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I found out from my parents that my mom’s outpatient PT that she is making my mother walk up and down their driveway that has a pretty steep incline. Of course she is with her and guiding her with her walker, but I feel this is far too aggressive. And since she has dementia, I feel once PT is over, she might take this upon herself to get the mail, which would be disasterous. She also wants my dad to help her with an awkward two step down onto a tile floor to do laundry.....which is where she fell to begin with. My sister and I do the laundry, but has to be done according to our schedule which apparently isn’t good enough. She also expects him to take her outdoors that is grassy and uneven. My dad is 90 and shakes a lot due to the beginnings of Parkinson’s. Mom has severe osteoporosis, PMR, and compression fractures. Needless to say she is a high fall risk. She is also on meds that could compromise her balance. With her dementia I feel she is being encouraged to do physical activities that will lead to another fall.


All things considered they should be in an AL facility, but both refuse....their home is too large and they would never spend the money on the renovations (bathrooms, ramps, etc.). I am going over to speak with the PT, but I am getting resistance from my parents. They both like her, but I’m afraid she is setting up unrealistic goals that will put my mom in jeopardy. Am I overreacting? Or should I speak with her and see how the PT orders were actually written?

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I think you had better assume that the PT knows her job. By all means ask questions, but at the same time respect her professional expertise.

I do sympathise with falls risks, I do know how stressful it is to worry about them, and I would have been with you in fantasising that it were possible to make mother lie flat on the floor and not move.

But we are wrong and the PT is right. If you want to reduce the falls risk, then weight bearing exercise is the way to go through improved muscle tone, stability and even bone density (eventually).

As for making your mother overconfident - if she doesn't remember that she can't walk around safely without help, why would she retain new information from her PT sessions all of a sudden?
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Abby2018 Apr 26, 2019
I agree with all the strength training and weight bearing exercises that PT insists upon. I feel as though I am getting conflicting advice from her Rheumatologist and what PT expects to accomplish. Compression fractures were brought on from her merely twisting her torso making beds. Even though she got her first shot of Prolia, she remains on Prednisone due to her PMR. She is also on Tramadol for pain management.....which can compromise her balance along with HBP meds. In short, I’m just not sure if PT is aware of all of this.
Mom can be exceedingly stubborn. She fell because she refused her drs. order to use her walker at all times for stability purposes. If she gets something in her head, she’ll do it with no thought of consequences. I fear PT is opening doors that are just not safe. Why have an 89 woman walk on very uneven terrain if her ADL’s are compromised? And I really question my dad being her caregiver to begin with..... he will now be responsible for keeping her from falling??
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I agree with what CM says.

But please understand first and foremost that you are hearing this information from your parents. Who, if I may put it kindly, from your other posts, sound as if they might be unreliable reporters.

You might do well to ring up the PT and have a friendly chat about what she thinks about your parents' living situation, what are her goals for therapy and how you and your sister can support her efforts. And like that.

My mother claimed, while she was in rehab, that they were making her manage all her own medications. Had I not been sitting right there, watching the nurse dole out her pills, I might have believed this particular delusion.
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Abby2018 Apr 26, 2019
Oh please....the meds! Another nightmare scenario! But back to topic.....this is the very reason why I want to speak with PT. I’m not really sure she has all the facts necessary. In the past, after her hospitalizations the outpatient PT’s had a very different approach...and I think because the orders were written for her compression fractures and osteoporosis. Strength and mobility exercises.....with a high regard for her fall risk.
Because of mom’s diminished mental state, and dad’s desire to go along with anything mom says ( to keep the peace) I’m not sure if PT is fully aware of the situation.
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Abby, deep breaths.

Yes, call the PT and make sure she's aware of all the doctors' orders.

But try to understand that you have Zero control here. You cannot force your mom to do anything. You cannot fix what's wrong.

