glorim Asked January 2013

My 87 year old mother is being transferred to a rehab facility. Is this the right decision?

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I want to make sure this is the right decision. Why do, in most cases, hospitals refer elderly to rehab facilities?

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Lizann Jan 2013
I placed my dad in 2 rehab facilities immediately after a hospital stay because he was not strong enough to come home. If you bring them home and then realize you need to place them in rehab, Medicare normally does not pay. I would advise touring a few rehab facilities before your father is "discharged" from the hospital. Trying to find a good PT service at the rehab was important to me. While I found PT services at each facility, they weren't the best. But he did get strong enough to stand and make needed transfers so I could manage his care back at his home. PT services and what they expect of each elderly person doesn't seem to be logically tailored to each persons level of disability and/or age. I found they frequently claim the elder isn't trying when it is normally an issue of stamina being low--but unfortunately they have their rules and the elderly has to comply or try to comply with them. The staff is overly concerned with what the elder can't do (ie walk long distances) and they need to focus on getting the elder able to walk enough to live the life they had before they went to the hospital in the first place.

Medicare will allow 3 months of rehab but normally the rehabs push for turn over. If you find a rehab, immediately start setting up the home if your plan is to bring them home. I found I usually received less than 4 days to make such arrangements. Trips to medical supply stores and setting up home health aide coverage needs to be arranged particularly if you work full time. It is left to the family caregiver to do all this leg work and work full time at the same time.

If your elder doesn't want to go to rehab, (my father didn't), just sell it as a step to coming home.

