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That seemed pretty odd to me, too. It would seem that either my husband qualified or he did not qualify for inpatient rehab. What the doctor seemed to be saying was that if my husband qualified for inpatient rehab at the hospital, at three hours of rehab a day, then he would be released so much earlier than if he was sent to some random "nursing home rehab" place where he would get maybe an hour of rehab a day but would stay much longer if he went to a nursing home. So perhaps, my husband would be over the first critical six weeks after his brain had swelled and bled (or something like that) if he went into a nursing home paid by Medicare ...
I tried to get my mother (age 87 then) into a rehab center after she was dismissed from the hospital less than 48 hours after having a hip replacement. She could not walk, bathe or dress herself, needed to have special hosiery put on her legs, had medication to take, and had special exercises to do. Needless to say her care, as she was a constant fall risk, was a 24-hour job. But her insurance would not cover even a day in the rehab. Why? Because her insurance deems joint replacement surgery to be "elective."
Honestly, I don't how emergency surgery a person had to have after an accident like your husband suffered could be called "elective." As other have suggested, I would agree that you should fight for a rehab stay for him. He needs "rehabilitation" quite LITERALLY. Most people do after a lengthy ICU stay. My mother was in a rehab for weeks once after emergency surgery, necessitated by bad care when she was in the hospital for a "routine procedure." She almost died and spent two weeks in the ICU, then another week in a regular hospital room.
Once a hospital determines that they can no longer provide care that will will "cure" the patient, the insurance companies insist the patient be discharged. But if a patient still can't make it at home without extensive assistance, most insurances cover a rehab stay or some amount of home health care therapy.
My mother's rehab was at the national chain called "Health South" and they were excellent with her. She had physical rehab multiple times a day, a special diet, someone to dress and bathe her, extensive testing related to her swallowing (her throat was damaged during surgery), etc., etc. For anyone to make a blanket statement that patients only get an hour a day of physical therapy in a rehab hospital was certainly wrong in my mother's case. No way could I have done for her at home what they did for her there. That's why I wanted her to go back after her hip replacement.
My mother's rehab was at the national chain called "Health South" and they were excellent with her. She had physical rehab multiple times a day, a special diet, someone to dress and bathe her, extensive testing related to her swallowing (her throat was damaged during surgery), etc., etc. For anyone to make a blanket statement that patients only get an hour a day of physical therapy in a rehab hospital wascertainly wrong in my mother's case. No way could I have done for her at home what they did for her there. That's why I wanted her to go back after her hip replacement.
Thanks for sharing your comments about rehab. It is possible that you were referring to one of my posts (with the bolded sentence) but what the doctor told me was that there would be three hours per day of therapy in a specific rehab hospital and if a patient could not handle three hours of therapy a day they could be sent to a nursing home that also provided rehab, where they would have only one hour of therapy a day.
This may be true in my area, but different in your area. Or true for certain rehab hospitals/nursing homes but not for others. Or this may be a Medicare related rule.
Last edited by germaine2626; 09-13-2015 at 09:40 PM..
where they would have only one hour of therapy a day.
Aw. Docs don't understand all the regs, either. The one hour a day isn't necessarily true.
It IS true that to be in an inpatient rehab, the patient has to be able to participate in three hours of therapy a day. It might be PT and OT. Or PT, OT, and Speech. Depending on the need. And they have to be able to consistently. A couple of days when they can't and the inpatient rehab facility or hospital has to find other placement. There are other odd regulations, too, like how many of certain diagnoses a place can accept.
But in a skilled nursing facility, the regulations just state that the amount of therapy has to be medically necessary. And it is all based on a complex system of minutes, days, and how many therapy disciplines are treating.
One person might need and get 720 minutes a week (or a bit more). Another might only tolerate 325 minutes a week. The facility gets a daily rate based on the amount of therapy a person participates in and the level of nursing care they need.
But, mercy, don't try to absorb all that. It sounds like you are busy enough seeing he is cared for appropriately at the hospital.
