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Mom age 87, fell and has been in the hospital for a week. We had a call from a rehab center that offers high-intensity rehab. She had been referred there by her GP just a few days before her fall, so we put in a request to send her there. This is her 5th fall in 18 weeks. Second hospitalization. Nothing broken. She cannot stand unassisted and must hold onto a person or walker to take a few steps. Very wobbly. Hearing loss and mild dementia. Lives alone. ADL's not good. Her physical therapists in the hospital are recommending low-intensity rehab skilled nursing care instead. We are told that the high-intensity rehab facility most likely will be denied by insurance but that we can appeal. But based on the PT report from the hospital, I'm feeling like we were wrong to request the high-intensity rehab and perhaps should go with the low-intensity skilled nursing care. Very confused about next steps - any advice?

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Can she handle the "high intensity" rehab?
With the "mild dementia" will she be able to participate in rehab AND will she or you be able to continue the therapy once she returns to her home? (does she live alone? What is her activity level like?)
Did she have any PT or OT after the first, second, and subsequent falls?
I think with the 5th fall in 4 - 5 months she may continue on this downward spiral.
What else is going on? It seems odd if it was a "simple" fall that she would be in the hospital for a week.
Have they done any PT or OT while she has been in the hospital? How has she done? And if she has had PT have you observed how she does?
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Acute rehab is generally pt/ot twice a day 6 days a week.

Can mom handle morning and afternoon sessions?

Can mom remember to do those exercises independently?

Is mom motivated to improve?
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Isabel21 Jan 2023
I'm not sure she can handle morning and afternoon sessions. She is very weak. Nevertheless, I've heard that PT can work miracles. So maybe I should not underestimate her. Motivation -- she is motivated to go home and so will try to improve when she is in the facility. But once home, I don't see much-continued commitment to doing her exercises.
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Lives alone? Well, going home certainly not an option. The falls are likely due to balance issues. My brother did well in rehab with balance exercises for certain, and while it was not "high intensity" it did help him; problem was he didn't continue to balance exercises once released. There would likely be some strength building exercises for your Mom, getting her up, deciding what equipment will work. I doubt a skilled nursing facility would help Mom at ALL.
It sounds to me like it would be the usual 21 days in rehab, hope for some improvement in balance and strength and some training in actually getting movement going, deciding what assistive devices.
Throw yourself on the mercy of the discharge planning team and social workers at the rehab right away, and it is looking like ALF next step if your Mom can get on her feet a bit. I doubt she will be able to return home from either facility unless things change drastically in that time.
I wish you the best of luck. Work with the team there, attend some training sessions in PT and OT if you are able.
Our balance gets just dreadful with age. I saw my bro go through it and I see it in my 80 year old self. While I weigh more than I ever did at 150, on a bus I feel like a feather in the wind flying about if I am not holding on, which is purely a matter of balance. Have had two falls in the last couple of years and while they were do to my carelessness with garden implements and walking backward while cutting my brugmansia, etc. they were ALSO primarily a matter of being unable to "catch" myself--the balance. I am greatly helped by balance exercise, when I remember to do them!!!!! (hee hee).
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Isabel21 Jan 2023
She does live alone and sits most of the day watching TV. After the last hospitalization (5 months ago), she was scheduled to go to SNF but discharged herself and went home instead. We then had PT visit her and they said she was doing well, but she didn't practice exercises when they were not there. Her balance is terrible. Before the accident, she walked around the house, by holding onto things like chairs and tables.
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She does live alone and is very sedentary. She did have PT before at home and would do exercises when they were there, but not on her own. They diagnosed her with AFIB too. She has had PT in the hospital. The first few days there, they could not get her to stand up unassisted. Now she takes a few steps down the hall with a walker. Still very wobbly.
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Isabel, you've also posted about your mom grunting and pointing, and washing and re-washing clothes that don't need washing.

If mom is currently in the hospital, have you considered asking for an assessment of her current cognitive status while she's there?
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Isabel21 Jan 2023
Barb - yes, we did ask her GP to do this. He asked her to count backwards, and who the president was etc. She passed, flying colors. Sometimes she seems as clear as a bell and sometimes not. Ask her a question about Putin and Ukraine and you will get an impressive answer, but she keeps asking who this boy is my daughter is dating and what is his name? Again and again. It's very confusing.
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Isabel, the counting backwards and who is the President doesn't rule out dementia.

She needs a SLUMS (St. Louis University Mental Status) or MoCa (Montreal Cognitive Assessment).

Ask the hospital for a consultation with a geriatric psychiatrist.
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