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Mom lives in an Alzheimer's Dementia care facility for 5 years. Two years ago she fell and cracked her pelvis. While in the nursing home they started PT but then stopped and no one knows who stopped it (you need a doctors order to stop it). It's been two and a half years I've been fighting/advocating for the care provider to start PT again but the OT says she thinks it's moms dementia that's preventing her from walking. I disagree because mom can comprehend and follow instructions. She fell again four months ago and the ER doctor wanted to know why she can't straighten her legs, my sister explained she's had no PT and he stressed that she must get PT and if she doesn't soon she will be in the wheelchair forever. The PACE program that manages my mother's healthcare still refuses to provide PT still saying it's her dementia that prevents her from walking, I'm at a loss as to how to proceed because this program also pays over $4800 a month for mom to live at the care facility and my sister pays $1200 a month and the contract is written so that either side can terminate it at any time. I have RA and can't physically care for her and my siblings don't help or visit. I believe it's out of the scope of practice for the OT to make such a decision and have her team agree with her. Need suggestions. Mom is 87 and I'm 67. I took care of her for six years without help until I found this program and placed her.

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That's correct, Medicare only approves PT and OT for a certain number of sessions.
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She has dementia, she is 87, she fractured her pelvis a couple years ago and is still dealing with that. She is not going to get OT and get up and go on nice long or short walks ever again. Even if she did walk again, another fall is in her future, probably a worse fall. She will be better off, safer, more comfortable in a wheelchair.
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Pamstegma is correct. Medicare only pays PT and OT for so long. Usually when a patient hits a plateau, meaning therapy will not help anymore, Medicare won't pay. You can ask for an evaluation where the physical therapist will determine if therapy will help.
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Mom's been in a care facility for 5 years and you took care of her for 6 years before that? Does that mean that she has had dementia for 11 years? If so, you are very fortunate that she has been able to walk up until 2 years ago.

Facilities can only bill for therapy if they actually provide it. They have no reason to turn someone down for therapy if they can justify it to the insurance company. If the therapy department says that progress is not being made and not likely to be made, that is their objective professional opinion.

Has Mom been using a wheelchair for two years? What do you think are the worst drawbacks of being in a wheelchair?

I'd rather walk than be in a wheelchair. I'd rather hear naturally than wear hearing aids. I'd love to read without artificial lenses. But if/when I'm not able to do what I'd rather do, I will work on making the best of the devices available to me.

About six months into his dementia, we got my husband a wheelchair. It cheered him up considerably. He had been falling a lot (even with his walker) and he was afraid to move around the house. With the wheelchair he could scoot it with his feet and was happy to be able to get around on his own.

My mother's hip broke and she fell (in that order) and after that she never walked again. The NH aides came and got her for every activity and for meals. Us daughters could push her around the neighborhood (which was hard with a walker because of arthritis). We were all sad that Mother would never walk again, but in a way it really didn't make any difference to the quality of her life in the nursing home. Nobody had to worry about her falling, and she was never going to wander out of building.

(By the way, my mother did get some PT to improve her upper body strength after she was in a wheelchair.)

Perhaps you should spend your energy in thinking of ways to ensure your mother's quality of life the way she is now. (Bloom where you are planted now, as we flower children used to say.)
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Yes they can if they determine through evaluation that the patient is at a functional capacity where she can no longer contribute nor benefit from therapy. It may be too painful for her now. Whoever stated that the therapist must document progress is correct, as Medicare can then no longer justify the cost of therapy if no improvement is noted.
I would recommend the family perform gentle passive range of motion on your mom but it may be too painful if she has contracture from non use due to hip fracture.
Good luck. I know this may be a difficult time for the patient and her family.
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A doctor will order a PT program, but the therapist has to carefully chart progress. If there is no documented progress, Medicare or the insurance company will not pay for it. Neurological conditions like Alzheimer's, MS, Parkinson's and others do eventually leave the patient unable to walk.
The muscles and the brain do not communicate anymore.
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You will need to get her GPS to order PT, to help with the pain (if she's having pain), for the contractures, but she still may never walk again, and you need to come to terms with that.
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Lynn, yes, dementia can stop someone from walking.   And with each fall, the dementia tends to become worse.

My own Mom had a very serious fall and was placed in rehab to see if physical therapy could get her walking again, but the brain just couldn't coordinate any more.   With every try, my Mom would fall.   It got to a point where Mom had to stay in a wheelchair for her own safety.

One has to remember, this isn't the OT first rodeo, they have been on hundreds and know the medical signs.... where you and I, this is/was our first rodeo and we expected everything to be back to normal.
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Are you saying she hasn't been able to walk for 2 years since she cracked her pelvis and now has contractures that won't allow her to straighten her legs? Whether or not her dementia is the root cause I doubt that she can regain the ability to walk after all this time, although she should be getting some treatment for the contractures. Will your doctor order therapy for that?
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