Mom drug her left foot, lost her balance and fell on both replacement knees last Sept; left knee was bruised and healed completely while right knee suffered a simple fracture just above the prosthesis which worsen when PT tried to push through a plateau earlier this year. PT has been discontinued for at least 3 months to give the bone a chance to heal, but doctor recommends she keeps walking daily but not to the point of pain. The latest assessment is that Mom will never walk normally again regardless of how well the bone heals because her spinal stenosis has finally impaired nerve function enough to imped walking. She now drags the left foot when using the walker (as she has throughout PT); she has more than enough strength to walk, as we see in her sit to stand and balance tests, but she can not lift that left foot well when standing. I've known for over two decades that Mom would probably end up in a wheelchair if she lived long enough and it seems we are nearly there now.
My challenge in this transition in managing (1) how many steps she takes a day so the simple fracture heals and does not cause pain and knee swelling and (2) how to prevent swelling in her feet from vinous insufficiency compromising her walking stability and possibly causing blood clots. When Mom goes to adult day care in her wheelchair, she doesn't walk at all except for a few steps in the bath room (rolls the wheelchair w her feet). The nurse puts Mom into a recliner for at least an hour in the middle of the day care day, but she still has some significant swelling when she arrives at home. When she tries to walk on the swollen feet, she is very unsteady (going from a medium to a high fall risk). I think it might hurt to walk on the swollen feet so we use the wheelchair to visit the bath room and then get into her lift recliner with minimal steps.
The problem is some days Mom wants to get up almost as soon as I get her feet up. Experimentation has shown that a minimum of 90 minutes (120 is much better) is needed for Mom to walk with her fairly stable new normal. Most days, I settle her in the chair with a snack and the paper and she's fine for a couple of hours, often taking a nap after she's done with the paper. Other days she wants up and out of the chair so she can walk with the walker to the bathroom because she wants to pee (even though she did that less than 5 minutes before). And then she wants to go again in 10-15 minutes, and sometimes again in another 5-30 minutes; she does have almost no short term memory and MCI. If I give in and help her up every time she asks I not only need to hold my breath and pray she doesn't fall again right in front of me, but we end up stressing the knee enough that it starts swelling too and hurting. For some reason she refuses to use the wheelchair for most of these repeat trips. Needless to say, the deposit from these close timed trips is almost non-existent (1 tsp to maybe 1 tbsp).
My current solution is unplugging the recliner so she cannot get out of it by herself and placing the bed side commode by the chair the first time she asks for an early bathroom visit. I give Mom the choice of using the commode or the incontinence panty she wears overnight and to day care (almost always dry when she comes back from day care). Often she tells me to never mind and at the end of 2 hours when she gets up the incontinence pantry is still dry. Since she doesn't have a UTI, I'm assuming this is MCI or maybe an early dementia behavior.
Any suggestions for how I could manage this balancing act better? There's a part of me that really hates telling her no when she wants something as simple as getting up to go to the bathroom but the larger part right now is screaming that we need to avoid another fall if at all possible. I can care for Mom at home as long as she can help with her transfers; with my own spinal stenosis problems, I not sure I can manage without her help even with some kind of lift system.