Dad (91 with vascular dementia) fractured his hip and shoulder. I'm worried he won't survive the rehab facility.

I know a gentleman with all issues, then broke his hip.

two days ago I heard him yelling in his room. He lives ina 6 pack 6 residents, 2 caretakers...Private home structure..

He is a few years younger...my point being, everytime something happens like this, a little or a lot is taken away physically or mentally....They will not recover to be 100% as they were before the incident. Its our bodies and our mental attitude.

The key words are: COULD REGAIN.

So do your best to help him regain most of what he lost int he accident. And keep him happy. Treats, milkshakes favorite movies, songs, ..

You could put up half a railing to keep him in. I think that may be ok. He is not fully locked in.

PUt up a mobile wheeling bed stand tray or a few chairs up against the bed that lock in place so they don't move... may be a way to get around "no rails" rules.
No rails rules mean they are kept in that spot against their will. from what I was told.

Having a night stand butt up against the bed seems to work well in locked position as well as a couple of chairs locked in place...

Hi Linkabit
So glad to hear your dad is doing so well and is holding his own.
I hope his wish comes true and he gets to go home for a visit as soon as you are able to handle it and he is strong enough. Good job on the appeal!
Thanks for the update.

Last week I moved my Dad from the rehab hospital (skilled nursing) back to his room at the memory unit of his AL facility. He is much better than two months ago. He can walk short distances (using the walker), and was able to walk the short flight of stairs they have at the PT gym. He still uses the wheel chair for any kind of distance (like getting to the dining room). The PTs at the rehab place said they had done just about all they can do with him, he just needs to walk more and get stronger. The staff at the AL facility visited him a couple of times at the rehab hospital and said he qualified to return a month ago (but of course...that's their revenue stream).

I asked for "reconsideration" when my appeal of his discharge decision was denied. I got a call about a week later from the "Quality" bureaucrat who said a different doctor had reviewed the case and decided to reverse the denial and keep him at the rehab hospital. So, Medicare paid for the entire stay and treatment.

Cognitively, he's back to where he was before the fall. The staff at the memory unit said he still gets confused, asking about dead family members, but is still able to read, watch tv, and talk to the other residents and his visitors.

I spent most of April and May with him when he was in the hospital and rehab, but I had to get back home for work (and my own medical issues). I got one of the sitters to visit him every other day at the memory unit to see how he is doing.

So far, this has worked out, but it's only been a week. He hasn't fallen, and there haven't been any medical issues (UTI, etc) come up (yet!).

What he wants most of all is to visit his house, like we've been doing each month for the past two years. I'm afraid to do that until he's stronger.

Update after 4 weeks back at rehab: He's survived; thanks to the PT/OT staff at this facility, who have been very attentive to his needs, and the sitters that I hired who have prevented him from trying to stand up and walk several times. They are also my "eyes and ears" about the treatment he gets when I'm not there. Unfortunately, the aides that seem to genuinely care about the patients are in the minority. I'm there each morning before the sitter arrives, then I watch him do PT, then leave to go to work. I go back over in the evening to watch TV with him and make sure his bed is lowered all the way to the floor after he's asleep when I leave.

He has made lots of progress; he wasn't even able to stand when he got there. Now he can stand and walk 30 feet (with a chair in tow...his leg buckles sometimes). Still, his progress has leveled off the past two weeks. He has days when he can't wake up, either because of the pain meds for the surgery or the anti-psychotics for the dementia, or just because he's 91. It's only every 2-3 days, but it's kept him from progressing. I was notified by Medicare that his funding for staying at the rehab center was being cut as of this weekend. I appealed this decision, and the appeal was denied. I asked for reconsideration, which keeps his therapy treatments coming, we might have to pay for them if the reconsideration is also denied.

In the meantime, we're paying for two places; his apartment at the memory unit in the assisted living facility where he's been living, and now the skilled nursing rehab room. We can barely afford one, let alone two.

The admissions staff from the AL is coming to evaluate him tomorrow. I think they will have to stretch their standards to allow him to return to AL. Even if they allow him to return, I'm not sure that's the best place for him now. So, I'm back in the hunt for another facility.

This hip injury really changed our lives.

