My mother can barely get out of bed to go to the bathroom. Even though we’ve hired an aide to help her at home during part of the day, I’m really concerned about her safety when she’s alone.What should we do?

73. My mother can barely get out of bed to go
to the bathroom. Even though we’ve hired an
aide to help her at home during part of the
day, I’m really concerned about her safety
when she’s alone.What should we do?

Nancy’s comment:

If you’re caring for someone who doesn’t live with you, it
can be helpful to have an occupational therapist (OT)
make a home visit to the patient’s house to evaluate the
patient’s needs for safety and mobility. This may be covered
by insurance. An OT can suggest placement of grab bars in
a bathroom, a ramp rather than steps for easier access, and
other safety and comfort measures, which can make a great
difference in how the person you’re caring for can manage
when he or she is alone. Just improving a person’s mobility
can buoy his or her spirits and speed recovery from a difficult
round of chemotherapy or radiation treatment.

There are times when people are unable to manage
alone, either because of physical limitations, mental
impairment, or both. Decisions about how to handle
this involve both practical and emotional considerations.

Ask yourself: Is the impairment temporary or
treatable? Or is the impairment long-term and not
likely to improve? If your mother has recently been in
the hospital for a couple of weeks or longer, it may not
necessarily be the cancer that leaves her unable to care
for herself, but rather the weakening and deconditioning
of the body that occurs when people are inactive
for prolonged periods of time.

In either case, talk with the doctor to see what she
thinks is contributing to your mother’s physical condition.
Ask her about having a physical therapy evaluation.

A physical therapist and physiatrist will both
assess your mother’s ability to manage safely at home
and suggest a program for her rehabilitation. Similarly,
if your mother just had surgery and seems confused or
“just not herself,” it could be a temporary side effect of
the anesthesia or other medications. If this continues,
do not be surprised if the physician wishes to consult
with doctors from other specialties to discuss possible
solutions.


Physiatrist = A doctor who specializes in rehabilitation
medicine.


If your mother is currently admitted to the hospital, it
may be that after a few days of physical therapy, your
mother will be able to return home directly and be able
to manage with support from family members staying
with her. A physical therapist may be able to visit her
at home to help her get back her strength, and a home
health aide may be included in these services to help
your mother get back on her feet again. With this
assessment and assistance at home added to what
you’ve already arranged, your mother may be able to
manage well out of the hospital.

Although you may still be uncomfortable with the idea
of your mother going home, it’s important that you take
into account how she perceives her care needs, before
imposing any plans or solutions. If she feels she can
manage at home with the help of an aide, or even by
herself, you can voice your concerns and discuss with
her additional ways of ensuring her comfort and safety:
having more family involved; hiring additional help privately;
or installing a Personal Emergency Response
System (PERS), which she can wear on her person so
that she can call for immediate help in a crisis.


Personal Emergency Response System (PERS) = 
A device that a patient can wear that can 
alert emergency help.


On the other hand, it may be that your mother does
require a longer or more intensive program of physical
therapy to get better, or simply needs more help than
can be provided at home. In this case, your mother can
transfer from the hospital to a skilled nursing facility
for rehabilitation (see the next question), where she
can receive both nursing and personal care around the
clock, in addition to participating in a daily program of
physical therapy.


Skilled nursing facility = A healthcare facility providing 
short-term nursing care with the aim of having the
patient return home or to a family member’s home.