Because my mom constantly refuses therapy in SNF where Medicare should pay, they are kicking her out. Has anyone had an experience like this?
She broke her femur 2 months ago due to her falling. She’s 87 and very weak. She wants to go back to AL but I doubt they will even assess her. The family feels mom should be in nursing home care. Thanks in advance for any helpful advice.
There are a few other possibilities why she's not cooperating:
1. Does she have any hearing impairment? Cognitive impairment? If she can't hear or understand PT instructions, it's hard to engage in them.
2. Does she now (or in past situations) have male or female therapists? That can make a world of difference. Someone who's got a busy schedule might not be as tolerant of her as other patients.
We experienced the latter situation. A male therapist from an Asian country was insisting my mother attempt exercises that she couldn't do; she was recovered from a broken leg.
We took her back to her ortho doctor, who was upset when he learned what Mom was expected to do. He wrote a letter, which we took to the SNF, and we asked for a consultation with affected staff., That was an effective meeting; the grouchy therapist moved to another facility, Mom got a wonderfully compassionate female therapist, and she improved.
Sometimes the difference can be in how the therapy is approached.
Susan, while mom is in the NH, see if there is a geriatric psychiatrist who can pay her a visit. These folks are often brilliant at putting together what is going on inside our elders heads in ways that are sem truly miraculous to me.
We were fortunate to encounter several during my mom's gradual decline. They were able to pinpoint mom's faulty reason and false beliefs (all part of her vascular demtia), which in turn allowed us to better c respond to her.
Constantly meaning..? How often, at what times of day, and in what way is the therapy being offered?
What does your mother say about it?
When your mother went to see her orthopod and he added new exercises to her px, there should have been agreed outcomes with a timeline attached. Did she agree to those outcomes? Does she agree that she agreed?
We are lucky: if our clients are suitable for reablement and need support with mobility to achieve it, our therapists get to work on them and rarely take no for an answer. Some poor clients don't know what's hit them!
But if, say, the PT is a nice idea rather than part of a SMART goal, and you are a busy therapist, and it quite suits your schedule if some of your frailer patients decline a session, it's really easy to get them to say no. It's only a matter of timing and manner.
Have you ever been present when the therapists attend?
The sad reality is she may eventually become immobile if she won't try to follow directions regarding her care. You can tell her that becomes a sad situation. She may not be able to use the toilet on her own. I don't know if stating that will give her any motivation.
We don't know your mother or her history but what matters now is her behavior. I don't see her lasting in AL which is alot more pleasant than SN.
My mother is in SN after years in AL. A septic infection caused her to lose the use of her legs. Then a series of other incidents happened which has made everything worse. She has a serious bedsore. She won't remember it is unlikely to heal. I think she finally comprehends she won't walk again. She would love to have PT but she would not be able to make any progress.
I just accept this reality. Some of what happened should not have but it did. I wish she had tried to be more fit when she could. Alot of this developed during Covid and I could not witness her physical state. All you can do is emphasize what you have been told and then deal with the reality. At times choices are made that can drive us mad but if you want a clearer mental state you just need to proceed with the reality and tell yourself she has made this choice. I wish you the best possible. I know firsthand how exhausting this becomes.
My guess is that you have done everything you can think of to ‘persuade’ your mother to be more co-operative. You’ve failed. The next step is probably to lay it on the line exactly where this behavior is going to lead her. Make it sound just as bad as it may well turn out to be.
It may or may not work to change her behavior. However it is in fact a kindness to be clear. Stubborn unreasonable old people sometimes think that eventually they will force things to work out the way they want – and it’s not true.
Perhaps it's time to find out what IS going on with mom; if she has dementia which would be why she's acting 'uncooperative' and 'stubborn', etc. AL will take her back if she meets their criteria for living there w/o needing a SNF level of care after being released from rehab. Medicare will only pay for her stay there if she is making progress; if dementia is at play, that is why she's refusing PT/OT, most likely.
Mom has never and probably will not ever see a neurologist since she is very uncooperative with every aspect of her life. We have tried and have scheduled her appointments but she cancels at the last minute. She is wheelchair bound and can somewhat transfer with 1 assist (barely) but she’s not getting any stronger so I don’t see her back in AL where she can only have 1 assist. I believe she’s where she can get the most care in the NH but without the skilled nursing. Honestly, I would be surprised if the AL facility took her back in since she was very much a challenge there as well. And I’m being nice to say it in those words. I never thought mom would end up like this. Thanks again for your thoughts.
