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So 3 years ago at 66 my mother went in for some routine surgery but unfortunately it caused a stroke which left her left side bad. After about 1 year she was talking fine but still very weak left leg (walker and other struggles) and little use of the left arm. She also has some memory issues and left sight issues but bless she is still able to live a life independently (with many struggles) though not how she dreamed. Yes she has been seeing dr regularly and she has had COPD issues even prior.


The last 2 years it seems like as she gains strength/endurance something comes along and she is right back where she was (COVID restrictions have really hurt her health). My single mother worked hard her entire life and I was excited for her to enjoy retirement. I wish I had $ or she did to hire personalized care since I really think it would have made a difference.


Anyway my question, she is going to be 70 this year. She goes out 1-3 times a week with friends but other than that she gets no activity. It's not that she doesn't want to but it is not easy for everyone to get her and she still gets tired easy. She has lost some weight (diet but she was not very overweight) which should help but I really have been trying to get her to look into hiring someone to come in for PT at least once a week to push her exercise. She says she knows the exercises and does them and is active so she doesn't want to waste what inheritance she has.


I know mental issues and vision are likely not going to change but I feel like she could get back that leg strength and maybe some more arm usage. Her legs function and she can walk with just a cane but weakness/balance don't let her and also rob her of any confidence trying to do it on her own. Am I hoping for too much at this point? I just hate to see her alone so much because she is too afraid to be on her own and fall.

my Mom also had a stroke and I know that Medicare renews every year for even in home PT/OT/ speech etc. her primary would just have to write up the script. It’s a new year so I would call her primary (with her) and request a script. Even if they come for 4/6 weeks and can help retrain her as well as give her some new exercises and ideas. My mom hasn’t made nearly the gains your mom has and yet every year if she wants to try outpatient or in home health PT/OT I always encourage her to try it - my mom always seems to feel better emotionally when she does it. We just came home with in home after a UTI - but right before covid her dr. wrote her the script - it can be her primary - her neuro etc. Beat wishes - maybe she will want to try it again and just have them refresh her and or find her some new things to do that she could get excited about 🌈
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RCK333 Feb 24, 2021
Thanks, that is a good point on refreshing and I will talk to her. I know she wants to get stronger and does not mind doing the work but she just can't do it on her own. The fear of falling means as soon as she is a little tired exercising she stops and its just not enough. She needs the support of someone just being there. Her issue is money, not that she couldnt do it but that she worked hard to give that to me (and I can't talk her out of it) so if she doesnt know there will be significant improvements she doesnt want to do it and also if not in home she will not do it because she doesnt want to bother someone to take her. Just need to keep doing what we can.
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It is very unlikely at this point that there would be appreciable change without a truly grueling exercise regimen. I don't think that your Mother wants that. I would speak honestly with her and ask her if she would want to try that or not. The truth is that most stroke improvement comes within the first two weeks after the swelling of the brain incident recedes. What is left is more permanent injury. Some of it may be changed minimally with massive amounts of work. Few can tolerate that.
So speak with your Mom and find out how she truly feels about this. We are the wrong ones to ask in this instance. There may have to be more work from you, as far as acceptance goes. I am so glad to hear she still is going out with friends. That's great news.
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RCK333 Feb 24, 2021
Thanks, yes I knew that your gains after a stroke come quickly and after a year or so likely not much more. I just wasn't sure about leg strength. To me it is still a muscle, exercise it to gain strength but didnt think that would change due to a stroke. We took her out today, an hour at costco and no issues other than very slow (and used her walker).

Yes there is definitely more acceptance needed but honestly I will never be able to accept her situation and stop trying to improve it. If she was 79 maybe but I know she has so much more she wants to do in life still. It boils down to $ like most things, she won't spend what little she has saved for me and I don't have the extra money after this past year to just pay for those things. It is nice to just get these things out, I know there is not magic answer but its nice to know you are not alone.
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Medicare plans mean Medicare Advantages. They have benefits that straight Medicare does not provide. Because of certain restrictions I choose not to have them. Straight Medicare may not cover a Silver a sneakers program. Now my BC suppliment does.

