My turn again - Dad fell and broke his hip

[Brat]

I have dealt with my Mom's hip fractures. A LifeAlert type of emergency caller will be very important. After he is in a rehab facility take a look at his apartment from a safety standpoint: look at stairs, trip hazards and the bathroom particularly. He should have a toilet that meets handicap standards (they are higher). Look for sturdy grab bars in the shower/bath.

If finances allow consider moving him to an assisted living apartment. Inquire where your parents friends are now living, often if friends are there the transition is easier.

 

[aaronc879]

I have dealt with my Mom's hip fractures. A LifeAlert type of emergency caller will be very important. After he is in a rehab facility take a look at his apartment from a safety standpoint: look at stairs, trip hazards and the bathroom particularly. He should have a toilet that meets handicap standards (they are higher). Look for sturdy grab bars in the shower/bath.

+1

When my grandmother fell and broke her hip she used her life alert and had help quickly. If she hadn't had it she may have been there for hours. She slipped on a rug so in addition to the points made in the quote above, check for slip hazards.

 

[Nuiloa]

I heartily agree with the Life Alert option.

My mom was home for a week after a 2-month stay in hospital. My bro and his wife checked on her daily by phone and spent every evening with her. One night they left at about 9 pm. Mom apparently got up from her chair and lost her balance. She fell against the fridge and broke a couple of ribs and did not have the strength to get back up. When she tried to reach the phone, she pulled it out of the wall. She wound up spending the night on the floor in her kitchen, unable to call anyone, half-frozen and in pain, unable to get to the bathroom and forced to lie in her own waste.

Normally, my bro would not have seen her until the next evening but, for some reason, my SIL decided to come over at 9 a.m. to check on her and found her semi-conscious. A few more days in hospital - but when she came out we insisted that she get Life Alert plus day-time nursing care.

Mom was an alcoholic, so falling was almost a weekly event with her. Life Alert made all the difference for our peace of mind.

Nui

 

[bikeknit]

From what I hear, hip breaks are not the disaster they once were. they fix em up with screws or whatever is needed and get people moving pretty quickly. It was the long period of bed rest for healing that used to result in pneumonia or other problems for older people. Of course everyone is different but if your Dad is motivated to do his rehab he most likely will do fine. Hang in there. We're thinking of you.

 

[LOL!]

...
So tell me your broken hip stories. Do people ever recover completely? I know this could be the beginning of the end, but I could use some hopeful news.

Sorry, all my broken hip stories end with death during surgery. At least y'all are past that.

 

[Dawg52]

Sorry for your Dad's misfortune. My mother(93) fell in early April and broke her hip and shoulder. The shoulder made her recovery tougher as she couldn't balance herself or hold onto a walker very well. But after 3 months of rehab in a nursing home, she is back home and can get around with a walker. She is frail and someone has to be with her as she walks or she could topple over. I have a sitter stay with her during the day. All in all, she's happy and glad she can live at home again. I stay with her at night and help her to bed before going home. I live in the neighborhood.

Her sister fell and broke her hip in her early 80's and she bounced back very well. She moved in with my parents and lived with them for several years before passing. She got around well during those years though.

You have already been giving good suggestions. Sounds like he has been very mobile up to this point so I'm guessing he will regain most of it again. Best of luck with your Dad.

 

[Sue J]

Today he moved from the hospital to the nursing home for rehab. We don't know how long he'll be in rehab but I expect it to be a few weeks. The move went fine, they helped him put his clothes on and he almost looked "normal". He was exhausted after the move and the whirlwind of people coming and going. We hated to leave the hospital, the place was excellent and the staff and care were outstanding. If you're ever in Northeast Ohio and have a need for medical care this is the place to go -
University Hospitals Ahuja Medical Center | University Hospitals | Beachwood, OH

On to the nursing home. As he was getting settled I went to the admissions office to see what needed to be done. I put some money on an account for him to use for personal stuff if needed. They had papers to sign and said I could sign them but he's still competent so we went to his room for him to sign things.

