95-year-old mother with good cognitive ability, good bloodwork, won’t stand after healed broken leg.

OP wrote: I had her evaluated by an outside assisted-living. They said the snf has not been giving her occupational therapy to practice getting in and out of bed and she has the upper body strength to do it.

and this in the original post:

"The therapists kept complaining to me that she didn’t have a good attitude, she wasn’t trying, etc. now she is due for discharge and they continue to use a Hoyer lift or a slide for her..."

The issue is with your mother not doing what she needs to do to stand up on her own. Have you spoken to your mother about this? Have you asked her what she wants?

She is not a candidate for assisted living at this point because she can't stand on her own and I am not sure what an outside assisted living facility evaluating her accomplished other than make you more convinced that mom will be the mom she was before the fall and break - she won't that is painfully clear.

Who mom was before falling and breaking her leg is not who she is now.

Have you asked mom if she is currently in pain? Asked her if she wants to continue living even? She may be tired and done. She may be fearful of falling again and breaking more bones.

She's 95 and trying to get her to live to 99 or a 100 is moot at this point. Same with her finances. Once her money runs out she will have to go on medicaid for continued care in the nursing home.

Is Osteoporosis part of the picture?
What position were the leg fractures?
Does she still have her own hips bones or had replacements?

When the bones thin with age they can keep on breaking. Any metalwear won't break so the bone around it will take on the stress & break instead. From tiny stress fractures to large open fractures.

It can happen, that an elder stands after knee or hip replacement/repair surgery & stress fractures appear in the other leg.

I know of someone who returned home after a knee replacement, was doing ok until fell out of bed. 'Just can't stand up' was his complaint. Detailed scans picked up #pelvis.

The xrays from the original injury - how long ago are they?

The SNF should NEVER try to lift your mother up w/o the Hoyer! We have a poster here who's mother was lifted up by an aide and fell, breaking her legs in the process, and then getting serious bed sores afterward. The whole situation was a horrible mess and led to her death. How are they "trapping" your mother there, that makes no sense! Nobody can or should force an elder to do anything!

If your mother will not or cannot stand, at 95, then so be it. Stop expecting the woman to perform miracles because you and the PTs think her "attitude" is bad. She's old and tired. And probably depressed, too.

An anti depressant is not a "quick fix" for a 95 year old woman who spent months in a body cast after losing her husband! You may want to cut the poor thing a break here. Speak to her doctor about an antidepressant reacting badly with her other meds before you make such assumptions yourself. A medication like this may be just what she needs to help her with feelings of hopelessness and sadness she could be feeling after a very very rough year.

When mom was 88 and acting depressed after 2 hospitalizations, I spoke to her PCP and he put her on Wellbutrin which made a huge difference for her. Her outlook brightened and she became social again.

My mother lost her core strength entirely after a short time being wheelchair bound at 92. By the time she passed at 95, she had to be helped up out of bed.....thats how weak her muscles were. Things can go downhill FAST at that age.

We tend to view our mothers from OUR age perspective instead of from being 95, expecting them to do what WE feel they "should" be capable of doing. Leave mom alone now to live the rest of her life as SHE sees fit, that's my suggestion.

As people age they become more fearful, my mother is 98, 99 on Feb 12th. She does not have dementia, she uses a roller to get around, yes, she is afraid of falling, at her age, who wouldn't be?

The older one gets they fear living, they fear dying, it is catch 22.

Your mother is tried of trying, she is afraid to try, she doesn't want to try. It is as simple as that.

Me, at 95, I would just like to lay around myself, I would have done my service to others, and so it would be my time to rest, not having to satisfy what others think I should or shouldn't do.

Pain
Fear
Worn out
Muscle atrophy
All of the above

I have read all the suggestions below and they all sound great. One of the poster was wondering if there was a walker that helped people walk. I had come across a wonderful walker that I thought might be a great fit for my father. Now 93 with lots of mobility issue but also has Dementia. If it was not for the dementia I would have definitely did the demo. Take a look on You Tube it is called Zeen Mobility device. It has a wonderful video, it might just give her the confidence and security to start living again. I called the company and had a great discussion with them of the pro and cons for my Dad. The closest place I could go demo was around 120 mile away at the time. I got a call from one of there representatives 2 weeks later and they were going to come to me to do the demo for my father. Unfortunately we were going on a scheduled vacation and Dad was going into respite care. I did suggest to her to contact the local place to see if they would carry there wonderful product. They seem to be a great company take a look and see if it would be a good fit for your mother.
Wishing you the best.

Do you know why she won't stand and walk? Posts like yours always make me think of another forum member whose mother was violently resistant to rehab, turned out she had an unnoticed spinal fracture after her fall. After a fall my own grandmother was scolded for wanting to used a wheelchair to get to the dining room instead of walking, turned out she had a hip fracture. Of course this may not be applicable in your case but it can't hurt to check for some other injury beyond the one she was originally treated for.

At this point, yes, it would not be safe to get her up and moving.

Her muscles will have seriously and perhaps permanently become too weak and too contractured to make this safe. If this professional help has been unable to get your mother up and moving at this point, then it is quite unlikely that it will ever happen short of a miracle.

Unfortunately, when we cannot cooperate with PT and the 90s is the age to not do so, we lose the muscle tone somewhat permanently. Even the bone and tendon structure deteriorates, and quickly.
I am hoping that before discharge the PT folk at the rehab will discuss all of this with you.

