<p>I am sorry but this isnt making any sense. First you say they want to discharge her HOME for a week to come off her meds (which meds??) then do the procedure in an OUTPATIENT CLINIC and then send her on her way again? You are NOT equipped to handle this. This is NOT a reasonable plan, nor is letting the caregiver go prematurely until you KNOW the plan. Is she being D/C’d HOME or to a nursing home? Will the nursing home accept her? And after the pacemaker surgery, will she need more care than the assisted living facility will be able to offer? If they are sending her HOME you NEED the caregiver for now. </p>
<p>DW- Do any of the meds treat her psych issues? If so, talk to her psychiatrist first (her primary/relevant specialist for other meds). This would be a very bad time for a psychiatric issue to escalate (could impact placement options), so in addition to all the compassionate reasons for being thorough about this, there are pragmatic ones as well. Very complicated. If I recall and you mother is close to 90, outpatient surgical procedures would create great caution on my part. Vet that with primary as well. I have been stunned at what surgeons will propose. </p>
<p>Learn what med related info you need asap and then bounce that new info onto this thread, if you need, (the specifics you learn.) You can push off the Barbara decision a few more hours. </p>
<p>I’m going to guess these are cardiac meds. You will find out.<br>
You may have to stop taking certain medications before surgery, especially anticoagulants (medicine to prevent blood clots). Google is good.</p>
<p>Agree you are in no position to care for her, tell them whatever it takes. Everyone. </p>
<p>Posters have flagged our concerns. But this is the sort of situation/decision that needs a custom answer- one based on mom’s specifics. </p>
<p>Ask whether a hosp is possible for the procedure. (I’m betting they want the clinic for scheduling reasons. It may have an opening before the hosp does. Or the doc’s next availability date may be when he is sched at the clinic.) </p>
<p>Ask: what if you delay this til the hospital is available, what risks with that, etc. Ask: what if you/Mom deny the procedure. Does a pacemaker enhance her quality of life, all things considered. What are the meds she would go off and what is the risk of going off them. Learn what you can. And tell them repeatedly, she has no care, needs skilled oversight.</p>
<p>I know what it’s like when the tsunami of questions comes at you, plus your own emotions. The trick is to lay this out in one short bullet list. </p>
<p>So many gifted responses to think about and answer. Firsst because I got the call from the discharge unit so late I have to wait till tomorrow am to find out what they plan to do with my mother - did her cardiac rhythmn become so erratic today that they want her to stay in the hospital? Or do they want her to go to a NH? Since the call came,from the discharge unit, I suspect it means they have changed their mind about sending her home. My question is, can I insist beause of her erratic heart rhythm I insist she be sent to a NH or even stay in the hospital. I mean, this is getting ridiculous - she has been in and out of the hospital for the same thing - atrial fibulation–since June. Why not just keep her there for careful nursing observation, perform the pacemaker,. and allow her to recover int\ the hospital?</p>
<p>CF. thank you for your powerful words. I will fight the MDs against doing this as an outpatient procedure. My mother is 88 and very delicate in her health. CF, I am so sorry to detect the pain and regret in your words about your father. It was modern medicine’s obsession with the almighty dollar which was responsible. You did your bravest and your best and kudos to you.</p>
<p>LasMa, about your question of my mother’s heart. In fact, a very focused MD told me that from looking at the CAT scan or whatever it was, they were able to detect that my mother had had atrial fibulation for some time. It only began to cause her collapse/weakness in June.
