Tips of caring for parent after coronary bypass surgery?

[Just Kate]

My dad is 79 years old and had emergency bypass surgery last Monday. He has been progressing well in the hospital and is set to be discharged on Wednesday. My dad lives with my mom in a one-story ranch home. My dad has always been fairly active, but my mom has some medical issues (her balance is very off - she seems so feeble). 

My brother and I have been splitting our time at the hospital.  Now that we know the discharge date, I’m starting to think of what we need to do and how we should prepare. 

Fortunately I work from home, so I should be able to work from my parents’ house some. My brother is a business owner, so while he is busy, he is also in charge of his own schedule. 

Thoughts on how we should be preparing? Anything we should make sure to have at their house? Any tips or tricks?

 

[Harriet Vane]

I don't have specific experience with bypass surgery but will strongly urge two common sense things based on my experience with caregiving dementia patients and someone after brain surgery.

Get in-home caregivers lined up for at least some of the time. You will need the respite and the help. 

INSIST on physical therapy.

These are not wait-and-see. They should both be in place immediately. It will take some doing, so best start talking to the hospital social worker and your insurance company right away.

[hellen]

Discharge instructions might vary by hospital, but this is the major points of what I tell my patients after this surgery.

The two most common issues that bring people back in to our hospital are an abnormally fast heart rhythm or difficulty breathing.  Atrial fibrillation (AFib) is a not uncommon side effect of the surgery.  Fast AFib (like 140sish) won't kill you but it could make you dizzy.  Go to the hospital.  Difficulty breathing is a result of fluid buildup after surgery.  Go to the hospital.  It's an easy fix.  

Your dad will need to weigh himself daily to look for any signs of rapid weight gain that would indicate fluid buildup.  His incisions will need to be kept clean.  Infections are not common, but they are very very difficult to resolve.

Patients seem to fall into one of two categories - those who underdo it and those that overdo it.  If your dad falls into the undergoing it category and does not want to get up throughout the day, encourage him to move around a bit throughout the day.  If your dad is the opposite, remind him to take it easy.  Depending on his fitness level prior to the surgery and the number of recovery days post-op, a walker for a few days could be helpful.  Maybe 25% of patients will benefit.

Your dad most likely had the sternotomy approach which means they made a long incision down the center of the chest.  He will not be allowed to lift, push, or pull more than 5 pounds for many weeks.  Yes, it is difficult for most 79 year olds to get out of bed without their arms and I bet the number of patients who can practically follow those directions is tiny, so give him grace.

This is unrelated to his surgery, but a general aging tip.  Elderly people can lose the flexibility to clean themselves well after a bowel movement.  Bidets should be more common for the elderly.  The second thing is to help both parents with foot care.  

 

[Just Kate]

30 minutes ago, Harriet Vane said:

I don't have specific experience with bypass surgery but will strongly urge two common sense things based on my experience with caregiving dementia patients and someone after brain surgery.

Get in-home caregivers lined up for at least some of the time. You will need the respite and the help. 

INSIST on physical therapy.

These are not wait-and-see. They should both be in place immediately. It will take some doing, so best start talking to the hospital social worker and your insurance company right away.

Good ideas! I will contact the social worker today to talk about home health. It is tiring to care for someone on this situation. I have been running back and forth between the hospital (30+ minutes away) and my parents’ house (15 minutes away in the opposite direction), while trying to work and take care of my house and my own family (youngest is 16…thank goodness). I sit at the hospital, but it just wears me out. How is sitting so tiring??

[Just Kate]

@hellen Awesome information…thank you so much!! 
 

Dealing with bathroom stuff is my biggest worry right now. I assume my dad will use a taller potty chair at first?

Regarding a bidet, I will talk with them about it. Funny side note, I have a bidet at my house. Back in 2020 my dh severed both of his bicep tendons 😳. We had like two days to plan for surgery and the first thing I did was to have a bidet installed. Saved my marriage!

[prairiewindmomma]

Bidet, stool softeners as most people become constipated from pain pills, shower bench with a detachable head if he tires easily….

Fwiw, for me, I always pack an instant pot to make meal prep easier (relatives usually eat out for almost every meal and dont have much in the way of pots/pans/devices anymore), noise canceling headphones (the tv is on SO loud), and sometimes a battery operated portable fan….  
 

Your dad should be offered cardiac rehab, and he should go. For my dad, that meant I needed to buy workout clothes and tennis shoes for him because as a retired rancher, he only owned jeans and workboots.

[hellen]

Your dad won't necessarily need a taller potty chair.  So much is dependent on his fitness level prior to surgery. At our hospital, we don't send patients home if they don't have help for the first few days.  They go to rehab instead.  Of the patients we send home, which is the vast majority, I can't think of one off the top of my head that needed assistance standing after using the bathroom by the time they were discharged.  Getting out of bed is actually the hardest thing.  

