My mom refuses to do physical therapy. What can I do?

Sparkling, I had the same thought as waytomisery, that there is a traumatic brain injury. Also possibly PTSD from the accident, and some degree of oppositional defiance disorder as part of her original personality, now increasing from the ongoing difficulties. Has your mother been seen by a neurologist and a geriatric neuropsychiatrist? The facility should have them available to come in. Push for it, if you have to. Also, her claim of pain needs to taken seriously, with an evaluation by a chronic pain specialist.

I feel terrible for her, that this happened, and for you, dealing with the fallout! What a nightmare all around. Thanks for taking the time to reply. Keep us posted on how things are going. There is always a lot of wisdom here,

Sparkling, many many posters have had relatives who ‘just wanted to go home’ and refused to co-operate in every way they could. No the relative didn’t “finally decide to move”. Usually they fought all the way. They moved when they were given no choice. At only age 71, it’s possible that M could go “back to normal”, but probably unlikely.

‘When the money runs out, she would be sent home’ – but it must be a safe discharge. That means ‘home’ includes adequate care and support. Even if you find a suitable caregiver, full time one-on-one care is considerably more expensive than a facility where staff time is shared, so you are stuck with ‘the money running out’ anyway. The alternative is to take on slavery yourselves – which many many posters have done and regretted.

That is the harsh reality. Waiting for M to become more reasonable all by herself is unlikely to help. As long as she is getting her own way, she is unlikely to change.

Oh my, what an incredibly distressing situation for you both! What devastating thing to happen at her age.

Good support and advice has been given to you by others.

Are you her PoA? If not, does she have one at all? If not, it will become increasingly more challenging to legally manage her affairs without it, including medical.

I'm an only child to a single Mom who is progressing in dementia. She created a PoA using an online service (Legalzoom.com but there are many others). You can download the forms, and then see if the facility has a notary (many do) to finalize the PoA (make it durable, and encourage her to give you all the authority). Then you can make decisions in her own best interests, whether she agrees with them or not, cooperates or not.

I have a cousin with ALZ who started to keep her eyes shut all the time, even when having conversations with people she knew. I agree with others that your Mom either was having the beginning of dementia before the accident or she now has a TBI, or was impacted my the anesthesia from her treatment, or all of the above. The Dad of a good friend of mine went in to surgery for a shoulder repair and came out permanently impacted cognitively by the anesthesia. Even so, there is nothing to be done about it other than to make sure she doesn't have a UTI or some other infection, which can alter a person's behavior.

I also agree with others who point out that PT will be resisted if her pain isn't under control. We learned this from my MIL when she broke her back and also refused PT -- and had the beginnings of memory loss, which we didn't realize.

Maybe what your Mom now needs is LTC in a good facility. LTC can be covered by the combination of Medicaid and her SS income. She has to qualify both medically and financially. You should talk to either a certified elder law attorney who is experienced with Medicaid, or a Medicaid Planner for your Mom's home state. They will help you figure out if she will qualify financially (because I don't think medically will be a problem for her) and when to apply. Please please do not for 1 minute think about paying for her care: it is unsustainable and will rob you of your own care options in your future.

Insisting on going home, especially if it is in the afternoon, is a dementia behavior called Sundowning. The home they are referring to is not their current home but one in their childhood, or an imaged place where they'd feel safe. It's possible if your Mom has dementia that this is what is going on, but hard to know. This is part of the reason why a PoA would need to be overseeing her care decisions.

My MIL was in LTC in a great facility for 7 years (and passed at 89). This may be the best and only option for her going forward. I don't have experience with TBI, but sounds very like she should at least get some sort of diagnosis regarding her cognitive condition.

Kudos to you for being there for her. Your relatives realize that helping your Mom will be a strenuous, ongoing committment that is beyond what they are willing and able to do. You need to realize this yourself. May you receive wisdom and peace in your heart as you work out the most appropriate care for your Mom.

Your mom is awful young to have given up on life already.
Hopefully the anti-depressant will help along with the pain medication they have her on. And if her pain medication isn't helping, make sure that you talk to her doctor about trying something else.
Perhaps it best that her doctor share with her what will happen if she doesn't do what needs to be done to get her moving again. And tell them not to mince words but to speak the cold hard truth.

Has mom been tested for dementia? Since her head was involved in the car accident, it's a good idea.

Also, if her pain is not being properly controlled, how can she be expected to do physical therapy exercises, I don't understand?

How is it there are 90+ women in a room at this rehab SNF?? This makes no sense to me?

If mom cannot make progress to where she can function, then she'll have to stay permanently in Skilled Nursing care because she'll be too much to handle at home.

What are you being told about her progress? What is the case manager's plans for her care moving forward? What does her doctor say?

There are many questions with no answers here. Not everyone can successfully be rehabilitated after such serious injuries, unfortunately.

Wishing you the best of luck with a difficult situation.

Is this facility known for rehab for people with TBI ( traumatic brain injury) ?
It is very important for your Mom to be in a facility with staff who have proper training working with patients with TBI.
Some of her behaviors could be TBI related .
I also agree about pain management needing to be addressed .

Perhaps start with the money. M’s own money should be paying for the ‘so expensive facility’. When will her money run out? What will her options be then? If they are a lot worse, she may realise that her current choices will make things worse for HER.

Second, check again on her reasons for her current choices. Is she really in a lot of pain? If so, does the doctor need to prescribe more pain medication, not just anti-depressants?

Third, I’m even wondering whether a therapist might help HER – perhaps pretending to be a helpful friend of yours because you have to go away for a week or two. If M is blaming the doctors, the accident driver, ‘the system’ and the family for her problems, talking to a new person might just help.

Very difficult, sympathy to everyone involved!

From what you said, M is choosing to have the ‘screaming ladies around’ because she likes the view. Why??? If you give in and let her move home, make it for a fixed time (eg a month) and on fixed terms (eg you go in every two days, she organises her food and other care). Sometimes things have to ‘fall over’ before they can change. Make her, not you, organise so that things don’t ‘fall over’. You have a big mental shift to appreciate that if she is refusing, she is staying in control, and you are not responsible. She needs to understand what she can control, and that it isn’t you!

I kind of skimmed over the replies. Are you from another country?

Why is Medicare not paying for her Rehab? And why are there so many people in one room? I live in a small populated area and our Rehabs have 2 people to a room. Even though Rehab and Longterm care are in the same building, Rehab is in a different wing. Even the LTC does not have more than 4 beds to a room.

If Mom were on Medicare and she was not doing the therapy, she would have been discharged. I don't understand why you are going thru Moms money when she won't comply.

Mom needs a good cognitive evaluation to see if she is capable of living on her own. An evaluation to see what her needs will be if she can be sent home. If her needs will be more than you can hanfpdle, then she may have to be placed in LTC. Really, if you have used up all her money on Rehab, where are you going to get it for Caregivers?

After a surgery sometimes elderly people react poorly to the meds they were given. My FIL and my dad both had bad reactions to the meds to the point they were violent, both very gentle old men otherwise. It took days to weeks to wear off. Get her checked for dementia as well. If you don't have POA, make sure someone does. If your mom was not easy to get along with before, it's only going to get worse. You might want to talk with some social workers that deal with the elderly on a regular basis and see what they recommend.