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Mom has had arthritis in her left knee for years. She's had several falls over the past year. The first one was when she was living in Florida, and I'm in Maryland.
In Florida, she fell, went to the ER, and they shipped her off to a rehab center. They were horrible, and did not help. It was so bad that my girlfriend and myself had to move her out of Florida, on one week's notice, and into my house in Maryland. She was living with us and it seemed she was getting better, when she took a fall in a grocery store. It was all downhill after that. All her confidence was sapped away, and she fell several more times, the last one resulting in a broken hip. Once again, she entered a rehab center. It seemed to me that she was getting better, but they said she was not progressing.
Now she is in long term care, where they don't do therapy, but "restorative nursing". I'm seeing her actually now go downhill, physically, and mentally.
She is just sitting in her wheelchair during daytime, even during activities. In the evening, she's in bed for 12 hours.
I've spoken to staff numerous times, and they say restorative nursing is all the law allows. I asked if we could bring in outside therapy, but they said no.
There is something very wrong with this, as I know she can get better. Maybe not fully, but I know with some real help, there is hope.
I'm at wits end and so is she.
Please let us know any suggestions you might have.
Thank you do much!

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I'm so sorry that you've had so many problems with the nursing home or rehab center she is in. You're right if the patient does not progress during therapy they just stop it. When my mom broke her knee and went to rehab my dad and I were there everyday being her cheering squad and did everything we could to keep her motivated. I can't say the same thing for the staff, though. They really did almost nothing to encourage her to stay motivated...it was an 'Oh well' atitude that was most disturbing. My mom has Alzheimers and needed all the help possible to stay motivated. I don't know why the staff of these places don't really sem to be in tune with their patients.....a lot of my moms therapy was stringing beads or putting pegs in a board...Really? for a broken knee?
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My loved one's doctor told me that Medicare will only cover physical therapy for someone in a wheelchair to get back on their feet, IF there is a good chance the patient can be rehabbed in that way. I don't know if that is true or not. I'm looking into it now, because I do want my love one to keep her strength if possible, even though she's now in a wheelchair.

When she was still walking, my loved one's legs grew very weak and she had very poor balance. She was falling frequently. After a fractured spine, injured foot, broken hand and other bumps and bruises, it became apparent, that she was not walking well. If she did not go to the wheelchair, she would have likely broken a hip.

The patients in wheelchairs that I have seen in assisted living and the memory care unit, have the feet removed from the wheelchairs. They are still able to move their legs and feet and push themselves along all over the place. They can dance in place while sitting in their wheelchairs, too. Anything to keep active. It's not a great option, but IMO, you have to weight the risk of repeated falls and fractures.
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Three questions:

How old is your mother?

Why is she falling?

