Managing PT for an 84-year-old. Is this a good idea?

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Managing PT for an 84-year-old. Is this a good idea?

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My MIL fell on Christmas Day and broke her leg and shoulder. She had a rod put in the leg and it's been healing well, but we were told the shoulder could only be immobilized and should take longer to heal. Last year she had 2 strokes so both her vision and short-term memory are not great.

She lives about 4 hours away from us so we can only visit on weekends, but her sister-in-law has been wonderful, visiting nearly every weekday. My husband's brother lives nearby and also visits occasionally. She has been doing physical therapy and making progress, moving from hospital to rehab to nursing care, but has lately "plateaued" in her progress. We were hoping to get her into assisted living in another month or two, but now they want to "take a break" from the therapy for a few weeks, so as not to use up all the Medicare allotted days at once. There are days she refuses to get out of bed--she has a hard time with the parallel bars, since her shoulder is not healed.

Is this a good idea? Will she "languish" and stop trying to recover, or is a break a good idea at this point? How long is too long to wait to resume therapy? We are worried about both her physical and mental state at this point. We were hoping she would look forward to moving on to assisted living nearby, but are worried she'll be stuck in nursing care longer if she doesn't put forth enough effort with the PT. Or is a break what she needs, while her shoulder heals?

Any advice on how long this kind of injury takes to recover, keeping her spirits up, and who to ask what questions when we are there this weekend, would be most welcome!

Long-distance Caregiving Physical Therapy Rehabilitation Center

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My Mom broke her left leg and right hip within a two-month period. She had the surgery to fix her hip then went from the hospital to an inpatient rehab facility where they worked her out at least twice a day with both PT and OT for about 15 days. When she was released from the rehab facility, she went home and had PT work with her there. When those home visits ended, her doctor ordered rehab at a local physical therapy place where she went twice a week for two or three months. Mom (87 when she broke her leg and hip and now 88 turning 89 in March) did not enjoy going to PT, and still doesn't as she has been back in PT since the end of January after a break of three months wherein we did notice a decline in her strength and balance. We really notice a difference when she is going to PT. She seems to be stronger and better able to get around with her walker. It is difficult to get her to exercise at home, so the twice weekly PT is good for her. We tell her that "motion is lotion" and "use it or lose it" but, honestly, at this point I don't think that really matters to her. She often reminds us of her age and lets us know that she is "tired" and has no desire to do her exercises at home.

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You will eventually run out of visits that Medicare will pay for. Even though the doctor or physical therapist recommends continuing. My 84 year old father was doing PT to gain strength and mobility in his legs and his Medicare visits ran out 6 weeks shy of the end of the year, even though he'd missed a few throughout the year. Medicare also pays for Silver Sneakers program at any public gym. See if you can get him to go with you there, but also supervise his activity. If you can, you'll both benefit. In my experience with my mother, once they quit they don't go back and they can lose muscle tone become weak much more quickly. My mother just gave up putting forth the effort and wanted someone to cater to her every whim and need. It's a use-it-or-lose-it type of situation with muscle and mobility. Wishing you all the best!

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So, too, did my late 94 year old mother take PT. But it was limited to 5 - 6 sessions; done very easy for a lady of that age. The Physical Therapist was so sweet! After Mother had died, I went back to the facility to advise him of her passing. He actually came to her funeral viewing.❤❤❤

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Following a hospitalization and a stay at a rehab facility, my MIL (in her mid 90s) was able to continue PT at her AL facility for several weeks (maybe even several months) until she was placed in hospice care. The PT must have been covered by Medicare and her supplemental insurance because she never was billed.

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You do know she’s not guaranteed 100 days right? That’s just the maximum Medicare will pay.

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When Mother took a break from PT for hip fracture, she never went back, but I'm somewhat of a drill sergeant (so I've heard), and I made sure she was doing the exercises. I just randomly worked them in like during commercial breaks. I also stopped wheeling her around in the wheelchair and told her she had to walk with the walker. No rollator either because she wanted to sit and be wheeled around on that too! Now she scoots around really well. Sometimes she ditches it in the house and gets around pretty well without it.
I am with her 24/7 though, so I know that makes a difference. I also encourage her to do things like dress or stand up from a sitting position on her own. And I bribe with candy or a drive on the days she says no. Any little bit of exercise counts.

