If you live alone...Go to In Patient Rehab or Recovery Home Alone?

[Zebra]

Have you tried contacting the Social Worker or a Case Manager at HSS for advice? Certainly they wouldn't want to send you to a facility like you visited

hi @PuppyLove , they really don't have any choice they just have a list of nursing homes that are in network with my insurance company. They haven't seen them or anything. The caseworker was helpful in letting me know that this nursing home thing was a real possibility.

Appreciate your advice added the washcloths to my Costco list.

I am totally OK with going home alone. I asked the OS doc's nurse about it and she said they would only send me home if it was "safe." If I could do stairs now I would feel pretty confident in passing the PT tests. But
I can't do stairs.

This is what happens when you wait too long.

 

[Jaycey]

I asked the OS doc's nurse about it and she said they would only send me home if it was "safe."

If it were me I would give the rehab a miss. You will not be discharged from the hospital until you can move around on your own anyway. Put things you will use within reach and you will be fine. Maybe have a friend drop by once per day for a few days. I was alone for most of my recovery and had no problem. That rehab sounds horrid!

 

[toohip]

Hi @Zebra - How many stairs do you have at home that you have to manage?

 

[Zebra]

hi @toohip , I have two flights of stairs, 7 stairs each, to access the shower upstairs. I can't raise my
"better" leg high enough to do stairs now properly because of impingement. I sort of crawl up sideways using a cane. Not sure what I'm doing now would be safe to do with a THR hip.

Did you have a water proof bandage/dressing? When did you take it off? Are you supposed to leave it on for two weeks or something like that? Did the visiting nurse look at the incision?

 

[toohip]

Hi @Zebra - is that the only place in the house you can shower, or is there a tub/shower on main floor, where you don't have to do any stairs...remember you could get in/out of tub by just bending your knees over the tub (that's what I did), this way your hips don't bend. The only thing i could think of is that after the first week, you will probably be strong enough to lift the operated leg up a stair and then drag the other leg (one step at a time) and then vice-versa to go down the steps. So, maybe the first week you have wash wipes or wash clothes.

Also, I had a woman come to the house for a few hours some days, to straighten up, feed/walk dogs, change bedding, do some laundry, etc. which was a big help...by the 3-4 week you should be much better, energy-wise, etc.

I had staples and i think that they put a clear coat protection over it (I don't really remember) but I don't remember having a bandage on the incision when i came home, they took it off in the hospital the day i left. After the visiting nurse came to the house (about 2-3 days later) she said i could shower and let water run over it but don't scrub the incision. About 10-12 days after the surgery, she took the staples out (no big deal/didn't hurt). I go to my OS tomorrow for the first time since surgery...i'll be able to give you an update then.

 

[Michegon]

@Zebra Hi, I had The Bilateral because of what you just talked about. Having both hips fused was one reason i had both done. I do not have to go back and do a second procedure. I healed just as fast if not faster than one at a time because of both hips being on the same page healing wise. I am 12 weeks out and smiling big time that i made the choice of less time off, one time getting put under, 50% less infection rate. Good luck to you.

 

[muckingabout]

I don't know if it's in your budget, but could you spend a few days in a hotel with a kitchenette?

 

[Zebra]

OK so I visited two more in patient "sub acute" rehabs in nursing homes today. Talked to the physical therapists at both facilities.

They said for the first three or four days I would be restricted to a wheel chair. That the only time I could use a walker would be during the 1-hour morning PT session. Then back to bed. That if I could demonstrate ability to walk with a walker, they might let me use one in the room to go to the bathroom.

It seems the modus operandi for these skilled nursing facilities is to keep patients in wheelchairs. They are more worried about liability and patients falling than ambulating. I didn't see ANY patient at either facility walking with a walker in a hallway.

Question: Doesn't sitting in a wheel chair go against the 90 degree posterior hip precautions? Wouldn't it tend to push your knees up, above your hips, more than 90 degrees like a low chair?

Patients are sent to rehabs in an ambulette, where you are sitting in a wheelchair that is secured to the bottom of the van. They wheelchair you out of the hospital too, right?

How can they tell you all this stuff about sitting in a high hip chair and putting pillows on a low chair to make it high enough and then have you sitting in a low wheelchair? Does this make sense?

 

[Jamie]

I would most certainly not go to any "rehab" facility who wanted to keep you in a wheel chair after hip replacement surgery. This is not good for you. You should be up and walking to the bathroom and be going for short walks down the hallway as you can tolerate. Obviously these folks do not understand recovery and my suggestion is to steer clear of them all.

This is frequently a problem with facilities that are more nursing homes than short-term rehab facilities.

