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My 92 year old aunt went into the hospital a week ago after a fall. No broken bones, but pain from a bruised hip. The doctors have run a lot of tests and scans, got her electrolytes back in balance, and everything looks very good at this point.


She doesn't seem to have any interest in getting out of bed. She refuses physical therapy, refuses to get into a chair to eat meals. There's always an excuse, like the PT came at the wrong time or the nurses must be too busy to help her to the chair. She's soiled the bed a few times but seems to find it funny that someone else has to clean it up. Today she's said she won't leave the hospital for rehab unless the nurses comply with a long list of demands (not happening).


Has anyone else run into this? She's starting to drive me a little crazy because she's calling me every two hours to ask me to run an errand or complain about something but she is showing no interest in her own recovery.

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Time for a nursing home.
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Is this a change in her mental status?  What was she like before this fall?

Has a stroke been ruled out?
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I’m very surprised the hospital staff is tolerating this. When my dad is hospitalized we make very sure someone has him up and walking several times a day, it’s a use it or lose it situation, and it’s just not optional. The therapists are very good at coaxing and cajoling a hesitant elder to participate. This is their job. Time to tell the hospital staff member most in charge of her care that more has to be expected immediately of aunt and then you not be available.
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jacobsonbob Feb 2019
Perhaps the hospital tolerates it because it generates revenue from what might otherwise be an empty bed.
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They've ruled out a stroke, yes. She has had a stroke in the past and we were worried she'd had another when she first went in.

This is a significant change in her mental status. She's always been very independent, the kind of person who won't ask for help even if she could use it. She's gone from that to not wanting to do anything on her own. Maybe it's time for a geriatric psychiatrist since there doesn't seem to be that much wrong with her physically.
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shb1964 Feb 2019
Maybe speak with her hospitalist about some sort of psych evaluation. If she has just given up and wants to be waited on hand and foot, Medicare won't pay for that forever. If she's deemed safe to be released, it is up to them to find a place where she WILL be safe if that isn't on her own, where she was before this hospitalization, or with family. By the way, they may try, but they cannot demand that she be released to your care. We were told by our elder advocate that it is up to the treating facility to wait until a safe place can be found for her to go. If family isn't willing/able, then it is up to them to find a place. Stick to your guns - she sounds like a handful.
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What conversations have you had with your aunt's doctors? How do they explain the change in her attitude and behaviour?

Don't underestimate how much bruising hurts, by the way. It is frustrating when people don't seem to be contributing to their own recovery, but put yourself in her shoes whenever you feel impatient with her.

