My 87-year-old mother had a fall a month ago, fractured her pelvis, had surgery and after 2 weeks in a hospital, has been in a rehab facility for two weeks. Her doctor told us that he doesn't want her to put weight on her leg for 3 months. We are trying to determine if he thinks she can put any weight on the leg to start lower mobility PT. As far as I can tell, Medicare will pay for 30 days of surgery-related rehab. I found on the Medicare site that they will pay for up to 60 days of rehab in a semi-private room. (She was in a private room for 2 weeks).
My mother does not want to do rehab, and wants to die. She tunes-out anyone telling her she needs to do rehab to go home. She just wants to go home, but at this point she needs two people to help her.
We can't afford 24/7 in-home care, which makes AL an alternative. I would appreciate your advice.
If the surgeon does not want mom to put weight on her legs for 3 months, how is she supposed to benefit from physical therapy in rehab? Furthermore, if she's making "no progress" with PT and OT in rehab, that can be reported daily to Medicare, the facility will want to release her because Medicare will stop paying.
You have multiple issues going on at the same time, mom being depressed and uncooperative, a doctor not REALLY wanting her to rehab, and the threat of being asked to leave rehab or stay in long term care permanently. She's in no condition to go home w/o the appropriate caregivers there to look after her 24/7.
Perhaps PT and OT are working with mom to gain upper body strength so she can wheel herself around in a wheelchair? That's what they focused on w my mom when she could no longer walk after a hospitalization.
It's time to have honest discussions with Mom, with Social Workers, with PT, with Palliative and/or Hospice consults, with the MD.
I am so sorry. It's difficult to tell with what you wrote whether this is a temporary situation with up pain causing up depression and anxiety, or whether this is the cherry on the Sundae. It's time for honest discussions with all involved. Don't negate what your Mom has to say, please.
I agree that it is time to have honest discussions with Mom, SW, etc.
I think that is the right question: what does she want now?
Unfortunately my father seems to be in denial; it's unlikely she will be able to go home, which will start a cascade of decisions including where she will go (AL?) and selling their house. TBH, I've seen this coming for about 10 years but my father has not been willing to acknowledge her limited mobility. The Sh*t hit the fan when she broke her pelvis. I think she is way beyond PT. I told her for years to please walk, walk around the block, etc. but she was afraid of falling. My dad, love him to pieces, enables her, but this has stretched him and we can tell he is spiraling....
Did she have anesthesia during her surgery that may have affected her cognitive abilities?
Was she catheterized during her hospital stay?
Lots of peripheral issues can happen to a senior when hospitalized.
If your Mom isn't motivated or cooperative, she won't do the PT. If she becomes permanently bedridden, she will be a candidate for LTC, not AL. This may be a "blessing" in disguise since most states' Medicaid programs will pay for LTC and not AL or MC.
Is she getting good care where she's at now. Is she eating and drinking enough on her own? My 100-yr old Aunt with mod/adv dementia fell and broke her hip. In the rehab facility her family needed to help her eat, drink and perform hygiene since it wasn't a NH.
I would make sure your Mom doesn't have any other issues (even depression) before having the "Do the PT" peptalk with her. If she is not cognitively impaired or depressed she needs to know that in-home care for a bed-bound person isn't going to be able to happen.
Once she can cope, she will better accept the rehab.
Everyone is different so you will wait and see how she does. If her doctors can’t pinpoint a prediction, this forum of anonymous strangers certainly can’t.
Give her love and support. Stop worrying about money and just make the most of time together.
good luck!
AL facilities can not use equipment so she would be a 2 person transfer.
If she is refusing rehab, if she is not progressing Medicare will not pay for rehab.
You need to reinforce the fact that you can not care for her at home.
Tell the discharge planner or Social Worker that you can not safely care for her at home and that you probably need to look for Skilled Nursing.
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