 

[Zebra]

@Jamie , the caseworker at the hospital told me that insurance is only paying for these "sub acute" rehabs in nursing homes, for patients with single hip replacements. So when she heard I live alone & don't have anyone to come stay with me, etc. she said I better go visit them to see what they are like, as the hospital might send me to one.

The "acute" physical therapy rehabs won't admit for single hips. I called them and asked. She was correct.

So I might not have a choice. Nursing home might be it if I can't pass the PT tests or they feel I need assistance.
Both my hips are fused and I can barely do stairs now with my "better" leg and a cane. I can't lift my "better" leg high enough now to go up stairs properly, so don't see how I would do it post op to satisfy the PTs that it was "safe."

Is it safe to be sitting in a wheelchair right after THR? Wouldn't it be like sitting in a low chair and tend to push your knees up above your hips beyond the 90 degree hip precautions? It seems odd to me because the OS doctors know at the hospital that you are transported to the rehab in a wheelchair by ambulette. The caseworker said it is the only way they will allow you to go.

 

[Jamie]

If you have a 90 degree restriction when you are ready to leave the hospital, they can put a foam cushion in the seat of the wheelchair if needed to make sure you stay within that restriction. This is something you need to address with your medical team and your surgeon.

When you're sitting, you'll be at the 90 degrees. But, depending on the wheelchair, it might be difficult to stand without leaning forward, which would break the 90 degrees. If you have this restriction, you'll want to be sure to use your arms to rise from any seated position so that you remain within allowed angle. Not everyone has this restriction, though.

You do realize that you have the right to decide whether you want to go to a rehab facility or not. No one can "make" you go. But....since you do have significant issues with your other hip, it may be best for you not to go home. This also is something you'll need to decide after surgery in concert with your surgeon. Please don't worry about it. You'll know the right thing to do once you see how you feel with the new hip.

I am a bit confused, though, about what facilities might be covered under your insurance. I agree that you don't belong in an acute facility. But there usually are rehab centers that are just that and are not connected with nursing homes. Are there no facilities like that near your home? If you want to tell me the city where you live, I'll take a look for you.

 

[Zebra]

You do realize that you have the right to decide whether you want to go to a rehab facility or not. No one can "make" you go

@Jamie , is this right? If they say it's "not safe" to go home alone can I refuse to be admitted to a rehab?
Will the hospital discharge me home AMA (against medical advice) then anyway? Will the OS doc be happy?

The OS doc nurse at HSS told me that they will not let me go home unless I can pass the PT tests and they feel it is "safe." They aren't going to keep me at the hospital more than two or three nights, so I assumed if they don't think it's "safe" and I'm not moving around well enough they would not discharge me to my house. That they would discharge me to a rehab, since they have to send me somewhere.

The caseworker said the issue with the rehabs is that the insurance companies don't see single hip replacements as a big deal, so they will only authorize "sub acute" care, which is mostly provided by skilled nursing homes.

The stand alone rehabs, like Burke in New York or Kessler in NJ, provide "acute" care, which means 3 hours of therapy a day. "Sub acute" provides one hour of physical therapy a day (much cheaper).

I found it confusing too. That is why I called the rehabs to ask them directly if the would admit me with a single hip replacement. They said they used to, but not anymore, because the insurance companies won't pay them.

 

[Jamie]

Gosh, their definition of "acute" and "sub-acute" is different to what I'm used to. And they run their standalone rehabs differently than here in Kansas City. Crazy me....I assumed they would all be under much the same guidelines.

I don't know what the hospital's rules would be for discharging you to home if that's what you prefer and they prefer you go to rehab. The best thing is to talk this over with your surgeon following surgery. You don't want to put yourself in a position that is unsafe and this decision should be made by you and your surgeon. Nurses and the hospital should not be part of the equation. If anyone gives you grief about that, you can nicely say that you want to talk it over with your doctor and could the nurse please either have him come by your room or get him on the phone for you. What I meant is that legally they cannot force you to do anything against your will. You wouldn't want to do anything against your surgeon's advice. My point is that you will be able to better make the decision about going home once you see how you're doing following surgery.

You might be able to get your surgeon to write orders following surgery to get you to an acute rehab facility if that is what's needed. It never hurts to ask if that's what you feel you need.

 

[bottomshollow]

My OS wanted me to go to rehab after my THR, but I insisted on being sent home. I knew that I would be able to take care of myself, and I had a semi-invalid hubby to care for. I did have a small three wheel scooter to use to do a lot of the getting around the house that kept me from overdoing in the general exercise department. And I found that taking care of things that HAD to be done was very good physical therapy for me.

