Rehab after broken hip; why is this rehab situation so difficult? - AgingCare.com

Rehab after broken hip; why is this rehab situation so difficult?

Follow
Share

Mom (88) fell and broke the head off the femur bone. She already had a broken fibula on the opposite leg for which she was wearing one of those big, awkward walking boots. She had a new ball and rod put in her hip during surgery last week. She suffered really bad delirium the second night after surgery but seems to be better now.


Her hemoglobin has dropped to 7.1 and they decided to give her one unit of blood which brought it up to 8. I think that is still way too low. She has been in the hospital for a week now and the case manager is starting to make noise about wanting to dismiss her even though Mom's hemo level is severely low. I keep asking her hospitalist to figure out WHY her hemoglobin keeps dropping. You would think I was asking him to come up with a cure for cancer!


Mom has to go to rehab after she leaves the hospital, especially since both limbs are now affected. She is weak and having difficulty getting out of bed. Each time she gets up to go to the bedside commode or to walk for PT, I have to put on her boot, get the walker, get the belt they put around her waist to help hold her, and set up the bedside commode. I do this all after I have pushed the button to call for a nurse or tech to come help her since it takes so damn long for them to get to the room.


My brother and I went to visit SNFs last Sunday and were underwhelmed with what we saw. One place even had a community shower with one stall! Yikes! We talked to some friends who had been in acute in-patient rehab at a place near the hospital where Mom is now. They require 3 hours a day of rehab or 15 hours a week. They are in the top 1% in the nation in success in returning people to the community. They truly have impressive stats. We have talked to admissions there and they reviewed Mom's hospital file and said she qualified for care there. Mom's insurance company denied her request to go to that rehab facility and said she should go to a SNF where she will maybe get 1 hour a day of rehab. Since she was independent and walking with a cane and dressing and bathing herself before all this, we want her to get back to that level or as close as possible.


I have filed an expedited appeal with the insurance company and it has been accepted as of today to be put before the decision-making committee. We will know within 72 hours. But the hospital may not let her stay that long (although she needs blood). Our Plan B for a SNF has not been approved yet as they have some "questions" about Mom's hospital file. Apparently, during the delirium episode, the doctor ordered Haldol which she never got. Now the SNF wants to know if she is violent or is "sundowning". She never took the dang pill! They may deny her admission for something that is absolutely irrelevant. She can not come home. I can not lift her or transfer her. I wish I had planned for this starting years ago instead of days.


Why is this rehab situation so difficult?

22

Answers

Show:
1 3
Today is Independence Day for Mom at rehab and her chance to show her therapists what she has learned and how far she has come in 2 weeks. Best of all, it means she is going home tomorrow!! Yippee!
Helpful Answer (1)
Reply to texasrdr22
Report

GardenArtist, that is good to know. Before all this happened (broken left fibula and fractured right hip) Mom was going through peanut M&M’s by the bagsful! She has not eaten them for almost a month now (hospital & rehab) so maybe it won’t be an issue. I will look up other potential iron binders and try to keep them out of her diet. Thanks for the info.
Helpful Answer (0)
Reply to texasrdr22
Report

Texas, I learned the hard way that chocolate binds iron. There are other foods that also bind iron and prevent its absorption. Keep a list of the diet she's been given, then research to see if any of them bind iron.

I can always tell when I've had too much chocolate and when my iron level is low. It's the primary reason why I'm phasing chocolate out of my life.
Helpful Answer (0)
Reply to GardenArtist
Report

Barb, you are absolutely right! The doc keeps asking her if she is dizzy, lightheaded or nauseated. She says “No” to all. She is leaving rehab on Saturday to go home. She benefitted from her stay here and the hard work continues for her at home. I am so proud of her for soldiering on!
Helpful Answer (1)
Reply to texasrdr22
Report

Text, from what I'm reading on Mayo Clinic and other reputable websites, its not just the hemoglobin number that determines when to transfuse.  7-8 Is the range where they look at the other factors. Since your mom doesn't appear to be experiencing fatigue ( it sounds like she's doing amazingly in rehab!) I'm thinking the doctors are factoring that into their decision making.
Helpful Answer (1)
Reply to BarbBrooklyn
Report

I asked the rehab facility doc today if they planned to check Mom’s hemoglobin level again and he said to wait until she sees her PCP after she leaves rehab. I think 8 is critically low and it wasn’t too long ago that 8 was the trigger for transfusion. Now it has been changed to 7 to need blood. Crazy! I have no idea how she is managing to do 3 hours of rehab every day. Plus, you can’t sleep for any length of time with vitals being checked throughout the night.
Helpful Answer (3)
Reply to texasrdr22
Report

Other than transfusions, Grandma ate beef daily. If the level wasn't over 10 immediately after the transfusion, she probably needed more a few days later. Most people can tolerate a slow transfusion. When my grandma's congressed heart failure progressed, they would check her into the hospital for 24-30 hours to use a very slow transfusion rate. At 8.0 her brain and organs are likely starving for oxygen and she's at increased risk for falls and/or a heart attack. Might need a geriatric physician to appreciate that 8.0 has a bigger impact on an older person with a weaker heart and organs than a younger person who can quickly regenerate red blood cells.
Helpful Answer (1)
Reply to TNtechie
Report

TNtechie - thanks for the heads up about the hemoglobin. The docs are giving her iron pills daily and I have not heard any plans to do more blood work. Did they do anything for your grandmother other than transfusions? Last check showed Mom's level to have dropped again from 8.1 to 8.0. It was 8.5 immediately after getting one unit but that was about 10 days ago.

Pepsee - I am lucky to have a brother who pitches in. Happy Mother’s Day to you, too!
Helpful Answer (1)
Reply to texasrdr22
Report

Wow, so glad your mom is doing so well. She sure is a fighter! What a great family you are, your brother and you support your mom so much it's so beautiful to see!
PS, happy Mother's Day to you and your wonderful mom.
Helpful Answer (3)
Reply to Pepsee
Report

My grandmother had a slowly declining hemoglobin count with no apparent blood loss and required periodic transfusions to maintain a level above 10. She had a femur break and cause a fall too. Doctors finally determine that she wasn't making enough blood cells anymore (femur is a major red blood cell producer and osteoporosis had damaged hers). If your mother's count hasn't started back up, you may want to ask her doctors if she could be having this problem too. As long as the count is coming back up the doctors may not want to give her another transfusion because that interrupts the process where she makes her own blood cells.
Helpful Answer (3)
Reply to TNtechie
Report

1 3
Related
Questions