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My 87-year-old mother had a fall a month ago, fractured her pelvis, had surgery and after 2 weeks in a hospital, has been in a rehab facility for two weeks. Her doctor told us that he doesn't want her to put weight on her leg for 3 months. We are trying to determine if he thinks she can put any weight on the leg to start lower mobility PT. As far as I can tell, Medicare will pay for 30 days of surgery-related rehab. I found on the Medicare site that they will pay for up to 60 days of rehab in a semi-private room. (She was in a private room for 2 weeks).


My mother does not want to do rehab, and wants to die. She tunes-out anyone telling her she needs to do rehab to go home. She just wants to go home, but at this point she needs two people to help her.


We can't afford 24/7 in-home care, which makes AL an alternative. I would appreciate your advice.

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The vast majority of ALs will not accept residents who are 2 person assists. She'd likely need Skilled Nursing for long term care at this point.

If the surgeon does not want mom to put weight on her legs for 3 months, how is she supposed to benefit from physical therapy in rehab? Furthermore, if she's making "no progress" with PT and OT in rehab, that can be reported daily to Medicare, the facility will want to release her because Medicare will stop paying.

You have multiple issues going on at the same time, mom being depressed and uncooperative, a doctor not REALLY wanting her to rehab, and the threat of being asked to leave rehab or stay in long term care permanently. She's in no condition to go home w/o the appropriate caregivers there to look after her 24/7.

Perhaps PT and OT are working with mom to gain upper body strength so she can wheel herself around in a wheelchair? That's what they focused on w my mom when she could no longer walk after a hospitalization.
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Logan1964 Sep 2023
Thank you. Agree, multiple issues. She missed her appt. with the surgeon since she told rehab #1 she wanted to kill herself, which meant she had to be sent to an hospital for a psych eval and missed her appt. She passed the psych eval, just wants to go home. As of today she is in a new rehab place. I agree with other comments that she is probably past meaningful rehab, which means AL or LTC. I agree, what does she want? It might not be what my father wants. He can't manage her, and 24/7 in home care is exhorbitant.
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Is your Mom in any pain? If so, is she receiving a correct dosage to address it?

Did she have anesthesia during her surgery that may have affected her cognitive abilities?

Was she catheterized during her hospital stay?

Lots of peripheral issues can happen to a senior when hospitalized.

If your Mom isn't motivated or cooperative, she won't do the PT. If she becomes permanently bedridden, she will be a candidate for LTC, not AL. This may be a "blessing" in disguise since most states' Medicaid programs will pay for LTC and not AL or MC.

Is she getting good care where she's at now. Is she eating and drinking enough on her own? My 100-yr old Aunt with mod/adv dementia fell and broke her hip. In the rehab facility her family needed to help her eat, drink and perform hygiene since it wasn't a NH.

I would make sure your Mom doesn't have any other issues (even depression) before having the "Do the PT" peptalk with her. If she is not cognitively impaired or depressed she needs to know that in-home care for a bed-bound person isn't going to be able to happen.
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Logan1964 Sep 2023
Thank you for your response. I am not sure how much pain she is in now, or what medications she is taking for it. Interesting about the distinction about LTC. She is not cognitively impaired, just depressed and the most stubborn person in the world. I agree, I think we are beyond the do the PT peptalk, although my brothers want to do that (I'm in Chicago, they are in NH and Vermont, parents outside of Boston). Perhaps this is TMI, but she threatened to kill herself to get out of rehab #1, had a psych eval (not a danger) and is now in rehab #2. In addition to Mom, I'm worried about Dad who has heart and pulmonary issues, dealing with this. You know, the greatest generation (born in 1936) have trouble talking about this.
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Yes, ALF and Hospice. As an RN I can tell you that many patients are ready to go but will be unable to discuss this with their families, thus are consigned to strangers, their nurses, to tell their truths. If this is NOT about only this pelvis issue, but is in general, then your Mom will not be able to even participate to the level (WITH PAIN) she needs to for rehab. It's time for honest discussion. Other than this recent break in the pelvis, is Mom read now to go? If so, you may be looking at placement and Hospice or at least palliative which will give adequate pain control. A broken pelvis is VERY painful, and there is virtually nothing you can move on your body without the pelivs registering the pain.

It's time to have honest discussions with Mom, with Social Workers, with PT, with Palliative and/or Hospice consults, with the MD.

