Will we be able to care for her again in our home? She has just been admitted to a facility where they are going to access her and do physical therapy. She is pretty weak and has more dementia now after the surgery it seems.
My 94 yo mother fell, broke her femur, and required a 4 hour surgery to fix. She started showing signs of Post Operative Delirium with hallucinations within hours of coming out of surgery. So much so, that her medical charts were marked 'Dementia' in SPITE of me showing every medical professional videos of her being fully mentally present just days prior. Due to the delirium, she thought she was back in her war torn country, and tried to get out of bed 'to escape', thought she was being held prisoner in her room. And she would moan in pain and all she would say is "help" over and over and over nonstop.
She was moved to rehab about 5 days after surgery (although hospital wanted to discharge her the day after- but I protested loudly). At rehab, the number of staff to patients is incredibly low and I ended up being there 12-14 hours a day. She was there 5 weeks, with only slight improvement (but enough to keep her there). PT tried to engage her, but she thought she was being 'tortured' and didn't cooperate. She didn't like the food, didn't like the nurses, etc etc. And her Post Operative Delirium continued for about 2.5 weeks. At one point they had the news on and she thought I had been in a fatal car accident, and wouldn't believe staff I wasn't. They called me and I was talking to her and she was convinced that I was an imposter - someone had 'duplicated' me. This went on for another 2 weeks.
Due to low staffing, her incision became infected, requiring another surgery - which, unfortunately, started her slide into her final days.
If you have the family members on board to help, and have the financial means to bring her home - including hiring a private nurse- then imho, I would bring her home to recoup. But only if you are not trying to do it alone - for it is impossible to be on-call, awake 24 hours a day for days and weeks at a time.
My mother was 97 when she fell, had compound fracture and they put 2 pins in her upper femur. Prior to this, she lived independently, no longer could drive, but was able to cook on a stove and walked with a walker, but many times, did not need it. Weekly, she walked to the grocery store which was a mile away.
After the surgery, we put her into an aggressive rehab hospital where she could reside only for 11 days. Most people were close to normal living activity when they left the hospital. The hospital got her up and walking, however, slowly and painfully for 100 feet. I had to go out-of-state and she needed to be released to a place that had 24 x 7 care, so we put her into rehab hospital #2. Rehab #2 had lots of elderly patients and therefore, the OT and PT were not as aggressive. One month later, they said that she was no longer improving, and wanted to send her home. However, I was not back "home" yet, so we paid for 2 more weeks of care, which did not include the PT and OT.
When I got her, she was a zombie. She basically could not walk and all she wanted to do was lay down and sleep. Pain pills were not working. Everything hurt. We went to the emergency room. They said they could find nothing wrong. We went to our followup visit with the orthopedic surgeon. He said everything was healed and should not be causing any pain. 3 ER visits later, I asked the doctor to tell me what was causing the pain. She had another pain episode at ER, and he gave her a dose of oxycontin. The pain did not abate. Then the doctor said "well, other than the arthritis, I don't see anything that would be causing pain." Well, no one had ever mentioned arthritis to either me or my Mom before and she was NOT taking pills for arthritis prior to the accident.
Long story shortened, I realized she was addicted to the pain medication and worked on getting the arthritis pain lessened. Once we got her pain under control, she responded to the PT exercises and she was much more aware of what was happening. 3 months later, she was occasionally out of the wheelchair and 1 month later, we rarely had to use the wheelchair. We lucked out because at that point, she was healed enough to undergo cataract surgery. However she could never be left alone again as she was a fall risk and she couldn't follow or remember directions.
I found a reluctant PT who was willing to help my Mom get back to walking. He showed me lot of things to do with her like stretching, sit-to-stand (which helps build abdominal muscles so she can walk), and balancing. I was present for all the PT sessions and asked a lot of questions on what to do. In addition, I remembered what the rehab #1 PT did, so I bought a stepping board and used it to buildup the muscles while learning to balance. Then came the pandemic. However, I continued the exercises. We still use some of them.
