broken hip, what to do

vtgsell

Hi,

I have been reading these message boards for the past 10 months or so.  It would not be an exaggeration to say you all have saved my sanity over the past months.

In early 2020 my mom had a car accident that made clear the amount of cognitive decline she was experiencing.  She was in Alabama and I in Virginia; I moved her to a small house 0.5 miles from me.

This worked okay, but just before Thanksgiving she was diagnosed with stage 3 bladder cancer.   She completed 6 weeks of chemo and radiation and 1 week after fell and broke her hip. 

I do not know what to do.

I have teenagers at home and a full time job, I am no where near retirement age.  

I hope to bring her home, bring in home care to help till she is Medicaid eligible.  Will be very quick.  And hope I am able to get a vaccine so I can see her when I have to place her.

Thank you all.  This is an amazing support group.  Although i have not participated till  now, i have felt supported,  Thank you.

Cynbar

She will probably be eligible for some short term rehab at a facility under her Medicare since she broke her hip. It likely wouldn't last for long, given her other problems, but it would get her in the door. Ask the hospital discharge planner or social worker about this if they haven't mentioned it to you. I have seen patients who don't realistically have much rehab potential still be able to access this benefit, assuming she is not on hospice (and actually you could temporarily revoke hospice if you want to pursue this.) Look around for a local facility that does short term rehab and also is a nursing home for long term residents. Make sure they accept Medicaid. Move her in and submit the Medicaid application ASAP, even if she is over the asset limit right now. When her rehab ends, she could seamlessly stay on. Your post sounds like you have a lot on your plate already so bringing her home would be difficult for everyone, plus too much moving around would just be disruptive and upsetting for her.

vtgsell

Thank you for the quick reply.  She is at an acute rehab right now and I will learn more this week about where it will be safe for her to be next.  We started talking about her being at a nursing home today.

I have known that a nursing home/memory care was in her future, but I so hoped to make it past COVID.  She is fully vaccinated, but I am not.  It would make all the difference in the world if I could see her.

She does not have a diagnosis, but I would put her at about stage 4 on a 7 stage scale.  She always knows who I am and who she is, and so she knows I am not there.  She is scared and confused because she is in an unfamiliar place.  This facility seems quite good, because her cognition is better now than it was in the hospital.  But, if she is not physically able to stand and transfer, I don't see how I can have her safely in even my home, never mind her home.  

I don;t want to put her care into my kids.  They are physically strong, but the are kids.  I don't think we could afford adequate care for many weeks.  I agree the transition to nursing care would best be made now.

Last year I accepted my mom had dementia, that it would take her from me.  A few months ago I had to accept that this cancer would likely get there first.  Thanks to this group, I already understood that might be the more merciful end.  Now, I just want to be able to be with her to whatever end will come, and not kept apart.  I'm an only child, my dad died about 20 years ago.  We have each other.  

To all of you reading, you help so many people.  Thank you.  I have wanted to post many times, but then my very question would pop up and I could just read.  This place is a treasure.  Thank you.

M1

So sorry vtgsell, hope she can get better. Such a terrible injury. Keep us posted on how she does.

dayn2nite2

Unfortunately, that chemo for the cancer probably caused a decline in her dementia and that started this domino effect with the fall and fracture.  If she cannot stand, she is going to need long-term care and your home probably isn't where she needs to be.  Does the facility she's in now offer Medicaid beds?  If so, ask the social worker what info you need to provide to apply on her behalf.  If not, I'd start looking for a Medicaid bed in the area and get on a waiting list (but apply in the meantime).

Also, I think from here out you should only do comfort care for her, no invasive surgery, no more chemo or other cancer treatments, etc.  The majority of people would say that dying of some cancer is probably preferable to getting rid of cancer for a while and having to go through all the stages of dementia.

abc123

You are wise to keep your children first. 

How old is your Mom? I'm so sorry shes having a rough time. You are a great daughter doing a great job!

A lot of people here have recommended placing their LO immediately from rehab straight to the facility. They have said its less stressful on the PWD. You have gotten wise advice from Cynbar. I wish you luck.

vtgsell

Thank you for the continued replies.  And I appreciate the directness of the advice.  My focus will be on comfort care now and making her happy while keeping her safe for the time she has left.

