Friends pride and denial risks Mom's safey

An old friend called a couple of days ago looking to find some way to help her mother after she returned home from a back surgery. It was an odd call full of questions from her and sound answers from me (or so I thought...) but I don't think she got the answers she wanted from me. Long story short, my friend can't realize that her mother probably needs the professional care of LPNs, RNs or CNAs after surgery. She wants to keep her mother in her own home rather than use the available resources to ensure that her Mom is safe and well tended during her recouperation. She seems too proud to admit that her mother needs the additional assistance of professional care givers.

Here's the scenario:
Friend's Mom is 84 and has severe osteoporosis; so bad that she broke three ribs trying to lift a 10 pound chicken from the freezer and thus the need for surgery. She lives alone, goes to mass each morning and walks 2 miles a day. In the past year she has been hospitalized and recouperated at home after a severe bladder infection and again after surgery to repair cracked vertebrae. The vertebrae surgery required a brace that was nearly impossible for her to get off and on by herself and limited her movement and increased her risks of falls. Friends Mom had bad experiences with pain medication; she was either allergic or took too much but because she was home recouperating alone, no one knows for sure. She woke up on a soaked kitchen floor with buckets, cups and plates all around her and no memory of what happened. There have also been some instances when Friends Mom got lost when she travelled to an unfamiliar part of town; it's small enough that she should have been able to find her way to familar territory.

My friend hoped to work out a schedule with her siblings (think no cost to Mom) but they all have commitments to jobs, kids in school and in-laws that need support during chemo and surgeries as well. Her dependable and responsible siblings used their available vacation time for Mom's previous recouperation so had none left to use.

My first response was : Let Medicare pay for time in a rehab center (nursing home). (They pay for 100 days, 3+ months of rehab care after surgery or hospitalization).
I thought my friend would have a herd of cows right then and there! You'd think I suggested throwing her Mom out the car door at high speed. It went something like this: (Explicative)...Mom can't go to a nursing home! She's not one of those old ladies! How could you even SAY that?!! My second suggestion was to contact a home health care provider to go by 3 to 4 times a day but at nearly $16 per hour that was out of the question as well.

In all honesty, Friends Mom IS one of those old ladies. She is quite frail, needs someone to ensure she eats and taked meds regularily. She also needs companionship and, most important of all, she needs some skilled nursing care (think professionally trained) and rehabilitation to get back on her feet after this surgery. She will ONLY get that at a nursing home or from home health care aides. If you can afford the care at home, by all means, do it, other wise take advantage of the Medicare policy and let your elder get the care s/he needs. 100 days is a long time to recoupe from a surgery and she would probably would not be there long but she's likely to recoupe faster with the care they can provide. Rehab centers or nursing homes are well prepared to deliver 3 meals a day, medications, physical therapy, bathing and toileting assistance. These are things that we just can't do well at home if we're helping out as our busy schedules permit. Our Elders deserve the full attention of professionals if we aren't able to do it.

To be sensitive to my friend - She has deep love and respect for her Mom. She wants to be supportive, she feels guilty and knows her Mom will feel best emotionally at home. Yet,she expects too much of local relatives who can't be there and she is unable to travel to help due to her own job. I can say, based on my own failure to act, denial is really easy but can cost Mom a lot in the end. There comes a time when our elders need our help in spite of our own preferences, pride and aversions. Let go of the stigma that nursing homes are terrible. Most of these facilities realize that the payments they get from Medicare are important and reliable revenue; they won't screw it up. Their employees also enjoy knowing that they can help elders get back on their feet and WANT to see them go home because it means they did their job well and had a success. They are proud of the kind care they can provide; we just need to swallow ours and let them do their jobs for our elders.