So she's in her second week of rehab. Every time I visit she just wants to "lie down". Plus she has a completely unbelievable fear of falling, I mean she's comfortably in bed and gripping the railings like she's on a boat being tossed at sea. She says there's no vertigo or dizziness there either. Today I merely tried to raise the bed a little so she could eat properly and see me and she starts carrying on like it's the worst torture imaginable.
So I was talking to the therapist and she tells me that on Friday they had to change the mattress so there was no other option but to get her in the wheelchair for a while. This has been a goal since day one. She tells me that after a brief struggle she did get in the chair and remained there for a few hours with no issues. I was astonished as Mom never mentioned it.
So today I'm there and we figure let's go for it again. They sit her up and immediately the death grip begins. This little old lady who's always too weak to move was fighting off three people and resisting with everything she had. There was no risk whatsoever of falling. Eventually the therapist had to give up and i could see the annoyance there, as I felt it too.
I'm wondering if maybe it's me. When I'm there she never stops with the hapless routine and the fear of falling, then I hear that while I wasn't she's actually doing something. Perhaps i should skip a few days and see if it helps?
Is anyone explaining to mom what's going on? Is she understanding the instructions? The fact that PT hurts, but it's ultimately going to help? Again, i think the cognitive/mental state thing is the wild card here.
With regard to the SW, in my experience, they are ALWAYS at the care meetings.
They want you there for several reasons. One, to be a friendly face and to aid communication with your mother. Two, so you can observe the techniques and provide some additional continuity in future. Three, for arse covering so you can witness exactly what they're up to - and don't forget they will have lots of patients' relatives calling them up and demanding to know what they're doing for their fees and why isn't mother/father/spouse making more progress.
When my mom, then 90, was in the hospital, post broken hip, they had her up out of bed VERY SOON after surgery. It's how they prevent blood clots, which are the real enemy. But DO make sure that you speak with the Director of Rehab.
Look, if they have orders from the doctor to start pt, no, they don't have to call you. Your mom's not incompetent, right? They tell HER they are starting pt and if she calls you, that's how it gets communicated. Since my mom has aphasia, I gave her a card that says "call my daughter" with my phone number. It took me a year to come up with that.
When I see the PT tomorrow I'm going to just ask her point blank, is she going to help Mom rehab from her spine injuries and is this facility equipped to handle my mother's case? Because if not, I have to find another rehab that will.
We had to do that for my mother, whose first therapist said there was nothing he could do because Mom wouldn't try. The bas**** even had her in tears. I was so angry with him for being so cruel to an 80 something woman recovering from a hip fracture, but with Dad and my sister, we turned the situation around with a good resolution.
Discussing it with her orthopedic surgeon, he said Mom should NOT be weight bearing on the fractured leg for 6 weeks. So Mom was instinctively not doing what shouldn't have been done.
We had a meeting with the Admins and addressed the issue, making it clear that the grouchy therapist's action was inappropriate and medically dangerous. Another therapist was assigned, and the recalcitrant one was moved to another facility, so they said. It wouldn't surprise me if he was given his walking papers.
I also don't understand why the therapist is pushing for your presence at PT unless she's using you to document something, like her concern for what she might interpret as a lack of progress. In my experience, therapists often suggest family don't participate because patients "perform" differently when family is present. She may have a hidden agenda.
Something's amiss; once again you'll have to be assertive and straighten things out.
This has really been quite an experience, hasn't it?
I spoke to her insurance carrier today and according to them they'd have no problem with covering her rehab based on a new assessment of her needs and goals but it has to come from the rehab staff. Apparently I have to go over the PTs head and speak to someone about this issue as she just refuses to listen. And she's already leaning on me again to attend Mom's PT, she's almost implying that it's up to me to demonstrate progress, which just annoys me further. I mean I want to participate but I certainly don't want the entire burden placed on me here.
And if I get one more somber head shake or if I'm dismissed as an idiot one more time I'm going to have to seriously consider moving her someplace else, if that's even possible right now. They're not seeing one thin dime until I see someone there prioritizing her care over Medicaid applications and insurance guidelines.
