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My mom has fallen twice this summer. In late June she broke her knee and required a knee replacement. We were livid when she insisted to the hospital staff that she be sent home (she and my father live with us) instead of to inpatient recovery as we are already dealing with my father with Parkinson's and still have kids at home and both work full time. Fast forward to late July and she cracked her pelvis and they discharged her home again this time from the ER. They essentially had her waiting at the curb when I got to there. Since she has been home she hasn't been able to leave the bed for pretty much any reason and seems to be getting worse instead of better. I am trying to determine if she insisted on being sent home again but should have been in a facility.

She likely should have been sent to a SNF for a few weeks for rehab, especially if she's bedridden now! How on earth are your parents being cared for at home if you and your husband both work full time??? How is your mother being toileted if your father has Parkinson's?

For the present moment, call mom's PCP for immediate advice about her condition worsening, and see what's suggested for rehab?

For the long term, you really need to consider placing both of your parents in long term care now, together...........they both require a level of care that you're unable to provide for them as at least your mom needs 24/7 caregiving. I don't know what condition your dad is in, but Parkinsons Disease often reaches the point where 24/7 care is also required. In home care is often not feasible for two parents with this level of need, with you working, and also having children who require your attention. It's too much. I had to oversee my parents care in Assisted Living (and then Memory Care) and it was almost a full time job, in and of itself! It went on for 10.5 years, too, and took all of my strength to manage. If I tried to do it in home, it would have literally killed me.

Wishing you the best of luck with all you have on your plate.
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Ebhmom Aug 8, 2022
Thanks so much for reply. The biggest problem is, she isn't being toileted and has resorted to using depends and laying on 'puppy pads' which she then dumps in a garbage can beside her bed. It seems she is working on a spectauclar UTI as she is suddenly no longer able to control her bladder at all and loses bowel function if she tries to stand. Dad is still marginally mobile, but fading fast. Prior to this they could manage during the day as long as we can be there in the evenings but with moms falls she is requiring more help than he is and she tries to get him to help her. We are at a loss for where to go from here. Most facilities where they can stay together cost way more than they can afford even if we help out and we aren't certain how long it will work for them as they don't seem to provide the care dad will require soon. We can't get them to budge on looking for places either. It is a bad situation that is getting worse and I don't really know how to navigate it.
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She can likely be admitted to rehab within 30 days of discharge.

The next time she is hospitalized, you start working with the discharge planner on Day 1. You tell them " no, she cannot return to our home; it would be an unsafe discharge."
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Ebhmom Aug 8, 2022
Thanks for the advice. I have been hanging back because they are discouraging visitors still do to covid, but I think I have learned my lesson there!
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When my husband with Parkinson's broke his hip, the doctor was going to send him home and I simply said there was no way I could handle him at home and he said well would you like him to go to rehab? Duhhhh??? Well yes... due to PD, he could not use crutches and it took a lot to even get him standing to try a walker or into a wheelchair. Many providers tend to think of everyone the same... they should be up moving as soon as possible and forget it takes elderly patients a lot longer. Of course it normally requires a three day hospital stay for Medicare to pay for rehab and the ER would have had to justified admitting her.

Start with your primary care doctor or maybe even the orthopedist, especially if they have a social worker to see if they can help get her admitted. If not, contact Medicare ASAP and appeal that she was discharged too soon. I would hope someone there would look at a knee replacement followed that soon with another fall resulting in a cracked pelvis would warrant an appeal that she had not totally recovered. Rehab is less expensive than hospitalizations for repeated falls. The least I would hope for is some kind of home health since she obviously can't leave your home. I'm thinking time would probably be of essence so work as fast as you can to call everyone you can to try and get her case evaluated. I think some issues need to be addressed within 30 days.

If perhaps your father is a veteran, at least check into benefits such as respite care for your father (I get 14 hours a week) and aid and attendance for your father and spousal aid and attendance for your mother.

My heart goes out to you as your plate is flooding over.
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Not sure if this will help
you but a year or so ago my Mom fell broke her wrist and cracked her pelvis. She went to rehab for about two weeks after hospital. They had her up using a walker. I went into rehab before her discharge and was shown what she could do/couldn’t do etc. by the PT. The PT told me that if my Mom stayed in bed she’d never walk again. She needed to be up and moving every day. I bought Mom home, she did at home therapy and in 12 weeks she was healed. A year later she broke her hip and same story there. Hospital, rehab, home with at home therapy. I cannot imagine her coming straight home after either of these injuries. I would definitely contact her primary doctor and/or her orthopedic doctor. In my opinion she needs therapy. Best of luck to you!
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The problem may be that she needs "custodial care) until the fracture heals and rehab after.

Is there some way for her to private pay for NH care until the fracture heals?

Have you ever consulted an eldercare attorney about Medicaid?

Your parents' needs clearly outstrip the resources available at your home.

You may need to have a tough conversation with them about the fact that you can no longer do this.

Alternatively, some folks take a "therapeutic fib" route-- we're going on vacation, the house needs to be fumigation, it's temporary for a month, for the winter-- and get their parents into care that way.
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Keep on doing what you’re doing, which is taking charge. Someone has to. They are beyond making their own decisions now. Also, it may not be possible for them to be in the same facility. Each one deserves the best care you can find for their situation. If it’s not in the same place, it’s sad but everyone will have to deal with it. Sorry you’re going through this.
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Hindsight is perfect. My wife started out that way now after a year her hip is fine but she can not walk because she will not do the therapy. Where that place is that forces therapy on her I don’t know. I do know if she’s says no they will push her. Perhaps they need mental therapy along with the physical. Also know your life is forever changed until she dies.
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ChoppedLiver Aug 16, 2022
Please talk to her doctor and see what options you have.

For me, we can only get PT at home if we have not gone to an office for PT for the same "illness". Once PT comes to the home, the first thing they will do will evaluate her. Don't expect much from the first session for her. However, from that first session, they should be able to tell you what they they can do and what she is capable of.

P.S. Walking in this case, means walking with a device like a walker or a rollator.

P.P.S. In my case, my Mom refused to do the exercises on her own. Hence, I worked with the PT to figure out what kind of interactive exercises we could do together. Doing exercises together helps you get stronger too.
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This is generic advice - not specific to your Mom but to give you a idea. Just the facts as I see 'em..

Emergency or Acute care is just that. It is not recovery care for the time it takes broken bones to heal.

Treatment for # pelvis is usually conservative management - meaning CAN move & walk as tolerated. Bones will heal in time. (But due to pain/fear/fralility many will stay in bed).
Once healed, physio may be useful. Often done as outpatient in community (or in-home if insured for).

If unable to self-care at home, then stay with informal carers (ie family/friends). If none available, then inpatient formal care instead (may be called respite care or skilled nursing where you live). Then, once bones healed, either inpatient rehab or direct home.

For your situation right now: You weren't to know this would be too much. But if it is, speak to Mom's Doctor & arrange a new plan asap.
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YOUR answer sounds correct. She said she would like to go home without consulting family. SENDher back to the er this time stating there is no one to care for her. Placement is easier from hospital then home.
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Unless you have Authorization to make medical decisions for her, she may be able to make her own and she may have said to send her home.

If she were living alone, they probably could not have discharged her to home care but would have her in a rehab facility for at least 30 days. It's not automatically a matter of whether the patient is elderly but depends upon the home situation he/she is being discharged to. Your mother's situation looked like she had care available, so she was allowed to go home.

You need to establish that you cannot do the level of care she needs and that she needs care and PT and OT and CT therapy in a facility. That may be hard to negotiate.
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