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Mother is being released from a hospital after breaking her hip. They say she can't go to rehab has to go to nursing home w/post acute care? The hospital says she is too weak for a rehab center.

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Full fledged rehab hospitals have a three hour active therapy participation rule that they typicaly can't break if they want to get paid and not dinged for fraud. Subacute, typically the level of rehab in a skilled nursing facility, is lower intensity and accomodates a slower rate of progress; in my experience the team coordination of all services may not be quite at the same level either. But I have had friends in subacute settings do really well and get back home, though many people run out of covered rehab days and/or stop making progress and have to transition to long term care. Some therapy may still be provided in long-term care depending on specific goals, but they are more likely to delegate it to nursing staff and maybe a therapeutic rec person to keep a resident mobile and active.
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In our area a rehab center is for stronger/younger patients. The general rule of thumb is that a patient be strong enough to do three hours of constructive rehab per day. If they have a low patient census, they might be flexible with that requirement.
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Based on your detailed description of your mom's health over the last few years contained in your profile, I would definitely discuss the plan of care with her doctor. Have you discussed palliative care with him? It might be important to decide what the goals are and how to accomplish it without placing your mom in undue pain and discomfort.
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I disagree with Babalou who infers from your message of what the doctors have said as a real statement that your mother could be slated to go to a nursing home rehab for comfort care only. There can be a big difference between that (which is hospice appropriate) and a nursing home with a good rehab program. You need to observe, question, and research what kind of program this particular nursing home rehab offers. Sometimes you can ask the patient themselves or even a family member. As a hospice nurse I would be the first person to advocate it for this patient if necessary but I certainly wouldn't assume it was the real intention of of the patients caregivers without checking thoroughly. The difference between different nursing homes is important to know also. Over time I have experienced this situation from all aspects: as a nursing home nurse, hospice nurse and the advocate for my 96 year old mother who has been in rehab at two different nursing homes. She got excellent rehab at both of them and and was worked to her tolerance in each. The government doesn't want to foot the bill for long term care for unsuccessful outpatient rehab programs, which has upped the level of care considerably. But I admit that not all homes are the same. Hence the need for thorough research.. Good luck!
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Ask a lot of questions. My mom recovering from a hip replacement and the facility we moved her to for rehab was principally a nursing home. They had a special wing for rehab patients but her room was so remote she had a hard time getting the attention of staff While she received excellent OT the in-room care seemed to regard her as a NH patient with dementia. So while the OT staff during the day was attentive, the nighttime care was casual at best.
During her second stay that new rehab wing had been closed for a plumbing problem and her room was in the middle of the facility but she still complained about not getting help when she needed it.
And mom was on Workers Comp from a work related fall so she was not an elderly/dementia patient which the staff had trouble understanding.
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RudiosoBb - none of it is easy! What is that quote...old age is not for the faint-hearted?
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GGs Girl, thank you for your comment. I do talk to my sister every few hours at least. I agree that it might be more important for me to be with them down the road. I am working all weekend to try and get as much done as possible in the event I have to leave without much notice. I am the CEO of a Chamber of Commerce so there are lots of people dependent on me and I am feeling so much anxiety right now. I would be calmer if I was in Houston but I can't go there for an extended period of time. My son and his family live in Colorado and fortunately we met in Houston to visit Mom a few weeks ago right before her accident. None of this is easy and my heart goes out to all of the care givers and the ones like myself that can't be there day in and day out. Not sure today which is the easiest.
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RuidosoBB, as long as you can talk to you mom a couple times a day by phone that is good, not only for you both, but for the staff to know there is family who cares - and who keeps tabs on things. That shouldn't be the case, but sometimes it is. It is common for our elders to get confused about where they are after hospitalizations. My mother has mild dementia, so I expected that and would have to remind her she was in a NH not a hospital, why she was there and that it was temporary. Don't beat yourself up about not being there. Give your sister support when you can. Your presence may be needed more when your mom comes home later.
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I really appreciate all of this input. My mom lives in Houston, Tx and we found a facility that seems nice. She moved in late Thursday and had a brief PT session Friday morning. She did okay but it wore her out. Last night she tried to get up and fell out of bed. They say that she didn't suffer any injuries just bumped her head. Today she is very depressed and wants to die. She hasn't eaten and says she isn't hungry. It feels like a serious downhill spiral we are seeing. She can't stand up on her own and couldn't even think about using a walker at this point. With assistance she can get in a wheelchair and use a bedside commode. I really only hope that they can keep her comfortable. I have a sister that lives in Houston and is spending as much time as she can with her however, I live in New Mexico. I think I need to go to Houston but my sister wants me to hold off and see how she progresses. Unfortunately my job is extremely demanding and the next two weeks I am very pressed as far as my time goes. I am so torn as to what I should do. I am able to talk to the nurses everyday to get reports from them and my mother still talks to me a couple times a day even though she doesn't know where she is or what is going on.
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Very sorry for your loss also Liamalover. Just another side to this story, as a therapist, I start to work at 7 am. When a new eval comes in, especially a hip fracture, nursing staff asks that therapy be the first ones to evaluate level of assistance, and give staff recommendations, fit a walker to correct height, look at their ability to follow weight bearing precautions, if any and any number of other real issues. For example, I just worked last Saturday after the hospital discharged 3 such patients late on a Friday night, staff and family were anxiously awaiting the therapy staff for these complex patients to be evaluated. I look at their ADLs as an OT and determine if they need a bedside commode or they can get to bathroom, can they use a walker, or do they need a wheelchair, etc. So can be a blessing too.