Once I looked that square in the face and had a good cry, I got some of my mental health back.
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Abby2018 Apr 26, 2019
Ahhh....thanks for that. Sometimes I feel as though I’m losing it too. I do have a tendacy to overthink, but to be honest, my fear is not only based on mom’s falling, but mere selfishness on my part. I know I do not have the mental and emotional strength to be a full time caregiver and that decision will have to be made sooner rather than later. At 68 my plate is already full with grand babies and a husband with heart disease and multiple myeloma. There is no way I can extend myself to the care they will need. In the interim I try my best to keep them safe and continue to harp on the benefits of AL. So far this has landed on deaf ears.
One thing I have learned from this is my limitations, and know I have done my best to keep them safe while living in their home.
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Abby, I was in the same situation with my folks. They refused any help, home care, meals on wheels, Dad was driving, getting lost, mom was falling, wouldn’t use her walker and on and on.......And would not EVEN discuss assisted living.

It finally took a bad fall that put mom in the hospital and she had to be drug into the hospital under protest, bleeding from a head wound. After a few days I had mom moved directly to assisted living from the hospital. Then moved dad in a few days later.

Unfortunately this is pretty common. You can’t fix this or stop this ship from sinking. You can only do as much as they will allow. You will not convince them to move.

Just be prepared when a crisis hits. Have a facility lined up. If at all possible get control of the finances, POA etc. Tell mom or dad THIS IS JUST TILL YOU GET BETTER.

My folks could’ve had 2 or 3 years of good care and activities in assisted living but I couldn’t force them until there was simply no other choice. Most of us caring for elders end up in that horrible void between competence and lack of reasoning. Mom died about a year ago and dad is in memory care in the same facility getting the best of care.
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Abby2018 Apr 26, 2019
Sorry for the loss of your mom......and happy to hear dad is getting the best of care. Yes, they can be stubborn....but even in difficult situations lessons are learned. Hindsight is 20/20, but in the elderly sometimes it’s just too late. I know my dad would love the social aspect of being in AL.....and in time ( once over her anger and resentment) mom might even take a liking to it. At least I know she would be safe (more so than living at home) and her needs taken care of. But you are correct....We can’t force our parents to do anything they don’t want to do. As long as my dad is of sound mind my DPOA won’t help. And I need to respect their wishes.....but I won’t and can’t do more for them than what I am now..... which is where their expectations will lead in the near future.
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May I gently say that yes, perhaps you are overthinking this?

If you question the PT, then talk to her! The fact that your mom can still walk is a huge plus, so any training on walking and mobility is going to be beneficial.

I think you're giving your mother, who has dementia, too much credit for thinking, planning, remembering-- these are all diminished in dementia.
You can't control what she 'might' do in the future. That's impossible.

If the most important thing is keeping your parents safe, then you have to find a way to get them into AL. Is there such a thing as an intervention for the elderly? If they don't do it now it's going to get more and more difficult. If there home is large, can it be sold and use the $$ for the AL?

My mom was very angry with me when we initially went to AL, as in, how dare I put her here!...and that very quickly turned into Memory Care. I was unable to assess the situation, and she was past the point of AL.

Another possible solution is to see if you can get them into a local day program.
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Abby2018 Apr 26, 2019
We’ve been trying to get mom into day programs, but she refuses. I think the stimulation from being with her peers would be very beneficial..... and open her mind for safe alternatives to occupy her time. As it stands now....as it has in the past ..... her entire focus is on her house and her possessions. And that is what prevents us from moving her to AL. When your “stuff” becomes more important than safety....it is very difficult to reason with. She does have an appointment with a geriatric specialist who will assess her mental capacity....and she is already refusing to go.
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:( I was sort of hoping the diagnosis might not be 100% certain and there might be hope of ditching the steroids but you've clearly been watching that one like a hawk. What a total bummer for her.

The better her mobility the more comfortable she'll be.
Plus, the last thing you want is her feeling discouraged. As long as the determination is coming from your mother it's probably good for her morale, too.

I should just bullet point the clinical history and make sure the PT does have the info.
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Abby2018 Apr 26, 2019
Thank you and that’s my plan....I honestly don’t feel she is fully aware of mom’s past history. Often times when my daughter was realeased from orthopedic surgeries PT orders were for rehab for the surgery, not always considering the underlying issues. I was her voice and advocate......can’t always be with mom to supervise : (
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Abby, if your mother falls again and needs more care, that does NOT produce a situation in which you become her caregiver.

Old people fall. All the time. She will fall and it will mean that next time, or the time after, she will Not be able to return home. NOT that you need to move in to provide care.

