My 86-year old father has had an MRI and is being considered for knee replacement as the MRI revealed bone-on-bone. The first thing is clearance from his cardiologist as he is on a blood thinner to prevent strokes. (He has had three, none which have resulted in permanent cognitive, speech, or mobility issues.)

He has Medicare plus Part A and B supplements through AMAIA. The orthopedist has stated he might be in the hospital day of surgery and one additional day. Because of this, he indicated that any type of skilled nursing facility would be an out-of-pocket expense for my father. Is this true?

As I read the Medicare FAQ page, it appears that he would need three days admittance...but that is unlikely unless there are complications...which we, of course, hope do not arise. Am I misreading this? The orthopedist said that Medicare would only pay for home health to come in a couple of hours a week to help with housecleaning...but that isn't needed as my father lives with my husband and me.

I am very concerned about doing bed to wheelchair or bed to bedside commode transfers...both for his sake as well as my and my husband's sake. My father weighs 185 pounds. He is currently going to PT right now for upper body strengthening exercises...but he currently cannot use his upper body for self-transfers.

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ruthie1460, I would get a second opinion regarding options for your Dad's knee. At his age it is common to take a year to get back to normal and feel comfortable walking. That in itself is something to think about. Your Dad would need around the clock care in the mean time, which is sounds like you are already planning.

My Dad, who was in his early 90's, went to a doctor about his knees which were also bone on bone, and quickly the doctor said time for surgery. Thankfully my Dad refused to schedule even though the doctor [surgeon] kept insisting. Dad took his walker and walked out.

With modern medicine there is now a gel that can be placed, via needle, to help cushion the bone on bone, and one would need to go every few months to have it done. I would vote for that. My Dad never had that was it wasn't available at that time.

Don't forget, long surgeries on someone your Dad's age could result in some type of memory loss. Did the doctor warn you and Dad about that possible side-effect? And has the cardiologist given thumbs up on this surgery?

I know a few people who are half your Dad's age and they wished they never had the surgery as the rehab was grueling.
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Reply to freqflyer
Geaton777 Jan 13, 2020
Yes! I forgot my mom did have the gel injection! It worked in one knee for a long time, but not the other. It also worked in her shoulder. But it is not a permanent solution. Ablation and Sprint PNS can be. If the OP lives near an ortho center they usually have a pain clinic. See there for options also.
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I would tell the doctor that they need to make rehab happen or you will find a surgeon that will.

86 with no rehab, sheesh, I don't know that I would trust this doctor. It doesn't even make good sense to not plan rehab for a 86 year old with knee replacement surgery. It's a big deal.
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Reply to Isthisrealyreal

My mom had back surgery (age 75) that was only going to be a 1-2 night stay. When the Dr. found out mom would be going home, alone, with no help, he made sure she got to stay in the hospital for 3 nights & then sent to rehab.
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Reply to mollymoose

If there is any money at all it IMO would be worth it to self pay for several weeks of rehab or convalescent care.
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Reply to cwillie

Usually you have to be admitted to the hospital for 3 days before Medicare will pay for rehab. Medicare won’t pay for house cleaning, the doctor is wrong there IMHO not that it matters since you don’t need housekeeping services. They’ll pay for someone to come out and bathe him, and they’ll pay for in-home physical therapy if the doctor orders it.
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Reply to worriedinCali

Perhaps you and your father are too far down the road towards surgery but due to his age has your ortho offered nerve ablation instead? Replacement is such a profound surgery at his age. Ablation cauterizes the nerve that sends the pain signal, and is not nearly as invasive and painful as replacement, with very little down time. And there is nearly no down side except that the nerve could grow back. There is also a newer 60-day therapy called Sprint PNS system where a physician inserts a lead near an identified nerve and there is a temporary external remote to control the signal that retrains the brain so that the pain stops. Then the lead is removed. Even less invasive than ablation but very new on the market so your physician may not have heard of it yet. My mom has the same problem as your father and for years they were saying she is healthy enough (in her 80's) for the surgery but she's worried about the anesthesia and as a former RN knows too much about the painful and long recovery.
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Reply to Geaton777
ruthie1460 Jan 15, 2020
I don't know why my step-father (who is a former physician) is so deadset on having surgery right now...except his mobility is severely limited. But...this is nothing that hasn't been going on for the last three years. My husband and I were finally able to get him to approach the VA to get PT...and he is actually going and participating.

As far as the physician treating him, I don't think there were other options discussed other than he would need to be cleared by his cardiologist and neurologist for surgery since he would have to go off his blood thinner. Perhaps once that hurdle has been cleared (or not), options will be discussed.
Yes, with straight medicare there is a 3 day rule before they will pay for rehab. But check with your supplemental insurance carrier to see if they waive that. I didn't think that was possible but when grandma was referred to rehab, I brought up the 3 day rule. They said with her supplemental, that requirement was waived. I confirmed it with both the insurance company and medicare. Indeed there was no requirement for a 3 day hospital stay before the rehab benefit kicked in. So check with the supplemental carrier.
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Reply to needtowashhair

Call Medicare and ask them about rehab after surgery.
My aunt had knee surgery when the choice was kneee replacement or wheel chair. She was in her 90s. It was the second replacement for that knee. First one 25 yrs earlier. She didn’t go to rehab. Although I think she was in the hospital for the three nights necessary but didn’t choose rehab. Call Medicare and ask.
My aunt didn’t have a heart condition but she was on dialysis so she had extra things to consider as well.
Since he is on traditional Medicare he can get home health to come in and check on his wound, bring in a bathing aide and bring in physical therapy. They can set up his meds and make sure he is doing well. If he is homebound he can keep home health coming in. Ask them to work with his doctor for doctors orders if you find them helpful. This could be his primary doctor when the surgeon is ready to release your dad from his care. Since you work it would be helpful to you as well as dad to have them coming in.
I’m not advocating one way or the other to have the surgery. Each persons situation and other health conditions are unique. My aunt knew she wanted the replacement because she didn’t want to be in a wheelchair. Find him the best doctor available and ask for all possible choices.
Helpful Answer (1)
Reply to 97yroldmom

Not all Medicare policies have a 3 day hospital stay rule before they will pay for Rehab in a SNF. Check your father's policy SPECIFICALLY before blindly believing the 3 day rule. My mother's Medicare policy has no such rule and she's entitled to rehab for ANY length of a hospital stay. Her policy pays 100% of a 20 day stay. Her Medicare plan is administered through Anthem BC/BS PPO.

Good luck with dad's surgery!
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Reply to lealonnie1

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