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In rereading the post, I saw that rehab was done in the hospital. Where I live only the larger hospitals have rehab on site and none of them close by. My friend had his amputation done in the larger hospital and Rehab done there. He came straight home. He was able to transfer.
I too wonder if Dad met his 100 days at the hospital or was discharged because he did not progress. Maybe the other Rehab feels he should have progressed to a certain point at the hospital and since he didn't, they feel they can't help him either. Thats why the need for him to be able to transfer.
There is so much that is looked at when in Rehab. How the person progresses. Is the patient copperative? Age, do they have Dementia, these two things could contribute to why they don't progress. Rehab does not work if the patient can't or won't help. They have to want to improve and will go thru the pain to do it.
Your Dads age will have a lot to do with him improving. My friend was in his late 60s. An amputation is a shock to the body. Anesthesia takes a while to get out of the elderly person's system. Who feels Dad did not get enough therapy, the hospital or you.
I don't know about your area, but mine, rehab in hospital is very expensive, since not only are there rehab charges, but hospital room charges as well. (Cleve Clinic definitely fits this description)
Some later answers bring up a critical point. Although a person can have rehab in a nursing home, the normal sequence is that the person after surgery, after a small amount of rehab in the hospital, transfers to a rehab program. It sounds like this person was NOT sent to rehab. As others have said, normally a person is sent to rehab to acquire the skills needed to go some, return to assisted living, etc. Was there a problem in the hospital that prevented this person from qualifying for rehab (a situation I haven't ever heard of)? If a person is unsuccessful at rehab, then the person could be sent to a nursing home for custodial care.
Alternatively, if the person has used up his/her Medicare days in rehab, the person might be sent to a skilled nursing facility for more PT at a less intensive level until the person is qualified to go home, etc. If there is no hope for recovery (very unlikely in the situation you described), then the person might be sent to a nursing facility for custodial care. Not being able to transfer should not be an issue for custodial nursing care.
It depends on the license that the facility has. I looked into an AL place near me for my parents but because my dad was bed bound their license did not allow them to take him until he could get up. Once he was able to get up, even if he needed help, he could be admitted. Then once he was settled in the AL if things digressed and he became bed bound, then the license would allow him to stay. He just couldn't enter that way.
All facilities have the right to refuse a person from hospital and they don't need a reason why. If his only issue is part of his leg amputated which I'm not understanding what you meant. If that's it then he should have no problem getting Physical Therapy at home. Maybe medicare/medi-cal said no they won't pay for a facility stay.
I am not sure any one of us would know the answer to that unless they are the administrator at this particular rehab. There could be a variety of reasons why they would refuse service to a potential patient.
I am not sure what your question is as you say he's had some PT but not enough. In any case, you need to talk to the administrator of the nursing home / rehab and ask what their policies are / what care / services they provide.
A nursing home/rehab could have staffing issues: both turn over, under-staffed, and inadequately trained / experienced aids, or over-worked aids.
You could talk to a Ombudsman or contact the licensing board of the nursing home and ask them - based on what the nursing home administrator tells you.
If you are interviewing nursing homes/rehab, ask them what their procedures are specifically to do with your dad's needs.
I am not sure why you are asking the question. Did a nursing home/rehab facility ALREADY tell you they couldn't take your dad for this reason? While it doesn't make sense to me, I feel there is more information that we are not getting to adequately respond to your question. If they refuse service, I personally wouldn't want my loved one there anyway.
That is exactly what a rehab nursing home is for. To help him achieve as much independent function as he is able to manage. I suppose it depends on the facility. Some have their own requirements based on what assistance they are able to provide. If one facility can't meet his needs, don't give up. Continue your search until you find a good fit.
There are different levels of care and to provide certain levels, they have to have specialized equipment and the more staff. Sounds like where you are looking to place him does not have those two things to accommodate his needs.
Where my mom is now is a skilled nursing memory care that has onsite rehab and they accept Medicaid. Mom is currently in a wheelchair because they think she is a fall risk, She has to be able to stand and pivot to stay in the particular unit she's on. Once she can no longer stand and pivot, she will have to move to the next unit that has specialized equipment and more staff.
