Mom is refusing therapy following surgery on her femur. What can we do?

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BarbaraBowen Asked March 2023

Mom is refusing therapy following surgery on her femur. What can we do?

Mom broke her femur bone from a fall. Surgery was a month and ago she is now in a rehab center for three weeks. However, she refuses therapy. She will do occupational therapy in bed, but refuses to get out of bed to do PT downstairs or sit in the chair. Now she hardly eats. What do we do? She’s on Medicare. I’m afraid they will release her. I’ve asked for someone to talk to her.

Care Decisions Medicare Refusing Care Rehabilitation Center

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score 0 · Answer 1

I went through this same thing with my Mom only she refused surgery too. She currently lives day to day in pain but, it’s what she chose. We tried assisted living for her but, she hated that and resides with my brother in NC. You are correct in assuming the rehab facility will release her for non compliance. Unless she has the availability of living with a family member I would talk to the social worker in her rehab facility to see if they can possibly get her a permanent medicaid bed there.

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score 2 · Answer 2

Perhaps she's just tired of it all and no longer wants to go on. And I'm guessing she still has quite a bit of pain as well. Is that being treated properly?
It sounds like she may just be giving up and it may be time to bring hospice on board.
They will allow her to be comfortable and pain free, and go on her terms. You should honor that if that's where this is going.

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score 1 · Answer 3

Barbara, what is your mother's plan for her care after she is released?

Can she afford to hire enough help at home, or does she plan to move to a facility of some sort?

Has she been diagnosed with any cognitive issues?

You might want to make YOUR boundaries known to the folks who do discharge planning at the rehab. Make they know if you are/are not willing to take on your mother's care.

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score 2 · Answer 4

Hi. They may not release her but her refusing physical therapy will suspend Medicare from paying for her stay at the rehab facility. They can't and won't force her to participate in physical therapy.

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score 0 · Answer 5

I am surprised she has not been discharged. 3 weeks means she now is past the 20days Medicare pays 100%. I was told that if a patient refuses therapy 3x they are discharged.

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score 1 · Answer 6

You might tell her she could easily develop a bedsore if she remains in bed. That is what happened to my mother when her femurs were broken. It is not able to cure and she is on hospice.

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score 4 · Answer 7

My mother was "refusing" therapy. It turned out she had a broken hip.

As for new xrays--pelvis, hips, ankles, the works. Ask for a different PT to come in and assess her.

My mother lost the ability to localize and express that she was in pain, post stroke.

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score 1 · Answer 8

No pain I think it’s anxiety I think she feels the pain of trying to work through the therapy

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A #femur 4 weeks ago? I image there is a tonne of pain.

Takes 6 weeks for an adult bone to start to knit together again. Elderly bones I image more. Depends on type of fracture too. A small crack will heal faster than larger more thorough break.

Was there a surgical repair (eg rods, screws, nails)? Even if stabilised with metalware, the actual femur bone is still broken.

Some fractures require that 6 week period to be *non weight bearing* before commencing any rehab. I presume your Mother was deemed ok to fully weigh bear on her leg & ok to start rehab? Has she had any follow-up x-rays?

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score 3 · Answer 9

Is she in pain?

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Mom is refusing therapy following surgery on her femur. What can we do?

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