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My mom, who is 87 and has balance issues, fell 9 days ago and broke her left hip and left wrist. She was in the hospital for 5 days after surgery then sent to a rehab facility for PT. She was there for 4 terrible days before they deemed her unrehabable (is that a word?) because of her broken wrist.


I brought her home yesterday where she has lived with my husband and me for the last 11 years. She started talking to me about her will and dying. It really scared me and I told her this doesn't have to be her end. That WE will take care of her and she WILL recover.


Since that conversation she has really started trying to help us help her and her progress in just 1 day has been amazing!


Do nursing/rehab facilities encourage their patients to think about dying???

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I think being in a rehab facility that gives up on a person so easily could well make anyone wish she were dead, poor love.

Of course I don't know, and you have to make allowances for how early on in her recovery this happened, but it does sound as though the facility perhaps just found her too much like hard work.

Coming home has clearly lifted her spirits, and that's a great start; but now what will you do about PT?
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Sounds like she’s scared. I would try and reassure her that you are there for her.
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Your mom is 87 and has had a scare, it would be unusual for her not to contemplate her mortality. Now that things have stabilized a bit I think you should take the opportunity to have that conversation with her in a calm and reasoned way, getting this chit all out in the open is a gift for both of you. This link may help you

https://theconversationproject.org/
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My mother is 90 and probably thinks about dying every day. But that doesn't mean she wants to die. Just facing a reality. I wouldn't worry unless it becomes obsessive.
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Have the doctor order in home PT and home health care. She was most likely discharged because she wasnt making progress. Difficult to manage a walker with a concurrent broken wrist, but a good PT will be able to tailor exercises to her current state.

I'm assuming that at her age, she HAS a will, right? Is she rethinking how she wants to leave her money? That doesnt mean she's worried about dying; it can mean she realizes that she needs to make a plan for an event that WILL happen in the next 15 years.
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It's possible your mother overheard someone in rehab venting about how could someone expect standard hip replacement rehab for someone with a broken wrist and misunderstood, maybe thought she would be immobile for the rest of her life.

Her rehab will be different and longer because she is going to be limited until her wrist heals enough for weight bearing on a walker, crutch or cane. Last year one of my cousins took a bad fall and broke her wrist and ankle on the same side. The in-home PT focused on maintaining muscle and flexibility while generating enough movement to reduce blood clot risks for over 4 months until the doctor cleared the wrist for walker use. The good news is hip replacement rehab is one of the simpler rehabs (compared to shoulder, knee or ankle), so once she can begin using a walker, your mother will probably get independent mobility back in a few weeks.
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No.

At her age, a major fracture like a hip often changes the person's way of thinking about life and the quality of life. I would caution you against making promises over which you have no control. Rehab for a hip fracture takes much more than one day. It is a slog. Be prepared that her change of attitude may not last and she may become depressed.
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A broken hip in the elderly is very serious. The whole experience was probably depressing. Surgery is also serious in a 87 yr old. She could still be under the effects of the anaesthesia.

I would talk to her PCP. See if he will write an order for home therapy. They will come in an evaluate Mom. Maybe the wrist will need to heal before they can do anything maybe not.

Me personally thinks rehabs are depressing. You only have rehab for a couple hours a day. The rest ur just sitting around. Your Mom probably in a wheelchair, not the most comfortable place. Its just not home where you have your things and its familiar. And activities, they seemed to be aimed at Dementia patients.
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NO! Unrehabable is not a word but, it just means she can't progress until her wrist is stable and stronger before ambulation therapy can start. The shock of falling, breaking her hip and wrist, and the realization of her inability to care for herself became reality. To look around in the PT room and see others failing at her age has scared her. NO ONE is immune to death at any age! Study up on range of motion and therapies you and she can do at home to keep muscle tone and work out the soreness. Facilities encourage residents to NOT think about dying and live their life to the fullest possible. 20 years of geriatric nursing was the hardest and most rewarding time in my life. Getting affairs in order is something everyone should do then you don't have to revisit the idea again. Keep her as active as possible and move those joints. Her hip may be so much better and be an unexpected improvement. More often than not, a hip breaks and then they fall. Good luck and get going on passive/active range of motion.
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No one should "encourage" someone to think about dying. But no one should DIScourage them from thinking about dying. When someone is in rehab they often share with caregivers things that their families are afraid to discuss; and they LOVE being able to do so. As a nurse I was often the recipient of their innermost thought on death.
Please allow your mother the dignity of her wishes and her feelings. Allow her to speak honestly to those she loves; try to listen. There is so much to learn from her now.
Of course it is lovely to encourage her. But do so honestly. For instance:
"Mom, I know that it seems impossible now with both an arm and a leg out of commission, but they WILL heal. I am sure it seems hopeless and depressing right now, but we can get through this together. You are talking now a lot more about dying, and it worries me a little. Can you tell me why? Is it because of your recent medical problems, or do you just want to talk about your wishes and feelings".
Admit to her it is hard for you to speak of her leaving because you love her so much, and don't want to lose her, admit your fears. But assure her you will try.
If you personally are unable to discuss end of life, which is a real issue for ME and for many other elders (and I am well and walking more than a mile daily), then please ask your Mom if she would like to see a counselor who will let her discuss her very normal human feelings. Perhaps a social worker who deals with life change issues.
The end of life has so much loss and sometimes it feels like ALL loss to the elder, with no upside. If she cannot discuss this with you honestly who can she discuss it with? Talking about death doesn't kill us. But we do eventually die.
I find it so sad that our culture overall is in such denial about death and dying. And for those who need to speak of it honestly it can be just another loss, being unable to discuss innermost feelings with those you love most.
It is so clear that you love your Mother very much. I am so sorry for your pain.
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NYDaughterInLaw Oct 2019
Absolutely right, Alva! I agree with everything you wrote.
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When your mother gets to the point in healing where she doesn't require a cast anymore you might consider some warm water therapy. With a floater vest, her hip wouldn't need to support any weight at all, but she could still start exercising through a good range of motion and maybe putting some weight on it during the light weight portion of rehabbing the hip. Due to knee damage from a fall last year, my mother needs a walker at all times (on dry land), but she can walk freely in the pool. Mom doesn't need the floater vest at this point, but I like her to wear one just in case she stumbles her head wouldn't be going under water. I hired a PT from the local rehab hospital to meet us at the local community therapy pool for 6 sessions to teach me how to safely get Mom into/out of the pool (using the lift) and what exercises would be beneficial.
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I think at 87, death is probably often on her mind and and fall that required hospitalization probably has her really thinking about her own mortality.
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