Bring a button down shirt for him to come in because he should not put his arms above his head and that is more easily done with a button down shirt.

Our surgeons always start patients on stations if they are not already taking them.  Any new meds are started for a reason and not taking them does bring people back in for a redo of their surgery eventually. The number of people who say THIS time I'll follow instructions is higher than it ought to be.  

In our area, we have outpatient cardiac rehab which everyone gets a referral to upon discharge.  

[Halftime Hope]

@hellen Can you specify how long it takes most of your patients that age to start cardiac rehab? My dh was extremely fit and much younger, and I don't think he started cardiac rehab for a month. He/we had some extreme complications with calves healing and other gruesome adventures, but even without those I doubt he'd have started earlier.

I think the OP's loved one may need both outpatient PT for a time, and then cardiac rehab, unless the health care providers can do both at home. The 12 week program dh was in would definitely take into account an individual's fitness level, but maybe an 80 year old would not be signed up for 12 weeks? (Dh wanted to push the envelope while supervised; if there was to be a catastrophic failure, he wanted it to happen where he could get care.)

 

 

[Carol in Cal.]

He might be far better off in rehab for a while.  The hospital will only discharge him home if they are told that there is someone there to take care of him, around the clock, and your mother is not up to that job.  But they won’t check on that, they just check off that there is someone home with him all the time.  So consider saying, My mother can’t possibly take care of him 24/7, and there is no one available to move in with them.  Then they should discharge to rehab, at least if he has been admitted and had at least a 3 night stay.  Rehab is temporary, but very helpful during early recovery, if you find a good placement.  Usually the hospital can give you a list of rehab places, and you can visit and then select the one you like the best.  Pay attention to noise levels there, and to how rushed people seem.  If he does go to rehab, encourage him to accept every single offer of PT and OT, because he has to show progress and cooperation for this to continue.  Also, visit often and unpredictably, and then he will better care plus you can help with stupid stuff like they deliver a meal but he can’t cut up the meat or they set the water cup down out of reach or whatever.

Also, STAY WITH HIM ALL DAY THE DAY OF DISCHARGE AND WRITE DOWN WHO SAYS WHAT TO YOU ABOUT HIS RESTRICTIONS.  I can’t possibly stress that enough.  Sometimes the different experts give conflicting instructions, and it is important to have an advocate available to make them be resolved before exiting.  I have seen this happen several times in my extended family.  Also, that gives you the chance to ask sensible questions like, the house is up a flight of stairs but you said no going on stairs.  What should we do about this?  Or, you said no raising arms above shoulder level, but then how can he put on a tshirt?  Or, Does no arms over shoulder level also mean no hands over shoulder level?  If so, is he allowed to brush his teeth?  Are  there dietary restrictions, and if so, for how long?  

Those kinds of answers often drive a much better set of helps after discharge, like more PT/OT, etc. whether he goes into rehab for them or has them at home.

 

[AbcdeDooDah]

My husband just had bypass surgery in February and has been at home for a few weeks now. Some things that helped here were:

Shower caddy- we used to just use the edge of the tub for supplies but I didn’t want him bending over

Scale- He still weighs himself twice a day to monitor fluid retention

Power recliner or adjustable bed. He still cannot sleep lying flat so we bought a power recliner to sleep in. Since it was new, it was not very comfortable so we ended up buying an adjustable bed. 

Heart pillow-for coughing and chest support. He will likely get one from the hospital. His surgeon/nurses, etc can sign it. We bought an extra one for the car so that one didn't get ruined. It is made with vinyl. We got it at cardiacbear.com.

 

[hellen]

@Halftime Hope I don't know how long it typically takes patients to start cardiac rehab afterwards.  Patients are most likely to be readmitted within a few days of their surgery which is too soon to have started rehab.  I never find out how most people fare once the leave.  

 

[Just Kate]

Thanks everyone for the awesome tips!! To answer a few questions…

We did consider him going to rehab rather than home, but his surgeon suggested that home would be better (since my dad does have a support system). Sadly, the rehab facilities in my area are just nursing homes and the care is not good. I have heard of several stories of folks going to rehab after a hospital stay and not progressing. Although my mom has some physical issues, my brother and I live locally and will be available. We have both been at the hospital every day since all of this happened and do a decent job of communicating with one another. My brother has adult kids, who can help. My teens may be able to help a bit too. 

My dad has a recliner he loves, so we will plan for him spending much time there at the beginning. 

We are installing a bidet and a grab bar in my dad’s bathroom. He was able to use the hospital bathroom yesterday and said the grab bar made a huge difference!

I will make sure my parents have a scale. Sounds like daily weighing is important. 

Other items we are looking into - home health for now (if it’s available) and then cardiac rehab. I mentioned cardiac rehab to his RN yesterday and she said that we should discuss this with his surgeon during his first follow up appointment. 

