Mom's stubbornness is confounding to me...

Adding to Babalou's last comment, you could ask for an alternating pressure pad mattress; it electrically rotates specific segments of the mattress in a designated order to decrease the likelihood of pressure sores developing.

It's also apparently really important for patients not to remain in the same position for more than an hour at a time. So yes, they will be asking your mom to move frequently.

Google PT after Kyphoplasty. It does seem that getting the patient up immediately, in addition to doing in-bed exercises is the standard. The article I read most completely (Houston Spine Surgeon, i think, was the site) also listed "criteria for progress".

Is anyone explaining to mom what's going on? Is she understanding the instructions? The fact that PT hurts, but it's ultimately going to help? Again, i think the cognitive/mental state thing is the wild card here.

With regard to the SW, in my experience, they are ALWAYS at the care meetings.

I agree with Babalou, Dman - they do like to get patients up and at it as soon as they possibly can. Having said that, it's far from impossible that special instructions got overlooked so I agree with you too - bang heads together and make sure that *everyone* is reading *all* the notes. And there's nothing wrong with asking politely whether your mother's PTs are experienced in treating spinal injury as well as elder care.

They want you there for several reasons. One, to be a friendly face and to aid communication with your mother. Two, so you can observe the techniques and provide some additional continuity in future. Three, for arse covering so you can witness exactly what they're up to - and don't forget they will have lots of patients' relatives calling them up and demanding to know what they're doing for their fees and why isn't mother/father/spouse making more progress.

So, you have the discharge orders from the current hospitalization, yes? Check what they say about PT. Check that the PT is reading the same orders. Call the doctor at the hospital and ask HIM what he thinks about this.

When my mom, then 90, was in the hospital, post broken hip, they had her up out of bed VERY SOON after surgery. It's how they prevent blood clots, which are the real enemy. But DO make sure that you speak with the Director of Rehab.

Look, if they have orders from the doctor to start pt, no, they don't have to call you. Your mom's not incompetent, right? They tell HER they are starting pt and if she calls you, that's how it gets communicated. Since my mom has aphasia, I gave her a card that says "call my daughter" with my phone number. It took me a year to come up with that.

And I don't know why they always want me there for PT either. Right now it almost seems like the PT wants to prove something to me, that being that Mom hasn't improved at all and needs to either be discharged or put into LT care right now. But I disagree, as I feel she hasn't even been given a fair shot yet.

When I see the PT tomorrow I'm going to just ask her point blank, is she going to help Mom rehab from her spine injuries and is this facility equipped to handle my mother's case? Because if not, I have to find another rehab that will.

If I go to visit tomorrow and get a bunch of sad head-shaking and chatter about LT care, I think I might have to seriously consider breaking the bank and even borrowing in order to hire an advocate. My mother needs to rehab from her spinal injuries (and she still has biopsy results pending too), not to finish up her last rehab stint right where it left off. I'm pretty upset that they tried to start PT without even telling me, as I thought that's what this meeting was about. If what the PT said was accurate, they were trying to get Mom out of bed just three days after her procedure and only one day after a steroid treatment meant to relieve swelling in a growth in her back was completed. If no one checked with her doctor before doing this I will be absolutely livid.

In my experience with my mom in rehab, I was totally NOT AN asset. I can't imagine why a therapist would want a relative around!

Talk to the DoN or Administrator and explain that there seems to be an (a) attitude problem or (b) personal disagreement with the therapist and ask for another therapist. It's permissible; I'm sure the facility would rather switch therapists than lose the funding.

We had to do that for my mother, whose first therapist said there was nothing he could do because Mom wouldn't try. The bas**** even had her in tears. I was so angry with him for being so cruel to an 80 something woman recovering from a hip fracture, but with Dad and my sister, we turned the situation around with a good resolution.

Discussing it with her orthopedic surgeon, he said Mom should NOT be weight bearing on the fractured leg for 6 weeks. So Mom was instinctively not doing what shouldn't have been done.

We had a meeting with the Admins and addressed the issue, making it clear that the grouchy therapist's action was inappropriate and medically dangerous. Another therapist was assigned, and the recalcitrant one was moved to another facility, so they said. It wouldn't surprise me if he was given his walking papers.

