My mother got pneumonia and has now been in rehab 2 weeks without much improvement in mobility. What's the point in rehab that's not helping?

I would discuss this with her doctor, especially the leg swelling. PT won't be continued if she's isn't showing any signs of progress, is uncooperative, or has plateaued. You mom needs to know that it's vitally important she does her best to try to improve. Are you able to go in and help her get up and move around more? Not moving isn't helpful with pneumonia. The swelling in concerning...

What does her care plan say?

Ask for a meeting with the Director of Nursing and her therapists. Ask them what the plan is and why your mother is not up, dressed and seated in a chair, ready to participate in activities each day?

Whay does the facility doctor say about the swelling in her legs?

If you don't get answers, get her back to the hospital and find out why she is retaining fluid.

77 is not elderly! (I am 72)

I would ask why she is only getting therapy once a day. Also, not being taken to the bathroom like every 2 hours. Why is she being allowed to stay in bed. When you have pneumonia you need to move. Its the laying around that does not help. Why isn't she being sat in a chair for a while. Maybe this rehab is not for her. I would ask about rehab at home. Seems to me she would get about as much therapy. At home you can get her up and sit her in the living room. Get her outside for some fresh air. You can continue her exercises.

You need to be, if you are POA or next of kin, included in the care conferences that Rehabs must have weekly. You should contact Social Worker in this facility at once and ask about expectations. If PT is only "working with" (this doesn't mean getting up) Mom once a day this is very poor rehab.
However, your Mother entered with bad knees. You mention she was already suffering falls at home PRIOR to the diagnosis of pneumonia.
Has there been an Ortho MD assessment of your Mom's knees? Does she need need surgery? Is she still suffering long term issues doe to the pneumonia? Does she have complicating factors other than knees (ie obestity?).
All of these things are factors in recovery.
Especially worrisome is that there have been knee issues at home, and falls, before anything like the pneumonia showed up. I am 80 and walk over a mile a day, so what you have here is a real physical issue. The longer Mom is bedridden the worse she will get. Laying about in bed in rehab is unusual to say the least. You need to get a consult with the Rehab doc and explore what is going on. Is this an issue of lungs, overall condition, knees??????
Be the squeaky wheel. I wish you luck.

Bring her home and have them do home therapy where the physical therapists come in and occupational therapists . The Doctor can order that

From all I've heard and read, if she doesn't get up and moving more, it won't be long until she's suffering from the after-effects of pneumonia plus even more edema (swelling) and also blood clots in her legs. The lymph system, unlike the circulatory system for blood, doesn't have a heart that pumps to move the fluid through it. Instead it relies on movement. It's no wonder that her legs are swelling.

The sad fact is that staffing at any of these support places is critically low. Independent living, assisted living AND rehabs so not have the staff necessary to support the patients/residents they have. The ratio is usually 1 CNA per every 8-10 patients during the day and 1 to 13-14 at night and that was pre-COVID. Now, it's even more dire. Your LO will not get the proper care, period.

The alternative is bringing her home and bring in PT and skilled nursing (Medicare should cover all of this). Or you can do it yourself which is really a dreadful alternative and takes a huge toll on you. But if you need to bring her home, her doctors can certainly arrange home health care and physical therapy/occupational therapy to help get her moving again and back on her feet. Rehab will let her lay in bed all day. And taking her 1x/day to the bathroom? I'd call the police and have them charged with elder abuse for that one. That is outrageous.

This most definitely isn't a rehab hospital. Try to get her placed into one. That will include 15 hours of therapy/week and they won't just watch shile she gets edema. This sounds like a mediocre SNF (skilled nursing facility). If she doesn't have acute illness they will provide minimal care while she convalesces.

Mobility is the key to recovery! But if you find out how to motivate a loved one inquiring minds want to know. I am finding it hard just to get my wife to use the bathroom. The doctor says there is nothing wrong with her other than she has not used her muscles enough!

Rehab should be doing Physical Therapy, Occupational Therapy and perhaps Cognitive Therapy at least 5 times a week for each type of therapy.

I would bring her home and ask that the therapy be done in the home! It is not like she is all alone at home. She has you there and you can help her. She would do much better!

Swelling in her legs is concerning and probably not due to lack of exercise. Please make sure she gets a doctor's appointment pronto to address this issue. Once this is addressed properly, you can work with staff to get her more mobile.