I would also speak to the business office about a way to extend her Medicare eligibility, given the errors that occurred the first time around. I would appeal for another 0 days full coverage, based on her second hospital stay.
As to creating an atmosphere that your mother can look forward to, what can you think of that she'd enjoy after PT? Listening to her favorite music? Favorite magazines to thumb through? I suppose you could consider bringing her a special treat she might like, or better yet, some flowers...perhaps "a daisy a day" or better yet some lovely roses?
babalou: The first time around her PT was a total disaster, as she was still not diagnosed properly. It was tough to really have a LT goal there as I was still deeply concerned about what was wrong with her, while PT's goals were based on treating her for an ailment that was merely a symptom of her actual problem. In short, it was a mess and I cringe when I think about it. My hope is that this time it can be more practical and well-thought out given that now we know exactly what her problem is. I know she'll never live independently again, that's a given, but I don't think it's entirely unrealistic to get her to a point where she can at least assist in some day-to-day routine things, like helping her get dressed, cleaned up, eating normally and etc. She's already not actively resisting her aides and nurses like she was before, so IMO there's a little hope there to expand upon (ideally).
And this time around I am absolutely insisting that no one is to badger her about "insurance cutting her off because of lack of progress" which I detailed elsewhere in this thread (and given her injuries it was even more awful when I look back on it) she has enough on her plate without having that crap thrown at her. In retrospect, IMO they were too quick to "give up" on her and label her as being "difficult", that needs to be atoned for even though realistically I know that I'm probably the only one who cares about that aspect of it. I only wish I could go back in time and insist on having those damned tests be done sooner, as we could have avoided a very sad and painful (esp. for her) situation.
When she complains of being bored, what does she actually say about it?
Regardless of "self destruct buttons", your mother may also be thinking of the phantom energy that's wasted when electrical appliances are left plugged in while not in use. For someone who went through the Depression, that's not unusual.
For me, it's an issue of minimizing my carbon footprint. Other than appliances and clocks, anything else gets unplugged when not in use. It's difficult to tell specifically how much has been saved, but it seems to be about $60 a year. For me, that's significant! I can buy a lot of seeds and a few plants with that savings.
If you've ever been the victim of identity theft, you can become hypersensitive to potential scams. We have gone through that, and I can tell you that you begin to think of everything you might have that could be compromised, sites you visit, etc. and how to protect yourself. Your mother may have that concern with verification of bills.
As to electronic gadgets, it's no longer easy to just turn them on; you have to have instructions even for phones. The KISS philosophy seems to have been vanquished in electronics manufacture in favor of one which is all inclusive - MIC - make it complicated.
After a while, an older person (even someone at my age) just gets tired of all the fooling around. I'd rather spend that 5 or 10 minutes in my garden than pushing electronic buttons.
An electronic gadget can't hold a candle to the pleasure of watching butterflies flit from one pollinator plant to another.
That's hilarious about your mother acting to stress out the recalcitrant granddaughter! Something I've noticed about the relationship though, is that the granddaughter seems to call you in panic for things that might seem unusual. How old is she? Does she have much real world experience?
And I think there's something to be considered about Babalou's suggestion of simultaneous orthopedic and brain issues
I want to posit an alternative interpretation to your mom's saga. Mom injures her back and at the same time, has a TIA iron other vascular event which also goes undetected. Now , using the reasoning skills of a 5 year old (it hurts, if I don't tell anyone, it will get better), she resists and evades intervention. What I'm saying is that it may not be the pain that has caused this; it may have been a vascular event that caused both the loss of cognitive skills AND the injury. Just something to ponder. The important thing is that she's getting better physically. Cognitively, you'll have to see where she is.
Like I said, stubborn is a broad word and to properly describe it would take all night, but yeah, she's always been like that. Example: My mom is from that generation that thinks every new piece of helpful technology features a self-destruct button that must not be pressed so it's just safer to unplug the device entirely (wouldn't want to start a fire!) and go back to the old way of doing things. Phones, TVs, VCRs, DVDs, car radios, you name it, she's afraid she'll somehow "break" it by using it. I've forced her to adapt, she loved the new TV I got her a few years back, yet she still has her old rotary phone, I kid you not. She can be incredibly resistant to the simplest things sometimes and if it involves money in any way she's SURE it's a scam. She'd call the water department to ensure that the bills were real then she'd pay them in person just to be safe.
