How can my mother get kicked out of the rehabilitation facility when the doctor said she could wait 6 weeks before starting weight-bearing therapy?

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Mom broke leg 9/25. Dr ordered 4-6 wks to heal before full weight bearing rehab. How can Rehab kick her out before 6 weeks and rehab starts. One month after break and repair surgery, Rehab Center kicking her out - has Medicare and Anthem and dr says with rehab can walk again but kind of break will take 4-6 weeks to heal. Rehab called one month after break to say has reached "plateau" and cannot stay there as of 10/30. Her prognosis for recovery to walk again is good with rehab but only once healed and can bear weight on the leg again. She broke hip and August and was at Rehab Center in patient a week from coming home from hip rehab when fell in her room and broke leg on same side as healing hip. Can they really kick her out or make her pay for the rehab now??? HELP!!!!!!

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You may want to contact your long-term care ombudsman for help. Go to ltcombudsman.org and type in the Zip code of the nursing home. You should get contact information. This person is your representative. Good luck,
Carol
Insurance requires that the patient is making significant progress in rehab to continue paying to having them in a facility. If your mom has reached a plateau, then rehab facility discharge them &before using up all the days in the policy.

Out of curiosity, is this a big rehab facility - almost like a hospital setting and does very intense & highly skilled rehab care, like massive trauma cases? If so, then a patient like your mom (elderly with hip & leg break) isn't really their type of patient so she doesn't "fit" for how this facility is run. Someone else posted a question like yours on this site a few months ago and that was the situation - their mom was at a trauma rehab hospital and was discharged for not making progress. They were able to get her into a NH.

What I'd suggest is that you speak with one of the social workers asap to find a NH facility that has a rehab wing for your mom to be discharged to for followup care. None of this is cheap but the r&b day rate @ a NH will be much less than that of a trauma center. Also if she doesn't get ambulatory, she can be admitted as a permanent resident of the NH and if you have to go the Medicaid route for NH payment, she will have the medical history needed in her file for the medical necessity review that is a part of the Medicaid application. Good luck.
When my mother-in-law was in a nursing home for rehab from a broken hip, her insurance also said that when she no longer is making progress, they won't pay any longer. They did however tell us that we can ask for a hearing or judgement of an impartial person to see if they would have to pay for a longer period of time, if we thought mil needed to stay longer. You might ask some questions to see if your insurance has the same stipulation. If she needs to stay longer, then if I were you, I'd be rattling cages all over the place to make that happen.
We are dealing with this right now. Basically each "type" of rehab facility has a different time allowance from insurance. MIL was heading to PT rehab facility close by but her Dr recognized her limits of coverage and realized she would need much longer.
She still needs some medical care, but not hospital, before she will be ready for rehab only. He is sending her to a "step down" medical facility until she is ready to do PT rehab so she doesn't burn her days up just waiting until she is well enough to rehab. I am SO thankful he saw that need and the hospital assigned a caseworker to her to make arrangements according to her Medicare restrictions. I am sorry you are dealing with this. It was explained to us that it often happens because the family (my husband and I) didn't get involved regarding understanding the elder's insurance benefits before the crisis and we would have just been out of luck because these fees are due up front at these facilities we were using. I am so thankful that the Dr got involved, but it certainly isn't normal that it happened like that, it isn't their duty, it was ours and we failed. Good Luck and thanks for sharing your story, you may save someone else the headache.
My mother is in rehab after spending 10 days in the hospital with sepsis now the ins company is saying she needs to get out they just found blood in her urine and she still can't walk she walked into the hospital now she can bearly but they want her out. How is this possible ???? B
They have to be able to make progress towards goals. We sometimes have to postpone rehab if someone is not allowed to weight bear, but if they can use both arms or an arm and a leg, we can at least work on transfers. Our rehab is within and acute care hospital so we can do a lot more medical care while they are in rehab than some other places can manage safely; but if someone is too sick to participate in therapy for more than a few days, we can't keep them in the rehab program. Again, we can get away with more than most places....but just blood in the urine does not sound like something they could not work up and deal with while still doing therapy (?) Or is she just not doing therapy either because she is still too weak or feels too bad?

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