Rehab versus hospice

atl86 · May 2

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 · May 2

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

HB

fmb · May 2

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 · May 2

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 · May 3

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.

[Deleted User] · May 3

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atl86 · May 3

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 · May 3

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

cdgbdr · May 5

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

atl86 · May 8

I elected to place Mom on hospice and planned for her to return memory care. MC was pushing for Mom to go to rehab first, but my husband and I have had bad experiences with other elderly relatives going to rehab facilities in our area. After much negotiation, the MC agreed that Mom could return upon hospital discharge if I paid for extra 24x7 caregivers for one week and paid a physical therapist to evaluate Mom and work with her for an unspecified period of time. While not ideal, I decided to go along with the MC's requests and renegotiate after the first week. Mom reminded in the hospital during this protracted negotiation period, but that turned out to be a good thing because she got to the point where she was able to transfer from bed to wheelchair and to bedside commode with help from one person. She was discharged this afternoon. Hopefully Mom will continue to improve physically over the next several days so that I can stop the 24x7 caregivers. Now, we enter a whole new chapter. I'm sure I'll be asking the community for more advice soon.

jjdoc1 · May 8

My mom is the same age and same stage of dementia. She has lived with me for the past 1 1/2 years and recently fell. Luckily, she didn't break a hip but she had a very deep intramuscular bruise and had to use a wheelchair. From the ER I placed her in a rehab facility but it was certainly not for a memory care patient. She was placed in a wheelchair that had an alarm that went off when she got up. Since she hadn't broken anything she kept trying to get up and they basically parked her in one nursing station or another so they could watch her and she just sat there staring. I hated it for her. All of her PT was over before noon and the rest of the day and evening she had to sit in the wheelchair or stay in the bed. In Texas we have residential care homes where around five residents live with two caregivers. Many times they are not CNA's but are trained sitters who work under the supervision of an RN. Here in Texas a home like this starts at about $4000 a month but it depends on you person's needs. Mom still always wants to come home and now that she is zooming around with her walker I will start taking her out on the weekends. This weekend will be our first trial run. She will also use a bedside commode and continue to use her walker. You can also have your mom on hospice while in a home.

a083129 · May 10

I agree with everyone that hospice and MC would be the better option. Don't second guess yourself. You would be doing the right thing by her. I remember when my mom was in the hospital in 2014. She was in a nursing home by her request because she did not want to return to her home. She had respiratory issues. Well, she contracted the flu and had to be taken to the hospital. In her last directive, she also didn't want to be connected to anything to prolong her life. She was ready to go. She and I had many discussions about it when she was in good health. Well, I was in the room with her (when my brothers and extended family went to lunch) and the doctor visited. I asked the doctor, "If she did not have the ventilator, would she survive?" He said "no". I told the doctor it was time to let her pass peacefully and I spoke with my brothers about it when they returned. They were the ones that had the difficult time of it, but I explained that this is what she would want and the most humane and loving thing we could do, to honor her wishes. They agreed. We are all hopeful things will get better. We all want our loved ones to come back and be normal before they became ill. It is the hardest thing to do is to "let go". I am going through VD and CHF with my ex-husband whom I am giving care. We have the same directive. For him, I am praying that his passing will be sooner than prolonged. This is NOT the life he would ever have wanted to live. He doesn't have a clue that he has any problems. That is probably a blessing. But, even so, I am trying to get a grip on my emotions and praying for his spirit to become free from the failing mortal body. Once he is free, he will be more alive than we are right now. I am praying for you and for peace and comfort in your decisions. I feel you.

blueheron · May 11

https://alzconnected.org/discussion/comment/242558#Comment_242558

Medicare should pick up the tab for PT

Rehab versus hospice

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