My Mother resides in a NH, immobile after a serious septic infection. They started PT under Medicare but have presently discontinued as she made no progress. I knew all this could happen and told her that. I also told her she could use not feeling well that day. I think this may have just happened once.
My question is do I make her very aware of the exact circumstance and why, or do I kick it down the road depending as her not always remembering plays into it?
I contemplate as she is 90 and sad to be immobile now. She only has me physically near. I, in my present state, would feel pretty hopeless in a NH regardless of the NH itself. The situation regarding her immobility is pretty hopeless. I should mention she is overweight. She also is someone who doesn't process reality. Do I be very honest and explain they are not going to hoist her up if she can't stand or sort of gloss over it? Her state of mind generally processes information as it is being told to her.
At the same time, you should be honest with her about the reality of what might be achievable, and what she has to do to make it worthwhile.
Do you mean she turned down a session once, because she wasn't feeling up to it, and they have stopped her PT without any plan to offer it again subject to [whatever] conditions?
Showing no progress towards what outcome? Are you satisfied that they're not being too rigid about expectations?
What have they tried? Weight aside (how heavy is "heavy" if it's not a rude question?) what are the mobility issues? Can she sit up, for example, with or without the aid of a bedstick, a grab rail, a profiling bed etc.?
What is she able to do? There are other ways to build on her remaining abilities besides formal PT, and if she makes progress on those then you have a good argument for reassessing her eligibility. So far at least I don't see any need, let alone justification, for crushing all hope.
Now if she is in a nursing home, I know for a fact that they do use Hoyer lifts when needed to lift their heavier patients for various things, so I wouldn't be concerned about that. And I'm sure she is not happy about not being able to be mobile anymore,(it was hard for my husband to accept)so I would just support her in any way you can, and just let her know that you are there, and that you love her no matter what. Best wishes.
my grandmaw was in rehab at NH and the care was horrible so she did not go back!
I think the NH tried PT a few times but finally settled on getting my mom mobile in a wheelchair and maintaining enough core strength so that she could continue to use a toilet with assistance.
We never, ever laid out for mom any sort of "this is the end of walking", or "you're never going home again".
Once in a while, mom would say "what's wrong with me?" and we'd say "you had a stroke". She was surprised by this information evevry time.
Riverdale, I feel for you because your wish for your mom to have had a better life is so palbable. I know you would never say "I told you so". But know that it IS okay to think it. At least I did. A lot.
She does do chair PT that they show her. Today she told me for the first time that one arm is weak which makes attempting to stand more difficult but I think it could be difficult anyway.
Regarding paying for PT: I can inquire as to the cost. She has money from a trust now paying for her care. It can last a few years. My husband and I take care of all her bills. My concern would be spending on extra costs that might not even come to fruition which would be her standing let alone walking. If I knew how long she has left I could answer this question you raise better but of course I don't know that. Thank you for your suggestions. I would have to look into whether that would be available on her TV.
My main hope for her despite ones of mobility is that she can remain at this facility for the rest of her life and there will be funds for that. This facility does not accept Medicaid but they do have a benevolence plan which we would apply for once her money is gone. She could or could not be accepted. Otherwise she would have to transfer to a Medicaid facility which they will help us with but would be more difficult I feel with acclamating.
I don't think its so much your Moms weight but the septis that has caused the problem. A few of the members have said it really seems to drain people. Since Mom does not fully comprehend things, I would not explain why she can't walk. I would ask the PT if PT can be started again at a later date. Maybe they started too early. Mom was still too week. And if Mom has a hard time comprehending what is said to her, that makes it that much harder for the PT to get her do do things. My Mom forgot from day to day.
Suggestion from a person who was overweight, you never continue to tell people about their weight. You get the opposite result, they eat. Its a self esteem thing.
I mean, this is the thing: initially too weak to sit up. Now able to sit up? Able to move legs over the edge of the bed (with or without help) and sit up to the edge of the bed? Able to "bottom walk"? Able to place feet? Able to pull up to stand with both hands using a stand aid, with or without assistance of 1 or of 2?
It's a matter of small victories. Giving up on PT because "she'll never be able to walk again" denies her the opportunity to take those first steps by easy stages. You can pretty much guarantee that she won't be able to walk again if they won't even work on it, but then I'd call that a self-fulfilling prophesy.
And "bedsores" is a misnomer - they're pressure sores, and you can develop them just as effectively by sitting too still as lying in bed. There are special cushions and there are barrier creams and all the rest of it, but the only really effective prevention comes from mobility. It's worth the effort!
I admit I'm feeling especially touchy just now on the subject of giving up on people because of one client, whose husband was insisting that she couldn't dress herself even as - with a lot of encouragement and prompting - she was pulling her jersey on. Any opportunity to praise achievement is good for morale, and how is that a waste of time?