Medicare will only pay for SNF while skilled nursing care is needed. Also the same for rehab. If a patient will not cooperate in progressing the notes will show that; there cannot then be any improvement, so why would Medicare cover this costly therapy? They will then ask for placement. Many ALF will accept patients who are wheelchair bound so long as they can make it to meals and etc. The levels of care (usually I-IV) will increase as Mom will need assistance now with almost everything including bathing. Discuss with her facility. Also there can often be home PT ordered; they do indeed come to the senior wherever they are housed, whether at home, at your home or in ALF. Discuss all this with the discharge planners. They and the Social Services will explain all and help you decide on next move. Wishing you good luck.
Thanks AlvaDeer. I understand about Medicare not paying if mom doesn’t cooperate. What I don’t understand is why isn’t my mom cooperating. She just visited her orthopedic dr who gave her new PT orders to allow her to add more weight bearing exercises. So why in the world did she even visit her dr if she’s not willing to do her PT?! This is mind boggling to me. I sometimes wonder if she is playing games. She tends to be very stubborn in her old age. I truly believes she has some mild cognitive behaviors but has never been diagnosed. I wish I could understand this behavior. I’m trying.
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1. Does she have any hearing impairment? Cognitive impairment? If she can't hear or understand PT instructions, it's hard to engage in them.
2. Does she now (or in past situations) have male or female therapists? That can make a world of difference. Someone who's got a busy schedule might not be as tolerant of her as other patients.
We experienced the latter situation. A male therapist from an Asian country was insisting my mother attempt exercises that she couldn't do; she was recovered from a broken leg.
We took her back to her ortho doctor, who was upset when he learned what Mom was expected to do. He wrote a letter, which we took to the SNF, and we asked for a consultation with affected staff., That was an effective meeting; the grouchy therapist moved to another facility, Mom got a wonderfully compassionate female therapist, and she improved.
Sometimes the difference can be in how the therapy is approached.
We were fortunate to encounter several during my mom's gradual decline. They were able to pinpoint mom's faulty reason and false beliefs (all part of her vascular demtia), which in turn allowed us to better c respond to her.
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Constantly meaning..? How often, at what times of day, and in what way is the therapy being offered?
What does your mother say about it?
When your mother went to see her orthopod and he added new exercises to her px, there should have been agreed outcomes with a timeline attached. Did she agree to those outcomes? Does she agree that she agreed?
We are lucky: if our clients are suitable for reablement and need support with mobility to achieve it, our therapists get to work on them and rarely take no for an answer. Some poor clients don't know what's hit them!
But if, say, the PT is a nice idea rather than part of a SMART goal, and you are a busy therapist, and it quite suits your schedule if some of your frailer patients decline a session, it's really easy to get them to say no. It's only a matter of timing and manner.
Have you ever been present when the therapists attend?
We don't know your mother or her history but what matters now is her behavior. I don't see her lasting in AL which is alot more pleasant than SN.
My mother is in SN after years in AL. A septic infection caused her to lose the use of her legs. Then a series of other incidents happened which has made everything worse. She has a serious bedsore. She won't remember it is unlikely to heal. I think she finally comprehends she won't walk again. She would love to have PT but she would not be able to make any progress.
I just accept this reality. Some of what happened should not have but it did. I wish she had tried to be more fit when she could. Alot of this developed during Covid and I could not witness her physical state. All you can do is emphasize what you have been told and then deal with the reality. At times choices are made that can drive us mad but if you want a clearer mental state you just need to proceed with the reality and tell yourself she has made this choice. I wish you the best possible. I know firsthand how exhausting this becomes.
It may or may not work to change her behavior. However it is in fact a kindness to be clear. Stubborn unreasonable old people sometimes think that eventually they will force things to work out the way they want – and it’s not true.
Good luck!
Mom has never and probably will not ever see a neurologist since she is very uncooperative with every aspect of her life. We have tried and have scheduled her appointments but she cancels at the last minute. She is wheelchair bound and can somewhat transfer with 1 assist (barely) but she’s not getting any stronger so I don’t see her back in AL where she can only have 1 assist. I believe she’s where she can get the most care in the NH but without the skilled nursing. Honestly, I would be surprised if the AL facility took her back in since she was very much a challenge there as well. And I’m being nice to say it in those words. I never thought mom would end up like this. Thanks again for your thoughts.
Discuss all this with the discharge planners. They and the Social Services will explain all and help you decide on next move.
Wishing you good luck.
Can't Dad move in with Mom. Mom had 2 couples at her AL. When the spouse died the other stayed on.
yes mom has had SN in AL in the past and became uncooperative there as well. Not sure what is going on with mom. Wish I knew. Thanks much