It’s time for Mom or Dad to prepare for hip replacement surgery. You’ve found the best surgeon, scheduled the procedure, and figured out which rehabilitation center they will be staying in. You’re both ready, right? Let’s make sure you know what to expect following the surgery and subsequent discharge to the senior rehab center.
While there have been many advances in joint replacement to minimize pain and recovery time, a hip replacement, whether partial or total, is still an invasive procedure. Understand that your loved one is going to be uncomfortable afterwards. The level of discomfort is highly individual and depends on a patient’s overall health, pain threshold and activity level prior to surgery.
At the rehabilitation center, the physical therapist and medical staff will use specialized pillows to position your loved one in bed to make them as comfortable as possible and prevent injury (dislocating the new joint). However, the surgery itself is going to cause pain.
As the caregiver, you’ll need to advocate for your elder. Don’t be afraid to ask for painkillers or ice packs to ease the discomfort. While heat is generally not a recommended therapy following a hip replacement, it can offer temporary relief for those who aren’t having much luck with traditional methods. It can’t hurt to ask if this would be a good option.
Proper timing of pain management methods is also crucial and will ensure your loved one sleeps uninterrupted through the night and is able to fully participate in their physical therapy (PT) exercises with minimal discomfort. Their physical therapist will advise you of the care plan and the best options throughout the rehabilitative process.
Depending on a senior’s age, cognitive abilities and activity levels prior to surgery, the hospital staff may have them up and walking around immediately after they are done in the post-op recovery room. At the rehabilitation center, walking will be the most important part of recuperating. For many people, this can be a slow, frustrating process. With a hefty dose of patience, it can also be very rewarding. Some patients even breeze right through the beginning stages, but one commonality is that everyone starts out using a walker for support.
Even if your dad was playing tennis three days a week prior to surgery, he is going to start off using a mobility aid. This can be a tremendous blow to someone who was very active and independent. These patients tend to overestimate their abilities too soon after the procedure and can end up in greater pain or develop complications. Eagerness to resume daily life is a great quality, but the body must have adequate time to heal.
For a senior who is cognitively impaired, rehab can be very confusing because they may not recall the surgery or the doctor’s orders to take it easy or understand why they must suddenly use a walker. In addition to basic rehabilitative care, close supervision following surgery is crucial for patients with any degree of memory loss. Without it, they may fall, hurt themselves or even damage their new hip. It is important for you to know the physical therapist’s plan of care for your loved one so that you can be their partner and cheerleader. Each step is a milestone, and they will need to know they’re doing great.
Physical Therapy Exercises
Your loved one must follow the physical therapist’s instructions and those of the medical staff in the rehabilitation center. The purpose of inpatient senior rehabilitation is increased access to supervised therapy programs and skilled nursing care. A stay in a subacute care facility provides seniors with the high level of care and assistance they require following an illness or surgical procedure without having to travel to and from countless appointments for weeks afterwards.
Complying with the prescribed therapy plan is paramount—nothing more, nothing less. If your loved one is improving quickly or making less progress than anticipated, then the therapist will adjust the plan accordingly. It is up to you to help them try their best but not overdo it. Dad may be motivated to practice walking on his own because he believes it will help him get better faster. But, if he goes about his exercises incorrectly while unsupervised, he could put himself at risk and inadvertently extend his stay in rehab or even require another surgery.
Additional challenges abound when it comes to encouraging a loved one with dementia to participate in physical therapy. The staff will take special precautions to prevent falls, provide reminders about walker use and encourage participation in PT exercises. If your loved one has dementia, one of your jobs is to reinforce that they are not to get up on their own. You can be certain that they are not the first patient with cognitive decline to stay at the rehabilitation center. The medical staff should be accustomed to working with people who have Alzheimer’s disease or other forms of dementia and do everything possible to ensure their safety.
Working with the resident physical therapist is the safest and best way to ensure that your parent is doing the proper exercises, walking correctly, bending the right way and not overworking any one muscle group. Partner with your loved one’s PT and other rehab staff to ensure all steps are being taken to promote their physical recovery.
As a caregiver, it’s your job to ask plenty of questions and monitor your care recipient’s recuperation. If you feel that your loved one is not progressing at the rate you expected, speak with the physical therapist about your concerns. If you notice something else is going on, such as depression, unwillingness to participate in PT exercises, or a loss of appetite, speak with the director of nursing, your loved one’s physician or a social worker about your concerns. These professionals have seen it all before and can help you navigate these issues.
Depending on the type of anesthetic used, your loved one may also experience a bit of brain fog for some time after the procedure. It can take weeks or months for the body to rid itself of these potent chemicals and return to normal cognitive functioning. Unfortunately, this recovery may not be complete for seniors who are already struggling with cognitive decline pre-op. Drinking lots of water will help to flush the anesthesia out of a senior’s system, and you should encourage this to help promote the healing process.
One huge question looms for a caregiver as their loved one’s date for discharge from the rehabilitation center approaches: What happens next? Will their time at the facility yield “enough” results for them to return to their previous living arrangements? Will they need to move in with you for a while until they have fully recovered? Do they now need a higher level of care that necessitates a move to an assisted living facility or a nursing home?
Prior to discharge, the rehab center should assess your loved one’s status and create a new recommended plan of care. Meeting with members of their care team, including a social worker, a nurse, a doctor, and a physical or occupational therapist, to review this plan will help you understand what their ongoing needs will be, what type of living arrangement will be most beneficial for them and what kinds of adaptations will need to be made to their home environment. The care team should also help you decide whether additional physical therapy will be needed, either on an outpatient basis or provided by a home health agency. If your loved one still needs some assistance after being discharged, it’s important for you to discuss whether you will be able to provide that support or in-home care must be hired to fill this role.
Modifications at Home
The physical and/or occupational therapist (OT) will teach you and your loved one all the things you’ll need to know to function properly and minimize the risk of injury at home. OT recommendations may include tips for getting dressed, using mobility aids and sleeping comfortably while your loved one’s hip continues to heal. Certain home modifications may be suggested as well to ensure the safest environment possible, such as installing grab bars, a raised toilet seat, a shower bench or seat, and a hand-held showerhead with a long hose. Removal of all throw rugs and other fall hazards is a common recommendation as well.
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If your elder is being discharged home and has a comfortable recliner, try to set that up as “home base,” because that may be the center of their universe for several weeks. In fact, many seniors decide that their living room chair is the most comfortable place to sleep following a hip surgery. Keep everything that they will need near the recliner. For the first few weeks, everything may feel like it requires an exceptional amount of effort, but it is important for them to get up and move around as recommended by their discharge planning team.
The muscles impacted during surgery are connected to the muscles around the pelvis. The recovery of these muscles coupled with pain, medications and confinement to bed may cause in increase in instances of incontinence. You may need to consider a portable commode if it’s a long walk to the bathroom. Incontinence after surgery is usually temporary. Speak with your doctor or physical therapist if urinary incontinence continues.
Remember, there is no set time on how quickly one should heal following a hip replacement. Ultimately, the goal is to eliminate pain and improve mobility. If you notice any setbacks, such as an increase in pain or a decrease in range of motion, it is crucial to contact the doctor immediately for a follow-up appointment.