What are her highly individual demands for rehab? Just wondering if they contain any clues about what's bothering her.
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Country mouse, so true! I fell in my kitchen not long ago and I was so sore that I could barely walk. I took a bad tumble and then I still had to care for my mom. It took about a week to feel better.
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When my mom falls and help comes, one of the first things they ask me is if my mom is acting like herself. Definitely something to consider if her personality or cognitive ability is different.
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qattah Feb 2019
Good point!
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Don't worry Here, dear, Auntie Cannot Stay Definitely in the Hospital. When they see Fit for her to Leave, And you Cannot take her In or Don't have Anyone, hun, Who will Comply, The Social Worker a the Hospital will Call in a family member, Possibly You, To Discuss a Nursing facility if she cannot Live Alone on her own at Home. For now, Do her Bidding but Limit Yourself or End up being a caregiver to her or even Sign on for Power of Attorney at this point.
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My question is why did the doctor put her in the hospital when there was no broken hip or brain bleed. If she has been in bed that long she's most likely bed bound and will have to go to a nursing home. Good luck. If the person refuses to get out of bed believe me physical therapy and nurses will not force her and will simply chart "refused" and be done with it.
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faranlee Feb 2019
They put her in the hospital because she really wanted to be there but in hindsight, maybe that was the wrong choice.
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I never experienced anything to that degree, but sadly, while most people would be in a hurry to leave hospital or not go at all, she is long passed the age where people feel entitled to not do whatever they can for themselves and they rather rely on people than being grateful for what independence she has at her age. I am so very sorry for you! Would you like for me to pray for you?
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faranlee Feb 2019
Thank you!
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I think you are right to be concerned about this sudden change in attitude and behavior and would urge to to make sure all of her doctors understand that this is a big and sudden change since the event that landed her in the hospital. Sounds like she is either in an especially overworked hospital or on a floor for people who don't require a high level of care. I know there was a huge difference between floors when my mom was in the hospital, they were very full at the time I guess and she was moved to more of a general medicine floor after getting out of ICU rather than the cardiac rehab where they intended to put her and the attention just wasn't there, I'm sure if she didn't want to get out of bed they wouldn't have tried very hard. Talking to her doctors about the sudden change and making them aware of the fact she isn't being encouraged to get out of bed might help them do a better job or move her to a floor where they will. But if they don't find and stop looking for something they can "fix" determining that all she needs is PT they are going to move her put of the hospital, probably to a rehab or NH. If she is communicative and aware, able to take information in and process it you could honestly tell her that if she doesn't participate in her recovery they are going to send her to a NH because they need to move her out of the hospital, Medicare is going to require if it the hospital doesn't and she simply doesn't have the option to "not leave the hospital". Now I guess you could call the rehab facility she is making demands of just another "hospital" if that somehow might make her more accepting of it. That also could be a good thing I suppose if they will send her to a real rehab facility that deals with her rehab/PT better. I just don't know if they feel there is enough of a lasting injury here that they will order a real rehab facility. Was she living at home, a IL or Al or NH facility before being admitted to the hospital? I'm wondering if she want's to go back to where she was living or if she is even going to put up a fight, does she care about where she goes from her current hospital bed at all? I mean she is going to be moved so if her resistance is she really wants to go back home to where she was maybe that can be used as bait, for lack of a better word. I'm so sorry you are going through this, I wish I had better suggestions for you because I'm worried it could get worse if she has to be forced but she may be headed that way. Just don't take on any feelings of responsibility for how this goes, you are doing everything you can she is the one forcing this, remember that and while you offer her all the options and suggestions you can let the professionals be the ones doing the "forcing". Good luck.
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faranlee Feb 2019
She says she wants to go back to her IL, so I'm trying to use that as bait. When she complains about the rehab, I tell her that the sooner she does the PT and meets her goals, the sooner she can go back home. I'm hoping her loathing of the rehab will translate into some positive motivation to work on recovery but so far that has not been the case.
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They are trying to find somewhere that will take her and haven’t found a bed. Trust me when they stop getting paid suddenly a NH will be destination.
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Just remember that if they send her to rehab and she won't cooperate, they will discharge her because Medicare won't pay. It will be their way or the highway.
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You say she lives alone and up to this point has been independent.

Could it be she is enjoying being able to make a call and you come running, pushes a button and her needs are met?

Maybe, just maybe she got very scared with the fall and instead of saying she doesn't feel comfortable or confident enough to try walking or to be independent, she is doing nothing so choices have to be made by others. Then if the facility isn't up to her desired standards she can blame others for her condition.

I can't imagine how it must feel to be a frail, weak (in comparison to her younger years) old lady living alone. If she watches the news she is fed fear by the minute. Now she feels safe, cared for and might be sleeping well in who knows how long. Just a couple of thoughts.

Can you request a chaplain visit and talk to them beforehand and ask if they would address her seeming desire to remain bedridden.

Unfortunately most people have a never gonna happen to me, it is always someone else attitude, until it's not and then we don't know what to do or how to move forward.

Help her understand her choices, she may be lonely and wanting a community around her.

Best of luck and please let us know how it goes. Take care of you with good boundaries during this transition and beyond, you don't want to train her that you will jump and run every time she calls.
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faranlee Feb 2019
She watches the news non-stop, I don't know how she can stand it!

There is a part of me that's wondering if she enjoys the attention. She's lost most of the people she was close to and her only child lives quite a distance away. On the other hand, she has a community of people she lives with in IL. She could leave her apartment to go to the store, get her mail, go to lectures, eat with others during the day. She was far less isolated there than she is in the hospital and now rehab.

