After a hip fracture: the records, the equipment and the house

Photograph the discharge paperwork before it goes in a drawer

You will be handed a folder on discharge day, in a hurry, while also arranging transport. The single most valuable thing you can do is photograph every page before you leave the car park, in order, right way up.

Do not attempt to interpret any of it. Instructions about how much weight the leg may take, wound care, or activity are clinical documents. Your job is to keep them intact, get them into the binder, and ask the physical therapist or the discharge nurse to explain in practical terms what they mean for daily life at home. Write their answer on a separate sheet with their name and the date.

Back home, file the originals in one sleeve in date order. Write the procedure name, the surgeon, the date and the facility on an index card at the front. You will be asked for those four facts on every form for the next two years.

• Photograph every page, in order, before leaving
• Procedure name, surgeon, facility and date on an index card
• Discharge summary and the printed medication list
• Any written instruction sheets, filed whole and unedited
• Who to call in the first week, day and night — copied onto the fridge page
• The follow-up appointment date, and who books it
• The date any stitches or staples are due to be dealt with, and by whom

The equipment list, with return dates

A walker, a raised seat, a commode, a grab rail, a wheelchair for outings — these arrive from a hospital, an equipment supplier, a loan closet, or a shop, and each has different rules. Some are rented and billed monthly until returned.

Keep one page: item, make and model, who supplied it, delivery date, rented or bought or loaned, phone number for repairs, and return date. Photograph each item with its label showing. Note who at home has actually been shown how to adjust it, because a walker at the wrong height is a walker nobody uses.

Ask the supplier two administrative questions and write the answers: what is the process to return this, and what is the number if it breaks at the weekend.

Put every return date in the calendar the day the item arrives. Rentals that are forgotten are billed quietly for a very long time.

• Item, make, model, serial number
• Supplier, phone, and the out-of-hours or repair number
• Rented, bought or loaned — and who is being billed
• Delivery date and return date, both in the calendar
• Who has been shown how to adjust or fold it
• A photograph of the label, filed with the record
• Anything bought privately, with the receipt attached

Walk the house with a notepad, before the ambulance brings her home

Do this while the house is empty, with a notepad and a phone camera, one room at a time. You are writing down observations, not making judgements about risk — the judgements belong to an occupational therapist, and a written list is exactly what they need to work from.

Go through the route your parent will actually take: the way in from the car, the hall, the bathroom, the bedroom, the kitchen, and any step between them. Photograph each one and note the date and the room on the photo record. Measure anything narrow — doorways, the gap beside the bed, the turn at the top of the stairs — and write the measurements down in inches.

Then ask, rather than decide. Ask the physical therapist or occupational therapist which of these matters, in which order, and what they recommend. Hand them your list and your photographs. That is a twenty-minute conversation instead of a home visit spent taking notes.

• The route from the car to the front door, including every step and its height
• Hall and corridor widths, and anything that has to be walked around
• Bathroom: door width, and what is beside the toilet and the bath
• Bedroom: which floor it is on, and whether it can be moved downstairs
• Kitchen: what is stored above shoulder height or below knee height
• Lighting: which rooms have a switch at both ends, which do not
• Floor coverings: loose rugs, thresholds, trailing cables — noted and photographed
• Where the phone charger and the phone will be at night

The first six weeks are a rota, not a feeling

There is a period after a hip fracture when someone needs to be there, often several times a day, and it lands unevenly across a family. Convert it into a written rota in the first week, before resentment does the job for you.

List every task that actually gets done — not roles, tasks. Then put names and days against them, in writing, and circulate it. A rota that lives in one person's head is not a rota.

Include the invisible work: phone calls to offices, prescription collection, laundry, bins, post, and the driving. The driving is usually the heaviest item and the one least noticed by whoever is not doing it.

If you are paying for help, keep the agency contact, the agreed hours and the invoice record on the same page. And keep a shared cost ledger from day one — who paid for what, with dates — because reconstructing it in month four is unpleasant.

• Every task listed, including calls, admin, laundry, bins and driving
• Names against days, in writing, circulated to everyone
• Who is covering the weekends, specifically
• Agency name, agreed hours, contact, invoice record
• A shared cost ledger with dates and receipts
• One family meeting with an agenda and written decisions
• A review date four weeks out

The dates to hold on to

After a fracture the calendar carries more than usual, and the items are easy to lose because they come from different offices. Put them all in one calendar page in the binder and photograph it.

Ask each office to give you the next date in writing before you leave, and note who is responsible for booking it — you, the hospital, or the therapy office. "Someone will call you" is a date you should write down as an expectation with a chase-up date attached.

If a therapy block has a fixed number of visits, ask how many are approved and when that is reviewed. That is an administrative question for the case manager or the plan's member services line, and the answer changes what you plan.

• Surgical follow-up appointment
• Any date given for stitches or staples, and who does it
• Therapy start date, number of visits approved, review date
• Equipment return dates
• Prescription reorder dates, one week before running out
• The date you will re-walk the house with your notepad
• A chase-up date beside every promised call

Questions