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Llamalover, I am very sorry for your loss and bad experience. I had a friend who lost her mother due to negligence of staff during rehab for a broken hip in a NH in a larger city. So very traumatic.

My experience is on the other end of the spectrum, where the only facility in our small town is above average in care and excellent with rehab. After my mother was hospitalized for three weeks, she was too weak to come home, so went directly to the NH for therapy. I had heard good reports about the PT, but was leery about the NH environment. The staff was overworked but very good, the facilty spotless, and the PT/OT department lived up to their reputation. It is unfortunate that they can't all be this way, but want to let others know some are good. The descriptions for the differences between rehab and nursing facilities in previous posts are good.
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Alert: Some NH's do PT at ridiculous hours. My mother was told "you're too well to stay in our NH." Then less than 48 hours later, they got her up at 7:00 A.M. to do PT and she suffered an ischemic stroke then. Sadly COD was a stroke.
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Cattgoodness: Could you kindly retype your story with punctuation marks? It's difficult to follow.
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My mother's NH in Westford, Massachusetts had 2 sections-a rehab section and a long-term care section.
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To be honest, it sounds like they are saying that they are recommending comfort care. Please clarify with her doctors if they are recommending any rehab at all, or for her to be kept comfortable and pain free. You might inquire if calling Hospice is the right move at this point.
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Two years ago my mom was in a nursing home facility for rehab on her fractured pelvis sustained in a fall that SSF, CA Kaiser had sent her to.
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I agree with cattgoodness. My Mom is currently in a rehab health center in Newark, NJ and I don't think in most days she does 5 minutes of real Rehab. My Mom suffers from dementia and she is just a # there. She gets told to do some leg pushes and Mom does one push they walk away to instruct someone else what they need to do, and my Mom stops her leg pushing because there's no one near her to direct her to continue the therapy. to me that is a waste of state funds. Luckily for my Mom she has family that visits her through out the day to make sure she eats all her meals and to keep her somewhat entertained otherwise she would go downhill instead of getting better..There are a few very caring nurses that I could only wish my Mom had them at all times but I also have seen some real rude ones and the rude ones could care less about their patients and don't like to be questioned about anything. All I can say from my own experience is watch and absorb the staff and within a day or two you will see if it's a good fit for your love one or not. I learned that you can't address the rude nurses yourself because of fear that they will take it out on your love one. But you should let the social worker make notes of any bad treatment. Best of luck to all caregivers and your love ones.
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In mom's case, the measure they used was a patient's ability to work for three hours daily at serious rehab. A rehab center would be a wasted resource for your mom right now. A broken hip means maximum of toe touch on that side for weeks. Most older seniors aren't even going to be on their feet walking because they can't effectively hitch their step.
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My mother was in the hospital for five weeks, during which she received minimal P.T. at her bedside. She is now going into her third week of P.T. through a Nursing/Rehab facility. I've learned a lot about the process. (One thing I've learned, it pays to have good insurance). She needed to be able to participate in 3 hours of day of P.T. and to demonstrate to Medicare she was making progress or they would not pay beyond 20 days. She will be discharged on Monday and now, with the assistance of the social worker, we are learning about in-home health care and more about Medicare/Medicaid benefits. Thank God for this forum. It helps to have a list of questions each day for the doctors, nurses and social worker. They were tremendous resources, even to the point of calling me at home to discuss her proposed treatment, improvements and goals.
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To follow OTJenn (I'm at OT too!). Rehab in the hospital is more intense for a shorter period of time. The person does need to be able to tolerate 3 hours a day of therapy, but not consecutively. There also needs to be a solid plan after discharge- someone to care for the person if needed etc.
Subacute rehab in a nursing home is less intense therapy for a longer period. Some facilities are very good but some are awful. You definitely need to do your homework and visit the facilites.
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Rehab in a hospital is more intents and rehape in nursing homes are in some cases almost none when my husband was 8n hospital rehab it was from when he got up to afternoon with 5 pt s when he went to nursing home he got 15 minutes with 30 people no one on one like hospital at nursing home I could never find a pt they closed there room at 9am and had all there people done in hafe hr the as worker was also done by noon and always never had time to talk to you about your loved one he became a living dron there he ate slept ate slept ate slept that was his day with TV running day and night no water by his bed as they don't want to be taking them to tolit all day so plants you bring die as your lobed one wilts not to give them a bad rep there are also great ones but its best to visit frit and often and don't except your loved one to tell you there unhappy with the place because they are glad to be with you and are worried where they will go next could be worst hope I did you some good
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The difference is that a rehab center which is normally hospital based reqiures 3 hrs of therapy/day and to be honest, the majority of their patient are very high level patients and.or complex. This might include a young person with a CVA, a motor vehicle accident, spinal cord injury. Very specialized. Nursing homes with skilled beds for rehab normally have full service rehabs which is all three disciplines. Pays to do a tour. I have worked as an OT in this environment in many places/states. Most of these facilities are very well managed and the rehab is great with very skilled therapists. Where I work our average length of stay is 21 days to home. We do home assessments, work with families and are very motivating environment. Again, do your homework. Across the country, many hospitals are closing their rehab centers as insurance companies are making decisions to send people out and unfortunately, this has to do with reimbursement to hospitals. Yes, it is still about the bottom line!!
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My mother is in a long term care facilitie... They also have a few beds that are for short term rehab as well. The care is amazing and all the safety procedures are in place.. Before my mother was long term she was in two other times for short term rehab .. I was very happy with the care she got and when I had to make the decision for long term it made it a little easier with knowing the staff already. Good luck!!!
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