From the Hospital to the Rehab Facility

Dad broke his hip on a Thursday, had surgery the next day, and by Sunday afternoon the hospital staff wanted to know where we wanted him to go for rehab. It seemed that there was a whole set of protocols already in place that would send him off to one of the closest places to our house with an available bed. I was told a social worker would check in soon. I wondered how many facilities were around. Were they that different? Did I need to go visit them? 

In thinking about what dad might need in a facility, I thought back to what he was like at our house. He had a hospital bed on which we’d raised the side rails and lowered the bed. This kept him in place at night and minimized his risk of falling. Mom had been sleeping right next to Dad and even though she did not hear well with her hearing aids in and took them out at night, most times she would realize when Dad started moving around. Dad was awake a lot at night. Really, his whole way of living was to be up for short periods of time followed by long naps. This was of course exhausting for Mom, and to a lesser degree me in that I was always half listening for Dad to fall. I’d wake several times every night in a panic thinking I’d heard something. Most times, he hadn’t fallen and I’d just dreamed or imagined he did. It reminded me a bit of when our daughters were babies. Back then, at least part of our consciousness was always listening for a signal of trouble.

The social worker came by dad’s room on Tuesday and gave me a list of nearby facilities and asked me to rank my preferences. She was ready to send out what she called bed requests. We could send out as many as we wanted and then make a choice among those who had availability. The best I could understand was that Medicare would cover dad’s stay at a rehab facility for up to twenty days as long as he was showing progress. There was another time period of something like twenty-one to one hundred days where dad’s supplemental insurance plus Medicare would cover some of the cost. It was terrible that dad had broke his hip and been in so much pain, but there was also a positive side that mom could get a break from caring for dad and that he could be cared for by a team of professionals instead of just mom and whatever additional help I could offer. The list of facilities the social worker gave me had star ratings. At least one of the facilities received less than two stars out of five. The social worker mentioned I could visit these places, no appointment needed. I left the hospital right away and headed for the facility that was closest to our house. 

The first facility was just over eleven miles from our house toward Banner Elk, North Carolina. Our house is about halfway between Boone and Banner Elk. Appearance-wise the facility looked just like what I expected. It was one level and made of brick with an awning to shield people from the weather if they were being dropped off. There was a small bus out front with the facilities name on it. The office was in the middle with a wing going out on each side. The building also would have been believable as a small rural mountain elementary school. 

The woman who worked at the front desk was extremely nice and spoke with a strong Southern accent. I’m a Midwesterner myself, and sometimes we Midwesterners and Southerners have a little trouble understanding each other. The facility was older and the carpet and furnishings were a little rundown. At this point, the bar for the care I expected was pretty low and that low expectation had come from what I’d heard from families about how difficult it was to find good care. A director came to the front desk to show me around. It was really a pretty small place. Maybe there were twelve rooms in each wing, two residents to a room. I suspected that mom would spend several hours if not most of the day with dad and there certainly wasn’t anywhere for a visitor to sit in the room. There was one television and a curtain that could be pulled between the two beds for a little bit of privacy. Even though dad sometimes had animated conversations with friends who had long ago passed away, he also had enough of his mental facilities that he had a strong preference that the news be on television, that he wanted to be at home and not in a facility, and that he didn’t like the food. 

When came to dad’s care, he needed to be able to hit a button to call for someone to help him, especially to use the restroom. To raise his bedrails or to lower the bed past a certain point were both considered restraints and not allowed. I did not think dad would ask for help and even though he had surgery on his hip, I felt pretty sure he would try to get out of bed. The rehab space was small without much equipment, but I think with the right therapist dad probably didn’t need much equipment. There were some bean bags and I was told sometimes the patients would enjoy making a game out of trying to throw beanbags into baskets. This was one of the highly rated facilities. The rooms were pretty small, and they only had one open bed. What I felt best about was that the staff at the facility were going to do their best with the resources they had and cheerfully care to dad’s needs. I liked that the facility was pretty close to home, but I wondered if any of the other ones might at least have a chair next to the bed for visitors. 

When I got home, I decided I’d try to see if there were any other facilities in the area. In order to look, I did what I do when looking for a place to stay on vacation. I used Google Maps, put rehab facilities in the search box, and started moving the map around to find places and click on websites. I would find each facility on the map and then drop that little Google figure onto the map to check out the area. I looked to see what might be on the way or near the facility. For example, I could imagine myself getting done with a basketball practice, grabbing dinner, and going out to visit dad. 

I came across a place called Margate with lots of good reviews and that looked good in pictures. It was thirty-three miles away from our house and approximately a forty-five-minute drive. This was pretty far but I thought maybe worth it in that it looked like all of the rehab patients had their own rooms and that there were nice chairs next to the beds. Because I thought Mom would probably be driving to the facility a fair amount on her own, it was important the drive be pretty simple. Mom was able to drive herself to the grocery store, to the pharmacy to pick up meds, and to her hair appointments. If she had to drive anywhere unfamiliar, she was at risk of getting lost. That had happened one time, but we’d had her location on Life 360 and been able to help her get home. 

I called up the facility on the phone, and even though it was almost five o’clock, the director told me she would stay late to meet me. I thought that was really generous of her. To reach Margate, there were really only three turns once you got to Boone. I felt confident mom could get herself to Boone. Her hairdresser was over on the east side of town on Highway 421 so I thought she could get there no problem. After that, there was an exit off of Highway 421, one more exit to where the facility was, and then a final turn to go up the hill and behind Ashe Memorial Hospital. 

When I reached the Margate facility, I was struck by how much larger and newer it was. It had the feel of a recreation center where you might go to the gym for a workout. There were a lot more people coming and going and that felt good. When I was welcomed into the office, what I remember most is talking to the director about how she’d recently lost her mother who’d had dementia. I asked her about some of the pictures on her desk, and she told me that one of her family members had been deployed and just been shot. He was supposed to recover, and he was on his way back to the United States. I was reminded of all of the challenges that we all have going on at any given time.

After I met with the director, she showed me around the facility. Margate was much like the Watauga Medical Center in that Dad would have a private room at least for the time he was rehabbing from surgery, there was a nice chair for visitors that could be reclined for sleeping, and everything had a clean and new feel to it. The gym up front was used for all sorts of rehabilitation and so there would be more people of all ages and stages of rehab coming and going. That made the place feel livelier than if it was only a small group of elderly patients. Although Margate was much further away from where we lived, I thought it was the right place. I took a short video on my phone of the room that would be Dad’s room and sent it out to Mom, my sister Anne, and my wife Megan. They all agreed this looked like the spot for Dad. It would be a much better place for Mom to spend time visiting dad. In Margate, I was choosing a living space for Dad that accommodated mom staying for the day, gave him more privacy, and was a sunnier and more cheerful place over something closer to our house. 

The day after I visited Margate, Dad was taken there by ambulance. The facility and especially its staff met all of our hopeful expectations in that they were friendly, patient with Dad, and they checked in on him as best they could. I remember one of the nurses saying, what a cute old man. In the weeks that followed, mom drove out to see Dad almost every morning. On the days she didn’t go, I tried to visit. Dad always seemed glad to see me. I’d ask him about his day. One time, he told me two huge tough guys had come into his room and took him away. He said they’d roughed him up, and he didn’t even know what information they wanted from him. At first, I thought Dad had hallucinated. That was certainly a symptom of Parkinson’s, but I realized that he was talking about his physical therapy. He’d mistaken his physical therapy session for a physical interrogation.