It doesn't matter how mad she gets. Her anger cannot hurt you. However, caregiving for her CAN kill you. And materially damage your husband's health and care.
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Abby2018 Apr 29, 2019
Thank you ...... at this point we are more or less biding our time. I was with her most of the day on Saturday and she continually does things she shouldn’t, even though she has aids near her ( reaching sticks in every room etc.). Also caught her not using her walker. Unfortunately she won’t see the geriatric neurologist until early June....takes months to get appts. We had to cancel her last one because of the fall.....and her dementia has gotten worse since surgery.

I couldn’t possibly do more than I am currently....and I am accepting the realization she WILL fall again. I would just be more comfortable if dad would understand the seriousness of the situation. I’m a planner, like to have my ducks in a row.....and this drives me nuts!
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Abby, that is a point you can check direct with the PT very easily and with absolutely no fear of treading on her toes: has she been given the full medical history including px? She should have been, but - !

The ramp up to the garage might look to you like mountaineering for your poor mother, but actually it's a really good surface - flat but with a gradient, it's ideal.

This is purely me being nosey, but when was the PMR diagnosed/how long has your mother been on steroids?
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Abby2018 Apr 26, 2019
You can be nosy....the more info.... the better your advice will be. She was diagnosed last September and was started with a shot of steroids and than 10mg. once a day first thing in the a.m. we were able to gradually wean her down to 5mg. and holding at that doseage. Before her fall we tried several times to wean her down to 4mg.....each time resulting in a flare. Even though we have her pain management under control (she was on Tramadol prior to her surgery) she feels it is not a good time to lower her dose. We have tried lowering her dose for Tramadol as well, with little success. Rheumatologist feels at her age, keeping mom comfortable is the most important goal at this time, which is why I question PT’s approach.
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Hi Abby,
Is anyone else at your parents home with them (at least during the day)?

From your description of your folks, I agree with you, they belong in an assisted living facility. Since your dad is of sound mind (I’m assuming) and he refuses to relocate, they had better be as prepared as they can be to handle ALL aspects of moving around in their home. I think this is why the PT is assisting with these “dangerous” exercises. He is showing your mom how to safely traverse the same area where she fell.

Neither of them are going to sit in one spot and not move so it’s better (in a less than perfect situation) that they understand HOW to maneuver inside and outside their home.

I’m sorry for you being between a rock and a hard place. Elders loose the ability to see the situation for what it is and dig their heels in. In my humble opinion, it sounds like it’s time to hire a home care aide.
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Abby2018 Apr 26, 2019
Hi Sue.....That’s the problem....they both have the Pollyanna ish attitude that things will get better and that the future will be a bright and happy place where they can do ( well mom... can do) things they haven’t done in previous years due to decreased mobility. They are not preparing for the obvious decline in the years to come. Again, part of the resistance to move to AL. Home aides? At this juncture, not a chance. They have my sister and I to do the basics and they both will be glad when outpatient services ends. That’s when the real test will begin.
As for PT....I plan on discussing mom’s other health issues she might not be aware of....and if she is, I will call mom’s Rheumatologist to make sure she is on board with PT’s approach.
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Home Care PT consists of a physical therapist but often those who see the patient at their homes are Physical Therapist Assistants (PTA). The licensed PT determines the treatment plan and often the PTA implements the PT plan.
First ask if the PT person is the therapist or if it’s a PTA. If it’s a PTA ask to speak with the senior PT and review the treatment plan. If not and the staff person is the actual licensed PT then discuss the plan with her.
I was a home care nurse and having seniors walk up and down their driveways was a common exercise (of course if the gradient is reasonable).
I understand your concerns about after PT leaves but she won’t be unattended during the day, will she?
Unfortunately falls are a common occurance in the elderly.
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Abby2018 Apr 29, 2019
Thanks for the input. I found out the director of the rehab facility is the one that approved the orders for PT at her release. He was fully aware of her health issues and meds. Apparently in order to release home PT, certain milestones need to be approved. I get that. My concern is for after home services is done, she’ll forget everything they taught her for safety and will take it upon herself to do things on her own ( we had problems with this before she fell).....fiercely stubborn with a strong desire to be independent at her own risk.
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