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  1. #1
    lizzywednesday is offline Red Diamond level (10,000+ posts)
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    Default Hip Replacement: Rehab and Recovery Needs - Mini Updates in #13, #14

    So, after starting to get his weight under control and actually seeing a doctor regularly (after IDK how many years), my 66-year-old dad is facing hip replacement surgery.

    Next month.

    As in, twenty-nine days from today.

    While I knew he was going to the doctors (GP and podiatrist), I did not know how much pain he was actually in because Dad being in pain is my normal - he's always had pain from his ankles (limited range of motion due to double clubfoot & corrective surgeries as a youngster) and he's never really been the most fit individual due to the moving issues, but this is pain enough where it's limited his ability to work (price stickers & odds and ends at the grocery store, so a more physical job than his former incarnation at a bank) and he's using a cane.

    He's prepping for his surgery and recovery, but my siblings and I don't think he's done enough planning for his care post-op. None of us are able to come help him during the day - I live ~2 hours south; my brother Joe lives in NYC and doesn't have a car; my brother Ger & his family have already done more than their fair share by allowing him to live rent-free at their home for most of a year after his (that is, Dad's) ex-wife kicked him out (also my SIL works for the Red Cross and may be deployed at any time if another hurricane hits PR); and my sister has maxed out her PTO, has a partner who travels for work (he's a truck driver), and 3 young kids (9, 6, and 2.5.)

    We are asking all kinds of questions and he doesn't have a plan.

    Allow me to repeat that: he. doesn't. have. a. plan.

    None of this surprises me, but it is sending me into a mild panic that he will be stuck in his apartment, need help, and nobody will be able to get to him. And somehow my brother Ger, sister, and I will be blamed, despite all of the above reasoning why we cannot help more.

    I have offered to come up next week to help him put his apartment in order and assemble his bedframe, but I can't be on call for emergencies; it's just not practical.

    So ... what else do I need to ask Dad about his recovery plans and needs so that he actually DOES it?
    Last edited by lizzywednesday; 10-01-2018 at 03:11 PM.
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    Liz
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  2. #2
    LBW is offline Sapphire level (2000+ posts)
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    Is he in NJ? This might help:
    https://vnahg.org/joint-replacement-therapy

    Best option would be arrange for VNA nurses to come out and check on him.
    There's also a downloadable guide w/pre op checklist.
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  3. #3
    cuca_ is offline Sapphire level (2000+ posts)
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    Is he going to a rehab facility after the surgery. I donít think he will be able to get around on his own once he is discharged. IME with my parents (knee and hip replacements) they initially need help moving and getting around.

  4. #4
    NCGrandma is offline Sapphire level (2000+ posts)
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    Default Hip Replacement: Rehab and Recovery Needs

    Based on the hip-replacement experiences of a number of friends and neighbors, one of the most important things to facilitate recovery is getting adequate physical therapy. Is there any possibility that he can be discharged from the hospital to a rehab facility for at least the immediate post-op period (when he will probably need nursing care as well as PT for at least a short time), maybe followed by home-based PT (if there are PTs in his area that make home visits). The PTs can also determine what kind of walker he will need, and for how long.

    Who is his health care POA? (I hope someone is...) That person should be able to talk in advance with the hospital's discharge planner (typically a social worker), who should know what rehab resources are available in his area. Hospitals really donít like to discharge post-op patients who live alone to their home without a plan. An interim stay at a rehab facility, followed by home health services, is fairly typical. Obviously this will depend in part on his insurance and other resources, but if heís 66, he is presumably at least on Medicare, and joint replacements are common Medicare- covered procedures. A good discharge planner should either have an idea what his insurance may cover, or can refer you (or his health care POA) to someone else at the hospital, who is often called a "financial counselor," who can help.

    And if it turns out that he doesnít have a health care POA and HIPAA release forms allowing his physicians, etc., to talk to you or your siblings, I think thatís top priority. Otherwise youíll have to rely on whatever info he wants to tell you, and even the best put-together person is often a little hazy right after surgery.

    Good luck, and keep us posted.


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    Last edited by NCGrandma; 09-12-2018 at 06:42 PM.

  5. #5
    Kestrel is offline Platinum level (1000+ posts)
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    Can he arrange for a visiting nurse to come in? We had a nurse come in once a day (we chose late morning) for two hours for FIL. Helped with bathing, made sure pills were taken, changed bed sheets, ect. Was a huge help to know there was someone there to help him get out of bed (if needed), check that meds were being taken, - and simply knowing that someone would be there was a great stress reliever for us, and let us work without worry. (We were also uncomfortable helping with bathing, FIL & DH & I. But someone had to!) We then followed up in person or by phone each night. In our case, it was 80% covered by short-term care insurance.
    We also stocked the freezer with heat-and-serve stuff; some store-bought and some home made.
    We set up (with Kroger/Fred Meyer Store where we are) where he can order and pay for groceries on the computer, and we would pick them up for him.

    But - yes, he's going to have to have a plan - for at least some things. How is he getting to post-op appointments? He won't be able to drive.

    Good luck!