You need to provide a little more information. Usually the case manager/social worker at the hospital can put in applications to all rehab facilities that your loved one can apply to. Some facilities have limited space for those with Medicare or Medicaid. Some facilities may not have devices if your loved one is larger than average size. Some facilities may not have the intensive PT/OT that your loved one needs. If your loved one has very specific dietary, hygiene or other requirements... then they may deny based on the difficulty meeting the requirement(s).
Your patient’s (father or someone else’s) situation is an emergency. Does this patient have a social worker to assist him to find space in a home facility?
Yes, a skilled nursing rehab center will cover up to 100 days with Medicare. Also, a patient who has gone through physical therapy hits a plateau. The therapist will decide there is nothing more that can improve the patient. I personally think it is BS. Medicare will provide continued therapy at home or in a personal care home. If the patient goes back into the hospital, the hospital will provide more therapy. This can all change for the worse under the new administration, since they want to cut back on anything beneficial. Please go through every resource to continue PT.
My husband (84) had a below knee amputation last December. Hospital PT opportunity was literally nonexistent. I asked for resistance bands and activities to do with him. Then moved to rehab for 3 months. The daily intensive PT and OT was wonderful. Rehab will require residents actively participate in therapy. He started with a stand aide device and first day taught how to stand and pivot from bed to chair. Is he cooperating with PT and nursing staff?
How much does he weigh? My neighbor's sister was over 350 lb and was placed 90 minutes away from home. The issue was that the hoyer lifts in local facilities either did not have that capacity or there was a limit based on how much a ceiling lift could hold. After several months, the sister was moved across state lines which was only 20 minutes away. The facilities in the next state had different scope of practice and a couple of facilities had the appropriate lifts. Is this something similar?
First, lets make sure we're talking about the same type of facility. I am surprised at how often I hear people referring to care homes and assisting living facilities as "nursing homes".
Skilled nursing facilities exist to provide the type of services that this patient seems to require, so it would be unusual for them to refuse him based on his inability to transfer. Insurance companies are a common reason that a patient is not accepted to a preferred facility.
Rehab facilities will want to ensure that patient is sufficiently healed up and able to pursue a more vigorous course of therapy, so they might not accept him.
Assisted living facilities cannot legally accept a patient who needs more than one aide to help them transfer, so they are obligated to refuse him.
This is the purpose of a Skilled Nursing facility (aka "nursing home") or Rehab. That said if a particular facility can not manage him at this time then they can refuse him. A SNF and or Rehab can use equipment to help move/transfer him.
Did the rehab or facility specifically tell you this? The Case Manager or Social Worker at the hospital should be able to help you. Have you attended any Interdisciplinary Team meetings (IDT) to have the “real” big picture of your father’s health? If a facility does not have sufficient staffing, the patient has progressed to a level where they will not get better or if the facility is unable to meet the patient’s needs, or no pay source then facilities may have a right to refuse. Sorry to be so blunt. Is your father’s pay source Medicare ( for a skilled need)? If so hopefully he has not used all of his Medicare days up, including lifetime reserve days. Rehab/ skilled nursing facility (SNF) offer services to assist patients with rehab and help build his strength up. They deal with patients unable to transfer self all the time. If Medicare is the payor source call Medicare and discuss with them. Any facility that receives Medicare for payments is under strict guidelines and they have to follow the guidelines or else they may loose Medicare /Medicaid funding. If your father is Medicaid or indigent ask the casemanager at the hospital if they have a rotation list for acceptance. Some hospitals have an agreement with local facilities for indigent care. Remember hospitals / dr cannot tell you where you have to go, it is patient choice, but you may not find acceptance at the facility you want. Your father’s physician may not follow your father at facility. If your dad is insurance call his insurance case manager for assistance. Physical therapy is a skilled need which can be qualifier for admission hopefully he has an additional need for them to meet. Good luck with this endeavor. Oh, just a reminder when speaking with them don’t loose your temper or use any colorful language that may only makes things worse.