Here’s what I’ve learned from Moms past falls. If he’s to be at his current facility for a while I would ask for a wider bed they use for very heavy people. It’s harder to get out of. Mom got one and she’s only 95 lbs. Also ask for a visually impaired call button. Moms is a flat disk about 4” across, and we place it by her legs so that if she swings her legs over to try to get up, and they hit it, it will activate the call bell. Also elevating the head and foot of the bed just a tad creates a small well at their bum that’s harder to climb out of. We roll up extra blankets and put them under the fitted sheet along both edges of the bed. (This is tippytoeing around the restraint issue, so it’s not written down anywhere). Make sure there is nothing he could hit his head on near the bed if he fell. Move the rolling tables, walker, wheelchair etc to the foot of the bed when he’s in bed. Pad with foam any sharp corners like a/c unit. Make sure the bed is lowered to the floor and the pads are down on both side. She still sometimes has managed to roll out but hasn’t gotten seriously hurt since we’ve done all theses things. Good luck, falls are a constant struggle.

I just went thru the same thing with mom. No side rails is crazy. What ever group of idiots made that rule needs to fall out of bed and break their hip

Thanks for the thoughtful answers everyone. Dad returned to his rehab facility this afternoon, but it was a tough week. The complications have started already. While he was at the ER, they noted an abnormality in his EKG that caused him to be admitted to the cardiac floor to make sure he wasn't about to have a heart attack. That problem resolved, and we were supposed to move him back to rehab on Wednesday morning. When I got to the hospital, they told me that his white cell counts were up and they were suspecting a urinary tract infection, and his lungs were congested. UTI test was positive, so they started antibiotics and decided to keep him another night. Today his counts were all good, so he rode the ambulance again back to the rehab center.

I've seen a cognitive decline in him; he can't speak as well, and speaks rapid-fire like he an auctioneer. I can only get 20% of what he says. He doesn't remember he's hurt and he wants to move around, so it's only a matter of time before the next fall and we're back on the hospital merry-go-round again.

I got him moved to an "Alzheimer's bed" for the rehab place that lowers almost to the floor with padded mats around it, so that if he falls out, it would not be far. It will also be difficult for him to attempt to stand if he's that close to floor level, so he should be OK when he's in bed at night. During the day, I'm hiring sitters to stay with him to keep him from getting out of bed or his chair without help. I met the first one tonight and she is wonderful.

Thanks everyone again for all your thoughtful comments.

I hate to say this but.....
With dementia of any kind participation in rehab is VERY difficult and the chance for a recovery is slim.
There is
1. The fear of falling again that will make him resist rehab.
2. Not having a grasp of what is trying to be done and following instructions.
I do hope the people doing the rehab are well versed in doing rehab on/with people with dementia. Very different doing rehab with a 50 year old with a broken hip or a hip replacement and a person with dementia and a broken hip.

At this point maybe the very best thing for you to do would be have an evaluation for Hospice done. If he is not compliant with rehab Hospice will help immensely for pain and symptom management.
If he is compliant it is still very possible that he would be eligible for Hospice and they will help you with supplies and equipment that he may/will need.
Sorry to be a "downer" on this but dementia and broken hips do not go well together. Not even mentioning the broken shoulder.
Best thoughts to you and your dad.

I agree 1,000% with MAYDAY suggestions!!. **No one can watch another 24/7 - (I tried; unrealistic for the long haul!) especially if patient "thinks" they can get up, walk, toilet them-
selves and is just uncooperative due to dementia or old age**
I found a licensed, 6-person board & care, private home "15 mins" away...best thing I did for parents, me & my marriage. You're always the "advocate"; observe / oversee
(in partnership with facilty owner & caregivers) seek the best care for your loved ones; it is a process - For me, I choose to show up unannounced during visiting hours (10am-7pm), different
days & times to observe what's happening. I "openly" check for bruises, injuries, issues & ask parents if they are in any pain while putting lotion on their arms/ hands/legs/feet. I attend 1 meal daily (my mom must be fed; it's our bonding time) or every other day so I see food types, quality & amounts being served. I pass on occasion from feeding mom to observe how various caregivers feed my mom; I offer tips or show them better ways. Overall, every-
one's intent at facility is very good ...Yet, I don't believe in just blindly accepting practices / methods that don't make sense to me (as a novice or not) I ask questions!! We each have a brain; research online & learn) In any industry, it's human nature to become compla-
cent, but my job as an advocate is to be alert & bring attention to the facility owner if best practices are lacking for my parents & other guests in home -Note: must be done with a humble heart, spirit & tone! I have challenged Hospice management regarding practices that made no sense to me; after calm discussion using fact-based reasoning, we found agreeable practices that board & care iwner / caregivers would and could
implement. (Often board & care owners get stuck "between" laws they MUST follow, the hospice directives, and family member wishes - "It takes a village" of cooperation & good will. As an advocate; important to create the atmosphere of Win-Win-Win
(Patient/Family - Board/Care Facility - Hospice/Med team of doctors). I appreciate ALL they do; I am so grateful as I cannot do this alone (I earnestly tried and I was ineffective, destructive to my own health, body, marriage & finances)
Pray, Ask for & Get Help, Take Action; don't over think, Don't be afraid, Have courage. Good luck.