  6. #6
    lizzywednesday is offline Red Diamond level (10,000+ posts)
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    Quote Originally Posted by LBW View Post
    Is he in NJ? ...

    Best option would be arrange for VNA nurses to come out and check on him.
    There's also a downloadable guide w/pre op checklist.
    Except for my brother Joe, we are all in NJ.

    He has a visiting nurse scheduled to come in, but they will only provide medically necessary care, not the day-to-day meal-prep, bathing, and toileting he will also require.

    Quote Originally Posted by cuca_ View Post
    Is he going to a rehab facility after the surgery. I don’t think he will be able to get around on his own once he is discharged. IME with my parents (knee and hip replacements) they initially need help moving and getting around.
    He should go to a rehab, but he does not currently have plans to do so with his surgeon (and his cousin) telling him he'll be up-and-around within a day or two of surgery.

    While it's true he'll be ambulatory, he will be limited in certain respects until he heals up.

    Quote Originally Posted by NCGrandma View Post
    Based on the hip-replacement experiences of a number of friends and neighbors, one of the most important things to facilitate recovery is getting adequate physical therapy. Is there any possibility that he can be discharged from the hospital to a rehab facility for at least the immediate post-op period (when he will probably need nursing care as well as PT for at least a short time), maybe followed by home-based PT (if there are PTs in his area that make home visits). The PTs can also determine what kind of walker he will need, and for how long.
    He has a PT lined up for home (or, I assume, rehab center) visits.

    Quote Originally Posted by NCGrandma View Post
    Who is his health care POA? (I hope someone is...) That person should be able to talk in advance with the hospital's discharge planner (typically a social worker), who should know what rehab resources are available in his area. Hospitals really don’t like to discharge post-op patients who live alone to their home without a plan. An interim stay at a rehab facility, followed by home health services, is fairly typical. Obviously this will depend in part on his insurance and other resources, but if he’s 66, he is presumably at least on Medicare, and joint replacements are common Medicare- covered procedures. A good discharge planner should either have an idea what his insurance may cover, or can refer you (or his health care POA) to someone else at the hospital, who is often called a "financial counselor," who can help.
    I might be his Health Care POA; I'm not 100%.

    He's got me as his primary beneficiary of his life insurance (etc.) and his replacement is 100% covered (to my knowledge) by Medicare. Honestly, Medicare is the only reason he's gone to doctors at all, and he really needed to a long time ago.

    Quote Originally Posted by NCGrandma View Post
    And if it turns out that he doesn’t have a health care POA and HIPAA release forms allowing his physicians, etc., to talk to you or your siblings, I think that’s top priority. Otherwise you’ll have to rely on whatever info he wants to tell you, and even the best put-together person is often a little hazy right after surgery.

    Good luck, and keep us posted.
    I'll have to ask him to get the HIPAA releases so I can chat with his doctors; I have offered to drive him to surgery if he gives me a straight answer about time of day. (I'm the only one of the 4 of us who is able to do so.)

    I don't want to rely on what he wants to tell us.

    Quote Originally Posted by Kestrel View Post
    Can he arrange for a visiting nurse to come in? We had a nurse come in once a day (we chose late morning) for two hours for FIL. Helped with bathing, made sure pills were taken, changed bed sheets, ect. Was a huge help to know there was someone there to help him get out of bed (if needed), check that meds were being taken, - and simply knowing that someone would be there was a great stress reliever for us, and let us work without worry. (We were also uncomfortable helping with bathing, FIL & DH & I. But someone had to!) We then followed up in person or by phone each night. In our case, it was 80% covered by short-term care insurance.
    We also stocked the freezer with heat-and-serve stuff; some store-bought and some home made.
    We set up (with Kroger/Fred Meyer Store where we are) where he can order and pay for groceries on the computer, and we would pick them up for him.

    But - yes, he's going to have to have a plan - for at least some things. How is he getting to post-op appointments? He won't be able to drive.

    Good luck!
    He gets a nurse for a limited time; I am not sure how limited. I am also under the impression, based on my mother's experience with hip replacement, that the nurse will not stay for anything non-medical. (This probably varies by state and service. Those kinds of services here in NJ are provided by a "home health aide" which is a different kind of caregiver from a nurse.)

    So ... bathing, toileting, and meals will be an issue if he is not placed in a rehab.

    He doesn't know and, as a result, cannot tell us what he needs.

    Thank you everyone; this is helpful.
    ==========================================
    Liz
    DD (3/2010)

    "Make mistakes! Get messy!" - Miss Frizzle

  7. #7
    mom2binsd is offline Diamond level (5000+ posts)
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    I work in adult rehab, and we have a lot of people who come in following hip surgery. Daily PT is vital to his recovery, and without anyone there how is he going to get there.

    Who knows how he'll react to the anesthesia, or if there are complications, but all of his daily needs such as toileting/dressing/meal prep etc are going to be almost impossible without 24 hr care, which is why rehab facilities exist. If he were a healthy younger man with someone who could be there for him he might be able to discharge to home, but in this situation he really needs to find a rehab facility for the immediate time post op. You can hire CNA's to come to help with bathing etc, but depending on how he responds he may not be able to even get around with a walker due to non weight bearing requirements etc.