I also don't understand why the therapist is pushing for your presence at PT unless she's using you to document something, like her concern for what she might interpret as a lack of progress. In my experience, therapists often suggest family don't participate because patients "perform" differently when family is present. She may have a hidden agenda.

Something's amiss; once again you'll have to be assertive and straighten things out.

This has really been quite an experience, hasn't it?

Get the director of rehab and the administrator of the facility together in a room and tell them that. Your mom should be reassessed as though she's a new patient, given what she's been through. "And if I have to move her to get that kind of assessment, I have no problem doing that".

For the first time during the course of this ordeal, I can honestly say I've developed a real dislike for someone involved with my mother's care, that person being her PT. I met with her today (and the social worker who IMO shouldn't have even been involved in the discussion as all he cares about is Medicaid) and frankly she came across as being a real jerk. Perhaps I'm just being an overprotective son here, but this woman seems to have already decided that Mom is simply an impossible case who cannot be helped and she doesn't seem to be taking the fact that Mom just endured a month and a half of agonizing pain into account at all. I visit every day and I'm seeing genuine progress here. It's slow and it's not dramatic but it's there. She's sitting up in bed without pain, she's slowly beginning to re-engage mentally, her movements are more confident, she's expressing thoughts and desires again. But according to the PT she's still a bedridden complainer who refuses to participate. When I suggested that maybe she has a bad association with the PT and the wheelchair based on how it went before, the PT just scoffed and dismissed me, which honestly annoyed the hell out of me as I just don't see what's so far-fetched about that notion at all.

I spoke to her insurance carrier today and according to them they'd have no problem with covering her rehab based on a new assessment of her needs and goals but it has to come from the rehab staff. Apparently I have to go over the PTs head and speak to someone about this issue as she just refuses to listen. And she's already leaning on me again to attend Mom's PT, she's almost implying that it's up to me to demonstrate progress, which just annoys me further. I mean I want to participate but I certainly don't want the entire burden placed on me here.

And if I get one more somber head shake or if I'm dismissed as an idiot one more time I'm going to have to seriously consider moving her someplace else, if that's even possible right now. They're not seeing one thin dime until I see someone there prioritizing her care over Medicaid applications and insurance guidelines.

Dman, what I meant was, the first time around , the therapists seemed to assume that mom would be returning home with you as her caregiver. Of course she needs to cooperate, but there is no reason that you should be there, except occasionally, for therapy sessions.

I would also speak to the business office about a way to extend her Medicare eligibility, given the errors that occurred the first time around. I would appeal for another 0 days full coverage, based on her second hospital stay.

Dman, ask when the first "this time around" care consult will be. You can raise these issues then, in front of the various department representatives, and ask if you're all "on the same page" (for lack of a newer expression).

As to creating an atmosphere that your mother can look forward to, what can you think of that she'd enjoy after PT? Listening to her favorite music? Favorite magazines to thumb through? I suppose you could consider bringing her a special treat she might like, or better yet, some flowers...perhaps "a daisy a day" or better yet some lovely roses?

Right now I'm getting kind of worried that they're going to present me with some wildly unrealistic "discharge day" scenario based on something other than her actual condition. I'm also worried that they're going to try and lean on me re: money and LT care and once again the focus will turn to everything but the patient. I was told this meeting was regarding her PT plan but you never know, I've already been ambushed before. As I said above, IMO she was initially assessed before she was properly diagnosed and I hope that doesn't color the way her status is regarded now.

I think her boredom is just a consequence of being (mostly) pain free for the first time in months, as she was unable to really think about much else during that span. My main goal here is to get her into a wheelchair where she's comfortable and not panicking about falling the entire time. This could open up a lot of options for her that might help stimulate her mentally as well as physically. Just expressing a desire to leave the bed is a step up given where she was a few weeks ago. However, she's stiff and sore from all that inactivity and I don't want to put her in a position where she's being pushed too far too fast as I don't want to see her re-injure herself or develop any new ones. Right now she's doing a lot of (unprompted) stretching in ways she hasn't moved in quite a while, which to me is a good sign. Her motor skills are still a little off but I see some real improvement there, she's not overthinking every single move anymore. It's minor improvement, but at least it's something.

babalou: The first time around her PT was a total disaster, as she was still not diagnosed properly. It was tough to really have a LT goal there as I was still deeply concerned about what was wrong with her, while PT's goals were based on treating her for an ailment that was merely a symptom of her actual problem. In short, it was a mess and I cringe when I think about it. My hope is that this time it can be more practical and well-thought out given that now we know exactly what her problem is. I know she'll never live independently again, that's a given, but I don't think it's entirely unrealistic to get her to a point where she can at least assist in some day-to-day routine things, like helping her get dressed, cleaned up, eating normally and etc. She's already not actively resisting her aides and nurses like she was before, so IMO there's a little hope there to expand upon (ideally).

