After a parent's hip fracture The surgery, the discharge choice, and what comes after

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Most hip fractures need surgery. The American Academy of Orthopaedic Surgeons reports moderate evidence for operating within 24 to 48 hours of admission, which it says is not always possible. Discharge is harder: skilled nursing, home health, or outpatient therapy.

Three things shape the next year: when the operation happens, where your parent goes when the hospital discharges them, and what shows up in the weeks after. The American Academy of Orthopaedic Surgeons writes that hip fractures in the elderly may cause disability and lack of independence, and that early movement and rehabilitation have been shown to improve long-term results.

The sequence is surgery, then the discharge decision and the coverage rules sitting underneath it, then the complications, then the house your parent comes home to. Almost every number here comes from AAOS, Medicare, or the National Institutes of Health, and each one is linked where it appears.

Surgery comes first, and the clock runs from admission

Most hip fractures require surgical treatment. AAOS describes two exceptions, both small: a group of nondisplaced fractures in healthy patients that can be treated without surgery, and a separate group of patients who are too sick to safely have an operation. Surgery is what relieves the acute pain of the fracture and allows the patient to get out of bed.

Which operation depends on where the femur broke. Fractures of the femoral neck that have not displaced are commonly fixed in place with pins, screws, or a plate and screw device. Displaced femoral neck fractures are often treated with a hip replacement instead, and AAOS says a partial hip replacement is typically the treatment of choice for elderly patients. Intertrochanteric fractures, the other common type, are treated with a sliding compression hip screw and side plate or with a nail placed inside the bone.

On timing, the AAOS plain language summary titled The Management of Hip Fractures in Older Adults, published in 2024, is precise about its evidence grade. Moderate evidence shows surgical treatment should be within 24 to 48 hours following hospital admission, because that is associated with better patient outcomes. The same document estimates 325,000 hip fractures a year in the United States, most of them in women over 65.

Calling that a clock overstates it, and the correction matters at the bedside. The same AAOS summary adds that the window may not always be possible, because of the patient's underlying health factors or resources within the medical facility such as the availability of the surgical team or an operating room. The OrthoInfo article goes further and says that getting a patient medically ready, a process AAOS calls optimization, should ideally happen within 48 hours, but that even when it takes longer it is better to be optimized than to rush to surgery. So the hour count on its own does not tell a family much. The question worth asking the surgical team is which kind of delay this is: a patient still being made ready, or an operating room that is not free.

What is not in dispute is the cost of lying still. AAOS writes that treating the fracture and getting the patient out of bed as soon as possible helps prevent complications including bed sores, blood clots, and pneumonia. It adds that in very old patients prolonged bed rest can lead to disorientation, which makes rehabilitation and recovery much more difficult. Most patients are able to get out of bed and start physical therapy the day after surgery.

Weight-bearing rules differ by operation, and the two sets are easy to confuse. After internal fixation, AAOS says the doctor will let the patient know whether weight-bearing is allowed immediately or restricted. After a hip replacement, AAOS says the patient can bear weight fully right away unless complications appear. Ask for that instruction in writing before discharge.

Discharge is the decision that shapes the next year

Before your parent leaves the hospital, the care team will present options for where they go next. AAOS describes the split plainly: many patients go home after hip fracture surgery, but some will need short-term care in a rehabilitation facility, usually patients who are elderly or have no caregivers at home. Patients who go to a rehabilitation facility stay until they can walk independently and manage daily activities. Patients who go directly home get in-home physical therapy until they are strong enough for therapy at an outside facility.

Underneath that clinical frame sits a set of coverage rules that removes some of the options before anyone in the family gets to weigh them, and those rules are worth reading before the discharge planner walks in.

Skilled nursing facility

A skilled nursing facility provides nursing and therapy care that, in Medicare's words, can only be safely and effectively performed by or under the supervision of professionals or technical personnel. Medicare-covered services there include a semi-private room, meals, skilled nursing care, physical therapy, occupational therapy, medical social services, medications, and medical supplies and equipment used in the facility.

Medicare attaches conditions to that coverage. It covers a stay only after a qualifying inpatient hospital stay, which Medicare defines as a medically necessary inpatient stay of at least 3 days in a row. The count starts on the day of inpatient admission and does not include the day of discharge. Your parent has to enter the facility within a short time, generally 30 days, of leaving the hospital. A doctor or other provider has to decide that daily skilled care is needed. Medicare notes two exceptions to the 3-day rule: some Accountable Care Organizations hold a Skilled Nursing Facility 3-Day Rule Waiver, and Medicare Advantage plans may also waive it.