Once she was walking again, I noticed that her forgetfulness was worse. She would get up and go to the bathroom 5 x or more, before settling back down in bed. Then 1-1.5 hours later, the same routine. In addition, she would accuse all of us of lying since she didn't remember us saying x to her. At about 8 pm, she would start remembering her Mom or her sister or her Dad (all passed over 5 years earlier) and all the emotions would either anger her or make her cry. Several times, she mistook my sister for one of her sisters. Because she waited so long for cataract surgery, she no longer could read a book or follow the captions on TV because she could not track. She couldn't remember how to use the TV.
My Mom is almost 101 now. Her memory is worse and she is now incontinent #1. Edema is really bad although she uses an exercycle and it helps. Pain is at a dull roar most of the time.
It really makes me NOT want to live as long as she.
Same with my father. His dementia got worse in rehab and needed to return to familiar surroundings to recoup any abilities. Anesthesia is also bad for memory problems.
Oftentimes dementia improves when returned to a familiar environment. However, you may need home PT, and to make adjustments with rugs, equipment to access tub and toilet, and she may need a walker until she heals. It just depends on how her body responds to the surgery. I will be praying for a quick and full recovery for her!
Your MIL sounds like mine, just keep an eye on physical therapy. (Watch the sessions whether they like it or not) They were limiting my mil to standing and sitting. If she is in a rehab room with a roommate ask the roommate if your mom gets up and walks to the bathroom when nurses do not respond. They were going to release my mil saying they could do nothing else she would need to be in a wheelchair. We shocked them by saying then why in the middle of the night does she walk to the bathroom. She also had some dementia. They then worked with her using a walker. When we brought in home PT he asked if she had ever used a walker and we said no. He did PT walking the halls of the house and outside on the grass. He said grass walking is the best for balance. My mil never did use a walker and fully recovered. I believe my mil would of lived to a 100. But a few years later my mil and caregiver were rear ended by a truck driver for at least a quarter mile saying he did not see them in front of him braked and waiting to make a left turn. No breaks or any thing. But lots of bruising. She passed 3 months after the accident.
I broke my hip 7 years ago and had hip pinning. Three days in the hospital and then 30 days in Rehab doing PT, OT and CT (Cognitive Therapy) if needed then discharged back home. I live alone and had no help, but I was not 93 with Dementia. Your MIL's situation will depend on her ability to co-operate with therapy and to what degree she recovers physical abilities.
This is so variable depending on the patient's age, mental state, and compliance with therapy. My mother was about 80 when she fell and broke her hip. She spent more than a month in hospital and rehab. She does not have dementia and is a pretty stubborn old bird - was determined to go back to her home and live independently. She did the PT and OT both at rehab and at home for a while and actually got a little more mobile than she'd been before the fall. A couple of years later she fell again and broke her clavicle, another stint in rehab. She's back at home again and a year later at age 85, in the process of moving to an independent living apartment. I think her reasons for moving are primarily to eliminate the home upkeep and for the social interaction, not that she feels she needs personal help at this time.
Her recovery will depend on her mental state. If she wants to do the exercises she will recover just fine. However if she refuses it will be the start of a slow decline that will lead to one thing after another. After my wife broke her hip 2-1/2 years ago she is now bed bound and going down hill fast.
My mother broke her hip in January 2020 and had it pinned. She spent 8 days in the hospital and then I brought her home to my house. She did not go into a rehab.
While in the hospital, she began physical therapy and was able to walk up and down a couple of steps and walk all the way around the hospital hallway before she was released.
Her doctor wrote orders for PT and OT through a home health agency.
In order to avoid potential blood clots, I had the hospital give her aspirin and I continued it at home for a period of time.
I slept in the room with her for 8 months (too long) before finally buying a bed alarm and going back to my own bedroom.
The biggest mistake I made was not monitoring her bowel movements which had slowed down after the surgery and it took a bit of work to get them moving again. I still use Milk of Magnesia which works very well and doesn't make her hallucinate like the Miralax did.
She continued her physical therapy at home and I would make sure that she was up and walking as well. We did her exercises every day and she recovered without any problems.
She's now 96 and is doing quite well.
I have no experience with a rehab facility, or how much attention and care she will receive, but in my opinion, she will need quite a bit in order to recover well.
