Hospital to Rehab; One Consumer's Experience

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I find that a lot of posters are caught off-guard when their parents go to rehab from a hospital and then turn out to need long term care. Often, the patient has no funds, is going to have to apply for Medicaid and the facility where they've been placed will not accept "Medicaid Pending" residents. It's SO very important while your parent is in the hospital to meet with the discharge planning folks, discuss what the long term plan might be and to be upfront about what resources your parent has. I can recall doing this with the RN who did planning at the hospital my mom was in, post hip fracture, which was 2 months after a stroke. She was a sweet but very businesslike woman who said "okay, what does mom have, asset-wise?" My brother and I were put off, but CPA/MBA sister in law had all the figures in her head, and having been through this with both of her parents knew what the nurse was looking for. If your parent can private pay for some number of months or years, many facilities will accept a patient for rehab and transition them to long term care, knowing that the funds are there to private pay for a certain term until the spend down and Medicaid application. I think it's absolutely essential to understand this. It's also good to know, if parent has NO funds, that it might be better to place them in a facility that accepts Medicaid from the outset of rehab so that you're not left scrambling to find them a "Medicaid pending placement" down the road.

22 Comments

Barb, always good advice from you.
GA, we were SO blessed to get this particular lady for discharge; she's the one who told me that her mom had broken her hip, standing in a room with three RNs, one of whom was her daughter. And who told me that sometimes the break causes the fall. If we don't share our experiences here, no one learns anything!
Whether it is a hospital, rehab, AL or NH, they all probably know of some things that families tend to drop the ball on over and over again. Wouldn't it be nice if each of them had their own one page handout outlining the most common issues with clear, simple bullet points?
CW, that would be the ideal! Maybe we could create a "questions to ask when your parent is transitions from hospital to rehab?".

One of my cousins faced the issue, again and again, of her father being discharged home from the hospital. He was "fine". (No, he was mentally ill, PTSD from the Burma Road in WWII, dementia, etc". But he knew who the president was and what day it was. And his PCP said "nice people don't get dementia". Oy.

My cousin's husband finally tracked down a SW at the hospital who sent in a psychiatrist. Once "Dementia" was a dx in his chart, everything changed. They were able to get home care, etc.

I have never encountered one helpful hospital or discharge planner even after hounding them

Once the medical decision to discharge happens they want the patient out and they don't care where they're sent

Even now that she's immobile the hospital planner thought I should be able to transport her in my car instead I had to pay $150 for gurney transfer

Even the hospital's senior network didn't have any suggestions for placement but referred me to an 800 number in another part of the county

Another recent poster is lamenting the lack of medi-cal facilities in the OC

Neither mom's memory care or the NH she was recently in while she was being treated for sepsis take medi-cal

If she outlasts her savings which is becoming a real possibility then I don't know what I'll do
Thank you for sharing! Knowledge is power.
Good points Barb! And though I know it’s not exactly on the same vein, there’s a related aspect to this that our family experienced. When my mom was transferred to rehab from hospital post stroke, there was huge optimism about recovery from all involved, from social worker to nurses to doctors to therapists to staff at rehab/nursing home. This despite the fact that it was a huge hemorrhagic stroke that she didn’t wake up after for 3 weeks. As a family brand new to all this we had no idea what to expect. I clearly recall telling the admitting nurse at rehab that mom was in a diaper not due to loss of bladder control but because she currently couldn’t signal anyone quickly enough to help her to the bathroom. The nurse smiled and said “don’t worry a bit about that, those diapers will be gone in no time, we’re here to fix that” We were told she’d be back walking and eating in a few weeks. So therapies began, and mom worked very hard at it as she wanted to come home so very much. There was literally zero progress. She couldn’t do one thing for herself. Little speech, no sitting up, no rolling over, couldn’t swallow, and the list goes on. The talk turned to stopping therapy and her turning into a regular nursing home patient. The Medicare paid days ran out and it became private pay. There was long term care insurance that also ran out. My dad had to take steps like getting rid of one car to qualify her for Medicaid as we were now told this could be a long haul. And it turned into 4 nightmare years, for her far more than us. I didn’t mean to write this much, and know I’m veering off from original post, but think it’s important for families to also be prepared that sometimes it doesn’t go the way the professionals think it will, and recovery doesn’t happen as expected or at all. The implications are enormous financially and in every other way.
My wife fell, broke her hip and had a new hip replacement a little over two months ago. Thank God we had saved a little money over the years to tide us over until we were called by God to come to a better place. But! that money will only last for a very few years. Then what? Sell the farm I would guess. We are FAR from being rich as I believe most middle class folks are in this country. We transferred her from rehab to a private facility who did not accept Medicare. Check from bank only. Thank God we followed this route as she is still getting PT as well as care that I could not give her at home. She, as I have mentioned in previous posts, is in the advanced stages of dementia and chemo about a year ago and this time being put to sleep for surgery has caused her to slip even faster.