Ok, here's where my head starts to spin. My Dad has an Anthem Senior Advantage Basic HMO Plan. I assumed this was a Medicare Supplement. The nursing home explained to me that it's not a supplement, it's a REPLACEMENT for Medicare. WHAT?? I never heard of this. All these commercials are on tv and I just hadn't really paid attention. My Dad has had this plan for a few years, he's been very pleased with it. The issue for the nursing home is that Anthem has them re-certify his stay every 5 days. I'm not sure if that's the correct term. They are encouraging us to have him change back to Traditional Medicare during the current Open Enrollment, by Dec. 7th.

Can anyone tell me, is this just an issue of the 5 day Anthem requirement being an annoyance to them with extra paperwork? Or is this a genuine issue of a Medicare replacement vs. Traditional Medicare?

We stopped at his apartment to get him some clothes and check his mail and I brought home his Anthem folder with his plan documents. 150 pages (large print) that explain the coverage. Looks pretty good to me but my experience with health insurance has always been regular stuff, I've never dealt with Medicare or any alternatives.

This is a whole new world and I think I'd like to rewind about 3 weeks and get prepared for what's coming.

 

[Rich_by_the_Bay]

I believe, but am not certain, that all Medicare Advantage plans are indeed like MC replacements. They cover more than MC alone, and effectively replace it with (for their premiums) a broader range of services, deductibles and co-pays.

It's unusual to call it a MC replacement, but in many ways that's what it is.

Glad things are stable for now.

 

[haha]

Ok, here's where my head starts to spin. My Dad has an Anthem Senior Advantage Basic HMO Plan. I assumed this was a Medicare Supplement. The nursing home explained to me that it's not a supplement, it's a REPLACEMENT for Medicare. WHAT?? I never heard of this. All these commercials are on tv and I just hadn't really paid attention. My Dad has had this plan for a few years, he's been very pleased with it. The issue for the nursing home is that Anthem has them re-certify his stay every 5 days. I'm not sure if that's the correct term. They are encouraging us to have him change back to Traditional Medicare during the current Open Enrollment, by Dec. 7th.

Can anyone tell me, is this just an issue of the 5 day Anthem requirement being an annoyance to them with extra paperwork? Or is this a genuine issue of a Medicare replacement vs. Traditional Medicare?

Sue, I just came from a Medicare Advantage seminar this morning. It sounds like what your Dad has is a Medicare Advantage Plan, aka Medicare Part C. These depend on your being enrolled in Medicare Parts A and B, but are in fact separate plans with separate rules, charges, and benefits.

Like most things involving seniors in USA, they are incredibly complex and frustrating. One thing about switching back to Medicare Classic- he likely cannot get a Medigap policy at this time, as these will be health contingent. So he will be exposed to various unpaid charges approved but left unpaid by Medicare.

I would recommend speaking to your state insurance department, and also a quality insurance broker. Also, we have a health insurance expert on this board named Gotadimple. If she is around, she may be able to offer some insight.

There are a lot of one way gates in this stuff.

Ha

 

[Sue J]

Sue, I just came from a Medicare Advantage seminar this morning. It sounds like what your Dad has is a Medicare Advantage Plan, aka Medicare Part C. These depend on your being enrolled in Medicare Parts A and B, but are in fact separate plans with separate rules, charges, and benefits.

Like most things involving seniors in USA, they are incredibly complex and frustrating. One thing about switching back to Medicare Classic- he likely cannot get a Medigap policy at this time, as these will be health contingent. So he will be exposed to various unpaid charges approved but left unpaid by Medicare.

I would recommend speaking to your state insurance department, and also a quality insurance broker. Also, we have a health insurance expert on this board named Gotadimple. If she is around, she may be able to offer some insight.

There are a lot of one way gates in this stuff.

Ha

Thank you, Ha. So far he wants to stay with his Anthem plan and I think the inability to get a Medigap policy makes staying with Anthem the best choice for now.

A quick update -
I'm no longer visiting daily, my sister lives a few miles away and I'm 30 miles away and have a part-time job so she's doing the daily visits and I'm calling frequently. DH went to visit yesterday afternoon and left to come home at 5:15pm and had to deal with suburban Cleveland rush hour traffic so it took him over an hour to get home instead of 35 minutes.