I would call her Doctor and ask if he can order physical therapy in home or out patient. Medicare will pay for the majority of it with her supplimental maybe picking up the balance or partial. Then you will find out if Mom can improve or she has hit her plateau.

You may want to check with Medicaid to see if Mom qualifies for an aide. Call your Office of Aging, some supply aides.
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When my husband had a massive stroke at the age of 48, I was told by his Dr's that whatever he gained back by the second year after his stroke would be pretty much all he would regain. And in my husbands case that was pretty much the truth. While I certainly understand that you want your mom to remain as active as possible, you must also remember that she has COPD on top of everything else. I'm sure that probably tires her out more than the effects from the stroke do. Perhaps you can get her to attend a Silver Sneakers class in her area, as a lot of Medicare plans cover that, so she wouldn't have to use her inheritance. Just a thought, though it seems your mom is doing quite well if she's getting out several times a week.

Now on a side note, you say in your last paragraph that "I know mental issues are not likely to change." I don't know if her Dr's have shared with you or not, but people that have had a stroke are much more likely to develop dementia(usually vascular) down the road. My husband who had his stroke at 48 was diagnosed with vascular dementia at the age of 70,(even though he showed signs before that) and passed away from it at the age of 72. Not to scare you, but to make you aware that that is a possibility. You are sweet to care about you mom so. Keep up the good work.
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RCK333 Feb 24, 2021
Sorry about your husband. Yes I know that is likely on the horizon for her, her mental issues when I said would not change I meant for the better but yes know they can go downhill. She's not had any noticable decline since the stroke at least. I think the classes would be great but she couldnt get there and even if she could she would be too nervous w/out someone watching her. She gets scared easily and anxious much more since the stroke. I will just keep trying to push her activity a little more each week.
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RCK, I really feel for you & your Mother. My Mother is in a very similar state, but minus the COPD & really needs assistance/supervision to walk with her cane.

While we encourage the *move it or lose it* approach & it increases independence we are mindfully that too much will fatigue her & increase her falls risk.

OT calls it 'Duty of Care vs Dignify of Risk'. I don't think there is any simple answer.

I suppose I'd be looking bigger & longer picture. What is important to her? When she does move from independence to semi-indepenant, what are her preferences? An assist lady to pop in a few times a week? Moving into an assisted living where some friends may already be? (My Aunt did that).

It sounds like she has a good balance between going out/ social connections & rest now.

Is there a middle ground of gentle encouragement? (To keep what she's got).
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RCK333 Feb 24, 2021
Yeah, she is only 69. While she does have COPD and a few other issues they all existed before her stroke and did not have a major impact on her daily life. She isnt the same as before the stroke mentally and she knows that too. She actually sold her home and moved into the 55+ apts to be hear her aunt but unfortunately the week before my mom moved in her aunt had a medical issue and had to be moved to a skilled facility.

I know she isnt sitting around all week alone but she wants to be active and more independent. Just trying to figure out if someone coming to help her work out and watch her to make her feel comfortable enough to push her endurance.
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Did she do the exercises that OT and PT give?

My mom’s occupational and physical therapist gave her specific exercises to do throughout the week. My mom did them.

You’re right about the achievements accomplished in rehab. It’s a workout!

I was totally amazed at how much work my mom did in her 90’s!
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RCK333 Feb 24, 2021
I do believe she does them but I think she also forgets some days when she has something going on. I think the issue is she does them but as soon as she thinks her leg is tired stops, never pushes herself.
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Hello,

Welcome to the forum.

Did your mom do rehabilitation after her stroke? Rehabilitation helped both of my parents. My dad went after his stroke and mom went after falls due to Parkinson’s disease.

Has she done home health?

Home health is wonderful.
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RCK333 Feb 24, 2021
Yes, her 1st 6 months were all rehab. I was thrilled how far she went but then she was mobile enough so insurance switched her to someone visiting 2 times a week in the home for OT/PT additional. After a while that ran out or at least it being 100% free ran out. I just saw the progress with daily rehab vs her doing it on her own at home.
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