She is 83.  She fell on her birthday, we had been focusing on that to celebrate the completion of the chemo-radiation.

I will see her tomorrow for a family education meeting at the rehab facility.  I expect this will provide me what I need to know if there is any chance to bring her home or if I need to shift focus to getting her placed and getting the application for Medicaid in work.  She has a small amount of funds to cover for a bit.  From the research I've done, those funds need to be paid down, but this will helpfully allow for a single move to a place that will transition from payment to Medicaid when the money runs out.  The elder lawyer is my next step.

She understands she is confused.  She knows she is alone and needs help, but doesnt know how to get it because she only asks me for help.  She doesnt seem to understand the concept of a nurse call button.  It's very hard to imagine her long term in a facility being miserable and not understanding how to make it better.  There is a place close enough I could visit every day.  And hope that she adjusts?  No easy answers...  Thank you.

JDancer

If you discontinue cancer treatment, she may be eligible for hospice care. As a cancer "survivor" myself, I would not want to go through cancer treatment at 83.

Cynbar

Glad to hear you're having a family education meeting. The staff will be honest with you about the progress she has made and her prognosis. They will tell you if she needs 24 hr care, or could be left alone for short periods. They will make recommendations, but in the end, the decision will be yours. I do have to add that it will be easier to find her a bed in a good facility if she can go in private pay, at least for awhile. Consider that if you might be thinking of spending her money on private care at home and placing her when it's gone. I also stand by my statement that it's less disruptive to her to place her from a hospital or rehab stay, rather than bringing her home first if placement seems likely. Good luck ---none of this is easy, as we all know too well.

vtgsell

Thank you again to all who have responded.

I visited with my mom twice this week on Tuesday and Wednesday.  On both days she was able to transfer well and to stand and turn to enable transfers, but she was not really able to walk.  They tell me she walked over 30 steps twice today, so she is getting stronger, but will need 24 hour care when she is released.  She is being released in 1 week.

I started making calls to have her move to a nursing home with rehab that also has memory care.  I talked to her case manager today and was greatly discouraged from doing this.  It felt as though she was just trying to make me feel guilty.  She suggested I hire home care providers so she can be in a familiar place to see if her cognition improves at home.  

I don't really doubt that her confusion will improve at home, but I don't know about her underlying cognition.  I tried to explain that looking at my family's needs and means, I don't know how I can provide the care she needs for more than a few months at home unless she experiences enough improvement to no longer need the 24 hour care.

I'm torn now between giving her a chance at home, knowing she will be more secure there or moving ahead with placement and Medicaid paperwork.  I suppose I will move ahead with Medicaid regardless so as to be prepared.  

It's clear to me that if I were able to be her 24 hour care giver, that she could live at home for a while longer.  But, I am not able to do that, and I fear that even trying to do half of that will have a very negative impact on my kids household and on the time I am able to be with them.  Neither is fair to them.

You all have given me the best advice that you can which is that I need to not feel guilty in putting my kids first as well as my mother's safety first.  Thank you.

Some of you asked about Hospice.  She is not on hospice and we are waiting to know if her cancer responded to the treatment she had.  If the cancer has continued to spread, even before the fall, it was my plan to move to comfort care and call hospice as necessary.  They wait about 2 months after the completion of treatment for CT scan so we should start to get some of that information in April/May.

Thank you

dayn2nite2

Sorry the social worker was trying to lay a guilt trip on you.  She's not trying to raise kids and facing the prospect of being the main caregiver to a person with dementia who has a broken hip.

Kids first, always.  If you need to place her, do it - it's far less disruptive to her to do it from the hospital and imagine trying and failing to be able to care for her at home (this is a certainty) and how much guilt you'll have placing her then.

There is guilt no matter what you do so you have to ensure that your priority for her is SAFETY.  And the safest place for her is a place where there are fresh sets of employees that come in for limited hours and care for their patients with proper rest and assistance from other staff when needed.  You mom is safe and has 24-hour care and your kids get a mother who is present in their lives.  Win-win.