does the office have a nurse practitioner? Definitely look into hospice care for both parents. Depending on what their needs are you can have access to in home nurse visits, cna 2x a week for showering assistance, O2 concentrators, meds, ect. They are a great group of people who are wonderful to work with. By having them come in things such as a cough can be evaluated and hopefully treated before it becomes a more serious problem down the road. It will be easier on your parents and on you with a little bit of extra help and not having to run out to see a doctor every time. Does dad lay flat while sleeping or propped up? Laying flat may cause more coughing, harder to breath. If laying flat, thet sell wedges that fit between the mattress and box spring to raise his head, yet another good thing about hospice is that they can get you an adjustable hospital bed for his / her use. If you can not get ahold of his doctor, try speaking to the patient advocate at the hospital, they may be able to help you get your parents evaluated for hospice care or at least point you in the right direction. Good luck, you have your hands full with caring for both parents. Hope everything works out for all of you.

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Hi, you are caring for 2 frail, elderly people 24/7, in other words, no break, no rest. If something happens to you, they have to go to hospital for care of some sort. I think you need to consider yourself now. Your father is sleeping 20 hours a day but he is frail, and some sleep that much as they get older. His sleep is restless, you cannot be up all with him, you need your rest too.
You are doing your very best as your parents age, you have done more than enough. Isn't it time you thought of what is best for you?

Arlene Hutcheon

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