I want my husband out of the nursing home.

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My husband, who has dementia, had CHF and developed pneumonia in the hospital. He was in ICU intubated for three days under anesthesia. It took him two and a half days to wake up. After two weeks in the hospital, he had to go to skilled nursing for rehab. He has been here two weeks. He's getting physically stronger, but mentally deteriorating. It's not just the dementia, its depression, anxiety, delusions, and paranoia. HE IS SO MISERABLE THERE. I want him home at the end of the week. They say he'd be leaving AMA, and Medicare might not pay. Is that true? I feel his mental health depends on coming home and having some in home care. He'll always have dementia and I know it will worsen. I can deal. He deserves what little quality of life he has. I think it is their interest to keep him there. MONEY. 😪


smcbeth, it is better for your hubby to complete the required number of days in rehab, which I believe is 20 or 21 days. It is possible if you sign him out early, that Medicare will not pay any future care if there is a re-occurrence of the pneumonia within a certain time frame. I wouldn't want to take that chance.

It is normal for someone who has dementia to feel depression, anxiety, delusions and paranoia when they are "living" in a new environment. That happens to 90% of our senior citizens, and 20% to much younger people recovering from a serious surgery or illness. Once you bring hubby home, it might take 2 or 3 days before he feels he is back at home.

If hubby leaves early, that bed will be filled within hours with another patient, thus money isn't the issue.

And whatever you do, do not say anything in front of hubby about how rehab is keeping him there without reason, etc. That would only depress him more. Ask the rehab director how is hubby doing, and what do they think is the time line for his discharge. Then put a wall calendar in hubby's room and mark off the days and show the day of leaving. Counting the days might help hubby look forward to returning home.

smcbeth has valid concerns. Some skilled nursing will keep a person longer, to get as much Medicare as they can (Medicare pays nicely for these services to the tune of 5 digits in some cases). If he has the full 100 days, they'll try to keep him almost as long.

One other thing, do research on home care. These same facilities will try to make the decision for you, why? Money. Home health will pay a referral fee to the facility because of being grateful to have a new patient/customer.

Many people don't know, those on Medicare have the right to choose Home health care as well as, Skilled nursing facilities, though again, some medical folks try to make the choice for you,
When it comes to rehab beds, even if a patient leaves the Rehab early, that bed is probably filled within a couple of hours.... so the facility wouldn't be losing any funds. Anyway that is how it is in my area. I remember my Mom being in the hospital an extra day because no Rehab beds could be found in a 20 miles radius.

My Dad had a choice of a Rehab over-night type facility and he choose home care where a physical therapist, occupational therapist, a nurse would stop by to visit him a couple times a week. In the mean time, my Mom [who was in her 90's] said she could take care of my Dad. Oh dear, no way my Mom could help Dad walk, so she was calling me frequently because Dad fell.

Dad would do the exercises only while the therapist was there. Other then that, he sat in his recliner. If he was at a facility, an Aide would be making him get up and do some walking with his/her help.
SMcbeth, are there any passive activities that might perk him up? I think specifically of the benefit of music and pet therapy. Those are 2 therapies that literally "reach out" and touch the patient in ways that aren't always completely understood.

I really do understand your frustration. If you think he would in fact be better at home (and there is the possibility that he's so overwhelmed he won't want to participate in home therapy), talk to his pulmonary or cardio doctor and ask if they'll script for home care, as the rehab facility might refuse to do so.
I firmly believe that hospitalization or rehab or tcu care is very hard on the elderly and especially the elderly with dementia. I'm not surprised if they go downhill in such places.

But sometimes they are necessary in spite of risks. Sometimes the potential benefits outweigh to downside.

Can you spend a lot of time with him in the facility? Can you rotate your visits with other family members or friends? How much longer does the staff think he will benefit from additional therapy? What will he gain from this, in their opinion?

As others have said, I doubt very much there is a financial motivation in recommending that he stay. TCU and Rehab places can very easily fill their beds.That doesn't mean they are always right, but please at least give them credit for having your husband's best interests in mind.

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