I wonder if there was another fall, if there are things going on that she isn't telling people because she's afraid of going to AL.
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My grandmother did a similar thing. She was in the hospital, and they wanted to send her to a rehab hospital. She was adamant she wouldn't go. The morning she was supposed to be transferred she died. She just couldn't take the thought of being jostled around and moved to yet another unfamiliar place.

The important thing, though, was that it also turned out she was riddled with cancer, and no one knew it. She'd had no particular symptoms because she wasn't in great health anyway. I thought that was really odd until this past autumn when my dad -- her son -- died of liver cancer after having no symptoms except fluid in his abdomen. (We did know he was sick, though, but he was diagnosed only six weeks before he died.)

Your aunt may have something else very wrong with her.
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faranlee Feb 2019
So sorry about your father. I lost mine recently to a liver cancer as well and it was also very fast from the time he was diagnosed. I do wonder if there is something like that wrong with my aunt because she seems to be so weak and so exhausted but none of the tests, xrays, cat scans etc show anything wrong with her.
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We had a different scenario - but still in regard to refusing hospital discharge. My mom had a massive stroke (Brian bleed) at age 87 that left her paralyzed on one side. She also had vascular dementia. She was comatose and the doctors asked us if we wished them to be aggressive or just keep her comfortable. We chose the latter, as that would have been her wish. After 4 days in the hospital, we were told the next step was at-home hospice or a local hospice facility with 24/7 skilled nursing care. My dad’s attitude became the issue. He adamantly declared my mom was comfortable, close to death, and he didn’t want her moved. Medicare was not going to continue to pay the hospital costs. We had a family meeting with the social worker and I later drove my dad for a tour of the hospice facility. The tour helped relieve his anxiety. He finally agreed to have my mom moved and in the end, he felt tremendous gratitude for the hospice workers (my mom lived another 4 days). It’s sometimes so hard for the very elderly to make decisions that seem so disruptive and unreasonable. I understand your aunt’s sentiments. Explain to her she’ll foot the bill of thousands of dollars if she stays in the hospital. If possible, have someone from the re-hab facility visit with pictures of the room she’ll have and amenities (re-hab facilities are often competetive for Medicare dollars and cater to patients by advertising special perks). Good luck!
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Thank you all so much for sharing your experiences and thoughts. She did finally move to a rehab which she does not like at all. She talks about wanting to go back to her IL apartment, but she acts like someone who will need to be transferred to AL (which she actively does not want).

I just don't understand what happened to her. The fall was 2+ weeks before she went to the ER. She'd said she no longer had any pain from it. She'd had some gastro issues around that time as well, either a bug or food poisoning, but had seemed well recovered.

The hospital was not going to admit her, but did when I got there and told them that she was not herself. They never found anything aside from an electrolyte/sodium imbalance which they corrected. She started requesting rehab as soon as she was admitted - I think they would have discharged her straight to home if that was what she had wanted.
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OkieGranny Feb 2019
One thing that concerned me was when you said your aunt would not get up to go the bathroom and laughed when others had to clean her up. That is definitely a problem. Would that mean she would have to go to a nursing home? I don't know that AL staff would do that. Anyone else know the answer to that?
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faranlee: She is similar to most patients in wanting to return to their comfort zone, which is their home. Elders do not like who they've become and who can blame them really? Prayers sent to you. Have her hip checked again because maybe a hip fracture was missed and that is sometimes the beginning of the end, so I've been told many a time.
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Well, they're sending her home. She hates it at the rehab, so that's the end of this adventure and the start of a new one.

According to her, she gets to go home and they are going to give her services at her IL facility, covered by insurance. She told me that the people at rehab had talked to the people at IL and made arrangements for everything except the ride home.

According to the rehab, she's getting sent home because insurance isn't going to pay and the PT nurse thought she was doing great. That's it. No plans for PT or OT and they aren't in contact with the IL.

Her version is just so different. It's unsettling.
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