While a primary care doctor can order home therapy, currently you cannot get just OT. So if the doctor writes for home PT and OT or home nursing and home OT then it will be covered.

How is her mobility now?

Please be aware that the Medicare guidelines recently reverted back to pre COVID rules. This states that patients must have a three night qualifying stay coded as an inpatient in order to qualify for inpatient rehab in a Skilled nursing facility. Usually the joint replacement surgeries are coded as outpatient or extended surgical recovery (again forced by Medicare) so patients are expected to DC within 24 hrs. To be converted to inpatient status she would have to have a lot of trouble with pain meds or other medical issues like blood pressure complications, something out of the ordinary.

So it's best to prepare for home. Do you have the option for her to stay on the first floor initially?

Your hotel room idea could work as well. We have had patients DC from hospital to a hotel and then the home PT can actually go to the hospital to start the therapy sessions there and then continue when she comes home.

A big issue is to make sure you clearly write out her med schedule for her Parkinson's meds so the hospital staff can put the correct timing on her chart.

Anonymous wrote:I used to do discharge planning for people who had knee replacements ( and other ortho issues). There are lots of small fixes to make in home work. Like a special raised toilet seat, a portable toilet, a shower chair that allows you to sit on it outside the tub and slide in, etc. Also, you can get an OT home eval yo help you get set up.

Lots of great feedback from everyone who responded.

THANK YOU.

I am especially interested in an OT evaluation to get me set up. Is this something we ask for (i.e. get the referral) from the surgeon at the time of the initial evaluation pre-operatively? Wondering if I can get this referral and evaluation started through her primary care.

I used to do discharge planning for people who had knee replacements ( and other ortho issues). There are lots of small fixes to make in home work. Like a special raised toilet seat, a portable toilet, a shower chair that allows you to sit on it outside the tub and slide in, etc. Also, you can get an OT home eval yo help you get set up.

My mom has had both knees replaced. She could do stairs as soon as she came home. Ideally you have access to a bathroom on the main floor so you don’t have to go up and down a lot, but my mom went upstairs to bed the first day she was home.
The shower/ bath might not need to be priority #1 because she’s likely not allowed to get the incision wet until the stitches and/or staples come out. So she may be washing at a sink for a few weeks.
Definitely invest in a raised toilet seat, maybe two if she will use bathrooms on different floors. A walker and a cane are also good to have. They might provide one or the other for her, so maybe wait to buy those.
Comfy shoes she can slip in and out of are important. By slip in I don’t mean clogs, but sneakers or shoe like slippers that don’t require laces are good.

I strongly recommend having your mother go through in-patient rehab after the knee replacement. You will be overwhelmed having to care for her after this painful major surgery. My DH had it done in his late 50s and it was one of the worst experiences I have gone through. He couldn’t do stairs and needs help to get to the bathroom, changing dressings, meals, etc. We had a hospital bed in our living room for weeks.

Full or partial?

Our neighbor (age 81'ish and not in great shape) is having the same soon and his wife was told they would have him doing at least a few stairs before he left the hospital.
We are in DC in a rowhouse so about 4-5 stairs into the house. She is planning to have him sleep in the living room for a night or two unless his ability surprises us all.
But since you Mom has Parkinson's, I would ask if the post-op hospital stay and therapy is longer than for other patients. I would also milk that condition to ask for at home PT services as long as you can. But I don't know. Is she managing stairs ok given her Parkinson's? Best to you! In a similar boat here.

Anonymous wrote:My mom had knee replacement done in her 60s. She has a first floor primary bedroom setup, so she didn't need to use stairs, but I'll say she was able to do stairs sooner than she was able to do distance (as in blocks, not miles!). If I were you, I'd forget about installing a stair lift and put your efforts toward temporary one floor living space, if possible.

PT began immediately and someone came to her house at first, then she was driven to appointments until she could drive herself.

Thank you - this is very helpful. The two bathrooms at home have a bathtub vs. shower stall. Therefore, I'm starting to think that it may be best to get a handicapped accessible hotel room for the weeks after surgery. I have young children at home so a little overwhelmed by all the logistics.

My mom had knee replacement done in her 60s. She has a first floor primary bedroom setup, so she didn't need to use stairs, but I'll say she was able to do stairs sooner than she was able to do distance (as in blocks, not miles!). If I were you, I'd forget about installing a stair lift and put your efforts toward temporary one floor living space, if possible.

PT began immediately and someone came to her house at first, then she was driven to appointments until she could drive herself.

My mom needs knee replacement. She lives with me. Her appointment with the orthopedist is only a few weeks before the surgery is scheduled so I need to plan ahead as much as possible. We have stairs and need to figure out if I need to install stair lift/chair in preparation for her surgery.

How long after knee replacement surgery were you able to walk up and down the stair?

Was the physical therapy post-surgery done on an outpatient basis or did you have to go to inpatient rehab for the first couple of weeks?

She is in her 70s and has Parkinson's disease so I anticipate a longer recovery period.

Thanks