Physio after broken hip

[OMFGSOB]

Mum is 78, very frail, has heart failure and dementia (such a cheery start to a thread 🙃)

About a month ago she fell and broke her hip. She's out of hospital now, with two carers coming 4 x day. She has improved a bit since the op, but can still only lie in bed or sit in a chair, and my dad is not supposed to move her when the carers aren't here.

She was having physio in hospital but apparently it will be several weeks until the community physios are able to come out, so she'll be pretty much completely immobile until then... My dad feels like they've given up on her 😔

To the question: would it be worth getting a private physio to fill in for the weeks before the NHS physio starts? Do private physios do this sort of thing? Or do they not like passing back and forth with NHS care?

Tbh I don't think she'll walk again, but even a small improvement in mobility would improve her life a lot!

the surgical management depends on the type of injury and the patient's baseline physiology. A hip replacement is not always the appropriate treatment.

@Hairyfairy01 she's only been home for a day and has been in bed the whole time as she's exhausted, but at hospital she was transferring using a transfer and stand aid (which we now have at home), and sitting out in a normal armchair for around 6 hours I think. She has a riser recliner chair at home. No hospital bed as the hospital said we didn't need one (carers now say we do).

She broke her hip just over a month ago but had the operation about 3 weeks ago as they had to deal with her other health issues first (one of her lungs had collapsed due to fluid in the lung cavity, so needed draining).

She's eating and drinking fine and can follow simple instructions I think.

I don't think she'll walk again but any improvement would be good!!

A bit of a dip when first home is normal, the move from hospital to home can be a big one.

is it a Mackworth she is using to transfer or a Molift? Either way at least she is getting some time on her feet, even if brief. Needing double up care is unusual and suggests either her transfers are poor or she is hard to turn in bed and needs 2 people?

it is still quite early days. A private physio isn’t a ‘bad’ move, they can help prevent deconditioning but I do feel it may also be around managing expectations but unfortunately some may take advantage and keep working with your mum despite no change in her presentation.

personally my focus would be on occupational therapy. They can assess your mum and how she interacts in her home environment. They try and reduce barriers and ensure your mums is leading the best quality of life possible and interacting with her environment . They can look into her transfers and she is the need for care can be reduced in anyway, the initial aim would be to reduce to single handed care.

that said i don’t think it should be underestimated how traumatic a hip fracture can be. You also have different types of breaks and different types of hip operations, some will heel better than others. Try not to compare recovery to those who have had a planned hip operation (elective).

Unfortunately outcomes in terms of full recovery are poor. You may also be dealing with other issues such as post op delirium, fear of falling, reconditioning from 4 week hospital stay etc. again an occupational therapist can help with this.

i would question why carers feel she needs a profiling bed. Is it concerns around pressure sores? Or is your mum unable to sit up to eat and drink? If so she needs one urgently to avoid the risk of aspiration. It may also be compatibility with the transfer aid, again Occupational therapy is your friend here. If nursing / eating related you need direct nurses asap.

Thank you @Hairyfairy01 , this is helpful.

I've spent the entire day on the phone to various agencies and care providers... It turns out the hospital OT didn't even make a referral for community OT (because "if I referred everyone then no one would get seen"). The district nurse is coming tomorrow though so I hope she can do a referral directly 🤞

Thanks again

District nurses are brilliant. They can refer on if needed but I suspect your mums nursing needs are the highest proirity atm, so you’ll be in good hands with them.