In our experience, rehab involves a lot of time in bed. One hour of PT and maybe an hour of OT and in bed the rest of the time. Staff are so busy that they don’t get to the patient very much. arrived once to find that my mother’s colostomy bag had come loose and she was covered in poop. I called an aide, I asked a nurse in the hall, and ended up cleaning it all up and doing the colostomy care myself.
We prefer having home health nurse, PT and OT.
At rehab my mother constantly got out of bed despite the alarm and fall risk was actually worse! Once back at the AL she was in bed voluntarily but also got a little more exercise going to the bathroom and down the hall.
If the choice is between home (not AL) and rehab that is a different story, and depends on who is in the house, their strength, the availability of help. But we preferred return to AL over rehab and took my mother out pretty quickly.
Great post. The only thing I might caution some is that even a “small woman” can be very difficult to handle physically for a family. My mother was small, about 120 pounds and much less toward the end. Still not easy and two people helping her was definitely easier than one. She was dead weight toward the end. You have to be careful you don’t jeopardize your own health (and back) by not bringing even a small person home prematurely, if family will be the only caretakers at home.
My father had to go to a rehab after a hospital stay after a fall (he was living at home) and they said 3 to 6 weeks. He lasted 3 days and insisted on going home. They arranged home nursing.
After another fall several years later, they sent him from the hospital to rehab. My mother visited the first day and he was really not breathing. Back to the hospital. Yes, breathing is good. He did die about 10 days later but not from lack of oxygen. Big problem was caused by the fact that the hospital was in one county and the rehab in another. Plus we lived in a third county and he originally fell at home, so was transported to County 2, to County 3, back to County 2. Who should issue the death certificate? Oh, and it was a Monday holiday. Turns out County 1 was responsible for it.
A person in rehab can choose to stay in bed if they don’t want to get in a chair or W/C. In our state, our skilled care/rehab cannot have bed alarms - hospitals can have bed alarms and restraints (they did when I started 6 years ago, but state regulators and opinions change). On skilled care, we have these thick floor pads (and we stuff pillows around the resident with pillow tucked under a half sheet so not easy to roll over onto the floor) and beds on the lowest setting to the floor so not much of a drop. In rehab, we can have the half bed rail (so they can use to pull themselves up in bed) but on skilled care we cannot use bedrails as of their latest edicts. They seem to think residents get injured more banging against a bed rail than falling out of bed. A confused/demented resident in skilled care is often in a special kind of reclining rolling chair that it is difficult for them to roll out of or pull themselves out of - and the nurse or nursing staff have to have that resident close to keep an eye out. Sometimes there is enough psych stuff going on that they go to a psych in patient and get their meds adjusted. But there are also rules on ‘chemical restraining’.
Due to low unemployment/better employment, we are low on available EMTs for ambulances.
As someone said on this thread, the dad who thought they could age in place at home was maybe not quite as firm on that with wife’s health challenges.
Our neighbor’s 85 YO mom (widowed a year or two ago) had socks on and slipped on the wood floor in her bedroom between the area rugs and broke her hip (about 1 in the morning - probably fell asleep watching TV in her sitting area). She crawled to the phone and called her son; son called EMTs and told them the code to get into the home. She was resistant to moving out of her 3 story home, but now she is at rehab at the facility where her own mother was in apt then assisted living then skilled care. She is going to move into an apt there when her rehab time is up; family will help get her home sold and possessions downsized.
If one wants to pay for home health nurse, PT and OT when insurance won’t pay, that is one’s choice.
It all depends - on the resident - the family - the financial resources. Way too many variables. And I totally agree about a small person having a lot of might - especially if they have their adrenalin pumping. When I worked in psych, a psychotics YA about 160 lbs – it took 8 EMTs and nursing staff to strap him in the gurney to go to ER and get the proper dosage of meds needed during a violent psychotic episode where he thought someone was coming to kill him (he eventually went to long term psych).
Our rehab area is hotel like. Covid did have a lot of limitations, but there also were limitations on elective procedures as well. Stating - no one wants to be in a hospital, and no one wants to be in rehab or somewhere other than home. Some people have better ways of coping with their personal circumstances than others, and some have families that handle things the way they do. Facilities offer services - they may not be viewed as ‘good enough’ - and a facility may have a worker or two that don’t meet expectations – and there are some residents or families that just do not like what a rehab facility offers.
We didn’t pay anything for nurse, PT or OT. Insurance covered home services provided in the AL. For my mother, who was so disoriented in rehab, this was the best course. Yes, every situation is different.
I can’t help but wonder what did the D have to do beyond taking her mother home. Did the woman live independently before the hospitalization? Did she have help? Did the D have to move in with her mother to become the caregiving slave (at least during rehab)?
I realize you probably don’t know the answers to these questions. I’m just pondering. But so often it is one sibling who takes on the lion’s share of the work, and they can be affected physically, mentally, and emotionally in bad ways. It’s usually a daughter.
