You should have had a care meeting before now. But I think ur jumping the gun when it comes to a discharge plan. This can't be determined until they see how your wife progresses. Medicare pays 100% the first 20 days. 21 to 100-50%. After 100 days its private pay or Medicaid.
You don't mention your ages. Age is a factor and so is your wife's willingness to do what needs to be done. They may set up some "in home" care but that is not permanent. Discissions can't be made this early in therapy.
Be aware that what your wife expects of you may be beyond your capabilities. What you expect of yourself may kill you. No matter how good your intentions, you may find that it’s much more difficult than you’ve been led to believe.
When discharge discussions begin, be sure to find out exactly what home care requires. Then multiply the difficulty times 2 or 3 or 4.
Typically, in my experience with rehab, they need to be able to assess the patient's needs and begin mapping out a plan for care before they meet with the family. But generally, unless my FIL was unresponsive (meaning he transferred and was unable to get out of the bed period, as he was the last time he was in rehab) he was typically assessed and had begun PT and OT within a week of arrival. And we typically had a family plan of care meeting within two weeks of arrival.
The only exception was this last time - as I mentioned - he transferred from the hospital unable (or unwilling, we were never sure which) to get out of the bed. He was lucid and awake and talking but he just wouldn't or couldn't get out of the bed. So they couldn't assess him. He stayed in the bed for over a week before he was finally able to get out of the bed with assistance. They were able to assess him and finally start some basic OT and then PT. After that we were able to have the family care plan at about 3 weeks in.
If she has already started her PT and OT I would definitely contact the Social Worker and ask for a meeting. Even if she hasn't, I think you are well within your rights to contact them and ask about progress and next steps.
Not knowing all the details about your wife and her condition after surgery and how able you are to care for her, I would just say that if you don't feel that you can at this point care for her at home properly, let the rehab social worker know that and they will have to find a nursing facility to place your wife in until she is better able to care for herself. Places often times will bully folks into taking their loved ones home knowing full well that the patient can't be cared for properly there, but it's one less thing that they have to be concerned about. So stand your ground if necessary and make sure that your wife is getting the best possible care whether at home or in a facility. Best wishes.
Wife went from hospital for spinal surgery directly to NYC snf/rehab center has been there 2 weeks how and when will a discharge plan be discussed -very confused as to next step-Any ideas would be appreciated to take her home
I understand more of your question now: Yes, you should definitely ask what is involved now in home care. Is physical therapy needed and will they come to your home, or must you do transit to rehab? What will be her limitations? What are the chances that you two can manage care at home if you yourself have some limitations in helping? What progress is expected going forward. Should there be some temporary SNF placement? Tell the team that it is very crucial now for you to understand what your wife is capable of doing, and what her limitations are, and can home care safely proceed. Ask them what steps you take if something goes wrong, if home care isn't proceeding well. Definitely ask about pain management, and see to it you have stool softener prescribed if she is requiring any constipating pain meds (many ARE, and patients have been known, in hindsight, to complain that constipation was the worst part of their after care.
You don't mention your ages. Age is a factor and so is your wife's willingness to do what needs to be done. They may set up some "in home" care but that is not permanent. Discissions can't be made this early in therapy.
Be aware that what your wife expects of you may be beyond your capabilities. What you expect of yourself may kill you. No matter how good your intentions, you may find that it’s much more difficult than you’ve been led to believe.
When discharge discussions begin, be sure to find out exactly what home care requires. Then multiply the difficulty times 2 or 3 or 4.
The only exception was this last time - as I mentioned - he transferred from the hospital unable (or unwilling, we were never sure which) to get out of the bed. He was lucid and awake and talking but he just wouldn't or couldn't get out of the bed. So they couldn't assess him. He stayed in the bed for over a week before he was finally able to get out of the bed with assistance. They were able to assess him and finally start some basic OT and then PT. After that we were able to have the family care plan at about 3 weeks in.
If she has already started her PT and OT I would definitely contact the Social Worker and ask for a meeting. Even if she hasn't, I think you are well within your rights to contact them and ask about progress and next steps.
Places often times will bully folks into taking their loved ones home knowing full well that the patient can't be cared for properly there, but it's one less thing that they have to be concerned about.
So stand your ground if necessary and make sure that your wife is getting the best possible care whether at home or in a facility.
Best wishes.
edit your post with your response to your post for clarification of what you are asking…
Yes, you should definitely ask what is involved now in home care. Is physical therapy needed and will they come to your home, or must you do transit to rehab?
What will be her limitations?
What are the chances that you two can manage care at home if you yourself have some limitations in helping? What progress is expected going forward.
Should there be some temporary SNF placement?
Tell the team that it is very crucial now for you to understand what your wife is capable of doing, and what her limitations are, and can home care safely proceed.
Ask them what steps you take if something goes wrong, if home care isn't proceeding well.
Definitely ask about pain management, and see to it you have stool softener prescribed if she is requiring any constipating pain meds (many ARE, and patients have been known, in hindsight, to complain that constipation was the worst part of their after care.
Wish you good luck, BOTH of you.