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Awesome! It will obviously take our determination as well as hers. We just want her to be as independent and happy as possible.

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My mom in a similar situation never went back after a break in PT. A year later she can barely walk. Yea for breaks! (Sarcasm.)

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Ugh. Hoping this is just a short break!!

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I believe that your mom is entitled to restorative physical therapy. This is provided in the form of group activities. At my dad's facility, it was called Fit For Your Life. He resisted going at first, until I offered to go to the class with him. He ended up enjoying it and probably attended it twice a week for a period of time. Not only did he not lose strength, he gained it. Some activities are even fun, like corn hole games etc. They don't even know it's physical therapy. If she is technically in rehab, ask if she can partake in some of the long-term care patient activities as medicare physical therapy hours aren't in endless supply. If there is a music program or movie to see, it might encourage her to get out of bed. Your mom has been through a lot with two strokes, broken leg and shoulder. It is no wonder she's plateaued and is taking a breather. It would take the perseverance and patience of a saint to not get discouraged or at least fatigued. When you visit, get her out of bed and into a little sunshine. Don't just talk, bring something for her to do. Dominoes are fun and easier for low vision. Give her a manicure...anything to encourage her to sit up and interact and move. The last suggestion I have is this. Every day is like the other in facility, so put up a calendar in her room and ask that she or the staff write down each day she gets out of bed and does any kind of activity. This activity diary provides a tangible reminder to her of what she is actually doing over time.

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These are great suggestions--thanks! She does have a calendar and checks off the days, and we got her one of those clocks with large numbers and the date, which also seems to help. She does well with reminders of how far she has come. She has indeed been through a lot.

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No break. Push through it.
In my experience, they generally don't go back and it slows recovery time.
Explain that to her. See if she gets it.

All the best!

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The rehab is telling them Mom has hit a plateau. Medicare will not pay and patient will be discharged. You are not guaranteed 100 days. That is just the maximum Medicare will pay.

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If she takes a break from scheduled PT she should not be "allowed" to languish. She should be continuing with the exercises that PT has been doing. A friend or family member can follow the exercises that PT can provide and they should be done at least as often as her scheduled PT has been.
If she does not continue doing the exercises she may fall behind in her progress.
When my Husband was in rehab I would show up and get him to walk around the halls. (He had broken his hip) and once he walked the halls I would get him into the elevator for a ride downstairs where the regular rehab was. (He was on a locked unit due to wandering in the past) the regular rehab always had a cart with juice and cookies on it. Well cookies and juice could motivate my husband like nothing else. So he would walk to the cart, I would get the cookies and juice then I would have him sit in a chair. the sitting and standing was also a part of his rehab.
On the way back to the room I often would sit on the seat of his walker and he would push me. (more resistance=more strength) several times I would find myself sitting on the walker, the walker not moving only to find he had left me in the hall and walked back into his room!
So even if you are going to take a break with traditional PT do not break from the routine. This will also help get her back into the PT routine when it resumes.

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Her sister-in-law is doing just this, and I think it is invaluable!! Her nurse is also very encouraging. All good suggestions!

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This is a Sad and Bad Situation when it comes to Medicare and just How Long someone who really needs this part of the package, Would Not be Allotted anymore because "Time is up."
Make those arrangements for Assisted Living ASAP. They will be able to deal with this. Also, In the Meantime, Try and get your Sister in-law to at least get her out of bed to help her walk and You and your husband on the weekends, Help with this as well If you all possible.

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Thank you all so much! Yes, it looks like she has more days up to 100, and that taking a break now while the shoulder heals is a good idea. Medicare pays for a bulk of it, and her private insurance pays the rest, but they evaluate every 20 days to see how much progress she is making. Since her progress has slowed, they are taking a break.

She's in a wonderful nursing facility, so we are encouraging her friendly helpful nurse to make sure she at least gets up and into the wheelchair each day. She has been going to the chapel on Sundays. She can now wheel herself around, which is definite progress! Her orthopedist will evaluate her in a few more weeks, and when her shoulder has healed will start back up the PT/OT. For now, we are encouraging her to do what she can--move her arm as much as allowed and do some bike pedals for her feet, to keep her legs moving.