On cost, Medicare's 2026 figures are $0 a day for days 1 through 20 once the $1,736 deductible is paid, $217 a day for days 21 through 100, and all costs from day 101. Part A limits coverage to 100 days in each benefit period. Medicare adds a carve-out that matters on this care path: you do not have to pay the Part A deductible for skilled nursing facility care if you already paid it for care you got in a hospital during the same benefit period.

The eligibility wording on that benefit is worth reading closely. Medicare's own page states the standard as needing skilled nursing care or therapy to improve or maintain your current condition, or to prevent or delay it from getting worse. If a facility tells your family that coverage ends because your parent has stopped progressing, that is a claim worth checking against Medicare's own wording.

Home with home health

Medicare's home health benefit brings part-time or intermittent skilled nursing care, physical therapy, occupational therapy, and speech-language pathology services to the house. Home health aide care is included only if your parent is also getting one of those skilled services at the same time. Medicare says home health care is usually less expensive and more convenient than care in a hospital or skilled nursing facility, and that depending on a person's needs it can also be just as effective.

Eligibility turns on being homebound, and Medicare defines that as two conditions together:

• Leaving home is not recommended because of the condition, or takes help such as a cane, wheelchair, walker, crutches, special transportation, or another person.
• The person is normally unable to leave home, and leaving takes a lot of effort.

Someone can still leave for medical treatment, for short infrequent non-medical absences such as religious services, and for adult day care. Medicare states one disqualifier in the same breath: you will not qualify for home health services if you need more than part-time or intermittent skilled care.

The gap families hit is what Medicare explicitly does not pay for:

• 24-hour-a-day care at home.
• Home meal delivery.
• Homemaker services unrelated to the care plan.
• Custodial or personal care with bathing, dressing, or using the bathroom, when that is the only care needed.

Covered home health services cost nothing. Durable medical equipment costs 20% of the Medicare-approved amount after the Part B deductible, and visits are as often as the provider orders. Medicare puts a ceiling on the hours. In most cases part-time or intermittent means skilled nursing care and home health aide services up to 8 hours a day combined, for a maximum of 28 hours a week. More frequent care may be possible for a short time, less than 8 hours a day and up to 35 hours a week, if the provider decides it is necessary.

Outpatient therapy

Outpatient therapy means traveling to a clinic, which takes enough baseline function to manage transportation and waiting. Medicare covers outpatient physical therapy to restore or improve physical movement after an injury, illness, or surgery, and also to improve or maintain current function or slow the rate of decline. A doctor or other provider has to certify that it is needed. After the Part B deductible, the patient pays 20% of the Medicare-approved amount, and Medicare says there is no limit on how much it pays for medically necessary outpatient therapy in one calendar year.

The three questions that separate the paths

AAOS ties the rehabilitation-facility route to age and to the absence of caregivers at home, and Medicare ties the home health route to being homebound and needing skilled care. Between them, three questions do most of the sorting:

• Can your parent follow the therapist? Weight-bearing restrictions only work if the person remembers them. The AAOS summary notes that interdisciplinary hip fracture care programs specifically address memory and confusion issues, especially in patients with dementia or other cognitive problems, so raise a known cognitive impairment with the team on day one.
• Does the house work? A bedroom and bathroom reachable without stairs, a bathroom that fits a walker, and a route that can be walked at night. The home preparation section below covers what to change and in what order.
• Who is there between visits? Medicare's usual ceiling is 8 hours a day combined and 28 hours a week, with up to 35 hours a week possible for a short time if the provider decides it is necessary, and it does not cover 24-hour care at home. Someone in the family holds the remaining hours. Name that person before discharge, not after.

Observation status can cost the rehab benefit

Observation status is worth understanding before discharge day. Medicare states that time spent at the hospital under observation, or in the emergency room before admission, does not count toward the 3-day qualifying inpatient hospital stay, even if the patient is there overnight. A parent can spend three nights in a hospital bed, be treated the whole time, and still fail the test, because the hospital classified the stay as outpatient observation.

Medicare's guidance is to always ask the doctor or hospital staff whether Medicare will cover the skilled nursing facility stay. Ask on day one, not on discharge day. If your parent does not have a qualifying stay and still needs care afterward, Medicare suggests asking about care in other settings such as home health, or whether other programs such as Medicaid or Veterans' benefits can cover it.

There is also a route backward. Medicare says a patient who was admitted as an inpatient and then had their status changed to outpatient getting observation services may be able to appeal the denial of Part A inpatient coverage that came from that change. Such appeals reach back to January 2009. If the appeal is approved, Part A may cover the hospital and, where appealed, the skilled nursing facility services.