I can tell you my FIL was transported from the hospital to rehab and they had to move him from bed to wheelchair and wheelchair to bed using a hoyer lift.
Once he arrived at the rehab facility - we had to remind him that if he did not regain his ability to transfer - he would have to be placed permanently in a SNF because Rehab would discharge him as "non-rehabilitatable" after some time period of non-compliance. If the hospital believes they can regain a benchmark of transfer - they will be moved to Rehab.
But if they do not regain transfer ability, rehab will discharge, And if they cannot go home, they must go to a SNF.
Is this a Medicare insurance patient over 65 or a younger patient with Traditional/HMO/PPO insurance?
Typically with a Medicare insured patient, after a trauma surgery, the hospital does IP rehab. Next, after the patient reaches the medical standard of improvement to discharge, the patient will be qualified for SNF rehab for more extensive therapy for 100 days or if the medical staff has deemed non progress and LTC is needed or fully progressed patient ready for discharge.
If assessments are that the patient has reached the level of ability he is capable of reaching, yes, a Rehab can by reading assessments say that there are no services they can provide that are likely to improve condition, and they can refuse.
Nursing homes are a different situation. As you can imagine, nursing homes have MANY patients who are wheelchair bound and cannot transfer; in fact they have patients who are bedbound. But a Nursing Home can refuse an admission for whom they have no current adequate "beds" or no current adequate staffing and etc.
As KNance stated, the purpose of rehab is to improve function and mobility. I think we’re missing some crucial information so please give us some more details.
By proceeding, I agree that I understand the following disclosures:
I. How We Work in Washington.
Based on your preferences, we provide you with information about one or more of our contracted senior living providers ("Participating Communities") and provide your Senior Living Care Information to Participating Communities. The Participating Communities may contact you directly regarding their services.
APFM does not endorse or recommend any provider. It is your sole responsibility to select the appropriate care for yourself or your loved one. We work with both you and the Participating Communities in your search. We do not permit our Advisors to have an ownership interest in Participating Communities.
II. How We Are Paid.
We do not charge you any fee – we are paid by the Participating Communities. Some Participating Communities pay us a percentage of the first month's standard rate for the rent and care services you select. We invoice these fees after the senior moves in.
III. When We Tour.
APFM tours certain Participating Communities in Washington (typically more in metropolitan areas than in rural areas.) During the 12 month period prior to December 31, 2017, we toured 86.2% of Participating Communities with capacity for 20 or more residents.
IV. No Obligation or Commitment.
You have no obligation to use or to continue to use our services. Because you pay no fee to us, you will never need to ask for a refund.
V. Complaints.
Please contact our Family Feedback Line at (866) 584-7340 or ConsumerFeedback@aplaceformom.com to report any complaint. Consumers have many avenues to address a dispute with any referral service company, including the right to file a complaint with the Attorney General's office at: Consumer Protection Division, 800 5th Avenue, Ste. 2000, Seattle, 98104 or 800-551-4636.
VI. No Waiver of Your Rights.
APFM does not (and may not) require or even ask consumers seeking senior housing or care services in Washington State to sign waivers of liability for losses of personal property or injury or to sign waivers of any rights established under law.
I agree that:
A.
I authorize A Place For Mom ("APFM") to collect certain personal and contact detail information, as well as relevant health care information about me or from me about the senior family member or relative I am assisting ("Senior Living Care Information").
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APFM may provide information to me electronically. My electronic signature on agreements and documents has the same effect as if I signed them in ink.
C.
APFM may send all communications to me electronically via e-mail or by access to an APFM web site.
D.
If I want a paper copy, I can print a copy of the Disclosures or download the Disclosures for my records.
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This E-Sign Acknowledgement and Authorization applies to these Disclosures and all future Disclosures related to APFM's services, unless I revoke my authorization. You may revoke this authorization in writing at any time (except where we have already disclosed information before receiving your revocation.) This authorization will expire after one year.