You might contact the social worker and ask to review the doctor's orders for your Mom's therapy. How long is she with therapy when they get her up? Usually the therapy time is 1-2 hours but that can include the long and often slow walk to and from the therapy area. For routine physical therapy you get 1 session per day. Many of the privately owned rehabs/STR contract out to Physical Therapy organizations so you can also ask which one they are using. If her legs and ankles hurt and she has indicated this to them, it may be the reason they are doing exercises at the bed

The 1x daily for bathroom seems a little weird if it states in her chart that she is a falls risk. Is she laying there for the rest of the day in a urine soaked diaper? That is definitely not right and is a cause for a complaint to the Ombudsman's office.

In any event, you need to find out what is going on in terms of therapy at this facility. My personal experience, both for my self and the many patients that have passed through my office, is that rehab in a facility causes you to strive just a little harder in your exercises (maybe just to get out of there, lol; it also set your mind up for including your exercises in your regular routine when you get home but everyone is different. You do need to move fast though because insurances will only pay so much for so long.
Good Luck to you and Mom

If she is still at the rehab, there is one day coming up where she will be up and about regardless her condition and that is May 8

Home rehab is a monumental undertaking.

What are your expectations, 2-3 weeks past serious infection requiring an ICU stay?

PT will be making notes - exercise tolerarance & improvements for bed exercises, sitting to standing & mobilising + what assistance level was required. PT will re-set realistic goals for each session or week.

Rotating ankles may not seem too exciting, but pumping the foot & ankle up & down presents 'foot drop' & gets the calf muscles working. This is important for building strength for walking again & also very importantly, reducing risk of blood clots in the legs.

Why not ask for a detailed PT update? You may find (while small) many gains are being made.

I can see it would be frustrating for you if you compare how Mother was before the pneumonia to now. - but give her time.

People can't jump from the bottom step to the top step in one leap. They move upwards, taking a step at a time.

GreyCe: Unless you're a medical professional, I do not advocate that you perform home rehabilitation. Perhaps you can opt for a different rehabilitation facility since you're unhappy with the current one.

Rehab should be 3 hours a day ! Although when my mom transferred from an acute rehab hospital to a snf that had continuing rehab they said it was 3 hours but it was usually just one ..though she was up and to dining room and in chair mostly. Then got flu there , they weren’t following cdc guidelines and she ended up being worse when she left there than when she arrived. One issue with all these places is their treatment of elderly. I think they just had an idea of how much an 84 y/o should do and got her to kinda that point. Similar treatment always after she reached 80..at emergency rooms and in hospital . They’d assume she needed walker or was normally confused ..not that her normal state was just what anyone else did other - walking , talking and reasoning well. Worst thing for elderly in hospitals now is the hospitalists ..might be fine for younger healthy patient but not for those with extensive medical history. Completely missed my moms extensive second stroke - and that was what we brought her in for! They dismissed our concerns and had her for observation which was obviously a joke. Talk to them ..docs and social worker , and also her health care because they are likely billing as intensive rehab but not doing that at all.

Oh....you hit a hot button with me.

If you have an older person who is healthier than others their age, they are "screwed" by the health system if they should get an injury.

At the age of 97, my Mom lived independently and was using a walker, could cook, wash dishes, walked to the grocery store (nearly 1 mile each way), balance her own checkbook, etc. We went on a 23-day cruise and she led her life while I led my life and went all over the ship, by herself. We ate and did a few activities together during the day. She got back home from the cruise, and within 24 hours, ended on the floor with a compound fracture in her left upper leg. She ended up with 3 screws, intense pain and of course, unable to walk.

They wanted to take her to a Nursing Facility because that is where injured people her age go. My siblings and I said NO and managed to get a rehab hospital where they did PT 3 times a day. However, the rule of the hospital was that she had to leave in 11 days. It was intense, however, my Mom was up and walking with her walker, although painfully, for over 100 feet. Because I had a trip scheduled and there was no one in her home that could take care of her, she was moved to another nursing facility with rehab. When I saw her a month later, she was a zombie, constantly in pain, and couldn't get in or out of the wheelchair or stand by herself. Medicare said she was well enough to go home. I was beside myself.

Through sheer perseverance, luck, and talking to my friends in another state for recommendations, she was out of the wheelchair in 3 months and not using the wheelchair at all in 5 months. However, she was never able to live independently again. But at least, she had the freedom to move, to get out of her bed when she wanted to, go to the kitchen when she wanted to, etc.

