About five years ago, I accepted a one-year travel position as a full-time physical therapist working in Home Health on the Monterey Peninsula and I had a chance to teach a brand new full-time caregiver about patient advocacy.

My very first case was a patient who had been found facedown by the FedEx man in her driveway after a fall and was transported to the hospital in an ambulance.

After she got out of the hospital, she was unable to return home or live alone again.

About 20-30% of people who fall sustain moderate to severe injuries which prevent them from ever returning home or living alone again.

This is one of the reasons I am so dedicated to promoting best practices, tips and strategies to reduce the risk of falling.

Due to the level of care needed, my new patient’s daughter, Missy retired as a teacher in order to care for her mother full-time.

When I arrived on the scene, the patient had just gotten home from the hospital and Missy had just taken over as her full-time caregiver.

Over the course of the next six months, Missy and I worked together to establish a home program and a caregiving routine that Missy felt comfortable with to maximize the quality of life for her mother.

Her mother was a lot of fun to work with and quite a lovely woman, but she did not like to exercise and she had difficulty with her memory, so she did require full-time care and advocacy.


Once Missy was independent and confident with all aspects of caregiving and a good plan was in place to ensure that her mother had the best quality of life possible, I discharged that patient from home health.

I have continued to keep in touch with Missy over the years and to be a support for her as she has gone through many different challenges in caregiving for her mother, as her mother’s condition has evolved over time.

Recently, I was privileged to receive a phone call from Missy and a request for support because her mother had fallen and broken her hip. She told me her mother also had pneumonia recently and had a new pacemaker.

Due to the hip fracture, she was going to be unable to walk for the next six weeks, or non-weight bearing.


Therefore, she was going to lose significantly lose muscle strength. 


Missy’s initial question was whether it would be best to rehabilitate her mother using home health physical therapy or in a nursing home once the orthopedic surgeon cleared her to try to walk again.

Since I already knew that her mother did not like to exercise and I am well aware that the amount of exercise and effort to recover from six weeks without any walking after a hip fracture would have required an absolutely tremendous effort on her part, I gently initiated the conversation with Missy about making her mom comfortable and considering hospice.

Without missing a beat, Missy said “If that’s what’s in my mom’s best interest, I will discuss it with her doctors and see what they think.”

The next time I heard from Missy was to share that her mother had passed away peacefully without any pain while her son-in-law was holding her hand.


Having witnessed many pecaregiver, preventing falls, fall prevention, advocacyople go through death and dying at this point in my career, I can honestly say that the quality of life for Missy’s mom at her end-of-life was the best it could possibly have been and it was the best gift that I believe any daughter can give to her mother.

Missy’s dedication to caring for her mother, her commitment to learning all aspects of caregiving and her tireless advocacy under all circumstances paid off in the end.

With Missy’s permission, I’m sharing with you this beautiful photo of her mother and the story in order to help you understand how important it is to get involved with the quality of care of an older person once they can no longer advocate for themselves. 

It is a selfless act – an expression of true love.


This blog was written with permission and approved by Missy Sepulvado.


This blog is provided for informational purposes only. The content and any comments by Dr. Kim Bell, DPT are not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. The details of any case mentioned in this post represent a typical patient that Dr. Bell might see and do not describe the circumstances of a specific individual.

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