I believe she is being transferred by several aides. Around a month ago she told me they no longer needed the lift which was a good sign. I will have to ask her exactly what transpires. She was in very bad shape when she arrived to the NH in late November.
I feel badly about loss of PT. Medicare here can be ruthless. I don't think she could pull herself up. This was starting to become difficult before the massive infection. I think her weight is a real issue there. I can get very depressed about all of this if I focus too much. I try to do what I can when I visit. It would be far too dangerous for me to try to have her attempt anything physical with me alone.
I am so sorry that you and your mom are going through this difficult situation.
I hope you will find a feasible solution soon.
It really is hard sometimes to know what direction to take.
I have lamented how sad her physical state has made me for years despite my efforts as well as how unrealistic she has been. That could be understandable now but she has been this way for a long time in many areas of life. I have accepted that my mother is odd. I just now have to continue to kindly be frank with her regarding the reality of her mobility and the inner knowledge that I am doing the best I can by her. There just has always been the sadness for me that perhaps if I mattered more to her she could become better but I have to abandon this thinking or else I will fall into a depression that is hard to live with and my family does not deserve of me.
If HER reality is different from yours, no matter what the reason is, you really aren’t accomplishing anything by attempting to convince ce her that she has to believe what you believe.
You ask if you should make her “very aware”. You understand that she “doesn’t process reality”. If she doesn’t process reality, will you be able to make her aware? Probably not.
You assume that she is “sad to be immobile now”, but you may indicate that you believe that because you are feeling great empathy for her losses. Has she given you any reason that she herself is depressed by her lack of mobility? Does she take part in activities in the NH. Is she willing to move from place to place in the wheelchair?
In my experience, the most comfortable way to interact with someone in your mom’s situation is to stay with HER IDEA of what’s going on, and to talk about things that are helpful and encouraging to her about what she’s ABLE to do, and not so much about what she isn’t able to do, or why not. Since you BOTH KNOW ALREADY that she’s not likely to walk again, she’s not likely to benefit from or enjoy too much discussion about that.
I apologize as I know this isn’t the question you asked. I thought it might be helpful to you nevertheless and wanted to clarify an incorrect notion I read on the forum from time to time about the circumstances under-which Medicare ceases to pay for therapy. Now what I’m going to post refers to services provided to a home bound patient and not a NH patient. I’m not familiar with what services are provided in a NH having not had that experience. But you might speak to your mothers doctor and ask for orders to be written to continue your moms therapy based on her declining without the therapy.
‘If you meet Medicare’s home health eligibility requirements, Medicare should cover your care regardless of whether your condition is temporary or chronic. Medicare covers skilled nursing and therapy services as long as they:
Help you maintain your ability to function
Help you regain function or improve
Or, prevent or slow the worsening of your condition
Providers and agencies may worry that Medicare will not cover skilled home care if you are no longer showing signs of improvement. However, Medicare should not deny your home care because your condition is chronic or unchanging, or when additional care will not improve your ability to function—as long as the care is medically necessary to maintain your condition or to prevent or slow deterioration.”
My own mother had OT for years at home to keep her arm operational. Medicare paid for every penny.
I have no idea how Medicare works when one is in the NH but to me it would be worth a conversation with your moms doctor. I’m sorry you and mom are going through this difficult time.
https://www.medicareinteractive.org/get-answers/medicare-covered-services/home-health-services/home-health-care-for-chronic-conditions
I was asked to buy her a new adjustable bed bc it's taking 2 caregivers to get her up in the morning. She's lost core strength from refusal to do PT as well. She too will insist it wasn't offered, or she wasn't feeling well, or 100 other excuses she has in her bag of tricks.
The exacerbation of her condition has occurred due to her own decisions, not mine. I have raised heaven and earth in an effort to make her understand the consequences of her own actions. She makes poor decisions day in and day out and then complains about how hard her chosen life is.
We make sacrifices for the life we want or we sacrifice the life we want.
Your mother has made her choices and is living with the outcome, as is mine. These choices have nothing to do with us. They have everything to do with our mothers and their power or lack of power to deal with the truth and reality. We have no control over that.
I can pay for my mother to have PT until I'm flat broke and she STILL won't make the effort.
Soon she will go to live in Skilled Nursing and a Hoyer lift can be used to move her about, if need be. I don't feel guilty about that because I've done everything humanly possible for the woman the past 10 years she's lived here. I will continue to do my best for her, too, while she continues to put forth NO effort at all. Yes, it's sad she's made that decision, but it doesn't cause ME depression because I did not create her situation, she did. And living 94 long years of life on HER terms, that too.
Realize it's not your job to fix your mother. Just to love her as she is and accept her on her terms, and that her life is as she wants it to be. If not, she will make the required changes, to the best of her ability, as will my mother. In the meantime, it's THEIR lives. We have ours, and we need to move on with them.
Good luck