The desire to maintain mobility is so important. My MIL refused to move much before she broke her pelvis last summer. She was unable to go to a rehab facility because she lacked both the ability and the determination to work in the way she would need to work in order to go to rehab. We got lucky & had a care coordinator at the hospital who pushed to get her into an acute care (skilled nursing) facility. She warned us that if MIL didn’t work, they’d discharge her.
Once at the facility, MIL realized that if she didn’t do the work, she’d be bedridden. She really didn’t want that, so she started working & gaining strength. They discharged her to her AL facility after a couple weeks. Months later, she’s still in outpatient PT to keep her strength at the level where she is able to move into and out of her wheelchair with assistance … which is so important.
Thanks for the reminder on the lifetime days. She used a lot of them in 2024 with two rehab stints — for broken vertebrae and broken pelvis!
== BUT ==
I’ve found additional information that it is 100 days per benefit period. According to the linked page, a benefit period begins on hospital day 1 and concludes 60 days after discharge from the hospital or Skilled Nursing Facility.
My mom fell out of bed again, and this time couldn’t get back in. She crawled to the door and her neighbor friend saw her and alerted staff. I found this out because she had sent another nonsense message so I called her. She was panicked and crying and not making a whole lot of sense, so I asked her to hand the phone to staff.
The AL director contacted Mom’s doctor a few days ago and he has changed her afternoon tramadol from “on demand” to just a regular dose, so she’ll not have to ask. Also wrote a script for lidocaine patches, and with Local and Preferred’s input, I got her an appointment with her gp next week. She is in so much pain; if I were there I’d take her to get an XRay but she gets one of those April 10 so we just have to hang in there until then. A few hours after I talked to her, she had someone call Local and tell them to come over; they made time for that and all she wanted was to tell them the story of falling out of bed. This is very unusual for her so we are scratching our heads. Preferred and I reminded Local that she is safe, even if she is upset, and they don’t need to start blaming themselves for not coming the second she thinks she needs them there. The painkillers don’t seem to be working very well (and she’s been on them almost 2 years off and on, so I’m not surprised) and we have to just hope it gets better somehow.
The hospital has a palliative care coordinator, but that is primarily just a means to move someone to hospice. (We did this with my father). Apart from this chronic debilitating pain in her back, she’s pretty good for a 92 yr old – there’s nothing they are doing that would be discontinued, and they can’t give her more tramadol (according to her gp) without risking heart failure.
Her AL technically does hospice care on the other wing since the medical wing is a different thing than the personal care unit, so she’d have to move for that; she would literally rather give up than move there (I am sorry, I know your loss is fresh)
Local’s MIL is a newly retired RN who ran the ER. She was a godsend when my father was sick and maybe we should ask her what she thinks. It’s also possible that another cortisone shot might help, but Mom was adamant that she doesn’t want to do that again. It’s just hard. I keep thinking that she’d going to die thinking that she was a burden and hard to manage, and I’ll feel badly for the rest of my life about not convincing her otherwise. Just a few weeks ago she was perfectly fine, and if the pain was managed she’d not have much to be concerned about.
Has she been xrayed recently to see if she has broken bones? My FIL was in debilitating pain and it turned out he had broken three vertebrae & no one realized it. He never had a big fall that anyone was aware of, but he ended up in the ER due to his unrelenting pain & they did the X-rays.
I wondered about ‘lifetime benefit’ with 100 days because I was also thinking benefit period. Certainly, something to check with the caregiving/financial individuals for the facilities be it the hospital or rehab. I do recall the period of days with specific hospitalization for rehab. Also to give specifics and check with the Medicare phone number in addition to reading what is said with Medicare written/web site information.
How Medicare states things - they may have their own way of ‘interpreting’ those things. Sometimes something might be a ‘higher’ rule – a big example is how one’s initial enrollment period rules ‘trump’ special enrollment (certain months right after turning 65 - there is one month that you have to enroll the month before or if you want to enroll that specific month it had been suggested to me that we enroll and ‘backdate’ - no we enrolled the earlier month and overlapped a month of coverage with our insurance and they still screwed up my husband’s file and he got his Medicare card almost 3 1/2 months late!) I turned 65 four months after DH, and I carried our insurance until I turned 65 and retired. I got my SS and Medicare fine. DH had signed up for Medicare A just before age 65 and he got that card. Medicare messed up his file because of the one skipped month with initial enrollment period rules after one turns 65. This is a ‘head’s up for any of you caregivers not yet 65. My BIL worked until after his wife turned 65, and her initial enrollment period also fell with those rules (her birthday is in Feb, and he worked through his first quarter in retail to receive his store bonus for the year as store manager) - she thought she had the right person she was talking to with SS and Medicare, and she reluctantly called them back and I told her to mention the rules on her initial enrollment period – and the SS/Medicare person said I was right, and they had to plan accordingly. I saved them the aggravation DH and I went through getting his Medicare A/B card and Medicare properly signed up….
