Should an elderly patient be in a nursing home to recover from a pelvic fracture?

She likely should have been sent to a SNF for a few weeks for rehab, especially if she's bedridden now! How on earth are your parents being cared for at home if you and your husband both work full time??? How is your mother being toileted if your father has Parkinson's?

For the present moment, call mom's PCP for immediate advice about her condition worsening, and see what's suggested for rehab?

For the long term, you really need to consider placing both of your parents in long term care now, together...........they both require a level of care that you're unable to provide for them as at least your mom needs 24/7 caregiving. I don't know what condition your dad is in, but Parkinsons Disease often reaches the point where 24/7 care is also required. In home care is often not feasible for two parents with this level of need, with you working, and also having children who require your attention. It's too much. I had to oversee my parents care in Assisted Living (and then Memory Care) and it was almost a full time job, in and of itself! It went on for 10.5 years, too, and took all of my strength to manage. If I tried to do it in home, it would have literally killed me.

Wishing you the best of luck with all you have on your plate.

She can likely be admitted to rehab within 30 days of discharge.

The next time she is hospitalized, you start working with the discharge planner on Day 1. You tell them " no, she cannot return to our home; it would be an unsafe discharge."

When my husband with Parkinson's broke his hip, the doctor was going to send him home and I simply said there was no way I could handle him at home and he said well would you like him to go to rehab? Duhhhh??? Well yes... due to PD, he could not use crutches and it took a lot to even get him standing to try a walker or into a wheelchair. Many providers tend to think of everyone the same... they should be up moving as soon as possible and forget it takes elderly patients a lot longer. Of course it normally requires a three day hospital stay for Medicare to pay for rehab and the ER would have had to justified admitting her.

Start with your primary care doctor or maybe even the orthopedist, especially if they have a social worker to see if they can help get her admitted. If not, contact Medicare ASAP and appeal that she was discharged too soon. I would hope someone there would look at a knee replacement followed that soon with another fall resulting in a cracked pelvis would warrant an appeal that she had not totally recovered. Rehab is less expensive than hospitalizations for repeated falls. The least I would hope for is some kind of home health since she obviously can't leave your home. I'm thinking time would probably be of essence so work as fast as you can to call everyone you can to try and get her case evaluated. I think some issues need to be addressed within 30 days.

If perhaps your father is a veteran, at least check into benefits such as respite care for your father (I get 14 hours a week) and aid and attendance for your father and spousal aid and attendance for your mother.

My heart goes out to you as your plate is flooding over.

Not sure if this will help
you but a year or so ago my Mom fell broke her wrist and cracked her pelvis. She went to rehab for about two weeks after hospital. They had her up using a walker. I went into rehab before her discharge and was shown what she could do/couldn’t do etc. by the PT. The PT told me that if my Mom stayed in bed she’d never walk again. She needed to be up and moving every day. I bought Mom home, she did at home therapy and in 12 weeks she was healed. A year later she broke her hip and same story there. Hospital, rehab, home with at home therapy. I cannot imagine her coming straight home after either of these injuries. I would definitely contact her primary doctor and/or her orthopedic doctor. In my opinion she needs therapy. Best of luck to you!

The problem may be that she needs "custodial care) until the fracture heals and rehab after.

Is there some way for her to private pay for NH care until the fracture heals?

Have you ever consulted an eldercare attorney about Medicaid?

Your parents' needs clearly outstrip the resources available at your home.

You may need to have a tough conversation with them about the fact that you can no longer do this.

Alternatively, some folks take a "therapeutic fib" route-- we're going on vacation, the house needs to be fumigation, it's temporary for a month, for the winter-- and get their parents into care that way.

Keep on doing what you’re doing, which is taking charge. Someone has to. They are beyond making their own decisions now. Also, it may not be possible for them to be in the same facility. Each one deserves the best care you can find for their situation. If it’s not in the same place, it’s sad but everyone will have to deal with it. Sorry you’re going through this.

Hindsight is perfect. My wife started out that way now after a year her hip is fine but she can not walk because she will not do the therapy. Where that place is that forces therapy on her I don’t know. I do know if she’s says no they will push her. Perhaps they need mental therapy along with the physical. Also know your life is forever changed until she dies.

This is generic advice - not specific to your Mom but to give you a idea. Just the facts as I see 'em..

Emergency or Acute care is just that. It is not recovery care for the time it takes broken bones to heal.

Treatment for # pelvis is usually conservative management - meaning CAN move & walk as tolerated. Bones will heal in time. (But due to pain/fear/fralility many will stay in bed).
Once healed, physio may be useful. Often done as outpatient in community (or in-home if insured for).

If unable to self-care at home, then stay with informal carers (ie family/friends). If none available, then inpatient formal care instead (may be called respite care or skilled nursing where you live). Then, once bones healed, either inpatient rehab or direct home.

For your situation right now: You weren't to know this would be too much. But if it is, speak to Mom's Doctor & arrange a new plan asap.

OMG! How did they discharge her from ER without someone responsible signing her out? Did you read the paperwork that came with her when she got home? What do the instructions say?

Where is her primary care physician in all of this? What does he suggest you do?

Is she well enough to tell you her side of the story as to why she didn't want to go to inpatient recovery? Could she have misinterpreted a question someone was asking her?

One option is to take her to the Emergency Room of a hospital. Tell them what happened and that she no longer can leave the bed and that you want to know why. If she gets admitted, make sure that she is not admitted with "observation status". Medicare will NOT pay for "observation". Otherwise, Medicare will pay for some number of days with 0 co-pay.

Come up with a care plan for your mother with the social worker at the hospital. It might include some time in a SNF. I believe Medicare will pay some amount for care at home if she opts not to go to a SNF and still needs medical care.

At this point, it doesn't matter if she insisted on going home or not. You need to deal with how she is now and what future action needs to be taken. The ER has all the records from the previous visit. At the ER reception area, make sure that they have all the approvals they need to share her medical information with you.

As a caution: There are a lot of confusing, contradicting names of medical facilities. Emergency Care at an Urgent Care Center is NOT the same as an Emergency Room in a hospital. In addition, ensure that wherever you go, they accept your Mom's insurance. Not all places do, even though they have an area called "Emergency".

YOUR answer sounds correct. She said she would like to go home without consulting family. SENDher back to the er this time stating there is no one to care for her. Placement is easier from hospital then home.