My Dad is sore from daily physical therapy. He's practicing transferring from his bed to the wheelchair without assistance. He says it's very hard but he knows he needs to do this to go home. He's eaten in the group dining room and talked with a few "old farts". They are probably younger than him!

I brought in a double picture frame from his apartment. One side is a picture of him at 17 when he quit school to join the Navy. Cute young sailor! The other side is him in a cap and gown at age 79 when he finally got his high school diploma in a ceremony with our younger son when he graduated from high school in 2005. It was done through a program where veterans can get their diploma by using their military service and life experience to complete the unfinished business of graduating. It was a very proud moment for him, my son presented the diploma to him in front of all the people attending the graduation and the local newspaper had a nice article about it. I figured this would give the people working with him in rehab a glimpse of the real guy before his current situation and it's a nice conversation starter.

I talked to his investments guy at Wells Fargo about his RMD for this year. He's already withdrawn about 2/3 of what's required and wants to make sure that it's completed. No problem, I can call and get that done.

As for when he leaves rehab, he's asked about the home health aide that helped my sister's DH's parents before they died. He knows who she is and how well she cared for my BIL's parents in their own home for many years. She's currently with an agency but would love to work for him if needed. Nice to know that she's available and he's interested!

I'll go visit soon, maybe over the weekend. I'd like to go on a day when I have time to make a stop at the cemetery. It was just 3 weeks ago but I feel the need to see it again. It all happened so fast and when I replay it in my head I just feel the need to go there and take it all in slowly. I think I'm doing ok except that frequently I wake up crying, which right now seems appropriate and healthy for what we've been though.

Thanks for all the comments and positive thoughts.

 

[marylandcrab]

Sue, you don't know me and I'm not a frequent poster, but I am sorry to hear about your mom and your dad.

My dad died a few years ago, and your comment about waking up crying brought back memories for me. I remember wondering 6 weeks later if there would ever be a day I wouldn't feel broken hearted and so incredibly sad. My advice is to be sure to take the time to acknowledge the loss of your mom. I was so focused on my mom, like you are with your dad, that I didn't give myself permission to feel the loss as well.

So if you're wondering, you will stop crying. You won't ever stop missing her and wishing she was there to tell your news, but it won't take your breath away like it may right now when you wake up remembering.

Your dad sounds like a great guy and his attitude will be what gets him through. There are a huge range of outcomes with broken hips, don't assume the worst, but be prepared on his needing extra care.

I'll be thinking of you.

 

[Brat]

My mother died a couple years ago. A SIL asked me if there was anything I wished I had done. I said I wished I had had more conversations with her while she had her faculties. We lived in another town, several hours away, so it would have been difficult BUT had I known I would have made the time.

 

[FurBall]

MIL was only 79 and in the hospital recovering from a heart attack when a nurse accidently let go of her and she fell and broke her hip. DH and I thought this was it for her -- heart issues, diabetes, tiny 90 lber and now a broken hip. We were very wrong. She sailed through rehab. After that she did use a walker but that was more for the neuropathy in her feet than the hip. She lived 6 more happy years.

I'm so sorry for what you've been through with the loss of your mother and your father's broken hip, but I think he'll do just fine.

 

[Sue J]

I got a sub for my job for Wednesday afternoon and went to the cemetery and then to the nursing home for a visit with my Dad. I stopped at the cemetery first. It was empty and I took my time. She won't have a stone until spring but it was easy to find the section and the grave. I looked all around and noticed the surroundings and details I missed before. A lot of the stones have poems or quotes and on the back of someone's stone it said "Enough with the pictures". I can imagine a family gathering and someone saying that after too much posing and smiling.

I'm glad I went to the cemetery. It must have been the right thing to do because I feel like a layer of grief has been lifted. I'm no longer waking up crying.

I had a nice visit with my Dad. He's working hard at the therapy and feels settled in. He says the staff are all kind and patient. He recognized one of the nurse's last name, it turns out that she is my late brother's ex-wife's niece. She never met my brother but knew the name. Small world!

Before my Mom died my parents used to eat out at restaurants every day, either lunch or dinner. My Dad always carried Hershey's Kisses in his pocket and he'd ask the waitress, waiter or cashier, "Can I give you a kiss?" and then hand out his Hershey's Kisses. So we brought him bags of Hershey's Kisses to the nursing home so that he can do the same thing there. He likes being able to do it again and it gives everyone a smile. A little chocolate can mean a lot.