I had a lot of meals pre-planned for the microwave and hubby was not hard to satisfy---so lots of soup and sandwiches for lunch. I managed very well after the first 2 weeks with doing small loads of laundry and doing a little dusting and keeping the kitchen floor swept up---I got a long handled dust pan which worked well for me.
I wasn't over fussy about housework---it wasn't going anywhere--so left the bigger harder stuff until about 6 weeks post op and did get some help from family when absolutely necessary.

So if you know that you're really up to taking care of yourself alone and want to go home, you just have to convince your OS.

Take care and keep us posted. We care.

 

[Peaches]

@Zebra ... everything you were told about acute versus subacute and that the ins. co. only pays for subacute for one THR was exactly what I was told. Exactly. I wish I had a nickel for every time someone chided me for not "going to rehab--why don't you go to Burke?" Some at my work even suggested that I could come back to work EVEN FASTER if I would "go to rehab--such as Burke." It was as if I were being kinda negligent for not "going to rehab--as in Burke." I gave up trying to explain what you have explained here about the ins. co.

Like you, I was a bit under the impression that my surgeon would not release me--of course he couldn't hold me hostage, but you know what I mean by "would not release"--to go home unless I had someone there. But when I was at the hospital and everyone kept asking me if I had someone to help me at home, all I had to do was say "yes" and they'd just check "yes" on whatever form they were filling out. They wouldn't have been the wiser.

I appreciate your anxiety and frustration, as I felt the same way. And I kept thinking that "waiting until you're in the hospital and then decide" was a little too late for my comfort zone. But the thing is, you don't know till after the surgery how well you are going to do. And odds are, you are going to do well enough to go home and not to rehab. I think for you, though, the issue really is about the fused hip on the non-op side, is that right? What I suggest you do is call your surgeon's office and ask his office manager for the name of the person at HSS who handles questions about these kinds of things. She is not a case manager. She's someone else. She fields questions like these. I spoke to her a couple of times and she was very reassuring. I was baffled for example about having been told (by the same people who assured me I could and should "just go to rehab--such as Burke"--that I could just "jump in a cab" and get home easily that way. Well, wrong. This woman I spoke to said no, you can't take a cab. But we will assist you in calling for a car service and will get you safely into the car. That was helpful. I will dig around in my "hip files" and will try to find the name of this woman and will PM you.

Thank you for posting your report on the rehabs you visited. That was very helpful. I was really curious about them. And you just don't see (or I haven't) any accounts on BS from people who have been in rehab.

I'll get back to you as soon as I can.

 

[Peaches]

@Zebra ... the person is in the Preadmission Division at HSS and I've left you a PM with her name and number, so check your PM in box.

 

[PhatTxDiva]

Hi @Zebra. I've been making my final preparations today and you ran across my mind. I hope you are doing well. (or as well as you can under the circumstances)

 

[craftdee]

As long as the hospital know your circumstances they will only discharge you when they are satisfied that you can cope alone. As @Jaycey points out, the pain post op is nothing like what you have now... for a start pain meds actually WORK after surgery (they never touched the pre-op pain in my hip by the end) I was surprised how mobile I was right from the start, and all you have to really do is get to the refrigerator and the toilet!
I don't know what approach they're using for your surgery, generally recovery is easier with an Anterior Approach, I had a Posterior THR three and a half weeks ago, and still I could lift my leg up without assistance from Day 0, really not a problem at all, I did get "log leg" a couple of days after getting home, it meant a bit more effort but I could still get it up on the bed, so it may not even be an issue for you.
I read your comment that you are buying a package of prunes... take my advice and buy SEVERAL packages, constipation can be a real issue, better to be safe than sorry especially if it is difficult to get out to buy more.
Having some spare ice packs is good too, it means it's not a disaster if you forget to return one you've used to the 'fridge... you can pick it up next time you're in that room. A walker with wheels is a good idea, I got a laundry trolley and carted things around in that; I'm on one crutch now and still use it to cart laundry to put it away... who new it would get used for the purpose it was actually designed,

 

[hburi]

I had a RTH performed back in October of 2009. I had someone stay with me for the first week, but realized after the fact that I really didn't need that. I was pretty much fine on my own.

I was able to have groceries delivered for the few weeks I could not drive. I was able to work from home. Physical Therapy came to me and I was able to get around, shower, dress, cook and do pretty much everything on my own during my recovery.

I suppose it is one of these "everyone is different" type scenarios but I'm getting ready to start the process of having my left hip replaced and I don't plan on having anyone with me this time.

For those that mentioned having a hard time getting their leg up and off the bed, one of the best things I was given by the hospital was a long strap that helped immensely with this issue. I would put it around my foot/ankle and then lift my leg with it and put it on the floor.

 

[hburi]

As far as stairs go, my PT showed me a clever trick on how to get upstairs using a walker. You actually go up backwards. I would have my back to the stairs, lift myself to the next stair and then bring the walker up. It worked pretty well.