She is no longer appropriate for ALF, unfortunately as she is unable to transfer. They haven't the staff in facilities to accommodate this. A lift takes two people for safety in facility transfers. She is otherwise basically bedbound. Her skin is at great risk. Bones, muscles, tendons, even the lungs and digestive system deteriorate with being bedbound.

Please speak with your mother now. She may have no wish to be forced to live to age 99. You may think she should want to/could do it. But this is her life, and she is perhaps looking at end of life, palliative care, being bedbound with all that means. The bones deteriorate and cannot produce cells. The skin cannot be protected no matter the amount of care. People tire of the fight to live. Many are ready to go.
Have a long talk with your mother. Be honest that she cannot return to ALF care now as she cannot stand and cannot transfer. Do not BLAME her. She cannot do it. But let her know what the steps and choices are now going forward. Perhaps speak with the social worker first, you and her, and then speak together with the social worker to your Mom.

A fall is often the harbinger of the end. It certainly was for my mother. And while it was one struggle after another after that, loss of appetite, pneumonia, catheterizations, UTIs, yeast infections, and on and on and on with depression on top of all of it, it was the end coming.
I think that you are having a hard time adjusting to the reality now, and encourage you to discuss with staff "where mom is at" currently. And what choices need to be made by you and her for her future.

I am so sorry. To me, the thought I might have to go on to 99 is anathema. It is perhaps to your Mom also. Hospice may be her choice. If that is so, then embrace her choice. If, on the otherhand she wishes to fight, then assist her all you can in that, knowing that so far she has been unable to adequately move forward.

You say your mom is fully aware. Please discuss with her where all this is at, instead of with us. We are perfect strangers, and likely as confused about the choices as you yourself are, and as divided as to the best way forward. Talk to your Mom.

Again, I am so very sorry.

You can’t push her to do what she does not want to do. Place her in LTC. Get her on Medicaid.

My mother also is 95 and she gave up. She is in a NH. Walks very little now even though PT said she was capable of much more. She also will probably linger to 100. But there’s nothing I can do to encourage her to do more. She does not want to. Shes given up. It’s her body and her life so it is her choice how much she chooses to do. I respect her wishes and don’t push.

No one can "push her further" than she is willing to go and you cannot make her "understand what she's doing to her future" because maybe she doesn't feel like she has one, or wants one.

She may now be a candidate for LTC, which is covered by Medicaid. My MIL is in a a very excellent LTC facility. She has very mild dementia and short-term memory impairment. She's on Medicaid, in a private room. She jokes with the staff and the facility has many offerings, and the activities director makes sure to get her out of her room to as many things as she's willing.

I'm just saying that these types of places exist and that even in LTC your Mom could be engaged to participate in things that she wants to be.

Too good daughter,
I am on year four of home care using a Hoyer for the very same reasons you describe. I think my mother’s fear of falling combined with mild dementia, a UTI (at the outset), and advanced age and weakness all combined to make walking again a pipe dream. Her best chance was while in rehab - but she fought them and as you experienced, they will not (and really cannot) push people who won’t cooperate and try. It was during COVID so I couldn’t be there to push her. Sometimes I wish in those early days that I had taken her home and had used home PT and worked with her myself. But, the reality is that the will to keep that level of independence has to come from the person. IMO, she gave up her ability to walk without a fight. I don’t think I would do the same, but I’m not 93. Who knows what time will bring?!!
I have the same feelings about SNF care. She doesn’t need it except for the walking issue. On the silver lining side, if she had regained her walking ability I am guessing it wouldn’t be long before she might fall and possibly wind up with a broken hip.

My mother was terrified of the hard floors and people rushing around in the SNF where she stayed. She was, however, willing to walk a little with the PT holding onto her with a gait belt and me right behind her with the wheelchair.  And she did a lot of standing for bed to wheelchair transfers during the day.

Once back in her carpeted home, she felt more safe and started moving around more. 

After the most recent hospitalization it took awhile for her to work up the courage to walk across the hard kitchen floor. For about a month I wheeled her across it and then she would walk again once we were back on carpet. But she's now traversing that area daily and is even back to making her own breakfast.

Are you able to visit? If you put a gait belt around her and had her side step alongside her hospital bed or something like that, might she regain some standing endurance? Talk to her therapists first, of course. A PT had my mother do this side-stepping once. The idea is that if the legs give out or balance is lost, the bed is right behind the bum. And of course someone is right there as a spotter to make sure than any fall is back onto the bed.)

Years ago my mom did outpatient physical therapy at a place that had a walking practice path with bars on each side. That creates a sense of safety, too (especially with someone right behind).

Has the PT given her strength-maintenance exercises that she can do in bed? 

Or any chair exercises? 

These won't help with practicing balance, but they can help with muscle maintenance. 

(But full disclosure: I had trouble getting my mother to do these. She'd do them only at my direction, never on her own initiative. For her it's all very binary: walking or not walking.)

Being frightened seems to me different from giving up / poor attitude. The latter is probably a greater obstacle.

There must be some way to address the fear. 

Is there any rehab tool for adults similar in design to baby walkers, I wonder?

At 95 Mom may not have the energy or stamina to do PT .

She may also be too afraid to walk again .
The facility is not “ trapping her there”.
Very often a bad fall at her age results in a permanent change in function .

Look around at some skilled nursing facilities. Perhaps you can find one with a unit that has more cognitively functioning people and activities that would interest her .

I’m sorry but since so much time has gone by since her fall and still not willing to stand , means she most likely will never . Good luck finding a facility .
Sorry but the “ least bad option “ is what you are left to find .