Brother’s Cracked Femur Creates New Worries

Dear Ellie:

My brother, who is 90 years old and lives in a skilled nursing facility, fell and cracked his femur near his hip. He had surgery this week and is still in the hospital. The surgeon used a screw to repair the break. I am concerned about his return to the facility in which he has lived for a few years now. It has both assisted living and skilled nursing rooms, and he has been very happy there.

Do you think that we are entering a new level of needed care? Might he have to go to a rehabilitation facility? What do you think that might cost? Does insurance usually pay for that? Phillip

Dear Phillip:

I’m sorry to hear about your brother’s fall. There are those who say that elderly people don’t fall and break a bone, but that the bone is cracked, which causes them to fall. However, the end result is the same: they lose mobility, at least temporarily, and often need very close supervision while they are bedridden. They also usually need carefully managed physical therapy for many weeks, or until they can move about with a walker. In the meantime, they are bedridden and may be able to use a wheelchair to get around.

Each case, of course, is different. I am not a physician or a nurse. The best sources of information at this point are his physicians, his nurse, and the case manager. Usually, in well-staffed hospitals, the case manager may be a registered nurse or a social worker. That person should be familiar with the local health care facilities and can match the resources of each facility with a patient’s needs.

I suggest that the main family member who is responsible for your brother make an appointment to talk to the case manager and review his status and the options available for his care. To avoid misunderstandings, a few family members might also be included in the meeting. Talking to the on-site case manager is often easier than trying to find the physician or registered nurse who knows him best.

As to cost, some rehabilitation facilities only take Medicare or Medicaid patients, or patients with certain health insurance policies. It is very important that you know about the financial arrangements before you place him anywhere.

Remember, he will be paying for his empty room at the facility where he has been living in addition to the interim rehabilitation facility that may be recommended. This can get very expensive. Be sure that you, or the family member who is responsible for your brother, know all about the financial obligations before making the final decisions.

If your brother is able to participate in the decisions, be sure to have him do so. Nothing is more disturbing than for other people to take over someone’s life when they are incapacitated. The incapacitated person is likely to get very irritable about not making his own decisions, if he is still able to do so.

This kind of situation is very common. People are living longer, and medical science has progressed a great deal in turning ailments that once would have caused death into something that can be repaired or rehabilitated.

I wish you well in your caregiving role. And I hope that your brother recovers enough to live well into his 90s. Ellie

By Elinor Miller Greenberg, EdD
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