IIRC there are rehab facilities and skilled nursing facilities/nursing homes. Coverage may differ for them, and usually a copay kicks in at day 21 of a SNF so they may try to kick a patient out before that. Also, Medicare will cover only if the patient continues to show progress, and if they don’t (either can’t progress more or have reached maximum expected improvement) then they may no longer meet Medicare’s criteria for continued inpatient care.
At the acute rehab place, my Dad got 3.5 hours of therapy a day. He only got an hour a day at the inpatient rehab place (skilled nursing unit as jym626 describes above). He had a stroke, though, not open heart surgery. But it sounds like your Dad really needs intensive therapy after he gets through this immediate crisis. He should NOT have developed bed sores. It does sound as if he wasn’t getting the care he needed. I hope you can get him admitted and then you can make sure his case manager is doing everything possible for him in terms of the correct therapy and follow up.
True. My Dad continues to improve, thank God, so he is still receiving therapy. Had his stroke at Thanksgiving, and just got discharged from home health to outpatient.
@MaineLonghorn , I am so sorry you are going through this. It brings back very painful memories of what my mother went through. Please, please be sure any bedsores are being properly treated. My mom died as a result of a bedsore that the doctors were supposedly treating (but did not properly treat).
I agree with those that he needs more time in a rehab facility. I always thought you had to be able to “walk” out of those before they sent you home.
I know how frustrating it can be. Imagine our surprise when our grandmother was in a rehab place and we had a “caregiver” meeting. We asked how her wrist was doing. The “caregivers” looked at each other around the table and asked what’s wrong with her wrist. Well she was there, among other reasons, because she broke it.
At the end of the day, you and sis need to be your father’s advocate (make sure you have a healthcare power of attorney so they can talk to you). Trust but verify. If at all possible, I would take the time to get there and send the message to all of the caregivers – stop “fing” around and take care of my dad. Good luck.
I am not making excuses for anything because I have no idea.
But we are at almost full employment right now in the US. So for lower skilled and less well paying jobs, it’s really hard to find qualified people. I was talking to someone today who was talking about how hard it is to find people to work at her Husband’s business.
And I know that my D’s friends who are nurses have their pick of jobs and signing bonuses. So I suspect that it’s hard to find enough nurses to staff.
I’ve been (un)fortunate to see more than a couple rehabs from open heart surgery. The older you get, the harder and longer the recovery is. And that things that are easy to recover from when younger are not when older, even in a very healthy person. And how having one small problem can hinder the recovery of the bigger issue.
It takes a lot a time and patience to recover from major surgery.
But I like the idea of trying home exercises on the days that there is no rehab scheduled.
Like I say, I have no idea. But I do know even in my experiences, what the professionals are saying and what I hear, can be very different.
How old is your father? In having now taken care of a few seniors before they passed I noticed definite “differences” in level of care provided at different ages. I would definitely get him back into a facility from what you are describing and one that has RN staff nursing and either a staff physician or one that stops daily. For one of “my” senior family members I did have home care, but none of the caregivers, PT or CNA, provided the degree of care that I found when I finally moved her to a facility. The idea of institutionalization is usually vehemently opposed by both the senior and sometimes family members, but sometimes it is the best option for stronger 24/7 care. Good luck to you in finding a better solution.
I just want to recommend a website that helped me enormously when I was caring for my mother during her final years. I’m a PT, I used to work in geriatrics, but still it helped me a lot.
So sorry to hear this. My late mother had open heart surgery at age 81 . She came home way too soon because my sister (who she lived with) wanted her home. I spent weeks coming from out of state to assist. She was a small woman but even getting her out of bed was a two person job . After experiencing the difficulty at 81 with bringing someone home, we advocated for having her stay in the hospital or rehab as long as was covered when subsequent hospitalizations came up. My mother had never had to be in a hospital before , except for the birth of her 2 children. It is very sad and stressful to see our parents have these issues as they age. Your dad sounds like he may need to be back in a facility to get better care. It is exhausting for a caregiver and I’m not surprised your sister is at the end of her rope. It is so difficult dealing with these issues . Best wishes to you and your family.
After a long, frustrating day, my sister finally managed to get my dad admitted back into in-patient rehab. Whoo hoo! I won’t bore you with the details, but it was another ordeal.
@CTmom2018, thanks for the link. I will look at it first thing in the morning, when I’m awake!
Good job for your sis! I’ve been through this with my father and both of my in-laws.
In our county, we have a Health and Human Services agency that also helps with ElderCare support.
Through them, we were able to access In-Home support services including OT and PT (from the VA) along with low incidence materials like hospital beds, bathroom supports, bed pillows, wheelchair lifts, etc.-provided by our county. We also learned about transportation services, that were free-via doctor’s notes, who provided door-to-door van service where my father’s wheelchair was lifted by movable stair into the van and transported him wherever he needed to be. Support people paid to ride with the patient.
For in-home support, (this is where our father became the employer) we helped with his interviews of in-home support tentative employees who interviewed for a job taking care of our father. He had several employers over the few years he needed them. They picked up his prescriptions, changed his bandages daily, prepared light meals for the day, took care of daily tasks (bed making, showers, haircuts) and anything else our mother couldn’t do for him. They came for about 3-4 hours a day and tried to come when the other service (OT’s and PT’s) weren’t there.
The issue is that every family has to learn about all of the services out there on their own. It’s awful the run-around you get. The hospital ombudsman is supposed to link up your family with the social workers, and, there are a ton of them. Some of them work on the insurances. Some, work on the home health. Some work on the emotional states of the patient. It just depends on who and how you ask. I wish you and your sister the best of luck.
Please do tell us how she navigated being able to get him readmitted directly to rehab without having to go to hospital inpatient first. Thats a real coup! How long had he been home?
@jym626, she has a friend who is a PT. The PT said, “They TELL you that you have to be in the hospital three nights before they’ll cover rehab, but that’s often not the case if you request it.” So that’s what my sister tried, and it worked. Dad had been home since May 3.
Thanks, @auntbea. I think we’ve found a good patient’s advocate. I had given the woman a little info about my dad yesterday, and I’ll be calling references today. Last night, she sent me an email with a couple of questions she thought were important for us to ask about Dad. I was impressed she took the time without knowing if we were going to retain her.
@MaineLonghorn -Just double check that the rehab will be covered under both his part A and B. You can get him back into rehab but sometimes (see the links I attached earlier) if it doesn’t meet whatever Medicare’s rules are, they may cover only part B and not part A, so you weill be out of pocket a lot more $, if that matters.
@jym626, thanks for that info. That will be the first thing we ask the patient advocate to check out for us, I think.
I just talked to a reference, and the woman couldn’t have offered a more glowing recommendation. She’s an attorney who lives in PA and uses this advocate for her brother in Austin. She said, “It’s the best money I’ve ever spent.”
As another potential cause of your Dad’s decline, is it possible that there is a problem with whatever the open heart surgery corrected? Someone I knew had an issue with a heart procedure that left her getting weaker and weaker until it was discovered that there was a valve leak (or something along those lines).
FWIW, after CABG snd and a week in the hospital, my mother went to SNF/rehab. After 3 weeks, they had the ‘time to go’ talk, then realized her medicare supp covered much more. Done. So check his plan on your own. You’re so thorough, maybe you have.
Thing is, we’re not qualified to offer them full care at home. Often, we need a trained observer, not a CNA, to assess and maybe flag issues. Visiting Nurses can offer this. In my immediate area, VNA is linked to hospice care’s palliative. It’s a higher level of savvy than a home asst/CNA can begin to approach.
Hope the present place gives him the attention he clearly needs.