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The patient is an 87 year old male who had lumbar surgery to treat spinal stenosis. He lived alone prior to the surgery. He was feeble when he entered the rehab facility due to an extended stay (16 days) in the hospital and has improved during his first week of therapy. He will be discharged at the end of his second week. He wants to be transferred to a SNF near his home for at least a couple weeks so he can get stronger and regain more of his mobility before going home. The rehab center says he will be able to go home after his 2 weeks with supervision and is resisting making the referral to the SNF because they say he doesn't need it. If he insists do they have to refer him to the SNF?

What I learned after moms stroke while searching for a rehab was Acute rehab gives you 2/4 weeks at most. If any acute care rehab accepts you they are basically telling your insurance that they will rehabilitate you “back to or very close to the exact level and independence you were before whatever Injury was”. Acute care is paid a one time lump sum no matter how long you stay (so they will push you out to get the next lump sum in). They get fined - monies they were paid deducted - or bad marks as an acute care rehab if they take you on and you need additional care after they were already paid.
acute care rehabs are very picky on who they take for this very reason - no insurance company wants to pay acute care and then paid for skilled they hold acute care responsible for this if they took the patient got paid the large amount of monies and then didn’t get the person to the same functioning level. Therefore acute care rehab will do everything in their power to send you home with home health and you have every right to fight like heck if you think skilled nursing rehab will give your loved one a better chance at rehabilitation.
My best friends husband just had brain surgery and went to acute care and becasue he did not do as well as they thought they also were trying to send him home and pretend he didn’t have a right to skilled. I told her the real reason and she put up a fight and made sure he went to skilled for additional rehabilitation. The patient has every right to go down to skilled - things happen and sometimes people need more time - usually acute care takes on only who they know they can get home to the same functioning level and when they can’t they do not inform the patient or family that it was their mistake and attempt to save their butt! Do not let them fool you or anyone else you know. Share this information and also make it clear to them that you know why they don’t want him in skilled. Sorry this is the one thing that bothered me the most and how our health system works and how many are unaware of their rights because of the games played in this country. This hits a nerve for me as you can tell. But I assure you - Medicare and or other insurance companies are upset when someone has to go from acute care to skilled as they don’t want to pay the higher owns time fee and then also have to pay for skilled nursing on top of it. In my opinion acute care should be for those who need the best equipment and care - strokes and TBI and higher level injuries but it’s not and because it is a one time fee only acute care chooses and accepts those they can rehabilitate quick to open up the room for the next one time lump sum.
Im wishing you the best to get your loved one into skilled if you feel that is what is in their best interest. 🙏🏼
Please share with others so we can all make sure our loved ones get what they deserve. 🌈
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Reply to Momheal1
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Maple3044 May 31, 2021
Thank you for this explanation. Now I understand why the rehab facility my stepmother was in shoved her out so fast on a Sat morning. Even tho she said she didn't feel safe going home alone. Because it was a Sat, I couldn't get any caregivers to come in that quickly. I was afraid to bring her to my house as I had 2 large German Shepherds and I was afraid they might knock her down; not recommended for an 88 year old recovering from a hip replacement.
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You can explain the situation to his primary care doctor. The doctor may order home health after his stay in rehab.

My mom did rehab and she also had home health several times throughout her years. Home health is wonderful. They have occupational and physical therapy along with an aide to help with bathing and dressing. You will also have nurse visits. Home health is covered by insurance if the doctor orders it.

If you need a walker that can be ordered through home health. You will pay a fraction of the price.
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Reply to NeedHelpWithMom
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How do they know it will only take two weeks. I was told for every day in a hospital, 3 days of therapy to get strength back is needed. So, that would be 48days.

What u can do is call a SNF in his area. Run this by them. If they are willing to do it, then you get his Dr to sign off. But, the cost will probably be on him. When he is released fro rehab, he is also released from Medicare. He may be able to do therapy in home.
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Reply to JoAnn29
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Families don't decide on referral to SNF/rehab. Doctors do. Doctors often listen to families and consider what they say.Basically however they decide things on rehab needed, ability of the patient to progress with further rehab or SNF. Make your feelings know to the MD currently in charge of the case of this 87 year old elder. Do know that medicare and medicaid and supplemental insurance plays into all this as well. Speak with the Social Services workers and make him or her your friend and helper.
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AnnReid May 29, 2021
I’ve placed and been POA for placing two people, and no doctor was involved in either.

Are we speaking about different situations or legal requirements AlvaDeer?
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If he can self pay he can do as he pleases, at least in the state I live in.
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