And this time around I am absolutely insisting that no one is to badger her about "insurance cutting her off because of lack of progress" which I detailed elsewhere in this thread (and given her injuries it was even more awful when I look back on it) she has enough on her plate without having that crap thrown at her. In retrospect, IMO they were too quick to "give up" on her and label her as being "difficult", that needs to be atoned for even though realistically I know that I'm probably the only one who cares about that aspect of it. I only wish I could go back in time and insist on having those damned tests be done sooner, as we could have avoided a very sad and painful (esp. for her) situation.

I would tell the PT folks privately ( i.e. not in front of mom) that you sincerely doubt she'll ever live independently again, and that you have every intention of going back to your own life/job/home. When my mom was in rehab, all the therapists were initially under the impression that I was bringing her to live with me (I guess maybe that's what some folks do). I cleared that up right away so they knew what they were aiming at, either AL or Memory Care.

It sounds like her mental state needs as much as attention as the physical. I would also get her evaluated. Your expectations of her seem pretty high. I would definitely make sure she was capable of meeting them. When you have a senior who has gone through what she has, I would be more inclined to suspect a stroke or some other brain issue, over manipulation. I had to attend PT once for two frozen shoulders and I did not look forward to it. It was quite painful and even with a very strong constitution, I was pushed to the limit.

When she complains of being bored, what does she actually say about it?

I'm meeting with the PT people tomorrow to come up with a program for Mom, hopefully one geared around her practical needs. I've seen genuine improvement each day since her surgery. She's still crabby and the pain meds have her a little buzzed so she's on the sleepy side but physically she's definitely made some slow progress. Mentally she's beginning to complain about being bored which IMO is actually good, as it means she's feeling better and not focusing on pain 100% of the time. This time around I want PT to be something she begins to look forward to as opposed to dreading and I hope we can make that happen. I also want the PT people to not rely on me so much, as I can't be there seven days a week based around their schedules. I felt they were a little unfair about that last time around. Of course I want to help and participate but I can't carry all the weight, plus I don't want to inadvertently injure her somehow and set the whole thing back again.

I need to offer some support of some of your mother's ideas and behavior (big grin here - sorry, no emoticons on this forum that I can find so words have to be adequate!).

Regardless of "self destruct buttons", your mother may also be thinking of the phantom energy that's wasted when electrical appliances are left plugged in while not in use. For someone who went through the Depression, that's not unusual.

For me, it's an issue of minimizing my carbon footprint. Other than appliances and clocks, anything else gets unplugged when not in use. It's difficult to tell specifically how much has been saved, but it seems to be about $60 a year. For me, that's significant! I can buy a lot of seeds and a few plants with that savings.

If you've ever been the victim of identity theft, you can become hypersensitive to potential scams. We have gone through that, and I can tell you that you begin to think of everything you might have that could be compromised, sites you visit, etc. and how to protect yourself. Your mother may have that concern with verification of bills.

As to electronic gadgets, it's no longer easy to just turn them on; you have to have instructions even for phones. The KISS philosophy seems to have been vanquished in electronics manufacture in favor of one which is all inclusive - MIC - make it complicated.

After a while, an older person (even someone at my age) just gets tired of all the fooling around. I'd rather spend that 5 or 10 minutes in my garden than pushing electronic buttons.

An electronic gadget can't hold a candle to the pleasure of watching butterflies flit from one pollinator plant to another.

That's hilarious about your mother acting to stress out the recalcitrant granddaughter! Something I've noticed about the relationship though, is that the granddaughter seems to call you in panic for things that might seem unusual. How old is she? Does she have much real world experience?

