The phone rings early in the morning. Your mom slipped on the way to the bathroom, and the emergency room doctor says she broke her hip. By afternoon, a surgeon is talking about pins and screws, and a case manager is already asking where she'll go after the hospital. You're trying to understand what recovery will look like and how to help.
Hip fractures are common in older adults, and most happen because of a fall4. Weak bones from osteoporosis make breaks more likely5. The recovery is long, and it's hard work for your parent and your family. But many older adults regain much of their mobility with good surgery, early movement and steady rehab. This guide walks through each stage and what you can do. It's general information. Your parent's surgeon and therapists will tailor the plan.
Hip fracture surgery
Most older adults with a broken hip have surgery, often within a day or two. Without surgery, a person may need to stay in bed or a chair for months, which can lead to life-threatening problems1. The type of surgery depends on where the bone broke and your parent's health1:
- Pinning with screws. For some breaks in the neck of the thighbone.
- A plate or nail with screws. For breaks just below the neck of the thighbone.
- Partial or total hip replacement. When the break may not heal well with screws, the surgeon replaces the ball, or both the ball and socket, of the hip joint.
Surgery is usually done under general or spinal anesthesia. Ask the surgeon what kind of fracture your parent has, which surgery is planned and why, and how much weight they'll be allowed to put on the leg afterward.
When surgery may not be the right choice
For a small number of older adults who are very frail, at the end of life, or too ill for anesthesia, the family and medical team may decide against surgery. In that case, the focus shifts to pain control, careful positioning, preventing pressure sores and keeping the person comfortable. See our guide to bed sores. Because long periods in bed or a chair carry serious risks1, this is a hard decision. Ask the surgeon and, if helpful, a palliative care team to explain what each path would likely mean for your parent's comfort and daily life. See hospice vs. palliative care.
The hospital stay
A typical hospital stay after hip fracture surgery is about three to five days1. Staff usually help patients out of bed and into a chair the day after surgery, then start walking with a walker or crutches1. That early movement matters. Many problems after hip surgery, such as blood clots, pneumonia and pressure sores, can be prevented by getting up and moving as soon as possible1.
Families can help by visiting, encouraging your parent to do breathing and ankle exercises, bringing glasses and hearing aids, and keeping a familiar routine. Ask whether your parent is an inpatient or under observation, since that affects Medicare coverage for rehab afterward. See Medicare observation status.
Confusion after a hip fracture
Sudden confusion, called delirium, is common in older adults after a hip fracture and surgery, especially in people who already had memory problems1. Your parent may be agitated, sleepy, or see things that aren't there. It often improves as they heal, but it should be treated as a medical problem.
- Tell the team right away if your parent seems more confused than usual.
- Bring glasses, hearing aids and familiar objects.
- Help keep days bright and active, and nights quiet and dark.
- Ask about pain control, since both pain and some pain medicines can add to confusion.
- Ask about infections, dehydration and constipation, which can make confusion worse.
Our guides to UTIs in older adults and dehydration explain two common causes of sudden confusion.
Where rehab happens next
Before discharge, your parent must be able to move safely with a walker or crutches, do their exercises correctly, and have a home that's ready, or they'll need more time in a rehab setting1. The main choices are:
- Inpatient rehabilitation facility. Intensive therapy for people who can take part in several hours a day, with close medical oversight. Medicare covers it when a doctor certifies it's medically necessary2.
- Skilled nursing facility. Daily therapy at a gentler pace plus nursing care. Medicare covers it after an inpatient hospital stay of at least three days, for a limited time3.
- Home with home health. Visits from nurses and therapists for people who are homebound6.
- Outpatient therapy. Once your parent can travel to a clinic.
You can ask which facilities have openings and good results, and you can choose. Read skilled nursing facility vs. nursing home and hospital discharge planning. If coverage ends before your parent is ready, see when Medicare stops paying for a nursing home.
Hip fracture recovery time
Every recovery is different, but a rough outline looks like this:
- First days. Surgery, pain control, sitting up and first steps with a walker1.
