Looking for advice on next steps post hip replacement. Have they given up on her?

My father died 10 months after breaking his hip and becoming unable to walk afterward and a 2 person assist in AL. A big no no. Getting him on hospice allowed me to keep him there with mom in the ALF until he passed, comfortably. Normally an ALF will allow a resident w huge needs TO stay until death IF hospice is on board to help. People have been known to live for 2 yrs or more under hospice. It's not a death warrant by any means. Find out what your ALF rules are and use your voice as her advocate. Don't let THEM boss YOU around, know their rules ahead of time.

Your mom may be too far gone to make progress w PT and OT now. They often give up and lie in bed which is not something YOU have control of. There has to be cooperationfrom the patient in order to see progress. Neither my mom nor my dad were capable of making such strides ( mom due to dementia and dad a brain tumor) so hospice was called in. I was very happy with their level of care for my late folks.

Hospice isn't "giving up" as much as recognizing the patient has maxed out on medical interventional care. Admitting it's time to stop pushing an old and addled body and mind to do something they're no longer capable OF doing. It's choosing a compassionate approach to allowing nature to take over w/o hospitals and "specialists" poking and prodding your mom's peace. They'll allow her vital meds and things, and Dr Kevorkian isn't lurking in the shadows to do away with her. My folks both took very few comfort meds and passed when God was ready for them. Hospice just gave the ALF another set of hands and eyes on them to provide care and required supplies all free of charge.

God bless you thru this part of the difficult journey

Having hip surgery at that age is very risky. I was a son taking care of my mom. She had partial hip surgery at age 88, and the Dr. performing the procedure warned me their could be complications. I was so relieved when he told me she made it through.

Then came rehab at the local nursing home. A "care plan" was presented which spelled out the daily PT/OT routine she was to receive. I made it a point to visit at least twice a day (different times) to keep her company and monitor what was happening. One day, I found her in bed with the blinds closed when she was supposed to be in a PT session. When I asked staff, they said mom had stated she was tired, so they just let her stay in bed. That was unacceptable to me and I made it clear to the supervisor that mom was there build her strength and return home. I ended up participating in many of her PT sessions, attempting to build her confidence, and learning skills I would use later on. There were some days in rehab when mom was just not up to it, so I took it slow, always encouraging her to try. You need to be your mom's advocate and have a say in the treatment she is receiving.

It was a whole new world when mom came home, as the once vibrant woman I knew now needed assistance with her daily routine. That is where my journey as full-time caregiver began, and what a journey it was. The great thing is that through it all, mom was very cooperative and we worked as a team to adjust to a new normal. Good and bad days followed, but in the end, she was still able to use her walker, was able to still feed herself, and she still had her wonderful smile. She was at home until the day before she died at age 93.

I certainly understand each situation is different, and my advice is to encourage your mom as much as possible, but also understand she just may be at the point where enough is enough. I learned the importance of empathy and compassion during my cargiving journey. You will need it too as part of yours. All the best.

Whatever you do, release any questions or regrets about how you’ve tried to figure things out since her hip was broken. Unless they actively help developing her planning in her immediate future, any mistakes from her past care should be left in that past.

Have you gotten an objective opinion/assessment from a cognitive specialist (psychiatrist/psychologist/neuropsychiatrist/social worker)? You need to get a better sense of where she is cognitively before you can fairly determine what her ongoing needs MAY be?

A specialist can also refine recommendations for dosages for specific medications, and hasten the efficacious use of them, AND make focused suggestions for behavioral management techniques and possibly modifications in her environment.

My mother never recovered cognitively from the surgery that followed her shattered hip, and it would have saved me (and her) a lot of suffering if I’d looked for a cognitive evaluation sooner.

After 9 horrific months in my home, she entered a very fine local skilled nursing facility where she lived in comfort for 5 years, passing at 95.

I have heard an experienced PT say that at 90, after a broken hip or leg, if the patient just refuses to get out of bed.. well there isn't much you can do. It's time for the family to move toward with what makes a 'good day' for the patient instead.

Be guided by Mom. Does she still enjoy her food, wants to get out of bed to sit in a recliner? Watch TV or listen to radio? Or is she holding your hand & telling you she's had a good life.

I agree that no-one can or should push hospice.
Why not go day by day & see what Mom's mind & body tells you.

What would provide the best comfort for Mom now? If that is her own room in AL, see if that is possible.

There's a lot going on for your mom. Medications she is getting need to be looked at and possibly reduced to clear her head a little. Also the sedation for the surgery can linger in the older folks and create delirium.

Have them check for a UTI immediately. Very common to change behavior and mental status and yet, for some reason, facilities put off testing for it even though they all know how common it is. Family or other advocate often have to push for it.

At your moms age and with her many health issues, she would qualify for hospice.
Hospice can mean a place, but is always a service.

When it is a place (not in the ALF or SNF or your home) it is generally for just the last week or so of life. The patient is actively dying.

