Adjusting the elderly to rehabilitation for a broken bone - The perils of the rehab system

This Squidoo article, Adjusting the elderly to rehabilitation for a broken bone - the perils of the rehab system is written from personal experience. My 95 year old Mom, Gertie, fell on November 11, 2011 and broke her hip. Actually, that's not exactly the right sequence; she broke her hip before she fell - more on that later

After two very excruciating days in a hospital bed, when she had to be manipulated every 2 hours to prevent bedsores, my brothers and I decided to go ahead with surgery. Right or wrong, it was the only chance we had of giving her some relief from the pain as, if we hadn't done the hip surgery, she would be in that horrible pain for 2-4 months, according to the doctors. It was a difficult decision to make though as the risk associated with surgery for an elderly patient with cardiac heart failure was obvious - she might not make it. So, with deep breaths, we kissed her goodbye and said our private prayers as they wheeled her into surgery.

Mom had surgery on her broken hip (a metal plate and screws inserted) on November 14, 2011. After 3 days in the hospital, she was mostly out of pain (amazing!) and she was stable enough to be relocated to rehabilitation which I thought would be great. Well, little did I know how rehab works.

I'm writing this Squidoo article in the hopes that others who might face similar challenges are more prepared for the transfer to a rehabilitation facility. It's a learning curve that I hope to shorten for those with a similar need.

It's a little known fact that a lot of elderly people, especially those with osteoporosis, have their broken bone BEFORE they fall. Most people think that it's the fall that causes the break but this is not necessarily true. In fact, the kind of break that my Mom suffered is called a pathological fracture. To read more about pathological fractures, check out this link: Pathological fractures, what they are and how they happen.

In short, bones can break spontaneously. It was important for my Mom to know that she didn't do anything wrong - her bone was broken before she fell. Once she realized this, the burden of the fall was off her back (and onto her broken hip - sorry, couldn't refuse...). Our excellent caregiver was also relieved to find that this type of broken bone (commonly, a fractured hip) would have occurred no matter who was with Mom.

Note: picture accompanying this area is of my Mom after her very first physical therapy session. I think she looks pretty darned good for having a broken hip a week ago!

To read more about pathological fractures, here's a few articles you might want to review:

MedTerms.com Pathological Fracture Definition

BoneTumor.org Pathological Fracture Risk Introduction

Orthopaedic.com Stress Fracture information

I'm a firm believer in arming myself with as much knowledge as I can. Unfortunately, I sometimes miss the mark and don't prepare myself for "what might happen." That's why I always seem to be buying books after the fact. I'm now on a quest to learn everything possible about nursing home rehabilitation units. The below books are helping.

Nursing room rehabilitation homes are kept at almost boiling temperatures, at least to me. I was so uncomfortably warm, I wore sleeveless blouses and shorts when I was staying with Mom. People looked at me like I was nuts but I couldn't take the temperature.

Yesterday, about mid-day, after being with Mom since 7 am, I started to feel like I had the flu. In a mild panic, I had the nurse take my temp. It was fine. I was sweaty, light-headed, dizzy, and nauseous. I now was in a full panic as how could I care for Mom if I was ill? So, I lined up more caregivers and went home where my the cutest boyfriend in the world fed me a big bowl of soup. Almost immediately, I started to feel better.

In hindsight, I was dehydrated! I hadn't been drinking water and, with the stifling temperatures of Mom's rehab room, I had sweated all day. Thankfully, I'm fine today.

So, note to all caregivers: Make sure to keep lots of water and/or Gatorade around and drink it on a regular schedule. A glass every hour should help stave off dehydration. And, good luck to you!

1. Nurse to Patient ratio

Nurse to patient ratio is quite low – meaning that there is, at our nursing home rehab, 1 nurse for approximately 30 patients. And, as we all expect, those in the most need get the most care. This means that Mom will most likely not be visited every 2 hours as we were assured at the hospital.

Suggestion: I’ve always suggested that the elderly should never be left alone in a hospital setting – see my article Helping a hospitalized senior citizen, and, after my foray into the nursing home rehab environment, I stress this even more. If a family member is not available to stay with your elderly loved one, hire an aide or a sitter. This means around the clock. I’ve found that getting a sitter for the night should cost somewhere between $17 - $25. And, not all sitters are created equally so make sure that you personally meet with the person you’re leaving in charge of your elderly loved one. Write down important things or reminders such as when meds are due so that your sitter can make sure the nurse responds. And, I suggest that you check in periodically, even through the night, to make sure that your elderly loved one is being tended to.