Up until now he has wanted to keep paying his bills himself. He asked us to bring in his checkbook and write the check and then he'd sign it and we could mail it in. Then he said I should just write his name so that it looks like his signature and just take care of it all. He has a Durable POA for personal affairs that names me so I asked him if I could just handle it all for him and he said that was fine. I stopped at a local branch of his bank yesterday, they copied the POA paperwork and now I can just handle it all. I looked at his bank account online and he has been doing a fine job, pays everything early and even after what he's been though he knows the amounts and dates of all of his bills. His files are neat and orderly. I should have no problem with this and I feel better knowing he wants me to take over and I'm doing it properly with the bank.

I had an email conversation with an insurance broker who knows all about Medicare issues. He agreed that staying with the Anthem Advantage Plan is fine for now. He is a friend of my sister's and offered any help if we had more questions. Also, I got a few books out of the library on Medicare and options just so I can get a basic understanding. How do the elderly manage this?

When I left him on Wednesday he was getting wheeled down the hall for a haircut and a nail trim. He had a big smile because he likes the attention from the ladies. He had already asked how much it would cost and had figured out the tip and checked that he had money in his personal spending account at the office.

When I talked to him yesterday he had been to the facility kitchen with a group of patients where they all peeled apples. I don't know if it was part of occupational therapy or KP duty but he seemed to enjoy it and there was pie later in the day!

DH and I are going to see him again on Saturday, my sister has been going every day and she needs a day off.

 

[Nova]

What a treasure you and your sister are to your father. I hope your dad has a speedy recovery.

 

[Dog]

I think his attitude and participating in physical therapy is the key. My grandmother didn't do her physical therapy exercises and paid the price. She ended up with a walker, bad posture and withered away. Such a shame as she was very healthy and independent up to that point.

I wish you the best.

 

[Sue J]

I spent the afternoon with him today. He's improving, but it's slow. He's doing more things for himself, but he's still in the wheelchair most of the time. He's progressing at the physical therapy. My sister saw him using the walker in the hall. He's been in rehab a little over 2 weeks and I expect he'll be there at least another 2 weeks. His biggest worry is that they will want to discharge him and he won't feel like he's ready. If that happens plan A is to have him go home with a Home Health Aide that my sister has all lined up. Plan B would be that he could stay in rehab and pay for it himself at $392/day. I don't think that includes the cost of therapy. My sister has a progress meeting with his case manager on Wednesday so we will see how he's progressing. So far it looks like it's planned that he stay through 12/10 which will be 4 weeks in rehab.

My sister also got an application packet for an assisted living facility that he's familiar with. He's open to the idea and we should apply soon as there is always a waiting list. He'd like to go home when he's ready but he knows he may need to make a change in the future. If your application is accepted and you are not ready you can defer for up to two years.

His attitude is very good. Three men on his rehab wing have been discharged and he noticed that all the newly admitted residents are women. Knowing him, he'll be handing out his Hershey's Kisses to them soon.

I've been enjoying taking care of his financial affairs. He never sat me down when I was a kid and said, "this is how to do this" but I seem to have been genetically imprinted. I'm so impressed by how clear his records and files are and it's so much like how I run my own financial life that it's all easy for me. He is comfortable in letting it go for now and he's grateful that I'm willing and able to do it.

Thanks for all the good wishes!

 

[haha]

These are all good things Sue. I am glad it is going so well for all of you.

Ha

 

[Nords]

If that happens plan A is to have him go home with a Home Health Aide that my sister has all lined up. Plan B would be that he could stay in rehab and pay for it himself at $392/day. I don't think that includes the cost of therapy. My sister has a progress meeting with his case manager on Wednesday so we will see how he's progressing. So far it looks like it's planned that he stay through 12/10 which will be 4 weeks in rehab.
My sister also got an application packet for an assisted living facility that he's familiar with. He's open to the idea and we should apply soon as there is always a waiting list.
Thanks for all the good wishes!