Blood clots, delirium, and depression drive the decline

Blood clots

The National Heart, Lung, and Blood Institute writes that the risk of developing venous thromboembolism is highest after major surgery, major injury, or during periods of infection and inflammation. NHLBI gives two reasons: clots can develop in veins damaged by surgery or injury, and lack of movement after surgery raises the likelihood of clotting. NHLBI lists swollen and tender legs that are painful to the touch as a sign of a deep vein thrombosis. Shortness of breath and pain when breathing are signs of a clot that has traveled to the lungs.

MedlinePlus's pulmonary embolus article, reviewed in October 2025, adds more signs:

• Chest pain that is sharp, stabbing, burning, or aching, and often worse with deep breathing.
• Dizziness or fainting.
• Fast breathing, a fast heart rate, or low blood pressure.
• Leg pain, redness, or swelling.
• A sudden cough that may bring up blood or bloody mucus.

Its instruction is direct. Go to the emergency room or call 911 or the local emergency number if you have symptoms of a pulmonary embolus.

Prevention is already built into standard care. AAOS says patients are placed on a blood thinner after hip surgery, given as pills or injections, with the doctor determining how long it continues. AAOS adds that compression boots may be placed on the legs while the patient is in bed. The AAOS plain language summary adds that early movement lowers the chances of developing a clot and that compression stockings may be prescribed. MedlinePlus says pressure stockings, where prescribed, should be worn as instructed. Anything about dose, schedule, or blood testing belongs with the prescribing physician, and asking for those instructions in writing at discharge is reasonable.

Delirium after surgery

In the days after an operation, some older patients become confused, agitated, or start seeing things that are not there. MedlinePlus describes delirium as a mental state of confusion and disorientation that usually starts suddenly and is often temporary and treatable. Its list of causes includes surgeries and reactions to anesthesia, hospitalization, medicines such as sedatives or opioids, severe pain, sleep deprivation, and infection. Older age, having surgery, and being in a hospital are all listed as things that raise the risk.

Delirium is not dementia, and MedlinePlus draws the line by behavior, not by cause. Delirium starts suddenly, can cause hallucinations, is mainly a problem with attention and staying alert, and can get better or worse over hours or weeks. Dementia develops slowly, does not cause hallucinations, and usually starts with memory loss. A person can have both.

MedlinePlus's encyclopedia article on delirium, reviewed in October 2025, says delirium often lasts about 1 week. It adds that it may take several weeks for mental function to return to normal, and that full recovery is usually expected but depends on the underlying cause. The MedlinePlus delirium topic page gives a wider window, saying recovery may take some time, weeks or sometimes even months. Its instruction to families is to contact the health care provider if there is a rapid change in mental status. A parent who is still not themselves at week three is inside what the source describes, and is also worth a call.

The first question is what is causing it. MedlinePlus says treatment of delirium focuses on its causes and symptoms, that the first step is to identify the cause, and that treating the cause often leads to a full recovery. So ask the team what they are looking for. The rest is environmental. MedlinePlus lists keeping the room quiet and well-lit, having clocks or calendars in view, having family members around, and making sure the person has their hearing aid, glasses, or other communication devices. It also says hospitals can lower the risk by avoiding sedatives, keeping rooms quiet and calm, and having the same staff members treat the person each day where possible. When confusion arrives fast and severe, sudden confusion in an elderly parent walks through what a doctor rules out first, and the point at which the answer is 911.

Depression in the weeks after

The National Institute on Aging writes that depression is a common problem among older adults but is not a normal part of aging, and that it can be hard to recognize because sadness is not always the main symptom. Some people feel emotional numbness or a lack of interest in activities instead, or are less open to talking about feelings than younger adults.

NIA's symptom list includes:

• A persistent sad, anxious, or empty mood.
• Feelings of hopelessness, guilt, worthlessness, or helplessness.
• Irritability, restlessness, or trouble sitting still.
• Loss of interest in once-pleasurable activities.
• Decreased energy or fatigue.
• Moving or talking more slowly.
• Difficulty concentrating, remembering, or making decisions.
• Difficulty sleeping, waking up too early, or oversleeping.
• Eating more or less than usual.
• Thoughts of death or suicide.

NIA's threshold is specific. If several of these signs last more than two weeks, talk with a doctor, because untreated serious depression may lead to death by suicide.

One item on that list does not wait two weeks. Where there are thoughts of death or suicide, NIA's own instruction is immediate:

• If you are thinking about harming yourself, tell someone who can help immediately.
• Do not isolate yourself.
• Call a trusted family member or friend.
• Call 911 or go to a hospital emergency room to get immediate help.
• Make an appointment with your doctor.

NIA gives the number with it: the 24-hour 988 Suicide & Crisis Lifeline at 988 or 800-273-TALK (800-273-8255). For TTY, use your preferred relay service or dial 711, then 988. NIA also notes that certain medications or medical conditions can cause depression symptoms, which is one reason the doctor rules those out first.