The two meds they want her off are the very common heart med Cumidin (sp?) and what I thinks an arthritis med called Arava. I told them by NO MEANS take her off the Depakote. LasMa, I don’t know if the PCP is “okay with that.” With all the calls I have to make tomorrow, by your guidance, I will add that call.</p>
<p>Somemom: “Ok, so, It costs more in home than ALF
You did a HELOC (on HER home I hope) and have not accessed it
I have no comprehension of paying more for home care than ALF and waiting for some magical 10 day perfect time to move
I say move her to ALF this week or next, you have the medical review so pick one and do it.”</p>
<p>Your input is invaluable. I|My husband arranged the whole home equity arrangement, bless him, he knows the details, I don’t. It was to ensure that my mother have income to pay the caregiver should the house sit on the market. something amateurs would do, I know, I admit it. Be patient with me, we have been paying the caregiver (although everything is out of waco as of today and depending on what I hear from outpatient services tomorrow, the caregiver may be gone)) because we know we can pay her through January, and the ALS want over $15,00 up front and $5,000 in thirty days. I was/am following the realtor’s advice to wait, but everything is topsy-turvy now. Sorry this sounds so dense and difficult. Waiting for the "magical ten days"means she will have give or take $230,000 CASH plus her social security. Many months in AL.</p>
<p>jym626: I have to quote you i full because everything you say is right-on.
"I am sorry but this isnt making any sense. First you say they want to discharge her HOME for a week to come off her meds (which meds??) then do the procedure in an OUTPATIENT CLINIC and then send her on her way again? You are NOT equipped to handle this. This is NOT a reasonable plan, nor is letting the caregiver go prematurely until you KNOW the plan. Is she being D/C’d HOME or to a nursing home? Will the nursing home accept her? And after the pacemaker surgery, will she need more care than the assisted living facility will be able to offer? If they are sending her HOME you NEED the caregiver for now.</p>
<p>Yes, if they INSIST on discharging her tomorrow against my protests, the caregiver certainly stays to care for her. Luckily, she has 17 years hospital experience in Poland). </p>
<p>According to advice given here, I am going to politely but firmly object to the pacemaker being inserted as an “outpatient procedure” on a frail; 88 year old woman</p>
<p>No,we do not know if the caregiver is leaving UNLESS the hospital; agrees to a long rehab/wait for thepacekaker and wait for an available AL roopm. Certainly, if they insist on sending her home tomorrow, the caregoer–who is in my mother’s house now–remaiins for the time being.</p>
<p>My 16 year old just came home from a tennis match. She wants to take an art course pn Thurs from 5"30 to 8:30 40 minutes away. She is already overloaded/ I dread approaching her to say No we can’t do all this andChinese school too. I think she will be very mad (she is 16).</p>
<p>I can’t sign off without saying how valuable, informed, intelligent, and “guidance-filled” your posts are. I can’t believe my good fortune at landing here… Wish me luck with my phone calls tomorrow!</p>
<p>Good luck! It’s certainly turned out to be a very complicated situation.</p>
<p>I cannot imagine that they would do a pacemaker outpatient. </p>
<p>Coumadin is a blood thinner so I can see why they want her off it before any procedure. But if she is off Coumadin her risk of stroke will go up in the interim depending on how bad her a fib is. I’m surprised they need her off Coumadin for an entire week. My MIL was only off it for a few days before a minor procedure. </p>
<p>My pacemaker was done as an “outpatient” but I stayed overnight. As long as I didn’t stay a second night, this was considered same-day surgery. Many heart procedures these days are done at a cardiac clinic – which is basically a dedicated surgical ward within a hospital. This was the case when I had the heart attack (and stents) and the pacemaker – done at different hospitals.</p>
<p>If they want to pull an A-fib patient off of Coumadin, they need to 1) test her INR/clotting time regularly over the next week and 2) probably switch her to Lovenox (which is an injectable anticoagulant that is much less volatile than Coumadin). No way would I let her go home the same day. No. No. No.</p>
<p>Not a doctor, just a cardiac patient.</p>
<p>Geez, did you see that the Pasadena property last sold in 1983 for $86K? Nice profit! @-) </p>
<p>CountingDown, I’m sure you would hasten to point out that, unlike Dharma’s mom, you’re in good health and not approaching 90 years old! 
