Hospital and Nursing Home Inactivity Vs Assisted Living
Is Nursing Home rehabbing the best exercise after the hospital or is Assisted Living with structured care and doing daily exercise a comparable choice?
This NYT article raises a good question about activity in the hospital and by extension Nursing Home Rehab where you are on your feet 43 minutes a day. They go on to point out that if you are allowed to walk more, provided an setting or support system that encourages twice or more a day activity that is better than less activity. We add in questioning the definition of the phrase “rehab” since we believe that confuses many who would walk more, do more, if they were allowed to be in a setting that encouraged ambulation. For example being on your feet more, walking to meals, doing day to day tasks that most people would do in a more supervised Assisted Living or structured care setting might give one more activity than in many hospitals or other nursing home type settings.
Nursing Home Rehab vs Assisted Living that has adequate staff and continuity of care to do assisted activity with seniors
A nursing home, which is the most common form of senior rehab, might only have them on their feet for 43 minutes a day. While the senior gets “rehab” from a licensed physical therapist they don’t get a lot of walking and ambulation for the remaining 23 hrs a day. If walking and ambulation are rehab then one might get more “rehab” or exercise in an Assisted Living or Residential Care home that focus on continuity of care and activity.
Just because the hospitalist doctor, who generally does not know you, and might have less interest in your condition months later since he does not expect to see you, suggests “rehab”, meaning nursing home rehab don’t assume you will get a lot of exercise. In fact, the system delegates your rehab to just the time you are in rehab which is not very long. The staff do their jobs but the floor staff like the senior to rest, and not get up, since they don’t have time to supervise that.
If you knew your doctor, your doctor participated in the care both in the hospital and after the hospital he might feel differently about your expected functional decline in nursing home rehab. Now the NYT is confirming this view.
We caution that all Assisted Living Homes may not have adequate staff or systems set up to allow or encourage mobility but note that if your setting favors continuity of care and senior independence it might be a good alternative to Nursing Home Rehab. All of these are speculative and each needs to discuss this with their doctor and health care team.
Free or paid by Medicare nursing home rehab is not always the best care, most care, or most exercise.
We bring this point up since many hear that nursing home rehab is free or covered by Medicare for 100 days. They want to use up this free resource. At first glance saving a few bucks is a good ideas but when you consider that many my decline further and not regain their previous community mobility with extended nursing home or hospital stays and the inactivity that accompanies them.
All nursing homes are not the same. Some staff will get you up and walk with you but practically it is hit or miss. Also management will direct staff to stay on task and walking with residents takes time, time that staff could be doing something else. Also walking with residents is risky for the institution in that the patient might fall so they want to be extra safe. Of course the senior wants to take that risk since to live a full life requires walking. If they fall it wont be the first or last time and that is ok. Aging and life are risky.
Example of a Assisted Living Care Option that probably does offer more exercise and supervision than many hospital and rehab settings.
At https://tlcsr.com we have a negotiated risk agreement with falls and encourage people to walk knowing that our encouraging then will encourage them to do more and when they do more they might not ask for help and fall. That is an acceptable risk the patient and family agree to which is the negotiated risk agreement. That should become a model for care.
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