So why is it my hot button? The first rehab hospital was able to get my Mom walking again (my Mom hated that place). However, the second one felt that she was lucky to be alive. Her mental state and pain were so bad, she was not lucky. They didn't work with her to regain her independence because they expected 97 year old people to be in a hospital bed and medicated. When we left there, they told me she would need this pain med for the rest of her life (it wasn't cheap). When the pain meds didn't relieve the pain, I tried to figure out why and what to do about it. That is when it came to me that she was now a drug addict. I weaned her off the addictive pain pills and we are now on a drug regimen that she has used for the last 3 years. Pain is tolerable and drugs less expensive.

When I was looking for a PT to work with me to regain her ability to walk, no one wanted to help me. They didn't believe me when I said she cooked for herself and was able to walk 1 mile at a time. They passed me around within the practice until I happened to get some fresh grad who had very few patients. I told him that if she were a 2 year old who didn't walk, what exercises would we do. At night, I worked with her on her exercises. By 1 month, she went from totally in wheelchair to mostly using the wheelchair. That's huge for a 97 year old body. He really didn't want to work with us so when COVID came, he dropped us immediately. I guess there is no recognition program for PT people that help elderly regain an active lifestyle.

People who saw my Mom during that time say that I was a miracle worker. I was not. I was just someone who thought that my Mom could have an active lifestyle.

Depending upon the injuries, you can repeat what I did. Find a PT who will work with you and your Mom. Find a doctor who will educate you on what to do and what to watch out for. Get the equipment to help you. My Mom had swollen legs for not walking enough. I did it and you can too. I am just an ordinary person.

Apathy and lack of compliance is maddening. My husband needs to move. He is very reluctant and has every excuse. Breaks my heart

I must agree with the user about her 97 year old mother and how she took it into her own hands to do the rehab. I am doing that with my 84 year old Father right now who was recently in/out of the hospital (4x) and rehab (3x) for 3.5 months and then finally they said he is a hospice candidate because he is too weak to get out of bed. The rehab said they couldn't do anything else with him, he needs to go home and die (he did look like he was on his deathbed). Once home, we were able to get occupational therapy and physical therapy to come to the home and so I hired a caregiver to repeat the exercises with my dad EVERY day 2x a day. It's been 2 months today that he has been home and he is able to transfer himself from bed to wheelchair, toilet, etc.(he has copd & parkinsons, too) and I contribute it to the consistent at-home Physical & occupational therapy done by the professionals but more importantly by the family.

I am sharing this with the forum here so that one might not immediately discredit people suggesting that an elderly person get out of rehab, the one my dad went to was really good, but some people just require more hands on that what a rehab can actually do and/or should be expected to do.

They will do all they can to see if she will get up this upcoming Sun.

More than likely if you checked the records on you mom, it will show she was up and out of bed much more each day than she really was. You pretty much have to be at the rehab with her to figure out what's really going on. One thing to check is finding out if they started giving her any kind of pain meds which sedate her. May not even need them, but common for facility elderly to get them.

Mom may even be saying I don't feel like getting up right now. That goes in the chart as refusal to rehab. They keep them as long as that problem allows and then send home in same/worse shape than before. Mom has to be more self motivated to get stronger because motivation coming from the other end of the spectrum really means more work for someone.

My mom did try with the PT and OT at a rehab, but with me sitting there watching had to repeatedly tell them she needed to be moving more during the day. Put her in chair and would let her sit all day if I didn't say something. Take her to rehab session and if I asked about nursing notes during the next shift, they would tell me she exercised X number of hours and could walk X number of feet. I actually observed the entire session - she was taken to the room and pushed into a corner until it was her turn. Her actual therapy was maybe a total of 30 minutes with chatting in between exercises. I had to make them stop the pain pills that made her groggy all day. When I took her home, she was in a wheelchair, using a diaper, and unable to walk further than 5-6 ft with her walker.

We had a discussion about all the reasons I had to get her up walking with her walker again - primary reason was I could not lift her. She wanted to remain in her home with my help. It came down to help me help you. Within about 2 mos, maybe less, I had her walking on her own around the house again and got rid of that nasty diaper. PT and OT came to the house a couple times a week - good company and someone else encouraging the work. No one is going to put in more care, concern and work to get your mom up and about than you. She is a source of income at a rehab or other facility - there is little concern to them if she does her time walking around or laying in a bed and the preference is a diaper if she cannot toilet alone.