FiL just had stroke - what to expect

[ErnesttheBavarian]

We live in Germany, FIL in Kent. We just spent Easter Saturday with him, and he stayed the night. On Sunday he was off to a birthday party- On Monday we got a call from sil, saying he'd gone to his neighbours early afternoon as he'd lost his keys and he was confused and droopy mouth so they called for an ambulance.

COnfirmed stroke. Suspected it happened in the night, but he didn't go to the hospital till the following afternoon. I know speed in treating strokes is important to limit damage, so this concerns me. Sil visited him yesterday and said he was very confused, unable to speak clearly or in comprehensible sentences, or just coming out with weird random stuff, but seems to be no physical damage (was walking to loo).

Expected to be in hospital a week.

Feel frustrated as we're now back in Germany and so far away. Have to idea about strokes. Can anyone shed any light on likely outcomes (it seems to be how long is a piece of string...) my main Q#s are is it likely to lead to more strokes, him need care, have to leave his home (he lives alone, mil dies 4 yrs ago) or could it well be that he recovers from this and is fine for another 20 years....

Something similar happened to my mil about 2 years ago. She did have another smaller stroke some weeks later so was in hospital twice (for about a week each time I recall). She was quite confused, unsettled and very dependent on others to help her dress, move etc (I think much to her embarrassment she had a couple of incontinence episodes ).

She did recover slowly but it precipitated her moving out of her house into a flat (this had been discussed before but it took a bit of persuading afterwards and she moved - now is loads happier where she is) and gave up driving.

She is "functioning" pretty much as she was (but had other health issues) but her short term memory is very patchy ESP when tired/unwell. They are watching/testing her as this may be dementia rather than stroke .

As you say hard to tell you what to expect but the recuperation was fairly lengthy with my mil (6-12 months).

Also think I remember you dimly from a 2008 baby thread (had diff name then ) but may be wrong

Very difficult to say what will happen next I think. My nan had a stroke was very confused although physically not too bad. Memory particularly. She did have a further 2 strokes and was not really able to return to living alone she moved to warden accommodation as she couldn't remember to have 3 meals a day though she could cook fine if she remembered to. The dr told me that generally either the patient keeps having strokes indefinitely or they have them until their body stabilises then a recovery is possible. A lot depends in the location, timing etc of the stroke as its easier apparently to stop a stroke than to reverse its damage. I was told the first 2-4 weeks were very important in assessing what will happen next. I hope any of this helps and that he makes a quick recovery

I did have a baby in 2008, so may be Gigondas :) good memory.

My concern is we are so far away in Germany. The only way I could help would be that I could come over and stay for a week or 2, and I think I could make arrangements for my school aged children here after school, but would have to bring dd (nearly 4) with me, and I think she would be upset and scared by grandad being all confused.

Sil lives in Wimbeldon, so I think a good hour each way away and she has 2 young dc, 2 & nearly 5, so also v difficult for her. e.g. hospital visiting times start at 3 - great, so she can't go during day when dc in school/nursery)

I am concerned about him living alone, but he lives in a small village, and has been there for over 30 years and v close to his neighbours (woman next door still cooks his dinner and pops it over the fence 3 times a week since he was widowed 4 yrs ago!) but they are all 70 ish, so not really in a position to do real caring. He is really involved in the village, chairman of bowling club etc, it would be terrible for him to have to leave and go somewhere where he doesn't know anybody :(

Shite.

I'm sorry this has happened - I know it's difficult when you're far away.

Unfortunately it is a bit like 'how long is a piece of string'. Some patients recover very well and go back to (almost) full functioning, others less so and major readjustments need to be made. Is your FIL on a stroke ward? If not I would push for him to be moved to one, its been shown to improve outcome. He will be investigated to see if he had a precipitating cause (blocked arteries in the neck etc) and by now he'll probably have had a CT head scan to check the type of stroke. He'll most likely go home on some new medications to try to prevent further strokes and if he does have a blocked artery he may need surgery (this is unlikely, most people don't actually need this but a small minority do).

If his language/speech is impaired, he'll be seen by the speech and language therapists who'll check that his swallow is safe and work on communication strategies with him. He'll also be seen by occupational therapists who'll ensure that his home environment is safe for him and alternatives/support put in place if not.

