AGING WITH CARE | Body parts are replaceable, not the caregiving

When compared to prior generations, baby boomers are an active bunch. Movement is good for the mind, as well as the body. There is a caveat, though: Because we are living longer, body parts are wearing out — things like knees and hips.

For prior generations, a hip or knee failure was a dead-end road; it meant curtailing normal activities and living with pain.

In the world of orthopedics, hip and knee replacements are “routine.” In reality, joint replacements are major surgical events demanding diligence in both preparation and follow-up.

It’s not only the surgery but the structure and operation of our health-care systems that can present challenges. My advice: Be prepared for what you’ll face.

I’ll share the experience of an acquaintance and the lessons she learned. The first lesson learned: the importance of having an advocate present. The second: Be watchful of medication management.

Due to arthritis, Patty had a total hip replacement. Patty is 75, mentally sharp and works full-time. Prior to surgery, the orthopedic hospital gave her complete instructions on what to expect.

Prescribed in-home care is available post-surgery, but a surgeon frequently recommends a post-operative stay at a skilled nursing facility. Patty toured two rehabilitation facilities covered by her Medicare Advantage insurance. Her first choice was very clean and had an excellent reputation. She thought she knew what to expect.



Patty’s surgery went well. Her stay was four days. Patty didn’t want to be alone so, for the first two nights, her partner, Alfonzo, slept overnight in her room on a couch and spent as much time with her as possible.

Being heavily medicated, Patty was grateful her partner was at the hospital to participate in conversations with doctors and medical staff. As an advocate, one needs a medical power of attorney prior to surgery. This legal document allows the medical staff to freely share information.

Pain management is critical following surgery; for several days, the medical staff adjusted her medications to find the right combination. To prevent blood clots, the staff monitored and fine-tuned her dosage of blood thinner.

The day after surgery, a physical therapist (strengthening and range of motion) and occupational therapist (activities of daily living) began working with Patty. Alfonzo made it a point to be there for the therapy sessions. He learned as much as he could about the restrictions of activity and the care he would provide Patty upon her return home.

Patty’s experience with the hospital staff was good. The only hitch was an occupational therapist who was insensitive moving Patty’s leg. Patty requested a different therapist, and the hospital complied.

Joint-replacement patients are often told they can return directly home. This is reasonable if the home is safe and properly equipped; a 24-hour care attendant must be available.

Hiring caregivers at home to assist is an option. For a time, mobility is significantly impaired, and assistance is required with basic activities: bathroom visits, showering, dressing and meal preparation. The home must have open pathways, with all tripping hazards removed.

Patty and her doctor jointly determined that a skilled nursing facility would be required before returning home. The hospital discharge planner deals with the logistics of this transfer of care. In transitional care, Patty would receive physical therapy, assistance with daily living activities and medication management.


The importance of an advocate

Skilled nursing facilities vary in the quality of facilities and treatment of patients. Prior to her hospital admission, Patty had done her homework and was going to a highly rated transitional care unit.

Again, for Patty’s comfort, Alfonzo slept in her room the first night and spent as much time as possible with her during the days that followed. This is a delicate time of transition. There is still significant pain, and mobility is surprisingly restricted.

Patty found her physical and occupational therapists outstanding. What she found to be disconcerting was the nursing staff’s inconsistency and lack of attention to detail. One young nurse had no training in hip-replacement movement restrictions.

Most nurses and aids were outstanding, but a number of decisions revealed a level of incompetence and a lack of communications that was surprising. Examples: A nurse attempted to remove her incision staples three days prior to the earliest removal date the surgeon had set. The director of nursing ordered the discontinuation of an antibiotic prescribed by Patty’s surgeon. The facility was using different guidelines from those used by her surgeon for monitoring the clotting tendency of blood when using Warfarin.

When there were inconsistencies, Patty and Alfonzo contacted the surgeon’s office to make sure the surgeon’s recommendations were followed.

In a follow-up office visit, Patty’s surgeon confided his misgivings about his post-surgery patients going into institutional settings; he was frustrated by the recurring reports of mismanaged care.

Once home, Patty received care from visiting nurses and therapists. Patty was relieved to be home; however, this experience left Patty and Alfonzo wondering what happens to the elderly who are without advocates or unable to be their own spokespersons.

MARLA BECK is the founder and president of Andelcare Inc., which provides in-home eldercare. Submit questions by calling (206) 838-1844 or via e-mail to

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