"Know what sucks? Taking the afternoon off work to drive one hour each way in torrential rains with flooding streets to attend a family meeting wherein you have to tell your aging family member you will not support them EVER returning home from rehab again."
Today was the tough talk day with Aunt Shirley that we'd prepared for over the past several months. "We" = Me, Uncle Jim (Shirley's brother), my mom (her sister) and my sister Karen (who wasn't present but holds the same sentiments), who provided recent home health services to Shirley to keep her afloat.
Three times this year Shirley landed herself in the ICU at Froedtert. She nearly died, no exaggeration, at least 5 times, and each time she returned home with less ability to physically function. Not only did she lose physical strength and the ability to walk more than a few feet, but she also lost her judgment. Shirley minimized physical health problems as they developed, refused to see doctors, tried to hold individuals to secrecy with any in-home failings (i.e. falling, bloody urine, etc.), and as a result she would decompensate until 911 emergency services were called. She has demonstrated a clear pattern of neglecting her health; posing a danger to herself if living independently.
Her most recent hospitalization began August 10th. Since that time, she has been so ill and close to death that all she could do is lie on her back trying to survive. Now that she is out of the woods, she is left with no muscle mass. This means she cannot stand on her own (if 2 people stand next to her, she can stand in a bent position, holding onto them, for about 6 seconds), cannot get herself into a seated position on her own (two people hoist her up and to the edge of the bed and she can sit for up to 7 minutes on her own), cannot use a commode, walk, etc. This does not bode well for a return to her apartment.
She is currently in a rehab facility for the purpose of using physical therapy to regain her strength, some modicum of functionality and a return to a more independent setting. Insurance has granted her 12 weeks of physical and occupational therapy. She is already doing less than the bare minimum (another pattern of hers we've witnessed in recent years). It is unlikely, even if she becomes a star patient (don't hold your breath), that she will be able to do much for herself by the end of those 12 weeks.
The meeting we had today was to finally share the family's united belief that she cannot return to her apartment - ever. We shared our perspective with her in a meeting with the rehab social worker, nurse and physical therapist present. They reinforced our concerns. At the start of the conversation, Shirley was absolutely convinced she would be functional enough to return home in 12 weeks. We poked doubts into that assertion, asking her to begin thinking about assisted living as the more realistic option. Even assisted living requires a higher level of independence with activities of daily living than she has now, so perhaps, she can use her PT time to get well enough for assisted living.
We stressed it's not just a matter of her being physically capable of managing in her apartment - that it's concerning how often she has negated and neglected her physical health needs until a crisis of a life threatening nature erupts. The toughest part of the conversation was letting her know that should she choose to go home, with or against medical advice, we would not help her or support her in any way. And that is the truth. That is how strongly we feel about her never going home.
So, a crappy conversation to have, but one that couldn't be avoided.
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