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We just came back from the rehab center where my 88-year-old father is living for the moment. He fell and broke his hip but he's too old for a hip replacement, so they just pinned the bones together. The therapists say he's ready to go home but we (the adult children) don't think so. How can they possibly know what he is or isn't able to do at home alone? Can we challenge this decision?
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Physical therapists are often called upon to help determine when an older adult is ready to go home after being in the hospital. Or when it's time to move from an independent living situation to an assisted living or skilled nursing care facility. These judgments are made with the assistance of standardized tests that measure physical performance.
For example, tests such as the Mini-Mental State Examination (MMSE), Physical Activity Scale for the Elderly (PASE), and the Six-Minute Walk Test (6MWT) might provide helpful information.
The PASE is a self-reported survey. It is usually filled out by people still living at home. The person taking the test answers questions about him or herself regarding exercise activity, work or volunteer activities, and daily household-related activity. The 6MWT requires the person to walk for six-minutes on a flat surface. Distance covered in that amount of time is recorded. Blood pressure, heart rate, and ratings of perceived exertion (e.g., no fatigue, moderate fatigue, most fatigue ever experienced) may also be collected.
After completing these tests, a special device called the StepWatch Activity Monitor (SAM) can be attached to the ankle. The SAM is used to count the total number of steps each person takes over a period of time. The device is designed to be used with people who have different walking patterns, speeds, and limps. It can be used by anyone with an assistive device such as a walker or cane. And the SAM can be used in water for those who participate in a pool-exercise program of any kind.
All of these results don't equal a crystal ball. They just provide an ability to predict function based on normal values for healthy adults of the same age. Most rehab teams take other factors into consideration as well, such as the patient's general health and presence of other disabling conditions (e.g., heart disease, diabetes, high blood pressure). The patient's home environment is usually also evaluated for any barriers to independence and continued recovery.
The family does have a valuable place in the decision-making process. If you did not speak up at the meeting but have concerns now, it's not too late to contact the rehab team leader. This is usually the case worker or social worker, but may also be the physician, physical or occupational therapist, or a rehab manager. Perhaps your father would benefit from a transition from rehab center to a step-down facility or assisted living situation before going home. There are always options that can be explored.
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*Disclaimer:*The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic. |
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