For what it is worth, my husband broke his hip when he was only 54. A pin was inserted and he was not allowed to put any weight on that side for 2-3 months which made it extremely difficult because he was already unbalanced due to Parkinson's. He spent 10 days in the hospital and 23 days in rehab. PT and OT came to our home for a while, but since I did not understand and we were both uncomfortable we refused the CNA to help with his bathing. It was about a couple of months before the confusion and hallucinations were no longer an issue. It was about nine months before we no longer needed a wheel chair. Please note, all of this was with him being at least 40 years younger.
As far as taking her home, it depends on how many family members are willing to step up and help as well as her finances and/or the family's ability and willingness to pay for a lot of extra home care. Can she come home again... yes, but it comes with a huge cost in finances, time, energy and emotions for the "family" but unfortunately the full responsibility usually comes down to one or two. If you decide to bring her home, be sure what the time limit is that she might still be eligible to be placed in a long term care facility with Medicare paying up to 100 days.
For now, take it one day at a time before making a long term decision to bring her home. As far as finances, whatever you choose, find out if your FIL or she ever served in the military and if so check to see if she is eligible for VA Aid and Attendance. It is for veterans and their spouses.
If she had dementia before surgery, you should have tempered expectations during her rehab.
Post-op "Hospital delirium" for seniors is a common problem, but can improve with time.
You need to closely watch and advocate for her. A rehab facility is not like a LTC or NH. Many are short-staffed. Know what meds she is on and make sure she is tolerating any well. Make sure she is eating and drinking (hydration is very important). If she isn't, this is a problem and you should help her with this since I don't think most rehab staff will do this. Maybe they will if they have enough help.
Is she at risk of getting out of bed and attempting to walk? If so, this concern needs to be brought to the staff's attention. Will your Mom cooperate with PT? If not, this is a problem and she will be discharged if she refuses to cooperate or fails to improve. Keep an eye out for a UTI or other infection. With large bone surgery, post-op blood clots are also a risk (and can be fatal).
I had a 100-yr old Aunt w/mod-adv dementia who broke her hip. We deliberated a long time whether to have the partial replacement surgery and opted to not do it. At rehab, she tried to get out of bed. She didn't eat or drink, wouldn't keep an IV in. She was doing the minimal PT to get her to stand a pivot. Then she passed in her sleep this January and we're not sure why. She was never going to return to her pre-fall level of mobility and we were in the process of finding LTC for her. You may want to consider starting that research in case this is the only other option. I wish you all the best at this stressful time.
I wouldn't take her home. She'd probably recover faster in a place where they have all she needs close at hand - 24/7 care, PTs, OTs, etc.
She may be delusional after anesthesia. No telling how long that will last, and she has dementia, so it may be a long time until she gets over it (if ever).
What you don't want is to have her in your home with both physical and mental problems, and then she starts going downhill but you're not equipped to take care of her. Then you'd have to find a facility for her while dealing with the mess in your home - constant stream of health care people, getting her to appointments, more laundry, and providing food, entertainment and managing meds That means you're going to be exhausted and having to make major decisions when you're not operating at top-notch level yourself. Also it's easier to place her from rehab than if she's already in your home.
Fawnby, the medical evidence with which I am familiar says that recovery from delirium is fastest when the patient returns home rather than remains n an unfamiliar environment. However, I don't think the OP is considering removing her MIL from rehab; she is asking for advice for the longer term.
My own experiences in post-surgical rehab were that I was kept very busy 6-7 hr/day, with 1/2 day Saturday. (Saturdays are not offered by all rehab facilities.) Additionally, each morning after the first, I was expected to figure out how to dress myself and to do it. (The latter might not be expected of a 97-year-old person with dementia.) For my surgeries, the expected time in rehab for my age was only 5-6 days, which is what I had; Medicare won't keep you there for the max number of paid days if you don't need them. I don't think I could have possibly had the same benefit if I'd had therapy at home 2-3 times/week. BTW, that's what I *did* have after I was discharged from rehab, and then I had outpatient PT/OT at a PT/OT office. I would expect a similar sequence for the O.P.'s MIL, except that the amount of time in each step will probably be longer. There should be a chance, in any case, for further improvement after rehab.