I am so sorry. It's difficult to tell with what you wrote whether this is a temporary situation with up pain causing up depression and anxiety, or whether this is the cherry on the Sundae. It's time for honest discussions with all involved. Don't negate what your Mom has to say, please.
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Logan1964 Sep 2023
Thank you for your thoughtful response.. I think my mother is ready to go now, which is probably why she is not interested in PT. I think this is the cherry on the Sundae, she has been pretty depressed for a few years now, and doesn't take pleasure in most activities. She rarely leaves the house (she doesn't drive) and just reads the paper, books and watches TV.
I agree that it is time to have honest discussions with Mom, SW, etc.
I think that is the right question: what does she want now?
Unfortunately my father seems to be in denial; it's unlikely she will be able to go home, which will start a cascade of decisions including where she will go (AL?) and selling their house. TBH, I've seen this coming for about 10 years but my father has not been willing to acknowledge her limited mobility. The Sh*t hit the fan when she broke her pelvis. I think she is way beyond PT. I told her for years to please walk, walk around the block, etc. but she was afraid of falling. My dad, love him to pieces, enables her, but this has stretched him and we can tell he is spiraling....
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In regard to the cascade of decisions regarding LTC and selling their home, please fold into your very busy schedule a visit with a certified elder attorney well versed in Medicaid. This to discuss the proper way to pay for moms care without jeopardizing dads ability to pay for his own care in the future.
My DH aunt will be 97 next month. She is completely bed bound for several years now and in skilled nursing. It is sometimes amazing how long a person will live beyond the time they say they are ready to go.
Please do see if mom is on an antidepressant or not. If she is on one make sure she is at a therapeutic level for her. Also, her pain must be managed in order for her to successfully do her rehab. Even if the rehab only makes it possible for her to go from bed to wheelchair it will improve her quality of life.
It’s the rare person who can just decide to die although there are posters who have had that experience with their loved ones.
Sometimes elders have a stigma against taking drugs but if there was a time for it, surely now would be the time.
Be sure to take a minute for yourself. You have a lot to manage.
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First talk to her doctor about help with depression. “Wanting to die” is spot on. This may be a reasonable response to a significant lifestyle change, but she needs help.

Once she can cope, she will better accept the rehab.

Everyone is different so you will wait and see how she does. If her doctors can’t pinpoint a prediction, this forum of anonymous strangers certainly can’t.

Give her love and support. Stop worrying about money and just make the most of time together.
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If the doctor said no weight-bearing for 3 months (at least), then she will probably not do well with a walker since she won't be able to put the foot down on the side with the broken hip. A wheelchair may be a better option for getting around. With a wheelchair, either somebody will need to push her or she must have the strength to push herself around. Also, she will probably need somebody to help her into and out of the wheelchair since those transfers are hard to do using only 1 foot.
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Beatty Sep 2023
Ability for one leg transfer at 30 - excellent, at 60 - ok, 87 with significant pain & low motivation.. ?
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As to your question, is it physically possible, that can really only be answered by PT but your mom will need to participate. I suggest you get a Geriatric Psychiatrist involved, if she is that depressed they may be able to help. The decision is really up to your mom as to weather or not she prefers to walk again or live in a wheelchair and realistically if she really wants to go home she will need to be walking again or at least self sufficient in a wheelchair, this injury isn’t going to kill her but it will make her suffer more by making her world even smaller if she chooses not to participate in PT. If she can understand that she can make her own decision even if it isn’t the one you want her to make. AL probably won’t be an option if they don’t have enough money for in home care so she will have to go to a NH and you should make sure she’s aware of that.

good luck!
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I'll soon be 87. I would probably not have undergone surgery except to the extent needed to alleviate pain. Although I cannot say for sure unless/until the situation arises, I would likely not elect to participate in painful PT at this point in my life. I think I would request palliative (or hospice) care. Although I would prefer to remain in my home with hired assistance--which we could manage financially IF it didn't go on for too long--that might be neither practicable nor workable if I needed 2-person help 24/7.
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I think with her not walking and needing assistance she probably would be placed in Skilled Nursing facility rather than AL
AL facilities can not use equipment so she would be a 2 person transfer.
If she is refusing rehab, if she is not progressing Medicare will not pay for rehab.
You need to reinforce the fact that you can not care for her at home.
Tell the discharge planner or Social Worker that you can not safely care for her at home and that you probably need to look for Skilled Nursing.
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Logan1964: Quite likely your mother is well past the point of AL and may require an SNF. She may not do well with PT as it also takes a positive attitude as well as the physical requirement. She cannot be cared for in the home setting; that needs to be made clear. I understand that she may not be able to help her mindset.
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Hospice. If she is ready to die she’ll probably agree to it easily enough since it means she can go home. If she doesn’t want to get better … zero chance she will. What will you do about dad once she’s gone? I would start looking for a place for him to move. Maybe he’ll be happier with some social interaction. My dad is.
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Speak with the discharge planning person assigned to her. Tell the discharge planner your questions , concerns, limitations, requests for inpatient continuing PT and, your understanding of Medicare payments etc etc. Do not let them send her home if you know you cannot provide care. If you get her into the extended PT, and,cage does not succeed , you can then explore hospice or other options ( the discharge planner should be able to communicate with physician and facility about patient's level of care needs and PT abilities) .

Or you can be sure that she is assessed by appropriate physician (s) for her cognitive appropriateness and deemed capable of making her own decisions; if she is , then honor her decision not to have more PT and, get care options from discharge planner for going forward. This may include having her assessed for admit to hospice care; she may or may not qualify for hospice care yet. Only a hospice evaluation can determine admit appropriatness.

Also be sure that she is receiving emotional care services such as from a psychologist or possibly starting with a licensed social worker to address potential grief and or depression that may be influencing her decisions or statements.

Practice self care !
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