I love taking vacation and unhooking from the normal paces of the real world. The hard part is returning to the office. My goal is to get traction on a normal schedule throughout the week. But I have one more goal for Monday. I need to call Dad’s physical therapist to see how he is progressing since I was gone a week.
“Tammy, this is Lee Ann calling on behalf of my Dad. I just got back from vacation, so I wanted to check in with you to see how my Dad’s therapy is going.”
“I am glad you called. We discharged your father last week for lack of progress,” Tammy said.
“What do you mean ‘lack of progress’?” I asked. “That sounds odd given that this facility is a ‘rehab’ facility.”
“What I mean is your Dad is self-limiting.” She continued, “We do physical therapy with many amputees, and we teach many to transfer from their wheelchairs to beds, or toilets, or shower benches with just one leg. When we try to work with your Dad, he just tells us ‘It’s not feasible.’ When we try to push him, he gets angry. In fact, when he told us he could transfer, we asked him to show us, and when he couldn’t, he got very angry with us. The bottom line is when patients don’t want to participate in therapy, we discharge them since there is nothing else we can do.”
“So he’s existing in his room, except to go to the dining area for meals, but getting no therapy,” I said.
“That’s right,” she said. “We have given him strength exercises for his arms, but he is not really doing much of those either.”
“So where do we go from here?” I asked.
“Your Dad feels certain that once he gets his second artificial leg, he will be able to transfer, and then we will be able to discharge him back to his assisted living apartment assuming his hypothesis is correct.”
“I hope he’s right,” I said. “What kind of timeline will he have to demonstrate that he can transfer once he gets his new leg?”
“It is my understanding that your Dad is running out of days according to the Medicare allowance of 100 days,” Tammy offered. “I believe he is going to have about two weeks to accomplish this, or we will be looking at other alternatives.”
“That sounds like a short timeframe given that he doesn’t have arm strength to push himself out of his wheelchair,” I said. I decided to change the direction of the conversation to be proactive in case Dad is not able to transfer.
“I want to be sure that any decisions regarding a transfer to another facility are made not just by my Dad, but also by my uncle, brother and me. We need to make sure that the decision made is not only in the best interest of my Dad, but also financially sound.”
“That is no problem, Lee Ann,” Tammy assured me. “I will make sure you’re included in the care plan meetings going forward so you are involved in the decision-making process.”
“Thank you, Tammy. I appreciate your time to update me.”
This is the conversation I had with the physical therapist on Monday following my vacation. Tammy’s report was very different than what Dad told me when I asked him, “How is your therapy going?” His answer was, “I can do it, it’s just not pretty.” My internal dialogue was “So if you can transfer now, why are you still here?” But I responded, “I am glad to hear that. So when do you think you’ll be discharged?”
“I don’t know,” Dad said. “I am starting to feel like a permanent resident here.”
I feel sad for him, but I am also not surprised. Dad’s amputation surgery was April 2nd, and no fitting for a new artificial leg could happen until his stump stopped swelling. It was June 14th before he got fitted, and it was June 21st before he finally had a new leg. That is a long time to wait for a prosthesis. And if Dad made up his mind that he couldn’t transfer without two legs, then two and a half months have elapsed without much practice in transferring. Before I left for vacation, I had this premonition that Dad was going to have problems negotiating this critical therapy. It felt like the cards were stacked against him.
First, he is heavy. His weight is an obstacle to push himself up. Second, he has lost significant arm strength. Because of his weight, his arms really need to be strong. How does a rehab hospital define strong? If Dad can push himself up in his wheelchair and hold himself up for ten seconds, then that is considered good arm strength. Have you ever tried that? I did just to make sure I could! If you’re not exercising, that can be harder than you think. Third, once he can stand up on his two artificial legs, he needs to show balance and stability, which is very hard after losing a leg. The brain and the leg need to start talking again. Third, he fears falling. Dad can’t picture using his walker and venturing too far from his wheelchair in case he falls. Finally, he fights depression. His level of discouragement influences his decision to not work at building arm strength.
When I walk into his room, the therapist has only one goal taped to the wall, “Push yourself up in your wheelchair and hold for 10 seconds. Do this once every 30 minutes.” Dad is struggling to accomplish that one goal. I tried to give him a pep talk. “Dad, your arm strength will come back, but it’s a process. Celebrate pushing yourself up and holding for three seconds. In 30 minutes, try it again, and you may hold yourself up for four seconds. Just keep working at it, and you’ll get there.”
My Dad has gambled on the hypothesis that he will be able to do transfer activities with two legs. It is plausible, if he can build up arm strength, that he can do this and go back to his assisted living apartment. I just don’t think it can happen in two weeks. I will see if my hunch is right. I have been asked to attend his Care Plan Meeting tomorrow to discuss Dad’s issues and the roadmap ahead. I have a feeling that it’s time to transfer, but it won’t be back to his apartment. May God’s grace be sufficient for my father to deal with this potential change. May God pour out His wisdom generously on our family as we seek God’s leadership to show us where he should be transferring next. Please keep us in your prayers.
