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Published August 31, 2013, 10:00 PM

Minding Our Elders: Dad’s stroke may mean nursing home

DEAR CAROL: Dad had a stroke three months ago at the age of 89. Before the stroke Dad lived in a retirement center and I’d take care of his medications and take him out occasionally. He’s now in a very nice nursing home on what we thought would be a temporary basis, for rehab. However, he’s become terribly paranoid about his caregivers, even though this is a highly rated facility and we’ve checked it out carefully. He thinks he has to pay the aides and we can’t convince him otherwise. He’s also very irritable, which is unlike how he was before the stroke. His doctor has him on an antidepressant, but I don’t see any improvement. Does this sound like a case where he will improve and go home, or are we looking at long term care? The doctor just keeps saying “time will tell.” – Rich

By: Carol Bradley Bursack, INFORUM

DEAR CAROL: Dad had a stroke three months ago at the age of 89. Before the stroke Dad lived in a retirement center and I’d take care of his medications and take him out occasionally. He’s now in a very nice nursing home on what we thought would be a temporary basis, for rehab. However, he’s become terribly paranoid about his caregivers, even though this is a highly rated facility and we’ve checked it out carefully. He thinks he has to pay the aides and we can’t convince him otherwise. He’s also very irritable, which is unlike how he was before the stroke. His doctor has him on an antidepressant, but I don’t see any improvement. Does this sound like a case where he will improve and go home, or are we looking at long term care? The doctor just keeps saying “time will tell.” – Rich

DEAR RICH: The trauma of the stroke and subsequent hospitalization may have pushed your dad over the edge into dementia. The stroke could have put him at risk for vascular dementia, but there are many cases of mixed dementia, as well. Paranoia seems to be more of an issue with Alzheimer’s disease so if he doesn’t improve, a neurologist may want to test him for several types of dementia.

The doctor is likely right that time will tell as far as how much your dad will improve. Yet, your dad’s issues seem quite severe and he’s already had three months to improve, so you may be looking at the need for long-term care.

You mentioned that your dad wants to pay the aides for their help. I think men of his generation are so used to tipping for special assistance that this is a fairly common problem. I had the same situation with my dad and eventually found that making him business cards to give people who helped him made him feel better. I hope that you can find some way to humor your dad, as well.

Antidepressants take time to build up in the system in order to be effective, and some people do improve over time. However, it seems to me that your dad has many issues to overcome before he could go back to the independent living of his retirement home. Since you like the facility where he’s now staying, I’d suggest that you discuss with the administrative staff the prospect that he could possibly need to become a permanent resident. Then keep working with the doctor and see what happens.

Carol Bradley Bursack is the author of a support book on caregiving and runs a website supporting caregivers at www.mindingourelders.com. She can be reached at carol@mindingourelders.com.

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