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She is 87, has congestive heart failure (CHF) and a congenital hole in her heart, is on oxygen 24/7, and is 90 lbs. She was under hospice (well, until today when she was rushed to hospital). She has a DNR. Orthopedic surgeon gave us two choices, surgery to put two pins in (femoral neck fracture) or palliative care.
This is very new to me and I don't know what is in store for her. She can't go back to memory care because she will need full-time care. What should I do?

S Wright, you have my condolences. You made the right decision as with her preexisting health conditions in addition to what others have said regarding respiratory ability, she would likely have had anesthesia issues and not able to participate in post surgery PT / OT rehab. So she’d end up being bedfast even with hip repair.

My mom - backside of her 90s & with Lewy Body Dementia - fell in her NH shattering a hip & the choice made was NOT to do surgery, so she went onto hospice staying in the NH. Hospice for 18 long l....o...n...g months of being bedfast. Hospice was wonderful but nevertheless it’s heart wrenching if their taking forever to finally finally die.
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Reply to igloo572
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Swright, I'm so sorry for your loss.
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Reply to BarbBrooklyn
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I would much rather have been wrong.

But I hope there is consolation for you in knowing that your mother was so frail and so very tired that she was genuinely ready to go.

Don't forget that a lack of response does not necessarily mean a total lack of awareness. Your presence may have been more comfort to her than you know. And at the very least, you know you did take your proper leave of her. My condolences to you and all your family.
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Reply to Countrymouse
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My mother passed away Monday, July 16. She never responded to any of us nor opened her eyes after they gave her morphine at the hospice facility.
As far as how she fell, we talked to the caregiver and she said mom stood up and fell, which leads me to believe that her femur fractured first and then she fell.
Thank you for all of your thoughts.
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Reply to swright2
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I'm so sorry you and your Mom have to go through this. I sounds like you received some good advice and opinions from experts. When we had to make a difficult decision for our Mom, it really helped to have that!

I hope the rest of her journey is peaceful.
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Reply to chdottir
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SWight2, I think you made the best decision possible. Undergoing surgery probably would have been very difficult for her. At least now, Hospice can keep her as comfortable as possible! Again, so sorry, take care!
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Reply to staceyb
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Update: we decided to do palliative care instead of surgery. Orthopedic said she may not come off intubation bc of her respiratory issues.
Last night she was in respiratory distress here in hospital that she is now on 10 liters of oxygen and is in the mid 80% of saturation.
We have decided to place her in a hospice facility. Hospice came to evaluate her and said she will pass very soon. They will be taking her very shortly to the facility. She is on pain medication and is sleeping most of the time with an occasional look of sadness. This hospital is a trauma center so two trauma doctors checked on her and one voiced her support for our decision which made me feel better.
I thank you all for your responses. God Bless
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Reply to swright2
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I'm so sorry this has happened to your Mom, as if life weren't challenging enough! What was your Mom's quality of life like prior to the fall, was she walking without assistance, with a walker? Is your Mom able to verbalize her wants and needs, her pain level?

Whichever way you go, there is going to be a certain amount of recovery, if no surgery, she will likely end up bedbound, but if surgery is decided, then there would be a lot of PT to get her up and around, and ambulatory again, and of course both ways, her pain levels will need to be addressed. From the little bit I know of this, if no surgery is the route you end up going, making sure adequate pain relief is delivered, as often is the case, so be sure to be on top of that!

I think that the most important thing is her comfort, and her quality of life, for the remainder of her life. The impact of the anesthesia will be most concerning, and if she is even strong enough to undergo surgery in the first place.

Speak frankly with the Orthopedic Surgeon Dr regarding the risks and benifits and ask him what he would do if this were His Mom, that's what I'd do. Whichever decision you make, once your Mom is admitted to the Nursing home, she should get right back onto Hospice, so they can keep her as comfortable as possible. Again, so sorry!
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Reply to staceyb
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What a shame, the fall was the last thing she needed (and you).

CM makes a great point. Are her bones strong enough to support pins? How mobile was she before the fall?

I wouldn't want my Mom to have to endure surgery at 90. If she was on hospice she must have a terminal disease, right? So why give her anymore grief?
Good luck to you both. I know these choices are heart wrenching.
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Reply to Pepsee
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I'm so sorry- is mom in a lot of pain ? Did ortho think her heart could stand the surgery? No one can understand your mom better than you - do you think she would want the surgery ?
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Reply to MsMadge
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Another question you'll need to clarify: did the fall break her hip, or did a silent fracture cause the fall?

The reason it's important is that there is, forgive me, bugger-all point in putting her through surgery if her bones are so fragile it'll be the other hip next (or, indeed, it proves impossible to pin this one). Is there a DEXA scan among her records? - that would tell you about her bone density.
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Reply to Countrymouse
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How is she taking it?

I'm wondering if perhaps the thing to do is to see how she's responding to what's happened before you come to a decision. I also think it's a bit much for the orthopods to dump this choice squarely on you. Does the hospital or would hospice have or do you know a geriatrician or dementia specialist you can talk this through with?

The surgery isn't as obvious a no-no as you might think, there are ways round the obvious problems, but it depends on how "manageable" for want of a better word your mother is as a patient.

As your mother is on hospice, though, how much of her remaining time do you want her to spend in recovery from surgery...?

This is a very complex situation. If it were me, I'd want to sit down with her primary medic (the one who knows her best, rather than any particular specialty) and go through the risks and benefits. Including what options either choice leaves her with next.
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Reply to Countrymouse
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It sounds like she will need to go to a nursing home on hospice care. Since she was already on hospice she would still be eligible -- her health certainly hasn't improved. If that was the best choice before it is still the best choice. If her present hospice company doesn't serve the new location, they can give you advise about other companies that do. Hospice will work toward keeping her out of pain and comfortable. They will provide a special wheelchair and perhaps a different bed arrangement -- anything they can think of to improve her comfort level.

Is her Memory Care unit associated with a Nursing Home?

I am so sorry about the fracture.
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