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My 89 year old mother fell and broke her hip last week. She has early onset dementia which is worsening at SNF. Dad is 90 and both expect her to return home after completion of rehab. Prior to her fall she had compression fractures in her back and PMR (polymyagia rheumatica). She has severe osteoporosis and is on a low dose of prednisone and pain meds and has high blood pressure. She was considered to be a high fall risk....which will only be worse once she gets home. She used a walker and has a commode in her bedroom. Pain management has been an issue for the past 6 months. I have no objection to her returning home, but I think the level of care she will need will be overwhelming and my dad certainly can’t be the caregiver. Up to this point we ( siblings...sister, brother not so much) have been doing as much as we can to help, but we have families, grandchildren to help care for etc....I can’t see us in a position to do more than we are. I would love to see them move to AL, but mom is stubborn and has refused to even consider the option. The house itself is a burden and not nearly as safe as AL would be. I guess I’m asking if anyone else could share their experiences with the very elderly coming home after hip fractures.....I am well aware of the complications and prognosis. Thank you!

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I’ve been in your shoes, and I know how hard this is. We begged & pleaded & couldn’t get my mom to agree to assisted living or hiring in home help, and yes, she had the money for it. She was only 75 & it was back surgery, but she had early stage Lewey Body Dementia. APS said she was still Mentally able to make her own decisions. Long story short she came home after rehab, wouldn’t listen to anybody & had dozens of falls. One year & another back surgery later (because of those falls) she was unable to walk & can’t stand at all. Now, all her money has been spent on24/7 round the clock care in her home. She’s currently in a nursing home. If your mom & dad are still mentally competent, you might have no choice but to let them “self destruct”. Which is a very, very hard thing to do!

PS: Between mom’s two surgery’s I still had preteens/teens at home, and was beginning to be neglective of them while trying to do so much stuff for her. I had to back off helping her then dealt with her pleading with me to come do her laundry, take her places, etc. (I was still taking her meals & to Dr. appointments) Once she realized I wouldn’t back down & do more she brought in help for about 12 hours a week, but at that point she had greatly physically deteriorated.
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At age 89 I don’t think it’s early onset Dementia. It’s Dementia. Do you mean early stages of Dementia? At 89 I think she will not be coming home. For some reason such a serious fall tends to make the elderly go down hill fast. I think you really need to talk to hospital team first
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Abby2018 Mar 2019
You are absolutely right....it IS dementia....we are unable to test her as she is adamant that her “brain” is fine, but has all the classic symptoms and maintains the diagnosis as such. She is in SN now and they she is doing well. With her other ailments, I think the bar is probably set pretty low. That said, my fear is that once released she will return to old habits because in the past she has refused to be mobile because of pain. Visiting PT stopped visits because of her lack of cooperation. She is lucid enough to be very manipulative and will convince all involved that home would be the best environment moving forward. I disagree, and feel this will be a very short term option.
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I’m reading your question to mean that your mom has mild dementia. (Is mom 89 or 99? Your profile says 99.)
Your question is whether anyone has experience with an elder who has broken their hip coming home after rehab.
I have but they were both men and didn’t have osteoporosis. They did fine. They both had wives in worse shape than they were. One was my FIL and the other an uncle. 87 & early 90s. They had a full recovery and no additional help after rehab.

However, my aunts neighbor lady had osteoporosis. Her hip broke, she was in hospital and then rehab. She then came home. Her daughter and SIL came from out of town to care for her. She was in terrible pain. She got better but one day a few weeks later she was standing at her Frig and with just a simple move her body seem to crumble. Back to the hospital and then a move to her daughters city to go into a SNF. She never recovered.
That would be my concern for your mom. The osteoporosis, not the broken hip.

Have her assessed for the appropriate level of care as soon as possible to help guide your decision.
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Abby2018 Mar 2019
She is 89.....and both her and my dad have convinced the staff that she will have the necessary resources for her care at home. Yet they won’t hire anyone for the care she’ll need. There is only so much my sister and I can do.....she can be VERY manipulative when it comes to getting her way......has been all her life. She is also stubborn and after being told a million times she was NOT to go anywhere without her walker (yes, she was aware that a fall would be devastating) she tripped and fell while the walker was in another room. SN is well aware of my concerns.
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Re discharge plan, due to AD and her age she may be able go to a skilled nursing facility where PT can be continued (if approved by Medicare) When I had THR surgery, at age 65, had short time of rehab at hospital then because of my age and my husband being able to care for me ( he was only 68 and retired) I was discharged from hospital to home and PT therapist came to our home 3 days a week for three weeks. There are many precautions the patient has to follow post hip replacement as well.
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I'm assuming that right now mom is in the hospital, yes?

Just to be fussy about terminology, she doesn't have "early onset" (which would mean that she was younger than 65 yo; she is in the early stages of dementia, meaning that she can no longer live alone and needs some, but not total, support. Terminology matters.

If mom is currently in hospital, you have access to discharge planning; a very good thing. THEY can tell the family what is needed in terms of care for mom, going forward. If they are recommending rehab, you need to point out to them that it's only elderly dad caring for mom at home. You need to be completely transparent with them about your parents' finances. You need to be firm in some cases about the fact that the siblings are NOT available to provide home care.

Start there, with assessing what mom's needs are going forward and what the financial resources are. Have mom and dad been to an eldercare attorney to do POA, etc?
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Abby2018 Mar 2019
Yes... words matter! I misspoke, and indeed she does have mild/moderate dementia as it has become worse since surgery. She is now placed in a SNF and PT and OT is well underway. My parents can easily afford AL but her refusal is holding dad back. I think once she is released and goes home and he can fully understand the level of care she needs he will allow us to look at different options. I just feel that even in the short term this will ultimately impact my dad’s health if for no other reason that the stress it will cause. SN is aware of the obstacles the family faces with my parents decision.
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Breaking a hip at her age is very serious. With Dementia rehab will be very hard. While in rehab have her evaluated for LTC. How are their finances? Your Dad will be considered a Community Spouse meaning Medicaid will not impoverish him. My GFs Dad needed care. He had SS and a pension, she had SS. They had 60k in the bank. It was split so Dad got 30k, Mom got 30k. Then the SSs and pension was split so Mom had enough to live on.
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Abby2018 Mar 2019
According to skilled nursing she is making strides with her therapy. She is adamant about going home. Her mobility was limited before the break and I don’t think dad or siblings can handle this additional setback. They could easily afford AL.
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