esposla Asked November 2017
Stay at home instead of rehab facility? What can we do to make it work?
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Our mom, 84yo, had a compression fracture. RN at hospital recommended rehab facility, but we opted to get care at their home. What can we do to make it work?
Does a hospital bed make it easier, TV in the bedroom?
I have a feeling the caregiver[brother] may have a hard time communicating with the PT and homehealth aides, [hard of hearing]
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The first time around, it was my who choose that Dad stay at home and she would take care of him. It wasn't easy as both of them were in their late 80's, early 90's. Mom found out she bit off much more than she could chew.
Physical therapy came to the house, but Mom wasn't user friend, she would glare if the PT was a pretty young woman. The Mom found there was no way she could help Dad up the stairs, she was frail herself, so Dad slept in his recliner and Mom slept on the sofa, either of which was good for either of them. Plus Dad didn't practice his exercise when the PT wasn't there. Recovery took a very long time.
The second time around, Dad choose the Rehab facility. Mom agreed. Dad liked physical therapy especially using all the machines. He couldn't wait for his time in the gym. Plus where his room was located and the dining hall, he got a workout walking back and forth. The food was very good, and Dad enjoyed talking to all the new people.
It depends on the person with what they are comfortable with.
Your profile says that your parents or is it your Mom and her brother or son are living at Independent Living.... or did you mean they are still living in their own home? Usually Independent Living facilities have their own physically therapy, plus options that your Mom can order to help your Mom until she is back feeling better. These options come with a fee.
If your Mom is still living at home, like my parents were, I remember they had to bring in a plumber to add grab-bars in the bathroom. A hospital bed would be nice, I think you can rent one instead of buying. Yes, a TV in the bedroom would be great for those days when Mom just can't get around. Depending on where the fracture happened, maybe a really nice rollor walker, but ask PT first.
If you're not comfortable with the rehab facility recommended by the discharge planner at the hospital (and by all means interview there, do a walk through, particularly at dinner time, ask many questions, including staff to patient ratio, whether meals are prepared on site or trucked in, etc.) search, and find your own. There are ones out there that are much better than the ones often recommended by hospitals. That's been my experience for 14 years.
Rehab facilities at least have some machines, which are like "force multipliers" and can leverage the therapy to make it more effective. You won't have those machines and equipment at home. Nor will you have as much therapy time at home; progress will be slower.
Care will be more difficult, so be prepared for that. A hospital bed would definitely be helpful, as would care for (sponge) bathing.
How many people would there be to offer help?
To make home therapy work, again, interview a number of companies before selecting one. Also discuss with the doctor the possibility of returning to a rehab center ( usually requires 3 days of hospitalization for Medicare to cover) and whether or not Medicare would in fact cover if she comes home first, then goes to rehab. This would be a major concern.
Is mom going to do exercise at home after PT leaves? PT is effective in good facilities in part because they have a variety of equipment on site as well as supervisors you can go to if things aren't going well.
I'd check if admission to rehab is allowed after discharge home. I'd also start researching rehab now for "the next time".
I so recall running around Connecticut one afternoon with my brother, visiting 4 rehab before picking one for mom. Do you and your siblings have the ability to do that sort of thing?
I will probably make at least one of my (all out of state) brothers participate in the "which rehab facility?" discussion (and make the ultimate decision), because I do not want to get constant complaints about the facility if I am the one to make the decision.
Also, make sure she has a home care RN visiting at least once per week. A good nurse will give you details on what to watch for. If the nurse isn't helpful, change home health companies.
Make sure she has the equipment that she needs. Gait belt, toilet riser with hand holds, walker, etc. The PT person can recommend.
Watch her diet. Make sure she is getting enough fluids and protein. And enough calories.
I'm glad that in home therapy seems to be working out well. I had a few more thoughts after rereading the posts.
It's a good idea if either you or your siblings can be present at the PT sessions, not necessarily all, but enough to write and diagram the exercises your mother is being given so she can continue them after PT ends. Good therapists will generally provide print outs though.
The best ever therapy I had was through a local hospital system. The therapist gave me a packet of exercises drawings and instructions to follow at home. I'm partial to hospital affiliated therapy facilities as well because they used to offer 2 months of self directed therapy (based on the exercises recommended by the therapists) at a reduced cost. It used to be $25/month, compared to well over $100 for a private therapy facility. But this was back in the mid 2000s.
The PT'ist might use therabands, which look like giant open ended rubber bands. They're colored coded for strength. Typically the lower strength band is used for starting, and changed to higher strength as the patient is able to handle a stronger band.
These are easy exercises to do with family, and can be continued even after the care agency therapist is through and won't be coming again.
Another exercise my father decided to do on his own, and has been supported by therapists, is with an exercycle. It's essentially the pedal configuration of a bike, but can be put on a table (and clamped to it) to strengthen hands, or placed on the floor and used as a bike pedal, for leg strengthening.
Google "arm exercycle". There are 2 series of photos; the second set shows the kind to use at home in the 3rd and 5th photos. My father's was only $14.99 when he bought it several years ago. It's probably twice that now.
It's a good way to get leg exercises while sitting down, especially if someone has limited leg strength, back problems, or weak arms. Playing a favorite CD helps create relaxation while working out.
As to good and bad rehab places, it's not much different (other than purpose) from any profession - there are good an bad doctors, car repair shops, plumbers, ...whatever.
Our first experience was when my mother broke her leg; there were problems, but they were resolved. Still, it wasn't the best. A different facility within the same chain was the best, by far, but it was in an area of teaching hospitals and standards were much higher than in our area.
So it depends on the area, the facility's individual management, whether there's a chef or meals brought in....that's why I developed a checklist and did some pre-placement interviewing.
You're talking spinal compression fracture yes?
My mom had 3 at the same time last October. It took 4 weeks for her to start to feel better. Her PMD told me she was better off resting at home. There was nothing to be done but to wait for her to heal. Home therapy came after. Honestly the biggest challenge was the pain management. The pain was constant. Tramadol was used but it made her confused and hallucinate and constipated. Tylenol was helpful. She never slept more than 3 or 4 hours those first 4 weeks. Not to mention the risk of falling from the tramadol and also Ativan.
The most useful things we bought for her were: the toilet bowl arm supports, so she could get up from the seat. We also installed grab bars in the shower ( had to have a handyman do that) and a bed support grab bar that slid under the bed so she could pull herself up in bed and get in and out of it easier. Most of it was purchased on Amazon. The doctor ordered lidocaine patches, they did help, they were expensive though.
I hope you are managing ok. I wouldn't wish that on anyone!
It was horrible to see someone go through so much pain.