There's a lot going on right now, and I am trying not to freak out (as we say here in California - I have to remember that expressions like "freaking out" and "bitchin!' are not part of the normal patois in other parts of the country!).

I got a call this afternoon from Kaiser, and they told me that they have set a discharge date of Friday 6/20 for Larry. They apparently did an evaluation yesterday (which nobody even told me was happening). The physical therapists, speech therapist, and a physical medicine doctor all met with Larry and assessed his current status and his progress, and they determined that he has "plateaued", at least for the time being. Their collective opinion is that he's not a good candidate for acute rehab right now, so they are planning to send him home on the 20th. I was fairly shocked, because when I talked to the acute rehab person last week she was hopeful that he would be able to go back to acute in a few weeks.

I called Terry, the person from acute, to find out what happened; she's been pretty much on the same page with me and has been a good advocate for Larry. She told me that by the time she got there yesterday the assessment had already been done, and she's not able to override the doctor. I feel like they held a kangaroo court (just had to go take 5 minutes to look up the etymology on that - what an odd phrase!), and that they didn't tell me or Terry ahead of time on purpose, because they knew we'd make a fuss.

I went to visit Larry tonight determined to fight this and to demand that he be given more time before they just cut him loose like this. I write insurance appeals every day as part of my work, and I'm fairly sure that I could buy him at least a few more weeks in the nursing facility, if not a transfer to acute. When I got there, I explained the situation to Larry and let him know that they are planning to send him home in a week and do not want him to go back to Memorial for more acute care - I've been telling him all along that the plan is to get him back to acute and then come home, so he knows all about that, and I wanted to let him know what's going on just in case. I wasn't prepared for the look of joy on his face when I told him they were discharging him in a week without going to acute, and I really wasn't prepared when he started to cry. I asked him if he wanted to just come home and not go to acute, and he was very emphatic that that's exactly what he wants. As much as I want him to have all the therapy he can get, maybe he has had enough for now and needs to come home. I forget sometimes that it really is not about me, or about what I want, and how depressing the nursing home is. It's bad enough going there twice a day to visit, but if I had to be there 24/7 I think I would lose my mind, not to mention becoming depressed beyond belief. I also forget sometimes that it's his life...not mine...and even if getting more structured therapy is what's best for him in the long run, maybe it should be up to him to decide whether or not that's what he wants to do.

So, I am asking for opinions. Should I fight this and try to get him more time in rehab? Or should I bring him home on the 20th? If there is a dramatic improvement once he comes home we can always ask that he be sent back to acute, although I think it's probably harder to make that happen once he's home. My feeling is that once he gets home and into a better environment he may improve on his own to a degree, even though he won't get as much therapy (they will send OT and PT to the house, probably a couple of times a week, but not ST). Based on what I've read, the major gains after a stroke take place in the first 2 months, and after that it's rare for big changes to occur, but some spontaneous recovery also happens as the brain makes new connections. I would appreciate it if anyone here (who I'm sure will be thinking more clearly than I am at this point) would let me know their thoughts before I make this decision - at least I have the weekend to think it over, so that's good. I've also let Larry's kids (in their 30's, so grown ups) know, and his siblings, and asked what they think.

In the meantime I am going to call the caregiver agency that I settled on and start interviewing to find someone to care for Larry at home while I'm working. I also met today with the contractors for the bathroom remodel and finalized those plans - the remodel starts on 6/23, the Monday after Larry is scheduled to come home. Great timing! Nothing I can do about it; they are booked until then. I'm also going to have to get the wheelchair ramp taken care of this week, and about 50 other things - my "to do" lists are pretty intimidating at this point, despite all that I got done in May when I took off from work.

Welll, enough for one night. It's been emotionally exhausting, and I'm going to try to sleep. I'll bet THAT will be fun!

xxxoo

-Janine