Are you willing to take her into your home and get her meds and diet adjusted to where she is functioning again?
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My mother is pending medical assistance. But here in Maryland, I am told it could take 3-12 months, maybe longer. Can't really wait that long.
My mother wants to get better, so she is willing.
I can just sense the lack of help she is receiving. I am there at least 4 times per week. Unfortunately I work and can't witness day time activities. I have taken off so much from work, I dare not ask for more time off. So I can't see what they actually do. But I can tell you she is doing much worse than she should be.
The excuse I keep hearing is that she is on "restorative nursing", not rehab.
Apparently it's the law? I'm ready to get in touch with state officials to see what the law actually is. I need to get the state involved with this situation one way or another.
Again, I'm doing this on my own as I am her only family, and I work 6 days a week, so it's a tough fight.
Very frustrated as I have been trying to get her on her feer for over a year, but seems like every approach I have taken has been the wrong one.
Thanks for all your help. Seems I'm not the only one who has had these problems.
The health system needs a major overhaul!
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Perhaps ask for a Hospice organization to evaluate her?
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Situations can differ from person to person. I know there are some facilities from h*ll out there. We do have to step back, though, and ask ourselves if it is the facility or if our loved one has chosen a path for themselves. Our parents are old and sick. Chances are that most are nearing death and some are addressing it in their minds. We do need to hear their "I don't want to do this anymore" and respect it. We want them to be better and hope that someone can fix them. What matters most, though, is how the elder feels. There comes a point where they are ready to stop, and there comes a point where they are ready to cross over to the other side. We know our loved one, so can usually figure what they want. We know their age and their health. There comes a time when we can't fix things anymore. All we can do is recognize this, stand back, and put it in God's hands.
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This is a difficult situation, one faced by many. They are just warehousing her at this point and you are right that they don't care. It is all about what gets paid for. My father, 96, recently died in his sleep in rehab after a fall after one week. In some ways it was a mercy. He stopped eating and was getting frustrated- I was planning on bringing him home but it would have been a long, painful process. Fortunately, he had the funds for home care since insurance usually does not pay for that. If you have the ability, perhaps you could move her to a better place or provide your own physical therapist to help her if they will not. Perhaps you can bring her to a clinic for therapy. In any case, just visiting and keeping her spirits up is a wonderful thing.
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Is she there "Medicaid pending?". You need to ask the director of rehab or director of nursing to have her reassessed once she goes on Medicaid. If she has regressed, they can start therapy again.
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I suggested the home helpers. But I don't think any insurance will pay as they are nonmedical helpers and probably deemed nonessential.
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My mother is currently on medical assistance, but it's pending. I was told that she would receive all treatment as if she was on medical assistance, including restorative nursing. Their idea of restorative nursing is walking her twice a week for 15 minutes, plus some activities. But the activities take place in her wheelchair.
My mother was willing at some point, but while I watch her struggle to get out of that wheelchair, I see why she is giving up. Not too long ago she could get out of that wheelchair, but when the facility basically has her sitting in it for nearly 1/2 day, I see how it becomes a struggle. Again, I have talked to different staff numerous times, and have been told the same thing.
By the way, this is the third rehab center, in 2 different states, that have told me the same thing regarding going from therapy to restorative nursing. They all have told me that if she does not show progress, that's the end of therapy. It's a ridiculous way to treat elders. She was absolutely showing progress after she broke her hip. While in therapy, she went from just laying in bed, to walking 200 feet behind a walker. But she lost all that when she went to restorative, because they do not help her.
She has Medicare and a secondary insurance, but I do not think they can provide 24 hour assistance. I looked into this after her previous falls, but I can look into it again. She absolutely needs 24 hour assistance as she is diabetic as well and needs her medication. And I feel it is unsafe for her to be alone.
My mother does speak English, though with an accent. She used to be in good spirits when she was in therapy and getting around better. That gave her hope. But the lack of effort by staff is diminishing her hope and her spirit.
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I have been in rehab, for a knee replacement. You have to be self-motivated and she is not. I think I would work on her depression first, and when that is getting better, move on with the PT.
I have seen other knee replacement patients who do not work at their PT on their own time. They do not make progress. If you go to PT 3 times a week, you have to repeat those exercises on your own the other 4 days, or nothing is gained. A year later they are no better than before surgery.
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Restorative nursing typically involves getting the person moving about as much as possible. If your mother is able to walk, she would be encouraged and helped to walk. They are probably not adding other therapies to her program because of insurance. If she did not progress at rehab, further investment in PT and OT would be denied.

Do you think you mother is not physically able to do things, or do you think that maybe she is giving up? After an elder gives up, there is nothing that people can do as long as there is the mindset. How old is your mother? Does she speak the language used in the facility? Does she have any other problems beyond the arthritis and immobility? If we know a bit more, we would have a clearer picture of something that might help.
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Oh! Ok. Then where are the staff getting the idea that your mother can legally only receive 'restorative nursing'? (I'm not familiar with what that includes, by the way) I wondered if your mother was perhaps refusing treatment, or has an advance directive of some sort?

It sounds possible that your mother has other medical conditions besides arthritis. Were her falls related, perhaps, to TIA's or stroke or blood pressure problems?
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Why not bring her back into your home and use a home health service to monitor her. Then you could bring in your own outside therapy. I don't know the issues related to finances, but you certainly have the right to move her somewhere else if she is open to having therapy but cannot receive it where she is at.

My mom broke her hip 11-2. She had surgery, spent 3 days in the hospital, 16 days in the rehab center, and is now back home, with home helpers basically around the clock when I am not there. She gets physical therapy twice a week. She is 88 and right now frustrated and overwhelmed. I don't know how it will all end, but at least she is at home. I say get her out of that facility and somewhere that is open to the possibility that she can get better through physical therapy. Good luck!
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I am her son and the only family she has here in the U.S.
Therefore, I make all the decisions regarding her health care.
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Is your mother making her own decisions about her health care? If not, who is?
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