Mom, 94 with dementia and mobility problems, has been in a nursing home since March. In April she broke her hip. Upon return from the hospital she enrolled in Hospice Care. She's had no physical therapy since then. She is now a two-person lift with a stand-to-lift machine. She has been discharged from hospice.

In a week or so there will be a care conference for her. My sisters and I will bring up the possibility of physical therapy for her at this time. The "nursing staff" does not want physical therapy, fearing that it will result in a greater risk of falling. Our concern is that the need for the sit-to-stand machine to use the bathroom or transfer to or from her wheelchair is a big limitation. For example, her sister is turning one-hundred and we know we could get Mom to the party and care for her there ... unless she has to go to the bathroom! Similarly, she could go on NH sponsored outings, except for the use of the bathroom!

Our hope would not be that she could walk again or even manage her own transfers. But it would be (we think) a good benefit if she could be helped without the use of cumbersome equipment and if we could learn to do it.

We will keep an open mind during the conference. Before then, I would love to hear from anyone who has had experience along these lines or has ideas about this.

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Has Medicare approved PT for her?
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I have had Mom in PT twice in the past three years. The first time was following respite of two weeks. The doctor had prescribed xanax while in respite to be administered only when needed. Well POA sis told them to give it to her nightly. On discharge Mom had become so terribly weak, I think from the nightly xanax building up in her system, that physical therapy was ordered. Once the xanax stopped, her strength returned quite quickly. Did PT help yes.

The second PT was following the first UTI just over a year ago. She had become very unstable, though still strong. I'm sure the PT helped but I questioned the value of it because they wanted to try to get her to walk less hnched over, so becoming more stable. But she does not remember to stand up straight and the constant reminder is a battle I have chosen not to fight. Are there benefits? Yes, but should be weighed carefully for benefit. Mom's therapist talked about memory in muscles that they would "remember".

I can see the nurses point also, easier to keep her down so she doesn't fall. JG your Mom will forget that she needs to use the walker and may fall. However, I don't think PT should be withheld to make staff's job easier.
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Jeanne, I can understand that reasoning, although it doesn't change my opinion on the value of PT. I was thinking years ago of a friend I met at college whose brother suffered brain damage in an accident. She learned how to "pattern" muscle activity and worked with him in therapy to "pattern" his legs to walk.

As I understood it then, the repetitive motions can be learned by the muscles even if brain activity is not motivating those motions.

I'm sure there are more advanced techniques for those types of injuries now, but I was wondering if in spite of the dementia your mother could be patterned in the movements of leg exercise before she even tries to walk.

I also would think that there would be more progressive ideas on addressing her mobility limitations to prevent her from walking ALONE. I'm not thinking of strapping someone in a wheelchair or something like that. I'm not really sure what could be done but it's hard to believe that just because she has dementia she shouldn't be as strong as she can be.

Maybe some type of alert button can be placed on her wheelchair?

Without surgery, was anything done to correct the fracture?
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Let me explain what I understand of the staff's reasoning, if I can:

Mom has dementia. She is a very pleasant lady. Everyone seems to like her. She is not defiant or strong-willed. She just can't remember her mobility limitations, has tried to get up alone and that puts her at risk. She fell three times in the NH in March. She is not very apt to fall now, because she can't get out of bed or out of her chair on her own. If therapy gives her the idea that she can do some stuff on her own, then she may forget that she needs help when she gets up, and therefore she may fall.

At least I think that's the reasoning. I'll probably hear it explained in more detail at the meeting.

She did not have surgery or therapy for the broken hip. The hospital staff thought she was dying.
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From my experience, PT has always been beneficial in the elderly. My aunt was 95 when she landed in rehab with a broken hip. She had extensive PT and it helped tremendously. She had trouble walking previously due to other hip having been replaced and polio in one leg from when she was young.

She required help transferring as well as she could no longer walk. The PT definitely helped her regain strength and stamina. It improved her mobility and was beneficial to her mental attitude about her limitations. With all due respect, I have to disagree with the "nurses" stating that PT would put her more at risk for falls. For my aunt, it was the opposite and PT enabled her to return home with 24 hour care. She did eventually have to go to a NH as dementia was becoming evident and it was the only way to keep her safe.

After caring for the needs of four elderly relatives, PT was always useful. As above stated "Go for it"!!!!!!! Often, I found, the staff did not give the proper advice. Good luck Jeanne and hope it turns out well at the meeting. Take care
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I had to read this twice - the nursing staff thinks that PT will increase the risk of falling? On what basis do they think that continued immobility would be helpful? I am aghast at this view - it's like thinking a woman should be confined during pregnancy!

My father has fallen twice first fracturing his left hip in 2012, then his right hip in 2013. He recovered what I considered to be very well after the first fall, but took longer to recover from the second fall.

After both surgeries, I immediately took him to a SNF which specializes in quick rehab, then got home PT for him afterward. He also continued to do some PT on his own, easy PT that he could do sitting down.

After he was stronger, I also took him to PT at a local therapy place where he learned even more different exercises to do. His strength increased markedly during these visits, and his balance improved as well.

He's been able to walk without a walker for several months, but we always bring it just to be safe. And he's now more concerned about falling, so the walker is omnipresent even though he walks about the house, in and out of buildings, etc. without it.

We just got a rollator (rolling walker) for him last week. That will increase his mobility because it has a seat, so he can walk farther, sit to rest, then walk even more. I see it as a mobility enhancer.

He would never be able to walk now if he hadn't had PT.

Not only was it physically critical for him, it was emotionally and psychologically critical as well. I could tell that he was a bit down (I wouldn't say depressed) after the second fall and was extra cautious (generally). But that was primarily during the winter.

Once spring and better weather arrived, he began going out for walks more and more and has improved since then.

If he hadn't had PT I'm not sure he'd even be walking now, or at least as well as he is.

With your mother's situation, the need for the transfer machine does severely limit her mobility, but I'm sure also psychologically weakens her emotional strength and outlook, which as you know is critical. If she feels dependent, she may come to think that way permanently and not even see herself as being able to walk again.

PT will enhance her self esteem and open the doors to more mobility and a better life.

I'm an avid advocate of PT for any injury. I say, GO FOR IT!
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