Nursing Care for Elderly Stroke Patients in Knoxville, TN

Question
Hi Ms. Ware:

My husband is dealing with his mother in an acute situation right now in Knoxville, TN. She will be 90 this month and has had her 4th stroke one week ago today. She is paralyzed on her right side and is having swallowing problems.

The issue is that although she's being treated acutely right now, it's obvious that she will not be able to return to her home and take care of herself. There is no one living with her who can care for her. The obvious solution is a nursing care facility.

However, her 3 grown sons are afraid to broach the subject -- certain she will refuse to go. They may be right. She's a stubborn and manipulative old bird. But she literally cannot stand on her own or feed herself, bathe herself or dress herself. She also is having trouble communicating--Her paralysis is on her right side and has also apparently affected her word power. She seems to comprehend what is said to her most of the time, but she tends to fall asleep in the middle of conversations.

As far as committing to a nursing care facility, is she considered 'competent.' Can she actually refuse to go. And if she can and does refuse, can her physician override that or will her sons be stuck with trying to figure out and pay for 24 hour home care because she won't be reasonable about her inability to care for herself.  By the way, it's perfectly possible she will refuse the home care as well.

What do you think can be done?  The sons believe that she will throw a fit and possibly hurt herself worse if they try to convince her (bully her) into doing the only reasonable thing -- going to a nursing care facility.

Thanks for your time.

Answer
Hi Rickey and thanks for writing,

Generally if a patient can not care for themselves the Doctors and Social Workers will do the 'dirty work' so to speak with difficult or reluctant patients and just tell them straight out that they will not be discharged from hospital until "Suitbale arrangements" are in place. The patient and family can then decide between a care home and home care; the Social Workers are an excellent resource to help you get started. If the patient tries to refuse, the doctors usually tell them they can not leave the hospital without choosing a home, and if they do not chose one, they will just be transfered to a rehab unit/home whether they like it or not. Sounds mean, but it happenes a lot.

Hope this helps, all the best,

Margot