I do get the impression that there are care providers that just ‘give up’ when people are over a certain age. I know with back issues, a MD Spinal Specialist, if there is nothing mechanically they can do, they will say “your back is XX age”. Lower back is problematic - sometimes structural things can be done. DH had cervical injections under anesthesia - the first one helped some but the second one totally took care of the problem. He had three injections under anesthesia a few years later for his lower back, and no relief – he has to be careful with his back; he doles out OTC medication on a 24-hour period (as his primary MD knows about). He also has had lifetime headaches that he manages in conjunction with the OTC medication schedule (if he doesn’t manage the headache, he has had terrible migraines - and he sometimes knows when a migraine is ‘coming on’ and immediately goes to bed in a dark room until it passes). We don’t know if his headaches and back aches are related.
Sometimes spinal stenosis takes place, and if that is discovered young enough for surgical intervention. My brother’s older wife has this condition, and she refused surgery. They live in a very distant state, and I tried to convince them - sent them materials years ago (I attended a continuing medical education session as a nurse with the MD who became my husband’s spinal MD, which gave case study information). I attended his sessions a number of years, such good information. She was a smoker and also with an eating disorder (skeleton thin) - and she is now almost 100% bedridden and home bound, and on NC oxygen as well. Needs portable oxygen to go out for medical appointments - not a way I would want to live. Brother is 70, and his wife is 83. It really limits my brother too, sad situation. Years later, I found out that when she was retired (while my brother was still working) she would vacuum on her hands and knees because of back pain.
This is what I’m concerned about. I’m not even sure there’s anything they can do, even if they discover she has some sort of fracture(s) going on. I feel like I couldn’t insist they take her for XRays since I am far away ; in addition, the local hospital ER is essentially the Urgent Care for the area and Local would be concerned that she’s gonna sit in a waiting room for 2 hours, suffer through the Xrays, and it will be nothing.
There was, unfortunately, nothing that could be done for FIL. But it helped inform his care. Once it was clear what was going on, he was properly medicated for pain. He wasn’t going to magically get better, and the pain was not going to go away on its own. He never gave up, working through his pain to keep as much mobility as possible for as long as possible. But he understood that he needed stronger pain meds than what he had been taking, and he was willing to take them. It was a trade off, because it affected his Parkinson’s regimen that had worked for so long - but being in constant pain is not tenable long term.
My father is lucky to not have much pain, except sometimes pain on the soles of his feet at around 5am. He does not appreciate that is such a blessing at his age (98, still living at home with the help of his younger and hard working wife). I’m not sure what to say when he laments that even with upcoming home PT/OT, he’ll never improve enough to drive again or get around without his walker. Me, I’m just glad to see him holding steady physically and mentally.
I wonder if there is a way to have MD ordered Xrays, so when brought into ER/Urgent Care, there would be no wait. Our Urgent Care takes appointments.
When college student DD went to an Urgent Care in her area for her sore throat and throat closing in on her/making breathing strained, she had MD orders for ER to give her a steroid shot and take a CT of her head and neck - she got immediate attention w/o wait. It turns out she needed to be admitted with strong IV antibiotics for a deep strep infection (rare for her age - typically someone at least mid-40’s) caught ‘early’ - in 24 to 48 hours w/o correct medical attention would have gone to her brain, her chest or both and been life-threatening.
In our area, we have a large orthopedic group that has its own urgent care - the wait is not too long (based on all the walk-ins) but we get Xrays by a skilled tech that takes all the Xray views needed right away, and those are seen by the medical staff pretty quickly. Xray, MRIs and CT scans have out-patient centers too, depending on your area - which if Xray is ordered and an appointment is made there - sometimes the radiologist will look at the imaging and have additional imaging if needed.
A friend of ours in Austin TX had been hit pretty hard on his left chest by a racquetball and pretty bruised and sore. He had an Xray (thinking maybe cracked ribs), and because they couldn’t image as well, they had him go for a CT scan. As he was leaving the building, the Radiologist ran out of the building after him - it turns out he had a thoracic aortal aneurism that needed immediate attention. MD expressed having ambulance transport to a specific hospital, but his wife was with him, and he drove as quickly as he could get there to that hospital that was awaiting his arrival - MD alerted proper medical team to take care of him. He immediately went in for surgery. The racquetball hit was unrelated to what was discovered - he was fortunate, a God lead intervention.
