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My mom was discharged from rehab back in Jan,and has had OT and PT at home after having a stroke that left her left side weak.She has no mobility in her left arm,and can barely walk with the assistance of a hemi walker and an aide. She was discharged from VNA back in March.Due to the New England weather and her mobility issues she didn't start outpatient rehab until late April.It only lasted 3 sessions due to her developing a pressure sore. As of now VNA is back in the home treating the wound ,as well as OT and PT for now. I discussed with her physical therapist about putting her back in outpatient rehab to get intense five day therapy. She agreed it would help. Now other than my mom falling, and being taken to the hospital,which she has fallen twice this month.No injuries,so she wasn't taken to the hospital.How do I get Medicare to pay for inpatient care for OT and PT. I know there has to be a skilled need. Does the wound which has gotten worse make her eligible? We don't want to nor can afford to private pay. What are her options? Where do we start? No one seems to know.Not her doctor at least.

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If her own MD won't make the recommendation, and the PT/OT was terminated due to failure to progress, it is time to look at Nursing Homes. Pretty soon she will need a Hoyer Lift and two aides to get her out of bed. Repeated falls are a sign of additional stroke activity. We went through this with mom.
As the muscles atrophy, they contract painfully. Be sure she gets good comfort care. Pressure sores hurt too and avoiding them means changing her position every two hours. You are at a point where she needs 24/7 nursing.
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I understand the frustration because we went through something similar with my mom. The only way Medicare will pay for inpatient rehab is if the person has been admitted into the hospital and stays at least three days. Then they can be transferred to a rehab center. The hard part is getting them admitted to the hospital. My mom finally got admitted with a diagnosis of failure to thrive. They kept her for four days and then transferred her to rehab. Can her regular doctor admit her into the hospital? This is where it gets frustrating...getting someone to admit her. It sounds like your mom is not thriving. Can you talk to her doctor about it? I feel for you. This is a tough situation.
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This website can help answer some of your questions https://www.medicare.gov/coverage/skilled-nursing-facility-care.html
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You may have another option which does not require the three day hospital stay. It does, however, require her to have the ability and desire to participate in vigorous therapy every day. Check to see whether you have an inpatient rehabilitation hospital in your vicinity. This is not a skilled nursing home with rehab...this is a dedicated rehab hospital. Many of them will conduct at home assessments. And they do not require her M.D.to order admission.
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ChrisinOregan, if the diagnosis was failure to thrive, why wasn't Mom put on Hospice. My MIL was in rehab getting worse by the day. We requested a doctor come in and evaluate her. Diagnosis was failure to thrive. She was then transferred to the nursing section on hospice where she passeda few days later.
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I'll add that it's possible (based on your description of her current functional level) that she may not qualify for admission, but it's worth a try!
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My mom does not have a terminal illness. She has Parkinson's and seven months ago she fell and injured her back and hadn't been able to walk since then. She continued to get weaker, but there was no physiological reason for it. It was explained to us that failure to thrive did not mean she was dying. It meant she was getting less able when there was no real reason for it. After four weeks in rehab she has improved quite a bit.
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Failure to thrive indicates a patient's inability to gain weight as expected. It's not a standalone indication of imminent death or terminal illness, although it may exist alongside other diagnoses or conditions that are terminal.
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