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.

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Sorry Ren. I did not mean to imply I was trying to give advice or suggestions. I was just wondering if you ahd considered that and if so, why not since I am trying to make that decision for my parents.
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Here is exactly what I wanted to occur with my mother: She goes to the hospital for her illness, she gets released from the hospital and the HOSPITAL'S PROTOCOL OF CARE IS TO NEVER SEND THE PATIENT HOME, but to the rehab unit of the NH. From there they transition to the long-term care unit of the same NH.
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commutergirl, you are lucky you had a big jolly loving Waltons type family to pitch in and get-er-done. Many of us are over 60, the last man standing, ABSOLUTELY ALONE IN THIS HORRORSHOW.

Windyridge, you sure said the truth! I think about this stuff for myself all the time. My barrier is a big fat retired spouse who pooh-poohs all that planning ("it's bad luck") and whose ultimate plan is to drop dead from a heart attack sometime in the future - until then, it's spend spend spend as we've never been able to spend!.....idiot...... (I am lucky in my own life with my family that we had jumped through all the hoops (will, living will, POA,  quit claim deed on the house) years before mom got dementia - all our ducks were in a row and even though I was the only one to handle things, and it was an absolute nightmare, we were in as good a position as we would ever be.) .....People reading this, listen up because when the time comes, you don't want to floundering around with no idea what to do!  
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Karsten, This been discussed but at this time I am still managing on a wing and a prayer and am afraid the added expense would deplete savings even faster. My main thought right now is trying to assure care for my wife. I do appreciate your thoughts and your suggestions. That move could very well be in my future. Thanks again for the concern.

Ren
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Lots of good experiences posted here. I just have a couple of points.

The hospital to rehab to care facility procedure is a crap shoot in this country. It can vary wildly from one place to the next. You might get the ANGEL social worker or discharge planner but usually not.

Look around the next time you go to the old folks rehab facility. It’s necessary for many folks after strokes, falls or surgeries and can get people up and at em again. But it almost seems like a reflex on most docs parts to send everyone to rehab. Looking around the facility my mom was in I’d guess it was a totally pointless exercise for about half the elders there. Many of these places are simply mills chewing up Medicare bucks.

Few people are prepared for caregiving at all much less the nightmare of making these transitions. After my sis died, then bro, and it was obvious mom and dad were going down hill so I started laying track 6 years ago. When the deciding crisis occurred recently it was still a nightmare getting two people in care at the same time. The hospital was trying to discharge mom, the AL room wasn’t set up, Dad was wandering the neighborhood...........Nightmare. Capital N.  But I was able to get it done....On a wing and a prayer.  Had I not had a handle on the legal and financial stuff....I can’t even imagine.

I don’t mean to sound boastful. There are endless situations and hardships out there. But I’m always struck by the amount of posts on this forum where it’s clear no one has given one thought to caring for 98 yr old granny who’s still driving, lives in the four story filthy house full of cats which is 40 miles out in the boonies,and  has a reverse mortgage. To be fair, the people posting are usually the unfortunate last man standing who inherits this mess. But many times you have to ask, What the hell were you guys doing the last 10 years?

I’ve been bugging the crap out of my young nephews about getting their parents wills, end of life matters and POAs done.  Have that talk now! Get your waterfowl aligned!

And BTW, I’ve spent lots of time reading this forum in the last 5 years.  For a Lone Ranger/long distance caregiver like me it has been a godsend.
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My mom went from hospital to NH for rehab due to double knee replacement. Therapy was a joke, showers were a joke and after 10 months we were done. We held a family meeting, everyone gave up off days to just see what could be done in 30 days. We Built a ramp into the house, got a hospital bed, bedside commode, small refrigerator, microwave, transport wheelchair, cordless telephone, signed up for incontinence supplies, shoe rack (held toilet supplies, small garbage can bags, baby wipes, toilet paper, pull-ups, disposable chucks all behind her bedroom door, next to commode, next to hospital bed. Once all in place brought her home on weekends for a few weeks and once we saw she was comfortable with preparing snacks/lunch in her room, from small frig to microwave brought her home permanently. This was 11 years ago. Set up doesn't have the makeshift kitchen as I am now a full-time caregiver, but she works at not going back every day. Small hand weights to keep upper body strength. Don't believe the bologna they shove at you always. Those 10 months had Mom so depressed and we altered our visits to the nursing home, not one family member ever caught her in therapy nor did she say she was in therapy. She would call us when she rang for the nurse so we could time how long it took. We treated ourselves to a baseball game and for all 3 shifts, no one changed her. That was our last straw and began the arrangements to bring her home. The limited mobility can sometimes be worked with and in our case, it could. All she had to do was stand and pivot. The transport wheelchair is so lightweight and all four wheels are small. We bought everything that was not insurance approved from the Bargain Finder (no Craigslist then). I don't have the family help I had back then, but at 80 years young, mom is doing great and still able to use the bathroom with assistance but still...I say give them a chance to see what they can do is motivating to be around loved ones (even a pet like a cat).
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Ren1935, did you ever consider going into an assisted living where you could remain together, but you would have the assisted living staff help you so you didn't burn out? Just wondering if that can be a realistic consideration for my parents.
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I often think how lucky I am to find to place for my spouse that cost less than $6000 a month. I see the cost increasing but I feel he couldn't be in a better place. Of course I have to admit that I am hitting panic mode when I see what I once thought was a decent savings disappear. He has ALZ, does not know anyone in the family and would be furious if he knew what his care is costing. I have heard from others how their long term care plans have not covered half of what they expected.
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Karsten, The cost for long term memory care at the facility where my wife now resides is $3950 per month but that is cheaper than Hiring round the clock care for my wife in my area. As I stated earlier I am suffering from long time care burnout and that can happen before you really realize it. She has been there now for about three weeks and I am just now just beginning to return to a somewhat normal status. Probably some time to go before getting to a "normal" status.

Ren
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This happened with my wife. She had any infection with which she became septic, got endocarditis, the had a stroke caused by "vegetation " breaking off the heart valve and going too the brain like a clot. She lost use of rt. side limbs. This was the 5th time this had happened and I was expecting a recovery. During her 100 days, she returned to the hospital 3 times for blood transfusions with hospital stays of 5 to 12 days searching for blood loss. Each time this set her rehab back. Finally due to many reasons LTC was decided. Since she was eligible for a Medicare SNP PPO, she already had partial Medicaid. Made transfer to another facility much easier.
My wife is 57 had been disabled since 2005, I'm 63 and have been disabled since 1996 due to a back injury, then 2 failed surgeries. My wife is bipolar and had multiple health issues. She weighs about 60 lbs more then I do so it is impossible for me to move her around. I think if we were able to get her more therapy, she could regain partial use of het right limbs. This may be wishful thinking but I strongly think this is possible. No way for private pay so she's stuck in limbo. It looks likeLTC for life.
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