Two weeks ago my MIL took a minor tumble from her wheelchair. Due to some pain in her R. hip (which she didn't tell us about unti 24 hrs. AFTER the fact) we had her transported by ambulance to the hospital ER for X-rays. No broken bones were found (not even a bruise) but the ER doc wanted to keep her overnight so she could be evaluated by a PT in the morning. Whatever was causing the pain she was feeling I don't know, but it was clearly impeding her ability to make transfers, so we figured no harm in that. Next day her case worker called to tell us that the PT felt she'd benefit from a few days in rehab - no harm in that either. Problem was she hadn't been in the hospital long enough for Medicare to cover a transfer to a sub acute rehab close by, so instead they located a bed for her at an acute rehab facility an hour away. MIL didn't like that it was so far away but we figured it was only for a few days, so we agreed. While there she rec'd 2 PT and 2 OT sessions/day, which tuckered HER out but we were fully on board with...figured anything they do to help her was welcome....until we found out the goals they had set for her were totally unrealistic. A year ago her neurologist determined that further attempts at walking had become too risky, and she should concentrate on just maintaining strength to make transfers from now on. So what goals do they set for her, after working with her for less than a week? "Stand longer"(independently) and "start walking". Then when it becomes clear to them she cannot meet these goals they determine she needs 24/ 7 care, and dump the decision into our laps to either send her to a step down facility or arrange for 24/7 care at home. Until now she has been pretty much "on her own" living at home - I say pretty much because we live right around the corner (and can actually get to her considerbly faster than local emergency services), she has a lifeline button she wears all the time (calls it her "tinker bell" LOL), and we check in on her several times each day...prepare her meals, help with dressing/ toileting etc...and right up until this happened she was making her own transfers with no problem (this fall did NOT occur in the process of a transfer). It wasn't a perfect system but it worked, for her and for us. She was able to maintain a sense of independance (even if most of it was an illusion) and we were able to maintain our place of refuge. Sigh.
Given the brief time frame we had to work in and the fact that we had no immediate "magic" plan in place for 24/7 in-home care we had no choice but to opt for the sub-acute facility. So that's where she is now. She lost several pounds during her stay at the acute facility, not because they didn't feed her - quite the opposite! They TRIED to "beef" her up with supplements (which she hated), encouraged her to snack, allowed her to order whatever she wanted for meals (and she did - boy, she did!)...the problem was they left her to fend entirely for herself. Due to problems with manual dexterity she has a very hard time with packaging, and she can't cut food well either...as a result her trays were nearly as full when they took them away as they'd been when they gave them to her! She looks haggard, fluctuates between depression and agitation, and seems more confused and forgetful than she's ever been (all in just two weeks!)
We're hoping she won't have to stay at this facility for long. We're hoping they will work with us (they do have weekly "family meetings" we can attend with MIL and participate...so they say...in decisions about her care), and we're hoping we can get her back home and back to her old familiar routine soon. If they want to order in-home PT and OT upon discharge then great! If her social worker can offer more options to increase the level of care we're already giving her at home, greater still! I just honestly believe she should be allowed to return to her old routine, AND I believe she would improve in every possible way if she was...but I also fear we're gradaually being railroaded into a major change in circumstances. I'm not ready for this. I don't know how to deal with these people. Any advice or input would be welcome.