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You consent to APFM's reaching out to you using a phone system than can auto-dial numbers (we miss rotary phones, too!), but this consent is not required to use our service.
I too wonder if Dad met his 100 days at the hospital or was discharged because he did not progress. Maybe the other Rehab feels he should have progressed to a certain point at the hospital and since he didn't, they feel they can't help him either. Thats why the need for him to be able to transfer.
There is so much that is looked at when in Rehab. How the person progresses. Is the patient copperative? Age, do they have Dementia, these two things could contribute to why they don't progress. Rehab does not work if the patient can't or won't help. They have to want to improve and will go thru the pain to do it.
Your Dads age will have a lot to do with him improving. My friend was in his late 60s. An amputation is a shock to the body. Anesthesia takes a while to get out of the elderly person's system. Who feels Dad did not get enough therapy, the hospital or you.
Alternatively, if the person has used up his/her Medicare days in rehab, the person might be sent to a skilled nursing facility for more PT at a less intensive level until the person is qualified to go home, etc. If there is no hope for recovery (very unlikely in the situation you described), then the person might be sent to a nursing facility for custodial care. Not being able to transfer should not be an issue for custodial nursing care.
I am not sure what your question is as you say he's had some PT but not enough.
In any case, you need to talk to the administrator of the nursing home / rehab and ask what their policies are / what care / services they provide.
A nursing home/rehab could have staffing issues: both turn over, under-staffed, and inadequately trained / experienced aids, or over-worked aids.
You could talk to a Ombudsman or contact the licensing board of the nursing home and ask them - based on what the nursing home administrator tells you.
If you are interviewing nursing homes/rehab, ask them what their procedures are specifically to do with your dad's needs.
I am not sure why you are asking the question. Did a nursing home/rehab facility ALREADY tell you they couldn't take your dad for this reason? While it doesn't make sense to me, I feel there is more information that we are not getting to adequately respond to your question. If they refuse service, I personally wouldn't want my loved one there anyway.
Gena / Touch Matters
I suppose it depends on the facility. Some have their own requirements based on what assistance they are able to provide.
If one facility can't meet his needs, don't give up. Continue your search until you find a good fit.
Where my mom is now is a skilled nursing memory care that has onsite rehab and they accept Medicaid. Mom is currently in a wheelchair because they think she is a fall risk, She has to be able to stand and pivot to stay in the particular unit she's on. Once she can no longer stand and pivot, she will have to move to the next unit that has specialized equipment and more staff.
Your family member needs a different facility.
Skilled nursing facilities exist to provide the type of services that this patient seems to require, so it would be unusual for them to refuse him based on his inability to transfer. Insurance companies are a common reason that a patient is not accepted to a preferred facility.
Rehab facilities will want to ensure that patient is sufficiently healed up and able to pursue a more vigorous course of therapy, so they might not accept him.
Assisted living facilities cannot legally accept a patient who needs more than one aide to help them transfer, so they are obligated to refuse him.
That said if a particular facility can not manage him at this time then they can refuse him.
A SNF and or Rehab can use equipment to help move/transfer him.
Once he arrived at the rehab facility - we had to remind him that if he did not regain his ability to transfer - he would have to be placed permanently in a SNF because Rehab would discharge him as "non-rehabilitatable" after some time period of non-compliance. If the hospital believes they can regain a benchmark of transfer - they will be moved to Rehab.
But if they do not regain transfer ability, rehab will discharge, And if they cannot go home, they must go to a SNF.
Typically with a Medicare insured patient, after a trauma surgery, the hospital does IP rehab. Next, after the patient reaches the medical standard of improvement to discharge, the patient will be qualified for SNF rehab for more extensive therapy for 100 days or if the medical staff has deemed non progress and LTC is needed or fully progressed patient ready for discharge.
Nursing homes are a different situation. As you can imagine, nursing homes have MANY patients who are wheelchair bound and cannot transfer; in fact they have patients who are bedbound. But a Nursing Home can refuse an admission for whom they have no current adequate "beds" or no current adequate staffing and etc.