Can inpatient rehab facility discharge before ready?

Inpatient rehab is not just about the person's progress but also about the amount of time that his/her insurance pays for. Since it appears that your partner's insurance days are running out, talk to the facility and the doctor about what kinds of help and equipment you will need at home. Then, get familiar with using the equipment to care for your loved one. The goal is for you and your partner to be healthy and managing both of your needs at home.

To stay in rehab the policy always was to have medicare continue to pay the patient has to show improvement with each PT/OT visit. That may be the issue. I would refuse to take him home and see what they suggest next. My mom stayed in rehab until the last allowed paid day {after a hospital stay} and everything was paid in full {30 days worth}. Mom got up even in pain and did the work expected of her every visit and she has Lewy dementia.

tngal68: It is imperative that you state to the facility that it would be an unsafe discharge to home. Be firm.

Interesting depending on how much "work" was needed you would think rehab would be at least 30 days.

I went through the same thing. I gave them a whole list of places that I researched based on Medicare ratings. All the top rated facilities either were full or did not want to accept my LO for the care that she needed ( hip surgery that got infected during initial surgery). Then you are left with 2-3 choices of places that will accept the patient and you have to accept one of them as they can't keep them at rehab hospital due to Medicare rules. The system sucks!

I had the same thing happen with my dad. We thought Medicare covered up to 100 days in skilled nursing and rehab. It is shameful. My dad couldn't go home because he was not strong enough to stand and go without a wheelchair. The facility said that he was physically ready but we would have to send my dad somewhere for his dementia. They blamed the anesthesia on worsening his dementia. We have to pay out of pocket for my dad to stay in personal care residence and that's the end of him. He will never go back home.

Please, please, please appeal.

Perhaps the inpatient rehab facility thinks that the patient has plateaued in his treatments and it’s time to release him from their care, or perhaps it has something to do with his medical insurance coverage.

To get an answer to your question, you will have to speak to the doctor in charge at the rehab facility to find out the reason why they are releasing him from their care.

This is likely an insurance and legal matter.
* Talk to administrator at facility. Ask what their legal responsible is.
* Ask his MD / make recommendations or prescriptions of needed care.

* Contact Medi-care and/or other government agencies that contribute to his care (if they do).

* It certainly might be up to the facility. You need to ask them for written documentation reflecting their decision. You need to talk to the facility management first and then get all their responses documented in writing.

* Start checking into other facilities / rehabs if you believe (and MD recommends) more rehab care is needed.

Gena / Touch Matters

You are going to have to play hardball here. Is he on Medicaid or Medicare? I know Medicare will pay up to so much for rehab. Two years ago rehab wanted to let Mark come home after two weeks when I knew he wasn't ready so I had to push saying how unsafe it was. We were able to wrangle two more weeks out of Medicare at a reduced rate (even this was barely there). Please do not endanger yourself or your loved one if you cannot physically help. Medical places will try to guilt trip you into taking a loved one back home. Once they come back home, unless they get admitted into the hospital, it is nearly impossible to get the help you need. Home health care is only for those with very light needs medically or physical.

If he gains some mobility in a wheelchair, enough to transfer where you just are there to help balance, you might be able to make changes to your home or he could live in a wheelchair friendly home, but right now he will need to be under supervision so he doesn't fall.

Typically - a facility will be able to assess pretty quickly if they will be able to get a patient back to their "baseline" - where they were reported to be prior to whatever landed them in the hospital.

You mention that your DH is currently in a wheelchair. He is taking 50 steps with a walker and on oxygen. I'm assuming that he didn't leave home with ANY of these things correct? Oxygen, walker, wheelchair? They will be able to help him get to a certain point, but there will likely be limitations even with hard work on his part. And they may already be able to see that in his daily PT and OT.

That being said - as you said - it is an unsafe discharge for him to go home right now - so Skilled Nursing is the only option.

Beds are a revolving commodity. What is available right this minute - won't be there in 24 hours or even 12. They are asking for additional options because there is no availability where you prefer him to go. You could look into it on your own - entirely private pay and private transfer and might potentially have more luck. But it's doubtful.

You could appeal it - but that takes time and in the interim they could try to force your hand - and the response to that is that he is an UNSAFE DISCHARGE. Learn those words. You cannot and will not take him home and he is an unsafe discharge.

Here is the thing we were told multiple times at multiple facilities. If FIL was "discharged" from the rehab - then he became skilled nursing care and he had to pay the private pay rate until he left as long as he occupied their room. Now I don't know if that is an option for you. But they weren't going to kick him out on the street because they knew they were playing with fire because he wasn't in a position to go home. There is some wiggle room typically - you just have to pay out the wazzoo for it.

