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 2^nd, and no fitting for a new artificial leg could happen until his stump stopped swelling. It was June 14^th before he got fitted, and it was June 21^st 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

The post 6.27.12 It’s Time to Transfer appeared first on LAPenick's Blog.