Who decides when the patient is too prone to fall and break bones and use a wheelchair?

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I have read that weight bearing exercise will help with bone strength, but what if the patient just keeps falling every few days and breaking bones? Who will step in and say the patient is better to stay in wheelchair, unless they are in physical therapy or getting in and out of bed or on the toilet? (Patient has osteoporosis and history of fractures.)

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Our family decided when Mother was just too weak to walk on her. No amount of PT made any difference. We called her doc and he prepared a script for a wheelchair which she hated; too big, bulky and she didn't have the strength to turn the wheels. We called the supplier and told them the Medicare provided chair was not acceptable. They picked it up.

I went to med supply store and purchased a pretty blue transporter chair that weighed only 14 lbs. It was easy for us to lift and handle, fit in truck of car, looked good, put a nice cushion on the seat and Mother was quite happy with it. Could have just done that without involving doctor and having to wait for delivery of the ugly chair. You do not need permission to get what you need.
The MD will write orders for the patient to stay in a wheelchair and be trained to use it. Often the patient is non-compliant, tries to get out of bed alone and disaster ensues.
I'd say the primary caregiver makes that decision. Once mom fell and broke her hip, she never walked unassisted again. It was walker/gait belt/Maggie behind her steadying her.

If the primary care giver is a nursing home, then I'd say they call the shots. When mom had PT at the nursing home for 2 months, they made it clear she was NEVER to walk unassisted. In fact, for the first six weeks? They wouldn't even let me handle her. The LAST thing they want is for a patient to fall.

Littleton, that's what we did for mom - a light transport chair. The home nursing people insisted on a wheelchair. After we got it, I sent it back. Big, bulky. Just.No.

Okay. That works for me. Her primary doctor has prescribed her a wheelchair, but it's because she fell and broke her hand and can't hold the walker. I think I'm going to insist they continue with the wheelchair even after her hand heals and is rehabbed. Her balance and leg strength just are not good enough to walk around anymore.
Medicare provides equipment for the patient not giving a flip about the ones taking care of the patient or the limitations of the patient. Same with hospital bed. Oh yes, we will send an adjustment; however, it is hand crank. If you want an electric bed the out-of-pocket was $35 per month. Worth every single penny. Plus you have to add a 4" mattress pad for comfort.
In such a situation, an orthopedic doctor can help in giving right recommendation. Take the patient to OrthoTexas for appropriate treatment.
my aunt was fresh out of rehab and doing great with a walker but had a couple of falld due to momentary blackouts . she went back to wheelchair on her own and i alerted doc about the blackouts . she is in nh ( same facility she done pt at ) and they have given up on the walker . i think doc carries even more clout than overzealous physical therapists .
With my mom is nh, it is her pt who clears her for supervised with walker/independent with walker etc.
UPDATE:
I had to move my cousin to a Secure Memory Unit this week. She wheeled out to the parking lot twice trying to find her car to leave the regular Assisted Living facility. (She had no car there.) I was surprised she was able to get the front door open and get outside. Someone must have opened it for her.

Anyway, her hand is healing, but it's kind of bent and I don't know she will ever have enough strength in it to use a walker. Her arms are also so weak. Her legs are stiff, but she was walking a few steps at a time last week near her bed and in the bathroom with an aid by her side.

I'm going to discuss it with the staff at the Memory Unit and see what they think about the wheelchair issue. This is the first week in awhile that she hasn't fallen. Her balance is so poor as well. I just think it's a set up for disaster by removing the wheelchair.

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