Correct. The shoulders are not built to hold the stress of your body weight, particularly from below. Crutches should be adjusted to have a 2 inch gap when you stand with your arms draped over them, and the handgrips at wrist height. Crutches are tall so that they are contained by your arms when you use them to keep the tip from splaying out of control, but your weight should not be on the tops, your weight is held by your arms, not your armpits. It requires a lot of arm strength to use crutches safely.
Also, crutches are a pain in the ass to keep nearby and to get arranged when you want to stand up and walk. And they offer absolutely no help with actually standing up - they’re a hindrance until you are fully upright. They are a terrible choice of assistive device in someone who needs assistance getting up off of a couch. People tend not to use them because they’re so cumbersome, whereas a walker will actually help you get up, as well as walk.
Is there an element of CYA when it comes to Fall Precautions in the hospital? Yes, there is, a little bit. If a patient falls - even if they don’t injure themselves - there’s paperwork to be filed and an Incident to report, and ain’t nobody got time for that. But far far far more is the element of Cover THE PATIENT’S Ass. Falls are a huge risk for injury, particularly in the hospital, where the surfaces are all hard and there is often unfamiliar equipment around your bed and you are usually tethered to IV tubing, oxygen tubing, monitoring wires…it’s a mess.
They don’t make up the Fall Risk on a whim or to be mean or to cover their ass. There are calculators for Fall Risk. It’s math. We know what’s strongly correlated with falling, and what’s weakly correlated with falling, and you get an objective score. Fallen and injured yourself in the last 3 months? You get 15 points for that. Taking medications which lower your blood pressure? You get 5 points for that. Carefully gathered and analyzed data over many years have shown that people who score more than 15 (on one particular rubric, there are others with other scores) are pretty darn likely to end up falling again.
So…let me turn it around for a second. What would you be posting if your wife wasn’t on fall precautions and you later found out that, statistically, she was really likely to fall? You would be screaming about substandard care because the nurse should have known she was likely to fall and did nothing to protect her.
I swear, they can’t win.
Now…about the Physical Therapy. Physical Therapy sounds like it probably is indicated here. If I was your home nurse (assuming your wife met the guidelines for home health), I would order a Physical Therapy evaluation and we’d probably agree that she needs home Physical Therapy twice a week for transfer training and gait training and therapeutic exercise. But A) Physical Therapy isn’t free, at home or otherwise. If you aren’t insured, that sucks, but that’s not the doctor’s fault and B) Physical Therapists aren’t Personal Trainers and they’re not cheerleaders (and doubly so for home Physical Therapists, as opposed to outpatient or inpatient PT). They are there to provide specific assessment and training you in balance building and strengthening exercises and to set up a home exercise program that you *must *do on your own. Doesn’t sound to me like she would benefit a whole *lot *from home PT, because she’s not shown me that she is willing and able to work on her own. So I’d order it, and it would probably help a little bit and she’d feel and function better the days she gets PT, but it’s not going to be a huge benefit, nor long lasting, unless she exercises on her own.
Finally, the one tiny part that may be “the doctor’s fault”: doctors and nurses often forget that not only do you not know things, but you don’t know what you don’t know. You don’t know to ask for home PT (setting aside whether you can afford it or have insurance that will pay for it) because you don’t know that home PT is a thing. Or you don’t know that there are outpatient PT facilities, so you don’t ask for it. It would be great if discharge was always handled with enough time and education to at least let you know what the resources in your area are and how to access them. But everyone wants to gtfo the second the doctor says they can go, and the discharge coordinator can only be in one place at one time. So people are cut loose because they’re not prisoners, and this stuff gets skipped or glossed over. And really, I have yet to see discharge papers that don’t include, at least, “Follow up with primary care provider in 1 week,” with the expectation that your regular doctor will arrange the ongoing care. Again, if you don’t have a primary care provider, that’s not the hospital’s fault.
Hospitals are not set up or funded to provide ongoing care. They are there to save your ass and get you stable enough to go home and get ongoing care from your regular doctor.
I absolutely agree that there is a gap in coordination of care between hospital care and home care, or hospital care and ongoing care with your out-of-the-hospital physicians and nurses. As a home nurse, this is something that frustrates me, and I know it frustrates the hospital nurses, too. All I can say is that we, as an industry, are working on it. Some of the ACA mandates, including electronic recordkeeping that can more easily be shared between providers, are expected to help (if Congress will stop delaying them, that would help, too). But there are big privacy concerns there, as well. How do we develop and implement systems that let unrelated health care providers get your information quickly, but that keep The Bad Guys out? How does your hospital verify that I’m a home nurse working with you, and not an asshole trying to obtain your personal information to steal your identity, or an employer illegally trying to get information about your diagnosis so I can fire you? We’re working on it. I’ve seen a couple of good systems put into use in just the last 6 months, but they aren’t universal yet.
In the meantime, my advice is to walk. Walk, walk, walk. It’s the best exercise for most people with the fewest contraindications (none of which you’ve mentioned your wife has; the contraindications for walking are generally cardiac related and congenital.) If she can only walk 20 feet today, fine. Walk 20 feet. Tomorrow walk 21 feet. The day after that, walk 22 feet. It will add up.
And talk about this stuff with YOUR doctor. The hospital doctors are done.
Which is why I landed in the hospital the first time. All I wanted or needed was a refill of my Prozac but the chair in his office was too low and I fell a little bit (no pain or damage) getting out of it. He later said I was near death, but he’s just an osteopath (AKA: A chiropractor with a prescription pad) so what does he know. I don’t go to him anymore, finding MDs (AKA: Real Doctors) more to my liking.
But when I wrote the OP I wasn’t blaming the medical people, who are all very good, but a medical system that seemed to encourage enforced bedrest for her, and for me a couple years ago, while they have heart patients doing laps a couple days after surgery. And yes, I know she was very sick and not capable of much at first.