A few days ago my niece was visiting and she sends me a panicky text saying that Grandma is moaning and carrying on complaining about being in pain and etc. and that she seemed pretty bad. So I visited later that day and she was OK, nothing unusual going on. So today I asked her what the deal was with that. First she said she didn't remember but I didn't really believe her as my niece hadn't visited in a few days before that and I knew Mom noticed and wasn't pleased about it. So I asked her, "were you just putting on a show to make her feel guilty there?" and wouldn't you know it, she cracked a grin then tried to hide it. I keep telling these medical people, you gotta watch this one, she's got cards up her sleeve.
Knowing what I do now, I think it all played out something like this. According to what her doctor just recently told me, she was treated in 2004 for a back injury, which became the lower back fracture she was suffering from. I never knew about this, which is totally understandable as my sister was probably involved and her view of modern medicine was completely bizarre, as was her desire (and Mom's) to "not worry me" by telling me about things like that. This injury became a degenerative thing which Mom chalked up to "arthritis" in her "hip" which was always her go-to complaint.
The second upper back fracture occurred far more recently, my guess is sometime in mid-June of this year. I have no idea how or when and if she knows she isn't saying. This injury was so painful it forced her to adopt a posture which in turn put even more stress on the lower back which led to a snowball effect of sorts. At the exact same time she became very withdrawn and disinterested in everything as the pain and the fear of having that pain diagnosed and treated kicked in. From there it was almost like she was in shock, as she became non-communicative and even more withdrawn.
Right now the best way I can describe it is that it's almost like she's emerging from a coma state. She's all achy and sore from the lengthy period of inactivity, she's shocked that so much time has gone by, she's surprised to have survived it and she's still exhausted from the whole ordeal. I can see her personality peeking out here and there but it's tough to say how far it's been buried as of yet. Hopefully I can get her assessed based on what actually happened to her as opposed to what the first impressions doctors have of her are, as IMO it's all symptoms from the same thing.
I think you need to get clear what her baseline was before. Was she declining cognitively ? Having trouble managing bills and such?
She may have had a TIA or small stroke somewhere along the line. She may not be able to clearly express "I have pain here, or I can't swallow that pill". Loss of cognitive function often leads to much anxiety and depression. Getting a clear picture about those issues is key in getting her the right meds and the right help.
If you don't feel that the psych people at the rehab are seeing her clearly, you might think, down the line, about taking her to an outside neurologist who specializes in dementia.
The big question is ALWAYS or NEW? Is mom's stubbornness a new development or has she always been this way? Usually cooperative or usually impulsive and pigheaded? Compliant with doctors or dismissive?
I have an appointment with the rehab people on Tuesday to discuss "her treatment and therapy" (and probably "her assets and money" too). My goals here are realistic, I'm not expecting any miracles or anything. I want to see her regain some modest physical functionality and confidence which could lead to more mental stimulation too, which I think she really needs. I hope they're on the same (or similar) page here and that they don't try to push some "wham bam discharge day" idea on me. Yeah I'm cynical, I know.
I think this time around it's crucial that we can get her comfortably in a wheelchair, as she not only needs the mobility but she needs mental stimulation. She's been in and out of reality in hospital beds for a while now and it's definitely making her weird and squirrelly. But this time she has to ENJOY things like talking to people and being outside which won't happen if she's in pain, so right now getting her to a point where she can sit upright for a few hours without being miserable is the first goal IMO.
The mental aspect is going to be tough IMO. See the "stubbornness" mentioned in the title of this thread. Trying to get a "straight" answer out of her is impossible sometimes and it can be extremely frustrating. I'm hoping they can put together a practical PT program for her that might give her a sense of accomplishment that she can build on, as "too much too soon" is just going to cause her to withdraw and make excuses to dodge it. Right now she's maybe 25-35% "there" which is definitely a step up from the 1-10% before, but still a lot of work to do.