Question 

My 80-year-old father fractured his hip and following surgery and a brief hospitalization, his medical team is recommending that he go to nursing home for rehabilitation. Dad is absolutely refusing to go to any kind of facility other than a hospital. 

It is actually a really good idea for dad to go to rehab. He could use some extra time to regain his independence. I do not think he can live alone right now. He can hardly prepare food, bathe himself, or drive. 

I am struggling to understand why he will not even consider a short stay in a nursing home. He is insisting that he go to his home even though it is not realistic. Dad is and has always been a very independent dude, and he has been quite active. 

Do other families have a problem like this, and how do they resolve it? 

Answer 

Your father sounds like he is in a bit of denial about his health condition right now. He may just be unrealistic. He expected to return home and an option other than that is too much to consider. It may take him a bit of time to come to the realization that he requires help to accomplish the activities of daily living. 

It is quite likely that your father is afraid that if he goes for rehabilitation in a nursing home, he will never return home. That is a reality for some individuals that do not rehabilitate successfully, so his fear is not unjustified. While he is not admitting it, at some level he knows that he is not independent. He may be hoping that if he refuses rehab, you will come up with a solution that involves him returning to his home. 

It is not unusual for an individual to struggle with loss of independence. A healthy sense of denial can be a powerful force. If your father can use his determination to propel himself through rehab, he may return to the home he craves. 

What is important now is that you work with your father to regain the skills he had before his injury. Consult with his medical team to identify what specific tasks he will need to accomplish to return to his home. With your father’s involvement, establish a plan. If he has always been active, as you say, his chances of returning home are greater than average. His prior mobility and strength will serve him well while he recovers. 

If he insists on returning home from the hospital against medical advice, please make sure to help him set up the proper support system to care for his needs for several weeks at least. He needs someone with him round-the-clock for the first week at a minimum. I would plan for longer support just in case. The house needs to be set up for easy navigation and with grab bars next to the toilet and in the shower. If he must navigate stairs to a bedroom and is unable, a temporary solution may be needed. Too often patients and families underestimate what caregiving will require and how an elderly person will recover. 

Returning home is what we all desire and expect when we enter a hospital. Success is dependent on our individual stamina, determination, home setup, and support system. Those key elements will determine what he is able to do in this situation. With your assistance and that of the medical team, he can sort out the best solution.