Mother had a mini-stroke and I need guidance on what to do. Any advice?

What sounds suspicious to me is when you said "Later when she woke up and stood up her knee gave out and she fell again, after that her leg was numb." If she's suddenly falling down b/c her leg is numb, and suddenly incontinent at the same time, there must be a connection there that is not necessarily stroke related. Google "Cauda Equina Syndrome" to read about the connection between numb leg(s) and incontinence.

The other thing that sounds reasonable to me is that when mom fell on her butt, she pinched a nerve which caused the incontinence; that is not unusual to have such a thing happen after a fall.

IDK if Medicare will pay for her to go back to the SNF for more rehab, but I would think not. Normally there has to be a hospital stay involved before rehab is prescribed, and then a certain amount of time in between hospital stays before the patient can go BACK to the SNF for rehab.

Once mom gets a PCP, s/he can write a prescription for a wheelchair. 1 device (like a wheelchair or walker) Medicare will pay for once every 5 years. There's probably a co pay, there was for my mother, I think it was $65; depends on the Medicare plan. Craigslist or Facebook Marketplace is a great place to look for durable medical supplies at a low cost, too.....in case you're in a rush and getting a run around from the powers that be ....gee, whoever heard of such a thing? :(

Ask the PCP about in home physical therapy, too. And buy some adult booster pads for mom's incontinence briefs if they are leaky and you can't find a brand to absorb all the urine. Here's an Amazon link:

https://www.amazon.com/s?k=adult+diaper+doubler+booster+pads&crid=3TP87Q4SHFJEW&sprefix=doubler+pads%2Caps%2C378&ref=nb_sb_ss_pltr-ranker-engagementacceptance_3_12

Depends also makes an overnight brief (Night Defense) that has a better absorbency to it:

https://www.amazon.com/DependsWomen-Overnight-Disposable-Underwear-Large/dp/B07SH1Z1FG/ref=sr_1_6?crid=2FK5052GKK9GD&keywords=overnight+depends+for+women&qid=1668461956&sprefix=overnight+depends%2Caps%2C138&sr=8-6

If all else fails, pull up's may not be ideal for your mother's body size and situation; she may need tab diaper type disposables instead. Those you can adjust for a snugger fit whereas you cannot adjust pull up's.

I hope you can find a good geriatric PCP for your mom who can help you navigate this journey ahead. It's not an easy one, God knows, but you're in the right place (here) for advice from those of us who have either walked this path in the past or who are walking it now.

Wishing you all the best of luck.

My mother is 73. She had a hemorrhagic stroke a couple of years ago. She became incontinent after the stroke. The Depends Maximum Absorbancy pull-ups worked great for mom. Never had an issue with them. We bought off Amazon "Depend Fit-Flex Adult Incontinence Underwear for Women, Disposable, Maximum Absorbency". Anything less than "Maximum Absorbency" was really not enough for her. The pull-ups supplied by Hospice were very thin, did not hold much, and ripped on the sides.  She is finally out of the Depends on most days after a lot of work on all our parts. We basically had to remind her to go to the bathroom when she got up, and then every couple of hours after that. Her doctor assigned her Kegel exercises as well.

As far as your medical equipment and medicare coverage, we found out that (in Florida, at least) all the "Durable Medical Equipment (DME)" came from her primary care doctor. Her doctor would put the order in and then whichever vendor was providing the equipment would either call to schedule delivery or just show up. We were never charged for anything that the doctor ordered because she has DME coverage through Medicare.

I would encourage you to work with your mother to find a primary care doctor who specializes in elder care to help navigate the Medicare supplies and coordinate any specialists she may now need (neurologist, PT, etc.). We had to choose a new primary care doctor after my mother was released from Hospice and used google reviews for our area to find someone close that is a very good match with her needs. She now only goes every 6 months unless there is an issue that arises in between.

I wonder if once your mother was released from the facility her need for equipment may have gotten lost in the shuffle a bit.

You could also contact your local Elder Affairs, they provide information and assistance about state and federal benefits, as well as available local programs and services and may have contacts to help you get the equipment you need for your mother to age in place. They are really good about home modifications and support services.

Just my opinion. At 77 I think its unusual to be this incontinent. There may be a fixable answer to the problem. Good thing you are seeing a doctor. I am healthy too but I have been doing my yearly physical. It helps catch problems before they worsen.

I think she needs to see a Neurologist, too, to see if there has been a stroke.

I am confused about Mom being sent to skilled nursing. I am under the impression that Medicare only pays for Rehab. The first 20 days 100%, the 21 to 100 days 50%. Sending to skilled nursing happens when the 100 days is done and its felt the person needs 24/7 care and its an "unsafe discharge" to send them home without proof that 24/7 will be provided. You better make sure Mom is not paying for the days in a SNF. Medicare usually does not pay for skilled nursing.

Ask the doctor if she/he can set Mom up for in home therapy. They can help determine what she needs. At 77 she should not rely on a wheelchair if therapy can help strengthen her.

I'm so sorry for what you and mom are going through.

It's GOOD that you are seeing her PCP. Go with a list in hand of questions to ask.

One thing I have learned is to follow up with calls, to the point of being almost obnoxious when someone has said "Oh, this and such will be delivered in 2 days"--if it isn't, then I call. Also keep a call log--whom you called, what the ? was that you asked and then get the name of the rep who talks to you.

Sadly, sometimes you have to be a squeaky wheel to get things going.

As far as the incontinence--bring extra 'diapers' and put a fresh one on her right before the Dr visit. Tuck a couple of incontinence pads inside the diaper and hope for the best. Maybe even a fresh pair of pants, or even a muu-muu, which would make changing the diaper much easier.

Get as much info out of the Dr and maybe ask for a new care coordinator. Sounds like the one you have has checked out on you. SO annoying!! As far as the meds--GOOGLE can answer a LOT of questions about those. I always check out any new med that a Dr. prescribes. OR, better yet, ask the pharmacist. They know stuff drs don't know.

The dr would be the one to send he back to a rehab facility, but since she has already done the requisite 20 days, IDK if they'll qualify her for more.

Does she need pain pills to keep the pain under control so she can DO her exercises? Since it was a fall that started this--they will be stingy about anything that makes her a fall risk. But if she is in pain, she won't be able to work out and then everything comes to a standstill.

Good Luck--you're probably going to have to be a little more aggressive in stating what mom needs and how to get it. You might also need to learn how to help her (brother should too!) do her exercises.

It's too bad that so much time went by after the stroke before she was dxed. If you can get someone to the ER and they 'qualify' for a clot buster drug--it's a miracle how quickly someone can return to baseline. Don't beat yourself up about that, my mom had several mini strokes and never got to the ER in time to do anything helpful.

And, if it helps you feel better-report the lousy care at the rehab and the lack of follow through by the SW.

Good luck with this!

At 77 this is unusual and doesn't sound like result of a mini stroke. There is something here not matching. Does your Mom have an underlying illness that has caused incontinence and etc? It seems clear to me that she needs a complete workup but I cannot imagine she went to rehab services without one. It sounds as though she was NOT progressing with therapy?
I can't really imagine what is happening her and what the full scope is. How long your mom has been basically chairbound, with some incontinence or if all of this is new.
I am so sorry, I can only suggest you have good medical followup and get a fully clear diagnosis of what happened with Mom, when, and why. I haven't a clue what is going on with her at all. You are definitely in medical expertise territory here, and I sure wish you good luck.