Linkabit
How is it going with your dad?
How are you?
Thinking about you.

CAn you try finding a "6 Pack"? Board n Care, private home style with 2 caretakers and 6 residents. They can get a hospital bed in there. Ask Hospice or Palliative care. 91 years old with dementia. If the PT or OT don't see improvement or he doesn't understand directions, then you may just want to keep him comfortable/

I don't understand why hospitalbeds are not allowed...

Perhaps doctor and prescribe a hospital bed, and then he can have the rails on.

If they have true hi-low beds they really do lower right to the floor making it pretty much impossible for someone to get up without help or to fall more than a few inches. The problem with restraints is that people with poor cognitive function will fight them, climbing over a full rail would cause a much greater injury.

You’re correct, this is the acceptable standard of care. It’s because of laws that have been passed, the NH has no choice but to follow them. I remember back in the 70’s as a younge kid going to visit my grandad in a nursing home. Everyone was restrained in their wheel chairs & they couldn’t hardly move. Evidently the laws have swung so far to keep that from happening nowadays that there is no common sense being used.

Grandma is pretty much the same way. She can't use the call button. She will try to get out of bed to go use the restroom. IVs are a disaster, she will pull them out. I warn them of this but they insist on having them even if she doesn't need it. They want it in just in case they need to push something. After the third or fourth time she pulls it out they wrap her entire arm so that she looks like a mummy.

Unfortunately this is the "standard of care". They are not allowed to restrain him. That's deprivation of liberty. Although they did this once to my grandma in the ER. They have a device for it. It's something they attach around the torso and then it's leashed to the bed. In that case though, I think the nurse did it more for his own convenience than for her safety. I had another problem with that nurse since he claimed to be too busy to help grandma with a bedpan yet had more than enough time to be chatting in the hall. His response when I asked was "She has a diaper on." Let's say he and I didn't end up on good terms.

All the other times I asked for both bedrails to be up, they told me they couldn't because it was illegal.

A bed alarm is no real solution either. Many times when that goes off they don't show up for minutes. A rehab or nursing home has even less staff. By the time they get there, they will already be on the floor.

As other posters have pointed out, even with professionals in the room, they can fall. That's why it's a pet peeve of mine when people say someone needs to be watched 24/7 to prevent falls. IMO, there is no preventing falls. You can reduce it but you can't prevent it. They can't even do it in a professional facility. Falls are common in rehab or nursing homes. Why do people expect someone miraculously to be able to do it at home? The people that say that have no idea what they are talking about. Generally it comes from people that no experience.

If you can get his doctor to write an order for restraints or alarms, there is an arduous approval process that would allow them to be used ( I'm told).

Can dad understand and cooperate with PT and OT instructions?

We were in a similar situation with my mom. We did hire a full time sitter. Mom fell with the sitter in the room; in fact there were TWO aides in the room . ( I'm told this happens frequently).

This fall broke mom's hip which immobilized her, and rehabbed well. She then lived in her NH for another 4 1/2 years.

I'm sorry you are in such a difficult and painful situation. I remember the angst all too well. ((((Hugs)))))))

Oh no. Linkabit
i am so so sorry. Unfortunately it does seem to be very common, this level of care in rehabs. And yes, sitters (who are well named) are about all you can do. My understanding is that they call the staff if the patient needs something. They don’t actually help the patient.
Does his hospital have a rehab that you can get him in?
You might be able to get hospice to provide an additional layer of care. I’m not sure that he could get hospice and rehab. Probably not. Talk to the doctor.
I know you will make the best decision for your dear dad. I’m sorry you are in this position I hope your dad’s pain is being controlled.
Hugs