My mother has been living with us since May. She is on her second round of PT and OT and has a home health aide. Any advice?

I am a PT. I work in another setting, but I know PT. The PT should not have reprimanded the caregiver as such, but unless the PT knows the exercises are too much, they expect them to be done. Not doing a home program means there is no time to strengthen the muscles, because the PT coming over 2x a week isn't going to do it. It sounds like they are doing too much with her and they need to either modify the exercises or decrease the time of the program.
As far as therapy for arthritis, it is a frustrating diagnosis to treat. Strengthening the muscles around the joint and keeping the joint mobile is the goal, but I agree causing more pain is not the answer.

What are the specific goals for PT and OT? Is there progress toward these goals? The therapists have to measure and keep track of progress. Ask to see their reports, and compare it to your own observations.

If there is noticeable improvement, possibly being shot for the rest of the day is worth it -- possibly, but you are in a better position to judge that than the therapist is. Discuss your concerns with each of the therapists. Perhaps they can make adjustments if they understand what this is taking out of your mom. But if the therapy isn't helping at all, stopping it makes more sense than adjusting it.

My husband like doing his exercises with his PCA better than doing it with me. ("She's not as bossy.") But no one can really force someone to do exercises if they don't want to. Encouraging the caregiver makes some sense. Reprimanding her is over the line!

No amount of exercise is going to cure arthritis. My mother's geriatrician told us not to try to get our mom to walk more than she was comfortable with or to try to do exercises with her. Just keep her out of pain! I don't think that means therapy is never good for people with arthritis, but I do think I'd want to know just what the goals are!

Medicare is paying for this, right. If there is no improvement then they will have the homecare discharge her. They also don't have the right to reprimand your aide, unless she is from their facility. I have been saying this a lot lately...these people are coming into your home. They can suggest but not demand. You have a right to ask for another therapist if u don't like them.

Ambly, you do have options and I think at this point it's time to consider them.

1. Who selected this particular home care agency? Was it a rehab social worker? Hospital discharge planner? You do have the right to substitute agencies, and it should be your choice.

And I think at this point that's a good plan to consider, but there is another option before doing that.

2. Home care agencies have become much more business savvy. Some have permanent reps at hospitals, who visit patients approaching discharge and market their services. That's what they do, but marketing can have its advantages.

When I learned about these reps, I met with them at the hospital, watched how they interacted with my father, asked them questions from a master list I had prepared. It isn't easy to select a home care agency w/o knowing anything about it or the therapists, but I tried to judge based on how professional, and especially how flexible the company was. Years in business was also a factor, as was having a former nurse marketer.

3. One company marketed not only in hospitals but at rehab facilities as well. I'm sure they have a business plan, for current and future activities, and since they're expansion oriented, I felt I had a better chance negotiating with them if problems arose.

4. After I learned more about the professional level of the various agencies, their marketing plans, scope of service (some also offer Hospice care, one was applying for Palliative Care), I then also made the selections. I wouldn't allow any hospital discharge planner or anyone else to choose a home care agency for my father.

5. You have 2 options right now:

a. Have a heart to heart discussion with the therapists and ask specifically what their goals are; that should have been noted in the plan of care. If you don't think they're realistic, ask about revising them. I don't know how feasible that is once therapy has been started, but it's worth a discussion.

b. Ask for different therapists, and make it clear that scolding a caregiver was unacceptable behavior and you won't tolerate that.

And you do have the right to call the agency and speak with a manger or supervisor about these issues.

Last year, one of the physical therapists was really gung ho about exercising to the max. All her family were military except her; I had the impression she was trying to prove something, in the way she pushed my father to work out until he was exhausted.

And she also insisted that there was no reason a 98 year old man couldn't have therapy twice a day. I disagreed.

She refused to back down; I called the agency and asked for a different therapist, and got a real gem, an older, more experienced, male therapist who got along very well with my father. He called me with recommendations, realistic recommendations and not pie in the sky goals.

6. If these suggestions don't work for you, contact the physician who scripted for the therapy and explain the situation, indicating that you want her to continue to have therapy, but with realistic goals. Hopefully he'll script for an extension of therapy, after you find a company with which you're comfortable.

7. I wouldn't conclude it's a waste of time; there are various levels of therapy that can be done, and some are probably more appropriate for your mother and whatever conditions she has. I suspect that the PT she's been given is way beyond her level at this point.

8. If she needs to strengthen her legs, there are little "bike pedal" machines that can be purchased for about $15. My father used to sit in his chair and pedal his "bike". He had the benefit of support, sitting down and not standing, and could really get going on those pedals!

