Broken hip & PT

[wisingup]

Hi everyone.  My uBPDm - 86 years old - took a fall yesterday & we learned today that there is a hip fracture.  She's having surgery as I type.  She will stay in the hospital another day or two, then will need some PT.  She lives in an assisted living facility.

Has anyone had this experience?  We will make some calls tomorrow to learn what the AL facility can/can't do for her & if she's able to return there after the hospital.  I'm afraid that she may need a rehab facility for some period of time & how that will work. I'd appreciate hearing anyone else's experience with this.

Neither my brother nor I can have her in our homes, both because they are not suitable (lots of stairs), but also because she is terrible for our mental health.  If she can't return to the AL, it will have to be some other option.  Thanks for any advice you can share!

[Sneezy]

Your mother should have a case manager or social worker assigned to her by the hospital. Ask for a meeting with that person. The case manager can help you figure out the next steps. You are likely looking at some time in a rehab hospital and/or some time in either skilled nursing or home nursing. Push hard for a rehab hospital followed by a skilled nursing facility if you can get both. Medicare has a web site where you can see all the Medicare-covered skilled nursing facilities near you and read their ratings.

Make it clear, every step of the way, that no family member is able to provide care for your mom. Make sure every medical person you talk to understands that your mom lives alone and can not be released to a family member.

You are right to talk to your mom's current assisted living facility to see what services they offer. Once she has been through rehab - in a rehab hospital and/or skilled nursing - she can then hopefully go back to assisted living and get the care she needs there.

Good luck, she will be uncomfortable and not easy to deal with for a while. Remember you don't have to spend every minute by her side. Take breaks and take care of yourself.

[wisingup]

Thank you Sneezy - this is tremendously helpful!

[wisingup]

Update - Sneezy, I sent your advice above to my brother who is the main contact for medical issues (I handle financial ones).  He spoke with the case worker and the AL facility and they had it all under control.  This is not their first rodeo, so to speak.  So it ended up being fairly smooth, UNTIL...they actually moved my mom last night to the rehab facility & she had a complete meltdown.  Yelling, thrashing, threatening to call the police.  They called my brother to try to calm her down & she told him to go to hell and hung up on him.  He will go to the facility today to see her & hopefully she will be better.  Oy. She is still under the influence of the UTI, so hopefully as that subsides she will become more reasonable.  I'm sure she's in pain, confused & afraid.  Wow, just wow.

[Sneezy]

they actually moved my mom last night to the rehab facility & she had a complete meltdown.

Oh no, I'm sorry to hear this.  Hopefully, the rehab facility can calm her down, they must be used to this kind of behavior.  Seniors coming out of surgery can be delusional.  For some reason, anesthesia really affects them.  I hope she's better today.

[wisingup]

Update - mom has calmed down a bit but is still very delusional.  Theoretically, they are treating both the hip and the UTI, but usually we would see improvement by now in her cognition.  Maybe the whole experience combined - the fall, the surgery, the move to rehab, etc. is just too much.

Anyway, due to her delusional state we are needing to pay for 24 hour caregiving to sit with her to ensure she does not try to get up on her own.  It will be 2 full weeks of that, not covered by Medicare. 

Quite a journey, this aging BPD thing. Some of the staff at rehab have "hinted" that she seems ready for memory care when she returns to her AL facility.  It's hard to know when to make that change.  I think we'll wait until the folks at her facility recommend it.

[Sneezy]

In the earlier stages of dementia some people can hold it together quite well. They compensate and can seem fairly cognizant, until something happens and then it all falls apart. I think you're right - the fall, the surgery, the move to rehab - it's overwhelmed your mom and she's gone off a cliff.

Does her AL facility have a memory care wing? If so, they can guide you as to what level of care she needs. Much of what you're paying for in memory care is that locked door. If your mom isn't a flight risk, which she isn't with a broken hip, she may be able to stay in AL. One thing to know about cost, though, is the tax implications. I'm not a tax expert by any means (haven't even done my own taxes for many years). But in general, AL costs are not tax deductible, but memory care expenses are. Not the whole amount, but there's a formula for how much of the memory care expenses you can deduct as an itemized deduction. So if there's not a big difference between AL and memory care, you might want to look at the tax advantages of being able to deduct some memory care expenses. For my mom, the cost of AL with a high-level care package added on, was almost as expensive as memory care. And so with the tax deduction, putting her in memory care (which is really what she needs) made both medical and financial sense.

[wisingup]

Thanks again Sneezy - this is great info.  I will be picking mom up from the rehab facility today & returning her to AL.  We've had to pay for a "sitter" for 2 weeks to ensure that she doesn't wander.  I wonder if that part would be tax deductible?  I'll look into it. It was quite expensive.