My parents all died in their early 70’s so I’ve not had the experience of aging parents. My in-laws have been blessed to lead an active life with good physical and mental health till now. FIL is almost 95 and is declining quickly. It started last year when he was hospitalized for pneumonia. He fully recovered but it took a physical toll on his muscles. His leg muscles and knees are weak and he has now fallen a lot. He had resisted a walker and was using one walking stick. After two falls from his truck he is no longer driving it. He took out the walker his daughter had bought for him months ago. He is using the walker at home but still using the stick when he goes out. Makes no sense but he is stubborn and my MIL doesn’t push.
He fell in the shower. They installed some bars yesterday but we don’t know what type. He needs a shower seat in our opinion. We are thinking of buying it and just bringing it to him. Any recommendations for type? Also for a shower mat.
Also how do your elders navigate taking a walker in the car when they don’t really have strength to lift.
Thanks
My sister-in-law fell while she was out walking on a sidewalk, 14 years ago when she was 60. She messed up her arm pretty badly. While that was being attended to, the doctor said he wanted to run tests to make sure she didn’t have a concussion. My SIL protested, because she didn’t think she’d hit her head, but the doctor insisted. Well, it turns out she had a chordoma, a very rare tumor that only about 300 people a year in the US are diagnosed with. It’s a really bad one, because it grows like vines around your spine. They said she probably wouldn’t have had any symptoms for another year and a half. The early diagnosis meant a surgeon could remove most of it (a two-day operation!), and then proton radiation would finish it off. Her city is one of only a handful in the US that has that type of treatment.
So she can’t turn her head at all, and she’s in pain a good deal of the time, but she’s happy to be alive. She NEVER complains. She’s been like a big sister for me, so I’m glad she’s still around.
I just bought my mom a transfer chair for her shower. It is really made to help get into a tub, but it is so much better than a regular shower chair. She resists most aids (hates using the walker, etc) but she admitted this chair makes showering so much safer.
# Drive Medical Tub Transfer Bench for Bathtub - Safer, Independent Bathing Aid - Height Adjustable Bench - Sturdy Aluminum Construction - Comfortable Backrest Support - 350 Lb Capacity
Thank you. They have a separate walk in shower. I’m going to have to ask my husband if he can recall the design details to see if a transfer chair would work. He loves his bathtub but is a sunken spa tub that really isn’t safe. Not to mention the tub is terrible for wound healing.
We are navigating with some difficulty as they are very resistant to help. Things appear to be accelerating and more help will be needed. Mentally he is also having a harder time with memory. Until a year ago he was playing tennis, boating and taking a huge fifth wheel camping. My mother-in-law is insisting that he should be the one to decide when he needs more help.
Ideal situation would be them having a professional come in and giving an assessment of how to navigate their home safely.
If you don’t have a bar already in the shower to hang on to, a shower chair with a back is good IF it doesn’t tip over (my dad wanted to grab the back and lean into it, which had bad results so we switched to a backless seat). Just leave it in the shower. Just buy one, they never agree to it and then it is wonderful and all their idea. We had the most success with assistive devices if we just acted like they appeared out of nowhere. I took every throw rug out of my parents’ home one afternoon when they were asleep. Took them weeks to notice. I admitted I did it for my own peace of mind and changed the subject. You have to think of safety like we did with children – they can’t play in traffic just because you don’t want them to feel bad, it’s a rule. Elderly can’t have throw rugs, it’s just a rule.
Bigger the bathmat on the floor, the better. Again, be sure it stays stuck down – slippery is worse than none at all. Don’t use a towel.
My dad refused a walker right until his death. My mom has one now; we refer to it as the bicycle and she is embarassed by it but needs it anyway. She rarely goes anywhere without somebody else who is willing to throw it in the back of the car so her ability to lift it is not part of the equation. Get those tennis balls on the feet, unless you have a rollator.
I have also found that bystanders are always willing to help if you just look at them. The number of middle age men who leap to our rescue is heartwarming. Snow, especially, they have already clocked us and are just waiting for me to look at them and give permission. DH is perpetually helping elderly people in and out of cars, and he’s a total introvert. But now it’s his life’s mission.
We used these (extra) grab handles to augment what we already had when Mom was staying with us – not too expensive, worked really well and don’t require drilling. We’ve put them back on for my pregnant DIL. Just be sure to test them before each use; occasionally they don’t hold but our first set we couldn’t get off for months.
They said she probably wouldn’t have had any symptoms for another year and a half. The early diagnosis meant a surgeon could remove most of it (a two-day operation!), and then proton radiation would finish it off. Her city is one of only a handful in the US that has that type of treatment.