I'm reading "A Bittersweet Season" by Jane Gross. The downsides of the book are that the events occurred in 1999-2003, back during the "dark ages" of geriatric care. Ms. Gross is also (hopefully) exaggerating her ignorance and her drama-queen behavior. It gets tiresome. You want to tell her to stop the dysfunctional family hysterics and get to the problem-solving.

Having said that, the book is packed with practical advice for geriatric medical treatment and care considerations. It's a good roadmap.

If there's one positive aspect about all of her emotional trauma, it's that it'll make you feel good about your father's progress!

J.D. Roth also has a great guest post about a woman who probated her father's estate:
Reader Story: What My Father’s Death Taught Me About Estate Planning

Now that you've managed the finances for a bit, you can look ahead and see what preps (if any) need to be tweaked. You have a valuable opportunity for a conversation with your father that many adult children never get to bring up.

 

[Brat]

Broken hip treatment for the elderly is a familiar dance for me. The key to staying in the care facility with rehab is continuing progress and cooperation with the PTs. It is painful and a lot of work, praise his every effort. Emphasize to the staff that he lives alone, avoid telling them that assisted living is an option because they will set a higher ADL standard for discharge.

Even if you think he will be able to live at home (with or without help) put him on the waiting list. If his name comes up and he is doing OK you can tell them to pass over him at the moment. In almost all cases he will maintain his position on the list.

 

[laurb44]

Wow I am so sorry about your loss as well as your father in the pain that hes in.. I just wanted to say is if you have ever considered purchasing a medical alert system so that if he is ever alone especially in the condition that hes in that he will be safe at all times? A medical alert system is basically an alarm that can be worn as either a pendant or a wristlet so that if God for bid your father has a fall and no one is around to help him that he can just press the button and the ambulance are on there way to help him. My mother has a med alert and it has saved her life more than once. Its really a life saver and might be extremely beneficial for your father.

 

[Sue J]

Another update -

We thought he'd be scheduled for discharge on 12/10 but so far they haven't told us so he may be able to stay longer. He's improved a lot and uses a walker well although he says it's hard work and it tires him out. He has learned to transfer from the bed to the walker and to the wheelchair with someone nearby. He says he's not ready to leave, he likes the support and having his meals taken care of.

When his facility says that Medicare will no longer cover his stay he would like to stay another week or two and pay for it himself. He's worried about going home and falling. The plan right now is for him to stay until Jan 2 and when he goes home he will have the home health aide that took care of my BIL's parents for 12 hrs a day for at least the 1st week and then less time if he can handle it. We will also make sure that he has a LifeLine device. The home health aide came to see him today and he remembered her. They talked about all the things she can do with him, including taking him out. He's looking forward to being home if he can have help.

I'm much more optimistic about his outcome. His attitude is good and his physical progress is encouraging. Sometimes he seems like the same old Dad, just injured. Other times he has become very elderly and detached. He always liked paying his bills and watching over his accounts. Since I have taken over to help him he says that I can just do it all for him, he doesn't want to deal with it again. I don't mind, I'm just surprised that he's given up on it, I thought he'd want control again as soon as he could.

Going through his very neatly labeled files I found years of spreadsheets, not the Excel digital kind, the old ledger paper and pencil kind of spreadsheets. He had years of these to record his expenses and his investments, including 2010 when he was 84 years old! I didn't check his math but they looked reasonable to me.

Sometimes I think this may all turn out ok, he'll get to go home and get his life back. Things will be different but he's like me, he finds joy in everyday little things. On the surface he wants to improve physically and live his life again. And then, the practical guy that he is, he says things like, "This would all be so much simpler if I could just be with Mom again." I always tell him that I understand, but life doesn't work that way and you just need to do your best and enjoy what you've got while you are still here.

Sigh...

Nords, thank you for the link to the Roth blog. Very good stuff and I also enjoyed the comments.

 

[REWahoo]

I'm much more optimistic about his outcome.

A lot of good vibes in those seven words.

 

[Nords]

Other times he has become very elderly and detached. He always liked paying his bills and watching over his accounts. Since I have taken over to help him he says that I can just do it all for him, he doesn't want to deal with it again. I don't mind, I'm just surprised that he's given up on it, I thought he'd want control again as soon as he could.
Nords, thank you for the link to the Roth blog. Very good stuff and I also enjoyed the comments.

