Question:My father is just home from the hospital after surgery for a hip fracture. When the home health nurse came and talked to him, he told her he could do all sorts of things he can't really do. I'm afraid he won't qualify for services based on the interview. What can I do?
You've just pointed out one of the major problems with self-report as a means of assessing function after hip fracture. Patients often over-report their abilities. Fear of losing their independence may be the reason for their over-inflated answers. Or they may not have made the mental adjustment yet to the change in the level of their daily function because they assume they will get it all back.
A new tool called The Lower Extremity Gain Scale or LEGS may help in this area. Patients must show the nurse or other health care worker that he or she can do nine activities. These include things like reaching for an item on the ground from a sitting position or getting on and off a toilet without help. Other dressing and walking activities are also part of the LEGS tool.
LEGS is a quick and easy test to give. It takes about five to 10 minutes. The patient has to actually do each activity, not just say 'yes' or 'no' that it's possible. Each activity is timed. Extra points are given for doing the items without assistance. A low score may suggest the need for home health services including nursing and/or physical or occupational therapy.
You have several options that may help. Ask your father for permission to contact the home health care agency. Let him know gently what your concerns are and your desire to see him get back his full function as soon as possible.Sheryl Zimmerman, PhD, et al. The Lower Extremity Gain Scale: A Performance-Based Measure to Assess Recovery After Hip Fracture. In Archives of Physical Medicine and Rehabilitation. March 2006. Vol. 87. No. 3. Pp. 430-436.
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