2. Nursing home hospital beds

Nursing home beds may not have bed rails. I was totally surprised to see my Mom's new bed in the rehab facility - it's a standard hospital bed without rails! Made no sense to me, especially since she's now deemed a fall risk.

I talked to the nurse and was told that, at least in Maryland, it's illegal to have bed rails on nursing home rehab beds. It's considered "entrapment." Good grief! I wonder what citizen watchdog group came up with this crap? Regardless, I knew that we had to secure her in bed and prevent another fall.

Suggestion: Get a few large pillows and slide them under the right and left side of the rehab patient to sort of form a cocoon with the patient in the middle. Mom is snug in bed now and cannot crawl over the pillows if she tried. Another suggestion is to buy a good sleeping pad and put it on the floor to soften a fall, just in case.

As mentioned above, keeping your elderly loved one in bed can be a bit of a challenge, particularly if the hospital bed doesn't have rails. The below items are helping secure Mom and make me rest better too.

3. Nursing homes can be loud and bright!

There can be a lot of activity happening, both day and night in the nursing home, from bells ringing, to intercom pages, to vital signs being taken every hour. Mom flinches (and pain ensues) when the lights are turned on or loud sounds get through her drug-induced sleep, so I’ve found a few creative ways to avoid these interruptions.

Suggestion: Invest in a good pair of ear plugs. If your elderly loved one wears hearing aids, you might want to adjust the volume down. To prevent interruptions from the lights being flicked on, get a good sleeping mask for your elderly loved one.

4. Hospital gowns, bed sheets and covers are not of a high quality

The blanket my Mom is wrapped in is very scratchy - a health issue for elderly loved ones who might have bruised or thinning skin. And, we're ready to bust her out of that old itchy hospital gown.

For more information, see my Squidoo article Helping the bedridden.

Suggestion: Talk to the nursing staff and see if you can bring in your own bedclothes for your elderly loved one. Try to find bed clothes that button up the front so that changing your loved one will be easier. Likewise, ask about bringing in your own bed sheets. Blankets are probably fine but bed sheets may get soiled more often so the nursing staff might want to keep your elderly loved on in the standard issue hospital bed sheet. I actually cover Mom with a Redskin Snuggie which gets her loads of attention, especially on game days.

The below items are a list I've compiled of things that we needed and either weren't supplied by the nursing home rehabilitation unit or were of low quality.

1. Toothbrush and toothpaste.
2. Good quality lotions and creams to keep skin moist and baby powder to soothe the skin. Keeping the skin moisturized will help prevent bedsores.
3. Shower cap with shampoo and conditioner – see Amazon link below. This is the best invention I’ve ever found for helping a bedridden patient.
4. A lip protector, such as chapstick as the air in a rehabilitation facility can be quite dry.
5. Eye drops.
6. Personal hygiene items such as Cottonelle fresh wipes flushable wipes, baby powder, and Depends, if needed.
7. Snacks such as Ensure plus (350 calories a bottle), crackers – anything that doesn’t require refrigeration.
8. Favorite nightclothes and fluffy socks. Check with the rehab to see if the socks should have grip bottoms or be smooth.
9. A cup with a handle. Insulated cups are nice for coffee. Beats drinking out of Styrofoam and it's much better for the environment.
10. Bendable straws.
11. Some sort of internet connection for you. Check with your rehab to find out if there is internet on the site. If not, you’ll go nuts! Invest in either an air card or use your cell phone as a modem. If you have a blackberry, it’s only $20 a month to get the tethering feature. If you have an iPhone, use the hot spot feature and you can enjoy internet on the go.
12. A power cord so that you have more outlets. Our nursing rehab room only has 2 plugs – not nearly enough for the plugged in society of which I’m a part.

I personally have experience with all of the below items. The shower cap shampoo/conditioner thingee is my favorite ever though.

I think these stuffed animals with heating pads are pretty cool! You just take the pad out of the animal’s belly, heat in the microwave for 2 minutes and insert back into the animal. My Mom loves this thing for her aching shoulder.

She loves to hear comments about my Squidoo articles and so do I. Please leave me comments. Everyone may comment - you don't have to be a Squidoo member.