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We are overwhelmed . My husband and I work and have children . Mom is not progressing in acute rehab . She’s not walking, dressing … doing anything on her own except eating . Prior to Covid isolation and this accident , she was a different person who drove , cooked, cared about how she dressed , had people over for dinner … I am touring sub acutes tomorrow . My own dr advised that they are effective but you need to hire an aide as understaffed. I am also looking at assisted living but since she needs 24 care not sure this is the right route … any advice appreciated as we are overwhelmed! We live in NYC and don’t have the extra space for her and a live in at a million dollars for each extra bedroom!
Really need advice. She’s very down snd scared. I try to push her to relearn the basics but she’s terrified of falling understandably . Her worst fear came true .

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BarbBrooklyn is in the city and knows plenty. She will probably be along.
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Shersher Dec 2021
Great thank you 🙏🏻🙏🏻
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Oy.

So, the thing is, sometimes, it's not the fall that breaks the hip. Sometimes it's a stroke or heart attack that causes the fall. Or with osteoporosis, the bone simply fractures and then she falls.

My point is, is all else well with mom? What has caused this sudden change in motivation and personality? I am a big believer in geriatric psychiatrist-- with my mom, they were always able to get to the heart of my mom's issue and advised us well.

Is mom doing ANY therapy in acute rehab? What does she say about how she is feeling? Is she still foggy from the anesthesia?

I'm sorry I'm not being very helpful, but a little more info about her specific situation will help. Welcome!!

You are correct that AL won't be a possibility for her if she is bedbound and needs help with all AL'S such as dressing and toilet ingredients.

Do you have a handle on her financial resources? Do you have POA for health care and finances?

How far is her home? Are there other siblings? Although I live in the city, we placed mom in Connecticut,close to one of my brothers, but also because it was somewhat less expensive and the regs a little different. Care in NYC is very expensive.
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Shersher Dec 2021
Thank you for your advice 🙏🏻🙏🏻
mom is a diabetic but thankfully is under control. She is doing therapy in acute rehab but very scared of falling so holds back . Thankfully medically she is under control other than she says she’s in lots of pain . She is a week and half post op. Still a bit foggy and the acute setting lulling here senses. Thank you for the advice about a geriatric psych . This would be very helpful. We did a psych consult but I think she needs more.
im at a loss but trying to be positive .

I’ m very scared about the sub acute decision but that is what they are pushing . My own GP said it’s effective but you need to hire an aide?

My sister has checked out. My husband helping me with all this .
Any advice appreciated 🙏🏻🙏🏻🙏🏻
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I see from a post a couple of months back that your mom was experiencing some cognitive decline. Perhaps attributable to COVID , but perhaps there is some early dementia which making it difficult for her to process instructions from therapists, increases her anxiety levels and has reduced her reasoning ability. Just something to consider.
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My mom spent only about a week post stroke ( different story, I know) in Acute Rehab, even though she worked very hard. I think step down to sub acute is quite common at that point.

Mom was fine in sub acute on her own, but that was Connecticut and not post COVID.

In looking at sub acute, we went for clean, good PT equipment/suites and a place that had a reputation for getting people moving again after knee and hip replacement, so a somewhat younger crowd.

They also had a geripsych on staff. Important IMO.

After mom's hip fracture, she went directly to a subacute facility that was also a long term care facility. And that accepted Medicaid after a period of private pay. I think that might not be allowed in NYS, but ask.

The therapists at the NH were great and got mom walking again, which was a miracle of sorts (91, with dementia!).
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One more thing. If mom has "resources", i.e., savings, I wouldn't hesitate to use a Senior Placement advisor service, either an independent one or the one that is operated by this site. They will keep calling you until you tell them you've found a placement, but in my experience, they know where the beds are. They also advise on home care. I don't know if they find rehab placements but it can hurt to ask. You don't pay them, the facility does. Again, I don't know how/if this works in NYC.

The only place I have any personal knowledge of is Cobble Hill Health Care in Brooklyn. Had a friend there for rehab years ago and it was fine. They had horrible COVID numbers, largely due to the lack of availability of PPE ( it's a private facility) so initially they got no help from NYS.
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Shersher Dec 2021
Thank you for again
invaluable advice
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Another thought. I think you are thinking that it's because of something mom isn't doing that they are recommending sub acute. Ask them that directly. I think most acute rehabs are very short stay, not because of how mom is participating.

If she has a 24/7 aide, she will have NO motivation to get moving. Proceed with caution there. Maybe start without and see how it goes.
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Where is your mother's home?
And where is the sibling who has checked out?

And are the answers to the above connected in any way?

A week and a half is nothing. Some seniors are zipping about like fireflies next day, but others are still feeling ginger about mobilising much further down the line, so it's certainly too early to despair.

Make allowances for the simple shock your mother's had and pile on the reassurance. Is she co-operating with the PTs, and happy with them? - because if they don't make her feel safe first and last they'll get nowhere.
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Be aware too, that breaking a hip in the elderly is very serious. If she was showing signs of Dementia before the surgery the anesthesia could worsen it. Anesthesia in the elderly is not good in people that don't have Dementia. It also takes longer to leave the body so there will be after effects.

I really have no idea the difference between acute and subacute. I did look it up and seems sub is more intense. Will Medicare be paying a share of the cost? It did say in what I read up to 100 days so I figured Medicare would be involved. Where I live our Rehabs and Nursing homes are one and the same. You are either in rehab for a few days on the whole 100 depends on how you progress. If pasted the 100 days and need 24/7 care you are transitioned to the nursing section if no way you can be cared for in your home. No acute or sub acute.

I would question a private caregiver. This can be expensive and you should be using Moms money. The caregiver cannot give her therapy. All rehabs are short staffed and always have been. What is the caregiver expected to do over what the rest of the staff can do? You will need to check and see if the facility will even allow a private caregiver. She may need her own insurance because the facility cannot cover her.

And why are you looking, the SW should be helping you with this.
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Cover99 Dec 2021
Acute is more intense, sub is slower and can take longer,
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Acute is therapy 3 hours a day; paid for like a hospital stay by Medicare.

Subacute is maybe one hour a day, not as regulated by Medicare in terms of how much therapy.
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