And I think there's something to be considered about Babalou's suggestion of simultaneous orthopedic and brain issues

My mom also thinks that she can break thinks by pushing the wrong button; I've got more sympathy for this idea now that my daughter has a very complex tv set up that my 3 year old grandson can work but which defeats me at every turn.

I want to posit an alternative interpretation to your mom's saga. Mom injures her back and at the same time, has a TIA iron other vascular event which also goes undetected. Now , using the reasoning skills of a 5 year old (it hurts, if I don't tell anyone, it will get better), she resists and evades intervention. What I'm saying is that it may not be the pain that has caused this; it may have been a vascular event that caused both the loss of cognitive skills AND the injury. Just something to ponder. The important thing is that she's getting better physically. Cognitively, you'll have to see where she is.

And BTW her stubbornness is not new, although her distrust of the medical profession sort of is. She was always good about her health, never missed her regular doctor appointments, never missed a pill, always followed doctor's orders. This was in very sharp contrast to my father and sister, who were complete opposites. (I ranged more toward her side of the spectrum there although on the whole she's probably been better about it than me). Now though, she withholds information, gives evasive answers and generally makes things difficult. My hope it that it was the pain and suffering that sparked this and that perhaps time and care will alleviate that somewhat.

Like I said, stubborn is a broad word and to properly describe it would take all night, but yeah, she's always been like that. Example: My mom is from that generation that thinks every new piece of helpful technology features a self-destruct button that must not be pressed so it's just safer to unplug the device entirely (wouldn't want to start a fire!) and go back to the old way of doing things. Phones, TVs, VCRs, DVDs, car radios, you name it, she's afraid she'll somehow "break" it by using it. I've forced her to adapt, she loved the new TV I got her a few years back, yet she still has her old rotary phone, I kid you not. She can be incredibly resistant to the simplest things sometimes and if it involves money in any way she's SURE it's a scam. She'd call the water department to ensure that the bills were real then she'd pay them in person just to be safe.

A few days ago my niece was visiting and she sends me a panicky text saying that Grandma is moaning and carrying on complaining about being in pain and etc. and that she seemed pretty bad. So I visited later that day and she was OK, nothing unusual going on. So today I asked her what the deal was with that. First she said she didn't remember but I didn't really believe her as my niece hadn't visited in a few days before that and I knew Mom noticed and wasn't pleased about it. So I asked her, "were you just putting on a show to make her feel guilty there?" and wouldn't you know it, she cracked a grin then tried to hide it. I keep telling these medical people, you gotta watch this one, she's got cards up her sleeve.

Babalou: It all kind of happened all at once. As soon as her physical symptoms appeared, she went straight downhill mentally too. It was like one day she was a somewhat creaky but generally happy little lady and the next she was all curled up, unable to move and unable (or unwilling) to elaborate on exactly what was wrong. Her stubbornness is a complex web of unwavering ideas, a distrust of medicine and a weird desire to "not trouble or worry anyone" by complaining.

Knowing what I do now, I think it all played out something like this. According to what her doctor just recently told me, she was treated in 2004 for a back injury, which became the lower back fracture she was suffering from. I never knew about this, which is totally understandable as my sister was probably involved and her view of modern medicine was completely bizarre, as was her desire (and Mom's) to "not worry me" by telling me about things like that. This injury became a degenerative thing which Mom chalked up to "arthritis" in her "hip" which was always her go-to complaint.

The second upper back fracture occurred far more recently, my guess is sometime in mid-June of this year. I have no idea how or when and if she knows she isn't saying. This injury was so painful it forced her to adopt a posture which in turn put even more stress on the lower back which led to a snowball effect of sorts. At the exact same time she became very withdrawn and disinterested in everything as the pain and the fear of having that pain diagnosed and treated kicked in. From there it was almost like she was in shock, as she became non-communicative and even more withdrawn.

Right now the best way I can describe it is that it's almost like she's emerging from a coma state. She's all achy and sore from the lengthy period of inactivity, she's shocked that so much time has gone by, she's surprised to have survived it and she's still exhausted from the whole ordeal. I can see her personality peeking out here and there but it's tough to say how far it's been buried as of yet. Hopefully I can get her assessed based on what actually happened to her as opposed to what the first impressions doctors have of her are, as IMO it's all symptoms from the same thing.

