Earlier this month, my husband picked up the phone and learned that his 92-year-old father had been taken to the hospital that morning, feeling sick and short of breath.
We were nearly 2,000 miles away, on a vacation in the mountains of southern Colorado.
No, it wasn’t COVID-19. My father-in-law, Mel, who has diabetes, high blood pressure, and kidney disease, was suffering from fluid buildup in his legs and around his lungs, as well as excruciating knee pain. Intravenous medications and steroid injections were administered, and he responded well.
Doctors monitored Mel carefully, adjusted his medications, and recommended a few weeks of home health care after eight days in the hospital.
In other words, this wasn’t a life-threatening emergency. Yet, we realized how poorly prepared we were for a real crisis, should one arise. We needed a plan.
Why didn’t we have one already? The usual reasons: denial, avoidance, and wishful thinking. It was easier to imagine that Mel would be all right until it became clear that we couldn’t take that for granted.
Although I routinely advise readers about preparing for changes in their health, I didn’t want to be a know-it-all with my husband’s family. Their assumption seemed to be “We’ll deal with whatever comes up when that happens.”
Now, eyes wide open, we got organized.
Hiring a Care Manager
Last year, as Mel’s kidney function declined, I suggested we hire a geriatric care manager who could look in on him regularly. After a few visits, Mel let her go. Her services were too expensive, he complained. In truth, we understood, he didn’t want someone interfering in his affairs.My husband respects his father’s autonomy and didn’t press the point.
So, when Mel went to the hospital a few weeks ago, he was alone, with no one to turn to for assistance.
This was especially problematic because Mel has hearing loss and it’s almost impossible to talk with him by phone. “How are you, Dad?” my husband yelled on twice-a-day calls to check on his father in the hospital. “What?” Mel replied querulously. This was repeated a few times, with mounting frustration and no useful information exchanged.
Finding Companion Care
What kind of assistance was Mel going to need when he left the hospital, deconditioned and weaker than when he went in?When we spoke with the physician overseeing Mel’s care in the hospital, he suggested that “companion care” for at least a few weeks would be a good idea. Mel needed someone to help him up out of the chair, stay at his side while he walked to the bathroom, and bring him a glass of water, among other tasks. (Also, we realized, we needed to arrange for meals to be delivered and for someone from his senior community to buy groceries for him—a service they’d started during the pandemic.)
An excellent organization that works with older adults in Mel’s area supplied me with a list of 21 agencies that provide these kinds of services—a dizzying array of choices.
Understanding the Options
Mel’s senior community incorporates assisted living and a nursing home for residents who need short-term rehabilitation services or longer-term, round-the-clock care.But it was clear that Mel wanted to go home after being in the hospital instead of going to that rehab. Medicare would pay for a few weeks of visits from nurses and physical and occupational therapists. Would that be enough to set him on the road to recovery? We had no idea.
Getting Paperwork in Order
Years ago, Mel assigned power of attorney for his health care decisions and financial and legal affairs to my husband. So long as Mel can manage on his own, he makes his own decisions: The legal papers were a backup arrangement.Understanding the Prognosis
Before Mel’s hospitalization, we knew his kidney function was worsening. But what lay ahead? Was dialysis even an option for a 92-year-old in this time of COVID-19?Who was best prepared to help us understand Mel’s prognosis and the big picture?
I’ve written for years about geriatricians’ comprehensive approach to the health of older adults. It turns out, there’s a top-notch group of geriatricians affiliated with the hospital where Mel was being treated.
Having the Conversation
What has yet to happen is the conversation that my husband hasn’t wanted to have.“Dad, if your health takes a turn for the worse again, what do you want? What’s most important to you? What does quality of life mean to you? And what can we do to help?”
With Mel’s hearing problems, doing this over the phone won’t do.
My husband would have to fly cross-country and, ideally, meet his New York brother at Mel’s place for a conversation of this kind. Before that happens, the brothers should talk among themselves. What’s their understanding of what Mel wants? Are they on the same page?
Also, no one has discussed financial arrangements.
Being Prepared
Professionally, I know a lot about the kinds of problems families encounter when an older relative becomes ill. Personally, I’ve learned that families don’t really understand what’s involved until they go through it on their own.Now, Mel has a new set of supports in place that should help him weather the period ahead. And my husband is keenly aware that planning doesn’t stop here. He’ll be attending to his father far more carefully going forward.