Rehab after broken hip; why is this rehab situation so difficult?

Day 9 of acute rehab and Mom is a rehab "star"! She is standing and walking using a walker and using the tools to dress herself. She gets a shower every other day and is even feeling like applying some makeup and having her hair done. Good signs! The required 3 hours of rehab a day really adds up to be more like 1.5 hours. There is a LOT of wasted time, especially in Group rehab where several patients sit in a circle and do sitting-down exercises. A lot of the time, the therapist wanders off, leaving the group to sit there doing nothing! Mom uses those occasions to lift her legs and arms and continue to move. Nothing starts on time and usually ends a little early. So, I was worried about nothing as far as Mom being able to handle the 3 hours.

Her hemoglobin is still low so it is incredible that she does as much as she does. She only takes Tylenol for pain and never complains about anything. She is my hero! She has about a week more scheduled there with a release date to home of 5/19. I go to all her rehab sessions as I want to learn and observe how I can best help her when she gets home. I also spend every other night there and my brother is there on the other nights. I am really glad she did not go to a SNF.

I am so sorry to hear about what has happened to your Mom. As people get older, their bones become more fragile and the possibility of falling and breaking a leg bone (or breaking a leg bone and then falling) becomes even greater. I agree that hemoglobin of 8 is too low--normal is 10-12 and that it is important to determine the cause of the blood loss. You need to calmly discuss your Mom's care with the case manager and the hospitalist again. I realize that you are upset and angry, however, acting and speaking angrily to the case manager &/or the hospitalist is not in the best interest of your Mom.

"Why is this rehab situation so difficult?" Because it is YOUR MOM who is the person who is having health problems and because it is YOUR MOM who needs to go a SNF for therapy.

I am glad that you visited various SNFs in your community. In regards to the "community shower", most SNFs have one "Bath House" that all residents use and not individual showers in each resident room. There is usually a "Bath Aide" who gives a shower or whirlpool bath to one resident at a time. Each resident usually gets one shower or whirlpool bath per week and is assisted with "sponge baths" in their private bathrooms on the other days.

You mention that "They require 3 hours a day of rehab or 15 hours a week."--who is "they"?--the friends who had been in acute in-patient rehab or the facility? The "3 hours a day" may mean 1 1/2 hours of physical therapy and 1 1/2 hours of occupational therapy per day. The SNF's "1 hour a day of rehab" may mean 1 hour of physical therapy per day or it could mean 1/2 hour of physical therapy and 1/2 hour of occupational therapy per day. You need to clarify exactly how many minutes of physical therapy and how many minutes of occupational therapy per day and per week are being prescribed for your Mom once she will admitted to a SNF.

Unfortunately all SNF facilities need to evaluate each potential resident carefully so the questions that they have been asking about your Mom's hospital file are not unusual. The SNF is just being thorough and is trying to get an accurate "picture" of what type of care your Mom needs. Please do not take their questions personal, the SNF asks these types of questions of every potential person they might admit to their facility.

While I understand that you want your Mom to get back to being independent, dressing and bathing herself and walking with a cane...the possibility of this actually happening decreases as a person's age increases. The reality is that many elderly people who fall do NOT ever return to their previous level of independence. The reality is that for many elderly people, the fall is the start of continual decline in health with them ending up in a LTC facility for the rest of their lives. :(

As for wishing that you had planned for your Mom's fall and for her decline in health and for her need for care in a LTC facility "years ago"...none of us are ever ready when it happens even if we "planned for this...years ago". It still comes as a shock.

I am so sorry that your Mom and your family are having to go through this health crisis. Unfortunately, many elderly people experience similar health problems. Fortunately, this forum is for people who are facing similar health problems, who are wanting to vent about their situation, or who have questions about their situation. I hope that we can help you as you cope with your Mom's health problems.

Mom is still in the hospital on the orthopedic floor where we wait for the decision from the appeal to her insurance company which will come tomorrow. While I think the denial is financially motivated, the insurance company also said she did not need daily physician visits that you get at acute rehab.

Please know that I have the utmost respect for those willing to be in the healthcare field. My exchanges with doctors and nurses caring for my Mom are always respectful and not without forethought. I asked the “hospitalist” in charge of her case (an Internal Medicine doc) why she can not have another unit of blood. The answer was that they did not want to create fluid overload. I still think 8 is too low. She was at 11.7 before coming to the hospital. She is definitely symptomatic with fatigue, paleness, dizziness. They have been giving her an iron tablet each day and multi-vitamin with iron. Stool test was negative. Internist keeps telling me low number is a result of surgery.

