Mom wants a PT even though she's not going to progress. What do I do?

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My mom, age 84, had a stroke in May and has been home for a few months now with 24/7 care. She had a lot of PT in the rehab place and then had some private visits at home which were covered by Medicare. She can stand, but her left leg was affected by the stroke. She can't walk and the Pos believe she will not walk again. She has been asking me repeatedly to get her a PT (for in-home sessions) because she wants to walk. I obviously don't want to discourage her, but I can't imagine a PT is going to work with someone who has "plateaued." There really is nowhere else to go with her physically. I guess I will call a PT and tell him/her my dilemma. I'm not even sure where to find one, as most of them seem to work at PT centers vs home visits.

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Your mother is MOTIVATED and that is about half the battle..now it's the difficult, maybe impossible task of getting her body to "agree".
I know Mother had in home PT following all her various surgeries. As soon as the PT had run out, she just did nothing. She can walk, but is definitely slow and walks so hunched over it's painful to watch. Her motivation was zero. I asked her PT if she was "capable" of standing up straight, as it looked so painful to se her bent in a C curve. He said "Yes, she can and if she keeps up her exercises, she will continue to improve, to a point."
By the next week, with no PT coming, she is bent completely over and shuffling in her walk...no cute PT guy coming, no reason to stand up!
If you cannot get PT in the home--see if you can learn a few strengthening exercises and just keep her spirits up, if nothing else. Even bedbound patients are given some kind of PT, improving blood flow, etc.
Your sweet attitude is wonderful--I know how much it would mean to your mom to not be in a wheelchair for the wedding---but that sounds very unlikely. Still and all, I'd do whatever to keep her hopeful without being overly "sure" that that's the outcome she'll get.
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I actually got my mom an appt with a neurologist tomorrow. She keeps asking me if this doctor will tell her she'll never walk. Sigh. I do hope the doctor wouldn't say such a thing, because it would depress her so much.
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Thanks so much for that advice about her hand, Churchmouse. That sounds like a great idea. The rehab place gave her a brace to keep it from clenching, but it's stiff and uncomfortable.

I am taking her to a neurologist in a few weeks, so that should be helpful. And I found a PT place that does home visits. Hopefully the neurologist will give us a referral.
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Your mother wants to get better which is at least half the battle. Do all you can to encourage that goal. If all else fails then get a book with exercises in it that you and her 24 hour caregivers can do with her. She may have made as much progress as conventional rehab has provided but have they looked into things like supportive devices for that leg so it does not give way when she tries to move. Can't remember what they are called right now.
Of course we all know what will happen when she can't stand and get out of bed but she has not reached that twilite zone yet so continue to encourage her and believe she can do it. You might be amazed at what she can achieve with her motivation.
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Not to depress you, Xinabess, but that clenching is not good - it's uncomfortable to painful, and it can progress. So if you can't get a PT in pretty soon, do the massage yourself, with some lotion she likes the scent of, and wipe off the excess carefully.

You'll also need to wash and dry that hand really thoroughly for her. It'll get sweaty and before long yeasty - not nice. We were told to roll up a soft cloth, a face flannel is a good size, and close her hand around it to stop the fingers getting too tight in a ball. Remember to change the cloth frequently. Be firm but careful when you're manipulating her hand so as not to hurt her.

When your mother insists on unrealistic guarantees, just agree and point out cheerfully that if she wants to reach her goals she'll still have to start somewhere. I really hope you find someone soon - why not call the centres anyway and ask if they know of any freelance practitioners? You can't be the only one whose mother can't go to them.
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Thanks, everyone. It is good that she is determined to walk (though it is extremely unlikely that will be possible). She told me she wants a PT who can pretty much guarantee she will walk again (sigh) and to find her stories of people who recovered fully from a stroke. It is sad, too. She keeps asking what will happen if she can't walk or get out of bed by herself ever again. To which I say: then you'll have to use a wheelchair. That does not sit well with her (no pun intended). The other issue is her left (dominant) hand, which is also completely useless and clenched. I just hope I can find someone. So far, I've only gotten references to PT centers, not in-home services.
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Above 97yroldmom is correct about 'progressing' and 'maintaining', and there being different therapies.
I believe the key phrase the ordering physician should use with the insurance companies is "the patient will get worse without treatment".

Hope this helps-be sure to appeal their decisions.

Who was it that completely over looked the fact that really wanting to walk is progressing!
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A little pep talk for you here. Call a home health agency in your area and ask them to help you. Ask them about your states rules for home health and therapy. Tell them your mother is better now mentally and ready to work with the therapist. Give them your mothers drs phone and fax number. Make a call to your drs office as well to let them know to be looking for the home health fax. Remember you are your mothers advocate. Make up your mind that you are getting this done. They will come out and evaluate your mom for services. I think they might even do the evaluation with out drs orders. You have to let them do something for her. Set up her pills, take her vitals. Help with her bath. They will have a PT and/or OT come and evaluate her for therapy. There is more to therapy than progressing. There is maintaining. If she doesn't continue the exercise she will lose the benefits she gained when she had therapy. Plus not all therapist are the same. My mother had physical therapy for years. Medicare paid for it. She needed it to keep the strength in her arm. Without the therapy she couldn't keep the muscles in her arm strong in order to lift her arm. She also needed the foot pedals to help her heart. She walked with her walker everyday. She knew that the more she moved the better off she was. If the first home health can't help. call another. Ask them what pt groups they work with and get their number if you have to go it alone without the help of home health. In one session they can show you how to help your mother. Which exercises for her to do and how to do them. You can also get reduced rates at some therapy facilities. I wouldn't call the ones who gave up. You need someone with as good of an attitude as your moms. Also consider mental therapy. She is motivated by the wedding right now. Use that motivation to help her progress on all fronts. Otherwise when the wedding has passed she may fall into a slump. Looking forward in life is a very positive sign for all of us. Good luck.
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Xinabess
I believe you can get a dr to prescribe home physical therapy as she has 24/7 care in home
The key here is that Medicare may only pay for so many sessions per year but it is a new year

The other thing that I found that makes a huge difference is finding the right home PT - did mom like the last one that visited ? If so great - otherwise it can be hit or miss - I found some are difficult and schedule at their convenience I.e., I'd ask them to come in the afternoon but they'd come at 9:00 am when mom was either still asleep or eating breakfast

Please try as if mom is willing any movement and massage will help her
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Thanks. She is determined to walk before my niece's wedding late next month. Sigh. It's so sad. I can't imagine I will be able to get a doctor's order.
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