She was moved to rehab about 5 days after surgery (although hospital wanted to discharge her the day after- but I protested loudly). At rehab, the number of staff to patients is incredibly low and I ended up being there 12-14 hours a day. She was there 5 weeks, with only slight improvement (but enough to keep her there). PT tried to engage her, but she thought she was being 'tortured' and didn't cooperate. She didn't like the food, didn't like the nurses, etc etc. And her Post Operative Delirium continued for about 2.5 weeks. At one point they had the news on and she thought I had been in a fatal car accident, and wouldn't believe staff I wasn't. They called me and I was talking to her and she was convinced that I was an imposter - someone had 'duplicated' me. This went on for another 2 weeks.
Due to low staffing, her incision became infected, requiring another surgery - which, unfortunately, started her slide into her final days.
If you have the family members on board to help, and have the financial means to bring her home - including hiring a private nurse- then imho, I would bring her home to recoup. But only if you are not trying to do it alone - for it is impossible to be on-call, awake 24 hours a day for days and weeks at a time.
After the surgery, we put her into an aggressive rehab hospital where she could reside only for 11 days. Most people were close to normal living activity when they left the hospital. The hospital got her up and walking, however, slowly and painfully for 100 feet. I had to go out-of-state and she needed to be released to a place that had 24 x 7 care, so we put her into rehab hospital #2. Rehab #2 had lots of elderly patients and therefore, the OT and PT were not as aggressive. One month later, they said that she was no longer improving, and wanted to send her home. However, I was not back "home" yet, so we paid for 2 more weeks of care, which did not include the PT and OT.
When I got her, she was a zombie. She basically could not walk and all she wanted to do was lay down and sleep. Pain pills were not working. Everything hurt. We went to the emergency room. They said they could find nothing wrong. We went to our followup visit with the orthopedic surgeon. He said everything was healed and should not be causing any pain. 3 ER visits later, I asked the doctor to tell me what was causing the pain. She had another pain episode at ER, and he gave her a dose of oxycontin. The pain did not abate. Then the doctor said "well, other than the arthritis, I don't see anything that would be causing pain." Well, no one had ever mentioned arthritis to either me or my Mom before and she was NOT taking pills for arthritis prior to the accident.
Long story shortened, I realized she was addicted to the pain medication and worked on getting the arthritis pain lessened. Once we got her pain under control, she responded to the PT exercises and she was much more aware of what was happening. 3 months later, she was occasionally out of the wheelchair and 1 month later, we rarely had to use the wheelchair. We lucked out because at that point, she was healed enough to undergo cataract surgery. However she could never be left alone again as she was a fall risk and she couldn't follow or remember directions.
I found a reluctant PT who was willing to help my Mom get back to walking. He showed me lot of things to do with her like stretching, sit-to-stand (which helps build abdominal muscles so she can walk), and balancing. I was present for all the PT sessions and asked a lot of questions on what to do. In addition, I remembered what the rehab #1 PT did, so I bought a stepping board and used it to buildup the muscles while learning to balance. Then came the pandemic. However, I continued the exercises. We still use some of them.
Once she was walking again, I noticed that her forgetfulness was worse. She would get up and go to the bathroom 5 x or more, before settling back down in bed. Then 1-1.5 hours later, the same routine. In addition, she would accuse all of us of lying since she didn't remember us saying x to her. At about 8 pm, she would start remembering her Mom or her sister or her Dad (all passed over 5 years earlier) and all the emotions would either anger her or make her cry. Several times, she mistook my sister for one of her sisters. Because she waited so long for cataract surgery, she no longer could read a book or follow the captions on TV because she could not track. She couldn't remember how to use the TV.
My Mom is almost 101 now. Her memory is worse and she is now incontinent #1. Edema is really bad although she uses an exercycle and it helps. Pain is at a dull roar most of the time.
It really makes me NOT want to live as long as she.
While in the hospital, she began physical therapy and was able to walk up and down a couple of steps and walk all the way around the hospital hallway before she was released.
Her doctor wrote orders for PT and OT through a home health agency.
In order to avoid potential blood clots, I had the hospital give her aspirin and I continued it at home for a period of time.
