Mom is 84, fell 3 years ago, broke her hip, never healed well. Never finished her therapy. Confined mostly to wheelchair. Can walk no more than 20' hanging onto walker, dragging oxygen behind her. Has to stop to breathe due to severe COPD. Cannot put her blouse on without stopping 3 times to breathe.

3 weeks ago she fell again and broke her pelvis and humerus (arm). Cannot operate due to extreme COPD. Was in tremendous pain. Put on morphine and dilautin which helped. She goes in and out between being lucid and "loopy".

She was put in sub-acute rehab after her fall and most time refuses to do it; says she cannot do so, doesn't want to bother and just wants to put a cover over her head and go to sleep forever. Asked if she can just die and stop the pain.

We have a staff meeting this week and think we are going to be told that mom cannot have more time in rehab since she isn't making "gains". The choices must be either nursing home long term wing or hospice wing.

I feel like hospice is a death sentence to her, but also think long term nursing care wing may not be good choice either. She still will have to do some therapy which she hates and the best that could happen is that she would be able to be in a wheelchair there. Wouldn't have the strength to push herself due to COPD. She would not mix with the residents and would not want to attend bingo and other activities. She cannot come home due to layout of bathroom and her tiny apartment and there is no one to care for her there.

Would appreciate your input on this. Thanks so much.

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dtrinfl2, I broke my humerus [upper arm] almost a year ago, and I still remember the terrible pain it caused. The strong meds made me too loopy so I bite the bullet and used over the counter pain meds.

Usually there is no rehab until the arm is fully healed, usually two months for us older folks. Then, and only when x-rays shows the humerus bone is completely healed, that rehab can start. I went to a sports rehab office 3x a week for four months to get my motion back. I am right handed and it was my right arm... couldn't write, couldn't eat [what a mess using my left hand], had trouble dressing, and I couldn't drive because I couldn't turn the key as it was way too painful.

COPD shouldn't interfere with her arm exercises, as one is sitting down for this and the therapist is doing most of the work stretching those frozen muscles.
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My situation was similar to yours except that my husband was already under hospice care in a nursing home because of heart and lung problems and dementia. He fell in the nursing home, breaking a femur. I was given a choice between surgery under general anesthesia or continuing hospice care in the nursing home. I knew he could not survive surgery. He lived and died peacefully in the nursing home. I do not regret my decision.
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I can offer a couple of corrections that may or may help with decisions:

1) You say that your mother will not use any of the activity options in the nh wing. Maybe that is true. But it is possible that if someone wheels her into the bingo room she'll at least have a little interest in what is going on. If she is taken to the hymn sing or to listen to the accordion player she will enjoy it. Possible. This seems like an obvious thing you can predict, but don't count on it! When our mother started attending nh activities my sisters and I said, "Who is this woman and what have you done with our mother!"

2) Hospice is not a death sentence. If death is imminent hospice is great comfort care. The person's condition (COPD, cancer, dementia, whatever) may have issued a death sentence; hospice only deals with what is. My mother went on hospice after a severe hip break in the nh. The hospital thought she would not last the week. She continued to get good palliative care from the nursing home staff and extra attention from hospice. She "graduated" from hospice after 90 days. She is still with us two years later. At 95 she is going to need hospice care again sometime. We won't hesitate to use it. Hospice doesn't bring about death. It helps ease the dying process if that is going on.

My heart goes out to you as you face this difficult decision.
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