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Hello All! My mother in-law is being discharged this coming week from the hospital. She has been bedridden for a few weeks and needs to build strength in her legs back up and she currently needs assistance to walk.


My MIL lives in a group home with one other person and 2 staff members at all times (so pretty much 1:1 attention). If we put her in a rehab facility for the short-term, we risk losing her bed at the group home (she’s in Medicaid/Title 19). We were thinking about seeing if we have the option of a visiting Occupational Therapist/PT come to the group home and I was wondering if anyone had experience with this versus a Rehab center. The thing we struggle with is if she’d really get more rehab at a facility versus at home as when she had a compound fracture and was in a rehab facility she says she only worked with the rehab staff every other day (However her memory is not always correct).


Thanks in advance!


Ann

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It would seem the bigger question would be whether the group home will allow her to stay there if she needs assistance to walk. If it is more like an AL facility and she cannot transfer herself from the bed to a chair or assist in moving herself via wheelchair, then she may not be eligible to remain at the group home until she is able to do those things. So, make a call or visit to the group home pronto.

If she is happy at the group home and CAN go there after hospital, then I vote for keeping her there and having OT/PT come there.

You do NOT want to lose her spot at the home, especially if she is happy there.
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I feel compelled to say this. The rehab facilities may say they give more hours of therapy, etc. , but do they really and will it be worth losing her place in the group home. These facilities are unpleasant places at best, and could actually make her mental illness issues worse. Don't risk it. The pt she will get at her group home will be better quality even if the sessions are fewer , plus she will be happier with it, I'm sure. Medicare provides a lot of needed equipment like the hydraulic lift I used for my father. My grown kids now know, after this experience with their grandfather, not to EVER put me in one of these rehab centers. No way.
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JoAnn29 Nov 14, 2019
I agree with you! I have told my husband this. I don't want to go to rehab if its just for getting my strength back. The last time my Dementia mother was in one it was awful.
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You should absolutely have the rehab done at her group home. These nursing home/rehab places are not good. My elderly father went to one after a broken hip and did not do well. For one thing he didn't like being there - and I couldn't blame him because I wouldn't either. I could never find out when he was scheduled to have his therapy because it wasn't the same time each day and nobody seemed to know when it would be. Just getting simple information was a maddening task. I was told he usually would not participate. So, I brought him home --- he lived with me---to have in-home therapy. That made him happier and he participated and even seemed to enjoy the attention from the PT. If I'd known all this I would have kept him at home to have his pt here. Please don't even think twice about this.
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IMHO, you may not be able to offer the PT that she requires at home.
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trisha17 Nov 14, 2019
Medicare will supply different types of equipment when necessary. They provided an easy to use hydraulic lift for my dad, plus some other things and the PT did even more therapy than he got at the awful rehab facility. The PT told me she could give him whatever therapy he needed at home. If I had realized this before, I never would've had him at the rehab center.
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My opinion...if its just to get her strength back, do therapy at home. You have a very good reason why this needs to be done. Not fair taking her away from what is familar. I think she will get just as much therapy at home than at rehab. Don't allow them to force her to go to rehab. Her PCP can write an order. She will do better at home. Rehab is depressing especially for a person suffering from a Dementia.
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Rather than risk losing her spot at the group home, get the doctor to write the order to get in home health at the group home. From my own observation at rehab, the patient leaves the room and goes to PT/OT area, and documents show patient exercised X hrs per day to meet Medicare/Medicaid guidelines, but the length of time exercising is not done. In a rehab, they have many patients taken to the room at the same time and those who are able to do more than others are getting the majority of the attention. - Even if you have to pay for some of the group home in-home therapy, it will be worth it. My mom got much more exercise attention in her own home than she did at rehab.
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My sister(78) with dementia, developed gout in her knee. Sent to rehab facility after a brief hospital stay. Her "rehab" meant going to PT daily, refusing to do the exercises, sitting in a wheelchair and watching all the activity. The rest of the day she sat in bed, except to take a few steps to the commode. When I (RN/NP) saw this (am not blaming PT) I asked to speak to her assigned Dr. He avoided me-LOL. Realizing if she returned to her AL facility, she would be walking to dining room 3 x day (long hallway), and wander the halls because her dementia allowed her to think she "worked" there. To quote sis, "I tell them when someone has fallen." With Dr. never available to see me, (he wanted the full 21 days of paid rehab), I mentioned to the Director of Nursing my plan for sis to return to her AL. When I arrived the next day for transport, Dr. appeared to write discharge order...but never spoke to me. And sister started walking the halls again.
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Annmilw Nov 13, 2019
This sounds ALL too familiar to some of things we’ve dealt with at hospitals and various facilities which is why we’d like to explore at-home care if possible in her group home where we know they push her recovery and care about her long-term well being versus the 3 week approved temporary time from
the insurance company.
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It really depends on how much PT/OT the group home is willing to do with her. In rehab you can get several sessions of OT/PT daily to strengthen muscles and work on regaining movement. Outpatient rehab, depending on the prescription, will come a couple times a week and rarely daily. It is the responsibility of the group home staff to make sure she does her exercises several times a day.
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Reply to Taarna
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Have you spoken to the staff where she lives? Would they be willing/able to give her the extra assistance she will likely need in addition to the outside therapy?
Rehab is available to come to the home. My dad had it at home rather than a rehab and did great with it. My mom had facility rehab more than once and then ongoing PT and OT at home for years. Her home therapist was great. I’ve read some negative things about it on this site. People have different experiences. I think it’s hard on the facility caregiver when the resident needs extra help but I certainly can understand your not wanting your MIL to lose her bed.
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Annmilw Nov 13, 2019
The staff at her group home are supportive of having in-home PT and OT. The nice thing is she has 1:1 care there as there are only 2 residents there and she has her own CNA to help with her needs. What I do worry about is how much time she will get with a therapist and what equipment they’ll be able to provide.

My MIL does suffer from mental health issues and currently is not on medication based on hospital observation that no medication is needed at this time (we feel like she may have been misdiagnosed in the past and administer medication that wasn’t necessary to treat what symptoms she did have which has led to multiple toxicity issues resulting in hospitalization so at this time we are open to holding off on medication.) We feel the group home would better handle if she were to fall into mental health episode versus a larger rehab facility).
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Can you give some information as to her baseline before this event & what her rehab would be for... compound fracture where? Did she fall? Why was she placed in a group home?

I recommend out patient/rehab facility depending on the needs. In a rehab facility activities are much more structured and each person has a specific plan for their rehab made by a Physical Therapist in concert with her surgeon. Her doctor gets regular reports of her progress.

My concern is MIL won’t get as much “push” to complete her exercises at her group home. Home PT is nothing like a rehab center’s exercises. At most she will get 3 sessions a week of 45-1 hour, ditto with home OT. That’s barely 6 hours per week.

All these factors should be considered in your decision. Good luck to you!
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Annmilw Nov 13, 2019
I was concerned too with the # of hours of care she’d get at home as well as the equipment she’d have to work with so I’m happy you touched upon that.

Her Baseline is stable movement with the ability to walk and stand with no equipment or assistance.

The compound fracture was from a few years ago which is healed (she was at inpatient rehab center for recovery).

The new need for rehab was based on her being bedridden for about 3 weeks due to toxic levels of lithium. She now needs to rebuild strength in her legs. She is processing well walking with a walker at the hospital with PT bad OT but will definitely need additional rehab.

Thanks again for your response!

Ann
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