I sure wouldn't be afraid of letting him get rehab at a nursing home, though. A high percentage of people who enter nursing homes for rehab go home and do very well.
There are two major kinds of "Rehab hospitals" you can be sent to after you are in the hospital.
The best kind is called an ACUTE rehab hospital. These hospitals are the ones that require you to be able to do at least 3 hours of rehab a day. They tend to have more providers, more resources/equipment, and better recovery rates. They tend to prefer patients that have a good potential for improvement over a reasonable period of time, and their goal is to get you back home, as independent as possible. But they also require that you have an ongoing medical need that requires more frequent oversight (nurses rounding daily and doctors overseeing daily).
The other kind of rehab hospital is called SUBACUTE rehab. These are essentially nursing homes. You typically only get 1 hour of therapy a day. Doctors only tend to peek in once a month. But a lot of people refer to them as "rehab" hospitals too. So it gets confusing.
Acute rehab hospitals cost the insurance companies more than subacute rehab hospitals. So your insurance is more likely to refuse the acute rehab coverage unless your doctors and therapists in the original hospital document in their notes that you are motivated, able to work 3 hours a day, with a good potential to improvement and that you have the potential to get back home after it is done. They are trying to save money. Often though, the insurance company can be short-sighted. Sometimes it saves them money in the long run to send you to Acute rehab now if your potential to get better is high because a healthy you costs few health care dollars than an unhealthy you.
Push the doctors/therapists to document in their daily notes that your loved one is a good candidate for Acute rehab, if that's what you want. If the doctors ask you "will your loved one be going back home after rehab?", just say yes. WHO KNOWS, so always hope for the best and push.
Here is a link to a nice table discussing the two types of rehab hospitals.
In general, acute rehab is the best place to be if your are motivated to improve.
HOWEVER, sometimes your loved one just isn't in good enough shape to go to acute rehab. They can't participate in 3 hours of therapy or they don't want to. Sometimes that is ok. Sometimes you can actually go home and get therapists to come to your house for awhile or you can do therapy as outpatient. There are many options. Discuss with the physical therapists what they think is the best for your loved one.
But know this..... Medicare has made it MUCH HARDER for us to get into Acute Rehab. They now require rehab centers to focus on admitting patients with certain medical problems that they know do best with Acute Rehab (ex. after heart surgery, after stroke, after spinal cord injury). They also require patients to have many more ongoing medical problems that require close supervision by a doctor. It has been discouraging for us....
I tried to get my mother (age 87 then) into a rehab center after she was dismissed from the hospital less than 48 hours after having a hip replacement. She could not walk, bathe or dress herself, needed to have special hosiery put on her legs, had medication to take, and had special exercises to do. Needless to say her care, as she was a constant fall risk, was a 24-hour job. But her insurance would not cover even a day in the rehab. Why? Because her insurance deems joint replacement surgery to be "elective."
Honestly, I don't how emergency surgery a person had to have after an accident like your husband suffered could be called "elective." As other have suggested, I would agree that you should fight for a rehab stay for him. He needs "rehabilitation" quite LITERALLY. Most people do after a lengthy ICU stay. My mother was in a rehab for weeks once after emergency surgery, necessitated by bad care when she was in the hospital for a "routine procedure." She almost died and spent two weeks in the ICU, then another week in a regular hospital room.
Once a hospital determines that they can no longer provide care that will will "cure" the patient, the insurance companies insist the patient be discharged. But if a patient still can't make it at home without extensive assistance, most insurances cover a rehab stay or some amount of home health care therapy.
My mother's rehab was at the national chain called "Health South" and they were excellent with her. She had physical rehab multiple times a day, a special diet, someone to dress and bathe her, extensive testing related to her swallowing (her throat was damaged during surgery), etc., etc. For anyone to make a blanket statement that patients only get an hour a day of physical therapy in a rehab hospital was certainly wrong in my mother's case. No way could I have done for her at home what they did for her there. That's why I wanted her to go back after her hip replacement.