We never actually had to use that - but the last facility did keep him until we were able to get him transferred to his SNF.

Repeat after me - UNSAFE DISCHARGE.

Not ready by whose evaluations?
Because YOUR evaluation and the patient's evaluation may not match the expert evaluation of the rehab.

There are many reasons for discharge and this is something, if you are next of kin or POA you should be included in by law-- legally mandated discharge conferences. There, the personnel, whether nursing or PT or OT will tell you of progress, or lack of it.

Some patients cannot fully participate. In those instances rehab is a waste and cannot be legally covered by medicare funds.
Some patients have made all the progress they can make in rehab in the opinion of the experts.

Briefly, the answer is yes, discharge can happen before you or the patient are ready if the facility believes that the goal is met, or if they believe it CANNOT BE MET.

Now we come to the important part for you:
If this patient is not well enough now to return to your care then THAT is what you need now to make clear to discharge planning, social workers at rehab. In facility placement may be necessary.
DO NOT ACCEPT home someone you cannot physically/mentally care for. THAT would constitute an unsafe discharge.

The rehab will tell you all sort of lies. "We can get equipment" , "we can get you help", "we can make this work". They won't, they can't, and it won't work. So don't buy that and tell them this old RN told you so.

Best of luck to you.

If the places where you want him to go are not available, then he will have to go to a facility that you are unhappy with. If you appeal his being forced to leave rehab, it shouldn't be on the basis that he will have to go to a facility that you don't want him to go to. Rather, it will need to be that he is now progressing rapidly and could be discharged to your home with a few more days of rehab. Is that a possibility?

I am a little unclear about why you would need to lift his wheelchair. Is it that your home is on 2 floors? If so, you could rent a wheelchair for each floor, and he could concentrate e in rehab on going up and down stairs. I had to rent 2 wheelchairs for myself for a brief period because I lived on 2 floors, and if you rent from a Medicare-approved supplier, it is not very expensive. You might also be able to have an OT/PT come into your home to show you how to assist him in other ways. In this situation, Medicare would also send home PT/OT providers, although they would probably come only twice a week.

I'm suggesting these alternatives because e it sounds as if your husband is very motivated, and the amount of therapy you receive in a nursing home is considerably less than in rehab. And however you cut it, if a home environment can be managed safely, it is happier for all concerned--especially since you know your husband will continue to work to improve. I'm speaking here from personal knowledge with the experiences of our family, and of my own experience when I had to be i a nursing home for 6 days. Your husband of course cannot come home if it is not safe, but I'm suggesting that it might be worth it to try to make it safe enough that he could come home and avoid the nursing home.

Speak with the case manager On the floor and ask to speak with a social worker .

Its up to them to look for choices. You gave them 3 and there are no beds. So they have to do the research. I was up for a job one time working in a NH/rehab facility. My job was going to be calling around to hospitals and other rehabs telling them we had empty rooms.

I would appeal.

You will have to make another choice of SNF if your first 3 choices are full. They can’t keep your husband while waiting for a bed in one of your original choices. They have to send him somewhere. They might make the choice for you if you don’t give them your preference of remaining SNFs in your area.

Thank you. Yes we requested a meeting with all of those people present. We just had the meeting and the social worker determined it was not a safe discharge to home so therefore he needed a SNF. Although he has started using a walker in the last couple of days (50 steps max so far), they want to discharge him in a wheelchair which I am not able to lift. So we are looking at SNF but they are saying they need more SNF choices from us bc the ones we have mentioned are currently full.

I would appeal the discharge since he is showing signs of improvement.

Have you had a care meeting with the social worker and other staff at the rehab? If not, request one and ask for the physical and occupational therapist to be present.

The other option would be to consider getting his doctor to order home health where he can continue PT and OT at home.

If you want to avoid skilled nursing for now, would it be possible to hire additional help at home?

Wishing you and your partner all the best.

How old is your partner? Is he on Medicare? How many days of PT does his insurance cover?

The person who decides he is making progress is not you, but his PT or doctor. If he is not making enough progress or is not cooperating, then they will stop his PT and send him home.

Is your partner telling the discharge staff that you are his caregiver? You need to have a discussion with them to let them know you are not his caregiver and not able to provide the care he needs at his current level of abilities.

let them know that it is unsafe for him to come to your home and the assigned social worker will assist you with working it out with another facility or rehab. Just make them understand that it is unsafe.