A parent who has just lost their mobility has an obvious reason to feel low, which is exactly why these symptoms get explained away in the weeks when they first appear. NIA's position is that depression in older adults is not part of normal aging and that the warning signs should not be ignored. Raising it with your parent is the harder half, and recognizing depression in a parent covers what to say first.

Will my parent walk the way they did before?

Every family asks this question, and no source answers it in advance for an individual person. AAOS says hip fractures in the elderly may cause disability and lack of independence, and that early movement and rehabilitation have been shown to improve long-term results. It also says patients recovering from these fractures often need more assistance in their daily lives and experience a stepwise decrease in their level of function afterward. That last phrase is the honest one. A step down is common, and its size is what rehabilitation works on.

Fear of falling is part of the picture and has its own effect. The National Institute of Arthritis and Musculoskeletal and Skin Diseases writes that after breaking a bone a person may be afraid of falling again and may feel they need to avoid exercise. Avoiding exercise, NIAMS says, makes you lose more bone and muscle. So the fear is worth naming out loud with the therapist, who can set up supported activity instead of a stop.

Ask the surgical team what they expect for your parent, then ask the therapist again a few weeks in. The second answer is usually better than the first, because it is based on how your parent is actually moving.

Home changes happen before discharge day

The house has to be ready when your parent arrives, not a week later. NIAMS publishes a list of home safety changes in Preventing Another Broken Bone, last reviewed in May 2023, and it opens by noting that most falls happen in the home.

• Bathroom: NIAMS lists grab bars on bathroom walls next to tubs, showers, and toilets, a bathmat in the shower or tub, and, for someone unstable on their feet, a plastic chair with a back and nonskid leg tips in the shower. Our guide to grab bar installation covers where each bar goes and how to anchor it.
• Bathing: If a tub conversion or a walk-in shower is on the table, the walk-in tubs and showers guide covers what to look for before buying.
• Floors and pathways: NIAMS lists keeping every room, especially the floors, free of clutter. It also lists making sure carpets and area rugs, including on stairs, have skid-proof backing or are tacked down, and keeping electrical cords and telephone lines out of places where someone might walk.
• Stairs: NIAMS says all staircases should have good lighting and handrails on both sides. Where stairs sit between the bedroom and the bathroom, moving the bed downstairs for the recovery period removes the trip entirely.
• Lighting: Nightlights around the home, and a flashlight with extra batteries next to the bed, both from the NIAMS list. The night route to the bathroom is the one to walk yourself, in the dark, before your parent has to.
• Shoes: NIAMS lists supportive, low-heeled shoes with non-skid soles, and boots with rubber soles outdoors in winter.

AAOS says patients work with physical and occupational therapists during recovery, and that those therapists show patients how to manage daily activities such as bathing and dressing. If a home safety assessment is offered before discharge or at the first home health visit, it is worth taking, because a therapist is looking at the house as a work surface for someone with a walker.

Second fractures are the risk to work on now

NIAMS is blunt about what this fracture usually means. If a person 65 or older has broken a hip or a vertebra in the spine, there is a good chance the fracture is related to osteoporosis, and a doctor will probably do some testing to find out. NIAMS also gives the window: for older adults, the risk of breaking another bone is highest in the year or two after the first break, which is why it says to take steps as soon as possible after a fracture.

NIAMS names four levers, and avoiding falls is the first, since having one fall increases the risk of another. Medicines can help prevent fractures in older adults with osteoporosis who have had a fracture, and the doctor may recommend one. Other medicines already being taken can be reviewed, because drugs with side effects like dizziness or confusion could increase fall risk, and NIAMS gives certain treatments for depression and other mood disorders, pain, or heart failure as examples. Vitamin D and calcium come up because not getting enough vitamin D can weaken muscles, and weak muscles increase the chance of falling.

Exercise is the fourth, and NIAMS routes it through a provider. NIAMS says the doctor might refer a person to a physical therapist or another provider for an exercise plan. Such a plan might combine weight-bearing exercise, resistance training, and balance exercises, and is meant to help strengthen bones and muscles and reduce the risk of falls. The AAOS plain language summary makes the same point from the surgical side, saying physical and occupational therapy in the hospital and after discharge is recommended to improve function and help prevent future falls and a possible secondary fracture.

Two smaller items from the NIAMS list are easy to schedule and easy to forget. Have a doctor check your parent's eyes at least once a year and update glasses if vision has changed, and check with the doctor or pharmacist about side effects of prescriptions and over-the-counter drugs. Where vision is already reduced, our guide to helping a parent with vision loss stay safe covers the home changes that matter most.

For an overview of other health conditions that commonly affect aging parents, visit the health conditions hub.