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My husband had covid....he developed pneumonia and MRSA while in hospital. They treated him for a week and "highly" recommended transferring him to the contract rehab hospital within the same building as the main hospital to ween him. He has gone down hill in all areas and the Select Hospital is telling me I can not move him to a better care facility because Medicare won't allow it if he is already in an "adequate care" facility.

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I've had experience with 2 Select Specialty Hospitals and was pleased with both, but ecstatic with the treatment provided by the second. 

Medicare does have some specific restrictions for these hospitals.  After being in the first one, getting good treatment but contracting MRSA and being moved to the main hospital ICU, I was advised by hospital staff that Medicare would not allow him to return to the SS Hospital renting space from the primary hospital.   I had to find a different SS Hospital, and found an even better one about 30  miles away, in a city known for its high quality medical care.

I suspect that what you're being told arises from a Medicare mandate.   It may have something to do with the long term care aspect, the plan of care, and Medicare not being willing to pay for hospital switching.   It may also be that, absent an interruption to return to higher level care, the patient's needs must be reassessed and a new plan of action created, by a different hospital.\

BTW, from what is he being "weaned?"   Was he on a ventilator?

Have you asked for consults with applicable doctors at the existing hospital to discuss the plan of care, why he's declining, and what the options are?   It may be that his condition (and I hate to suggest this but it may be a factor) can't be improved and will continue to decline.

Please try to meet with the decision making staff ASAP, and I hope you're able to get an answer to your concerns.
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igloo572 Feb 3, 2021
Garden, just a lil fwiw SS & Kindred have done some type of merger for contract rehab and acute care facilities EOY.
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My gut reaction was "of course!" but I didn't know about select hospitals. Never heard of it. If you are unhappy with his care, perhaps there is a way to appeal to medicare to allow a transfer?

Wow, covid, pneumonia AND MRSA?? That's a lot for a body to be fighting! With all that going on, it's no wonder he's unfortunately gone down hill. He might go bak up as he recovers from all these difficult medical issues.
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Mumsey, I think you’re going to find that moving him is going to be quite challenging; it’s not going to be so much that MediCARE won’t pay for a different facility but more that he has a continuum of care going on in his health chart right now that is tied between the hospital & hospitalist MD team next door and the adjacent Select Services acute longer term care rehab facility that he’s in. Moving him will disrupt the “continuum of care” and the logistics of getting a very frail still very ill patient up & out and into speciality ambulance then transferred to another Select Services or another hospital, I bet, will be written up as AMA (against medical advice) in his chart. Often if you go AMA, insurers can decline paying benefits and seems you end up having to do appeals and have all sorts of cooperating MDs at the new facility that will provide the paperwork needed for an appeal. Dealing with AMA issues - should that happen - will not be simple.

Should you want to do the move, please pls clearly speak with his current care team and the new ones as to how the transition is to be handled and who sets up the logistics. You may have to up front pay for the ambulance transfer.

If the “weening” is his getting off a ventilator, that can take several weeks. It’s a slow go, is my understanding. There could be risk in moving him. It’s something to clearly speak with his RT and MDs about.

He had to be significantly ill to have gotten into the Select care facility. Hospitals - if they can - always want to discharge them back to the NH for rehab done there or back to their home & out-patient rehab. He’s at risk or poses risk if he’s at an acute care LT rehab place.

My MIL became very ill at the NH & was hospitalized. Long story short she had pneumonia + was very septic and going into cascading organ failure. She went from a hospitalization to an acute LT care rehab facility located in a seperate but directly adjacent building (hers was affiliated w Kindred). NH was not going to take her back. She needed specialized intensive long term care w pretty serious drugs. That’s what the acute care rehab place provided. Medicare covered the costs and seems to do it under the rehab rules that if they get better & “progressing positively” thier rehab will run out eventually at 100 days. For my mil, she died of organ failure not quite at 3 weeks. Had she gotten better & actually been discharged, she would have gone into the hospice wing at her old NH.
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Igloo has excellent advice for you below.
I am so sorry. Covid-19 is not so much a flu as it is a viral pneumonia. If they are talking MRSA it is sounding as though there may be a bacterial infection superimposed as well?
When the ventilator is needed it is not good, and when the news is the MRSA is on the scene you know that the bugs now invading are likely not bacteria that are going to be beaten down by Vanco and the other first line of defense for same. Many bugs are now resistant to our antibiotics. Few pharmaceutical companies want to attempt to create new ones because they are not the money makers that drugs taken daily are.
By other areas do you mean organ failure? That is to say are they seeing failure in the major systems other than the lungs, in the heart, kidney, and etc. when one system is under such devastating assault sometimes systems begin to go down almost like the dominos you see in ads.
Do know that there is very little that CAN be done but support of ventilators to attempt to get the air into lungs that may not be receptive to it even with this push, and to give the medications available and hope other organs don't shut down. You do not say how old your husband is. But age if involved in making the fight more difficult, as is weight, some other factors relating to it.
I am so sorry. This is a waiting game to see if your husband's systems have the strength to come back from this. I hope you discuss this with doctors who will tell you that there are only so many things to be done against Covid-19. I hope that he is successfully weaned and that there is no invasion of bacteria to add to the viral load. This is dreadful to see and live through and with our numbers on my coronavirus dashboard showing at 462,000 deaths, so very many are going through this pain. We have lost more than the entire loss of WWII for America. We have a big population, but this is a lot of loss.
I hope you will update us. You post was on the 1st. Is there any improvement, Mumsey?
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Addressing only the MRSA  (and VRSA), my father had MRSA twice in less than 6 months and was treated with Vancomycin.   Then he contracted VRSA, which was more challenging I was told b/c it's Vanco resistant.   Yet he was able to conquer that as well.   

Those were unsettling, challenging, and emotional times.   But I was proud of him and pleased with the staff that (a) he was D'X'ed quickly and (b) the staff responded quickly.

Both MRSA events occurred when he was in a hospital, and the VRSA event occurred while he was in a Select Specialty hospital.    I don't blame anyone; it just happens when someone is very debilitated and patients share rooms.
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I want to ask you if you are expecting 100% recovery to when things started. It is unfortunate that he got COVID pneumonia. He has a long recovery during a time where hospital services are strained. If he is still on a ventilator, then for every day that he is there means 3 times the rehab time which will mean long long recovery time. He may plateau before that.
You need to stay a step ahead and start looking for LTC facilities once he gets past the specialty part.

Please do not blame medical staff for his inability to come off the ventilator. That was never a cure, just a means of support until the internal workings of his body could try to heal.
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