Thank you all so much!! If you think of anything else, please let me know. 

[TechWife]

I think waiting until the follow up appointment to discuss  cardiac rehab is too long. There are often wait lists for the program and it is a good idea to call to get on the wait list immediately after surgery. They will ask for the surgery date and he will be in line for an opening after it is safe for him to start the program.

Recliner - dh slept in the recliner for a couple of weeks. Due to both movement restrictions and pain, he wasn’t able to push back on the arms enough to get the recliner to open. He used an ottoman instead.

Movement restrictions are in place to help his sternum heal. It’s a broken bone, and they take time to heal. This is a good explainer video:

 

[Just Kate]

40 minutes ago, TechWife said:

I think waiting until the follow up appointment to discuss  cardiac rehab is too long. There are often wait lists for the program and it is a good idea to call to get on the wait list immediately after surgery. They will ask for the surgery date and he will be in line for an opening after it is safe for him to start the program.

Recliner - dh slept in the recliner for a couple of weeks. Due to both movement restrictions and pain, he wasn’t able to push back on the arms enough to get the recliner to open. He used an ottoman instead.

Movement restrictions are in place to help his sternum heal. It’s a broken bone, and they take time to heal. This is a good explainer video:

 

Good point about cardiac rehab! My brother is at hospital with dad now, so I’ll have him mention it to surgeon when he comes in. 

Thankfully my dad’s beloved recliner is powered, so he won’t need any strength at all to push it back. 

[Harriet Vane]

I agree on not waiting. The bureaucracy grinds along slowly. It’s always better to try to get in front of it.

[Beth S]

Agreeing with PPs.

We've BTDT with our elderly parents (post-op for various surgeries).  Rehab is wonderful for those first difficult days/weeks.

You don't want to fall yourself while helping him with transfers.
You can visit and get familiar with what is required . . . but it's a LOT to undertake right after surgery.

[Just Kate]

4 hours ago, Beth S said:

Agreeing with PPs.

We've BTDT with our elderly parents (post-op for various surgeries).  Rehab is wonderful for those first difficult days/weeks.

You don't want to fall yourself while helping him with transfers.
You can visit and get familiar with what is required . . . but it's a LOT to undertake right after surgery.

Rehab isn’t really an option for us. We live in a more rural area and the rehab options aren’t good. Even my dad’s surgeon told us that while rehab is an option, he feels that my dad will do better just going home. 

[TechWife]

1 hour ago, Just Kate said:

Rehab isn’t really an option for us. We live in a more rural area and the rehab options aren’t good. Even my dad’s surgeon told us that while rehab is an option, he feels that my dad will do better just going home. 

Cardiac rehab is an outpatient program here. There are inpatient rehab centers here for people who aren't able to go home for various reasons. If he's able to go home & his surgeon says it's fine for him to do so, that's a good thing! Older people tend to do better the earlier they can get home. The risk of hospital delirium increases with age and length of hospital stay. Of course, any inpatient scenario also has risk of contracting an illness from another patient.

I hope he is able to access some home PT and OT if outpatient cardiac rehab isn't an option.

 

[Just Kate]

36 minutes ago, TechWife said:

Cardiac rehab is an outpatient program here. There are inpatient rehab centers here for people who aren't able to go home for various reasons. If he's able to go home & his surgeon says it's fine for him to do so, that's a good thing! Older people tend to do better the earlier they can get home. The risk of hospital delirium increases with age and length of hospital stay. Of course, any inpatient scenario also has risk of contracting an illness from another patient.

I hope he is able to access some home PT and OT if outpatient cardiac rehab isn't an option.

 

Cardiac rehab is definitely  an option, which I will  ask about before we leave the hospital tomorrow. His surgeon has already mentioned it to us, as have a few of the nurses. 

[Halftime Hope]

8 minutes ago, Just Kate said:

Cardiac rehab is definitely  an option, which I will  ask about before we leave the hospital tomorrow. His surgeon has already mentioned it to us, as have a few of the nurses. 

So what I was trying to say is that cardiac rehab may be awhile down the line for him. He may need PT coming to the house to get him ready for cardiac rehab.

Also, a word to the wise: keep a very, very close watch on his voiding output, including both urine and bowel mvmts. It's easy to miss that someone isn't voiding correctly and end up with a catastrophe.

[Just Kate]

3 minutes ago, Halftime Hope said:

So what I was trying to say is that cardiac rehab may be awhile down the line for him. He may need PT coming to the house to get him ready for cardiac rehab.

Also, a word to the wise: keep a very, very close watch on his voiding output, including both urine and bowel mvmts. It's easy to miss that someone isn't voiding correctly and end up with a catastrophe.

Got it…I completely understand what you are saying now. I will see what options we have available to us tomorrow. The more help, the better! If we can do anything in-home, I will definitely request that. 

And thanks for the tip on output. Good thing to keep in mind!!