Glad it's helping!

My father was extremely independent-minded until the care facility showed him that he no longer had to do chores. Then he immediately relaxed and started enjoying the benefits of letting them cook, do laundry, and clean his room.

Maybe your dad is just having a "Why the heck was I working so hard?!?" epiphany.

If you're struggling with the care facility's discharge coordinator, or if good home aides aren't just dropping into your lap, then a geriatric care provider can help navigate the maze of benefits and referrals. Many of the better discharge coords and home health aides would rather work through a care manager anyway, especially if that means they can talk directly to the manager and no longer have to spend all their time educating us ignorant adult children. We felt that we got huge value for every penny we spent.

 

[Sue J]

Update - He's home

Dad was discharged from the nursing home today and is home with the home health aide. My sister bought groceries and made a dinner for them but he insisted that he wanted a pepperoni pizza so they called for a delivery. My sister was disappointed but I'm glad to see my Dad having some spunk.

He had a Lifeline service installed this afternoon. The home health aide will be there 8am-8pm. She will get him to bed before she leaves. He's worried about having to get up during the night and being alone but he has a urinal container if he needs it. He does very well with his walker, he's just concerned about having to get out of bed alone.

While he was in rehab we had his apartment cleaned including a carpet cleaning service so it all looked great when he came home. I even took videos of where all his stuff was before the carpet cleaners moved things so we could get everything back the way it was before he broke his hip.

He's very appreciative of all that my sister and I have done for him. She handled logistics since she lives nearby and I handled all his finances, including details associated with Mom's death in October. I made a trip into downtown Cleveland (I hate going downtown!) to the County Administration Building and presented the death certificate and had their survivorship deed changed to sole ownership. Then I added Transfer On Death to my sister and I. Dad had signed all the papers with a notary at the nursing home. I also did the same process with his bank accounts, changing them from joint accounts with Mom to single accounts with me as POA and my sister and I as Payable on Death. We also changed the beneficiary on his IRA from Mom to my sister and I. This changed his future RMD to a smaller amount, I'm assuming that's because it's calculated on him being 85 and my sister and I being 56 and 59. He knew exactly what I was talking about when I explained it to him and he understood the advantage of a smaller RMD. An estate attorney had recommended these steps to avoid probate and they were all easy enough to take care of outside of having to deal with downtown Cleveland.

On one of my trips to see him I brought home his computer. It was full of viruses and spyware, had only 128K of RAM and hadn't been properly updated for years. A couple of his automatic Microsoft updates had not installed completely. I think he didn't let the downloads finish. Anyway, it seriously needed to be updated. I upgraded the RAM to 1GB and reinstalled Windows. Now it's quick and easy to start and I hope he uses it. I've been paying all of his bills online so I bookmarked all the sites I used, printed out his logins and passwords and I'm hoping he'll want to use the computer again.

I've also been monitoring his insurance claims. His Anthem Advantage insurance plan has been wonderful. Everything has been paid at 100% except for his $225/day co-pay for the 4 days in the hospital and an outpatient x-ray at his surgeons office. He will have a $128/day co-pay after the 20th day in the rehab. I think it was well worth it.

This is the first time I've had any dealings with Medicare. I'm astounded by how little actually gets paid to the provider. The allowed amounts are much smaller than on our own health insurance plan. I looked at these claims and wonder how hospitals and doctors can make any money if they have Medicare patients. But that's a whole 'nother issue, probably for the Political Forum....

I've also researched some old claims of my Mom's from 2010. She had some outstanding bills from outpatient treatments and I found some errors and had them resubmitted.

It's been a long ordeal. He left home for an errand on Nov. 7th and everything changed. He still needs help with many things and I think he will never be back to where he was. But we are hopeful that he will have a good quality of life with some compromises. We are lucky that his mind is still sharp. He's still himself - practical, logical, optimistic with a sense of humor. He hates having to depend on other people, especially for the personal stuff but he's willing to accept that he does need the help for now.

Thanks for all the support and advice. It really did help to hear from others who have been through this.