Managing PT for an 84-year-old. Is this a good idea?
My MIL fell on Christmas Day and broke her leg and shoulder. She had a rod put in the leg and it's been healing well, but we were told the shoulder could only be immobilized and should take longer to heal. Last year she had 2 strokes so both her vision and short-term memory are not great.
She lives about 4 hours away from us so we can only visit on weekends, but her sister-in-law has been wonderful, visiting nearly every weekday. My husband's brother lives nearby and also visits occasionally. She has been doing physical therapy and making progress, moving from hospital to rehab to nursing care, but has lately "plateaued" in her progress. We were hoping to get her into assisted living in another month or two, but now they want to "take a break" from the therapy for a few weeks, so as not to use up all the Medicare allotted days at once. There are days she refuses to get out of bed--she has a hard time with the parallel bars, since her shoulder is not healed.
Is this a good idea? Will she "languish" and stop trying to recover, or is a break a good idea at this point? How long is too long to wait to resume therapy? We are worried about both her physical and mental state at this point. We were hoping she would look forward to moving on to assisted living nearby, but are worried she'll be stuck in nursing care longer if she doesn't put forth enough effort with the PT. Or is a break what she needs, while her shoulder heals?
Any advice on how long this kind of injury takes to recover, keeping her spirits up, and who to ask what questions when we are there this weekend, would be most welcome!
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Unfortunately, insurance doesn’t pay for maintenance PT. They only pay if she’s making significant progress. So try to set something up to keep your mom moving on days that no PT comes, for example a friend visiting and doing easy exercises.it is a slippery slope once they stop moving. It’s like a race against time to keep the muscles from wasting. Good luck to you.
Her SIL got an exercise list from the PT and we are encouraging her grandkids to write to her. We brought her more of her favorite pictures to decorate her wall. Slow but steady progress. Sounds like its good right now to "bank" the days.
She's in a wonderful nursing facility, so we are encouraging her friendly helpful nurse to make sure she at least gets up and into the wheelchair each day. She has been going to the chapel on Sundays. She can now wheel herself around, which is definite progress! Her orthopedist will evaluate her in a few more weeks, and when her shoulder has healed will start back up the PT/OT. For now, we are encouraging her to do what she can--move her arm as much as allowed and do some bike pedals for her feet, to keep her legs moving.
Thanks for all the advice! We will just try to keep up the regular visits and keep her spirits up, and encourage her to be patient. Baby steps.
If she does not continue doing the exercises she may fall behind in her progress.
When my Husband was in rehab I would show up and get him to walk around the halls. (He had broken his hip) and once he walked the halls I would get him into the elevator for a ride downstairs where the regular rehab was. (He was on a locked unit due to wandering in the past) the regular rehab always had a cart with juice and cookies on it. Well cookies and juice could motivate my husband like nothing else. So he would walk to the cart, I would get the cookies and juice then I would have him sit in a chair. the sitting and standing was also a part of his rehab.
On the way back to the room I often would sit on the seat of his walker and he would push me. (more resistance=more strength) several times I would find myself sitting on the walker, the walker not moving only to find he had left me in the hall and walked back into his room!
So even if you are going to take a break with traditional PT do not break from the routine. This will also help get her back into the PT routine when it resumes.
PT is boring to most people who have to do it. That's understandable. After a certain time it's done by rote and many people don't see the point. But if it's discontinued without a doctor's authorization hands will curl into themselves to the point where the fingernails are cutting into the skin of the palm and in order to clip the nails those fingers have to be opened and that is very painful for someone whose hand has curled in. Shoulders become frozen in place where there's no mobility and are painful, feet turn in toward each other which prohibits walking.
Although someone may be doing well in PT, unless directed by a physical therapist to stop, PT should continue as ordered to avoid a worsening of mobility.
In my experience, they generally don't go back and it slows recovery time.
Explain that to her. See if she gets it.
All the best!
Overview only, Medicare paid the first 20 days 100%. 21 to 100 they will only pay 50%. Suppliment may pick up balance but 150 a day was what my Mom paid. Unless Mom is paying for private care, then she is now in the 21 to 100 days. If therapy feels she is as far as they can go with her shoulder, she will be discharged. Medicare will no longer pay. You are not guaranteed that 100 days. To keep her in LTC it will now be private pay.
Anytime someone your MILs age goes thru something like this there is a decline. Hospital stays, rehab and NHs are not pleasant places to be. Elderly don't adjust well. The change to an AL may show some changes. Once she acclimates herself to new surroundings and people, she maybe OK.