Blessings, Lee Ann
Praying for strength and determination. Love Tinka
Thank you, Tinka. He needs determination for sure.
Love, Lee Ann
Lee Ann, you show so much empathy for your dad! Sometimes I allow myself to be frustrated with my dad when he is being “stubborn” and I forget to looks at things thru his eyes. Will pray now for wisdom and grace for all of you!
Debbie
Thank you, Debbie. I know all the help you provide your father, so I appreciate your emotional and prayer support! Blessings, Lee Ann
Praying for you and your dad. I can’t imagine being in either of your shoes! I’m praying that your dad will determine to do whatever is necessary to be able to be independent again. I can only imagine how hard it is knowing that you can’t force him to do what he should, but that he has to choose his attitude and his outcome himself…so hard! Asking God to surround you in His love and comfort, give you wisdom in your input in the Care Plan Meeting, strength and peace.
Thank you, Debbie! He really does need to make the decision to face this challenge with strong resolve that the Lord will help him in rehab. He really fights an attitude of defeat. Blessings, Lee Ann
Prayers are with you both. Love, Deb
Thanks, Deb! Your prayers are greatly appreciated. Blessings, Lee Ann
Praying for your dad, you, and your family. God is good and I’m excited to see how He works in this situation.
Thanks so much, Jody! You are a wonderful sister in Christ, and I know you have us covered. You are right that God is always good and He’s never taken by surprise by our circumstances, so He already has the plan.
Blessings,
Lee Ann
One day, I know that I will be faced with care of my aging parents. THANK YOU for sharing so openly about your experiences; I am taking it all in for future reference. Psalm 91 has become a heart passage for me, so my thoughts were directed to verses 14-15 as I stopped to pray for you, your dad and family. “Because he has set his love upon Me, therefore will I deliver him; I will set him on high, because he knows and understands My name. He shall call upon Me, and I will answer him; I will be with him in trouble, I will deliver him and honor him.“ Sending much love and lots of prayer, ~Annette
Annette,
That Scripture passage was BEAUTIFUL and so timely! Thank you for sharing it with me. I deeply appreciate your prayers for my father and our family.
Blessings,
Lee Ann
Bliss Angerman wrote:
Oh wow, I’m sorry to hear this Lee Ann. I understand your situation, and the limits Medicare puts on treatment are frustrating. July 1 is a year since mom went into the hospital with her stage 4 wound. She’s still in skilled nursing, but it’s long term care and there’s not much PT that goes on. Her large wound has healed and is much smaller, but it’s still there, plus there is a stage 2 and a new stage1 wound on her bottom.
This is not an easy road trying to help parents who want to be self-reliant and make their own decisions. My mom is always optimistic that she will get better eventually because she has overcome so much in the past. I sure don’t want to discourage that, but I also am responsible and must deal with the realities of today. As you’ve written before, it’s our balancing act to be respectful of their independence while we take on more responsibility.
I’ll continue to pray for you and your dad.
I’m going to Galveston with my kids this weekend, so I’ll miss Sunday school again. Hope to be back on the 8th.
Take care,
Bliss
Thanks for your thoughts, Bliss. I have watched and prayed with you on a similar journey with your Mother, so I know you understand what’s going on here. The Medicare allowance of 100 days to get rehabed seems woefully inadequate given the obstacles amputees face.
I can identify with the wound issues going on with your Mother. That’s what would happen with Dad, but we could never get rid of all of the ulcers, and just when you thought they were being conquered, a new one would crop up. It’s a tough situation to deal with.
Thank you so much for continuing to pray for me and Dad. We have major decisions to be making soon. I look forward to seeing you on the 8th!
Blessings,
Lee Ann
Dear Lee Ann, you and your father are in my thoughts and prayers. I am amazed at your strength as you take this journey with your father. It is especially hard when we can’t control others so close to us. It sounds like you have learned much about turning the problems over to God and not taking them back. I hope you both continue to learn and love as this process continues.
Thanks so much, Letty. My father and I are very strong in our faith, so turning problems over to God has not been an issue. Dad’s attitude is amazing. He called today and was emotionally prepared to possibly move to a VA facility, and his words were, “If God is in it, he will provide me a place to stay at the VA.” One of my goals in this blog is to be able to brag on God and how He sees us through all life situations. I also want people to see the power of prayer. He has never failed us and never will!
Blessings,
Lee Ann
Debbie Mielke wrote: “Lee Ann, God will prevail and guide your Dad in the best way possible! I also pray that your Dad be given a change in spirit and mind. He sure has a bumpy road ahead and you can’t blame him of being frightened. Lord, I pray for strength of arms and of mind for your Dad to get through this present task. God bless Lee Ann. You stay in our prayers too. Love, Debbie
You are so sweet, Debbie! Thank you for your wonderful prayer. Love, Lee Ann