In the ALF it would be a service. The service includes a nurse (usually once a week) a doctor rep. (NP, PA) each recertification period, and a CNA for baths. Most of the posters say they only receive a CNA 2 or 3 times a day. I was able to get my DH aunt a daily CNA visit. Not all hospice companies offer the same services. There is also spiritual support and a social worker. All of this gives the ALF more help to care for your mom. They also provide medical equipment, assorted supplies, hospital bed if needed, etc. The only thing your mom would be giving up would be therapy. She can still have all her meds plus the weekly nurse to help manage any additional meds needed to manage her cognitive decline. It really is not giving up as much as it is meeting mom where she is now and giving her the oversight of more medical staff. It’s more, not less.

I would encourage you to keep her in the ALF with hospice instead of moving her to a SNF at this point for all the reasons you mentioned and she wouldn’t have the stress of moving. If she recovers to the degree that she is willing to try therapy, she can come off hospice and go on Home Health which offers many of the same services, as well as therapy. Even though it is called Home Health, she can have that in the ALF as well. And it is possible that she will get better.

The Care Director may have a hospice they like to use and are familiar with. I made it a condition when my aunt was moved that she have her same hospice we had used at home as we had used them for several years.

Your mother requires more care now than the Care Director can provide is what I’m hearing. She is willing to give you the comfort of the ALF with hospice oversight rather than your having to move mom to a SNF with or w/o hospice to get that same oversight. She is telling you that they aren’t equipped to do the level of nursing your mom requires and giving you a way to keep mom where she is.

I put my aunt on hospice at home because I wanted her to have more baths than HH provided, not because she was dying. She already had home health with the same company. She was not then nor now actively dying. She is 96, with dementia, takes thyroid and blood pressure meds but has no cancer or CHF or diabetes or broken bones etc. She has no pain. She just refuses to get up except to transition to a wheelchair to go to the shower with her familiar CNA.

Many of the seniors at advanced age qualify for hospice that are not on it. They are in decline. The word hospice scares us. It was hard for me to sign the papers even though I knew I was just making it possible for aunt to have more care, not giving up. It is more a recognizing that it is your mom who has given up and doesn’t want to do anything that will help her regain or maintain her strength. It is more that she is in decline and that’s the reason she will qualify and that she needs 24/7 care.

My aunt is in a SNF currently with hospice. She was in an ALF before going to the SNF. She had hospice there as well. I knew she would run out of money soon so I had to move her where she could get Medicaid when needed. ALFs in her area don’t accept Medicaid. They told me they would keep her and called me for months after she moved to see if I would reconsider.

Talk to the hospice “community educator” or social worker and share your concerns. My aunt still sees her geriatric primary via zoom. So she basically has three doctors. The SNF doctor, the hospice doctor and her long term doctor. She has been off and on hospice at least twice in the past three years. It is very easy to go off and on hospice IF the person is in decline.

I like what 97 said. Try the Hospice with the AL. It will cost you nothing because Medicare pays for it. But Hospice is not there 24/7 so what kind of care is the AL going to give? Does this mean the care rates will go up? And if Moms a 2 person assist, are they willing to do this? I would ask if PT can come in if Hospice is there? Even bed/chair bound there are exercises that can be done.

I just saw why this AL was chosen. Seems Mom didn't like the SNF. I read between the lines on this one "she will have to transition her to hospice after about 2 weeks". You are being given options. The option is Hospice and if you don't agree with it, Mom must move. So for now I would agree to do what they suggest.

Breaking a hip at 90 is very serious. It was said on another post that if at 90+ you have a hospital stay and lose the use of your legs because u have been in bed, its like use it or lose it. PT does not always help. This may be where Mom is at for the rest of her life. And I would not force her to do anything she does not want to do. She is 90 and this all has taken a lot out of her. Maybe the Director is trying to tell you something. People get where they just want to be left alone. No more poking or prodding. No more people trying to tell you what to do. Just want to rest.

My mom, age 90, broke her hip in AL (with 2 aides in the room). She had already been diagnosed with Vascular Dementia and had CHF.

She was eligible for Hospice when she finished a few weeks of rehab in the SNF. We chose not to engage hospice at that time.

Mom lived for 4 1/2 years after entering the SNF. Just one metric.

The anesthesia will cause /trigger mental issues. Often it improves. When my grand dad broke his upper femur and had a rod installed at 99 he could not understand why he was expected to walk with a broken leg. Rehab let him get bed sores, he languished... He only improved when we sprung him and brought to my house. He was motivated to learn to walk and use the toilet for morning coffee....

Wish I could help you but my mother 81 yr old mother at the time of her hip surgery went thru the same behaviors post op and in rehab that your mom is experiencing and after 7 mos passed away there. Hospice was involved and were very helpful. Don’t want to give you false hope but most of the time a hip surgery at her age is “the beginning of the end”. I feel for you and wish I had answers but this is your mom’s journey now as well as yours. God bless you both.