Non-compliance and physical therapy....a rant is coming....

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In addition to all of the other doctor appointments my mother always seems to have, her orthopedic surgeon has just added outpatient physical therapy 3x/week to the mix. The center is 20 minutes away from our house, & each session is to last an hour....due to the location, it's not enough time to drop her off & go run errands as nothing is around it.

The thing is, the physical therapy has been ordered because she hasn't been progressing well after her hip replacement. She refuses to follow the hip precautions & as a result she's already dislocated the new hip once. She was in a SNF for 3 months after the surgery, where she received daily physical therapy and if they didn't "make her" do something, she wouldn't do it. They finally said there's no more they could do with her because she wasn't improving, so she left the SNF the way she went in - wheelchair bound. Physical therapists that have come to the house work with her for a few minutes, tell her to do ___ number of exercises on her own, then they leave (waste of time, in other words, as she won't do the exercises...she's always got an excuse as to why she can't do them) She continues to bend past 90* to pick something up/put on her socks/etc., and then turns around & complains that her hip/leg hurts. I'll ask "do you think there's anything you're doing that's making it worse???" (KNOWING that it is what she's doing that is causing the pain) The answer is always no, or "i just bent over really quickly to pick up that _____" - Seriously? It doesn't matter how "quickly" you do it, YOU'RE NOT SUPPOSED TO DO IT! I just can NOT get that through her head!! I tell her everyday to call me when she's ready to get dressed - I'll help her with her pants & socks so she doesn't have to bend over...nope...she rolls on out of her bedroom fully dressed to the shoes.

Sooooo because my mother complained to the ortho about how she's "so upset" that she can't get around on her own yet, and is tired of the wheelchair, I am now going to be driving her 3 times a week to more physical therapy that is going to have the same result as all the others...she won't put in the effort, she'll make excuses for why she didn't do her at-home exercises, and we'll be back to square one again having wasted all of that time and gas for nothing. I expressed this frustration to her ortho and he said "well, all we can do is suggest she do them...we can't force her to do it." I wanted to bang my head against his office wall.

So I guess the 2 days a week I had "reserved" for myself are now being encroached upon (because some of the drs. are only open certain days of the week, etc.) and I find myself having to re-arrange my own appointments to accommodate her new PT schedule, which I am NOT happy about. Ugh.


Rant away! I know you need to vent, and don't expect us to have a solution. Let me just run idea by you: My husband's insurance covered transportation to his medical appointments. The only one I used it for was the dentist, because I wanted to be present at dr. appointments, but it was very nice not to have to go to all of his dentist appointments. Do a little research to see what might be available in your community. Even if insurance doesn't cover it, it may be well worth it to have someone wheel Mom into the van, wheel her out at the therapy clinic, and reverse the process in an hour.
Funny you mention that, because my husband just asked me the same thing. He said now that she's on Medi-Cal, they should cover that stuff...I'm not sure if they do or not, but it is worth checking into for sure. If nothing else, it will be a good back-up plan to have in place. Thanks. :)
That's infuriating, purplesushi. A lot of elders go through PT and OT without following through -- both of mine did several times. How many weeks is she signed up for? If you do end up taking her, maybe you can read the riot act to her. If she doesn't follow through with the exercises, then you aren't going to take her anymore. And if she doesn't stop bending, you aren't going to take her.

I'm taking my mother for radiation appointments for skin cancer (basal cell) right now, so I know how demanding it is. The getting ready and getting there takes so much time that it chews up half a day (especially because I have to build in an extra 20 minutes each time so she can use the restroom twice -- once before and once after treatment).
The radiation treatments are three times a week, too.
Purplesushi- having just finished a year of two knee replacements and weeks of PT, I know definately if you do not do the PT, you might as well not have had the surgery. Sadly, if she did the PT, her quality of life would probably improve dramatically. I am with Jessie- if she does not do a minimum amount of PT at home, do not take her. At that point, she is wasting everyone's time. Forcing her to go 3 times a week will probably help her. Those therapists have heard everything. B
Hey Chris, in view of her age/other issues, is it possible she needs a mood elevator? Perhaps she is depressed. This would contribute to her 'non-compliance' with PT. Is there a friend/neighbor/member of a church group that would take her to some of the appointments? It would give you more time.
I so get it. I'm a PT n deal with these situations all the time plus my mother won't follow any suggestions I make to help her neck n back. You need to set boundaries n tell her how it's going to be ( as nice as possible). The doc is trying to make his life easier by complying to her request to get better. U can't make her do exercises but u can tell her if she doesn't n her mobility declines u will not be able to physically help her n she'll have to go to a NH. Talk with the PT sometime alone n tell them she's noncompliant n for them to tell her they will give her 2 wks. N if she doesn't improve they will have to discharge her. It's true too. They can't fix her 2-3 hrs a week. She has to take responsibility and ask for ur help as needed with exercises. How many weeks post op? 6 wks or so hip precautions don't have to be so strict but depends in Doc they all have different rules. You'd think she wouldn't want to dislocate it again. Try not to harp on her bc she dig her heels n harder. Don't do anything for her she can do for herself. Don't feel guilty you can only help her if she chooses. Easy said but u have to take care of ur own needs n stay sane. I've gone thru this with my dad n now my mother. I told my dad I wouldn't take him to therapy but he wasn't a good candidate. The PT's u got at home were not doing there job. They need to have mom do exercises n activities while they r there. Call agency n tell them u want another therapist one who can be firm. If she does go to out-patient see if someone else can take her. A sitter can n u can get a service for a usual minimum of 6 hrs a week. Good luck! There is a fine balance between caregiving for ur mom n for urself n fmly. god Bless!
I took her to the P/T appt. today. The P/T assessed her condition, and told her (and me) that her muscles were extremely weak, and that to expect her to build them enough to where she could walk again is probably an unrealistic goal. She noted that she had 3 months of daily physical therapy after the hip replacement surgery & said if that didn't do it, then the limited number of therapy visits medicare would cover now probably wouldn't do it either. Since she has been in a wheelchair for over a year,she has lost a lot of muscle mass so the PT wants her to instead concentrate on keeping the muscle strength she does have so she doesn't lose her ability to transfer herself, etc. The PT said she was going to talk to her ortho surgeon & see if she could get him to authorize home-based PT again (she was only allowed 4 visits when she was discharged from the SNF...and the guy that showed up was not effective - i will NOT let them assign him again) so we'll have to see how it goes.
Good luck on the home PT!
My husband is the same way. Won't do anything at home but he puts on a big show for the PT-ist. He always has an excuse as to why he can't do the exercises. I'm tired of arguing and being told I'm the one who is arguing and being miserable. It's the same way with his meds. I'm at wits end and my journey has only just begun. I really don't know what I'm going to do.

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