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Just wondering if any of you wise people here can help me brainstorm. My mother is immobile in a wheelchair after a serious septic infection last November. She can ambulate with her feet but cannot even stand alone.


She thinks PT will help her. They do not. I have a call in to them to inquire what it would cost out of pocket for them to work with her more. They are not rushing to return my call even though I have clearly stated I understand this would be a cost we would pay for.


My mother has often had a lack of realism. I do feel though that I should try to help her until it may prove fruitless which is likely.


I realistically can only take this to a certain level as she is on private pay which is a little over 9,000 a month and the fund we are drawing from could run out depending on how long she lives.


While I want to give her a sense of hope I also have to factor her lifelong lack of reality. I have posted before that this has become my worst nightmare. She has been overweight for years. Oddly now she is losing some weight but not any large amount. I do not say "I told you so" even though I think that. Some previous calls to PT have gone unanswered but awhile back when I inquired about this they actually said not to waste the money. I will continue to pursue the cost issue. I guess I am wondering what my position would be if they flat out refuse regardless of my willingness to pay.

If she is keen to move then IMHO any movement is beneficial, even if it never leads to any improvement. Anybody who has had PT in the home knows that the therapist comes in for one session every week or two and you are left to do your "homework" in between, so it seems to me that you don't necessarily need a licensed physical therapist to continue to work with your mother. Think outside the box, a student with an interest in nursing, personal training or kinesiology who has half a brain should be able to follow guidelines and simple exercises.
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Reply to cwillie
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Get her one of those bike pedal things you can use while sitting in a chair. If she does that daily for a month, then consider paying for a few sessions with a personal trainer who specializes in older people to help build up her overall strength.

It's probably safe to say she won't progress past the bike thing, and you'll only be out about $40.
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Reply to MJ1929
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Did the therapist tell Mom directly that more PT will not help her walk?

What you may need to do is take her to her doctor. Hopefully PT sent him their report. When u make the appointment, ask if they have the PT report if not ask if they can request it. Make sure they know why ur making the appointment. Then her doctor can review the report. He can then tell your Mom how he feels. No matter if Medicare pays or u private pay, they need a doctor's order to take Mom on as a Client.

If the doctor feels further PT will not help Mom, HE needs to tell her. Sit right down in front of her, look her in the eye and tell her that further PT will not help her walk. Then when she starts again you can say, "Mom the doctor sat there and said PT will not help. And without an order from him, PT cannot be ordered." There is nothing YOU personally can do.
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Reply to JoAnn29
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1st of all - - most seniors aren't motivated or interested in physical therapy. If she is, I'd do what I could to get it for her.

2nd - - you need to contact Medicare for advice. The OLD standard was "improvement", but that changed in December 2013 with the Jimmo Settlement. Here are the critical words:

"...to maintain, or to prevent or slow further deterioration..."

Many health care providers either aren't up-to-date or refuse to acknowledge or apply the change. The end result is that more PT should be financially covered than actually is.
____________________

The Jimmo Settlement Agreement provides for the re-review of certain Medicare claims under clarified maintenance coverage standards for the SNF, HH, and OPT benefits, applicable when a patient has no restoration or improvement potential, but that patient requires skilled SNF, HH, or OPT services to maintain, or to prevent or slow further deterioration of, his or her clinical condition.

https://medicareadvocacy.org/medicare-info/improvement-standard/improvement-standard-update-cms-revises-medicare-policy/
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Reply to CarolLynn
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Riverdale,

I think that I would check into a chair exercise instructor and a massage therapist to come in and "work " with mom.

Both could help build her strength and help her feel better.

They would probably be cheaper than paying a PR to entertain her desires.

The chair instructor could set daily goals that mom could reach on her own and a massage is just yummy.

I hope you find something that helps her feel like she is making the effort and she is being listened to.
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Reply to Isthisrealyreal
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Riverdale Jun 15, 2021
I will look into that. There was just another Covid case and the facility went back into lockdown but they are easing restrictions. I just am not sure I can bring a total outsider in but maybe they might have some answers to your suggestions.
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There is a certain law of diminishing returns, it's true. More is not necessarily better. Are the PTs working with your mother at all at this point?

If she were on our books, and she wanted to work at mobility, we certainly wouldn't tell her no however unrealistic it might be that she'll be leaping about like a young gazelle ever again. There are so many things she *might* be able to improve on, such as standing with a stand-aid, with or without a sling - that's certainly what springs to mind.

There could be a dozen reasons the PTs aren't getting back to you, not limited to their (slightly snotty, I have to say) attitude that they won't waste their time/you shouldn't waste your money; don't forget the Covid Chaos going on out there, for a start.
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Reply to Countrymouse
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I think I would tell mom "I'm talking to the doctor about that" and " the doctor is talking to thectherapists, mom".
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Reply to BarbBrooklyn
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There could well be ethical concerns here; you might ask them about that. If they truly assess that PT would be of no help, and could possibly harm a patient there are certain places they "cannot go". That is my only thought, because as is a more "norm" in all things USA, you can follow the money, and once people are willing to PAY a lot of ethics go out the window. I would ask them to discuss honestly with you, and tell them all you told us.
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Reply to AlvaDeer
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My husband with vascular dementia, who had been walking very slowly and falling a lot, developed aspiration pneumonia, which led to sepsis, and septic shock. He almost died twice during that time, and by the time he got out of the hospital, he was completely bedridden, and under hospice care.
He too had aspirations of walking again, and getting out of bed, but I knew realistically that was never going to happen, and it never did.
If it makes her feel better, maybe you can just try and do some simple leg exercises with her, either lying down, or while she's sitting in a chair. Wishing you and her the best.
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Reply to funkygrandma59
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Riverdale Jun 15, 2021
Thank you. She does do some leg lifts and arm exercises. She was not expected to survive. She was on oxygen for around two months. As much as she has avoided many medical interventions she does love therapy. I will have to be a dog without a bone trying to get them to discuss this with me. Even if it proves pointless I feel I have to try rather than totally avoid the subject which would be much easier for me.
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If the therapists believe she has peaked in her ability to improve, they won't keep going no matter what amount of money you offer them (in the U.S.) because of how they get paid (through insurance billing codes) and they probably don't have any way to bill for it privately, don't have the facility and don't have liability insurance. We tried this with my own MIL and once she stopped improving (or refused to cooperate) they were done. Period. If they refuse your mom, I think she is done with rehab as well because it would be unethical to continue, and you are not the one who decides her medical prognosis. Should she have an appendectomy just because you think it will "help" her? Of course not. The same is true in physical therapy. Healthcare differs by state so maybe you will find a loophole and if you do please share it with the rest of us. Thanks!
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Reply to Geaton777
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