I follow a message board specifically related to elder caregiving, and the above seems to happen more often than not. The D above could have told her brother that SHE wasn’t going to take the mother home. If the brother wanted their mother home, HE could arrange for it. The frequent refrain on the other message board is that we can’t control what others do, but we can set limits on what we will and won’t do. (And then stick to them!)
I think an important factor in when to leave rehab or to go to rehab at all is are you functioning at the level you were before your hospitalization. For my father, this is true now, he is functioning the same as before his most recent hospital stay. I don’t know why the rehab was not looking at it this way. I told them he was bed bound before etc., but they were setting up unrealistic goals like his being able to walk on his own.
At the end of one of his longer hospital stays they had my father in the acute rehab ward of the same hospital. This was actually a really good solution - he was just moved to another section of the hospital and he never realized this ward was different from any other ward he had been in (he had been moved around quite a bit during that longer stay.)
Is it true that going to rehab after surgery is bad? My 85 year old mother with Alzheimer’s is having her knee replaced in a month. She unfortunately is mean/nasty, and frankly I do not want to take on the responsibility of her immediate recovery because of that. (She does not live with me). She needs more hands on care because of her cognitive issues (eg not sure she would take meds appropriately etc). I was planning on rehab after the surgery. But should I reconsider?
Fortunately, there was no choice for my mother after her hospital stay. There was no mention of in-home rehab (other than the PT and OT who would say ridiculous things like, “We’re going to have you back home in no time, young lady!”)
My mother had similar traits to yours. There was no way I was going to subject myself to that. Consider your own health, and let her go to rehab.
It’s hard. There’s probably no alternative. Just stay very involved and make sure she’s getting attention. We found we had to be involved all the time or Dad went downhill. That’s why I’m going to Austin for his surgery even though his caregiver will be with him, also.
Like all medical care facilities I think some rehabs are better than others (just like some AL facilities are better than others). Select one that offers what she needs, is used to dealing with Alzheimer patients, and is conveniently located.
Yes. We work with a nurse who consults with families caring for elderly relatives, and I have the scoop on area facilities (including one to avoid). I plan to see my Mom every day.
Here’s a tip: Try to get a room in rehab that is close to the nurses’ station. Our first experience with a certain rehab was pretty darn good, with a bed close to the nurses’ station. Second stay was abysmal, with bed down a hall and around a corner. It is even worth waiting for a better room if you can.
Rehabs are a good alternative when going home isn’t. We had assisted living staff to help with ADL’s and lifting. I would never have been able to bring my mother home, even if I lived in a house (I live in a small apt.).
It is good to stay on top of things at the rehab. And transfers from home to hospital to rehab means med list clean up is often needed so watch out for that. The hospital adds and deletes and there are sometimes mistakes in the record too. The rehab will follow the hospital list unless we intervene. My mother would have been doped up on ativan because there was an old Rx on her record!
But so often it is one sibling who takes on the lion’s share of the work, and they can be affected physically, mentally, and emotionally in bad ways. It’s usually a daughter.
Love your term “caregiving slave.” It is up to us to set boundaries but they keep slipping! My mother pays my rent as compensation, partly for staying in this high rent area. But it keeps me from feeling like a martyr.
Support groups tell us over and over about all the effects on caregivers. I cannot imagine the stress on those of you who have an elderly parent at home with you!
Boy, I’m glad you pointed out about the outdated med list - so true! I think my son’s has been messed up every time he winds up in the hospital (every couple of years, typically). When he lived at home, I knew exactly what he was taking, but now I don’t, so I get the list from his housing staff.
As an in-my-home caregiver for my mom for 9 years, I can tell you a 125 lb woman who randomly drops to the floor is heavy as heck to handle. I am always holding her by a handled gait belt when she walks with her walker to the bathroom or kitchen/family room chair. She only lost weight in the past year or so and was 150 for the first 7 years. It’s been very hard on my, physically.
Our rehab experience was pretty good. After five days in the hospital, five years ago, she went to rehab and I insisted she needed to be able to step up three steps to get into my house with assistance. When she didn’t want to do the work to get stronger, they wanted to release her. I had to tell her over and over ( and attend her PT) that she could not come home unless she got stronger. She has Medicare advantage through my deceased dad’s work, and they evaluate every three days, much shorter time period than regular Medicare. I had to appeal one decision to get her three more days and won. She had been fully independent with walking before the hospital stay. After, she’s needed the rollator walker and me with her 100%.
Here, there’s no way a bed bound person could be in assisted living. It’s really interesting how different states and facilities have different requirements.
I may be using the wrong term - he can not get himself out of bed. The AL use a hoya lift to get him into a wheelchair and move him around. So he can leave his room with assistance.
It may be how insurance/Medicare is handled in your state. In our state, one has to go to rehab in order to have PT/OT/ST services covered by Medicare for the ‘event’ that caused the hospitalization.