- First weeks. Rehab in a facility or at home, building strength and learning safe ways to move, bathe and dress.
- Weeks to months. Many people use a walker or crutches for weeks or months, then move to a cane as strength returns1.
- Three months to a year. Full recovery can take from three or four months to a year1.
Some older adults return to their earlier level of activity. Others need more help than before, at least for a while. Factors that affect recovery include strength and health before the fall, memory problems, and how quickly your parent gets moving after surgery. Ask the therapists for honest goals and check progress together. Progress is rarely a straight line. A bad week, a minor illness or a setback in confidence is common, and it doesn't mean recovery has stopped. Keep a simple log of walking distance, pain and sleep so you can show the therapists and doctor how things are going over time.
Getting the home ready
Prepare the home before your parent returns78:
- Remove loose rugs, cords and clutter from walking paths.
- Add good lighting, including night-lights to the bathroom.
- Install grab bars in the shower and by the toilet, and use a non-slip mat.
- Get a raised toilet seat and a shower chair.
- Set up a bed low enough that feet touch the floor when sitting on the edge.
- Use firm chairs with armrests, not low, soft sofas.
- Put everyday items between waist and shoulder height.
If stairs are a problem, consider setting up a bedroom on the main floor for a while. See aging in place for more home changes.
Daily life during recovery
- Follow movement rules. Your parent may be told not to cross their legs, bend far at the hips or sit in low chairs, depending on the surgery8.
- Keep moving. Avoid sitting for more than about 45 minutes without getting up8.
- Do the exercises. Every day, as the therapist taught.
- Watch the incision. Call the surgeon for increasing pain, foul-smelling drainage, or spreading redness8.
- Watch for clots. Get urgent care for new leg swelling or pain, chest pain or trouble breathing.
- Eat well. Protein, calcium and vitamin D help healing and bone health5.
Help with bathing, dressing and errands may be needed for weeks. Home health covers skilled care for homebound people, but not ongoing help with daily tasks. See does Medicare pay for home health care and home care vs. home health.
Questions to ask the care team
- What type of fracture and surgery does my parent have?
- How much weight can they put on the leg, and for how long?
- Which movements should they avoid at home?
- Do you recommend inpatient rehab, a skilled nursing facility or home health, and why?
- What equipment will they need, and who orders it?
- What signs should make us call you or go to the emergency room?
- Should they have a bone density test or osteoporosis treatment?
Write down the answers or ask for them in writing, and share them with siblings and any paid caregivers so everyone follows the same plan. Keep a printed copy near the phone in case of an emergency at home.
Paying for help after rehab
Medicare covers skilled rehab and home health when the rules are met, but it doesn't pay for ongoing help with bathing, dressing, meals or supervision9. Many families combine help from relatives with a few hours of paid home care each week while their parent regains strength. Long-term care insurance, VA benefits and Medicaid waiver programs may help in some cases10. If your parent needs help for months, compare the options in home care agency vs. private caregiver and Medicaid waivers for home care.
Preventing another fracture
A person who has broken one hip is at higher risk of another fracture. Talk with the doctor about:
- Bone health. A bone density test and osteoporosis treatment, if appropriate5.
- Why the fall happened. Dizziness, vision, medicines, blood pressure or footwear1.
- Strength and balance. Ongoing exercise, such as programs a physical therapist recommends4.
- Medicine review. Some medicines raise fall risk.
Read fall prevention for older adults for a full checklist.
Mood, confidence and family support
Many older adults feel frightened, frustrated or low after a hip fracture. Some develop a fear of falling that keeps them from moving, which slows recovery. Encourage small goals and celebrate progress. Watch for signs of depression and tell the doctor promptly if you see them. See depression in older adults.
Family caregivers carry a lot during these months. Share tasks among siblings, accept help, and take breaks. If your parent can't safely return to living alone, it may be time to talk about more help at home or a move. See signs it's time for senior living and caregiver burnout.
