Can nursing home/rehab center keep grandma after doctor gives ok to go home?

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My grandma (age 80) fell about 2 months ago & broke her hip. She had surgery to replace the ball joint (not the whole hip). She was in the hospital for a couple of days & was then moved to a rehab center for the past several weeks. Her doctor, both her normal doctor & the doctor who performed the surgery saw her mid week last week & both said she was doing really well - better than they thought she would at this point. So they told her she could go home sometime this week. Well now the Occupational Therapist is saying she won't let my grandma leave until she has a home visit completed & the OT wants to watch her dress the next few mornings. The OT said she wouldn't let her leave until end of next week at the earliest & if she had her way she'd be there for 3 more weeks yet. She lives in a well known senior apartment here in town. They have all the amenities that the OT is saying she needs to have - railings in the hallways, walk in shower, elevators, etc. The watching her get dressed in the mornings bothers me - seems a little creepy. She's been dressing herself for a good week, week & a half without help. Why does it matter how she got there? My grandma has no other health issues & wants to go home. Can they legally keep her there if the doctor gave the OK for her to go home?

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Well we called the nursing home and they wouldn't give us any answers (my mom, my grandma's daughter). My mom then went the route of saying that her insurance is running out & there's no out of pocket pay. So that kicked someone into gear in calling the insurance company - waited 24 hours to hear back from the rehab center on what insurance's answers were. Long story short... apparently my grandma's made a miraculous recovery in OTs eyes & she can now go home Saturday - when her insurance runs out.

Thank you all so much for your help! Great suggestions all around.
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Have you spoken with the OT? They very seldom work all alone. They have regular, if not daily meetings with each other to discuss patient progress.. There is a system of checks and balances and the therapists have to answer to someone for their decisions. When my husband was in rehab last year, everyone knew what his plan of therapy was so they could help him, from the aides to the dietician to the charge nurse.

At some point, Grandma’s Medicare will run out and she will HAVE to be discharged or she will be self-pay. When my husband came home, he did not have a visit by the Visiting Nurse until he’d been home for about a week. A few days after that, the therapists came and approved the house as safe for him.

Rather than guess and wonder why the OT says Grandma needs more time in Rehab, call an emergency Care Conference with the therapists, social worker and the nurse if she has time. They are the only ones who can honestly answer your questions.
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They Can't force her to stay. Tell them there is no money. Call the doctor and tell him what is going on. They are trying to milk her.
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The NH is charged with making a "safe dishcarge:. the OT may be the person who needs to certify this. At least in my mom's case, it was the OT who was going to go to mom's home to see that it was set up correctly so that rehab could safely dishcarge her.

Don't personalize. Be grandma's advocate, but understand that this may be part of protocol.

Do post back and let us know what happens.
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Who has spoken to the OT?

The things the OT is recommending are a good idea. Checking that your grandmother's (ideal-sounding) apartment still works for her now that her ways of going about her activities of daily living may have altered can't possibly hurt, and might highlight some issues that could be easily solved. Things may even end up *better* all round than they were before, it's all good.

But if she and the family really feel that everything already meets all conceivable standards, an OT's visit on top is de trop, your grandmother is competent and wants to go home, and her surgeon and primary care doctor have signed her off - then she can go home.

If it were me I'd give the OT a quick courtesy call and just check that she isn't talking about something we hadn't thought of. And while I was at it I'd check that there hasn't been some misunderstanding of the NH's discharge process.
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OT is for upper body is it not?
I do believe that Drs have final say, get the administration involved asap, tell them there is no money for self pay, you'll have to run to keep up with discharge.
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Wow, this OT person is really brazen! Several issues:

1. She/he doesn't have complete authority to override others, especially the doctors. Sometimes there's a physiatrist doctor at rehab; this person usually has the last say in terms of therapy decisions.

2. I can't guess why the OT is flexing his or her muscles, apparently trying to override the doctors. Something is going on there, but I don't know what.

3. Find out who oversees the therapists and discuss the issue with him/her.

4. Your GM can dress at the rehab, using the adaptive tools she needs, although I do understand that a therapist could legitimately be concerned about someone dressing w/o any help, especially if there are fall issues.

5. Has anyone addressed the issue of follow-up home care, very typical after discharge from rehab? The social worker should have raised this issue at least a week or so ago.

You have the right, and if a doctor scripts for it (which in my experience is usually done w/o issue), GM can get about a month's worth of home therapy, which does include adapting to her specific environment. She isn't going to go home "cold turkey" w/o any further support.

SW should have some brochures to hand out for home health care agencies, but do your own vetting. Some are good; some are horrible. One thing you absolutely want is one therapist per discipline rather than whoever's available, which I've discovered is the way some large home health care agencies operate.

Whoever's available the night before and will take the assignment gets it, then either calls that night or something the next day advising when she or he will be coming over. This is the worst situation we've ever had; I fired that agency after day days, 2 different nurses (although they were both top notch), two therapists (one stunk) and a totally irresponsible, arrogant, unprofessional therapist who way overstepped her boundaries.

6. One sure way to bring this issue to a crashing halt though is to present the administrator of the rehab facility with a letter (of which you'll obviously keep a copy), which states something like this.

a. Restate the situation, that the doctors have approved discharge but the OT has created additional demands

b. OT has not stated the reason for her specific demands.

c. Medicare will not reimburse for care after today. The family has no way of paying directly. Reimbursement by Medicare is therefore unavailable, as is payment by the family.

d. Therefore, any plans to keep your GM will have to come from another source, or be provided gratis (free) by the facility. (Perhaps the OT would be willing to reimburse the facility for the charges Medicare would have paid??)

Item d should shake up the admins enough to get the OT on board.

Good luck. Let us know how this works out. We had a similar issue when a facility wanted to keep Mom longer but her orthopedic doctor said she was ready to go home. My father, sister and I stood up to them and told them we were taking Mom home, and that was it. I probably inferred some legal action, but this was 19 years ago and other than standing our ground I don't recall what else we did.
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There is a tendency to discharge too quickly and the OT could be trying to fight for a safe discharge. The way medicare and rehab works is that you (the patient) are required to be notified about discharge 3 days prior. If you feel that discharge is too soon, you can file an appeal. If the appeal is not in your favor, you can file another appeal. A safe discharge is so important. It can make the difference. I have experienced one parent who was not safely discharged. He managed to make it 25 days at home, suffering a fall the very first day (injury: gash on his thumb), and being treated for an infection. The 25th day at home a hospital acquired resistant infection forced him back into the hospital where he deconditioned, and a subsequent discharge resulted in a fall (injury: broken pelvis). It was a nightmare. In another instance, after only 18 days of rehab, Medicare discharged my mother from rehab. On the home visit, she could not get into her bed. That is a situation where a fall or displaced hip would be likely. She stayed in the rehab/nursing home longer where an underlying fainting conditions became evident. That early discharge would most definitely resulted more falls. Maybe your OT has seen these scenarios and is trying to protect your grandma. My advice is to fight for as much rehab as possible before your grandma is discharged. If she dislikes being in rehab, a few more days would likely assure her of not going back!
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An OT visited my mother's house prior to discharge from the nursing home and I was glad. He noticed a number of small things to adjust that improved safety. The OT also noticed a difficulty my mother had with dressing and suggested a slight adjustment that made it easier for her. The changes suggested for my mother's home cost zero to a few dollars. The NH needs to assure that the discharge is appropriate and that is a good thing. Dr, surgeon, PT, OT....each of these people has an important role to play in a patient's health care.
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You can ALWAYS sign yourself out of a facility unless you are under arrest or a court order. Sometimes people get intimidated by the medical establishment.
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