Recognizing a possible hip fracture
- Sudden severe pain in the hip, groin, or upper thigh
- Inability to bear weight or stand
- The affected leg appears shorter than the other, or the foot/leg is rotated outward
- Visible swelling at the hip or upper thigh
- Bruising may take hours to appear — its absence does not rule out a fracture
- In older adults with dementia or high pain tolerance: unusual stillness, refusal to move, or sudden agitation with no obvious cause
What to do immediately
Do not move the patient. Do not attempt to help them stand or walk.
- Call an in-home urgent care service like DispatchHealth if available in your area — some can send a provider with portable X-ray equipment to confirm or rule out a fracture on the spot, avoiding an ambulance and ER unless one is truly needed.
- Outside their hours or coverage area, call the 24/7 nurse advice line on the back of your parent's insurance ID card for triage.
- If the patient is in severe distress, unconscious, or shows signs of serious injury, call 911 immediately.
While waiting: keep them warm with a blanket, place a small pillow under the head if available, don't give food, water, or pain medication (surgery may require an empty stomach), keep them still and talking if alert, and note the exact time of the fall for the clinical team. Don't apply ice directly to the hip.
Treatment: what actually happens
Surgery is required for the large majority of hip fractures in older adults. Non-surgical management is reserved for patients too medically unstable for anesthesia, and even then it's a last resort — prolonged bed rest carries its own serious risks. Which procedure is used depends on where the break is:
- Fractures near the femoral neck (closer to the hip joint) are often treated with a partial or total hip replacement, especially when the patient was already less mobile before the fall.
- Fractures lower down (intertrochanteric or subtrochanteric) are typically repaired with a metal plate and screws or a rod, rather than replaced.
Ask the surgical team which was done and what weight-bearing status it means — that detail changes the home safety setup below. Surgery within 24–48 hours of the fracture is standard and improves outcomes; delays are usually about stabilizing other medical issues (heart, blood thinners, blood sugar) enough to safely tolerate anesthesia, not about scheduling.
Recovery timeline: what to actually expect
Recovery time varies a lot by age, prior mobility, and fracture type — treat any specific timeframe as a rough guide, not a promise.
- Day of surgery to day 2:most patients are helped to sit up or stand with a walker within 24–48 hours. Getting moving early, even briefly, meaningfully lowers the risk of pneumonia, blood clots, and further deconditioning.
- First 1–2 weeks: hospital or short-term rehab facility, daily PT — the highest-risk window for the complications covered below.
- Weeks 2–6:home or continued rehab, PT 2–3 times a week, weight-bearing increases gradually per the surgeon's specific restrictions.
- Weeks 6–12:most patients progress from a walker toward a cane, if they're going to. It usually becomes clearer around now what the new normal will look like.
- 3–6 months and beyond:strength and confidence keep improving gradually. Some older adults return to their exact prior mobility; many settle into a new, somewhat lower baseline instead — that's a common outcome, not a sign that something went wrong.
The single biggest lever a caregiver actually controls is attendance and consistency at PT — see "Fear of moving again" below.
The first 72 hours after discharge — the highest-risk period
Wound and surgical site: watch for increasing redness, warmth, or swelling; drainage that persists or increases; fever above 101°F; or wound edges separating.
Blood clot warning signs — call the surgeon or urgent care immediately: significant swelling in the calf, ankle, or foot of the operated leg; new calf pain or tenderness; warmth in the lower leg. Sudden shortness of breath, chest pain, or rapid heart rate is a possible pulmonary embolism — call 911.
Mental status: increased confusion or disorientation is common post-surgery, from anesthesia, pain medication, disrupted sleep, or an underlying UTI. If confusion is sudden or severe, call the surgeon's after-hours line — don't wait.
Medication-related: constipation from opioid pain medication is nearly universal — a stool softener should be used without exception, and no bowel movement in 3 days warrants a call. Watch for oversedation (difficult to wake, slow breathing) — call 911 if this happens.
Positioning: follow weight-bearing restrictions exactly as given at discharge. Don't let the patient cross their legs, bend the hip past 90 degrees, or rotate the foot inward — these risk dislocating the joint. Elevated toilet seats and raised seating are dislocation prevention, not a comfort extra.
Pain management
The goal is pain controlled enough to participate in recovery, not zero pain. Take medications on schedule, not just when pain peaks. Don't skip doses to save medication for later — undertreated pain slows recovery. If prescribed medication isn't controlling pain adequately, call the surgeon's office rather than doubling doses. Stool softeners must accompany any opioid without exception.
Call immediately for: a sudden sharp increase in pain beyond baseline, a pop or click sensation (possible dislocation), or numbness/tingling/inability to move the foot or toes.
Preventing a second fall
A second fall is the primary risk during recovery. Before your parent comes home:
- Remove all throw rugs and loose mats; clear pathways of cords, furniture edges, and clutter
- Ensure adequate lighting everywhere, with nightlights for nighttime bathroom trips
- Install grab bars at the toilet and inside the shower or tub
- Raise the toilet seat — the patient can't bend the hip past 90 degrees
- A bedside commode eliminates nighttime bathroom trips, the highest-risk time for falls
Transfer technique: stand on the patient's operated side, provide a stable arm rather than a push. "Up with the good, down with the bad" — lead with the non-operated leg when standing, the operated leg when sitting. Never rush a transfer.
Fear of moving again is normal — and it needs a response, not pressure
The fear is rational; the patient fell once and knows what it cost them. Frame movement as the treatment, not the obstacle — the more they move, the faster the hip heals — and celebrate small milestones without adding pressure for more. If the patient refuses PT for the day, don't argue; confirm tomorrow's session and report the refusal to the PT. Refusal for 2 or more consecutive days needs a call to the physical therapist and surgeon — prolonged immobility causes blood clots, muscle atrophy, and contracture.
Physical therapy and Medicaid coverage
Physical therapy is a covered Medicaid benefit in Virginia, including home PT for patients who can't travel to a clinic. Home PT requires a physician order — this should be issued at discharge; if it wasn't, call the surgeon's office and request it. Your Medicaid managed care plan must authorize the visits (typically 2–3 per week for 4–6 weeks); if authorization is delayed, call the member services line on the back of the Medicaid ID card and ask for expedited prior authorization for home PT following hip surgery.
Ankle pumps — moving the foot up and down every hour the patient is awake — help prevent blood clots between PT visits. The caregiver's role is to prompt the exercises, not perform them for the patient.
Common questions
How long does hip fracture recovery take in an elderly parent?
Most older adults spend 1–2 weeks in a hospital or short-term rehab, then continue improving over roughly 3 to 6 months. Reaching a stable new normal — not necessarily identical to pre-fracture mobility — commonly takes several months of consistent physical therapy.
What is the treatment for a hip fracture in an older adult?
Surgery, in almost all cases — either a hip replacement or a plate/screws/rod repair depending on where the break is, usually performed within 24–48 hours of the injury. What determines which procedure is used is covered in the Treatment section above.
Can an elderly person fully recover from a broken hip?
Many do, especially with prompt surgery and consistent PT attendance. Some settle into a somewhat lower mobility baseline instead — using a cane or walker where they didn't before. Both are common outcomes, not a sign that care went wrong.
What does a hip fracture care plan actually include?
Surgery, then a structured PT schedule, home safety changes to prevent a second fall, a plan for pain and constipation management, and close monitoring for infection, blood clots, and confusion in the first 72 hours after discharge.