What was she like, mentally (sharp, forgetful?), emotionally (depressed, anxious, perky, optimistic, self sufficient, happy) before this recent downturn. What was she like in her day to day interactions with you and others? What was she managing on her own (checking account, bill paying, setting up and taking meds, driving, shopping for and preparing food)?.

I think you need to get clear what her baseline was before. Was she declining cognitively ? Having trouble managing bills and such?

She may have had a TIA or small stroke somewhere along the line. She may not be able to clearly express "I have pain here, or I can't swallow that pill". Loss of cognitive function often leads to much anxiety and depression. Getting a clear picture about those issues is key in getting her the right meds and the right help.

If you don't feel that the psych people at the rehab are seeing her clearly, you might think, down the line, about taking her to an outside neurologist who specializes in dementia.

The big question is ALWAYS or NEW? Is mom's stubbornness a new development or has she always been this way? Usually cooperative or usually impulsive and pigheaded? Compliant with doctors or dismissive?

Dman, does the facility have pet or music therapy?

Babalou: She is in the rehab now. I definitely want the psych issues to be re-addressed, as the first time around they were based on an assessment done before she was accurately diagnosed. Thus IMO the issues have to be seen differently now, how much of it was due to the severe pain she was trying to hide? IMO she was dismissed too many times early on as being more out-of-it than maybe she was due to her reaction to the pain and diminished movement. In fact I can remember my concerns being brushed away with sympathetic looks, like "oh poor deluded son, can't see the truth" even when I insisted that her sharp mental decline matched the timing of her physical symptoms exactly.

Countrymouse: That's a good point, thanks! Entirely possible and treatable...if only she'd just SAY "I feel backed-up". With my mother it's always guesswork as she never just flat-out says "my ABC is XYZ". Or "there's a pill I didn't swallow on the bed".

I have an appointment with the rehab people on Tuesday to discuss "her treatment and therapy" (and probably "her assets and money" too). My goals here are realistic, I'm not expecting any miracles or anything. I want to see her regain some modest physical functionality and confidence which could lead to more mental stimulation too, which I think she really needs. I hope they're on the same (or similar) page here and that they don't try to push some "wham bam discharge day" idea on me. Yeah I'm cynical, I know.

I think this time around it's crucial that we can get her comfortably in a wheelchair, as she not only needs the mobility but she needs mental stimulation. She's been in and out of reality in hospital beds for a while now and it's definitely making her weird and squirrelly. But this time she has to ENJOY things like talking to people and being outside which won't happen if she's in pain, so right now getting her to a point where she can sit upright for a few hours without being miserable is the first goal IMO.

Is she still in the hospital? Any plans for a psych workup? It would be good to have a professional opinion about her cognitive skills and her state of anxiety/depression.

If the pain pill is codeine do not underestimate the agonies of constipation. Which is especially no joke if you were in pain to start with. If that is what they're giving her she should be being given lactulose or similar, too; but believe me I've just been through this and I expect my moaning and groaning frightened the neighbours. Too much information..? :/

Weird day today. I visited around lunchtime, I walk into her room and I almost have a heart attack as she's in that leftward-leaning position, moaning and groaning, like the last week never happened. A few minutes later I found a half-masticated pill on her bed. Turns out she spit out her pain pill and was all achy and etc. I had to let the weekend staff know that she CANNOT be trusted to swallow every pill, best to crush them up and give her them in some applesauce or whatever. Came back a few hours later and she was back to what's "normal" now, a little pain but otherwise not bad.

The mental aspect is going to be tough IMO. See the "stubbornness" mentioned in the title of this thread. Trying to get a "straight" answer out of her is impossible sometimes and it can be extremely frustrating. I'm hoping they can put together a practical PT program for her that might give her a sense of accomplishment that she can build on, as "too much too soon" is just going to cause her to withdraw and make excuses to dodge it. Right now she's maybe 25-35% "there" which is definitely a step up from the 1-10% before, but still a lot of work to do.

Thanks all, she's crabby, frustrated and bored but definitely not in the sort of pain she was before, it's obvious. Now we have to get her on the mend but at least this time we know what the problem really is. Hoping the rehab folks will work with us here and not play hardball with payments, as we really need to set up a practical payment plan to cover the remaining copay days here.