Has anyone had to question a PT for their approach to an 89 year old after hip surgery?
I found out from my parents that my mom’s outpatient PT that she is making my mother walk up and down their driveway that has a pretty steep incline. Of course she is with her and guiding her with her walker, but I feel this is far too aggressive. And since she has dementia, I feel once PT is over, she might take this upon herself to get the mail, which would be disasterous. She also wants my dad to help her with an awkward two step down onto a tile floor to do laundry.....which is where she fell to begin with. My sister and I do the laundry, but has to be done according to our schedule which apparently isn’t good enough. She also expects him to take her outdoors that is grassy and uneven. My dad is 90 and shakes a lot due to the beginnings of Parkinson’s. Mom has severe osteoporosis, PMR, and compression fractures. Needless to say she is a high fall risk. She is also on meds that could compromise her balance. With her dementia I feel she is being encouraged to do physical activities that will lead to another fall.
All things considered they should be in an AL facility, but both refuse....their home is too large and they would never spend the money on the renovations (bathrooms, ramps, etc.). I am going over to speak with the PT, but I am getting resistance from my parents. They both like her, but I’m afraid she is setting up unrealistic goals that will put my mom in jeopardy. Am I overreacting? Or should I speak with her and see how the PT orders were actually written?
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I do sympathise with falls risks, I do know how stressful it is to worry about them, and I would have been with you in fantasising that it were possible to make mother lie flat on the floor and not move.
But we are wrong and the PT is right. If you want to reduce the falls risk, then weight bearing exercise is the way to go through improved muscle tone, stability and even bone density (eventually).
As for making your mother overconfident - if she doesn't remember that she can't walk around safely without help, why would she retain new information from her PT sessions all of a sudden?
Mom can be exceedingly stubborn. She fell because she refused her drs. order to use her walker at all times for stability purposes. If she gets something in her head, she’ll do it with no thought of consequences. I fear PT is opening doors that are just not safe. Why have an 89 woman walk on very uneven terrain if her ADL’s are compromised? And I really question my dad being her caregiver to begin with..... he will now be responsible for keeping her from falling??
But please understand first and foremost that you are hearing this information from your parents. Who, if I may put it kindly, from your other posts, sound as if they might be unreliable reporters.
You might do well to ring up the PT and have a friendly chat about what she thinks about your parents' living situation, what are her goals for therapy and how you and your sister can support her efforts. And like that.
My mother claimed, while she was in rehab, that they were making her manage all her own medications. Had I not been sitting right there, watching the nurse dole out her pills, I might have believed this particular delusion.
Because of mom’s diminished mental state, and dad’s desire to go along with anything mom says ( to keep the peace) I’m not sure if PT is fully aware of the situation.
Yes, call the PT and make sure she's aware of all the doctors' orders.
But try to understand that you have Zero control here. You cannot force your mom to do anything. You cannot fix what's wrong.
Once I looked that square in the face and had a good cry, I got some of my mental health back.
One thing I have learned from this is my limitations, and know I have done my best to keep them safe while living in their home.
It finally took a bad fall that put mom in the hospital and she had to be drug into the hospital under protest, bleeding from a head wound. After a few days I had mom moved directly to assisted living from the hospital. Then moved dad in a few days later.
Unfortunately this is pretty common. You can’t fix this or stop this ship from sinking. You can only do as much as they will allow. You will not convince them to move.
Just be prepared when a crisis hits. Have a facility lined up. If at all possible get control of the finances, POA etc. Tell mom or dad THIS IS JUST TILL YOU GET BETTER.
My folks could’ve had 2 or 3 years of good care and activities in assisted living but I couldn’t force them until there was simply no other choice. Most of us caring for elders end up in that horrible void between competence and lack of reasoning. Mom died about a year ago and dad is in memory care in the same facility getting the best of care.
If you question the PT, then talk to her! The fact that your mom can still walk is a huge plus, so any training on walking and mobility is going to be beneficial.
I think you're giving your mother, who has dementia, too much credit for thinking, planning, remembering-- these are all diminished in dementia.
You can't control what she 'might' do in the future. That's impossible.
If the most important thing is keeping your parents safe, then you have to find a way to get them into AL. Is there such a thing as an intervention for the elderly? If they don't do it now it's going to get more and more difficult. If there home is large, can it be sold and use the $$ for the AL?
My mom was very angry with me when we initially went to AL, as in, how dare I put her here!...and that very quickly turned into Memory Care. I was unable to assess the situation, and she was past the point of AL.
Another possible solution is to see if you can get them into a local day program.
The better her mobility the more comfortable she'll be.
Plus, the last thing you want is her feeling discouraged. As long as the determination is coming from your mother it's probably good for her morale, too.
I should just bullet point the clinical history and make sure the PT does have the info.
Old people fall. All the time. She will fall and it will mean that next time, or the time after, she will Not be able to return home. NOT that you need to move in to provide care.
It doesn't matter how mad she gets. Her anger cannot hurt you. However, caregiving for her CAN kill you. And materially damage your husband's health and care.
I couldn’t possibly do more than I am currently....and I am accepting the realization she WILL fall again. I would just be more comfortable if dad would understand the seriousness of the situation. I’m a planner, like to have my ducks in a row.....and this drives me nuts!
The ramp up to the garage might look to you like mountaineering for your poor mother, but actually it's a really good surface - flat but with a gradient, it's ideal.
This is purely me being nosey, but when was the PMR diagnosed/how long has your mother been on steroids?
Is anyone else at your parents home with them (at least during the day)?
From your description of your folks, I agree with you, they belong in an assisted living facility. Since your dad is of sound mind (I’m assuming) and he refuses to relocate, they had better be as prepared as they can be to handle ALL aspects of moving around in their home. I think this is why the PT is assisting with these “dangerous” exercises. He is showing your mom how to safely traverse the same area where she fell.
Neither of them are going to sit in one spot and not move so it’s better (in a less than perfect situation) that they understand HOW to maneuver inside and outside their home.
I’m sorry for you being between a rock and a hard place. Elders loose the ability to see the situation for what it is and dig their heels in. In my humble opinion, it sounds like it’s time to hire a home care aide.
As for PT....I plan on discussing mom’s other health issues she might not be aware of....and if she is, I will call mom’s Rheumatologist to make sure she is on board with PT’s approach.
First ask if the PT person is the therapist or if it’s a PTA. If it’s a PTA ask to speak with the senior PT and review the treatment plan. If not and the staff person is the actual licensed PT then discuss the plan with her.
I was a home care nurse and having seniors walk up and down their driveways was a common exercise (of course if the gradient is reasonable).
I understand your concerns about after PT leaves but she won’t be unattended during the day, will she?
Unfortunately falls are a common occurance in the elderly.