Moving Elderly Parent

[ photo by cottonbro ]

Moving elderly parent due to health changes.

I had a patient in acute rehabilitation some time ago with a long history of Multiple Sclerosis (MS). Given her history of MS, she was really doing well. Prior to COVID-19, she was living independently in a single family home. Her daughter and her family lived nearby and helped with outside work, but for the most part, she was independent.

Her health was complicated by her MS. With MS comes spasticity. Spasticity is an abnormal increase in muscle tone. This increase in tone can lead to decreased range of motion for the joints that are crossed by that muscle. It can be very painful. Spasticity generally leads to a significant decline in mobility, causing an increased risk of falls.

My patient, whom I will call Becky (not her real name), had spasticity secondary to her Multiple Sclerosis. The spasticity was present for many, many years, and given the duration of her spasticity, it had been fairly well controlled. Just like I mentioned above, however, it did lead to falls.

(Related blog post: Falls At Home, Medical Alert For Aging Parent)

Unfortunately, it led to a fall a few years ago that caused her to break her hip. The hip fracture was surgically repaired with a rod and screws. Over time, however, the repair did not hold up, and just before the onset of the COVID-19 pandemic, the pain in her hip was nearly unbearable.

She saw a local orthopedic surgeon who did imaging studies that showed her to have severe arthritis in the hip joint. He recommended a total hip replacement, as he felt that was the best way to improve the pain she was experiencing. Well, elective surgeries were stopped shortly before she was scheduled to have the hip replacement.

(Related blog posts: Should I Get A Knee Replacement?, What To Expect After Knee Replacement)

Consequences of delayed surgery due to pandemic shutdown.

In a very short amount of time, her hip pain, which she had been able to work through to an extent, caused her to nearly lose her ability to ambulate. The pain caused her spasticity to worsen. The combination of the pain and increased spasticity worsened her range of motion in the affected leg, nearly leading to a permanent contracture of the hip joint. 

You might wonder what took Becky so long to get her hip replaced since elective surgeries were resumed as the COVID-19 cases declined in the summer. Remember that Becky had MS and was taking immune suppressing medications to fight the MS, thus she was terrified to go into the hospital for an elective procedure until she was able to be fully vaccinated for COVID-19.

(Related blog posts: COVID-19 Vaccine, In-Person Gatherings)

Fortunately, she was able to receive both doses of the vaccine in early March. Her surgery was then scheduled and successfully completed in April. There were no complications during and after the surgery, but due to the fact that she had been near complete immobility for the previous several months, she had lost a large amount of strength. She also had very limited range of motion in the affected hip and knee on the same side. She was no longer able to ambulate and was really having difficulty even doing transfers.

Acute rehab after surgery.

It was recommended she go to acute inpatient rehabilitation, and that is how she came into my hospital. She was there for just over two weeks and made incredible progress. Once the rehab team was able to get the spasticity and pain better managed with medication and therapy intervention, she went from needing heavy assistance with her transfers to being able to walk household distances with her rollator at her time of discharge. She did even better than I would have expected her to do, and I know that when she discharged, she would continue to improve. 

(Related blog posts: Top 5 Things To Do When Selecting A Short Term Rehabilitation Facility, Acute Rehabilitation Versus Subacute Rehabilitation: What’s The Difference?, Mobility Assistive Equipment)

Becky’s story of her MS, hip fracture, hip arthritis, surgery and rehabilitation is a great story in and of itself. I think this story is an excellent story to share just based on that, but I also wanted to touch on the living situation changes that occurred for Becky during this entire process. I mentioned earlier that she had been living on her own in her own house prior to COVID-19.

Moving elderly parent out of independent living situation.

Well due to her worsened pain, she got to the point where she could not care for herself on her own, thus she could not care for her home. The patient and her family ended up selling her house, and she moved in with her daughter and her young family. The family had a mother-in-law’s suite on the main level of the house, so it worked out well for them. Both the patient and her daughter, however, knew that this was not a good long term plan given the fact that both Becky and her daughter are fiercely independent women with their own ideas of how day-to-day activities should run.

(Related blog posts: Taking Care Of Elderly Parents At Home, When Aging Parents Need Different Levels Of Care)

They did both agree that it was the safest place for her to be during the pandemic before all of the adults could be vaccinated. It allowed for the daughter to care for her mom rather than a caregiver coming into the home. Both Becky and her daughter, however, wanted her to be able to live on her own again in some form. 

Moving elderly parent back to independent living.

In the last week of her rehab stay, decisions were being made as to what would be the best living situation for Becky. Becky’s daughter pushed for her mom to move into either assisted living or a senior adult complex, at a minimum. Becky, however, wanted an apartment. The senior adult complexes were not all that close to her daughter’s home, but she had found a new apartment complex that was just a few miles away. The complex had a first-floor, fully accessible apartment available for rent. Fortunately, Becky had done so well with the surgery and her rehabilitation, I felt that she would be okay in a small apartment with some help coming in a couple of times a week.

(Related blog post: Where Do You Go After Acute Rehab?)

There were several discussions between Becky, the therapists, the case manager, and myself regarding what would be best for her. All of the options that were laid out for Becky were great options. I could understand Becky’s daughter’s rationale for wanting her to have more assistance available for when she needed it. Becky, however, was not ready to make that leap. She had already taken a huge step in selling her long-time home. That’s a hard decision for most people. Given how well Becky had done with rehab and the extra steps for safety that were being arranged for her when she was alone, everyone ultimately felt good about her discharging to her new apartment on her own. 

(Related blog post: From Independent Living To Senior Assisted Living Facility)

Sometimes making the decision of where a loved one “should” live is pretty obvious (though not always easy). Sometimes, like in Becky’s case, there are a few different options. Some of the options might be better than others, especially for the long term. It often, however,  makes it easier on those that are the ones making the move to get to have the final say when there are multiple good options available. That was certainly the case for Becky!

Is moving an elderly parent something you have had to do recently? Let me know in the comments what living situation you decided on and why. 

© 2021 Jessica Kluetz, DO