Thanks for all the advice! We will just try to keep up the regular visits and keep her spirits up, and encourage her to be patient. Baby steps.

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Therapy is probably correct in taking that break so not to use her entire 100 days . If you use them all now and she needs therapy after the fracture is at a point that therapy is safe there would be no days left to use. You can't MAKE a person do therapy. She's old and she hurts, it's not easy.

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Thank you! No, not easy at all. She seems to have good days and bad--we are trying our best to all keep her spirits up!

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I was in my 30s when I broke my ankle and I was 6 weeks in a cast followed by 6 more weeks of no weight bearing, I can't imagine how much more difficult that would have been if I'd had a shoulder injury too. Even without that I was floored at how weak and exhausted I was and how long it took me to recover. Older people take longer to heal, they suffer greater side effects from surgery and she also has other health problems, I can't say I blame her for feeling too tired to get out of bed! I think the fact that she is able to be up and moving at all is amazing, if she has plateaued it may actually benefit her to slow down a little.

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Sometimes, a pause in PT is helpful. JoAnn is right about Medicare paying for PT. If your Mom has stopped making progress, they won’t pay for the PT to come. But, after a few weeks, the doctor can order it again and your mom might be willing to participate. We did something similar.

Unfortunately, insurance doesn’t pay for maintenance PT. They only pay if she’s making significant progress. So try to set something up to keep your mom moving on days that no PT comes, for example a friend visiting and doing easy exercises.it is a slippery slope once they stop moving. It’s like a race against time to keep the muscles from wasting. Good luck to you.

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Thanks! It's good to know someone else has been this route. We keep telling her "use it or lose it" and she seems to see the wisdom in that. It was great to see her making a real effort to get around in the wheelchair this past weekend.

Her SIL got an exercise list from the PT and we are encouraging her grandkids to write to her. We brought her more of her favorite pictures to decorate her wall. Slow but steady progress. Sounds like its good right now to "bank" the days.

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If MIL is paying privately then what I said below doesn't have anything to do with her. Let the therapist take the lead. MIL can have therapy at the AL. With Medicare, there is a waiting period and they will pick up therapy again with a doctors order.

Anytime someone your MILs age goes thru something like this there is a decline. Hospital stays, rehab and NHs are not pleasant places to be. Elderly don't adjust well. The change to an AL may show some changes. Once she acclimates herself to new surroundings and people, she maybe OK.

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Now I maybe wrong here but Mom is in rehab because of her injuries, right? If so, if she plateaus, Medicare will no longer pay for her therapy anyway. Medicare determines if PT is continued based on reports sent to them. Plateau means they have done all they could for her. My Mom broke her shoulder in such a way it couldn't be cast so she wore a sling to immobilized it. She was in her late 70s. Even with PT her shoulder was never normal. She couldn't lift the arm over her head. When I put on her coat the bad arm went in first because she couldn't bring the shoulder back. So your MIL may never have full mobility of her shoulder.

Overview only, Medicare paid the first 20 days 100%. 21 to 100 they will only pay 50%. Suppliment may pick up balance but 150 a day was what my Mom paid. Unless Mom is paying for private care, then she is now in the 21 to 100 days. If therapy feels she is as far as they can go with her shoulder, she will be discharged. Medicare will no longer pay. You are not guaranteed that 100 days. To keep her in LTC it will now be private pay.

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PT is very important and if it isn't continued the injury (due to a stroke or a fall or other mishaps) will not only not improve but any progress that's been made will be adversely affected. She could lose more mobility than she had to begin with prior to the fall. Even in just 2 weeks.

PT is boring to most people who have to do it. That's understandable. After a certain time it's done by rote and many people don't see the point. But if it's discontinued without a doctor's authorization hands will curl into themselves to the point where the fingernails are cutting into the skin of the palm and in order to clip the nails those fingers have to be opened and that is very painful for someone whose hand has curled in. Shoulders become frozen in place where there's no mobility and are painful, feet turn in toward each other which prohibits walking.

Although someone may be doing well in PT, unless directed by a physical therapist to stop, PT should continue as ordered to avoid a worsening of mobility.

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Managing PT for an 84-year-old. Is this a good idea?

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