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My mother fell and broke her hip 8 days ago she has been placed in rehab and because of Covid-19 we are unable to see her. She states that the people there are rough with her and she wants to come home. Of course I have concerns about being able to provide her with the care she needs but if your mother says she wants to come home I feel I must do as she asks.

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Not sure this will help, my mother had the same complaint about them being too rough and hurting her. A friend of the family is the director of admissions at a rehab and she said they move or turn people fast because it hurts less and it is easier on the client.

I am not sure this will be any help to though
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Often, while in a facility, elder seems a little more OK than they really are. In the controlled environment where there is a staff to give meds, therapy, meals, incontinence care, general hygiene, etc they can adapt somewhat and seem better. They are feeling fairly good, look pretty good, sound pretty good and believe they will be fine at home. The 24/7 care situation also feeds elder's belief that he/she does not really need a lot of care or help. In the controlled environment, elder loses track of ALL that's being done for them because it all becomes just part of their day. Elders tend to downplay or not notice at all what's being done for them and can become quite verbal that "nothing" is being done for them in the facility. Then, a lot of families start thinking the elder's home environment is a controlled environment as well, but there's a huge amount of additional functioning to be in a house/apartment (even with help) as compared to a 24/7 facility. Elders can decline rapidly if they go home too soon because the home environment spins out of control because there is not enough "staff" to meet all of elder's needs. It can very quickly turn into a burned out caregiver who cannot keep up paired with an elder who just had an accident and is wondering why you have kept them waiting for 2 minutes for more coffee. Elder won't see the problem, but the caregiver will.
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A repaired 'break' is much different than an elective replaced hip.

Likely your mom IS in pain, and bringing her home without all the PT she is getting on a routine basis, not to mention the correct administration of meds, etc is something you will tire of very, very quickly. Add in to that meals, bathing, basic moving about the place--it's FT care, don't kid yourself.

Mother had a knee replacement and did the first rehab in house. She did well and was a good sport about it. Her 2nd one, (both were elective) she demanded to be taken home (YB's home has an apartment) and so they took her home. She ran us all ragged and I don't LIVE with her. It was a pure nightmare, and brother had to take leave from work to simply be there to open doors for the PT people and visiting nurses. We figured out pretty quick what she WANTED was the non stop attention. She did not rehab well at all and went from walking w/o assistance, to needing a cane. A couple years later and hip replacement took her to requiring a walker, FT.

She is now begging for a 2nd hip replacement, but at age 90, is in no condition to have one. YB said she can if she wants, but he will have her discharged to a NH for life if she does this.
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Beatty May 2020
"but he will have her discharged to a NH for life". Good answer 😁

A Friend's FIL surgeon-shopped until he found one willing to do him an elect hip replacement. Late 80's, has history of major confusion after anaesthesia, falls, multiple medical issues, non-compliance at rehab, self discharges, arriving home in taxi. Expects CCF wife to wait on him. Asked his families' opinion of hip op: answers included 'is your will up to date?' & 'what an expensive way to kill yourself!'.

Amazingly, a surgeon took him on, he had the op, stayed put for most of the rehab stay & is still alive at home as far as I know. But every month brings a new drama, a new cycle of hospital-rehab-home. He told his family he wants to die at home. They are at the stage if saying 'OK do that - stop calling us'.
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TNtechie's response was very good.

I would call and ask to talk to the DON. Tell her/him that Mom wants to come home because staff is "rough" with her. May be the DON can find out what Mom means by "rough". Then explain why going home is not a good choice.

Rehabs cannot make someone stay. Getting the doctor to discharge AMA protects the rehab. Medicare and insurance companies will pay for any care given up to that point. Don't allow the rehab to tell you different.

My opinion though, Mom needs to stay put to heal. In home therapy may not be enough. If you find you really don't like the facility, you can always place her in a different one.
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You will not be able to provide the care she needs at home. Use your energy to find ways to get mom to relax and work at therapy. The sooner she is successful with therapy, the sooner she gets to come home.

Of course it hurts and she thinks they are rough. Maybe they have to be to get her to work hard.
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CAN you bring her home is your question but please backstep & ask 'SHOULD you'?

Has she had surgery yet?
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Has the break been repaired or not?
If the break has not been repaired then ANY movement will cause her pain and she may construe that as "rough"
If it has been repaired this will still be painful for a while and again she may see this as "rough" treatment.
You are going to have the same problems at home, maybe more so. In rehab facility they can use a Hoyer Lift if necessary or they can use 2 or more people to help position or transfer someone. Can you do that at your house?
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As a practical matter, your mother can check herself out against medical advice at any time; however, unless your have a lot of resources there are consequences your mother might not like. For example, if in home care doesn't work out or if your mother needs rehab at some future date, the facility may not readmit her as a patient. Sometimes insurance will not cover certain treatments following a discharge against medical advice.

When my mother had elective hip replacement at age 66 (sounds strange that anyone would "elect" to have hip replacement but that's what it's called when you have the replacement before the hip breaks), she spent one week in a rehab to learn how to use the walker for things like steps and how to do things while using a walker (toilet, shower, cook, etc.). My mother had used a water walking class to maintain fitness and muscle strength prior to her surgery so she didn't need any rehab time to build enough muscle and/or endurance to use a walker. Typically when people suffer a broken hip, their pain level has reduced their activities and fitness level prior to the break requiring several additional weeks in rehab to build strength.

I spent the 10 days after my mother came home with her 24/7. Hip replacement is a major surgery and even though Mom could use the walker, her energy level was low and she was still on pain medications and post-surgical blood thinners. She needed my help to get her shoes on, track her meds and administer those blood thinner shots, cook, clean, do laundry. Before I left for 5 days on my travel job, I cooked a big pot of soup and a beef roast with vegetables so Mom only had to reheat her food in the microwave. By that time Mom no longer needed pain medication and had a small basket on the walker and a water bottle that fit in the basket, along with other things re-arranged in the house to fit Mom's current capabilities.

The next week when I traveled, I took Mom with me. Since I was a frequent traveler, the airlines and hotel were very helpful with the arrangements. Mom and I stayed in a handicapped suite and the hotel staff was very supportive to any request Mom made during my work day. The suite included a kitchen so Mom could cook her morning oatmeal and fix a sandwich for lunch and I brought take out back for dinner.

My mother had excellent health at the time of her surgery, did all her in home PT and got back on her feet quickly; however, it took almost a year for her energy levels to get back to pre-surgical levels. If your mother is not solid on her feet using the walker, then she has a least a couple of weeks where she should not be left alone. If she is not the type to independently follow the PT program, then you may need to arrange in home PT and OT. If she falls when alone, you may need some kind of panic or alert button she can use to summons help.

Your responsibility as her daughter is to listen and consider your mothers needs and wishes and well as the needs of your family; however, your statement "I feel I must do as she asks" is very concerning. If your mother is not steady on her feet and therefore has a high fall risk (and the chance to rip the hip replacement out of the bone and sever the femoral artery) then I believe you have a duty to leave her in the rehab. Make sure if you help her leave against medical advice you are prepared to handle all the potential consequences, including blood clot complications or additional fall injuries.
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Beatty May 2020
Excellent real life example. You give a very realistic view of the details that need be considered 👍.
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