The AL facility is saying they will keep an eye on her, but from what they saw from their visit to her on Monday, she may be headed for memory care (and yes, there is a mc wing to her current facility).  We've agreed that we want to keep that as a last resort, if she doesn't regain some of her cognitive functioning.  I know that she will hate it there & as poor as our relationship is, I will hate her being there.  But if she needs a locked door between her and the outside world, that is the only option.

[NarcKiddo]

I am in the UK so our systems will differ from yours in some respects. But I wanted to tell you about my MIL (in her 90s) who is in a care home and has been for years. She is frail and now has dementia but her mental state can vary wildly. She had a fall earlier this year and was hospitalised for some time. Her mental state was terrible then. Back in her care facility the mental state can be good but only for a day or two before she relapses for a while. The general progression is downhill but it is not linear. Clearly one wants to make the most of any "good days" but I think it is important not to be lulled into a sense of false security by those days. She tends to make a lot of untrue claims (care staff do not wash her, people are stealing her stuff, she's not getting fed properly etc) which can cause a lot of family worry until they are proven untrue. As for her claiming to hate it there, that can vary, too. It is hard to tell if she does have periods of hating it there or if she is continuing her life long habit of enjoying drama when she can generate it. I think what she actually hates is her own frailty but there is nothing that can be done about that.

[wisingup]

The general progression is downhill but it is not linear.

Thanks NarcKiddo - this is definitely what we are seeing.  When I showed up to pick her up at the rehab facility, she was very emotional & weepy, very confused to see me, couldn't seem to remember what had happened to her & had no concept of how much time had passed.

Once we were in the car on the way back to the AL facility, she improved markedly and I could tell that she was having coherent thoughts, but having trouble expressing them, finding the right words etc.

Then once we arrived, the staff took her right in to sit down to lunch with her usual friend group & she seemed to improve even further.  She's fairly happy there in the regular AL and has several good friends who look out for her.  Here's hoping the memory care option isn't close on the horizon!

[wisingup]

And the saga continues.  Mom is back in the hospital with another UTI.  These things are just terrible - they addle her brain so badly & just keep coming back.  It is pretty much impossible to tease out what is true cognitive impairment with what is the effect of the UTI.  It's probably best that she's gone to the hospital.  Hopefully they will fully treat this one until it is GONE. 

[moglow]

Wisingup, all I have running through my head right now are our parallel parentals. Mommie dearest is much the same as yours - went into hospital mid-late July then to "rehab/nursing" facility nearby with UTI. Then they discovered she had a compression fracture and possible opioid addiction [with predictable digestive side effects]. They've addressed UTI and fx [some kind of injected filler to boost that vertebrae and relieve the pain] - But now she likes the push button fetch and carry, is looking for ways to not go home and someone else to foot that bill. Shes also dropping LARGE hints to brother about how they can "make this work for both of us." i.e. move in to same house.  Never mind that she's not fit company for man nor beast on her very best day ... all things considered I totally see mine being discharged then readmitted quick fast and in a hurry like yours.

It is pretty much impossible to tease out what is true cognitive impairment with what is the effect of the UTI.

Brothers and I are having the same discussions - what's fact or fiction? Which came first, chicken or egg? And does all this stop?!

Anyhoo, just here in spirit with you. Mine rarely speaks to me anymore other than very random texts and frankly I'm more okay with that every day. It's not always easy but possibly easier?

[wisingup]

Thanks Moglow - appreciate the solidarity!

Brother and I were splitting things so that I handled financial/legal/administrative stuff for mom & he did medical.  Well, right now the medical is overwhelming, so I'm back into the fray. 

My brother sounds so defeated/depressed right now - I'm way more worried about him.  He overcame cancer last year, but is having serious after-effects of the chemo AND is dealing with serious issues with both of his two adult sons.  Mom doesn't know about any of this because of her "make it all worse" super-power, so she just complains and complains when he doesn't show up to serve her.  He also has covid right now - yikes.

Anyway, all of the above puts me front & center.  Her brain is mashed potatoes - she can form words, but cannot convey her thoughts in a way that I can understand.  She can still get the guilt trips in somehow though - she gave me an earful this morning for being in the bathtub last night when she called & said my DH was rude to her (he wasn't - he's way nicer to her than anyone else in the family).

and possible opioid addiction [with predictable digestive side effects].

Oh my!  This ramps up everything a few more notches, yes?

Hang in there brothers- and sisters-in-arms - elderly BPD parents can take us right down if we don't care for ourselves!