I had looked ahead before the fall for senior living services and had placed us on a waiting list for the facility in which now she is being cared for. The first day after being placed in rehab, after surgery, a room became available. Who would have imagined! I do believe a Greater Power was at work here folks and I am very thankful. I was in a total burnout phase after caring for her for five years and the last year being a very difficult one.

She isn't doing great but is learning to walk again. Only time will tell our future as right now it appears very dim.

Just thought I would share with you folks as that seems to help.

As a side note, both of us are eighty two years old and have been married sixty two years.

Ren.










Barb - wonderful discussion, thanks ever so for framing it. One of the difficulties in dealing with the maze that is Medicaid and Medicare is that one really has to - to me - change how you think. Most of us - especially women- are directional thinkers. But the world of the M&M’s, insurance, healthcare, Hospice, etc. are all about binary thinking.

Trying to deal with like Medicaid LTC eligibility and going about it directionally is going to mean there’s going to be delays in getting them approved or even in getting them eligible; forget about spending time and energy on the nuances of how & where mom could have spent a cashed in CD. Either it’s accounted for or its a penalty, it’s a binary approach. Either they get the whole life policy cashed in or their not eligible, it’s binary. Either they show need for skilled nursing care or they don’t, it’s yes or no, binary. That’s what Medicaid, insurance etc are going do. Whether it’s fair, kind, rude, whatever is besides the point, you need to view the situation from the yes/no, in/out binary decision making of the M&Ms, insurance co, etc.

To me what’s the simplest way to start thinking binary for a dpoa is assume they are going to outlive their $, need skilled nursing care and will apply to Medicaid and plan for it. Gabriel Heiser’s book “Medicaid Secrets” is really priceless in giving an overview of the whole process as to how the system works. ISBN-13: 978-1941123o41
well timed discussion for me as well although a slight tangent. As detailed before on other threads, my alzheimers dad was hospitalized a couple weeks back for aspiration pneumonia then transferred to rehab facility for the various therapies. The speech pathologist thought he should be on a thickened liquid and pureed food diet to lower the risk of aspiration again, though they said it is just lowering the risk. Dad not crazy about that.
Anyway, yesterday the OT, PT, and ST met with my mom and me and said based on their evaluations, my dad needs 24 hour care, thus long term care. My own naïve hope had been that he could go home for a while as he still is aware he is not home and yearns to be. The staff says they always see families wanting to take their loved one home for at least a while finding out that it is just too hard. My mom had hoped to move in with my dad to assisted living, but the staff thinks even that would not provide the care my dad needs. Although they conceded that different AL facilities offer different assistance, the variable paying what you pay.
My parents are not bloody rich, but have the funds for probably a few years of care, depending on what the costs would be. Kind of like Ren1935 above. I guess the options are going home and hiring in home care, though I know that would be VERY expensive. Going to an assisted living with mom with extra care available, if that is possible. Or long term care, and then the question would be regular long term care of memory care.

The other option is I have the personal means to stop what I am doing and be there to take care of my dad at home as a full time caregiver. The staff at rehab thought that was noble, but said they hear people say that all the time and it rarely turns out well. In my case, I feel my dad would be the easy part. My mom who is physically healthy but neurotic would be the hard one to tolerate.

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