I slept in the room with her for 8 months (too long) before finally buying a bed alarm and going back to my own bedroom.
The biggest mistake I made was not monitoring her bowel movements which had slowed down after the surgery and it took a bit of work to get them moving again. I still use Milk of Magnesia which works very well and doesn't make her hallucinate like the Miralax did.
She continued her physical therapy at home and I would make sure that she was up and walking as well. We did her exercises every day and she recovered without any problems.
She's now 96 and is doing quite well.
I have no experience with a rehab facility, or how much attention and care she will receive, but in my opinion, she will need quite a bit in order to recover well.
As far as taking her home, it depends on how many family members are willing to step up and help as well as her finances and/or the family's ability and willingness to pay for a lot of extra home care. Can she come home again... yes, but it comes with a huge cost in finances, time, energy and emotions for the "family" but unfortunately the full responsibility usually comes down to one or two. If you decide to bring her home, be sure what the time limit is that she might still be eligible to be placed in a long term care facility with Medicare paying up to 100 days.
For now, take it one day at a time before making a long term decision to bring her home. As far as finances, whatever you choose, find out if your FIL or she ever served in the military and if so check to see if she is eligible for VA Aid and Attendance. It is for veterans and their spouses.
Post-op "Hospital delirium" for seniors is a common problem, but can improve with time.
You need to closely watch and advocate for her. A rehab facility is not like a LTC or NH. Many are short-staffed. Know what meds she is on and make sure she is tolerating any well. Make sure she is eating and drinking (hydration is very important). If she isn't, this is a problem and you should help her with this since I don't think most rehab staff will do this. Maybe they will if they have enough help.
Is she at risk of getting out of bed and attempting to walk? If so, this concern needs to be brought to the staff's attention. Will your Mom cooperate with PT? If not, this is a problem and she will be discharged if she refuses to cooperate or fails to improve. Keep an eye out for a UTI or other infection. With large bone surgery, post-op blood clots are also a risk (and can be fatal).
I had a 100-yr old Aunt w/mod-adv dementia who broke her hip. We deliberated a long time whether to have the partial replacement surgery and opted to not do it. At rehab, she tried to get out of bed. She didn't eat or drink, wouldn't keep an IV in. She was doing the minimal PT to get her to stand a pivot. Then she passed in her sleep this January and we're not sure why. She was never going to return to her pre-fall level of mobility and we were in the process of finding LTC for her. You may want to consider starting that research in case this is the only other option. I wish you all the best at this stressful time.
She may be delusional after anesthesia. No telling how long that will last, and she has dementia, so it may be a long time until she gets over it (if ever).
What you don't want is to have her in your home with both physical and mental problems, and then she starts going downhill but you're not equipped to take care of her. Then you'd have to find a facility for her while dealing with the mess in your home - constant stream of health care people, getting her to appointments, more laundry, and providing food, entertainment and managing meds That means you're going to be exhausted and having to make major decisions when you're not operating at top-notch level yourself. Also it's easier to place her from rehab than if she's already in your home.
Nope. Nope, nope, nope.
My own experiences in post-surgical rehab were that I was kept very busy 6-7 hr/day, with 1/2 day Saturday. (Saturdays are not offered by all rehab facilities.) Additionally, each morning after the first, I was expected to figure out how to dress myself and to do it. (The latter might not be expected of a 97-year-old person with dementia.) For my surgeries, the expected time in rehab for my age was only 5-6 days, which is what I had; Medicare won't keep you there for the max number of paid days if you don't need them. I don't think I could have possibly had the same benefit if I'd had therapy at home 2-3 times/week. BTW, that's what I *did* have after I was discharged from rehab, and then I had outpatient PT/OT at a PT/OT office. I would expect a similar sequence for the O.P.'s MIL, except that the amount of time in each step will probably be longer. There should be a chance, in any case, for further improvement after rehab.
She flourished.
I gained 60 pounds, slept on the floor by her bed, lost my job, and finally gave up.
She ultimately lived 5 1/2 VERY good years in a fine residence about 3 miles from me.
Make decisions based on a balance between what’s best for her and what’s best for you.