Rehab versus hospice

atl86

My 91 year old Mom is somewhere between late stage 5 and early stage 6. She was fairly stable for the past year, but I (and her caregivers in memory care) saw a precipitous decline over the past couple of months. She has completely lost her appetite and is eating very little. Even her former favorite sweets have no appeal. She still knows who I and my husband are, but I'm not sure she recognizes anyone else, but then again, we are the only ones who visit her. She doesn't know where she is or when it is most of the time. She has been ambulatory with a walker, but she often forgets to use it. The staff have been good about reminding her, but every time they aren't looking Mom walks off without the walker. A serious fall with head injury have been happening about every 3 months. However, over a recent 2 week period, she had four major falls with injuries, the last one causing a hip fracture. She had a partial hip replacement 3 days ago. She doesn't remember falling and having surgery. She has been sleeping almost non-stop since surgery. And, she isn't eating any food since breaking her hip 5 days ago. They have been giving her Ensure and she drinks 1-2 a day. She had a visit from PT the first day post-op and it didn't go at all well. I'm hoping PT will visit today so I can see how she responds. The hospital is rushing me to decide on a rehab facility so they can discharge her. I am hesitating because I'm not confident she will be able to make adequate progress while in rehab. And, if she surprises me and succeeds in getting more mobile, what chance is there that she will stop falling, getting injured and making regular trips to the emergency room? She's very weak and touching her anywhere is very irritating and distressing to her. I'm starting to wonder if it would be better to have her assessed for hospice and send her back to memory care instead of rehab. Before her dementia progressed too far, Mom signed an advanced directive with instructions to let her die a natural death with no feeding tube, ventilation, etc. She also chose DNR. I'm not sure if I should send her to rehab to see how she does or if it is a bad idea. What are your thoughts and experience?

harshedbuzz

Unless the next PT session goes well, I'd return her to the MCF with hospice services.

HB

fmb

I agree with HB. Don't let the hospital pressure you. Most rehab facilities are not equipped to effectively help someone who also has advanced dementia. My DH was in rehab twice after suffering falls with severe injuries. Other than the hour or so a day that he was actively receiving PT, he was ignored. He was expected to sit in a wheelchair on a motion sensor pad (due to fall risk) that emitted a very loud noise whenever he shifted his weight. He was also expected to use the call button if he needed anything. He had no idea how to do that, and I had to stay with him all day every day. He made almost no progress with PT and couldn't retain the directions for the exercises.

My mother fell and broke her femur on February 24. Since she was already in hospice care, we decided against surgery. She was in Stage 7 at the time, and was unwilling and incapable of performing the necessary rehab exercises due to her dementia. Hospice kept her pain controlled and kept her comfortable. Nine days later she appeared to have a stroke, and she died March 7. We were grateful that she was given this 'exit ramp' from prolonged further progression of dementia.

easy23

My DH recently had his toes and part of his left foot amputated. His MC won't take him back unless he is a one person assist, which he is not. He was sent to sub-acute rehab where he fell and developed delirium I stayed with him all day and hired sitters for the nighttime.

A week after the fall, I took him to the ER where it was discovered he broke his hand. The doctors are recommending more sub-acute rehab and then a nursing home.

SDianeL

my DH was in memory care and PT and OT tried to teach him to use a walker but he couldn’t learn. They stopped after 2 visits. I would call hospice and have her returned to MC.

I_LOVE_MY_MOM

HAVE THEY DONE ANY PT IN THE HOSPITAL? IS IT POSSIBLE TO DO A SESSION OR TWO BEFORE YOU MAKE A DECISION? I WOULD WANT TO KNOW BEFORE IF SHE CAN DO PT. THEN I WOULD MAKE A DECISION. THAT'S JUST MY OPINION. GOD BLESS YOU!

atl86

Thank you for the helpful comments. Mom is still in the hospital. Yesterday, I got the hospital to back off the pressure they were putting on me to select a rehab facility. PT was attempted yesterday and Mom refused to cooperate. She is barely eating and is sleeping most of the time. I am having her evaluated for hospice by the nurse at her memory care. That will happen on Monday (today is Saturday). I've started doing some research on local hospice companies. I'll post an update early next week.

blueheron

make sure your mother’s memory care will take her back

cdgbdr

It sounds like hospice may be the best option. I do wonder if the MC will accept her in her current condition.