The rehab facility is an “acute” rehab hospital (not nursing home) and, after a lot of soul-searching, I am questioning her ability to handle that level of rehab even though the rehab place thinks she can. The 3 hours per day required by the rehab facility are not consecutive and includes both PT and OT.

My comment about not coming home meant not straight home from the hospital. I am hoping that, with the proper rehab, she will be able to return home, with a caregiver (most likely me.) My brother has been great in helping care for Mom. She was at his house when she fell and he got her to the ER.

Doctors won’t hazard a guess as to what caused either fall. But ER doc says he thinks the bone broke causing the fall that put her in the hospital.

Contrary to what I originally thought, I won’ t be devastated if the expedited appeal for acute rehab is denied. Maybe she could rehab at an SNF first and when stronger go to acute rehab. Medicare most likely would not approve that tactic.

Mom has been in rehab both before and after dementia, and it is very difficult to do even 15 minutes of PT let alone 3 hours

Medicare is strict and will stop paying if a patient refuses or can't participate 3x

Recently, with sepsis and on an iv, mom was asleep during her designated therapy time, so the SNF cancelled it without even telling me

Much of your mom's recovery will depend on her ability and willingness to participate but wherever she goes, she will need your support and encouragement and yes your help in planning where she goes next, as discharge from rehab could come quickly once Medicare stops paying

Haldol is used to attempt to calm extreme agitation. Whether she got it or not, seeing it on the chart would make them question why it was ordered. If she is violent or uncooperative for periods each day, she may not be a good candidate for physical therapy. After all, you can't retain your impressive stats if you accept patients who are not likely to return to the community. Delirium in the hospital is certainly not unusual or a reason to assume she won't do well in PT, but you can see why they screen so carefully. They have a reputation to maintain.

Is the insurance company objecting because this place is more expensive? Or out of network? Or what?

When you say "she can't come home" do you mean without successful PT, or are you thinking that she will need a long-term care facility even after she completes therapy?

So to clarify for you, you want mom to go to "acute rehab", which is a different level of therapy than regular rehab. In our case with mom, after a stroke, she was approved for acute rehab initially, but discharged from there after about 10 days to a regular rehab. So you are most likely looking at two different placements in short order.

In retrospect, we should have looked for a place that did less great knee and hip replacement rehab , ie, younger folks, and more stroke rehab that had a long term care possibilty built in.

I'm going to assume that your mom is on an orthopedic floor of the hospital.

Ask for a hematology consult IMMEDIATELY to figure out the blood loss. Jump up and down. Call the patient advocate.

Years ago, mom was on a neuro floor becasue they thought she'd had a stroke--but she hadn't. they discovered that her sodium was out of whack and that's what had casused her symptoms.

It took me a full day to realize that these brilliant neurologists were in over their heads when it came to salt. One came in and said "no water". The next came in with 5 pint bottles of water and said "drink these all". The first guy came back and yelled "who gave you all this water?". It was like a circus.

I found the internal medicine chief resident and asked him to get my mom tranferred off the neuro unit before they killed mom. He was reluctant, so I said "Are you going to let these bozos tell YOU how to manage electrolyes?".

They rolled mom out of there 10 minutes later.

If you can't get hematology, at least get Internal Medicine in to see her. And dont fall for "oh we'll do testing once she gets home". Likely, it's the blood loss that CAUSED both falls, don't you think?

My grandmother had a slowly declining hemoglobin count with no apparent blood loss and required periodic transfusions to maintain a level above 10. She had a femur break and cause a fall too. Doctors finally determine that she wasn't making enough blood cells anymore (femur is a major red blood cell producer and osteoporosis had damaged hers). If your mother's count hasn't started back up, you may want to ask her doctors if she could be having this problem too. As long as the count is coming back up the doctors may not want to give her another transfusion because that interrupts the process where she makes her own blood cells.

Wow, so glad your mom is doing so well. She sure is a fighter! What a great family you are, your brother and you support your mom so much it's so beautiful to see!
PS, happy Mother's Day to you and your wonderful mom.

I asked the rehab facility doc today if they planned to check Mom’s hemoglobin level again and he said to wait until she sees her PCP after she leaves rehab. I think 8 is critically low and it wasn’t too long ago that 8 was the trigger for transfusion. Now it has been changed to 7 to need blood. Crazy! I have no idea how she is managing to do 3 hours of rehab every day. Plus, you can’t sleep for any length of time with vitals being checked throughout the night.