She has his the 20 day Medicare limit and so they say she must leave. She is unable to perform basic tasks to take care of herself. What options are there for continued care. She cannot go back home.
That happens is the patient is released from the rehab center if they are not cooperating or not meeting up to the potential. Some elders can become very stubborn.
My Mom was in rehab for 20 days, and I then asked about the 100 days where the 2nd insurance will kick in. They told me that my Mom was refusing to do any of the exercises, and I understood that, she was 97 and had a brain injury due to a fall. My Mom couldn't go home, either, so she is now in the long-term-care section of the rehab and will stay there for the rest of her days.
Now, if your Mom can afford it, she can hire professional caregivers who are familiar with her health issues and they can be at her home around the clock to help. But note, it can become very expensive.
Talk directly with the Physical Therapist. It sounds like a failure to progress. If the patient declines PT more than once with excuses like "I'm too tired. I don't feel like it. I don't feel good." then Medicare will stop paying for the PT.
You should ask the facility social worker about applying for Medicaid on her behalf if she has little income. You also want to ask if the facility will accept her 'Medicaid Pending" for long term care.
Options at rehab? None. They discharge either to home or long term care. Then you sit down with the discharge coordinator to discuss long term care options. Often the patient insists they are going back home. You can't force her to go to a nursing home unless she is certifiably incompetent.
Yes, if she refuses to do PT and/or makes little to no progress they'll give her the boot and/or push hard for LT care. You MIGHT be able to stall for time in order to get her house prepared and line up care but a) you'll only get a few days and b) you'll have to pay the copay for any time after the first 20 days. Definitely talk to the SW and tell him/her you need assistance with lining up things like hospital beds and nursing and etc. Also look into speaking with an elder care advocate, just to understand what rights you have and so forth. It was a huge help for me.
My Mom was in rehab for 20 days, and I then asked about the 100 days where the 2nd insurance will kick in. They told me that my Mom was refusing to do any of the exercises, and I understood that, she was 97 and had a brain injury due to a fall. My Mom couldn't go home, either, so she is now in the long-term-care section of the rehab and will stay there for the rest of her days.
Now, if your Mom can afford it, she can hire professional caregivers who are familiar with her health issues and they can be at her home around the clock to help. But note, it can become very expensive.