</p>
<p>Dharma, since things seem to be really up in the air, I wouldn’t let Barbara go just yet. Wait until the dust settles a bit. A few more days isn’t going to make a difference. Maybe you can negotiate a reduced rate for the days your mom isn’t at home. </p>
<p>I can’t stress it enough – talk to the hospital case manager early tomorrow morning. Discharge plans may get set in stone by mid to late morning.</p>
<p>In my experience, these are the magic talking points. </p>
<ol>
<li> Mom lives alone.</li>
<li> She is not capable of doing her own post-hospital care.</li>
<li> You cannot take care of her, and there is no other family in the area.</li>
</ol>
<p>All of those things are true. Don’t explain why you can’t take care of her. Don’t mention Barbara.</p>
<p>If the case manager is difficult, ask to talk to the nursing supervisor. Ask the nursing supervisor to chart your 3 talking points. You want them on the record.</p>
<p>If at all possible, don’t have these conversations on the phone. Go down there first thing tomorrow. </p>
<p>Remember the goal. You want her released to skilled nursing. Three nights in the hospital is the key.</p>
<p>^^LasMa, I had mentioned that upthread… 
I don’t wish this cardiac stuff on anyone – it was hard enough to deal with at age 51!</p>
<p>Felt hopeful listening just above to Lasma, then realized my talkative mother has probably told all the MDs,nurses and case manager too that she has a live in caregiver. I will have to urge the point that the risks to her health are to great to have her sent home and a skilled care facility is the much better option. </p>
<p>Thanks Counting Down. Sorry you had to go through so much.</p>
<p>Dharma, the caretaker is a caretaker, certainly not certified to do skilled nursing care. Another talking point: your mother will say anything to get out of the hospital.</p>
<p>Good luck today! Of course you are flustered by your mother. She’s a monster mommy. Not that you are stupid, just that she knows how to manipulate you.</p>
<p>I just realized that even if my mother has told everyone she has a caregiver, I can tell them that because my mother is in the hospital, I sent the caregiver back to Brooklyn.</p>
<p>When you visit your mother, observe how she manages bathroom trips, dressing herself, etc. Is she able to take a walk around the unit with you easily, get herself out of bed independently? Amazing how such critical variables are often stirred into the aftercare decision making only at family’s initiation. Help at home doesn’t mean it is a safe place to navigate for a frail person. Help can’t make her able to ambulate securely if she isn’t. Leave help out of it and focus on her physical limitations and weakness, making sure the hospital stay is certified as an actual admission with a Medicare qualifying 3 night stay so her rehab is covered. </p>
<p>Thank you travel nut for the good advice. The case manager finally called me back. It was a bizarre conversation. She asked me when I was coming to pick up my mother. I replied, Because her heart rate is so erratic, because she is 88, frail, and at risk of a stroke, I would be much more comfortable about her safety if she were sent for a week while she waits for her pace maker to a skilled nursing facility! The case manager replied, yes, that makes very good sense, we will arrange for that–she can go to name of the place she prefers. </p>
<p>Isn’t that crazy?</p>
<p>When it comes time for the pacemaker to be installed I will say I want her to stay in the hospital at least one night for observation. </p>
<p>So Barbara takes the train back to Brooklyn for an unpaid week, very graciously</p>
<p>Glad that your mom will be observed in a skilled care facility. Take this time to talk with the cardiologist about the pros and cons of a pacemaker. My 97 yr. old aunt with a-fib refused a pacemaker over a year ago. She is also on plavix versus coumadin. Her episode of uncontrolled arrythmia occured because of severe dehydration and an electrolyte imbalance. The residents pushed and pushed for a pacemaker. I suggested that they restore the imbalance and told them to change the cardiac medications when my aunt refused the pacemaker. Every patient is different of course, but if they were planning to discharge her for a week it seems that the arrythmia has been stabilized and the pacemaker is a plan to prevent further uncontrolled episodes. What are your and your mother’s expectations about measures to preserve life? I know that this may sound harsh, but it is something that all of us face and some point with our elderly parents. Sending hugs!</p>
<p>So now you have a week to focus on getting the house sale moving along. If you are doing the oil tank/soil test on your nickel, why do you need the buyers approval? Get it scheduled. They cant always get out there pronto quick. Call a few and get quotes.</p>
<p>JYM brings up a great point, whilst your head is reeling and you deal with minute hospital decisions, you have to keep pushing on the house sale. If you can get the house done ASAP you can arrange that she never go home again. NH, then ALF.</p>