Google "stationary pedalers" and you'll see some examples.

Good luck, and please follow up and let us know how this situation worked out.

Gentle stretching and basic range of motion exercises in a warm therapy pool helped my Mom a lot! The water supports part of the body weight and provides a gentle resistance while the warmth helps loosen the muscles. Although it helped strengthen the muscles and tendons over time (including core with improved balance), the big benefit was an immediate reduction in pain. You can start with 5-10 minutes in the water. If the pool has an underwater "bench" just sitting in the warm water is helpful for pain reduction. Mom started with a prescribed out-patient arthritis program at a rehab hospital and later moved to a similar program in the local senior center.

I would be very cautious about using therapy pools because public ones are teaming with bacteria and parasites which can kill an elder as there is also risk for slipping and falling. In the water. People with dementia can also be incontinent and pools of any kind are highly likely to stimulate bowel or bladder activity..in the water.

If she's just 3 months past surgery for a broken hip, she needs to do the PT. Maybe she needs shorter sessions more frequently (though that might cost more) ... or maybe it's okay that she's wiped out for the rest of the day. If she doesn't do her post-surgery PT she will remain disabled, which isn't what she wanted when she went for surgery.

I would hope the PT is aimed both at recovering strength and mobility in the injured limb AND improving her balance. Sometimes that's a matter of retraining the brain's balancing function, but often with elders it's also a matter of strengthening the small muscles that correct for slight off-balance moments so the person can prevent falling.

Separately from that, we sometimes use PT even for people on hospice, because PT can help people maintain a plateau of present function and slow or stop a decline in mobility, even in the presence of life-shortening disease. Since falling is awful for elders, PT to help people learn NOT to fall, as well as learn HOW to fall if it's too late, is enormously useful.

There are no miracles! The older the person is, the more difficult the situation probably will be. Emotional support and positive reinforcement will go along way to help revitalize a person's physical and mental abilities and attitude.

I agree that your mom's falling could be a result of a change in her system and that could be leading to her exhaustion as well as the fact that she deconditioned after her injury (anyone would, let alone an elderly person!) My mother fell and fractured her hip. It likely was a first sign of adrenal insufficiency due to aging. When you have this, exercise intolerance is part of it. Unfortunately, she did not recover from it. My dad fractured his pelvis due to balance issues. He benefited from a kinder, gentler approach to rehab. I like the idea of the little cycling machine. In his case he stayed in the nursing home under long-term care. The best part of that was that he strengthened by propelling his wheelchair with his feet as he sat in it. Most home settings are tighter quarters but the bike idea might create a similar effect. I also agree with shorter more frequent exercises. Did the PT give your mom (therefore you) exercises to do on the days that the PT didn't come? Many things can be done in bed, seated, or standing at the sink that would be quite simple. If your mom tried this, you would then know if any chance of forward progress is possible. Also, remember that physical improvement isn't a steady thing. There are ups and downs and plateaus. Lastly, try to make it fun for her. Find out what motivates her, then use those things as mini-goals. You know her better than the PT and can tap into those things.

I feel like I'm only seeing part of your mom's history and problem in your question. From what I'm reading, she fractured a hip after a fall. How old is your mother? Does she have any other medical issues?

First, if you're her medical POA, you are in control of this situation. If not, then your mother is. It is absolutely not okay for any therapist to reprimand a client in a way that would make them feel demeaned. The question for both the OT and the PT are this:
What are your mother's goals? Are they relevant to her, measurable in terms of progress, is she able to achieve the goals and are they time limited?

From an OT perspective, her treatment should be aimed at all things functional, including bathing, toileting, bathroom transfers and dressing. Along with this, if your mother is interested in participating in household chores/activities, then OT should be working to make modifications so she can do this. Moving around in the household should also be included as part of self-care and household activities. If the OT is only focused on arm exercises and there's no functional progress, then they're not doing their job.

If you're planning on caregiver assist from this point on, then the OT should be doing thorough caregiver training with instructions to encourage your mom to help with self-care so that she doesn't become overly dependent.

I don't agree with anyone saying that her being exhausted after therapy is a good thing. But I would also be asking the MD if there are any underlying medical issues that would be causing the fatigue now and if there was anything medically going on when she fell.

Finally, you mention she gets confused. Does she have dementia? That in itself is a risk factor for increased falls. 

Be direct with the therapists and make sure their treatment plans and rationale are what your mother wants and needs. Ask if any changes can be made to increase her participation on non-therapy days. Then a trip to the doctor for a thorough check-up and cognitive evaluation to make sure there's nothing else going on.