Good luck.
Elizabeth
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waddle1 Jan 2013
I experienced some of the same things with my mom in rehab at a nursing home following a hospitilization as did Braida with her aunt (above). Unfortunately, the rehab experience did not end with my mother returning home. And I have come to the same conclusion as Braida about the care and what your role should be. Yes, you should support your mother going to rehab, but stay on top of things. Be aware of what's going on with her while she's there. You know her better than the rehab people will so you will have gut feelings if something doesn't look right concerning your mother's demeanor while there. Don't be afraid to ask questions and do follow-up to make sure that what is suppose to be done is done for your mother. Probably the most helpful thing I can say, which you may already know, is with senior citizens in their 80s+, the simplest medical thing can become serious and quickly. Therefore, your role should be to oversee, observe and advocate for the best care for her.
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Braida Jan 2013
Here are some things I learned (the hard/sad way) about rehab facilities that I'd like to pass along to you. My 89 year old independent living aunt fell in her home and broke her hip. Surgery and a 3-day hospital stay followed. She wasn't coming out of the anesthesia fog very well, and seemed somewhat combative in the hospital as the staff attempted to get her to respond to various commands, etc. A CT scan revealed she'd had a small stroke. (And I strongly believe that her small and fragile self had too large a dose of anesthesia, which took her longer than normal to come out of.) Not being able to do anything more "medically" at the hosp for her, they discharged her to a rehab. We had some time to check out rehabs in our town prior to this discharge, and got the best one. When she first got to the rehab, she finally came out of the FOG, and recognized all of us (her family) and talked and responded, tried to get out of her bed to go to the bathroom, etc. But as the days went by, she became less responsive, and seemed extremely fatigued as the therapists put her through various routine exercises that she seemed way too fatigued to take part in. She began to retreat, and want only to sleep. She stopped talking to us. She was on a feeding tube, as well as taking food by mouth. (the feeding tube gave her additional nutrition as she wouldn't eat enough to stay alive.) She developed a cough, which she never had before. I spoke to the nurses about it everytime I went in (at least twice a day). I told them I was worried about pneumonia. They repeatedly insisted her lungs sounded fine. I asked why she stopped responding to us, and seemed to withdraw and retreat. Could she have had another stroke, I asked. They said she was just tired, and this was normal sometimes. After two weeks in the rehab, she was abruptly taken to the hospital on a Sunday night, as they finally suspected pneumonia. A CT scan revealed she had pneumonia, and a brain scan revealed she had suffered two more strokes. The pneumonia was aspiration pneumonia as a result of the staff failing to keep her elevated 30 degrees following feeding tube intakes. I think the strokes may have been as a result of forcing her to take part in rather grueling exercises when she was in frail and weakened condition. (she had high blood pressure.) My LESSON from this (unfortunately too late to help my beloved aunt, as she died) is that although I don't blame the rehab totally, I think it is extremely emportant to be on top everything while your loved one is in rehab....especially at first. If you THINK something is wrong, don't let the staff just waive it off, and go blindly along thinking they know what they're doing. That isn't necessarily the case. Be very assertive and insist on tests to rule things out that you may suspect, or speak up and say that your person is too tired and/or weak and to back off on some of the things that could maybe be done in a more gentle and relaxed way at first. I truly believe my sweet aunt would still be with us, if I had known some of this ahead of time, and been more on top of things. I accepted that she was having proper care, and backed off. And it was the wrong thing to do. I hope this helps you with your Mom's care in the rehab. The rehab facility my aunt was in was the best in town, and highly rated. But I feel they were careless in regards to important things concerning my aunt. Blessings and good luck to you.
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195Austin Jan 2013
A good rehab will encourage the family be there with the elder and teach you how to help your elder get ready to go home-if a PT dept does not let anyone in the room-I would use a different rehab because they should teach you how to assist the person getting rehab-this time gives you a chance to talk to the social worker and the dietician also-most people get a lot of help from rehab.
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IsntEasy Jan 2013
I think you should absolutely let her go to rehab. As jeannegibbs points out, you could very easily be overwhelmed with her care if she comes straight home. Rehab not only offers more weeks to recover, it also provides an adjustment period to get a handle on whether or not your mom will be able to come home and what will have to be in place at home if she can.
We were lucky and had a few days and a few options when my FIL was discharged to rehab. We called each of them (3). Questions to ask are, how rigorous is the rehab therapy (x per week or per day, nature of the therapy), what happens if your mother isn't ready to move home and her Medicare coverage expires, etc... If possible, visit them, too. That's the only real way to get a sense of how much of what the facility does is rehab and how much is traditional nursing home care. Most all elderly are discharged to rehab at SNF rather than strictly rehabilitation centers. Some have a strong rehab program, some are almost completely filled with very frail, long-term residents. That may not effect the outcome of the therapy (the therapists will be licensed professionals regardless of where they work) but, if your mom is mentally alert and pretty chipper, it may affect how pleasant it is for her to live there during therapy.
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My mother was in rehab after surgery. It usually consists of care, like physical therapy, etc. Then, after they get out, you can also ask for home health care which can provide extra therapy if they need it and help with baths and so on. Remember they no longer keep them in the Hospital to recover like they use to, so this is basically recovery time in a supervised facility.
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CatGrace Jan 2013
Rehad is very important for their continued health. Just be aware of the facility as mentioned above. Not all are created equal. I was in one for 30 days last April. It could have been a better place, but was the only one available at the time because of Medicare only. They only allowed 30 days there, then home for inhome rehab. I am still receiving home Rehab and once a week nurse visit's. It's best you allow your mother to go there. Best Wishes
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bubble Jan 2013
What are you afraid of? Her age has nothing to do with it. It's another step to better health.
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Mamoogins Jan 2013
Jeanne is right. If you have time you might want to check out a few of the facilities, but Med rehab was the perfect place for my father after both of his hospital stays last year. He was very sick and this allowed us time to regain some of our own strength and get everything ready for his release when he came back home.
He still continues to decline and we fear if he's hospitalized again, he won't be returning home, but at least we know what to expect and that he will be well cared for in his final days.
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jeannegibbs Jan 2013
(The question seems to be a repeat of one posted earlier, so I am repeating my answer.) Rehab is an interim step between hospitalization and home (even if home is assisted living or skilled nursing facility, etc) It is done when the person no longer needs the expensive care provided in a hospital setting, but it not quite strong enough or well enough to return to their normal activities. Rehab can be recommended for any age but the elderly generally take longer to heal so it is very common for them. Medicare pays for rehab right out of the hospital, for a certain length of time.
I think you should definitely let your mom go to rehab, whether she has dementia or not. This not only gives her more time to regain her strength, but it also gives you more time to observe her and to explore the options for her release. Return home with in-home care? Go to assisted living? Does she need a memory care unit? A nursing home?
Rehab buys you both some time. Take advantage of it.
(My mom's been in rehab twice. My husband, who had dementia, was in rehab once. All facilities are NOT created equal. Stay with your mom as much as you can the first few days until you get a sense of the place and what kind of continued observation/care may be needed from you while she is there.)
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