    You need to have him also make you and your siblings his POA so that you can be given medical information.

  8. #8
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    He absolutely needs to go to a rehab facility post surgery. I doubt the surgeon knows all his life issues. Call the surgeon's office and explain what is going on. (is the surgeon his cousin or is it that the cousin also thinks he doesn't need rehab?). Talk to the discharge planner. You only need/want one person to have POA. For the rest of you--have dad sign Release of Information Forms and then people can talk to you. I don't think the POA has to have an ROI form but it probably doesn't hurt. Home Health does all the daily stuff. You might contract with another company to do that--ask the discharge planner. If he is really in an emergency situation and nobody can get to him--he can always call 911. Not the best, but possible. MIL used to call 911 just to get FIL off the floor in the middle of the night. Obviously she didn't have to do it too much or she could have had issues with abuse of 911 services.
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  9. #9
    lizzywednesday is offline Red Diamond level (10,000+ posts)
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    Thank you both! I was away this weekend (camping with Scouts) and had a lot of laundry to do when I came home, so haven't done the email/forum BS 'til now.

    Quote Originally Posted by mom2binsd View Post
    I work in adult rehab, and we have a lot of people who come in following hip surgery. Daily PT is vital to his recovery, and without anyone there how is he going to get there.

    Who knows how he'll react to the anesthesia, or if there are complications, but all of his daily needs such as toileting/dressing/meal prep etc are going to be almost impossible without 24 hr care, which is why rehab facilities exist. If he were a healthy younger man with someone who could be there for him he might be able to discharge to home, but in this situation he really needs to find a rehab facility for the immediate time post op. You can hire CNA's to come to help with bathing etc, but depending on how he responds he may not be able to even get around with a walker due to non weight bearing requirements etc.

    You need to have him also make you and your siblings his POA so that you can be given medical information.
    I know this, but IDK if it's his surgeon or his stubbornness coming out (he's really reminding me of his mother right now) but he says his surgeon's office recommends discharge-to-home over rehab due to infection risk, etc., which I understand, but somehow I don't think they understand that he lives alone and NONE of us can come help him.

    Quote Originally Posted by StantonHyde View Post
    He absolutely needs to go to a rehab facility post surgery. I doubt the surgeon knows all his life issues. Call the surgeon's office and explain what is going on. (is the surgeon his cousin or is it that the cousin also thinks he doesn't need rehab?). Talk to the discharge planner. You only need/want one person to have POA. For the rest of you--have dad sign Release of Information Forms and then people can talk to you. I don't think the POA has to have an ROI form but it probably doesn't hurt. Home Health does all the daily stuff. You might contract with another company to do that--ask the discharge planner. If he is really in an emergency situation and nobody can get to him--he can always call 911. Not the best, but possible. MIL used to call 911 just to get FIL off the floor in the middle of the night. Obviously she didn't have to do it too much or she could have had issues with abuse of 911 services.
    His similarly out-of-shape cousin had the same surgery done by the same surgeon; sorry, mentioning both of them in the same sentence was confusing. BUT ... his cousin has family members (wife, kids; one kid's a doctor, IIRC) who were able to help him.

    I have a friend who is the dispatcher for the local-to-him 911 service; I could probably give her a heads' up if he's discharged to home over my/my siblings' objections. (And we REALLY object right now.)

    I'm the eldest, so he'd probably be best off giving me POA rather than my other siblings.
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  10. #10
    NCGrandma is offline Sapphire level (2000+ posts)
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    Quote Originally Posted by lizzywednesday View Post
    I know this, but IDK if it's his surgeon or his stubbornness coming out (he's really reminding me of his mother right now) but he says his surgeon's office recommends discharge-to-home over rehab due to infection risk, etc., which I understand, but somehow I don't think they understand that he lives alone and NONE of us can come help him.

    His similarly out-of-shape cousin had the same surgery done by the same surgeon; sorry, mentioning both of them in the same sentence was confusing. BUT ... his cousin has family members (wife, kids; one kid's a doctor, IIRC) who were able to help him.

    I have a friend who is the dispatcher for the local-to-him 911 service; I could probably give her a heads' up if he's discharged to home over my/my siblings' objections. (And we REALLY object right now.)

    I'm the eldest, so he'd probably be best off giving me POA rather than my other siblings.
    I canít really imagine the surgeon's office recommending that a post-op patient who lives alone and has no family members who can help would be better off discharged to home instead of to a rehab facility. Either your father misrepresented his situation or at least was over-optimistic about you and your siblings' ability to help. This really underscores the need for someone to be named health care POA as soon as possible and talk directly with the surgeon.

    Re: who should be POA: many people in health care recommend that, when there are several possibilities, it should be a person who can communicate clearly and hopefully can keep her head in a potentially emotional and stressful situation. If thatís you, great, but no preference is necessarily given to the oldest sibling. Depends on family dynamics.

    Also, depending on the setting for the surgery (hospital, outpatient surgery facility etc), itís common that the facility requires or strongly encourages a pre-op patient to have an advance directive that spells out what interventions he does or does not want in various situations. If thatís true in this case, itís important for you to be familiar with what he has said.


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