The problem was the hospital didn't keep her long enough. Both Medicare and Medicare Advantage Plans require a 3-day (full 72 hours) hospital stay before the person is eligible for rehab. It doesn't start at the ER either, the clock doesn't start until they are admitted, and if they get released at 71 hours, it's too bad, they get nothing. Next time insist the hospital keep her an extra day.
Also, I work in nursing home rehab, you get more than an hour a day, normally it's an hour a day of both PT and OT, if they need speech it's another hour.
he problem was the hospital didn't keep her long enough. Both Medicare and Medicare Advantage Plans require a 3-day (full 72 hours) hospital stay before the person is eligible for rehab. It doesn't start at the ER either, the clock doesn't start until they are admitted, and if they get released at 71 hours, it's too bad, they get nothing. Next time insist the hospital keep her an extra day.
Also, I work in nursing home rehab, you get more than an hour a day, normally it's an hour a day of both PT and OT, if they need speech it's another hour.
Absolutely correct. If you're doing caregiving you really need to learn the ropes.
I guess you learn as you go along.
But the basics are: 3 full days in the hospital for rehab, you can refuse to have the patient discharged(this can bide you at least another night), and STRESS to the doctor(like the OP needs to do) that you physically cannot handle taking the patient own due to your own health issues or lack of help.
DO NOT bring up financial hardship like the OP did, they don't care about that. But if you say I physically can't do it, they have to go the rehab route. Because if they try and discharge someone home who doesn't have the help needed they could be held liable.
You have to know patient's rights as a caregiver otherwise you will be bullied. Once you start talking like you know the rules you see a shift in the attitude quickly. They may not like it, too bad. They have to follow the protocol.
A good analogy is going to the car mechanic with some knowledge of cars(even if you have to bluff a little) they realize they're not dealing with a no nothing and can't pull a fast one on you.
Absolutely correct. If you're doing caregiving you really need to learn the ropes.
I guess you learn as you go along.
But the basics are: 3 full days in the hospital for rehab, you can refuse to have the patient discharged(this can bide you at least another night), and STRESS to the doctor(like the OP needs to do) that you physically cannot handle taking the patient own due to your own health issues or lack of help.
DO NOT bring up financial hardship like the OP did, they don't care about that. But if you say I physically can't do it, they have to go the rehab route. Because if they try and discharge someone home who doesn't have the help needed they could be held liable.
You have to know patient's rights as a caregiver otherwise you will be bullied. Once you start talking like you know the rules you see a shift in the attitude quickly. They may not like it, too bad. They have to follow the protocol.
A good analogy is going to the car mechanic with some knowledge of cars(even if you have to bluff a little) they realize they're not dealing with a no nothing and can't pull a fast one on you.
Knowledge is power.
Good points.
BTW, I never told the hospital about my financial issues just my good buddies here on C-D.
And the three days (actually nights, where the patient is there at midnight) have to be logged as "Inpatient."
I've seen some cases recently where hospitals keep people, on the books as "Observation," for several days. Then, in a weakened condition and not being able to go home alone safely, they didn't have a qualified Medicare stay.
There are a few reasons a hospital may do this to their favor. Hospitals are also regulated in who and what can qualify as inpatient.
Dealing with all of it is mental gymnastics for family and/or friends of the patient.
I doubt that there are 3 hours devoted to physical therapy. Odds are that there will be three hours a day at any hospital or facility that can handle brain trauma. They have OT + PT + speech therapy each day. Even the regular skilled nursing facility had 2 hours a day for my mom's broken hip with OT each morning followed by PT at noon.
You can stretch out the rehabilitation if there are physical issues with the home environment that make it unsuitable for your husband at the present time. If he isn't able to use the stairs and his bedroom is on the second floor, they have to work with him until he's able to climb the stairs. At some point, they will discharge him if he doesn't make progress toward this goal (happened with my mom) and you have to make the changes in your home environment to accomodate him.
I would look for the best setting for your husband's dietary needs, whether it is hospital or rehab center or ??? His doctor can prescribe therapy in either place.
Keeping a good thought for the OP and hoping she has had a chance to talk with her husband's doctors by now and explained that taking him home is out of the question.
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