Often when I am getting Dad into bed at night I flash back to a day nearly 50 years ago. Outside that same bedroom window, my brother and I were playing tackle football in the lush green grass on the side lawn. Just my brother and I. He was nearly five years older and had a considerable advantage in this simple game of hiking the ball to ourselves and then trying to rush ahead with it in a “field” only 10 yards wide. He always won, and I hated to lose, so I kept wanting to play, and I guess it was entertaining enough for him to go on with it.

But I guess I was a bit noisy, and Dad, who was working third shift that week was trying to sleep late in the afternoon. The Miami-style window slowly rolled open and Dad called for me to come in. This was the second or third time he had asked me to be quiet, but now he also wanted me to come inside. I obeyed and was horrified when he told me to lay down in bed beside him and not to get up until he was sound asleep. He seemed like a mean alien creature, half-naked, gruff, in no mind to relent. Funny that I recall that event so vividly this many years later. In a way it set an odd emotional tone in my relationship with him. Dad did shift work for nearly 40 years. Mom was around all the time but Dad would appear and disappear, sleep at odd hours, and always seem to be passing through instead of a permanent part of the landscape. Of course, I had no appreciation for the hard life he had, how much he disliked his work, and the sacrifices he always made for his family. I found it hard to be close to him, and given his relationship with his father, he had no example of paternal intimacy to follow.

Now, I sit next to him on his hospital bed at night. I put my arm around his shoulder and pull him close to me. He leans his head on my shoulder and sighs, sometimes relaxing. He tells me he loves me and I tell him I love him and that he is the best. He tells me I am a good boy. I raise the head of the bed up to a sitting position and put one arm behind his back and the other under his legs and lift him into his bed, carefully position him on his side, examine his troublesome toe, put a small pillow between his legs, and draw the bed covers up to his shoulders. I give him a kiss on his cheek and slowly speak, “Get a good rest tonight Dad, and have sweet dreams. I’ll come get you up for breakfast in the morning and we’ll go get something to eat together. I love you Dad. Good night.” Sometimes he also says ‘good night.’

Outside I can hear a small boy playing with his brother.

A little before the events surrounding our efforts to get Dad to take Aricept, I had come home, around the Christmas holidays as I recall.  Mom was having serious problems with Dad wanting to get up in the night and start to wander, even catching him outside about 4am at one point. Needless to say these were very distressing times for her.

One event impressed on my own mind the seriousness of the circumstances that had befallen Dad, even though objectively other events probably should be given greater import. I guess it was just the shock value that hit me.

One morning during this visit, I had awakened early and was reading the newspaper in our family room.  Mom awakened shortly after and came in with a cup of coffee. I could hear Dad running the water in the bathroom and the other usual morning sounds.  I was heading down the hallway toward my bedroom and encountered Dad turning the corner from the master bedroom into the hall.   He was fully dressed but had made one remarkable error–his underwear briefs were on the outside of his long pants! He seemed a little embarrassed; I think he knew that he probably was not dressed properly, but he wasn’t quite sure where the problem was.  I was shocked; this was one of the first instances when his confusion had been expressed in such a clear and obvious manner.  I was also quite sad and at the same time felt a lot of love for him. Even in these most difficult circumstances, he was trying his best to do it on his own.

In addition to Alzheimer’s Dad has long had very arthritic hip which has prevented him from walking for about 3 years now.  We did our best to extend his mobility with physical therapy and exercise, but while his spirit was willing, the act became too painful.

We purchased a sit-to-stand lift (made by Apex, model “Stella”) for transfers and toileting at that point and it has served us very well, though it was rather expensive at about $2200. We found a particular sling (another $250) that enables us to change his Depends while he is on the lift, fully supported by padded straps under his arms and legs, and back support. That has been a godsend, enabling me and Mom to take care of Dad at home without the extra expense of attendants coming 4 times a day–a routine we accepted for a couple of years.  We bought the lift online at a great discount to anything available locally. We took a bit of a chance by purchasing it before we actually tried it out, but it was not difficult to assemble, and has been a good helper. If you need a lift, I recommend having a look at models offered by local dealers and if you can get a good price, buy from them. If not, the savings by purchasing from the Web can be quite substantial.

But now, Dad is becoming too frail to be safely comfortable using the sit-to-stand, and so I am seeking a hoyer-style lift. I’ve started to focus on the Invacare Reliant 450 lift. I first spotted it on the web and a local DME store happened to have a hydraulic model in stock, and for rent, so I had that delivered a couple of weeks ago as a month-to-month rental. The lift seems fine.

Getting the right sling has been harder. I ordered one from Personal Health Choice (http://www.phc-online.com), an online reseller with a reasonable return policy. That particular sling (Divided Leg sling) had great support, but came down so low on his back that we could not access the waistband of his pants to pull them down for toileting . . . but transfers were very comfortable for him. I called PHC and they accepted the sling back (with a 15% restocking fee), and will send another–the Dress Toileting High sling, which seems to allow for better access.  PHC also has decent prices for the lifts, and we’ll probably buy a powered version of the Reliant 450 (around $2000) from them if I can find a sling that meets all our needs. Then we’ll sell the old sit-to-stand lift, which is still in great shape.  I’ll let you know how it goes.

UPDATE 5/20/10

We’ve decided to not buy a new lift for now. I’ve made some adjustments in the transfer process that has made it a little easier on Dad. Finding a good lift is not difficult–Invacare or, a little cheaper and built for home use, Apex Genesis–seem like they would work well. Finding the right sling for Dad, on the other hand, has proven to be a challenge. I’ve tried 4 different Invacare slings none have both been a good fit and allowed us to toilet Dad while suspended by the sling. Right now the Apex sit-to-stand life (Stella) and the Apex toileting sling is still better than other options.  The key now is finding the right sling for our unique needs.