I know this is a stressful time but only time will tell how he's going to get on. I'd speak to the ward sister just to see where they're at and plans. If not particularly helpful, ask to speak to the ward doctor or arrange an appt to speak to the consultant. Explain the distance and I'm sure they'll try and give you as much info as they can (they will have to ask your FIL if it's okay).

I hope he gets better soon

Find out as much as you can about the care he´s entitled to-tell them that he cannot go home alone & that there is no one to help him.

A week doesn´t sound long, but if it´s only speech therapy that is needed I guess it could be.

I think there should initially be six weeks of three visits a day-free-when he first goes home.

You can find out who him social worker is & look into it.

Also, look into attendance allowance

If he´s not entitled, it still might be worth looking at putting something in place for your own peace of mind.

If anyone you know would want to look after him, they could possibly claim carer´s allowance, for example.

ok, updates - sil was told they are thinking of sending him home in a couple of days! She says he's very confused and can't complete sentences. They haven't noticed, cos they walk past and call out, how are you feeling, are you ok and he answer fine, and they chalk it up as he understands and responds fine!

Anyway, more worrying is he's now pulling off the monitors and wires (his heart rate has been going dangerously wild, he had a minor heart attack last year and seemed to be heading that way again). Anyway, he's demanding to go home, but he's so confused and don't think he understands what's happened, but they've called sil and said she needs to come and persuade him to stay. But he is insisting on going home :(

Thanks for tips and Q, but good to know what sil needs to ask and do and how we find out what care he's entitled to, esp if, madly, he is insisting on going home.

He needs a capacity assessment - it's a fairly short task that assesses whether someone has capacity to make a specified decision, in this case whether to go home or not. It checks whether someone can understand the information given to them, retain that information and weigh up the pros and cons. His capacity may come and go but if he has capacity and gives a decision, that decision has to be stuck to regardless of whether he loses that capacity later on (without a change in condition so in cases of fluctuating confusion). When I have done these it can surprise us that someone doesn't have capacity because, as you say, we normally see people for limited periods of time and have limited conversation. I have also been on the other end when a chap did have capacity to decide to go home, even though I didn't think it was in his best interests and his family were furious. However, just because we don't think its a great plan doesn't give us the right to overide someone's autonomy.

He is entitled to care, which should be based on OT assessments - if they manage to do all this in a couple of days I'll be amazed as sorting out our patients normally takes weeks! For longer periods of care an assessment will be made as to whether he will be self-funding or government paid. This normally means working out assets etc and your SIL should be contacted with regards to this by a SW.

Personally I would be asking to speak to someone at this stage (sister in charge or doctor) to explain my concerns about sending him home. Unfortunately there is sometimes (and not as often as the Daily Mail would have you believe) a drive to get people home and it just takes a concerned relative to refocus minds - it shouldn't need this but it does happen. I would certainly be wanting someone to tell me that they have specifically checked his capacity and what his MMSE (mini-mental state exam) score was. If it is low I'd be wanting them to explain to me how they intended to a) let someone who didn't have capacity to make a decision decline further management and b) what exactly their plan for community assistance would be.

sil there now. he's seems to have gone AWOL, though maybe he has just disappeared off to loo. Nevertheless, sounds like he is insisting on going home. Can anyone do anything, or does he really just get to go home, even though none of these things done and he's clearly not in the right frame physically or mentally.

Ernest he really needs a capacity assessment. If he lacks capacity and by the sounds of it he does and its not in his best interest to go home, then he doesn't go home.

thanks for support. His heart is now racing uncontrollably, and they've had to stop and then restart it twice with a defibrillator so it's not looking too good and he's been moved out of stroke and into cardiac ward, so he's not going anywhere.

Am starting to wonder where this is going.

Thinking of you-it must be a difficult time.

It really can be hard being away.

Hi, back again, quick update, fil been moved to stroke rehabilitation wing of local hospital.

In some ways he seems fine. In other ways not so - even today he#s still planning on going on his holiday to Greece he has booked for 2 weeks time and

In the tests to see how well he can look after himself he was asked to get out his toothbrush, and he pulled out a razor, he didn't recognise a toothbrush, and didn't understand to put toothpaste on it, couldn't make a cup of tea etc etc.

Anyway, I wondered if anyone knows about getting power of attorney. D h got stroppy with me when I brought it up, but if he can't talk on phone & stuff it seems pretty sensible & necessary. Anyone have any infos about this?