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My Mom has had a couple of falls in the past week, one resulting in a sprained ankle. We have noticed that she is leaning back on her heals when she stands up and walks. We have drilled "nose over toes" into her head, so she hunches forward about mid back over her walker, but still leans back on her heels. No matter what direction, encouragement, etc., we give her, it doesn't seem to help. A couple years ago she ended up in a rehab center after a fall, and when they released her, they had physical and occupational therapists coming to her house a couple times a week. Is there a way that we can schedule something like that? How do we do it? Does she need a referral? What is the process?

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My mom has had 2 serious orthopedic injuries since 2018 and in-home physical therapy. Most local VNA's (Visiting Nurse's Association) have physical therapists on staff for home visits. It was pretty easy to arrange once we called the VNA.
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My mom has dementia and now lives with us. Since she is now home bound, I have transitioned her primary care doctor to a visiting home physician group. Best thing I ever did. Through them she now has a visiting nurse once a month as well as an occupational and physical therapist that come to the house three times a week all covered by Medicare.
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Get an appointment with her primary care provider. Ask for a referral to physical therapy. She might benefit more from going to a clinic, which has more training aids available that do not fit into a vehicle.
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Kimstark68: Perhaps you can inform her primary care physician of the PT need and your mother's unusual gait.
The following is a little off topic: My mother listed to one side when she walked or stood. Her problem was solved when her podiatrist made her a lift, which fit inside one of her shoes.
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We would do a video call with my dads doctor and then she could right an older for in home PT
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Don't think I've ever seen a person using a walker and leaning backwards. The walker with a seat would catch her fall if that happened. Might want to have her evaluated by her primary doctor for vertigo, I know it made me so dizzy that I actually caught myself leaning backwards...........frightening!

You seem to be the daughter we all wish we had, your parents are lucky to have you. Warning, do not wear yourself thin, always make yourself a priority.

Here's one site to get an idea of what mom needs: https://www.walgreens.com/q/walkers+with+seats
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Her doctor can order the therapy. She'll probably have to go in for a visit so he can do the evaluation required by Medicare, but that's all it should take.

I recommend both PT (lower body) and OT (upper body). And when home health calls you to set it up, ask them to start one now and when that one ends, start the other one. This keeps the therapy going longer. If you do both at the same time, you'll get about a month or so of service and then both end. You really have to wait a couple months to get dr to order again.
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My wife has home health and needs a therapist. I got one, she came a few times then refused to come any more. They said I could do it. I said its not my job that’s why you get paid and I don’t.
First the patient wants to do the work.
next the most difficult thing for me was the pain. Obviously you do not want to hurt your loved one. True the pain will subside as they get stronger but that is not now. I’m just frustrated at the system
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You get her Primary Care physician to order it through a home health care agency if she qualifies under Medicare for the PT and the doctor certifies that she is home bound or would have extreme difficulty going to PT outside of her home.
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Her primary care doctor can refer you. They may want her to come in and be seen by the doc first.
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Make an appointment at her doctors he will examine her and write a script and you can ask for a cane or Rolllater - Medicare will cover one of those . Ask for a VNA to come in if you need help with her medicines .
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Call her doctors office, they may want to see her first but they can order home PT.
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Check out: https://www.foxrehab.org/what-we-do/physical-therapy/
They provide outpatient therapy in the home that is not considered "Home Health" so they can bill under Medicare Part B. I think they are available in most states. They can tell you what is required to use their services.

Check out: https://www.cms.gov/center/special-topic/jimmo-settlement/faqs
Medicare was challenged about limiting therapy and now in some cases provide unlimited therapy when maintenance is needed. It can be more cost effective for them to try and prevent broken hips.
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In order to get PT in my state, a doctor needs to order it. Make the request to the doctor for at home PT. At first, my Mom could not get at home PT because she had already received PT in the office and her mobility had not significantly changed. (We wanted at home PT because we found a really good PT through a relative.). Then COVID happened, and we got at home PT and have made sure not to do PT in an office.

If there is a specific PT that you want to go to, make sure you tell your Mom’s doctor. Then he can send the referral directly to that person.
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I think Medicare allows physically therapy ever few months. We had it to teach Mom how to walk with a walker. She had it at her Daycare center. And at her LTC. All with a drs order.
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I believe that even if a Dr. orders PT, home PT visits are only covered by insurance/Medicare if the person is either (a) considered homebound and eligible for home healthcare services, or (b) is rehabbing from something acute, and in either case is deemed unable to safely go to PT on an outpatient basis. You mom got in home PT and OT before because she was rehabbing from something acute (the fall). Would she now be considered homebound so insurance would cover in home PT if ordered by her Dr? My husband, like your mom, got in home PT after an acute episode (broken hip), but there came a point where the therapist said he was ready to go for PT on an outpatient basis so couldn't get it at home any more. My husband continued to be covered by Medicare for outpatient PT for a while. Later, we decided to pay privately for in-home PT when Medicare would no longer pay as he had Parkinson's and really benefited from it.
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Kimstark68 May 2023
Yes, she is homebound and eligible for home health. She did have an X-ray of her ankle, which showed no fracture, just a really ba sprain. She currently has an independent care giver who comes in four hours a day. She works with Mom on excercises, etc., but this thing with leaning back has become a problem. Part of the issue is that she resents it when her care giver or any of the family try to help her. She responded beautifully to the therapists that came in before, so I was thinking that might be the way to go. She has both really good private insurance and Medicare. I will reach out to her primary care provider and see what we can do. Thank you for your response!
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Usually PT has to ordered by a doctor, you can't just request it.

Was your Mom taken for imaging after the couple of falls this past week? Are you deciding it is a sprain, or did she go to Urgent Care/ER for xrays? If it wasn't imaged, I wouldn't make any assumptions... it could stilll be fractured. Sprains take a long time to heal.
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Call her doctor and ask her/him to order Home health care services.
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